A performance audit of the Board of Physical Therapy Examiners

              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
OF THE
BOARD OF PHYSICAL THERAPY EXAMINERS
MAY 1983
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 83- 10
DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE OF ARIZONA -
OFFICE OF THE
AUDITOR GENERAL
May 16, 1983
Members of the Arizona Legislature
The Honorable Bruce Babbitt, Governor
Ms. Charlotte Perotti, President
Board of Physical Therapy Examiners
Transmitted herewith is a report of the Auditor General, A Performance
Audit of the Board of Physical Therapy Examiners. This report is in
response to a January 18, 1982, resolution of the Joint Legislative
Oversight Committee. The performance audit was conducted as a part of the
Sunset Review set forth in A. R. S. § § 41- 2351 through 41- 2379.
The blue pages present a summary of the report; a response from the Board
of Physical Therapy Examiners is found on the yellow pages preceding the
appendices.
My staff and I will be pleased to discuss or clarify items in the report.
Respectfully submitted,
Douglas R. Norton
Auditor General
Staff: William Thomson
Peter N. Francis
Michael T. Murphy
Richard B. Booth
Addie L. Ceballos
Enclosure
1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 ( 602) 255- 4385
OFFICE OF THE AUDITOR GENERAL
A PERFORMANCE AUDIT OF THE
AKIZONA BOARD OF PHYSICAL THEMPY EXAMIIJEKS
A REPORT TO THE
AKIZOKA STATE LEGISLATURE
REPORT 83- 10
TABLE OF CONTENTS
INTRODUCTION AND 3ACKGKOUND
SUNSET FACTORS
Fcegulation of physical therapy appears necessary
due t o the p o t e n t i a l f o r public harm; however,
evidence of a c t u a l harm caused by physical t h e r a p i s t s
i s lacking.
CONCLUSION
FINDING I1
Probationary permit provisions a r e too
r e s t r i c t i v e .
CONCLUSION
RE C 02, IMENDAT I OX
OTHER PEkTIF; EIiT IPiFOR. tUTIG? v
AREAS FOR FUKTIIER AUDIT WOW
WRITTEN RESPONSE TO AUDITOR GENERAL' S FEPORT
Page
i
1
5
11
LIST OF TABLES
Page
TABLE 1 - Actual Expenditures and Revenues f o r F i s c a l Years
1978- 79 through 1981- 82 and E s t i m a t e d E x p e n d i t u r e s
and Revenues f o r F i s c a l Year 1982- 83
TABLE 2 - Summary of Board A c t i v i t i e s
F i s c a l Years Ending 1978- 79 through 1982- 83
TABLE 3 - Mature of Each Board Complaint November 30, 1979,
through J u l y 17, 1982
TABLE 4 - Malpractice Premiums
The Office of the Auditor General has completed a performance a u d i t of the
Arizona Board of Physical Therapy Examiners i n response t o a
January 18, 1982, r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight
Committee. This performance a u d i t was conducted a s a part of the Sunset
Review process s e t f o r t h i n A. R. S. Ss41- 2351 through 41- 2379.
The Eoard of Physical Therapy Examiners, e s t a b l i s h e d i n 1952, i s c u r r e n t l y
comprised of f i v e members appointed by the Governor. Three Board members
a r e licensed physical t h e r a p i s t s and two a r e public members. The purpose
of the Eoard is t o examine and l i c e n s e physical t h e r a p i s t s and physical
t h e r a p i s t a s s i s t a n t s , renew l i c e n s e s b i e n n i a l l y , i n v e s t i g a t e complaints
and hold hearings and e n f o r c e s t a n d a r d s of p r a c t i c e f o r the physical
therapy profession. The Board is provided s t a f f support through the
Arizona S t a t e Board's A d m i n i s t r a t i v e O f f i c e . A d d i t i o n a l part- time support
i s provided by the Board of Physical Therapy Examiner's executive
s e c r e t a r y .
Need f o r Licensing ( page 11)
Although r e g u l a t i o n of physical therapy appears j u s t i f i e d because of the
p o t e n t i a l f o r public harm, evidence of a c t u a l harm caused by physical
t h e r a p i s t s i s lacking. This l a c k of evidence may, however, be the r e s u l t
of h e a l t h c a r e i n s t i t u t i o n s ' f a i l u r e s t o r e p o r t complaints t o the Board.
I f l i c e n s i n g of physical t h e r a p i s t s is continued, improvements a r e needed
t o ensure the Board r e c e i v e s complaints involving incompetency or
unprofessional conduct. Physical t h e r a p i s t a s s i s t a n t s , on the other hand,
a r e u n l i k e l y t o cause harm and do not need t o be l i c e n s e d .
Because the evidence of harm caused by physical t h e r a p i s t s is p r e s e n t l y
l a c k i n g , t h e need f o r r e g u l a t i o n of physical therapy should be reviewed
abain i n four t o s i x years a f t e r r e p o r t i n g and enforcement have been
strengthened. To strengthen enforcement, t h e L e g i s l a t u r e should consider
amending the s t a t u t e s t o r e q u i r e mandatory r e p o r t i n g of physical t h e r a p i s t s
who v i o l a t e standards of p r a c t i c e and r e p o r t i n g of malpractice claims and
s e t t l e m e n t s t o the Board. The Board should pursue means t o educate and
inform the medical community a s t o the Board's r e s p o n s i b i l i t i e s concerning a
problem p r a c t i t i o n e r s .
S t a t u t o r y requirements f o r l i c e n s i n g physical t h e r a p i s t a s s i s t a n t s should
be d e l e t e d . a
Probationary Permits ( page 23)
S t a t u t o r y provisions governing the issuance of probationary permits a r e
overly r e s t r i c t i v e and may be unnecessary. Because these provisions a r e
i n f l e x i b l e , q u a l i f i e d f o r e i g n - t r a i n e d g r a d u a t e s cannot r e c e i v e r e g u l a r
l i c e n s e s t o p r a c t i c e i n Arizona u n t i l a one- year probationary period is
served. As a r e s u l t , u n f a i r b a r r i e r s t o entry i n t o the profession a r e
imposed and the supply of physical t h e r a p i s t s i n Arizona may be
unnecessarily l i m i t e d . The L e g i s l a t u r e should e i t h e r ( 1) g i v e t h e Board
d i s c r e t i o n a r y a u t h o r i t y t o waive o r reduce probationary permit
requirements or ( 2 ) d e l e t e probationary permit requirements and allow
foreign- trained t h e r a p i s t s t o receive l i c e n s u r e through temporary permit
procedures.
Areas f o r Further
Audit Work ( page 31)
Further review i s needed i n t h r e e a r e a s . During our a u d i t we i d e n t i f i e d
p o t e n t i a l problems including the 1) adequacy of Board record keeping and
record aaintenance, 2) e f f i c i e n c y of administering Board c l e r i c a l and
support functions through the S t a t e Board's Administrative Office, and 3)
extent t o which exan~ inations and l i c e n s i n g f e e s a r e adequate t o support
Board operations.
INTRODUCTION AND BACKGROUND
The Office of tlie Auditor General has completed a performance a u d i t of the
Arizona Board of Physical Therapy Examiners i n response t o a January 18,
1982, r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight Committee. This
performance a u d i t was conducted a s a part of the Sunset Review process s e t
f o r t h i n A. R. S. $ 541- 2351 through 41- 2379.
Physical therapy is primarily an e x t e r n a l form of treatment designed t o
r e l i e v e pain, improve o r maintain body functions and t e s t f o r body
s t r e n g t h , mobility or coordination. Treatment agents used by physical
t h e r a p i s t s include water, l i g h t , sound, r a d i a n t energy, h e a t , e l e c t r i c i t y ,
massage and e x e r c i s e . Physical therapy emerged a s a s p e c i a l i z e d form of
h e a l t h c a r e following the polio epidemics of the e a r l y 1900s.
The Board of Physical Therapy Examiners, e s t a b l i s h e d i n 1952, i s c u r r e n t l y
comprised of f i v e members appointed by the Governor. Three Board members
a r e licensed physical t h e r a p i s t s and two a r e public members. The purpose
of the Board is t o examine and l i c e n s e physical t h e r a p i s t s and physical
t h e r a p i s t a s s i s t a n t s , renew l i c e n s e s b i e n n i a l l y , i n v e s t i g a t e complaints
and hold hearings and e n f o r c e s t a n d a r d s of p r a c t i c e f o r the physical
therapy profession. The Board is provided s t a f f support through the
Arizona S t a t e Board's Administrative O f f i c e . A d d i t i o n a l part- time support
i s provided by the Board of Physical Therapy Examiner's executive
s e c r e t a r y .
The Uoard operates on an annual General Fund appropriation. Also 90
percent of the examination and l i c e n s i n g f e e s c o l l e c t e d by the Board a r e
deposited i n a s p e c i a l Board fund t o support its operation. Table 1 shows
Board expenditures and r e c e i p t s f o r f i s c a l years 1978- 79 through 1982- 83.
Table 2 shows the Coard's a c t i v i t y l e v e l s during t h i s period.
