SD19 - Review of the Regulation of Acupuncture in Virginia
Executive Summary: INTRODUCTION Senate Joint Resolution Number 16 of the 1988 Session of the Virginia Legislature requested the Council on Health Regulatory Boards (renamed Board of Health Professions effective January I, 1989) to "conduct a special study... on the practicality and desirability of authorizing nonphysician professionals to practice acupuncture and, if such practice is found to be appropriate, the means of regulation for such practice." The Board of Health Professions is authorized to evaluate the need to regulate health professions and occupations and the appropriate methods for regulation, as well as to examine scope of practice conflicts involving regulated and unregulated professions, and to "advise the health regulatory boards and the General Assembly of the nature and degree of such conflicts" (Code of Virginia, § 54.2510.2. and 12.). Because acupuncture is licensed by the Board of Medicine, the Board of Health Professions did not interpret the request to include assessment of whether the practice should be regulated. Rather, Senate Joint Resolution No. 16 makes clear that conflict exists between those who support the current system for regulation and those practitioners who believe themselves to be competent and qualified to provide acupuncture services but are prevented by existing statutes and regulations from doing so. As a consequence, this review was assigned to and conducted by the Board of Health Professions' Committee on Scopes and Standards of Practice. The report and recommendations have been approved by the full Board of Health Professions. The Current Regulation of Acupuncture in Virginia. Acupuncture in defined by statute in Virginia as "an experimental therapeutic modality, used in the practice of the healing arts, intended to alleviate pain, and involving the selective stimulation of the human body's neurological mechanisms by the insertion of needles" (Code § 54.1-2900). The healing arts are further defined as "the arts or sciences dealing with the prevention, diagnosis, treatment and cure or alleviation of human physical or mental ailments, conditions, diseases, pain or infirmities" (Code § 54.1-2900). Except as they are exempted from such governance by law, the healing arts practiced in the Commonwealth are regulated by the Board of Medicine. The health professions and occupations regulated currently by the Board of Medicine are: • Medicine (M.D.) and Osteopathic Medicine (D.O.) • Chiropractic (D.C.) • Podiatry (D.P.M.) • Physical Therapy (and Physical Therapist Assistant) • Clinical Psychology • Respiratory Therapy • Physician's Assistant • Correctional Health Assistant • Acupuncture The Board of Medicine defines and restricts the practice of acupuncture in Virginia by regulation (Regulation 1.1) as follows: Acupuncture is an experimental therapeutic procedure, used primarily for the relief of pain, which involves the insertion of needles at various points in the human body. There are many acupuncture points, and these points are located on most portions of the human body. Insufficient information is available regarding its general usefulness and the risks attendant. Among the risks that are attended upon it are the possibilities of prolonged and inappropriate therapy. It is clear that the administration of acupuncture is accompanied by the possibility of serious side effects and injuries and there are reported cases of such injuries. Possible complications and injuries included peritonitis, damage from broken needles, infections, serum hepatitis, acquired immunity deficiency syndrome, pneumothorax, cerebral vascular accident (stroke), damage to the eye and/or damage to the external or middle ear, and the inducement of cardiac arrhythmia. In the judgment of the Board, acupuncture should be performed only by those practitioners of the healing arts who are trained and experienced in medicine, since only such a practitioner has (1) skill and equipment to determine the underlying cause of the pain, and (2) the capability of administering acupuncture in the context of a complete patient medical program in which other methods of therapeutics and relief of pain, including the use of drugs and other medicines, are considered and coordinated with the acupuncture treatment, and (3) skill and training which will minimize the risks attendant with its use. No person shall practice acupuncture in this State without being registered by the Board to do so. Based on the foregoing considerations, the Board will register only doctors of medicine (M.D.), osteopathy (O.D.), and podiatry (D.P.M.) since only these practitioners have demonstrated competence in medicine by passing Parts I, II and III of the medicine/osteopathy, and podiatry licensure examination. Podiatrists shall use acupuncture for treatment of pain syndrome originating in the human foot. One hundred (100) hours of postgraduate training in a school of acupuncture approved by the Board shall be prerequisite to registration as an acupuncturist. Records of the diagnosis, treatment and patient response to acupuncture shall be maintained and submitted on request to the Board. . . . Acupuncture is interpreted strictly by the Board as the insertion of needles. In regulations proposed by the Board of Medicine to become effective in January 1989, the substance of existing regulations is continued, but prerequisites for acupuncture are increased to include (1) "at least 100 hours of instruction in general and basic aspects, specific uses and techniques of acupuncture and indications and contraindications for acupuncture, and (2) At least 100 hours of supervised clinical experience approved by the Board of Medicine and under the supervision of a currently licensed physician in acupuncture" (Proposed Regulation 4.2.A.l and 2). The level of regulation of acupuncture is also changed from registration to licensure. Senate Joint Resolution No. 16 implies that statutes and regulations governing acupuncture may be more restrictive than required for the protection of the public health, safety and welfare, observing that: • other jurisdictions have come to accept the practice of acupuncture as a valid treatment; • many states, including some that adjoin Virginia, license nonphysician professionals to practice acupuncture; • many citizens of the Commonwealth find it necessary to travel to an adjoining state to obtain acupuncture treatment; and • access to this treatment should be provided to those Virginians who desire it. Currently, there are 50 individuals registered by the Board of Medicine to perform acupuncture, compared to 28 registered in 1985 (although only 38 current registrants have paid renewal fees now due). Thirteen of the current number reside in states or countries distant from Virginia. Thirteen are located in the Greater Metropolitan Washington area, ten are in the Richmond area, eight are in the Tidewater/Peninsula region, and the balance are dispersed throughout the Commonwealth. Two are osteopathic physicians and 48 are M.D.s. Process of the Review. The Committee on Scopes and Standards of Practice devoted three work sessions to this issue, and an informational hearing was conducted in August 1988 in Richmond. In addition, a review of the Iiterature relevant to the issue was conducted by the Chairman. The status of the regulation of acupuncture in other states was reviewed, and the Committee attempted to determine whether harm related to the practice of acupuncture has been documented. Organization of the Report. This report is organized in the following sequence. First, the patterns of regulation of acupuncture among the states are reviewed. This review is followed by an analysis of issues raised in testimony presented at the informational hearing and in subsequent written comments. A review of the literature is then provided, and the report concludes with an executive summary of findings and recommendations. Additional material of interest is appended. |
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