61 comments
It is critical that health care providers be able to set safety protocols for their offices that protect their most vulnerable patients. Requiring patients to wear a mask to help protect everyone in the space from infectious disease may be appropriate in certain situations. In particular, physical therapy is often provided in open spaces, with multiple people receiving treatment at any given time. It would be unsafe for providers to be forced to allow patients to set the safety protocols in their offices. Furthermore, gathering a complete health history can be critical in understanding certain symptoms and conditions. The proposed rules would make it impossible for providers to protect the health of all of their patients and I am opposed to the petition.
Oppose petition. Duplicate of another petition.
This is a decision that each facility must make for its staff and clients.
Health care providers must be allowed to set protocols to protect patients, clients and staff members from infectious diseases. Physical therapists are often in very close contact with clients and clients are often in shared gym space with other vulnerable patients/clients. The proposed rule makes such protections impossible. Physical therapists should be encouraged to follow CDC guidelines and make decisions based on risk levels in their communities.
It is imperative that facilities be allowed to make appropriately and timely decisions on behalf of their patients and staff. These decisions should made with adequate data and not driven by political agendas or unfounded rhetoric.
This petition seems politically-motivated and not in the best interest of keeping all patients safe. Allowing physical therapists (and the organizations they work for) to enact safety precautions based on the needs of their practice is the only way to allow PTs to "First, do no harm."
Physical therapist, physical therapy assistants, and all medical professionals should be courteous and offer to wear a mask upon patient request but mask should not ever be mandated for any party. If you’re sick, stay home. Everyone can choose where to receive services, if it bothers them and the professional refuses to mask, they can go elsewhere. It will naturally work itself out.
This seems to be a non evidence based and politically motivated petition. Not being able to enforce health and safety regulations related to disease would hinder our ability to provide safe and effective care to patients as well as reduce the ability to protect ourselves and our loved ones. I do not believe that we would say we don’t need to wear gloves if we suspect our patient may have C.dif or shingles. Why then would it be inappropriate to ask patients to mask when we have a Covid or Flu surge? What if there was an epidemic of Ebola or tuberculosis? Where is the logic in not being able to enforce regulations related to safety around an infectious disease?
I strongly oppose any measure that reduces therapists ability to keep themselves and their patients safe. I also oppose this as it would limit the ability for a business to make decisions that would protect itself and keep its customers safe. If you could show me some evidence for why this is a good idea, then I would maybe consider with compelling evidence. Otherwise this seems like an inappropriate petition based on politics
I oppose any requirment that interferes with a therapist's ability to keep their patients, themselves, and their families safe.
I support this petition. If wearing a mask makes someone feel safe, then they should wear one. It is however not fair to require those who feel comfortable without one to wear one. They are only putting their life at risk. If people are following the guidelines provided by the CDC and staying home if they are sick then there shouldn't be an issue.
Practices must remain in control of their own policies regarding safety measures in their clinics. No one has the right to impose any restrictions on practices that choose to protect their patients.
As physical therapists, we work in healthcare system and deal with many patients daily. I understand that wearing mask might be difficult for some people, however, we need to feel safe working. This safety is needed for us and our families. This has to be mandatory for all the patients to wear masks to help their provider team feel more comfortable treating them.
I strongly oppose this petition in best interest of other patients, care providers and their loved ones.
In our physical therapy clinic, we have seen an uptick in the amount of patients who are cancelling due to COVID concerns. Not having the ability to require patients to wear masks in the clinic puts the clinicians at risk if a patient comes in with COVID and they are not aware or have mild symptoms.
I strongly support this motion as mentioned by support statement, CDC has amended its mask mandates long back and all the other institutions which accept people mask less, we as healthcare practitioner should respect and accept patients. If patients do ask for us to don a mask when treating them also should be respected and wear a mask. At this time we should be flexible and be more welcoming than entertain any one side.
