Here's freedom to him who would read.
Here's freedom to him who would write.
There's none ever feared
that the truth should be heard,
But they whom the truth would indite.
Scottish poet, 1751-1796)
PART 1: UNREGULATED MASSAGE DOES NOT HAVE "A SIGNIFICANT RISK OF HARM"
The February, 1999, "Preliminary Report" of the Health Professions Council on the "Massage Therapists Scope of Practice," states, "There is no evidence that microtearing, bruising and inflammation are a widespread problem or a serious consequence of unregulated massage. The College" of Massage Therapists of British Columbia (CMTBC)] "has provided no literature or scientific studies to show objective evidence of a significant risk of harm."
Unregulated massage therapists in British Columbia do not get referrals from doctors, and are not compensated by the Medical Service Plan. Registered Massage Therapists (RMTs) get referrals from doctors and are compensated by the Medical Service Plan.
PART 2: MICROTEARING IS
A microtear of tissue may occur in the course of our day-to-day activities when we put more stress on our musculoskeletal system than it can normally accommodate. When that happens, we may injure the tissue of a joint by microtearing. This is usually not serious, and uneventful recovery usually occurs if we do not aggravate the injury.
But massaging people with serious musculo-skseletal problems, such as those to which Peter Behr refers (below), may entail a serious risk of harm because of the nature of the patients's problem and the amount of biomechanical force the RMT applies.
Tearing tissues can cause serious
When RMTs tear an individual's tissue, they are causing harm, and the consequences of that harm may be serious. Information (about those serious consequences) is in CMTBC's "Supplemental Response to the Health Profession Council's February 1999 Preliminary Report on the Massage Therapists Scope of Practice." CMTBC filed this Submission on November 17,1999. The following information about those serious consequences is quoted from '"A Physician's Guide to Therapeutic Massage" (2nd edition), in which Dr. Yates wrote:
"Where the treatment involves sufficient biomechanical force to alter tissue structure, significant damage may be done to vulnerable tissues. The occurrence following treatment of pain, bruising, and inflammation in particular are indicators that the treatment has exceeded tissue tolerance and tissue damage has occurred. There is real risk that such damage may not be trivial, that the presenting condition has been exacerbated, and that significant and lasting harm has been done and an otherwise treatable condition may have become chronic or disabling."
These serious consequences of excessive biomechanical force are iatrogenic harm.
Common sense tells us that Dr. Yates would not have cautioned practitioners about these serious kinds of harm unless they have actually occurred in a significant number of patients.
PART 2: PETER BEHR'S COMMENTS ON THE NEED TO TEAR TISSUE
Peter Behr is a RMT in Powell River, British Columbia. In CMTBC's July 28,1998, Submission, Behr reported that "Over 90% of my patients are referred by physicians." And "Typically, I give 40-50 treatment a week."
On June 8, 1999, Behr (who was then President of CMTBC) testified at a "Scope of Practice Hearing for the Profession of Massage Therapy" (for the Health Professions Council). At this hearing, Behr said, "When I started, I was getting more kind of just backaches and neck aches and then, over the 20 years that I've been in practice, the doctors have trusted me more with more complicated conditions."
Behr also acknowledged that some of the treatments he provided included "quite a bit of force" which was required to "actually tear tissue" (which he said he needed to do), and that these treatments had "a fairly high risk of harm ... especially on the elderly."
"There are things," he said, "I do that I know have a fairly high risk of harm." "One of ... the techniques I do ... is ... pelvic stabilization, and I often use it, especially on the elderly... The sacroiliac joint often gets pulled out of line by a fall, so I get people and they've had a fall and a broken hip or a pelvic fracture, and they're still getting pain. Now it takes quite a bit of force... I actually have to get up on the table and push the pelvis back into line."
Note how aggressively Behr treats some patients, including the elderly with a "broken hip" or "pelvic fracture" and when "they're still getting pain."
"Now there's certainly some risk of harm with people with osteoporosis or lymph --- arthritis or other, you know, elderly people, and I have to be careful. I've massaged about 4,000 people. I've done more than 35,000 treatments, and I think I know what's safe and what's not. And there are things I do that I know have "a fairly high risk of harm."
"We do tear tissues sometimes ... we do that in the hip and in the shoulder and in other joints where we actually have to tear tissue" "The ligaments that surround the hip can be strained and often they will have adhesions, so that there will be pain, and you actually need to stretch these ligaments. Now that is microtearing."
It is logical to assume that other Registered Massage Therapists in British Columbia also tear tissue with "a fairly high risk of harm" because Behr's use of the plural "we" indicates that he is talking about what he and other RMTs do. Also, Behr, was then President of CMTBC and should therefore know what other RMTs did.
PART 2: REGISTERED MASSAGE THERAPISTS MAY CAUSE IATROGENIC HARM
The June 8, 1999, hearing included Behr's following testimony:
Mr. BEHR: I guess my point is that there is a risk of harm. I disagree with Mr. Lau, who spoke first. In Powell River we had a man die of a heart attack from being in hydrotherapy. We had a man recently who had a stroke on the table..."
