Letter Regarding Upcoming Massage Legislation in Minnesota

Dear (Head of Movement to get Massage Licensed in Minnesota),

I am writing to you about the legislation effort ALMT is championing to bring about MN state licensure for massage therapists. I attended a meeting awhile back that you led, sharing the process and requesting help from massage therapists to see it through.

I am concerned about a few things and request your response to these concerns before I can honestly and whole-heartedly support your organization’s efforts. These have come from discussions with other MT’s and from thinking back to the earliest attempts that I can recall to make such legislation happen.

First, it appears that this legislation has been prewritten without much of our input. I wonder if the AMTA didn’t write it quite awhile ago and then tweak it as they go from state to state?  I don’t recall being asked for input and I have asked many therapists that I know if they were. Their responses have all been a resounding “no”. The meeting I attended just asked for my support to get it passed and to encourage other therapists to do the same. It appears that it has been brought in by people outside of the state with an agenda to get legislation in place, not to tailor anything to our needs. What does the legislation really say? Can I get a copy of it?
How many massage therapists have you actually contacted in Minnesota? I venture to say it is a minority of them because Minnesota has one of the largest therapist to client ratios in the country. It’s hard to access them all, I am sure. Word of mouth is probably your main means of contact, correct?

I am very concerned about how this legislation would restrict me. It appears to be telling me how to do my work, rather than assuring prospective clients if I am ethical, honest and legal. How does limiting what I do make my chosen work field a progressive one? One small “for instance”, stretching. Does the legislation intend to limit my capacity to use stretching in my work? A muscle flexes, contracts, relaxes, and can also atrophy. If a client’s muscles only seem to know contraction mainly, am I going to be restricted from encouraging these muscles to know what stretching is and feels like (ie. assisted stretch)? Can I not encourage the client to stretch more and show him or her different stretches to help their body? Once this legislation is implemented, it would take forever to undo, so I want to know what it looks like before I agree to it hook, line and sinker. Don’t assume everyone is on board. Some people I’ve spoken to are actually feeling too paranoid to respond to your calls to action because they may be limiting their scope of practice. I remember way back that many objected to legislation like this because it was either the chiropractic or medical or physical therapy field that was going to oversee our practices and work and there was great fear of limiting our capacity and scope to do our work. Has this legislation addressed these concerns?

Please don’t read this as an attack on your hard work. I am not “yelling” at you in this email. I am voicing strong concerns and worries. It would be nice not to have to be subjected to the whims and fancies of each city for licensing, but at what price? Did you know that some cities still plan to enforce their own licensing policies anyway, despite this legislation passing? Heck, this is a source of revenue for them and many of them don’t know what the legislation entails, either. They still have their concerns about who will be practicing in their city…is this therapist ethical, honest and legal? Will this legislation calm their fears? Prostitution hiding behind massage therapy is still a huge concern. How will your legislation assure them that this will be stopped?

I thank you for responding to my email. I would appreciate a copy of the legislation or knowing where and how to go about getting a copy.

 

MM from St Paul, MN   April 2009

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One Response

  1. Here is a reply from Jeremy Miller ALMT

    —– Forwarded Message —–
    From: “Jeremy E. Miller”
    To: “mm”
    Sent: Wednesday, April 8, 2009 9:15:21 AM GMT -06:00 US/Canada Central
    Subject: Re: LMT St. Paul and Bloomington

    Greetings –

    Thank you for your interest and the note concerning the Massage Therapy Licensure effort here in MN. Sorry for the delay in getting back to you. You raised several questions/concerns and in an effort to make sure I do not neglect any of them, I will type my response just below the text of each question/concern in your email below, and then share a few thoughts at the bottom.

    On Thu, Apr 2, 2009 at 6:24 AM, wrote:

    Dear Jeremy,

    I am writing to you about the legislation effort ALMT is championing to bring about MN state licensure for massage therapists. I attended a meeting awhile back that you led, sharing the process and requesting help from massage therapists to see it through.

    I am concerned about a few things and request your response to these concerns before I can honestly and whole-heartedly support your organization’s efforts. These have come from discussions with other MT’s and from thinking back to the earliest attempts that I can recall to make such legislation happen.

    First off it is important to point out this is an entirely new effort. The attempts that were made in the past laid a good groundwork in many ways, by getting some folks on board, but the legislation we have been working to to pass is brand new this term and not recycled from a previous effort, more on that in a moment. Some of the members of the Steering Committee were in involved in previous attempts, myself not included, but we have gone in new directions with trying to bring people on board and with transparency in the process from previous attempts.

    First, it appears that this legislation has been prewritten without much of our input. I wonder if the AMTA didn’t write it quite awhile ago and then tweak it as they go from state to state?

