Asm. Bob Wieckowski’s AB 1000 should be fixed to protect patients

The state legislature is currently considering a bill authored by Fremont Assemblyman Bob Wieckowski, AB 1000, that would allow patients direct access to physical therapy treatment for 45 calendar days or 12 visits, without a doctor’s referral. After that window, a signature approving the physical therapist’s plan of care is required from a physician and surgeon, or a podiatrist.

While there are a number of provisions worth supporting in AB 1000, the bill still needs work. As it’s currently written, Assemblyman Wieckowski’s bill doesn’t do enough to allow for patients’ continuity of care.

In many instances, patients being treated by physical therapists have a doctor of chiropractic as their primary treating provider. Since 1922 doctors of chiropractic (DCs) in California have been educated and licensed by the State of California to serve as portal of entry/primary care providers. DCs are educated to differentially diagnose all conditions of the human body. After undergraduate study, chiropractic students earn a four-year doctorate degree with classroom and laboratory work in basic clinical sciences, physical examination, diagnosis and differential diagnosis, x-ray and interpretation of laboratory blood work and other treatment procedures. Clinical education includes a year -long internship overseen by a licensed DC on patients with various clinical presentations using manipulation as their primary clinical procedure.

Only health care providers who are trained in the complete diagnosis of all conditions that affect the human body can provide adequate patient safety. A seemingly “simple problem” for which a patient may seek treatment directly from a physical therapist might actually be masking a much more serious condition such as heart failure, diabetes, cancer or other disorder.

That is why the California Chiropractic Association (CCA) appreciates the provision in AB 1000 providing that if the physical therapist has reason to believe the patient has signs or symptoms of a condition that requires treatment beyond the scope of practice of a physical therapist, or if the patient is not progressing toward documented goals, the physical therapist shall refer the patient to an appropriately licensed health care provider. 

However, we have concerns with how this requirement will be enforced.  Additionally, CCA believes it would be appropriate to include language that outlines the minimum penalty for a physical therapist who violates these limitations on direct access.