Donna Guthery RN, MSN, LAc, DAOM
Thank you to the Board for the opportunity to speak about my concerns
I have been a certified nurse practitioner for over 30 years and a licensed acupuncturist for over 10 years. 
While the discussion tends to focus on scope of practice, I believe the real concern should be patient safety. 
As a clinician trained across two systems of care, Western and Oriental, I have an appreciation of the depth of knowledge required to bridge both. While direct interventional harm is rarely reported in the literature, there is real harm that can be done to patients without appropriate considerations. Patients do have real anatomy that must be considered in any intervention. Low back pain due to a bulging disc is an example. One cannot just treat the pain without a consideration of the potential causes that may require Western medical intervention. This occurs quite frequently, and is one reason why the understanding of, and collaboration with Western medicine, is essential to good medical care. 
More importantly, is the knowledge of “what not to overlook”. I have had patients come to me for symptoms that caused me great concern, such as a patient who came to me with low back pain after being evaluated by an orthopedic surgeon: upon exam I palpated a large mass in her lower abdomen- I immediately referred her to a gynecologic surgeon- diagnosis was ovarian cancer)  luckily she was treated in time and was cancer free after surgery and chemotherapy) , Besides my approach to their pain relief, I strongly reinforced the need for my patients to see a physician. 
My experience is that physical therapists, while well versed in their specialty, do not have this level of training and critical thinking. In addition, as the Board is well aware, they and others who perform acupuncture do not even have the same quality and quantity of training in acupuncture. 
I am well aware of the opinion of the Attorney General of the State of Texas regarding this matter in that licensure of non-acupuncturists should be at the discretion of their Boards. But you and the Medical Board, tasked with the safety of all medical practice in the State. Calling them “practice examiners” does not mean they are not treating real patients with real medical problems. 
One additional point. In its June 2016 meeting, Dr. Susan Hubbell, AAPM&R Delegate to the AMA, introduced the following resolution:

Resolution 223:  Dry Needling is an Invasive Procedure.  This resolution asked our AMA to “recognize dry needling as an invasive procedure and maintain that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.”

From the minutes of the House of Delegates: Our resolution was adopted.  We received many thanks for bringing this resolution to the meeting. 

The motion noted that “physical therapists are increasingly incorporating dry needling into their practice. Dry needling is indistinguishable from acupuncture, yet physical therapists are using this invasive procedure with as little as 12 hours of training, while the industry standard minimum for physicians to practice acupuncture is 300 hours of training”.

Delegates agreed that the practice of dry needling by physical therapists and other non-physician groups should include—at a minimum—the benchmarking of training and standards to already existing standards of training, certification and continuing education that exist for the practice of acupuncture.

“Lax regulation and nonexistent standards surround this invasive practice,” AMA Board Member Russel W.H. Kridel said in a news release. “For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”

It should be notied that this resolution was proposed by a PM&R physician. 

I ask that the Board of Medical Examiners concur with the AMA House of Delegates and ensure that those who practice acupuncture, in whatever form it is called, are delivering safe and effective care to the patients who assume that this is true.  
Thank you again for the opportunity to speak. 

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