    Let me tell how we drafted the legislation we have been trying to pass. The legislation that has been introduced was written by a drafting team of 27 members. 24 Massage Therapists, 1 Shiatsu Therapist, 1 Reflexologist and one Massage Therapy clinic/business owner. All the Drafting team members were Minnesotans. The drafting team was split up into groups to focus on one clause of the legislation at a time. Each group had a minimum of 3 drafters and fro the more contentious clauses we assigned more drafters to those groups. Prior to the drafting team being put together, I went through the then 39 states that had a Massage Therapy law on the books and broke the language of their laws down into tables by clause. (So in other words there was one table that had 39 different Grandfathering clauses, and another table with 39 different Scopes of practice, and another table with 39 different city ordinance preemption clauses and so on through all the clauses that make up a Licensure law.) Each group of the drafting team was assigned a table of clauses to go through and highlight the language that they liked or thought would be good to include here for our law in MN. We built our legislation like that for the clauses that are specific to Massage Therapy. Then there is also a lot of language that goes into a law like this that is not specific to Massage Therapy. For that we used the language of the Licensure laws from here in MN that are already in place, We used the laws of the PTs, DCs, RNs, Athletic Trainers, Traditional Midwives, Acupuncturists and others to make sure we had the language in our law that needed to be there to meet MN’s standards. We then passed our language through the national offices of the AMTA and ABMP, and made sure we had met their wish lists for legislation, since they not only collectively represent over 3200 practitioners here in MN, but the folks that work in those offices review these kind of laws for a living, and certainly know more about this process than a group of Massage Therapists would. Finally, our language was passed before all the groups that were originally mentioned in the exemptions clause to make sure our language would not convey any unintended negative consequences on those practitioners, which is after all the whole point of the exemptions clause. This includes the organizations representing fields of PT, OT, Athletic Training, Nursing, Chiropractic, Acupuncture, and others as well as the organizations for Asian Bodywork Therapy, Reflexology, Rolfing/SI, Feldenkrais, Alexander, Polarity, Movement Education, Trager, Colon Hydrotherapists and others. After all this checking and feedback, the ALMT Steering Committee (made up of Massage Therapist volunteers who are all from MN) voted on final tweaks and submitted the language to be finalized or “jacketed” by the state Revisor’s office. That jacketed version is what you can rad on the state website using the references below. So we did our best at due diligence in bringing in and gathering input from any and all interested parties.

    I don’t recall being asked for input and I have asked many therapists that I know if they were. Their responses have all been a resounding “no”. The meeting I attended just asked for my support to get it passed and to encourage other therapists to do the same. It appears that it has been brought in by people outside of the state with an agenda to get legislation in place, not to tailor anything to our needs.

    The drafting process described above started in July of 2008. Prior to that the volunteer recruitment effort had been on-going since January of that same year. Being a member of the Drafting team was open to any registered supporter of the ALMT who was interested and could sign on to the time commitment. The number of Drafting Team members we ended up with was not a maximum, or a magic number, by any means. That just happened to be the number of people who signed up to help. If more had responded to the calls for volunteers, we would have gladly had all of those people help. (In fact, we could have probably gotten finished sooner had we had more help which would have been beneficial on many fronts.) The early recruitment took place by email blasts to the AMTA and ABMP membership of MN, the launching of a website, placing info on both the ABMP’s legislative updates page which I understand is sorted by state, and the AMTA-MN chapter’s web page, and through the collective database of supporters from efforts past, much of which was unfortunately woefully out of date. In November, we did a series of Town Hall Meetings all over the state to try to get the word out more. (The majority of the drafting process was complete by that point, but there were other avenues for volunteers to help in the shaping of the effort.) If you or the other therapists with whom you are in contact have other ideas for how to get the word out, I would honestly love to hear it. One of the issues we have faced and still do, is the lack of having people who support the legislation not speaking out for it. It sounds like you do support it or at least would if you knew more about it. How could we have reached you? I am asking sincerely. And it sounds like you would like to help in the effort. We have several ongoing projects with which we could certainly use your help.

    What does the legislation really say? Can I get a copy of it?

    If you follow THIS LINK you will be taken to the state legislature’s page where you can read the draft in it’s current form. I would fully encourage you to read it and pass this link along to your colleagues that you’ve been talking to so that they can read it.

    How many massage therapists have you actually contacted in Minnesota? I venture to say it is a minority of them because Minnesota has one of the largest therapist to client ratios in the country. It’s hard to access them all, I am sure. Word of mouth is probably your main means of contact, correct?

