Proposed ordinance changes for Massage Therapy
in the City of AlexandriaThis meeting was specifically focused on the administrative changes proposed by the Health Department. The Director of Environmental Health, Bob Custard, acknowledged that by proposing those changes the door had been opened to the possibility of re-tooling the current ordinance into one more functional for all parties involved.
Administration of and compliance with the current ordinance is cumbersome and expensive. Certified Massage Therapists are already regulated by the State of Virginia through the Board of Nurses. Certainly there is a way to simplify bureaucracy without increasing the presence prostitution, human trafficking or the ills that come with that.
A 6 to 8 person working group is being appointed, to include representatives from the Health Department, Police Department, The City Attorney’s office, Massage Establishments, independent Certified Massage Therapists and concerned citizens with expertise in areas such as human trafficking.
The proposed ordinance is posted on the Alexandria Health Department's website www.alexandriava.gov/MassagePermits. Comments are welcome on the proposed changes AND anything else that is of concern in the ordinance as it is currently written. Please submit your comments by NOVEMBER 1, 2009, to Kristin Garcia, Environmental Health Supervisor, at Kristin.garcia@vdh.virginia.gov.
If you have any questions, please contact Becky Bowers-Lanier, AMTA chapter lobbyist, at becky@macbur.com.
In the following texts, please be aware "massage therapist" refers specifically to Certified Massage Therapist (CMT), unless stated otherwise.
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The following comment is from Rebecca Bowers-Lanier, EdD, MPH
Legislative Consultant,
Virginia Chapter, American Massage Therapy Association
Send comments to: becky@macbur.com
memorandum
TO: Kristin R. Garcia, M.P.H., R.E.H.S.
Environmental Health Supervisor
from: Rebecca Bowers-Lanier, EdD, MPH
Legislative Consultant,
Virginia Chapter, American Massage Therapy Association
subject: Proposed ordinance on massage therapy permits,
City of Alexandria
date: 10/20/2009
I bring you comments on the proposed changes on behalf of the Virginia Chapter of the American Massage Therapy Association (VA-AMTA), the membership organization for Certified Massage Therapists in Virginia. Our association exists to develop and advance the art, science, and practice of massage therapy in a caring, professional and ethical manner in order to promote the health and welfare of humanity. I am the Chapter legislative consultant, and my credentials include a master’s in public health.
In my statement, I am proposing that the permitting process outlined in the proposed ordinance is not only arcane, but it is also archaic and discriminatory. I believe that the permitting process needs to be repealed and that Certified Massage Therapists (CMTs) who own and operate their practices in Alexandria should be required solely to obtain a business license and pay the appropriate business tax, using the same process to which other state-regulated healthcare practitioners adhere.
Speaking of other state-regulated healthcare practitioners, I ask the following questions. Must these individuals, such as physicians, chiropractors, and physical therapists, obtain permits in a similar fashion to what is being required of massage therapists? If not, we would suggest that obtaining a permit to practice massage therapy places an undue burden on massage therapists that other healthcare providers do not have, and we believe this is discriminatory.
Since massage therapists are regulated by the Commonwealth, methods exist for disciplining CMTs. The statutes and regulations governing the practice of CMTs provide an avenue for the reporting and investigation of allegations of misconduct, incompetence, and malpractice. No additional City regulation is needed. I refer you to the appropriate sections of the Virginia Code which are cited in my refutation of the current and proposed permitting ordinance below.
Below are the flaws that I believe exist in the current and proposed permitting ordinance.
Sec. 11-4.2-2 Provision of massages (pp 1-2 lines 22-45 on p 1, lines 1-17 on page 2).
The terms “massage therapist” and “certified massage therapist” are protected by the Code of Virginia. The current Alexandria ordinance appears to make a distinction between massage therapists and persons who are certified as massage therapists. According to the Code of Virginia, there are only massage therapists or certified massage therapists. No one else may use this term of art. I refer you to Virginia Code §54.1-3008 – 7, which reads: [A. It shall be a Class 1 misdemeanor for any person to:] Claim to be, on and after July 1, 1997, a certified massage therapist or massage therapist or use any designation tending to imply that he is a massage therapist unless he is certified under the provisions of this chapter.
Furthermore, there should be no prohibition for massage therapists to deliver therapy in nursing homes, hospitals, and other healthcare facilities. I believe that the proposed ordinance does not prohibit that, and I suggest that the language be clarified. The Code of Virginia does not mandate that massage therapists be supervised by any other health care provider.