TABLE 1
ACTUAL EXPENDITURES AND REVENUES FOR
FISCAL YEARS 1978- 79 TIIROUGH 1981- 82
AND ESTIllATED EXPENDITURES AND REVENUES FOR FISCAL YEAR 1982- 83
Actual Estimated
1978- 79 1979- 80 1980- 81 1981- 82 1982- 83
p e r s o n a l s e r v i c e s $ 1,795 $ 1,683 $ 1,874 $ 4,700 $ 5,800
Employee- related
expenses 5 4 3 82 100 100
Prof e s s i o r l a l and
o u t s i d e s e r v i c e s 4,661 5,914 8,219 9,200 14,800
Travel 3,045 2,325 1,894 2,000 2,500
Other o p e r a t i n g 613 942 1,320 2,800 2,200
Other
T o t a l
Revenues* ( 90% of
r e c e i p t s ) $ 10,319 $ 10.904 $ 29.996 $ 12.420 $ 46,170
* The Board r e t a i n s 90 percent of i t s r e c e i p t s and d e p o s i t s 10 percent
i n t o t h e General Fund. The m a j o r i t y of t h e Board's r e c e i p t s came from
examination and l i c e n s e f e e s and renewal f e e s . I n 1980, t h e Board
implemented a b i e n n i a l renewal system. Thus, revenues f o r f i s c a l y e a r s
1980- 81 and 1982- 83 exceed t h o s e f o r o t h e r y e a r s .
TABLE 2
SUbiMARY OF BOARD ACTIVITIES
FISCAL YEARS EhDIKG 1978- 79 THROUGH 1982- 83
- F i- s- c- a- l- Y- - e ars
Actual Estimated
A c t i v i t y 1978- 79 1979- 80 1980- 81 1981- 82 1982- 83
Licenses i s s u e d 7 2 98 8 4 102 110
Renewals 464 460 485 12 605
Examinations
a d m i n i s t e r e d 2 6 43 51 3 3 37
Complaints received* 2 7 2 3 N/ A
Hearings l* * I***
* Complaint f i g u r e s were determined by A u d i t o r G e n e r a l s t a f f reviewing
Board r e c o r d s .
** Drafting 1980 l e g i s l a t i o n
*** Hearing on r u l e s and r e g u l a t i o n s
Scope of Audit
Our a u d i t of the Board of Physical Therapy Examiners addressed i s s u e s s e t
f o r t h i n the 11 Sunset f a c t o r s i n A. R. S. 541- 2354. Additional d e t a i l e d
work was conducted on the following i s s u e s :
0 The need t o r e g u l a t e the p r a c t i c e of physical therapy,
e E f f e c t i v e n e s s of the Board's enforcement a c t i v i t i e s , and
e The adequacy of l i c e n s i n g provisions.
Due t o time c o n s t r a i n t s , we were unable t o address s e v e r a l other i s s u e s of
concern. See page 31 f o r a l i s t of a r e a s f o r f u r t h e r a u d i t work.
The Auditor General and s t a f f express a p p r e c i a t i o n t o the members of the
Board of Physical Therapy Examiners and i t s executive s e c r e t a r y f o r t h e i r
cooperation and a s s i s t a n c e during the course of t h i s a u d i t .
SUNSET FACTORS
In accordance witli A. K. S. $ § 41- 2351 through 41- 2379, 11 f a c t o r s a r e
considered t o determine, i n p a r t , whether the Arizona Board of Physical
Therapy Exa~ ilirlers should be continued or terminated.
1. O. bjective and purpose i n e s t a b l i s h i n g the Hoard
The Board's o b j e c t i v e and purpose is not e x p l i c i t l y s t a t e d i n S t a t e
law. According t o a statement submitted by the Board p r e s i d e n t ,
however, the Board ' s o r i g i n a l purpose i n l i c e n s i n ~ physical t h e r a p i s t s
was to a s s u r e t h e public t h a t those persons holding themselves out a s
physical t n e r a p i s t s were properly t r a i n e d a s such. Since the 8oard1s
inception i n 1952, i t s purpose has evolved t o include p r o t e c t i o n of
the public from incompetent p r a c t i t i o n e r s . This purpose is
acconlplisiied through exainination of physical t h e r a p i s t s and physical
t h e r a p i s t a s s i s t a n t l i c e n s e a p p l i c a n t s , renewal of l i c e n s e s ,
i n v e s t i g a t i o n of complaints and dissemination of information t o Goard
l i c e n s e e s and the public.
According t o the Board p r e s i d e n t , a secondary purpose of the Board is
t o provide the l i c e n s i n g required f o r third- party reimbursement of
physical therapy s e r v i c e s . I- iowever, l i c e n s i n g by a S t a t e agency is
not necessary t o s a t i s f y t h i s requirement ( see Sunset Factor 10, page
9).
2. The e f t e c t i v e n e s s with which the Board iias met its o b i e c t i v e s and
purpose and the e f f i c i e n c y with which the Board has operated
The Board lias e f f e c t i v e l y examined and licensed q u a l i f i e d physical
therapy a p p l i c a n t s , however, enforcement a c t i v i t y has been minimal.
. The Board does not receive complaints d i r e c t l y a l l e g i n g p a t i e n t harm and has not suspended or revoked a l i c e n s e i n a t l e a s t e i g h t years.
IIealth care f a c i l i t i e s apparently handle any problems with physical
therapy p r a c t i t i o n e r s " in- house" without ' doard involvement. The Board
needs t o improve its enforcement e f f o r t by strengthening the r e p o r t i n g
process and i n c r e a s i n g p u b l i c awareness of the Board ( see page 16).
The Board has increased its e f f i c i e n c y by o f f e r i n g the l i c e n s i n g
exarriination Illore f r e q u e n t l y , up to four t i n e s per year, and by s e t t i n g
somewhat f l e x i b l e t e s t i n g d a t e s . These rirnprovements have enabled the
Goard to i s s u e l i c e n s e s on a schedule which Inore c l o s e l y coincides
with the graduation of Arizona physical therapy s t u d e n t s .
Three i s s u e s r e l a t e d t o Board e f f i c i e n c y could not be addressed due to
t i n e and s t a f f i n g c o n s t r a i n t s . These i s s u e s concern Board record
keeping, f e e s and a d m i n i s t r a t i o n and a r e p o t e n t i a l i s s u e s f o r f u r t h e r
a u d i t work ( s e e page 31).
3. Tlie extent t o which the Board has operated w i t h i n t h e public i n t e r e s t
The Coard ' s examination and l i c e n s i n g f u n c t i o n s e r v e s the public
i n t e r e s t by ensuring t h a t physical t h e r a p i s t s p r a c t i c i n g i n Arizona
meet ~ ninirnuni education and t r a i n i n g standards. However, overly
r e s t r i c t i v e probationary permit requirements do not serve the p u b l i c
i n t e r e s t . kegardless of q u a l i f i c a t i o n s , f oreign- trained a p p l i c a n t s
cannot be licensed u n t i l a minimu: n one- year supervised probationary
period i s served. This r e s t r i c t i o n imposes an unnecessary b a r r i e r t o
entry i n t o physical therapy and reduces the supply of physical
t h e r a p i s t s a v a i l a b l e t o serve the public ( see page 23).
4. The extent t o which r u l e s and r e g u l a t i o n s promulgated by the Board a r e
c o n s i s t e n t with the l e g i s l a t i v e lriandatc
kollowing enactment of its new p r a c t i c e a c t i n 1980, the Board
pro~~ lulgatedr u l e s arid r e g u l a t i o n s which became e i f e c t i v e i n June
1982. P r i o r t o t h e i r promulgation, these r u l e s were reviewed f o r
consistency with s t a t u t e s and were approved by the Attorney General.
5. The extent to which the Board has encouraged input from the public
before promulgating its r u l e s and r e g u l a t i o n s and the extent t o which
it has informed the public a s t o i t s a c t i o n s and t h e i r expected impact
on the ~ u b l i c
Cefore the Board's 1932 r u l e s were promulgated, the Eoard held a
hearing and p u b l i c i n p u t was s o l i c i t e d . The Board sent l e t t e r s
request in^ input t o the Northern Arizona U n i v e r s i t y P h y s i c a l Therapy
School, the Arizona Physical Therapy Association and the Arizona
Hospital Association. A n o t i c e of the meeting was sent t o a l l
l i c e n s e e s and t h e meeting was a d v e r t i s e d i n a newspaper.
The Iioara appears t o have complied with Open Irieeting Law
requirenents. Pfeetings have been p r o p e r l y n o t i c e d and minutes
aaequately maintained. Additional e f f o r t s a r e needed, however, t o
i n c r e a s e public awareness of the Board and i t s enforcement
r e s p o n s i b i l i t i e s ( s e e page 16).
6. The extent t o which the Board ha. s been a b l e t o i n v e s t i g a t e and resolve
cociplaints t h a t a r e within its j u r i s d i c t i o n
Coriiplaints received by the Board as of J u l y 17, 1982, none of which
d i r e c t l y alleged p a t i e n t harm, have been i n v e s t i g a t e d and resolved.
Health care f a c i l i t i e s , however, appear r e l u c t a n t : t o r e p o r t problem
p r a c t i t i o r i e r s t o the Eoard, and public awareness of the Board's
conplaint handling a u t h o r i t y is low. To overconic these problems, the
Board needs t o strengthen the r e p o r t i n g process and i n c r e a s e public
awareness of its r o l e and r e s p o n s i b i l i t i e s ( see page 16).
7. The extent t o which the Attorney General or any other a p p l i c a b l e
agency of S t a t e Government has the a u t h o r i t y to prosecute a c t i o n s
under enabling l e g i s l a t i o n
A. R. S. 532- 2643 e s t a b l i s h e s c r i n d n a l p e n a l t i e s f o r v i o l a t i o n of the
physical therapy s t a t u t e s . The following offenses c o n s t i t u t e a c l a s s
1 : nisderneanor : 1) obtaining a l i c e n s e by fraud or misrepresentation,
2) knowingly making a f a l s e statement i n an oath or a f f i r m a t i o n i n
connection with l i c e n s i n g or enforcement a c t i v i t i e s of the Board,
3) p r a c t i c i n g physical therapy without a l i c e n s e unless exempt from
l i c e n s i n g requirements, and 4) v i o l a t i n g any other provisions of the
physical therapy s t a t u t e s . Violations may be prosecuted by the
Attorney General or County Attorney.