    While word of mouth is certainly an effective means of recruitment, our primary tool has been email. As you point out there are a lot of Massage Therapists in MN. And to be honest I have no way to know how many therapists have been contacted with our messages. I send information to our contacts with the ABMP and AMTA to blast out to MN members of each organization, and they can tell me how many members they have total, but how many of that total number have an accurate email address on file, I don’t know. I’m sure it is probably lower than the 3200 membership number of those two organizations combined. From previous legislative attempts we have a database of around 125 Massage Therapists with emails that do not send back an automatic reply saying the email address is no longer valid. And how many of that 125 are also members of AMTA or ABMP, that would theoretically get the information in the email blasts from them, again, I have no way of knowing that. We have several hundred registered supporters who also receive calls for volunteers and email updates, but again, if you have an idea for how to reach more practitioners, I am all ears.

    I am very concerned about how this legislation would restrict me. It appears to be telling me how to do my work, rather than assuring prospective clients if I am ethical, honest and legal. How does limiting what I do make my chosen work field a progressive one? One small “for instance”, stretching. Does the legislation intend to limit my capacity to use stretching in my work?

    The current draft does include “passive and active stretching within the normal anatomical range of motion” in the Scope of Practice, which is the list of things we could do legally as an entry-level Massage Therapist under this law. Take a look at the list of other things under the Scope clause, and tell me if you think it is limiting. We tried to include all the techniques within the Massage Therapy field that are currently being used. But if you see something is missing, please let us know. The part that is limiting is the section of the Scope that are prohibited activities. Intentional spinal adjusting, administering injections, etc are all things that are not really Massage Therapy, and if a person is specifically trained to use those treatments, in those cases as a DC/DO, or an RN in the case of injections, they could of course still use those treatments, but for an entry-level Massage Therapist (which is who a License law is aimed at) those would be out of bounds, and I would argue should be out of bounds, since an entry level MT is not trained at school I know of to do adjustments or injections or any of the other activities on that list.

    A muscle flexes, contracts, relaxes, and can also atrophy. If a client’s muscles only seem to know contraction mainly, am I going to be restricted from encouraging these muscles to know what stretching is and feels like (ie. assisted stretch)? Can I not encourage the client to stretch more and show him or her different stretches to help their body?

    Nothing in the current draft would disallow you from doing that, unless what you’re calling “assisted stretching” includes doing a “high velocity low amplitude thrusting force” or chiropractic-style adjustment.

    Once this legislation is implemented, it would take forever to undo, so I want to know what it looks like before I agree to it hook, line and sinker.

    Again, I would fully encourage you to read the legislation. It has been online on the ALMT website since 02Dec2008, and on the state of MN’s website since 05Mar2009 when it was officially introduced. But the first part of your last statement is not necessarily correct. Laws get tweaked all the time, and our’s, once it does get passed, will be no exception. The majority of bills in the House and Senate right now are simple bills, less than a page, tweaking a word or two or just adding a line to make the law more effective and efficient.

    Don’t assume everyone is on board. Some people I’ve spoken to are actually feeling too paranoid to respond to your calls to action because they may be limiting their scope of practice.

    If the people you are speaking of read the bill or would write and ask about their concerns, or would get involved in the process, they could help shape the future of our profession, and turn that energy into something positive. What can happen if we don’t get a bill that we have a hand in writing is what almost happened in Maryland 15 years ago, where the PT association tried to run a Massage Therapy Licensure law through the state legislature. (You want to see a law that is limiting to a Massage Therapist’s practice?) The Massage Therapy community finally came together after having bickered for years about the finer points of getting a law, to fight against the PT’s proposal, and won that fight because they came together. They then stayed unified and got a basic entry level Licensure law that worked for them by again working together as a unified Massage Therapy field. We are and have been trying to get the word out to people here in MN about what this law would do and what it wouldn’t do.

    I remember way back that many objected to legislation like this because it was either the chiropractic or medical or physical therapy field that was going to oversee our practices and work and there was great fear of limiting our capacity and scope to do our work. Has this legislation addressed these concerns?

    The current draft establishes a MN Board of Massage Therapy, instead of having an Advisory Board under the Chiro’s or PTs as you are describing. The trade-off there is we end up with higher licensure fees. Personally, I am okay with having higher fees if it means having my peers making decisions for our profession, but others who have written to us don’t feel the same way. One reason the cost is so high in the current proposal is we have no way of knowing just how many MTs there are in MN, which is a big determinant of the fees. So as I said before, if there is another way to get the word out to people, so we can get a better head count, please let me know.

    Please don’t read this as an attack on your hard work. I am not “yelling” at you in this email. I am voicing strong concerns and worries. It would be nice not to have to be subjected to the whims and fancies of each city for licensing, but at what price? Did you know that some cities still plan to enforce their own licensing policies anyway, despite this legislation passing?

