1. BOARD OF REGISTRATION FOR THE HEALING ARTS

2. DISCLAIMER Pursuant to section 324.023.2, RSMo, any opinions contained in this presentation are for educational purposes only, are in no way binding on the licensees of the Missouri Board of Registration for the Healing Arts, and cannot be used as the basis for any discipline against any licensee of the Missouri Board of Registration for the Healing Arts.

3. BOARD MEMBERSHIP Benjamin Lampert, MD Springfield Anesthesiology/Pain Medicine Bradley Freeman, MD St. Louis General Surgery/Critical Care Jeffrey Carter, MD St. Louis Anesthesiology David Tannehill, DO St. Louis Critical Care/Telemedicine James DiRenna, DO Kansas City Family Practice David Poggemeier, MD St. Charles Emergency Medicine John Lyskowski, MD Jefferson City Psychiatry Jade James, MD St. Louis Obstetric & Gynecology Public Member – Vacant

4. ABOUT THE BOARD Meets 4 times a year in person Holds at least 4 conference calls a year Mission: To protect the citizens of the state through the licensing of physicians and other health designated professionals, assessing their competence to practice and their moral character. It is also the board’s duty to investigate all complaints against its licensees in a fair and equitable manner.

5. ADVISORY COMMISSIONS Physical Therapists Speech Language Pathologists/Audiologists Physician Assistants Athletic Trainers Clinical Perfusionist Anesthesiology Assistants

6. PHYSICAL THERAPIST ADVISORY COMMISSION The Advisory Commission for Physical Therapists was created in 1989 and is responsible for advising the Board on the licensure and regulations of the physical therapist profession. Made up of five (5) members, four (4) of which shall be licensed as physical therapists, and one (1) shall be licensed as a physical therapist assistant. Members serve three (3) year terms. Meets on average once a month via conference call to discuss pending discipline cases and licensure matters.

7. ADVISORY COMMISSION MEMBERSHIP William P. Hopfinger, PT, AT, Chair St. Louis, MO Judith E. Pastorino, PTA, Secretary Columbia, MO Tamara L. Burlis, DPT St. Louis, MO James A. Dronberger, DPT Kansas City, MO

8. STAFF ORGANIZATION Connie Clarkston (ED) Jimmy Leggett (Executive I) Information Coordinator Kim Brester (Administrative Coordinator) Licensure Supervisor 6 Licensure Techs Bill Smittle (Chief Medical Officer) 3 Med Staff in Office (part time) 3 Med Staff (work from Home) Kim Beffa (Supervisor Enforcement) 4 Staff Frank Meyers (General Counsel) Vacant (Associate General Counsel) Paralegal and Clerical Vacant (Chief Investigator) 2 Probation Supervisors 14 Investigators

9. LICENSED PHYSICAL THERAPISTS PROFESSION# OF ACTIVE LICENSES Physical Therapist5,938 Physical Therapist Assistant2,699

10. THE PRACTICE ACT

11. WHAT IS THE PRACTICE ACT? The “Practice Act” is the title commonly used when referring to the statutes and rules governing the practice of physical therapy in Missouri. Chapter 334 of the Revised Statutes of Missouri. Sections 334.500 to 334.687, RSMo. Regulations 20 CSR 2150-3.010 to 20 CSR 2150-3.210. Available online at: http://pr.mo.gov/healingarts- rules-statutes.asp

12. WHY DO I CARE ABOUT THE PRACTICE ACT? Rules for How to Practice in Missouri Scope of practice Medical record requirements Supervision requirements Unintended Consequences Board investigation Complaint Discipline

13. INVESTIGATIONS

14. AVENUES FOR COMPLAINTS Complaint Received Complaint Review Committee (“CRC”) Malpractice ReviewInvestigativeDisciplineMedical Staff ReviewBoard DirectionParalegalClose

15. COMPLAINT REVIEW All complaints and reports (other than malpractice) are reviewed by CRC (20 CSR 2150-1.011) First level of the screening process CRC determines how complaints are handled Quality of care Routine Investigation Paralegal Gathers Information Letter to Doctor Closed agenda

16. WHAT IS A COMPLAINT? Uniform Complaint Form Letter from Program stating non-compliance Information from Licensee (self-report) “Yes” question on renewal Newspaper Article about Court Conviction Staff concern Misc.

17. INVESTIGATIVE TOOLS Letter to Licensee Gather documents Routine Investigation Quality of Care Records Review

18. APPEARANCES Appear before the Board Gives the Board a chance to meet licensee and evaluate the case and the licensee Gives the licensee a chance to provide his/her side of the story directly to the Board

19. BOARD DECISIONS

20. Close Order Further Investigation Order Appearance Order MSI Propose ILOD (§324.043, RSMo) Propose Settlement Agreement (§621.045.4, RSMo) File a Case AHC (§334.100.2, RSMo) Emergency Suspension (§334.102, RSMo) Board (§§324.042, 334.102.7, and 334.103, RSMo)

21. COMPLAINTS

22. NUMBERS OF COMPLAINTS 20122013 Total Complaints1,067954 Unprofessional Conduct 361249 Negligence245188 Inappropriate Prescribing 189187 Cases Resulting in Discipline 6959

23. TYPES OF DISCIPLINE Reprimand Probation Suspension Revocation Restriction Can be used in combination

24. HOT TOPICS

25. PTA SUPERVISION Section 334.506.7, RSMo states: 7. A physical therapist shall only delegate physical therapy treatment to a physical therapist assistant or to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education (CAPTE) who satisfies supervised clinical education requirements related to the person's physical therapist or physical therapist assistant education. The entry-level person shall be under on-site supervision of a physical therapist. On-site supervision… See also 334.610, RSMo

26. PT TECHS Related to issue of proper supervision/unlicensed practice Section 334.506, 334.510, and 334.610, RSMo PT Techs are NOT licensed Amount of supervision is irrelevant Don’t fudge on your resume/application

27. DRY NEEDLING Not addressed in statute or rule Beware of overlapping practice Acupuncturists ARE licensed in Missouri (see chapter 324, RSMo) Federal requirements? Type of needle being used? Requirement to purchase and use?

28. LICENSURE ISSUES Most issues are licensure related Reciprocity and “substantially equivalent” (see section 334.611, RSMo) FCCPT (see 20 CSR 2150-3.010) TOEFL (see 20 CSR 2150-3.010) FSBPT Scaled Score (see 20 CSR 2150-3.030) Returning to active practice Temporary License (see section 334.665, RSMo)

29. RENEWALS/APPLICATIONS Lying on your renewal/application is cause to discipline § 334.100.2(15) states that “knowingly making a false statement, orally or in writing to the board” is cause to discipline

30. POSITIVE ANSWERS ON RENEWALS If you answer a question on a renewal “yes” you should submit an explanation with your renewal Board may take no further action Board may request more information Board may investigate

31. NAME CHANGES Written request (licensure@pr.mo.gov) Send the document showing the name change Marriage certificate Divorce decree Court order Tell us how you want your name to appear Jane Smith Jane Smith-Doe Jane Smith Doe Jane Doe

32. THINGS TO KNOW Update your addresses with the Board Know the law Attorneys and the Board

33. QUESTIONS Email questions to: legal@pr.mo.gov