8. The extent t o which the Board has addressed d e f i c i e n c i e s i n the
enabling s t a t u t e s which prevent it from f u l f i l l i n g its s t a t u t o r y
mandate
The Board has addressed d e f i c i e n c i e s i n its enabling s t a t u t e s .
Comprehensive new l e g i s l a t i o n enacted i n 1980 modernized the Board's
s t a t u t e s and corrected d e f i c i e n c i e s i n the Board's previous
l e g i s l a t i o n . Some of the provisions of the new law, such a s
enforcement procedures, may be d e f i c i e n t ; however, these provisions
have not been widely used and remain l a r g e l y untested. Nevertheless,
the Board supports the following s t a t u t o r y changes:
e C l a r i f i c a t i o n of supervisory requirements f o r physical
t h e r a p i s t a s s i s t a n t s , a i d e s and a t t e n d a n t s .
Amendment of membership requirements t o allow Board members
t o serve consecutive five- year terms. Currently, Board
members a r e r e s t r i c t e d from serving consecutive five- year
terms of o f f i c e .
Revision of both temporary and probationary permit
requirements. The Board would i s s u e temporary permits v a l i d
f o r 45 t o 60 days t o graduates of an approved school or
t h e r a p i s t s licensed i n another s t a t e . The t h e r a p i s t would
be required t o work under supervision of a licensed Arizona
physical t h e r a p i s t and could apply f o r a one- time extension
of the permit. No s p e c i f i c proposal has been developed f o r
r e v i s i o n of probationary permit requirements.
e Revision of f e e provisions t o allow the Board t o charge
higher f e e s .
C l a r i f i c a t i o n and review of enforcement procedures.
9. The e x t e n t t o which changes a r e necessary i n the laws of the Board t o
adequately comply with the f a c t o r s l i s t e d i n the Sunset Law
Additional changes are needed i n Board s t a t u t e s . The L e g i s l a t u r e
should consider:
Deleting the requirement t o l i c e n s e physical t h e r a p i s t
a s s i s t a n t s ,
Lnacting a mandatory r e p o r t i n g law a p p l i c a b l e t o physical
t h e r a p i s t s and h e a l t h c a r e f a c i l i t i e s which employ
t h e r a p i s t s ,
Revising probationary permit requirements t o allow q u a l i f i e d
f o r e i g n - t r a i n e d g r a d u a t e s t o o b t a i n l i c e n s e s i n Arizona
without serving a probationary period, and
e Amending the insurance code t o r e q u i r e r e p o r t i n g of
m a l p r a c t i c e c l a i m s and s e t t l e m e n t s t o the Board.
For j u s t i f i c a t i o n of these changes, see Finding I ( page 11) and
Finding I1 ( page 23).
10. The e x t e n t t o which the termination of the Board would s i g n i f i c a n t l y
harm t h e p u b l i c h e a l t h , s a f e t y or welfare
We were unable t o conclusively determine whether termination of the
Board would s i g n i f i c a n t l y harm the public h e a l t h , s a f e t y or welfare.
The p r a c t i c e of physical therapy appears t o have p o t e n t i a l f o r harm,
however, a c t u a l evidence of harm caused is lacking both i n Arizona and
n a t i o n a l l y ( s e e page 12).
According t o a statement from the Board p r e s i d e n t , termination of the
Board would jeopardize reimbursement of c o s t s by third- party payers.
Licensing of physical t h e r a p i s t s by a S t a t e Board, however, is not
required. For example, Federal r e g u l a t i o n s r e q u i r e S t a t e l i c e n s i n g
f o r Fledicare reimbursement - i f t h e S t a t e l i c e n s e s physical t h e r a p i s t s .
In the absence of a S t a t e r e g u l a t o r y program, the t h e r a p i s t may s t i l l
be reimbursea f o r s e r v i c e s i f other t r a i n i n g and experience
requirements a r e met.
11. The e x t e n t t o which the l e v e l of r e g u l a t i o n exercised by the Board is
a p p r o p r i a t e and whether l e s s or more s t r i n g e n t l e v e l s of r e g u l a t i o n
would be a ~ ~ r o p r i a t e
The l e v e l of r e g u l a t i o n exercised by the Board can be reduced.
Physical t h e r a p i s t a s s i s t a n t s do not need t o be l i c e n s e d ( s e e page
18). I n a d d i t i o n , s t a t u t o r y provisions governing probationary permits
can be made l e s s r e s t r i c t i v e or eliminated ( s e e page 23).
FINDING I
WGULATION OF PHYSICAL THERAPY APPEARS NECESSARY DUE TO THE POTENTIAL FOR
PUBLlC IiARPl: HOhXVER. EVIDENCE OF ACTUAL HARM CAUSED BY PHYSICAL
Although r e g u l a t i o n of physical therapy appears j u s t i f i e d because of the
p o t e n t i a l f o r public harm, evidence of a c t u a l harm caused by physical
t h e r a p i s t s is lacking. This lack of evidence nay, however, be the r e s u l t
of h e a l t h c a r e i n s t i t u t i o n s ' f a i l u r e s t o r e p o r t complaints t o the Board.
I f l i c e n s i n g of physical t h e r a p i s t s i s continued, improvements a r e needed
t o ensure the Board receives complaints involving incompetency or
unprofessional conduct.
Physical t h e r a p i s t a s s i s t a n t s , on the other hand, are unlikely t o cause
harm and do not need t o be l i c e n s e d .
Physical Therapy Regulation
The Board of Physical Therapy Examiners l i c e n s e s both physical t h e r a p i s t s
and physical t h e r a p i s t a s s i s t a n t s . Physical t h e r a p i s t s must o b t a i n a
bachelor's degree or c e r t i f i c a t e from an approved school t o be l i c e n s e d .
Their schooling provides the necessary background t o allow t h e r a p i s t s t o
evaluate p a t i e n t s and w r i t e treatment programs. Physical t h e r a p i s t
a s s i s t a n t s receive a s s o c i a t e degrees from junior c o l l e g e s a f t e r two years
of schooling and are considered s k i l l e d t e c h n i c i a n s who may administer
c e r t a i n portions of the treatment program w r i t t e n by the physical
t h e r a p i s t . Physical t h e r a p i s t a s s i s t a n t s must work under the d i r e c t
supervision of a p h y s i c a l t h e r a p i s t .
S t a t e r e g u l a t i o n of an occupation o r profession is j u s t i f i e d i f the
unregulated p r a c t i c e of t h a t occupation or profession poses a s e r i o u s
t h r e a t t o the public h e a l t h , s a f e t y , o r welfare. This p o t e n t i a l f o r
public harm must outweigh t h e p o s s i b l e negative e f f e c t s of l i c e n s u r e .
Licensure may a l s o be j u s t i f i e d when the consumer cannot be expected t o
possess the knowledge required t o properly e v a l u a t e t h e q u a l i f i c a t i o n s of
tlie person providing p r o f e s s i o n a l s e r v i c e s .
11
The Need f o r Licensing
Physical Therapists
The p r a c t i c e of physical therapy appears t o have the p o t e n t i a l f o r public
harm, however, t h e r e is l i t t l e a c t u a l evidence of harm caused by physical
t h e r a p i s t s . The Board h a s r e c e i v e d r e l a t i v e l y few complaints and none
have d i r e c t l y alleged p a t i e n t i n j u r y . On a n a t i o n a l l e v e l , the Board's
low complaint a c t i v i t y appears c o n s i s t e n t with experience i n other
s t a t e s . Moreover, physical t h e r a p i s t s pay r e l a t i v e l y low malpractice
premiums, a l s o suggesting t h a t l i t t l e public harm is a c t u a l l y caused.
However, harm may be occurring which is not reported. One reason the
Board may receive few coniplaints is t h a t medical i n s t i t u t i o n s may handle
complaints a g a i n s t physical t h e r a p i s t s in- house, without making r e f e r r a l s
t o the Board.
P o t e n t i a l f o r Earm - The p r a c t i c e of physical therapy appears t o pose a
p o t e n t i a l t h r e a t t o the public h e a l t h , s a f e t y and welfare. The p o t e n t i a l
f o r i n j u r y during physical therapy care is suggested by both the
v u l n e r a b l e c o n d i t i o n of some p a t i e n t s t r e a t e d as well a s the treatment
techniques commonly used. This p o t e n t i a l f o r harm could increase a s
t h e r a p i s t s g a i n g r e a t e r autonomy i n the p r a c t i c e of t h e i r profession.
The p o t e n t i a l f o r r i s k t o the consumer's l i f e , h e a l t h and s a f e t y is
demonstrated by both the s e r i o u s condition of c e r t a i n p a t i e n t s and the
complexity of physical therapy techniques. Physical t h e r a p i s t s ,
p a r t i c u l a r l y those employed i n h o s p i t a l s , work with s t r o k e and post head
i n j u r y p a t i e n t s . Therapists a l s o work i n i n t e n s i v e c a r e u n i t s and/ or with
p a t i e n t s j u s t days out of surgery. These p a t i e n t s may be weak, e l d e r l y or
completely unaware of t h e i r surroundings. They may be unable t o speak or
have l i t t l e c o n t r o l over t h e i r own movements. Therapists a r e involved i n
l i f t i n g these p a t i e n t s i n and out of wheelchairs, teaching them t o walk,
or administering various forms of e x e r c i s e . These motor- skill impaired
p a t i e n t s a r e completely dependent on the t h e r a p i s t s . I n a d d i t i o n ,
t h e r a p i s t s i n a l l s e t t i n g s use techniques which, i f misapplied, could
i n j u r e any type of p a t i e n t . For example, the use of s p i n a l or body
~ i a n i p u l a t i o n is becoming i n c r e a s i n g l y popular. Therapists a l s o employ
t r a c t i o n , hydrotherapy and e l e c t r i c a l and ultrasound m o d a l i t i e s . The
improper a p p l i c a t i o n of any of these techniques could r e s u l t i n p a t i e n t
i n j u r y .
