39506 N Daisy Mountain Dr. Ste. 122178 Phoenix, AZ 85086 Email: azacupuncturesafety@gmail.

com

April 24, 2014 Honorable Janice K. Brewer Governor State of Arizona 1700 W. Washington Phoenix, AZ 85007 Dear Governor Brewer, On behalf of the Coalition of Arizona for Acupuncture Safety, we are writing to urge you to veto SB 1154 Sponsored by Senator Kelly Ward. This legislation is unsound to the degree that we believe there are important public safety and public policy implications. At the very least, this legislation will create a number of unintended negative consequences. Among them are the following: 1. No education or safety standards are established. Although there has been testimony to the contrary, this legislation fails to establish adequate assurance to the public that physical therapists will receive the minimum amount of education, training and testing required to practice an invasive needling technique such as dry needling. While we appreciate the effort of the bill to attempt to address the public safety concerns, it does not provide a standard to achieve this intended goal.
a. In fact, Jim Farris, Chair of Physical Therapy at A.T. Still University indicated, Dry needling is not an entry-level skill so how to dry needle is not taught in our program. We make students aware of the practice and have had an introduction to the concept of dry needling but we do not teach this skill in our program.

2. Definition of dry needling nearly identical as acupuncture. a. Our Board requested a response from the Physical Therapists Board asking that they accept that that dry needling was a form of acupuncture. We have received no response. b. Dry needling is acupuncture, in practice and in reality. Both definitions are essentially the same. c. This bill limits the use of dry needling to physical therapists only, and does not acknowledge or create an exception for those already licensed to perform the same procedure (MDs, DCs, NDs, DOs, and L.Ac.s). It is also confusing to the public and to third party payers to have two definitions for the same procedure. d. The United States Attorney, Center for Medicare and Medicaid Services (CMS), and other states (California, Florida, Hawaii, New York, Oregon, Pennsylvania, South Carolina, Utah, West Virginia)!around the country have all determined that dry needling is acupuncture. e. It is noteworthy Physical Therapists malpractice insurance carriers acknowledge that dry needling is acupuncture.
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f. *Because the definition issue has been such a contentious subject, we would point out that we believe it goes to a question of how Physical Therapists bill and code for dry needling. We would respectfully request that you direct the Department of Insurance to investigate how Physical Therapists might bill for the practice of dry needling, which they acknowledge is not defined in statute. How Physical Therapists have coded such practices would be of great interest to both taxpayers, its own regulatory Physical Therapy Board and the regulated insurance companies alike. g. On January 23, 2014, the Oregon Court of Appeals concluded "it appears that dry needling is substantially the same as the insertion of needles treatment modality of acupuncture...and even recognizing that 'dry needling' is but one technique or modality within the broader practice of acupuncture, respondent has not explained how 24 hours of training, with no clinical component, provides sufficient training to adequately protect patients." h. The Utah Department of Commerce agrees, dry needling is acupuncture. Additionally, in Utah, on April 1, 2014, dry needling was only allowed so long as PTs obtained 300 hours of training, of which 250 hours were supervised clinical treatments. 3. Physical Therapy Association skipped the statutorily required Sunrise Process. An earlier legal opinion (see attached opinion from the firms of Coppersmith Schermer & Brockelman, and LaSota & Miller) demonstrates that dry needling is NOT in the scope of physical therapy practice. Thus, like all other regulated entities, the Physical Therapy Association is required to go through the Sunrise process to expand its scope. While SB 1154 claims to address the public safety concerns, unfortunately it falls short of accomplishing the goal and potentially does more harm than good. Please veto SB 1154 and allow the Sunrise Process to create a more logical bill that creates real standards, protects the public, and acknowledges the realities of the practice. Sincerely,

Lloyd Wright, LAc, DNBAO Co-Chair CAAS

YM Chen, LAc, PhD Co-Chair CAAS

CAAS represents concerned practitioners and citizens, members of Arizona Society of Oriental Medicine and Acupuncture and Asian Medicine and Acupuncture Society of Arizona Cc: Senator Kelly Ward Representative Heather Carter Governor Brewers Health Advisor, Don Hughes Department of Insurance, Germaine Marks Enclosures

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