I see no rationale for the remaining parts of Sec 11-4.2-2 about where certified massage therapists may provide therapy and under what conditions. I believe this is archaic language that refers back to a time when massage therapy was confused with massage provided by persons such as prostitutes and call girls. These individuals were not practicing massage therapy.
The subsection found on page 2, lines 12-15, in which physical therapists are authorized to supervise “persons” delivering massage, is in conflict with the Code of Virginia. I recommend that this subsection delete this provision. A search of Chapter 34.1 of Title 54.1, Physical Therapy, failed to find any reference in the statute governing the practice of physical therapy for a physical therapist to supervise any “persons” administering massage. Physical therapists are authorized to supervise physical therapy assistants in the performance of physical therapy, but not massage. Physical therapists themselves are exempted from certification as a massage therapist by law.
Similarly, I have searched the Code of Virginia and the regulations governing the practice of chiropractors and have found no reference to supervision of “persons” performing massage therapy. I recommend that this be clarified as well.
Sec 11-4.2-3 Massage therapists; issuance of massage therapist permits.
Sections (a) and (b) are in conflict with Sec 11-4.2-2, Provision of Massages, in which, as detailed above, three types of persons may perform massage. This section provides that only certified massage therapists may be issued a permit. Again, I ask the question: why CMTs and not other state-regulated healthcare providers?
Sec 11-4.2-4 Same—issuance of home massage permits
Why are these necessary? Must physicians who make house calls obtain home permits to practice medicine?
Sec 11-4.2-7 Same—minimum standards
Are there minimum requirements for physician offices similar to these? That is, is there an ordinance that states that “the premises shall have adequate equipment for disinfecting and sterilizing non-disposable instruments used in administering massage.”
And speaking of sterile instruments, I would ask what massage therapy session would require sterile instruments? The Code of Virginia (§ 54.1-3000. Definitions) defines massage therapy as “the treatment of soft tissues for therapeutic purposes by the application of massage and bodywork techniques based on the manipulation or application of pressure to the muscular structure or soft tissues of the human body.” Where in that definition is implied that a sterile instrument is needed?
I am exceedingly skeptical of the new subsection (10), lines 17-35 on page 8 on the requirement of a sink in each room and the detail with which massage therapists are required to wash their hands. Are these requirements included in ordinances for physicians’ offices? Of course, hand washing is important, and all healthcare providers should wash their hands between patients/clients. However, I fail to understand the rationale for requiring a sink in each massage room, unless the same requirement is applied to all other healthcare providers’ offices in Alexandria. Otherwise, I think this requirement is discriminatory.
I recommend that you review each of these requirements in this section and determine their applicability to massage therapy.
Thank you again for providing us with this opportunity to make comment. I will be pleased to work with you to refine the language to bring it up to date with current massage therapy practice and assure that the language is consistent with the Code of Virginia as well as non-discriminatory against the practice of massage therapy and the massage therapists who seek to operate their practices in the City of Alexandria.
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October 25, 2009
To Kristin Garcia, Environmental Health Supervisor
Kristin.Garcia@vdh.virginia.gov
From Viktor Bocharnikov, Landmark Center for Therapeutic Bodywork
Thank you for this opportunity to comment on the current massage therapy ordinance. Here are my comments and suggestions for Massage Regulations in the City of Alexandria.
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Comments and Suggestions for Massage Regulations in the City of Alexandria:
1. It is absolutely absurd to regulate an activity per se. When an activity is a profession and conducted for compensation, it makes sense to regulate the profession for two reasons: to withhold taxes and to prevent the public from damage. The taxes do not favor the public: the higher taxes, the higher the price for the service, and the fewer customers use it. If massage is a luxury, then it should be only for wealthy people. If this is the attitude of the government, it is a shame, because a government represents all classes. However, because majority of all classes consider massage therapeutic rather than a luxury, this should not be an issue.
2. If you really want to ensure public safety and increase revenue from massage therapists, here are some ideas:
a. Public Safety: Do not hold us as a potential prostitution institution; instead facilitate our exposure to the public as ambassadors of healthy style of living. For example, we can volunteer our complementary service to the same population whom you offer free medical service. We can participate in educational services you provide to residents, bringing to people knowledge of stress management tools such as relaxation and mediation. You can facilitate our exposure to the other health care professionals.
b. Revenue: You can facilitate our professional growth through continuing education we need for Virginia re-certification. For example, our National Certification Board requires us to take a total of six hours of professional ethics classes every four years, costing us at least $60. You can issue our annual permits at a two-hour seminar of professional ethics. This is required by our national Certification Board every four years. If you hold it in the City premises and ensure the instructor is an NCBTMB provider, the city could have additional revenue. The same is for other 48 hours of continuing education required for recertification, which costs us between $10 and $50 for each contact hour.