This p o t e n t i a l f o r harm could grow a s the physical therapy profession
g a i n s i n c r e a s e d autonomy. H i s t o r i c a l l y , physical t h e r a p i s t s have provided
treatment only upon r e f e r r a l by a l i c e n s e d p h y s i c i a n or surgeon. This
provides some p r o t e c t i o n f o r the p a t i e n t s i n c e t h e physical t h e r a p i s t is
s e l e c t e d by the physician who presumably knows i f the t h e r a p i s t is
competent. However, t h e r a p i s t s have been g r a n t e d t r e a t m e n t autonomy i n
Maryland and C a l i f o r n i a , and House B i l l 2266 enacted by t h e L e g i s l a t u r e i n
1983 w i l l grant s i m i l a r autonomy t o Arizona t h e r a p i s t s . Thus, physical
t h e r a p i s t s w i l l be a b l e t o o f f e r s e r v i c e s d i r e c t l y t o t h e p u b l i c without
physician r e f e r r a l .
Lack of Complaints - Although physical therapy appears t o have the
p o t e n t i a l f o r public harm, a c t u a l evidence of harm is lacking. A review
of Board records since 1975 revealed the Board has not received any
complaints a g a i n s t p h y s i c a l t h e r a p i s t s which d i r e c t l y a l l e g e p a t i e n t
i n j u r y . The Board received and acted upon f i f t e e n complaints between
November 30, 1979, and July 1 7 , 1982. F i l e s f o r those complaints a r e
maintained a t the S t a t e Board Administrative Office. The nature of each
complaint is shown i n Table 3.
TABLE 3
NATURE OF EACH BOARD COklPLAINT
NOVhliBER 30, 1979, THIXIUG11 JULY 17, 1982
Number Type
P r o f e s s i o n a l s o t h e r than l i c e n s e d p h y s i c a l
t h e r a p i s t s a d v e r t i s i n g p h y s i c a l therapy care
2 P h y s i c a l t h e r a p i s t s o f f e r i n g d i a g n o s t i c s e r v i c e s
Physical t h e r a p i s t p r a c t i c i n g i n a p h y s i . c i a n l s
o f f i c e
1 P h y s i c a l t h e r a p i s t v i o l a t e d p r e s c r i p t i o n
2 Aides working without s u p e r v i s i o n
h a t u r o p a t h and p h y s i a t r i s t o f f e r i n g p h y s i c a l
therapy s e r v i c e s
- 1 P h y s i c a l t h e r a p i s r s o f f e r i n g s e r v i c e s without
r e f e r r a l
- 15
The m a j o r i t y of complaints were r e g i s t e r e d a g a i n s t p r a c t i t i o n e r s who were
i l l e g a l l y o f f e r i n g o r a d v e r t i s i n g p h y s i c a l therapy s e r v i c e s . F u r t h e r
review of Board records revealed t h a t h i s t o r i c a l l y t h e Eoard has not
received complaints d i r e c t l y a l l e g i n g p a t i e n t i n j u r y . A t l e a s t 23
complaints were f i l e d between January 1975 and J u l y 1979. Although
s p e c i f i c d e t a i l s were lacking f o r these complaints s i n c e f i l e s had not
beer1 c r e a t e d , inforliiation i n Board rr, inutes i n d i c a t e d t h a t t h e s e c o n p l a i n t s
did not involve s e r i o u s p a t i e n t harm. I n a d d i t i o n , a review of Board
r e c o r d s s i n c e 1975 revealed the Board has not suspended o r revolted a
l i c e n s e i n t h e p a s t e i g h t y e a r s .
National Cor, q, laint Ijata - The low nu~ llber and rcinor n a t u r e s of the
complaints r e g i s t e r e d with the Eoard a r e c o n s i s t e n t with n a t i o n a l d a t a .
Tile corilplaillt a c t i v i t y of l r t o t h e r s t d t e boards r e g u l a t i n g p h y s i c a l
therapy was reviewed. The number of complaints f i l e d a g a i n s t p h y s i c a l
t . t ~ e r , ~ ~ ~ iisnt st he 14 s t a t e s was low and tlie m a j o r i t y of the complaints
received concerned a d v e r t i s i n g i n ~ p r o p r i e t i e s o r o t h e r p r o f e s s i o n a l s
o f f e r i n g physical therapy care. Only one s t a t e mentioned receiving any
coriiplaints which alleged p r a c t i t i o n e r incompetency. Thus, the lack of
evidence of harm caused by physical t h e r a p i s t s i n Arizona appears
c o n s i s t e n t w i t 1 1 the experiences i n other s t a t e s .
I\ lalpractice E'reniurns - This minimal l e v e l of harr; caused is f u r t h e r
supported by the low malpractice premiums paid by physical t h e r a p i s t s .
Table 4 shows the annual premiums which have been e s t a b l i s h e d f o r the
lowest p r o t e c t i o n r a t e of $ 100,000 t o $ 300,000.
TABLE 4
PIALPMCTICE PEE? IIUT, iS*
P r i v a t e l J r a c t i c e
Employed Physical Therapy
( Hospital, e t c . ) A s s i s t a n t s
* Tliese r a t e s were obtained from a n i n s u r a n c e company endorsed by the
Arizona Physical Therapy Association.
Tile highest premiums, $ 135 per year, a r e paid by physical t h e r a p i s t s i n
p r i v a t e p r a c t i c e . For the same amount of p r o t e c t i o n , medical doctors may
pay up t o $ 6,7137 annually, depending on the number of claims f i l e d a g a i n s t
then.
Problen,~ IJot lieported - Iiarm may be occurring which i s not reported. One
reason the Board receives few complaints is t h a t h e a l t h c a r e f a c i l i t i e s
appear t o be handling problela p r a c t i t i o n e r s on t h e i r own and not r e p o r t i n g
cases of incompetency t o the Board. Administrators of various h e a l t h c a r e
i n s t i t u t i o n s i n d i c a t e d coinplaints a g a i n s t physical t h e r a p i s t s , would he
resolved " in- house."** Nursing c a r e and h o s p i t a l a d m i n i s t r a t o r s explained
tllat p a t i e n t complaints a g a i n s t physical t h e r a p i s t s would be handled by
a p p r o p r i a t e personnel w i t h i n t h e f a c i l i t y .
** A d ~ : i n i s t r a t o r s were r e l u c t a n t t o d i s c u s s t h e s e c a s e s i n s p e c i f i c
d e t a i l .
A major home h e a l t h care o r g a n i z a t i o n a l s o s t a t e d t h a t complaints would be
handled by t h a t i n s t i t u t i o n ' s riianakemerit. Iieal th care i n s t i t u t i o n s a r e
apparently r e l u c t a n t t o allow other e n t i t i e s t o i n v e s t i g a t e c o n p l a i n t s and
p r e f e r t h a t t h e i r own personnel i n v e s t i g a t e i m p r o p r i e t i e s . According to
o f f i c i a l s interviewed during our a u d i t , opening medical records t o outside
s c r u t i n y is discouraged.
Board Enforcement
Needs Improvement
If l i c e n s i n g physical t h e r a p i s t s is continued, improvements a r e needed to
i n c r e a s e t h e Board's enforcement e f f e c t i v e n e s s . The public may be unaware
o i the Loard's d u t i e s and a u t h o r i t y . I n a d d i t i o n , h e a l t h care
p r o f e s s i o n a l s and f a c i l i t i e s a r e not required t o r e p o r t incompetent
physical t h e r a p i s t s t o the board, and insurance companies a r e not required
t o report m a l p r a c t i c e c l a i m s and s e t t l e m e n t s .
Lack of Public Awareness - Lack of public and p r o f e s s i o n a l awareness of
the Board's r e s p o n s i b i l i t i e s may a l s o account f o r the Board's low l e v e l of
coniplaints and enforcement a c t i v i t y . The Eoard p r e s i d e n t s t a t e d t h a t most
physical t h e r a p i s t s don't know what the Board does, a s i d e from renewing
l i c e n s e s . One T5oard member i n d i c a t e d t h e small nunlber of complaints
received is probably due t o the public and pliysical t h e r a p i s t s being
unaware t h a t there is an agency which provides recourse. I f the Board's
own l i c e n s e e s a r e uninformed a s t o the Board's enforcement
r e s p o n s i b i l i t i e s , then the average consumer i s a l s o not l i k e l y t o know
about the Board and i t s complaint handling a u t h o r i t y .
The Board has Eaue attempts t o inform l i c e n s e d p h y s i c a l t h e r a p i s t s a s to
i t s d u t i e s and r e s p o n s i b i l i t i e s by means of a n e w s l e t t e r . The n e w s l e t t e r ,
however, has been p r i n t e d and mailed s p o r a d i c a l l y over the last few
years. Although a newsletter is scheduled t o be sent with the 1983
l i c e n s e renewals, the Board is r e l u c t a n t t o formalize n e w s l e t t e r mailin6
s c t ~ e d u l e s , and a r e g u l a r p u b l i c a t i o n scllcdule has not been e s t a b l i s h e d .
