As a private citizen in the Commonwealth of Virginia, I have seen many medical practitioners, including MDs, DOs, physical therapists and licensed acupuncturists, during my lifetime; mostly related to congenital musculoskeletal issues that often cause me significant pain. Recently I was made aware of a very troubling development in Virginia healthcare relating to a proposed regulation: 18VAC112-20-121.

It is my understanding that, unless this regulation is revised, physical therapists will soon be able to legally perform acupuncture under the guise of “dry needling” without having undergone any defined standard of training or certification as it pertains to this very invasive treatment modality.

At present, it is not within the legal scope of physical therapists to perform invasive procedures on their clients. As I understand it, given the necessity of deeply inserting acupuncture needles to perform “dry needling”, the risk of creating nerve damage or other serious complications is omnipresent. What is even worse, in spite of repeated requests from MDs in the medical acupuncture community, as well as licensed acupuncturists, it appears that Virginia has repeatedly failed to formulate common-sense requirements for PTs over the course of nearly five years, dating back to the McAuliffe administration.

As things now stand, Virginia is on the verge of institutionalizing a flaw in its healthcare system for the sole purpose of appeasing Physical Therapists' over-riding desire to add a therapy class for which it can bill, rather than add a therapy for which they are unquestionably qualified. While no one questions that patients properly and appropriately treated with acupuncture modalities (calling a treatment “dry needling” does not change the fact it is acupuncture) receive profound benefits, the slap-dash approach taken for competency qualification to allow PTs to effectively practice acupuncture shows that the desire to bill patients and insurance companies takes precedence over the health of Virginia citizens.

Seemingly unlike most of the commenters on this forum, I actually read the supporting documents because I was curious as to how the draft of this regulation came to be. A very disturbing aspect appears to be that a primary aim of the physical therapists appears to be economic. You need only to look to the minutes of the Regulatory Advisory Panel (RAP) meetings within the background materials. (See: http://townhall.virginia.gov/L/GetFile.cfm?File=meeting%5C133%5C26752%5CMinutes_DHP_26752_v1.pdf)

During the meeting in November, 2017 where competency requirements for PTs were either watered-down or altogether removed, Assistant Attorney General Erin Barrett put the PTs' interest in “dry needling” in stark commercial terms to the sole licensed acupuncturist on the Panel, stating “the assertion of unlicensed practice would be an antitrust issue, and the scope of physical therapy practice is not an issue.” “Antitrust” issues are purely commercial and economic, not medical, and according to the minutes, Barrett framed the issue as such. My interpretation of this is that the Virginia physical therapy Board is effectively allowing a lawyer’s opinion to dictate medical practice. According to those minutes, she made a none-to-veiled threat against licensed acupuncturists, who are the needling experts in this field, that opposition to watering-down competency requirements for PTs could result in litigation.

The duty of the Physical Therapy Board is to protect the public from harm. This regulation, as it is currently written, does not protect us. That all relevant agencies in Virginia appear to be abrogating their responsibility to demand strict training requirements in favor of expediency to appease the PT profession, many of whom are already practicing “dry needling”, is both astonishing and disheartening.

In the interest of public safety, I urge you to draft specific and stringent training and competency requirements and articulate them within this regulation in order to clearly define a standard of care that should be expected upon walking into the office of ANY medical professional.