    Actually the city can keep the ordinance on their books forever if they want. But whether they do or not, for any practitioner Licensed by the state, a city Massage Licensing ordinance does not apply once the state Licesning law is in effect. So their keeping the ordinance on the books would only indicate that their city codes are out of date. The state law would supersede the local ordinance, whether the city wants it to or not.

    Heck, this is a source of revenue for them and many of them don’t know what the legislation entails, either.

    There are some cities that view it that way, but the majority do not. I can say that confidently because the League of MN Cities has been one of the longest running non-Massage related organizational supporters of MN Massage Therapy state-level Licensing. This is an organization that represents over 850 cities in MN, and if their member cities didn’t want it in enough numbers, you better believe the League of Cities would come out against us on this. The majority of cities see having to regulate Massage within the city borders as a drain on their resources, time and man-hours. But they feel because the state has not stepped up to the plate to do the regulating as they should, they (the city) need to have something on the books to keep the red-light district places out of their cities. And the majority of the cities ordinances are aimed at just that, prostitution. Not legitimate Massage Therapy. St Paul, from which it looks like you hold a city license, is an example of a city that has tried to set up an actual Massage Therapy licensing process with the written and hands-on tests they require. Unfortunately, even in St Paul, the city ordinance is ineffective and has no real teeth to protect the public. Did you see the article about the Massage Therapist a few weeks ago who came into St Paul to do a housecall session, without a St Paul “license” and sexually assaulted the client in the midst of the session. He did get arrested as he should have, but when they got before a judge, while he was convicted of the assault charge, the charge of practicing without the city license was dropped. So even in a case where the city has gone to the trouble of working to establish an actual licensing process, and where there was clear harm to the client, the city’s licensing authority holds no real power to protect the public. The guy who did that assault by the way will not do any jail time, just probation and have to undergo a “sexual offender evaluation”. And unfortunately even if he is labeled a “registered sex offender” he could still go into a city like Falcon Heigts or Chaska, where there is an ordinance in place but it does not include a background check looking for a criminal history of crimes like this. Or he could go into a city where there is no city ordinance at all like Minneapolis, or Apple Valley, or Woodbury. In both sets of cases, there would be nothing stopping him from setting up shop as a Massage Therapist today. That is why I believe we need the state to set up a consistent requirement to protect the citizens of MN. And of course even the strictest License is not going to prevent these horrible things from ever happening again. But if we screen practitioners prior to them being legally allowed to call themself a Massage Therapist to a public that has no way of knowing any better, we stand a much better shot at reducing how often it happens. There are now 42 states who have passed a state level credential that are protecting their citizens in a way MN is not. That is not a situation MN finds itself in too often, and one that needs to change.

    They still have their concerns about who will be practicing in their city…is this therapist ethical, honest and legal? Will this legislation calm their fears? Prostitution hiding behind massage therapy is still a huge concern. How will your legislation assure them that this will be stopped?

    With the legislation currently proposed, only those who meet the educational and or experience criteria for Licensure will be able to use the words Massage Therapist in their advertising. Only those with the state License will be able to say they are LMTs. If the cities wanted to then pass an ordinance that only state LMTs could practice massage in their city, that would be fine, as long as they don’t charge the often outrageous fees that some currently do. (Brooklyn Center is $3500 per year.) And again, the state law is not a panacea. Having the state regulate MT will not stop prostitution from happening under the guise of massage altogether. But it will make it less likely, and it will give law enforcement a tool with real teeth to try to more effectively stop it.

    I thank you for responding to my email. I would appreciate a copy of the legislation or knowing where and how to go about getting a copy.

    It appears the legislation will not be advancing in this 2009 session of the 2009-2010 term, but we will be be working to see that it is taken up in the other half of this term. That means we have several months to continue to get the word out about the bill and get more leg work done to be able to build our strongest case. We have you in our database of supporters, and from the sounds of it, you want to be involved in the process. We could really use your help. We will be sending out an update to all the supporters, as well as blasting info to the AMTA/ABMP members very soon asking for help in a variety of ways, with options to fit any schedule.

    Let me know if you have any questions after reading the draft proposal on the state website. I look forward to working with you.


    Best regards,

    Jeremy E. Miller, LMT (WV), NCTMB, BS

    Massage Therapist, Abbott Northwestern Hospital: Institute for Health & Healing
    Chair – Alliance for Licensing Massage Therapists
    Chair – AMTA-MN Government Relations Committee

    ALMT Website: http://almt.synthasite.com

    Cell: 612-483-5858
    Work Voicemail: 612-863-6145

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