The Board of Massage began this particular rule writing process in August of 2014! The reasons for this lengthy and arduous undertaking was to…clarify, streamline and modernize the rule language, to make sure that current best practices with regards to public health and safety are reflected in the rules and to comply with several pieces of legislation. The Board is on track to have these rules become effective July1 2017.
The process during the meeting was as follows…
1. Written comments that had been received by the board were available to the board members to review and were also available to those attending the meeting.
2. Verbal comments were taken from anyone present that wished to provide comment.
3. Comments that were received by staff after the cut off were also provided to board members.
At this point the public comment period ended and the board began their deliberation of the proposed rules and the comments received.
The bottom line is… not much, of substance, was changed from the last draft of the proposed rules.
One area that had lots of discussion was around consent. Consent is called for in several sections of rule…Scope of Practice-Limitations, breast massage, draping and record keeping, all of the those section will have the same language for consent. The requirement will be “signed, written and verbal informed consent”. It was helpful to listen to the board deliberate this one because it gives us guidance as to how they will interpret this in disciplinary cases.
Here is what I heard…All clients/patients must give signed written consent forms on file to have a massage, they should separately (can be on the same form) give consent for breast massage and then every session that you do breast massage with that client/patient you will make sure to get additional verbal consent and note that in your charting. Same goes for perineal massage and for variations in draping. There is one complicating factor thought, when the board members described what they though “informed” meant they used phrases like educating/communicating to your clients/patients about what you will do and why, making sure they understand what they are agreeing to. But, the medical profession as a much more detailed definition of “informed” and there are many medical malpractice lawsuits that revolve around what is “informed” consent and what is not. So we will have to see how this plays out.
The other area where there were lots of written comments was recordkeeping. The board stood firm with the proposed language. They felt strongly that this level of documentation is necessary to protect the health and safety of the public and by allowing for documentation to be “appropriate to the venue” that the burden to the provider will not be greater than the benefit to the public’s health and safety.
The proposed language currently reads:
WAC 246-830-565Recordkeeping.(1)A massage practitioner providing professional services to a client or patient, must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services, and in sufficient detail to support and enable anticipated continuity of care. The documentation must include:(a)Client or patient name and contact information;(b)Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;(c)Date massage therapy is provided and the duration of treatment;(d)The types of techniques and modalities applied;(e)The location or areas of the body that received massage therapy;(f)Written consent to treat;(g)If breast massage is performed, an additional written consentt o treat per WAC 246-830-555, and documentation of a therapeutic rationale;(h)If breast massage of the nipples and areolas are involved,documentation of the prescription or referral per WAC 246-830-555(3)(a), or an additional written consent to treat per WAC 246-830-555(3)(b);(i)Documentation of any written consent or any modification in draping as required by WAC 246-830-560; and(j)For massage therapy where the focus is on treating a healthcondition, the following additional information is required:(i)Symptoms, for example, pain, loss of function, and muscle stiffness;(ii)Evaluation and findings, for example, movement, posture,palpation assessment and findings;(iii)Outcome measures, for example, improvement in symptoms,movement, posture, palpation, and function; and(iv)Treatment plan for future sessions.(2)Client or patient records must be legible, permanent, and recorded within twenty-four hours of treatment. Documentation that isnot recorded on the date of service must designate both the date of service and the date of the chart note entry. Corrections or additionsto the client’s or patient’s records must be corrected by a single line drawn through the text and initialed so the original entry remains legible. In the case of computer-organized documentation, unintended entries may be identified and corrected, but must not be deleted from the record once the record is signed and completed or locked. Errors in spelling and grammar may be corrected and deleted.(3)Correspondence relating to any referrals concerning the evaluation or treatment of the client or patient must be retained in theclient or patient record.(4)Client or patient records should clearly identify the massage practitioner who is the provider of services by name and signature or electronic signature and date of service.
So the board voted to approve the proposed rules as amended in today’s meeting. These rules will now go the Secretary of Health. He can approve them as is or he can make modification. Once the Secretary approves the rules he will send them to the Code Reviser to be filed and they will become effective 30 days after that.
So where does this leave us… with lots of question to be sure. Even the board recognized that it is impossible to write perfect rules; rules always have gaps, limitation, inconsistencies and a multitude of interpretations. Once the rules are finalized the board can revisit them and create some guidelines and interpretations (an informal process) that will help us all to be able to follow the letter of the law.
Oh, and we are not done yet! The board hopes to start the rule writing/revision process again later this year with the rules around curriculum, training and continuing education!
You can read the latest version of the rules in their complete form here.1707113massagetherapypractic102final PDF (as accessed from the DOH Website on April 24, 2017)
WSMTA is also working on creating templates that you can use for your consent forms and intake that will follow the new rules…coming soon for Members only! Join Now!