I strongly oppose the removal of the mask mandate for patients. We are currently experiencing an increase in number of cases and the mask wearing has prevented spread through clinics and patients. Without everyone wearing a mask we are putting both the patients and the clinicians at increased risk for contracting COVID and further spreading it.
Don’t force us to do anything. Let each individual practice set its own rules!
Don’t force us to do anything. Let each individual practice set its own rules!
I have been exposed multiple times at work when patients are not showing signs and symptoms until the day after treatment when they contact the clinic to tell us they tested positive. I have yet to catch COVID likely because both myself and the patient are masked. Unfortunately given the nature of our work we are unable to social distance effectively and for the safety of ourselves and others it is critical we continue to mask.
I see many people who are immunocompromised including very young children and some are too young to be vaccinated. These children should not have to be exposed to COVID-19 because another person does not like to mask.
I respectfully oppose this petition secondary to the increased health risk to our community.
My opposition to this petition is based on CDC recommendations for healthcare settings and the health risk to myself and my family, our patients and our guests.
The sources used to attempt to prove that masks do more harm than good are laughable. The sources are either not credible, based on opinion and commentary rather than scientific studies, or in the case of scientific studies do not support the petitions. For example, in Petition #362 (Virginia Regulatory Town Hall View Petition) this source is used to cite why wearing a mask is more harmful for the patient: Effects of Prolonged Use of Facemask on Healthcare Workers in Tertiary Care Hospital During COVID-19 Pandemic - PMC (nih.gov). I read this study and it is based on the use of masks for healthcare workers, not patients. The adverse effects ranged from nasal discomfort to nasal congestion. Hardly life-threatening risks. The article itself states "Since facemasks are essential to protect us from COVID-19, certain strategies can be followed to reduce the heat burden due to its prolonged usage such as encouraging nasal breathing, pre-use refrigeration of the respirator " Also, healthcare workers wear masks for 8-12 hours during the day. Patients are only asked to wear masks while they are in treatment - approximately 15-90 minutes.
This petition disregards access to health care for immunocompromised individuals and high-risk patients including children too young for a vaccine.
This petition disregards our need for a full and accurate health history when making decisions for patient care.
This petition dismisses the need for precautions against public health diseases.
The proposed petition does not support the independent clinical judgements that are crucial to the physical therapy practice. Policies and procedures to the extent that are proposed here are the responsibility of the practitioner or the organization in which the clinician is employed. This additionally restricts the physical therapy practice in a manner that has not previously been performed by the state board.
The profession of physical therapy should support public health and guidance. Not all patients can be vaccinated, however preventative measures can and should be taken such that others may be asked to wear masks to prevent public spread of COVID. This petition is prescriptive and not supported by evidence. Each practice setting should set forth appropriate rules to protect vulnerable patient populations and health providers as informed by evidence based decisions and the CDC.
Each Clinic/Business should be allowed to make the appropriate decisions for the health and safety of their patients and staff based on the current scientific evidence and in accordance with current state law.
I strongly oppose this. Before the mask mandate more than 2 years ago, I would get sick a couple of times a year from working with patients. I even got sick with COVID in March 2020 from a patient before the mask mandate went into place. My husband then got COVID from me. I have not been sick since the mask mandate went into place, and I would prefer to continue to not bring sicknesses home to my family especially now that I have a baby at home that cannot be masked or vaccinated.
There are multiple problems with this petition. It seeks to impose blanket, punitively enforced sanctions on all physical therapy practices in Virginia; force the abandonment of all masks for any reason, "...including when following policies of insurers or organizations or when following guidance issued by the Centers for Disease Control, local health departments, or the Virginia Department of Health..."; and preemptively deny these practitioners the ability to check vaccination status, presumably in perpetuity.
Other aspects of this petition suppose a problem that does not exist. Physical therapy services do not routinely query vaccination status for patients. However, in the event of a different pandemic, this should not be explicitly disallowed for all the reasons stated above. Denying physical therapy clinics a future ability to protect their staff, other patients, and the business is unwarranted.
