Opinion on California AB-1000 Physical Therapists: Direct Access to Services Bill

In my opinion as a lymphedema patient advocate, a California resident and author of a California bill for the treatment of lymphedema patients according to current treatment protocols, this bill is a disaster for the 200,000 lymphedema patients in California, the majority of whom are cancer survivors. The bill runs counter to the current drive towards "patient-centered medicine".

Briefly I contend that:

1. The accepted protocol for treatment of lymphedema, "complex decongestive therapy" includes manual lymph drainage, compression bandaging, garment fitting, decongestive exercises and home self-treatment protocols are not part of a PT curriculum and are not tested for in the licensing process;
2. Any licensed PT or OT in California, trained & certified OR NOT in the specialized lymphedema treatment protocols can legally treat a lymphedema patient;
3. Self-referred treatment of self-diagnosed lymphedema is dangerous absent a physician's determination that certain co-morbidities do not exist. This is the main reason for requiring a physician referral for treatment of lymphedema.

On May 25, 2005 I received the following statement from the Physical Therapy Board of California after I pursued this same issue with that Board: "While it may be that treatment of lymphodema [sic] patients by massage/Manual Lymph Drainage is within the scope of practice of a physical therapist, it is considered unprofessional conduct if the physical therapist has not been adequately trained and is not proficient in the treatment."

AB-1000 offers no lymphedema patient protection. There is no cause for disciplining a PT who may not be qualified to treat a lymphedema patient because of lack of adequate training, demonstration or certification. There is no standard for measuring effectiveness of treatment (current measures of therapy outcome utilize functional disability measures, and are insensitive to lymphedema severity--which is the condition being treated). There is, in fact, no law that limits ineffective treatment by under-trained therapists, and the removal of the physician from the treatment loop and offering self-access for the lymphedema patient compounds the disaster.

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Lymphedema Treatment is Good Business as well as Good Medicine
© 2002 Robert Weiss, Porter Ranch, CA