Health care f a c i l i t i e s a r e a l s o unaware of the Board's complaint
j u r i s d i c t i o n and r e s p o n s i b i l i t y . This nay a l s o e x p l a i n why so few
physical therapy p r a c t i c e problems a r e reported t o the Board. The Board
has not taken any measures t o educate h e a l t h c a r e a d m i n i s t r a t o r s
concerning the Board's d u t i e s or a u t h o r i t y . When contacted, these
a d n l i n i s t r a t o r s seeriled unaware of the Board's r e s p o n s i b i l i t y t o handle
complaints a g a i n s t physical t h e r a p i s t s . Other boards, f o r example the
Board of Nursing, have a c t i v e l y sought through conferences t o inform
h e a l t h f a c i l i t y a d m i n i s r r a t o r s of t h e i r boards' r e s p o n s i b i l i t i e s .
lie ? landatory Reporting - Unlike some other regulated h e a l t h c a r e
professions i n Arizona, physical t h e r a p i s t s and medical o f f i c i a l s a r e not
required to report dangerous o r incompetent p r a c t i t i o n e r s t o the Board.
The Board of Xedical Examiners and the Board of Osteopathic Examiners,
through A. B. S. 532- 1451, subsection A and $ 32- 1855, subsection A,
r e s p e c t i v e l y , r e q u i r e physicians and medical i n s t i t u t i o n s and a s s o c i a t i o n s
to report any i n s t a n c e s of doctors o r o s t e o p a t h i c p h y s i c i a n s d i s p l a y i n g
unprofessional conduct or incompetence, a l l e g e d or otherwise, t o the
Board. Mandatory r e p o r t i n g l a w s increase the r e g u l a t i n g Board's a b i l i t y
to review, d i s c i p l i n e and make a matter of public record cases of a l l e g e d
inconpetence or unprofessional conduct. The lack of such s t a t u t e s i n the
Physical Therapy P r a c t i c e Act, on t h e o t h e r hand, allows h e a l t h c a r e
f a c i l i t i e s t o keep the Board of Physical Therapy Examiners unaware of any
problem p r a c t i t i o n e r s .
No Flalpractice Reporting - Arizona s t a t u t e s do not r e q u i r e insurance
companies t o report t o the Board m a l p r a c t i c e c l a i m s and s e t t l e m e n t s
involving physical t h e r a p i s t s . Other h e a l t h r e g u l a t o r y boards such a s the
Boards of Medical Examiners, Osteopathic Examiners and Podiatry Examiners
have such report in^ requirements i n t h e i r enabling s t a t u t e s . These
r e p o r t i n g requirements a r e a p o t e n t i a l l y i n ~ p o r t a n t source of information
regarding problem p r a c t i c i o n e r s .
However, i f such a r e p o r t i n g requirement is considered f o r the Board of
Physical Therapy Examiners, the requirement should be placed i n the
insurance s t a t u t e s r a t h e r than the Board s t a t u t e s . Previous performance
a u d i t s have repeatedly found t h a t l i c e n s i n g boards have d i f f i c u l t y i n
obtaininb compliance by i n s u r e r s with malpractice r e p o r t i n g requirenients.
In Report KO. 81- 19, A Performance Audit of the Board of Podiatry
Examiners, we aadressed t h i s i s s u e and noted
" A possible s o l u t i o n to the f a i l u r e of insurance
conpanies t o report malpractice data would be t o make
such p r a c t i c e s a v i o l a t i o n of the insurance
code-- possibly with a f i n e o r other penalty f o r
noncompliance. The Department of Insurance could then
noni t o r and enforce the r e p o r t i n g p r o v i s i o n s through
i t s market conduct examinations and o t h e r r e g u l a t o r y
programs. F u r t h e r , under t h i s system i f nonreporting
was found, a c t i o n could be taken by the Department of
Insurance, which is involved i n the d a i l y r e g u l a t i o n of
insurance companies. . . ."
P h y s i c a l T h e r a p i s t A s s i s t a n t s
Do liot : Jeed t o l; e Licensed
While l i c e n s i n g physical t h e r a p i s t s may be j u s t i f i e d , physical t h e r a p i s t
a s s i s t a n t s do not need t o be licensed. A s s i s t a n t s work under the d i r e c t
supervisiorl of licensed 1: tysical t h e r a p i s t s and a r e unlikely t o cause any
ham. Requiring l i c e n s u r e f o r a s s i s t a n t s c r e a t e s unnecessary b a r r i e r s t o
occupational e n t r y .
A. R. S. $ 32- 20Gl. A. 6. d e f i n e s physical t h e r a p i s t a s s i s t a n t as:
". . . a person who a s s i s t s under the o n s i t e
supervision of a p h y s i c a l t h e r a p i s t i n the p r a c t i c e of
piiysical therapy and who perforn~ s delegated procedures
corilmensu~- ate w i t t i the a s s i s t a n t ' s education and
t r a i n i n g and who is licensed i n accordance with t h i s
cilap t er but docs not include e v a l u a t i o n ,
i n t e r p r e t a t i o n , implemerltatiori or modification of
est. iblis11ed t r e a t l l ~ e n t programs."
Thus, a s s i s t a n t s must be supervised d i r e c t l y by a t r a i n e d physical
t h e r a p i s t . F u r t h e r , according t o the Board's s e c r e t a r y , most physical
t h e r a p i s t a s s i s t a n t s a r e employed i n i n s t i t u t i o n s which a r e a l s o
l i c e n s e d .
Persons supervised c l o s e l y by o t h e r l i c e n s e d p r o f e s s i o n a l s do not need t o
be l i c e n s e d . Benjamin Shimberg, a noted a u t h o r i t y on occupational
l i c e n s u r e , comments:
" There i s l i t t l e j u s t i f i c a t i o n f o r l i c e n s u r e i f
p r a c t i t i o n e r s work under d i r e c t supervision. I f
r e g u l a t i o n i s needed, it should be the supervisor who
is regulated ."
While a l l 50 s t a t e s l i c e n s e physical t h e r a p i s t s , a t l e a s t 19 do not
l i c e n s e physical t h e r a p i s t a s s i s t a n t s . I n the s t a t e of Washington, f o r
example, unlicensed a s s i s t a n t s perform the same d u t i e s and t a s k s a s t h e i r
c o u n t e r p a r t s i n Arizona. Yet, t h e r e i s no evidence t h a t a s s i s t a n t s i n
Washington a r e l e s s competent nor t h a t they have caused any public harm.
The p o t e n t i a l f o r harm from physical t h e r a p i s t a s s i s t a n t s is c u r t a i l e d by
the r e s t r i c t i o n s imposed on t h e i r scope of work. A s s i s t a n t s have l i m i t e d
r e s p o n s i b i l i t i e s f o r a p a t i e n t ' s treatment and a r e t r a i n e d t o c a r r y out
s p e c i f i c o r d e r s . F o r i n s t a n c e , the t h e r a p i s t is r e s p o n s i b l e f o r
determining 1) which type of modality the p a t i e n t should r e c e i v e , i f
any, 2) the frequency of a p p l i c a t i o n , 3) the dosage necessary, 4) the
d u r a t i o n of each treatment, and 5) the s p e c i f i c a r e a t o be t r e a t e d . The
a s s i s t a n t may only a c t i v a t e the modality and perform the treatment a s
described. A s s i s t a n t s may not perform c e r t a i n complex treatment
techniques, such a s s p i n a l manipulation. Removing l i c e n s u r e requirements,
furthermore, would n o t e l i m i n a t e t r a i n i n g programs and/ or minimum
q u a l i f i c a t i o n s e s t a b l i s h e d f o r h i r i n g a s s i s t a n t s . Education and
experience requirements of h o s p i t a l s and other f a c i l i t i e s would not be
a f f e c t e d . Therefore, l i c e n s i n g of a s s i s t a n t s on t h e b a s i s of public
s a f e t y concerns appears t o be u n j u s t i f i e d .
Requiring l i c e n s u r e f o r physical t h e r a p i s t a s s i s t a n t s c r e a t e s unnecessary
r e s t r i c t i o n s on entry i n t o t h i s occupation. Persons wishing t o work a s
a s s i s t a n t s must pay examination and l i c e n s i n g f e e s and pass an
examination. These requirements could be a burden f o r some i i l d i v i d u a l s
and may discourage o t h e r s from e n t e r i n g t h i s occupation.
Despite t h e apparent p o t e n t i a l f o r public harrri from the p r a c t i c e of
physical therapy, a c t u a l evidence of public harm is lacking. However, a l l
i n s t a n c e s involving harm may not be reported t o the Eoard. I f l i c e n s i n g
physical t h e r a p i s t s is continued, improvements a r e needed t o i n c r e a s e the
Board's eilforcerlient e f f e c t i v e n e s s . Physical t h e r a p i s t a s s i s t a n t s , on the
other hand, a r e not lilcely t o cause harm and do not need t o be l i c e n s e d .
RECOPIIENllr'iTIOi~ b
1. Cecause a c t u a l evidence of hani, caused by physical t h e r a p i s t s is
l a c k i n g , the need f o r r e g u l a t i o n of physical therapy should be
reviewed again i n four to s i x years a f t e r r e p o r t i n g and enforcerrient
have been strengthened a s recommended below.
2. The L e g i s l a t u r e should consider amending the s t a t u t e s t o r e q u i r e
physical t h e r a p i s t s , h e a l t h care i n s t i t u t i o n s o r such other persons a s
a p p r o p r i a t e to report to tllc Board any inforloation which appears to
show t h a t a physical t h e r a p i s t may be involved i n unprofessional
conduct or niay be incompetent.