The final issue with this petition is that it is punitive. It is known that not all patients can wear a mask. Most clinics recognize and work with patients to enable their access to care while not exposing all others to unneeded risk.
This petition is a missed opportunity. Rather than creating solutions such as asking practices to post their policies publicly, designating a therapist or space for those unable or unwilling to wear a mask, or creating a task force to determine the need for an expanded solution set, this petition is asking physical therapy clinics to expose their staffs, patients and businesses to a known health risk with punitive enforcement that will ultimately cost all Virginians in terms of access to effective and efficient healthcare.
I support this petition to allow patients to make their own decisions on mask use. There are already places in the country that allow you to access health care without a mask including physician offices. If you can be seen by a physician where people are going when they are actively sick, you should be able to be seen in a physical therapy clinic where you are asked to physically exert yourself without a mask. Masks are not required in gyms and studies have shown that the spread of COVID-19 is very low in these settings. I don't see why a PT clinic would be classified any differently. Also, if the PT feels uncomfortable for any reason, there is nothing that is keeping them from putting on a mask themselves.
I support the concept of access to Physical Therapy Services without discrimination based on Covid-19 disease, Covid-19 vaccination, or “masking” status in general. However, I oppose elements of this petition for regulation change as a means to achieve access ends they fail to accomplish therapy access ends while creating other service provision problems. While I assume and appreciate the intention of this petition to ensure access to physical therapy services for all Virginians without discrimination based on personal healthcare decisions and status, I oppose this petition as worded because it creates the following (assumed unintended) negative consequences which may result in as much or more public harm than safety:
1. Creates conflict of interest ethical dilemmas for therapist providers.
Physical therapists are already bound by their Code of Ethics to treat patients without discrimination as to the “patient’s health condition.” as stated in section 3D. However this petition fails to consider that therapists can and have a duty to remove themselves from patient care (making appropriate transfer or referral of care) when the therapist’s status results in a conflict of interest that poses an ethical dilemma (in which one deeply held set of values is in conflict with another, namely the best interest of the patient) as stated in section 3D of the Code of Ethics, “Physical therapists shall not engage in conflicts of interest that interfere with professional judgment.” Therapists have resolved these conflicts ethically as a matter of course throughout the pandemic to accommodate their need to provide patients with access to treatment with their need to minimize infecting others. For example, at one place where I work, one vaccinated, healthy, male therapist with no vulnerable household members volunteered to treat a patient who was COVID positive, who could not tolerate a mask, and was otherwise scheduled with a pregnant therapist close to her due date. The pregnant therapist (to whom the patient was originally scheduled) instead treated one a COVID-negative patient originally scheduled with the male therapist. They might have done the same kind of therapist swap for non-mask or Covid issues (if the pregnancy prevented safely lifting the patient’s weight, or if the assigned therapist was not fit-tested, or was allergic to the vaccine, or had a history of Guillian-Barre). In this case it was the therapist’s status, as opposed to the patient’s status that was the cause for care reassignment. This type of everyday, common, prudent, ethical problem-solving based on clinical expertise would be undermined, disrupted, and perhaps even precluded should this petition go into effect as worded.
2. Fails to assure non-discrimination in that it conflates patient access with patient status and tries to solve a hypothetical access problem with a status solution. It falsely assumes that only one behavior on the part of the therapist is the best and only option for access, and erroneously labels patient’s status as opposed to inaccess as the discriminatory element of concern. This point is nuanced, but significant in that the petition as worded creates a logical fallacy of syntax. In other words, the wording makes it a violation of regulation to refuse service to a patient for any reason (e.g. abusive behavior, non-payment, no-shows, etc.) if they just incidentally happen to also refuse to wear a mask.