THE CHAIRMAN: You mean in a nonreg-ulated --
Mr. BEHR: No. They're regulated, but that means they're --. I realize that -- I understand the difference, but they -- there is a risk of harm associated with these techniques. These techniques are not --
THE CHAIRMAN: But these things happen whether the profession was regulated or not regulated.
Mr. BEHR: That's right. That's right. But these are risky techniques, and I'm questioning whether they would have -- if more people hadn't -- didn't have the amount of training they had.
THE CHAIRMAN: You mean the conditions that you're talking about were the results of the treatment they were being given?
Behr danced around this question which refers to the above-mentioned - "heart attack from being in hydrotherapy" and "stroke on the table". Presumably, this table is a massage table. But Behr did not answer the Chairman's question as to whether these two cases of harm, had actually resulted from the treatment.
The fatal heart attack and the stroke both occurred in Powell River, where Behr's Massage Therapy Clinic is located, and there were only seven RMTs in Powell River. One year later, in his June 5, 2000, letter to Lincoln Lau, Behr wrote, "I do not recall making statements" [at the June 8, 1999, hearing] "about deaths that have occurred in Powell River as a result of massage services." It is surprising that Behr does not know whether massage therapists were involved in the fatal heart attack and the"stroke ton the table".
PART 3: QUESTIONS FOR
I would appreciate it if you would please provide the information requested in the following questions, and give me permission to publish your reply in the Massage Law Newsletter. These questions concern some of your comments at the June 8, 1999, hearing.
1. If you have no well-documented evidence that the above-mentioned two cases of harm (a heart attack, and a stroke) were caused by the RMTs who were treating those patients, why did you refer to them at the June 8, 1999, hearing?
2. If you have no well-documented evidence that the individual (in Alberta) became a paraplegic as a result of a massage, why did you refer to that at the June 8, 1999, hearing?
3. You testified that you talked to "quite a few people" in Powell River "who have been injured by" [unregulated] "practitioners," but they were not willing to testify, and you said, "I'm not making it up." Why did you present this information which is completely unacceptable as reliable evidence?
4. About 3.600 of your patients (90% of the 4,000 patients your treated) were referrals from physicians. Approximately how many of these 3,600 patients had the kinds of problems for which your treatment involved what you call "a fairly high risk of harm" because you "actually" [had] "to tear tissue"?
5. For approximately how many of these 3.600 patients, did you get up on the table in order to push their pelvises back into line?
6. For approximately how many of these 3,600 patients, did you need to tear tissue? How many of these patients had adverse effects that resulted from your having torn their tissues? What was the nature and seriousness of that iatrogenic harm?
7. Appendix H of CMTBC's 1998 Submission has your report "How RMT's Are Commonly Employed." In this report, you refer to "Discussion of treatment and treatment plan and patient questions."
Do you discuss with each of the your patients, for whom it is relevant,that the treatment, you intend to provide, involves "a fairly high risk of harm" because you would "actually have to tear tissue" and that tearing would be painful and could result in the iatrogenic harm described by Dr. Yates?
8, If you do not provide your patients with the information in the preceding paragraph, how can there be"patient questions" about that treatment and about the iatrogenic harm that might result? And how can your patients give their informed consent for a painful and severe treatment about which you do not provide what is legally called "full disclosure"?
9. In the June 9, 1999, hearing, you said, " I think I know what's safe and what's not." If you only "think [you] know what's safe and what's not," does it not follow that you do not always know "what's safe and what's not"?
10. How do you know what amount of tearing is safe and what amount of tearing is not safe" in treatments during which you "actually have to tear tissue"?
11. In how many of the approximately 3,600 patients, who were referred to you by physicians, did you cause any of the iatrogenic harm which Dr. Yates described?
PART 3: HOW MANY TREATMENTS
BY REGISTERED MASSAGE THERAPISTS HAVE CAUSED IATROGENIC HARM?
"In 1996, over 200,000 patient referrals were made." This information is in CMTBC's July 28, 1998 Submission. You treated about 3,600 people (90% of 4,000 who were referred to you), and provided them with an estimated 31,500 treatments (90% of the total 35,000 treatments you provided). This amounts to an average of about 8.75 treatments per patient.
Using this 8.75 ratio, the 200,000 patient referrals in 1996, received about 1,750,000 treatments by RMTs in 1996. It is logical to assume that:
Some other RMTs have practices comparable to yours, and may sometimes "actually have to tear tissue," as you do.
These treatments by other RMTs also entail the "fairly high risk of harm" (especially for the elderly who come with "broken hips, "pelvic fractures," and other serious injuries, and are in pain.
Since RMTs gave about 1,750,000 treatments in 1996, it is difficult to believe that there were no adverse effects including the harm associated with tissue tearing, to which Dr. Yates directed attention.
It is therefore legitimate to ask, How many RMTs in British Columbia caused iatrogenic harm to how many patients in 1996, when they "actually " [had] "to tear tissue"? What was the nature of that iatrogenic harm? And how serious was it?