3. If nandatory r e p o r t i n g by physical t h e r a p i s t s is required, the Board
should amend its r u l e s and r e g u l a t i o n s t o include f a i l u r e of a
l i c e n s e e t o report v i o l a t i o l l s of the physical t h e r a p i s t s t a t u t e s a s
unprofessional conduct.
4. The Board should explore ways t o inform and educate h e a l t h i n s t i t u t i o n
a d m i n i s t r a t o r s , physical therapy department s u p e r v i s o r s and l i c e n s e
holders oi the Board's r e s p o n s i b i l i t i e s t o i n v e s t i g a t e and resolve
matters involving problem p r a c t i t i o n e r s .
5. The Insurance Code should be amended to r e q u i r e companies writing
malpractice coverage f o r physical t h e r a p i s t s t o r e p o r t malpractice
clainis and s e t t l e m e n t s t o the Board.
6. S t a t u t o r y requirements f o r l i c e n s i n g of physical t h e r a p i s t a s s i s t a n t s
should be d e l e t e d .
FIXIIIhG I1
PROBATIONXl? Y PERTIIT PROVISIOIU'S ARE TOO RESTilICTIVE.
S t a t u t o r y provisions governing the issuance of probationary permits a r e
overly r e s t r i c t i v e and niay be unnecessary. Eecause these provisions a r e
i n f l e x i b l e , q u a l i f i e d f o r e i g n - t r a i n e d g r a d u a t e s cannot r e c e i v e r e g u l a r
l i c e n s e s t o p r h c t i c e i n Arizona u n t i l a one- year probationary period is
served. As a r e s u l t , u n f a i r b a r r i e r s t o entry i n t o the profession a r e
imposed and the supply of physical t h e r a p i s t s i n Arizona may be
unnecessarily l i m i t e d .
S t a t u t o r y Kequirenents
Probationary permits a r e issued t o f o r e i g n - t r a i n e d g r a d u a t e s f o r a period
of a t l e a s t one year. During t h i s probationary period, t h e
f o r e i g n - t r a i n e d g r a d u a t e rnust work under t h e s u p e r v i s i o n of a l i c e n s e d
physical t h e r a p i s t i n a f a c i l i t y approved by the Board. After
s a t i s f a c t o r i l y conipleting the probationary period, the t h e r a p i s t may talce
the Board's examination and, upon passing, receive a l i c e n s e . A. R. S.
§ 32- 2022, subsection M e s t a b l i s h e s the board's a u t h o r i t y to i s s u e
probationary permits:
" An a p p l i c a n t f o r l i c e n s u r e a s a physical t h e r a p i s t
whose a p p l i c a t i o n is based on a diploma issued t o him
by a p h y s i c a l therapy school outside of the United
S t a t e s , s h a l l f u r n i s h documentary evidence t o the
s a t i s f a c t i o n of tlie board, t h a t lie has s a t i s f a c t o r i l y
completed a course i n physical therapy s u b s t a n t i a l l y
equivalent to the requirements prescribed i n subsection
II. For l i c e n s u r e a s a physical t h e r a p i s t an a p p l i c a n t
who n e e t s such requirements s h a l l be issued a
probationary permit f o r a period of twelve months and
t h e r e a f t e r s h a l l , to the s a t i s f a c t i o n of the board,
complete a period of supervised c l i n i c a l p r a c t i c e , f o r
a f a i r and reasonable remuneration, of a t l e a s t twelve
months i n the s t a t e under the continuous and immediate
supervision of an Arizona licensed pliysical t h e r a p i s t
i n a f a c i l i t y approved by the board. I f t h e a p p l i c a n t
s a t i s ~ a c t o r i l y completes sucit period of s e r v i c e , he
s h a l l be issued a c e r t i f i c a t e of l i c e n s u r e a s a
physical t h e r a p i s t , a f t e r having, s u c c e s s f u l l y completed
t h e e x a n i n a t i o n r e q u i r e d i n t h i s section."
23
The Board o r i g i n a l l y intended probationary permits t o allow q u a l i f i e d
foreign- trained t h e r a p i s t s t o p r a c t i c e i n Arizona. During the three- year
period 1980-$ 2, the Board has issued s i x probationary permits t o e l i g i b l e
a p p l i c a n t s .
Provisions Are I n f l e x i b l e
and 2.13y Be Unnecessary
Because s t a t u t o r y provisions governing probationary permits a r e
i n f l e x i b l e , foreign- trained t h e r a p i s t s otherwise q u a l i f i e d t o p r a c t i c e a r e
denied l i c e n s u r e i n Arizona u n t i l a one- year probationary period is
served. ? loreover, t h e s e p r o v i s i o n s may be unnecessary.
Current probationary permit provisions lack f l e x i b i l i t y . Under c u r r e n t
law, i n a d d i t i o n t o passing the examination every graduate of a f o r e i g n
physical therapy program must serve a supervised periocl of probation of a t
l e a s t one year i n an approved f a c i l i t y . Regardless of the a p p l i c a n t ' s
q u a l i f i c a t i o n s , the Board cannot waive o r reduce the one- year probationary
requirement.
This problem is well i l l u s t r a t e d i n the followir, g case example. A
Canadian- trained physical t h e r a p i s t applied f o r l i c e n s u r e i n Arizona. The
a p p l i c a n t had received a bachelor of Science dekree i n physical therapy
from McGill University i n Montreal, Quebec, Canada. Iier t r a i n i n g was
assessed by a p r o f e s s i o n a l e v a l u a t i o n s e r v i c e ( s e e below) and c e r t i f i e d as
equivalent to U. S. bachelor- level t r a i n i n g . I n a d d i t i o n , the t h e r a p i s t
had over e i g l ~ t y e a r s e x p e r i e n c e i n physical therapy and was f l u e n t i n
English. 3ecause probationary provisions were a p p l i c a b l e and could not be
waived, tile t h e r a p i s t was required t o f i n d an employer a t a Board- approved
f a c i l i t y and to serve a supervised probationary period of one year. I n
l i g h t of the t h e r a p i s t ' s equivalent t r a i n i n g , subs t a r l t i a l p r a c t i c e
experience and English fluency, however, a p e r i o d of probation appears t o
have been unnecessary.
Pro tatioriary perxrii ts f o r Foreign graduates nay not be needed. According
t o Doard members, permit provisions were intended to serve a s a check on
the r o r e i p t h e r a p i s t ' s competence aria a b i l i t y t o adequately communicate
i n L n ~ l i s h . Iiowever, equivalency of t r a i n i n g is assessed f o r the Board by
t h e I n t e r n a t i o n a l Education Research Foundation, a p r o f e s s i o n a l e v a l u a t i o n
s e r v i c e located i n Los Angeles. The Foundation's evaluation is
comprehensive and includes a records assessment of basic education,
p r o f e s s i o n a l t r a i n i n g and c l i n i c a l / p r a c t i c a l experience. Furtller,
language a b i l i t y , i f i n question, can be t e s t e d through other means. For
exanple, the Educational Testing Services ( E. T. S. ) has designed an
exaniination f o r English competency. The Test of English as a Foreign
Lanbuage ( TOEFL) is c u r r e n t l y offered to f o r e i g n - t r a i n e d g r a d u a t e s i n
other professions, such a s pharmacy.
Even i f t r a i n i n g is judged equivalent t o U. S. standards, the Board
believes q u a l i t a t i v e or other d i f f e r e n c e s i n c l i n i c a l experience may
require a probationary p e r i o d . This need could be addressed, however,
through a l e s s r e s t r i c t i v e temporary perroit procedure. F u r t h e r , a t l e a s t
t h r e e s t a t e s do not require f o r e i g n graduates t o serve a probationary
period of p r a c t i c e . In Kentucky, Delaware and Montana, foreign- trained
graduates may sit f o r the l i c e n s i n g exam a f t e r t h e i r t r a i n i n g has been
deternlined equivalent t o U. S. standards.
R e s t r i c t i v e Licensini: Reauirements Bar
Entry and Limit the Supply of P r a c t i t i o n e r s
R e s t r i c t i v e probationary permit provisions have a t l e a s t two adverse
impacts. F i r s t , they inpose b a r r i e r s t o entry i n t o the profession which
a r e u n f a i r to some a p p l i c a n t s . Second, they nay l i m i t unnecessarily the
supply of physical t h e r a p i s t s i n Arizona.
Current permit p r o v i s i o i ~ s impose u n f a i r b a r r i e r s t o e n t r y of q u a l i f i e d
foreign- trained t h e r a p i s t s . To become l i c e n s e d , these t h e r a p i s t s must
f i r s t search f o r an employer w i l l i n g t o supervise t h e i r probations and may
be required t o forego income. As an a l t e r n a t i v e , some f o r e i g n graduates
i n t e r e s t e d i n moving t o Arizona may seek l i c e n s u r e i n other s t a t e s because
of Arizona's r e s t r i c t i v e l i c e n s i n g requirements. .
A s a r e s u l t of these r e s t r i c t i o n s , the supply of l i c e n s e d p h y s i c a l
t h e r a p i s t s inay be unnecessarily l i m i t e d . Q u a l i f i e d f o r e i g n graduates a r e
r e s t r i c t e d i n t h e i r p r a c t i c e s o r discouraged from seeking l i c e n s u r e i n
Arizona. l h i s reduces the supply of physical t h e r a p i s t s a v a i l a b l e t o
health care f a c i l i t i e s and to the public. According t o some f a c i l i t y
a d m i n i s t r a t o r s , t h e r e is c u r r e n t l y a s h o r t a g e of licensed t h e r a p i s t s
a v a i l a b l e f o r h i r e .