Perhaps the intended concept could be more accurately worded as “to patients or prospective patients for those individuals or their accompanying representatives refusal to wear masks” or “to patients or prospective patients based on the individuals or their accompanying representatives refusing to wear masks” or “refusing mask-wearing” more accurately conveyed syntax than “to patients or prospective patients if those individuals or their accompanying representatives refuse to wear masks” as stated in the policy proposal. Also, I recommend reconsidering the negative, judgmental connotation with the word choice “refuse” and consider the appropriateness of replacing “Physical Therapy Assistant” with “Physical Therapist Assistant.”
3. Creates unnecessary and less robust duplication of effort as therapists are trained in implementing clinically expert infection control procedures and ethics at the individual, precision, patient level of care (some might say precision medicine), which far exceeds the standards of patient-centered of a general public policy and is far more precise in meeting individual patient needs than the petitioned regulation would. Access, as a standard of care issue, is already addressed in infection control guidelines, regulation, education, and practice act standards elsewhere. As an ethical issue, access is already addressed in the APTA Code of Ethics, which is industry standard. (Emphasis added below.)
“Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals.
(Core Values: Compassion and Caring, Integrity)
1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race,nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability.”
“1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration.”
“Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients and clients.”
“2A. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients and clients over the interests of the physical therapist.”
“2B. Physical therapists shall provide physical therapist services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients and clients.”
3. Item 2 creates a regulation with potential legal and ethical conflict with other oversight regulatory agencies or standards of care in a dynamic environment sowing confusion about regulatory oversight. Any mention of other authoritative institutions should clearly state the difference between those which provide laws and regulations to which therapists are bound versus those which are merely informational in consideration of the Code of Ethics “Principle #5: Physical therapists shall fulfill their legal and professional obligations. (Core Values: Accountability, Duty, Social Responsibility) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations.”
4. Item 4 is at conflict with a physical therapist’s ethical and standard of care requirement to take a history and Review of Systems, and to refer when necessary. For example, if a therapist suspects an adverse vaccine event, referral to a neurologist or PCP before treating the patient could be construed as refusing treatment under this petitioned regulation proposal.
5. Creates a specific disease category of discrimination not enumerated elsewhere. We already have oversight devoted to non-discrimination based on behavior and health status in general. There is no more need to enumerate Covid-19 and masks than there is any other disease, vaccination, or behavior, or health choice.
6. As worded, this petition seems to have a Covid-19 disease bias that fails to consider other infectious disease transmission and regulatory considerations as well as the OSHA hierarchy of hazard controls and NIOSH PPE distinctions that set standards for infection control including and beyond Covid-19. I object to the term “mask” in professional regulation without operational definition. Therapists are educated about specific PPE that fall into categories of N95 respirators, surgical masks, face coverings, face shields, PARPs and other NIOSH definitions. Use of wastebasket, non-specific terms such as “mask” reflect a standard of care that is non-expert, sows confusion about infection control principles, and undermines public education and confidence.
7. What evidence exists that such a regulation is needed and not covered elsewhere?
Any physical therapist or physical therapist assistant licensed by the Board or practicing pursuant to a compact privilege, as defined in § 54.1-3486, approved by the Board shall be considered guilty of unprofessional conduct if he:
2. Knowingly and willfully commits any act which is a felony under the laws of this Commonwealth or the United States, or any act which is a misdemeanor under such laws and involves moral turpitude;
4. Conducts his practice in such a manner as to be a danger to the health and welfare of his patients or to the public;
A. A practitioner shall not:
3. Engage in an egregious pattern of disruptive behavior or interaction in a health care setting that interferes with patient care or could reasonably be expected to adversely impact the quality of care rendered to a patient; or
4. Exploit the practitioner/patient relationship for personal gain.
Physical therapy offices (particularly OP) should follow local ordinances for mask wearing and should make exemptions for patients with health issues that make mask wearing challenging. If the locality or state does not require it, the PT clinic should not either.
If this petition passes, it will put the most vulnerable people at risk. Facemasks are a minor inconvenience as we hope to minimize the potential for infection of our neighbors, friends, and family. Physical therapists take an oath to do no harm, and this petition will likely cause harm to those we seek to care for. I do not believe patients should be denied care if they have not been vaccinated, however. The petition is too broad.
