BRATTLEBORO — Vermont is one of only seven states that do not regulate massage therapists. Professional licensing is not required. No recourse for complaints or censure exists, and Vermont has no registry that citizens can access to check basic education and licensing, or to see whether clients have complained about any particular massage therapist.
“In Vermont, we have a lot of really wonderful massage therapy practitioners who deserve recognition for the work they do,” said Eve Baker, a massage therapist licensed in New York state who practices in Brattleboro. “But in this state, we are not considered professional by other professionals. We are not brought into the circle of health care. We don't have licensing or regulation.”
This might soon change.
In October, the state Office of Professional Regulations (OPR) took testimony regarding regulation of massage therapists in Vermont.
The testimony was part of what the office calls the “sunrise process,” in which applicants must prove a need for regulation.
Chris Widlund, a licensed massage therapist (LMT) who leads the Vermont Initiative for Massage Standards (VIMS) task force, and Janet Kahn, a medical sociologist, nationally certified massage therapist, and assistant professor in the Department of Psychiatry at the University of Vermont, stated their intent to advocate for the safety of their clientele when they requested the hearing last June. That request came as part of their sunrise application.
Long hours of research went into the application. Widlund, starting in 2007, traveled throughout the state and the nation to meet with professionals and massage therapists in order to “see what went wrong in other states' regulation.”
Finally, the task force had put together 1,000 pages stating all the reasons the public would be safer if OPR approved regulation of massage therapists.
The application requests a clear standard of education and practice, registration of massage therapists and an avenue of recourse for complaints from clients in Vermont.
OPR's legal counsel Larry Novins and Director Christopher Winters accepted testimony at the hearing.
“Right now,” Widlund explained, “anyone from out-of-state or in-state can say they are a massage therapist and set up a practice. I have listened to complaints from clients who come to me about [supposed massage therapists] they got a massage from. Because I am bound by confidentiality, I can do nothing. Eventually, that person could move to another county where they could still be giving massages.”
According to Widlund, some opponents of regulation say that since referrals are largely word of mouth, a bad massage therapist won't get work anyway once word gets around. But what about who haven't heard yet?
Training matters, licensed therapists say
Baker joined VIMS last year, and explained how some massage therapists view things.
“There is an aspect of fear associated with regulation in Vermont,” Baker said. “Vermonters in general don't like regulation, and there is always fear associated with change. Some people aren't good at taking tests. That's why they've chosen kinetic work like massage therapy. They learn kinetically.”
Baker noted that the task force's aim is to keep a client safe. She explained that Vermont has plenty of excellent massage therapists who are not certified or licensed anywhere.
“It's important for people to know that one of the inclusions in our request to the state for stricter regulations includes a 'grandfathering in' of massage therapists who can prove they have been practicing for a certain amount of time,” Baker said. “We have no wish to put anyone out of business who is legitimately practicing massage.”
VIMS' application to the OPR last month was focused on the public harm perspective, Baker said.
“Education and training are important,” Baker said. “There have been instances where harm has been done to a client because the massage therapist did not have training in anatomy and physiology, let alone an understanding of pathology. If someone has a serious medical condition, you're going to want to know that.”
Widlund gave examples of conditions, such as deep-vein thrombosis, that could be dangerous to a client if the massage therapist does not know how massage therapy can cause harm.
“If a patient has that diagnosis from a doctor, massage could release a blood clot into the bloodstream with serious consequences to the patient,” she said. “Or in geriatric patients, you don't want to massage the carotid artery because you could release plaque into the brain.”
If a massage therapist is not trained in anatomy, physiology and pathology, he or she is unlikely to know these things, Baker noted. Injuries to clients have occured, Widlund said.
In 2000, Baker said, her love of massage and use of kinesthetic solutions in her teaching motivated her in her education. She had worked as a literature and writing educator for 20 years, teaching children at risk and adults with learning disabilities.
“I chose the Finger Lakes School of Massage specifically because over 1,000 hours are required for licensing [in New York state],” she said. “I wanted the strictest licensing requirements available so I would come out with the most knowledge. Some massage therapists who have done a weekend or month intensive are missing whole pieces we need to know in order not to cause physical harm to someone. And ethics are never talked about.”