S t a t u t o r y provisions governing probationary permits a r e too r e s t r i c t i v e
and may be unnecessary. Qualified foreign graduates cannot receive a
l i c e n s e t o p r a c t i c e without f i r s t s e r v i n g a one- year probationary p e r i o d .
As a r e s u l t , u n f a i r b a r r i e r s to e n t r y i n t o p h y s i c a l t h e r a p y i n Arizona a r e
inposed and the supply of p r a c t i t i o n e r s r2ay be unnecessarily l i m i t e d .
RECOi~ 2lEtJDLiTIOPi
The L e g i s l a t u r e should consider e i t h e r :
Giving the Board d i s c r e t i o n a r y a u t h o r i t y t o waive or reduce
probationary permit requirements or
Deleting probationary permit provisions from the s t a t u t e s and
allowing foreign- trained t h e r a p i s t s to receive l i c e n s u r e through
temporary permit procedures.
OTIIER PERTINENT INFOPJlATION
During the course of our a u d i t of the Board of Physical Therapy Examiners,
we reviewed t h e following p e r t i n e n t information.
Relationship of Physical Therapy t o
Other Forms of Treatment and T h e r a ~ v
The l i c e n s i n g of physical t h e r a p i s t s p r o h i b i t s unlicensed persons from
holding themselves out a s " physical t h e r a p i s t s " or p r a c t i c i n g p h y s i c a l
therapy. The scope of physical therapy p r a c t i c e is defined by A. R. S.
s32- 2001. A., which s t a t e s i n p a r t :
" 7. ' P h y s i c a l t h e r a p y ' means the treatment of a bodily or
mental condition by the use of physical, chemical or other
p r o p e r t i e s of heat, cold, l i g h t , sound, water, or by
massage and a c t i v e and p a s s i v e e x e r c i s e , . a i r , mechanical
energy, e l e c t r i c a l energy, electromagnetic energy and t h e i r
necessary physical measures, a c t i v i t i e s and devices. . . ."
A number of other a l l i e d h e a l t h and healing arts p r a c t i t i o n e r s , however,
engage i n treatment modalities which e i t h e r overlap with or border on the
p r a c t i c e of physical therapy. Some of these occupations, which appear t o
have the c l o s e s t r e l a t i o n s h i p t o physical therapy, a r e described below.
Occupational Therapy - The American Occupational Therapy Association
r e c e n t l y adopted t h e f o l l o w i n g d e f i n i t i o n :
" Occupational therapy is the use of purposeful a c t i v i t y with
i n d i v i d u a l s who a r e limited by physical i n j u r y o r i l l n e s s ,
psychosocial dysfunction, developmental o r learning
d i s a b i l i t i e s , poverty and c u l t u r a l d i f f e r e n c e s o r the aging
process i n order t o maximize independence, prevent
d i s a b i l i t y and maintain h e a l t h . The p r a c t i c e encompasses
e v a l u a t i o n , t r e a t m e n t and c o n s u l t a t i o n . S p e c i f i c
occupational therapy s e r v i c e s i n c l u d e : t e a c h i n g d a i l y
l i v i n g s k i l l s ; developing perceptual- n: otor s k i l l s and
sensory i n t e g r a t i v e functioning; developing play s k i l l s and
prevocational and l e i s u r e c a p a c i t i e s ; designing, f a b r i c a t i n g
or applying s e l e c t e d o r t h o t i c and p r o s t h e t i c or s e l e c t i v e
adaptive equipment; using s p e c i f i c a l l y d e s i l n e d c r a f t s and
e x e r c i s e s t o enhance f u n c t i o n a l performance; administering
and i n t e r p r e t i n g t e s t s such a s manual muscle and range of
motion; and adapting environments f o r the handicapped."
Occupational t h e r a p i s t s must graduate from a c e r t i f i e d occupational
therapy program. This is usually a four- year c o l l e g e which g r a n t s a
bachelors degree t o graduates. Occupational t h e r a p i s t s a r e a l s o required
to serve a c l i n i c a l a f f i l i a t i o n of a t l e a s t s i x ~ o n t h s . Upon graduation,
students a r e then e l i g i b l e t o be r e g i s t e r e d through a n a t i o n a l examination.
Occupational t h e r a p i s t s a r e not always required t o p r a c t i c e w i t h p h y s i c i a n
r e f e r r a l . Certain f a c i l i t i e s ( i . . h o s p i t a l s ) r e q u i r e occupational
t h e r a p i s t s t o p r a c t i c e under physician r e f e r r a l , however, occupational
t h e r a p i s t s i n p r i v a t e c o n s u l t a t i o n may work d i r e c t l y with the c l i e n t . The
p r a c t i c e of occupational therapy i s not licensed i n Arizona.
Respiratory Therapy - Respiratory therapy involves the treatment of lung
d i s e a s e , breathing problems and c e r t a i n heart problems. Kespiratory
t h e r a p i s t s use oxygen, carbon dioxide and helium; medicines of various
kinds i n a e r o s o l spray form; and r e s p i r a t o r s , e x e r c i s e and various methods
of c h e s t p h y s i c a l therapy i n the prevention and treatment of lung and
h e a r t d i s e a s e s and a s s o c i a t e d breathing problems. Kespiratory t h e r a p i s t s
t r e a t conditions such a s asthma, b r o n c h i t i s , c y s t i c f i b r o s i s , emphysema,
hyaline membrane d i s e a s e , pneumonia, a s b e s t o s i s , c o a l miner's " black
lung," h e a r t a t t a c k and s t r o k e . Respiratory t h e r a p i s t s a l s o t r e a t
breathing complications following surgery or r e s u l t i n g from automobile or
other a c c i d e n t s .
The profession t r a i n s f o r two l e v e l s of e x p e r t i s e . Respiratory
t e c h n i c i a n s a r e t r a i n e d f o r approximately one year. Respiratory
t h e r a p i s t s receive approximately two years of t r a i n i n g . Upon c o ~ i p l e t i o n
of t r a i n i n g , both groups sit f o r s e p a r a t e , n a t i o n a l exams. Technicians
are c e r t i f i e d and t h e r a p i s t s a r e r e g i s t e r e d t o p r a c t i c e by the National
Board of Respiratory Therapy.
Kespiratory t h e r a p i s t s work s o l e l y i n h o s p i t a l s o r ' other h e a l t h care
f a c i l i t i e s . None a r e i n p r i v a t e p r a c t i c e . Respiratory t h e r a p i s t s a r e not
subject to the physician r e f e r r a l system although they t r e a t p a t i e n t s
under the a u t h o r i t y of a licensed h e a l t h c a r e p r o f e s s i o n a l . Respiratory
therapy a l s o is not licensed i n Arizona.
Speech Therapy - Speech therapy as defined by C o l l i e r ' s Encyclopedia is
the treatment of speech d i s o r d e r s . Experts i n t h e p r o f e s s i o n of speech
therapy work with persons whose speech i n t e r f e r e s with communication or
c a l l s a t t e n t i o n t o i t s e l f and f r u s t r a t e s both speaker and l i s t e n e r .
Speecil t h e r a p i s t s evaluate and c o r r e c t d e f e c t i v e speech and teach new
s k i l l s . The f i e l d of speech therapy is o f t e n c a l l e d speech pathology and
speech t h e r a p i s t s a r e a l s o known a s speech p a t h o l o g i s t s or speech
c l i n i c i a n s .
I n order t o be c e r t i f i e d , speech t h e r a p i s t s must graduate from approved
bachelor and master degree programs, complete a year- long c l i n i c a l
fellowship and pass a n a t i o n a l exam.
Massage Therapy - P r a c t i t i o n e r s i n the f i e l d d e f i n e massage a s the
s c i e n t i f i c movement of s o f t t i s s u e , connective t i s s u e and muscle t i s s u e .
The body receives a relaxing massage. The treatment is designed t o a i d
c i r c u l a t i o n , d i g e s t i o n , e l i m i n a t i o n and r e s p i r a t i o n . Massage t h e r a p i s t s
are licensed by t h e C i t y of Phoenix but a r e not s u b j e c t t o S t a t e l i c e n s u r e
requirements.
Rolfing - The executive d i r e c t o r of the Rolf I n s t i t u t e d e f i n e s r o l f i n g a s
". . . a s e r i e s of t e n s e s s i o n s of deep connective
t i s s u e ( f a s c i a ) manipulation and education, and is
based on the theory t h a t the body is " p l a s t i c " or
changeable. This q u a l i t y of p l a s t i c i t y enables the
human body t o be anatomically ordered, thus lengthened
and centered along i t s v e r t i c a l a x i s . The purpose of
r o l f ing i s t o b e t t e r balance an i n d i v i d u a l ' s body
around a v e r t i c a l l i n e i n the f i e l d of g r a v i t y so t h a t
g r a v i t y can support the body r a t h e r than t e a r it down.
The r e s u l t of t h i s b e t t e r balance is s a i d t o be
enhancement, not only of p h y s i c a l w e l l being, but a l s o
of emotional and s p i r i t u a l well being."
To q u a l i f y a s a r o l f e r , a candidate must be c e r t i f i e d by the Rolf
I n s. t i t u t e i n Boulder, Colorado, the only i n s t i t u t e of i t s kind.
hPJAS FOR FUKTHIZR AUDIT WOYX
During tlie course of our review of the Board of Physical Therapy
Examiners, we i d e n t i f i e d s e v e r a l i s s u e s f o r f u r t h e r a u d i t worlc. These
i s s u e s , which were beyond the scope of our review due t o time c o n s t r a i n t s ,
include:
The adequacy of Board record keeping and record naintenance,
The e f f i c i e n c y of administering the Board through the S t a t e
Board's Administrative Office, and
The extent t o which examination and l i c e n s i n g f e e s a r e adequate
t o support Eoard operations.