3. Policing a professional activity requires manpower, and even if you put somebody on checking and “spying” duty it will not prevent possible damage to public. For example, in Maryland they have licensing Board. A license costs around $500, but they cannot prevent unlicensed practitioners from operating in their state.
The better way for this is staying in good contact with the whole group of massage therapists and our clients. There are several ways to do this.
a. Issue permits at an annual, city sponsored, ethics class. This will bring the therapists together, and could provide time for city officials, residents and massage therapists to express any concerns regarding massage therapy in the City of Alexandria. People would now each other as human beings with mutual concerns.
b. Create “feedback forms” that clients can send into the city, expressing concerns they have about any practice. Require that these be in clear sight and easily accessible in the therapists’ offices. Copies of comments can be given to the therapists and corrections made, without a lot of bureaucracy. It is in the therapist’s business interest to keep clients and city happy.
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The following comment was provided by Linda MacDonald, CMT in Alexandria, VA. (NOTE from Linda, Oct 22, 2009: I am pleased to report that I have received a call from the Vice and Narcotics Department that the Chief of Police has approved my request for a permit for a home visit. I understand that, as of next week, the application for permits for home visits will be available on-line.)
LMacDappt@aol.com
Thank you for your letter advising of draft of proposed ordinance and resolution affecting massage therapy in the City of Alexandria.
There are several items on the list that I will comment on separately. However, the one I am most concerned will do no one any good is item #13, "...the fee for a home massage permit at $100 annually (currently $25 annually), ..." Perhaps you are not aware that the current code, which requires an application be created be the Chief of Police, to be submitted by the applicant with the $25 fee in order to receive a home permit, is NOT in operation. There is no such application, there is no permit.
Early in September a potential client was referred to me by a physical therapist. The PT had been going to the home of a woman who is homebound, transferred from chair to bed via wheel chair. The physical therapy prescription had lapsed, but massage had been helpful in creating more range of motion and diminishing pain. I applied for a home permit as directed. Sergeant Tom Magyar, Narcotics & Vice, assured me that such a thing does not exist, but he would be willing, if I put together a package of credentials and information about the woman and her doctor's recommendation, to submit that to the Chief of Police for special consideration. I included a check for $25. The check was returned to me. I called Sgt Magyar earlier this week and the package was still sitting on his desk, pending opportunity to bring it to the Chief of Police.
According to Sgt Magyar's sources, the Police Department determined it did not have the manpower to monitor home visits, and so had never created the application or the permit. Thus, those who are unable to leave their homes (or for whom it is a great hardship) do not have legal access to a certified massage therapist's professional service.
It really won't matter what the fee is if there is no way to collect it. Further, asking a client to divulge health information to the Narcotics and Vice Department is a nonsensical requirement. The Health Department already has the information required for permitted massage therapists, and could issue the home permits for those who have been permitted.
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The following comment is provided by Diana Simonton, CMT, in Alexandria, VA.
Dear Kristin,
Here are my comments on the proposed changes to the ordinance. I support the simplification of the city ordinance to reflect the fact that massage therapists are already under the jurisdiction of the Virginia Board of Nursing. Since the Code of Virginia was adopted in 1997 directing the BON to certify massage therapists in Virginia, they have been given the task of addressing any grievances filed against a CMT, defining our scope of practice and formulating our regulations.
I believe that the simplification of the ordinance will help to achieve the stated goals of reducing paperwork and making massage therapy oversight self supporting. When these ordinances were originally formulated (in the 1970s, I believe) they were designed to address prostitution in the city. At that time, the city had allowed places of prostitution, termed "massage parlours) to operate in the city, and there were few or no authentic massage therapists in business here then. Massage therapy has had a resurgence locally and nationally, and city residents have indicated their enthusiasm about receiving massage by supporting the many massage therapy businesses which now are established here. It is in the interest of the residents, as well as massage therapists and the health and police departments to greatly simplify this ordinance to reflect this new day and time. Many of the proposed changes will make the ordinance more cumbersome.
My comments to specifics proposals:
#4 Putting the cart before the horse. A person may intend to open a business where massage therapy will be offered, and yet not be hiring until after the zoning and permitting process are completed. Requiring a business to declare their employees or contractors before actually opening the business doesn't make sense.
#9 Are other business which are charged fees to be regulated charged in this manner- 5 years in advance?