I have 2 family members that have health risks at home It is not safe for me to bring Covid home to them
Physical therapy practices follow evidence based guidance from the CDC and other public health experts to determine the appropriate steps to keep their patients and health care professionals safe during the current pandemic. Individual PTs and practices should be able to enact precautions as they deem necessary.
Strongly Oppose all aspects of this petition.
We need to keep our healthcare professionals safe!
If we want our healthcare professionals to continue being able to provide care, it is our duty to keep them safe!
PTs should be able to refuse service if the patient refuses to wear a mask.
The practice of physical therapy is grounded in science & so is the practice of weating masks to prevent the spread of disease. This should be dismissed immediately.
If we want our healthcare professionals to continue being able to provide critical care to our community, it is our duty to keep them safe and those around them, as well, seeking healthcare services in a safe environment, following evidenced based practices as the field of PT does.
This pandemic is constantly evolving. Standards and expectations continue to change as our knowledge of a new virus, the virus itself, and our science of prevention change. We have no way to know what the state of the pandemic will be like in 6 months, a year, or 2 years, or how the next pandemic will play out. Codifying prohibitions such as these in the regulations is not appropriate, as they may be clearly outdated in a month, or a year. Further, therapists should always be allowed the option to implement higher than standard infection control practices in their workplaces, for the protection of themselves and other patients. The Board should not prevent therapists from acting safely, in an evidence-based manner.
I have read through the 28 comments posted to date and think the most eloquent are those expressed by Laura Baldwin, PT, DPT and agree wholeheartedly with her comments. A few in support of the petition speak to symptom status. It is well proven that someone can be asymptomatic and a carrier and hence the argument of symptoms is mute.
I strongly opposed this proposed rule. If enacted it would not be in the best interest of the health and well being of the citizens of Virginia, according to the present information provided by the CDC and WHO.
I strongly oppose this petition, which would decrease the safety of Virginia physical therapy clinics and practice for patients, providers, and staff.
1. Wearing a well-fitting face mask helps prevent the spread of covid-19, a life-threatening illness which has caused over 20,000 deaths in our commonwealth (as counted by our own Virginia Department of Health).
2. Every person in a physical therapy clinic has the right to expect their providers to provide a safe environment in which to work and in which to give and receive physical therapy care.
3. Health care providers licensed by the state of Virginia need to be able to follow policies of insurers or organizations they are affiliated with, and must be able to follow guidance issued by the Centers for Disease Control, local health departments, and the Virginia Department of Health. This is necessary to maintain relationships based on trust and safety, without which we can not provide effective care.
4. A complete and thorough medical history is relevant and necessary to provide comprehensive care. Physical therapy is typically not emergency medicine and it does not take priority over potentially lifesaving measures such as covid vaccination. Also, health care providers have the right to preserve their own health and safety by not exposing themselves to unmasked, unvaccinated individuals. There is also a responsibility to protect other people present in the clinic.
5. The Board of Physical Therapy has a responsibility to keep everyone safe while providing, receiving, or being near physical therapy. This petition would make that impossible during this ongoing covid crisis.
Thank you for your time.
This petition disregards the health and safety of our patients and colleagues. It is very short sighted and clearly dismisses the protection and support for those who are vulnerable. I do not believe this petition aligns with our core values as a physical therapist.
I oppose this petition for many of the same reasons already listed by much more eloquent commenters.
In a time when personal rights are being questioned, this petition comes in a timely manner. For those who are concerned for their own health, masking (or double or triple masking as I have seen many people do) themselves is a wonderful option. Turning those away who are in need of help simply feels wrong.
Practitioners and patients should continue to follow CDC masking requirements and have the choice to protect the health and safety of all who enter spaces that promote health. Masking should continue as a hygiene measure to prevent disease transmission