It is quite interesting to read arguments against increased educational requirements and standards from educators who are required by law to provide education that complies with California regulations.These regulations pertain to our licensure as primary health care providers, are outlined in the education code, and are set by the state Acupuncture Board. How is it that California's allied health professions, workers' compensation, the Industrial Medical Council, and the insurance industry understand our responsibility, but the educators do not?
In a November 9, 1999 memorandum, the California Department of Consumer Affairs' legal office defined primary health care professions as they relate to section 4926 of the state's business and professions code. The memo states: "Primary care provider means a person responsible for coordinating and providing primary care to members, within the scope of their license to practice, for initiating referrals and for maintaining continuity of care."
Our responsibility as primary care providers was further evaluated in 1990 in a July 16, 1990 memorandum from the Department of Consumer Affairs' legal office. It clarified our responsibility to evaluate and diagnose prior to rendering treatment ad is addressed in California Labor Code 4600, sec. 133, 139, 4603.5 and 5207.3. Under LC 3209.3, all providers listed as "physicians" including acupuncturists must provide "complete, accurate, uniform and replicable evaluations, the procedures shall require and evaluation of anatomical loss, functional loss, and the presence of physical complaints to be supported, to the extent feasible, by medical findings based on standardized examinations and testing techniques generally accepted by the medical community."
These laws and regulations require licensed acupuncturists to evaluate not only using TCM, but also using professionally recognized standards with medically-based criteria (physical exams; consultation between other providers, verbal or written; Western medical DX; and ordering x-rays and laboratory tests). Ignorance of the law is not a defense.
I have heard concerns and complaints from practitioners, students and patients that they are being taught in some schools and colleges to practice "energetic medicine" and to treat energetic patterns or imbalances, thus relieving them of the role and responsibility as outlined above. There are no legal definitions for energy patterns or energetic medicine in California.
The legal definition of acupuncture is clear as written in chapter 12, article I, S4926-S4927 of the business and professions code: "To prevent or modify the perception or to normalize physiological functions, including pain control for the treatment of certain diseases or dysfunctions of the body by the insertion of needles." Under section 4926, the California legislature established a "framework for the practice of the art" (application of procedure) "and science" (traditional and physiological) "of Oriental medicine through acupuncture."
Some will make the argument that this is practicing Western medicine. Utilizing evaluation, assessment and diagnostic techniques only serves to enhance your ability to effectively treat, refer when appropriate, and coordinate the best care for your patient. The application of the modality based on these criteria is the practice of medicine as designated by law.
As a consultant and expert witness in a number of cases in California, I can assure you the issues of safety and liability have been grossly misrepresented. While acupuncture may be generally safe, its application by some providers is not. These cases reveal a deficiency in the basic knowledge and application of acupuncture and Oriental medicine, and the aforementioned education required by sections 94700-94705 of the California Education Code and the California Acupuncture Board. These cases involve:
- Pneumothorax, nerve damage, and puncturing of organs due to the lack of training in anatomy and instruction by some teachers that the "chi" will move structures out of the way;
- Misdiagnosis, improper evaluation and observation of body parts causing infection and emergency medical treatment;
- Use of illegal diagnostic devices, Voll machines, applied kinesiology or O-ring testing in lieu of TCM or accepted, replicable techniques;
- Illegal use of homeopathic remedies (illegal remedies; no educational standards; no licensure; and outside the scope of practice in California) for head trauma (concussion in lieu of emergency medical care) and treatment of post laminectomy syndrome;
- Removal of prescription drugs;
- Improper examination techniques and procedures (sexual assault);
- Improper and/or no medical records; and
- Improper insurance billing, billing for acupuncture or electroacupuncture (an electric stimulator connected to needles) when using crystals, pendulums, topical electrical stimulation (i.e., PENS) and/or different color discs (five element?).
These cases were and are avoidable with proper education. Yes, the argument can be made by some that we affect "energy of the body," but what energy, and how? Why neglect the obvious physiological basis of acupuncture, when there is research available explaining the mechanisms and instructors able to teach these concepts? Why are these concepts not utilized in all the schools?
What gives the national commission, the schools and the national organizations the right to change our educational standards and undermine our ability to practice as primary care providers? They exist to fulfill their responsibility under our laws to provide education as outlined.
How can we as practitioners fulfill our role when the very people entrusted with providing education try to lessen standards? No other profession lessens their standards. There are no provisions in our laws and regulations to create technicians with minimal training providing "cookbook acupuncture" for financial gain to schools or individuals who would exploit them. I invite and welcome your response.
- California Education Code, sec. 94700-94705.
- California Labor Code 4600.
- California Acupuncture Regulations, Title 16, Art. 3.5, acupuncture training programs.
- Memorandum. State of California, Department of Consumer Affairs Legal Office. A: Primary health care profession. B: Scope of practice.
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