;! riznnn s t a i r ? barb nf vIEeisal i5hrrayQ ri-- t xarninrre
1 6 4 5 West J e f f e r s o n , Room 312 P h o e n i x , AZ 85007
May 12, 1983
Mr. Douglas R. Norton
Auditor General
111 West Monroe, Suite 600
Phoenix, AZ 85003
Dear Mr. Norton:
The Arizona State Board o f Physical Therapy Examiners received the May
4th, 1983 d r a f t r e p o r t of the performance a u d i t o f t h e Board o f Physical
Therapy Examiners. The Board thanks you and your s t a f f f o r meeting w i t h us
on A p r i l 28th, 1983.
The f o l l o w i n g areas continue t o concern the Board:
PROBATIONARY PERMIT REPORT ( Page ii, Paragraph 3 Report)
The Board agrees t h e c u r r e n t s t a t u t o r y p r o v i s i o n i n t h i s area i s o v e r l y
r e s t r i c t i v e . However, the Board p r e f e r s t o r e t a i n d i s c r e t i o n a r y a u t h o r i t y
t o r e q u i r e a probationary period f o r f o r e i g n t r a i n e d t h e r a p i s t s f o r the
f o l l o w i n g reasons:
1. No u n f a i r b a r r i e r t o e n t r y t o the p r o f e s s i o n e x i s t s . The f o r e i g n -
t r a i n e d t h e r a p i s t works under the o n - s i t e supervision of an Arizona licensed
t h e r a p i s t during the probationary period and i s reimbursed a t the same r a t e as
other qua1 i f i e d t h e r a p i s t s i n the sarne f a c i 1 i t y . The f o r e i gn- trained t h e r a p i s t
only i s l i m i t e d i n being unable t o set up a p r i v a t e p r a c t i c e during the pro-b
a t i ondry period.
2. To p r o t e c t the p u b l i c t h e Board proposes the probationary requirement
f o r f o r e i g n - t r a i n e d t h e r a p i s t s be reduced t o a minimum o f n i n e t y ( 90) days and
a maximum o f twelve ( 12) months. The a p p l i c a n t s h a l l complete a period o f
supervised c l i n i c a l p r a c t i c e , f o r a f a i r and reasonable remuneration, under the
o n - s i t e supervision o f an Arizona licensed physical t h e r a p i s t i n a f a c i l i t y
approved by the Board. The a p p l i c a n t [ nay take the examination requi red w i t h i n
the time l i m i t requi renent o f the Board.
3. As allnost d l 1 f o r e i g n - t r a i n e d a p p l i c a n t s f a i l t o meet United States
standards of t r a i n i n g , t h e Board's c a r e f u l screening o f a l l f o r e i g n - t r a i n e d
a p p l i c a t i o n s provides a f u r t h e r p r o t e c t i o n f o r the pub1 i c . The a p p l i c a t i o n
i l l u s t r a t i o n used by the A u d i t o r General ( Page 24, Paragraph 4 Report) c i t e s
the sole exception o f one such from a f o r e i g n - t r a i n e d a p p l i c a n t . Most foreign-t
r a i n e d applicants, as a general rule, must complete one and one h a l f t o two
years u n i v e r s i t y course work before issuance o f a permit. The Board has
a1 lowed some course work t o be done d u r i n g t h e p r o b a t i o n a r y p e r m i t period i f
the a p p l i c a n t f e l t capable of handling a j o b and course work.
A t t h i s time, there i s no way t o compare o r e v a l u a t e a f o r e i g n - t r a i n e d
a p p l i c a n t ' s actual c l i n i c a l s k i 11s and/ or abi 1 i t i e s other than t h e n i n e t y ( 90)
day t o one ( 1) y e a r p r o b a t i o n a r y period. Schools a c c r e d i t e d i n the United
States by t h e American Physical Therapy A s s o c i a t i o n guarantee a c e r t a i n degree
of c l i n i c a l ski1 1. U n i t e s S t a t e s T r a i n e d T h e r a p i s t s undergo a four ( 4) month
t o a one ( 1 ) y e a r p e r i o d of c l i n i c a l i n t e r n s h i p s f o l l o w i n g t h e i r formal
academic t r a i n i n g p r i o r t o t a k i n g t h e exam and l i c e n s u r e , except t h a t the
United States t r a i n e d t h e r a p i s t s receive no pay or i n some c l i n i c a l f a c i l i t i e s
only a s t i p e n d or p r o v i s i o n o f room and board. The Board s t r o n g l y f e e l s the
need f o r a minimum o f n i n e t y ( 90) days c l i n i c a l p r a c t i c e t o continue our job o f
p r o t e c t i n g t h e using pub1 i c .
4. The purpose o f the p r o b a t i o n a r y p e r m i t i s t o p r o t e c t the p u b l i c , n o t
the a p p l i c a n t and t o a s s i s t t h e f o r e i g n - t r a i n e d a p p l i c a n t t o enter the
profession f u l l y cognizant o f the c l i n i c a l standards t o which each s h a l l be
held i n the United States.
5. Test o f English as a F o r e i g n Language ( TOFEL) assesses only an
a p p l i c a n t ' s reading and w r i t t e n s k i 11s i n E n g l i s h . P r o b a t i o n a r y c l i n i c a l
p r a c t i c e permits the Board t o assess t h e v i t a l o r a l communication s k i l l s o f the
a p p l i c a n t i n a d d i t i o n t o assessment o f c l i n i c a l s k i l l s . TOEFL appraises s k i l l
w i t h the w r i t t e n Engl i s h language but communication between p a t i e n t and
t h e r a p i s t , t h e r a p i s t and physican as well as basic c l i n i c a l s k i l l s a r e n o t
being appraised by any t e s t i n g .
LICENSURE OF PHYSICAL THERAPIST ASSISTANTS The Board s t r o n g l y endorses
the c o n t i n u a t i o n o f l i c e n s u r e f o r physical t h e r a p i s t a s s i s t a n t s f o r t h e
f o l lowing reasons:
1. Licensure of Physical Therapist A s s i s t a n t s does not hinder o r p r o h i b i t
e n t r y i n t o t h e f i e l d .
2. Licensure o f Physical T h e r a p i s t A s s i s t a n t s p r o t e c t s t h e p u b l i c from un-t
r a i n e d and u n q u a l i f i e d persons h o l d i n g themselves out t o be P h y s i c a l T h e r a p i s t
Assistants.
3. Licensure o f Physical T h e r a p i s t A s s i s t a n t s c o n f e r s j u r i s d i c t i o n on t h e
Board t o screen, and s u p e r v i s e P h y s i c a l Therapist Assistants. Further the
Board may d i s c i p l i n e a P h y s i c a l Therapist A s s i s t a n t w i t h o u t recourse t o the
c o u r t systems.
4. Licensure prevents the Physical Therapist A s s i s t a n t from working un-supervised
and p e r p e t r a t i n g a f r a u d upon the p u b l i c .
5. The p r o f e s s i o n o f Physical T h e r a p i s t A s s i s t a n t s evolved only i n t h e
l a s t ten years. Arizona now has a school which w i l l begin g r a d u a t i n g P h y s i c a l
Therapy A s s i s t a n t s i n 1984.
6. Several o t h e r s t a t e s have independent Boards f o r l i c e n s u r e o f Physical
T h e r a p i s t A s s i s t a n t s .
- A- U-- T ONOMY OF PHYSICA- L- - T-- H-- E RAPISTS I n A p r i l , 1983, the ~ r i z o n aS tate
L e g i s l a t i v e amended t h e Physical Therapy s t a t u t e t o a1 low p r a c t i c e without
r e f e r r a l . Physical Therapists w i l l continue t o seek more autonomy i n the
f u t u r e .
MALPRACTICE Ma1 p r a c t i c e insurance r a t e s f o r Physical Therapists and
P h y s i c a l T h e r a p i s t A s s i s t a n t s and m a l p r a c t i c e f o r medical doctors ( Page 15,
Report) cannot be compared f o r t h e f o l l o w i n g reasons:
1. The scope o f p r a c t i c e o f P h y s i c a l T h e r a p i s t s and Physical Therapist
Assi s t a n t s and ~ nedcia l doctors i s t o t a l l y d i f f e r e n t . Medical doctors p r e s c r i b e
and a d m i n i s t e r drugs, anesthesia, and perform surgery - none o f which are done
by P h y s i c a l T h e r a p i s t s or Physical Therapist Assistants. For t h i s reason
medical doctors r e q u i r e more m a l p r a c t i c e insurance p r o t e c t i o n and consequently
pay higher rates.
2. P h y s i c a l T h e r a p i s t s receive a group r a t e based on n a t i o n a l mernbership.
3. Increased autonomy o f P h y s i c a l T h e r a p i s t s w i l l , i n a l l p r o b a b i l i t y ,
increase m a l p r a c t i c e rates.
The Board i s i n agreement t h a t a mandatory r e p o r t i n g s t a t u t e i s needed. The
Board w i l l continue t o explore ways t o i n f o r m and educate licensees, consumers
and providers o f services t o the Board's r e s p o n s i b i l i t i e s . The Board i s
a c t i v e l y seeking improvements i n enforcement effectiveness.
The Board appreciates the assistance and cooperation o f t h e A u d i t o r General's
O f f i c e during t h i s review process.
Respectful ly submitted,
C h a r l o t t e L. P e r o t t i , P. T.
Presi dent