#10 I suggest that this is increasing the workload, not decreasing it. The opposite effect could be achieved by requiring massage establishment permits only for those facilities not operated by a CMT. This would greatly cut down on the whole oversight process while still allowing the city to screen proposed businesses. There is the opportunity for the Health Department to save a lot of money by considering dropping or greatly reducing the inspection of our businesses. Every year for the 17 years that I've been in business here in the city, I've been visited by an inspector, I believe it's four times annually. I have asked these inspectors from time to time what they are looking for as far as violations. The only responses I have ever received are that they are (1) looking for lapsed permits (that can be determined at the department, and doesn't require on site inspections) and (2) checking to see if dirty laundry is in hampers and clean sheets are in enclosed spaces. This seems like such a waste of city resources. This could be established in a few visits. Is it really necessary to keep inspecting on an ongoing basis?
11 There are already yearly fees for a massage establishment. Why have a proposed business screened both by the Health department and the City Council?
#13 I understand the need to raise fees. To quadruple the fee for a permit seems a bit much.
#16 & 18. I understand the need for good hygiene. This was covered in my basic training. My table has a number of layers like a mattress pad and extra sheet in addition to the basic sheets. Disinfecting the table after each use is not necessary or practical. The table itself is not exposed to a client. The hand washing description seems overly directive. In the summer I often work in a no sleeved garment, as it becomes warm and I have a very physical job. To soap my entire arms before and after each session seems over the top to me.
#17 This provision would go a long way to reduce the number of massage therapists working in the city, as these types of rooms are not readily available nor is it often possible to convert an office space to include a sink. Does this serve the residents who now patronize our businesses?
Thanks for the opportunity to reflect on this proposal.
Diana Simonton CMT
www.dianasimonton.com
703 519.0760
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Arlington County Regulations:
http://www.arlingtonva.us/departments/humanservices/publications/permits/HumanServicesPermitsPermitsLicenses.aspx
Fairfax County Regulations:
have not found link, phone call not returned - have copy of regs - will provide details soon.
City of Fairfax Regulations:
http://www.fairfaxva.gov/Police/PeddlerSolicitorsPermits.asp
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Chapter 10.5 MASSAGE THERAPY AND BODYWORK -- proposed alternate ordinance _________
Sec. 10.5-1. Definitions.
Sec. 10.5-2. When and where massages may be given.
Sec. 10.5-3. Display or presentation of certificate.
Sec. 10.5-4. Exemptions.
Sec. 10.5-5. Violation.
Sec. 10.5-1. Definitions.
The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning:
Certified massage therapist: any person who administers a massage to a client, in exchange for consideration, and who is qualified as a certified massage therapist pursuant to the requirements of Code of Virginia section 54.1-3029.
Client: any person who receives a massage in exchange for consideration.
Massage, massage therapy and bodywork: the treatment of soft tissues for therapeutic purposes by the application of massage and body work techniques based on the manipulation or application of pressure to the muscular structure or soft tissues of the human body. The terms "massage" and "massage therapy" do not include the diagnosis or treatment of illness or disease or any service or procedure for which a license to practice medicine, nursing, chiropractic therapy, physical therapy, occupational therapy, acupuncture or podiatry is required by law.
Office: Any place where a certified massage therapist conducts his or her business and recordkeeping, regardless of whether he or she actually performs massage therapy for clients at that location.
Sec. 10.5-2. When and where massages may be given.
Except as provided in section 10.5-4 of this chapter, it shall be unlawful for any person to give a massage in exchange for consideration within the county unless the person giving the massage is a certified massage therapist.
Sec. 10.5-3. Display or presentation of certificate.
Each certified massage therapist shall conspicuously post his or her current certificate issued by the State Board of Nursing in a public area at his or her office or, in the case of an off-premises massage, shall present his or her certificate to the client.
Sec. 10.5-4. Exemptions.
The provisions of this chapter shall not be applicable to the following persons while such persons are engaged in the performance of the duties of their respective professions:
(1) Physicians, surgeons, chiropractors and osteopaths duly licensed to practice their respective professions in the state.
(2) Physical therapists duly licensed to practice physical therapy by the state.
(3) Employees of nursing homes and hospitals which are duly licensed by the state, provided the employees are acting under the direction and supervision of a licensed health care professional.
(4) Nurses duly licensed by the state.
(5) Trainers of any amateur, semi-professional or professional athlete or athletic team, and Licensed Athletic Trainers.
(6) Barbers and beauticians duly licensed by the state who administer massages only to the scalp, face, neck or shoulders of clients.
(7) Students of a state-approved massage therapy program, provided that each student is identified in writing to the client as a student and is acting under the direction and supervision of a certified massage therapist.
Sec. 10.5-5. Violation.
A violation of any provision of this chapter shall constitute a Class 1 misdemeanor.