“I took classes in anatomy and physiology, kinesiology, and pathology. I'm bound by a set of ethics in a professional setting,” Baker added. “I create professional boundaries as soon as I greet my client.”
Training in ethical issues, such as confidentiality, is crucial to set the proper standards, she said.
“I bind myself and my clients by having them sign a HIPAA [The Health Insurance Portability and Accountability Act of 1996 Privacy and Security Rules] agreement when they start with me,” Baker said. “I have to add the caveat that in the state of Vermont, that [agreement] does not hold for massage therapists, as we are not licensed here, and a court of law could require me to break confidentiality.”
Baker also said she takes extensive patient history on medical conditions and writes notes after each visit.
“I keep records of every session on every patient I see,” she said. “I need to know if they have any medical conditions. If they have a cardiac condition, high blood pressure, a pinched nerve, whether they've ever been in a car accident - all the things a regular doctor needs to know to treat someone safely and ethically. But not every massage therapist does this.”
Widlund said that with regulation, “clients know what to expect from a massage therapist. They would know what is normal and what is not.”
She said it's important to have a true jury of her peers to investigate complaints, for only someone who is an expert in the field of massage therapy can understand what occurred and why, she said.
“They wouldn't know what we were talking about. How could they make a fair judgment?”
“We live in a world where there are only two kinds of touch: sexual touch and violent touch. Most people have no understanding of what therapeutic touch is or does for a person,” she added.
“If someone comes out of a massage therapy session with a complaint of inappropriate behavior on the part of the clinician, before a complaint is lodged with the police or lawsuits are filed, an advisor could examine the complaint and determine if what the practitioner did was legitimate or not,” Widlund said.
“A complaint could be taken to an advisor or board. The claim can be investigated. The findings would not be arbitrary. And,” she said, “it saves the state court costs.”
Beyond bodywork
Among the submissions for evidence at the hearing were reports from the Burlington Free Press of police actions, taken from 2004 through February of this year, involving sexual assault, prostitution, and sex slavery at several spa locations in Burlington.
Widlund added she presented the evidence simply to illustrate the need for regulation and an avenue of protection and complaint for clients.
Baker spoke of the need for clients to understand how massage therapy works. She noted that, for instance, to relieve sciatic nerve pain, a therapist would deeply palpate the gluteus maximus, or butt muscles.
“This could easily be misinterpreted if a client did not know what to expect,” Baker said.
“I try to educate my clients as I am doing the therapy,” she continued. “I want to learn from them, and I want them to understand what I am doing.”
In the case of arbitration, a practitioner could be censured, with tiered responses based on the severity of the offense.
“It could mean further education requirements, say in ethics and communication,” Baker said.
In an case of an extreme transgression, a massage therapist could lose his or her license to practice in Vermont, “but we would first like to assume a mistake was made and lack of knowledge or experience was the reason,” she said.
Right now, “there is no regulation and no recourse for an injured party.”
Baker said that in New York, “massage therapists are brought into the circle of care by physicians. Insurance companies pay for our services.”
She added that a loophole that insurance companies use in Vermont lets them get out of paying for services.
“I have several clients whose insurance would not reimburse them or pay me,” Baker said. “I asked the insurers why, and they said 'because you aren't licensed in Vermont.'”
“When I said, 'but I'm licensed in two other states [New York and New Jersey],' they said, 'but not in Vermont,'” she continued. “It's pretty hard to get licensed in Vermont when they don't require it.”
On the other hand, Baker noted, she has never had any problem getting paid for massage services for employees of Brattleboro Memorial Hospital. “They have paid me every time.”
Moving forward
Widlund reiterated that the motivation behind VIMS is “not financial, but so clients can have recourse to in the case of harm, and to regulate massage therapy on a professional level.”
While national lobbyists for the Associated Bodywork and Massage Practitioners (ABMP) attended and testified at the hearing, Widlund revealed that “this movement originated and was moved forward by Vermont massage therapists.”
Novins said he was not aware of any insurance company representatives involved in the hearing or providing testimony, except those who submitted evidence of actions taken on the part of their clients following complaints.
He said that he is compiling testimony and that he will submit his recommendations to Winters. He will then decide whether to submit the proposed regulations for the Legislature to consider when it reconvenes in January.