NEVADA STATE BOARD OF
PHYSICAL THERAPY EXAMINERS
BOARD MEETING MINUTES MARCH 26, 2015
Item 1- Call to order / roll call to determine the presence of a quorum.The meeting was called to order at 9:30am by Chairman Puentedura, who welcomed all in attendance. Board members present: Louie Puentedura, PT, DPT, PhD, FAAOMPT, Chairman; Tina Baum, PT, ATC, CLT, Vice Chairman; Jim McKivigan, DC, PT, MPA, MA, Secretary-Treasurer; Sherise R. Smith, PT, MSPT, CBIS; Andrea Menicucci, MS, CCC-SLP, Public Member. Non-members present: Richard Dreitzer, legal counsel and Deborah Dieter, PT, board inspector. Allison Tresca appeared telephonically from the Board office. Others in attendance: Pam Hogan, PT; Carolyn Hultgren; Clarence Hultgren.
Item 2-Pledge of Allegiance.
Item 3-Public comment period. Mrs. Hultgren stated she was a long-time therapist and was interested in Items 4 and 5.
Item 4-Jenelle Lauchman, PT, President of the Nevada Physical Therapy Association, requests the Board’s opinion on physical therapists ordering imaging. This request is being made due to action on the part of the American Physical Therapy Association to draft language regarding same.
Jenelle Lauchman, PT, NVAPTA President and Jayce Campbell, physical therapy student appeared on this item. Ms. Lauchman stated that the House of Delegates of the APTA is considering adding language to the scope of practice for therapists to order imaging. She noted that in the military, therapists can order imaging, and have been able to do so for many years. She stated she believes it is within scope to refer to a radiologist to order imaging, and not have to refer to the doctor to order the imaging. She noted that the current Nevada regulationstates thatany healing arts professional can order x-rays, but does not include therapists in the list. Carolyn Hultgrenstated that therapists are indeed part of the healing arts professionals. She also noted that CAPTE needs to change to require this in the formal education. Ms. Lauchman noted that only basic reading of x-rays is provided in schools at this time. Ms. Lauchman noted there will likely be some problems in getting this into scope in the practice act and asked the Board to have their lobbyist look into this and the Board take the lead. Richard Dreitzer noted that expanding or changing scope of practice is an association role, not the role of the Board. He noted the Board can certainly offer their opinion and/or support of any changes presented to the legislature, but the Board cannot lead the charge in changing scope of practice. Chairman Puentedura stated the Board will provide support if they agree with the language of a bill, but the Board is not in a position to drive it or push for it. Richard Dreitzer noted that anything expanding scope is perceived to increase the income of the provider. Ms. Lauchman stated that there is no financial gain from ordering x-rays. Ms. Lauchman said the goal is to be able to refer to a radiologist for an x-ray. Board member Menicucci suggested that perhaps they should try to expand practice to offer x-rays like chiropractors. Vice Chairman Baum noted that it may matter to the insurance company who orders it when determining reimbursement. Chairman Puentedura stated the physical therapy education moving to DPT provides fora larger diagnostic component; ultrasound, radiology; MRIs; x-rays, and the therapists can use that to provide the best care to the patient. Chairman Puentedura noted that the item was to request the Board’s opinion and it appears thus far there is support. Mrs. Hultgren stated this is an item for the HOD in June, and she believes the first critical step is for the HOD to adopt this so there is national support. Ms. Lauchman asked if she can go to APTA and state that the Nevada Board supports this. Secretary/Treasurer McKivigan noted that in Ms. Lauchman’s memo to the Board, she makes a difference between ordering and referral, and there should be eithera distinction of the two, or only use one term. He also stated that he often hears people discuss what military physical therapists do. He noted he was a therapist in the military, and noted that the therapists who order x-rays are few, and have additional education and training before they are permitted to order, and there are specific situations in which they can order. He noted it is not allowed for any military therapist to order x-rays. He also noted he was able to order radiographs, but as an extension of the physician, and not working independently. He noted that at one location he was able to order under specific criteria, but two miles down the road at the Army hospital, he was not able to order. He noted that if the military model is going to be referenced, the entire model needs to be provided, not just the language that supports the position of expanding scope of practice. Ms. Lauchman stated she would look into the federal language regarding this. Chairman Puentedura asked Ms. Lauchman what the distinction was between referring and ordering; as they appear to be interchangeable in her position paper. Ms. Lauchman noted that getting an x-ray on site is ordering, and sending the person to a facility it is a referral. Board member Smith noted she would want to see better language when a bill is presented. Chairman Puentedura noted that therapists in other countries have had referral rights for years. Board member Smith asked how speech therapists could refer for barium swallowers. Public member Menicucci stated they refer directly to the radiologist. Ms. Lauchman asked if that was in the practice act language or the healing arts law. Public member Menicucci stated she was not sure where the language was located, and noted there was a CPT code for the barium swallowing. Board member Smith noted that referring it is the radiologist interpreting the x-rays, it is not the therapist interpreting anything. Vice Chairman Baum noted that the FSBPT Model Practice Act doesn’t cover this. Pam Hogan stated she sees it as protection for therapists if they suspect something, they should be able to refer the patient to x-ray. She noted that her patients have not had to physically go to the doctor for the referral, she simply calls it in.
Motion to support the NVAPTA with regards to their pursuit with the APTA to be able to refer for x-rays and to provide an update to the Board; and that the Board will entertain other matters in the future as presented and warranted: Puentedura.
Second: McKivigan.
Passes unanimously.
Item 5-Janelle Lauchman, PT, President of the Nevada Physical Therapy Association, requests the Board’s opinion on licensees engaging in health and wellness activities and/or screening.
Ms. Lauchman stated the HOD will be addressing health and fitness to determine if it is within scope. Ms. Lauchman read the proposed language from the APTA:
That the following population health priorities be used to guide the American Physical Therapy Association (APTA) work in the areas of prevention, wellness, fitness, health promotion, and management of disease and disability. Physical therapists can positively impact these areas and, where opportunity exists, can improve the health status of individuals and populations.
She noted this was just one section of proposed language and referenced the APTA’s House of Delegates Packet Preview issued in March 2015.
Chairman Puentedura noted the therapists promote patients to get better, so is this really an increase in scope? Ms. Lauchman noted they want to provide information and guidance, not sell anything; it would be providing educational information on diet and activity. Public member Menicucci noted it may be out of practice as non-evidenced based. Ms. Lauchman noted the approval for continuing education course criteria would need to be changed. Vice Chairman Baum noted there were seven new proposals dealing with health, wellness and nutrition be considered at the next APTA meeting.
Motion to give the NPTA support to gather more information from the HOD and present it to the Board for consideration: Puentedura.
Second: McKivigan.
Passes unanimously.
Item 6-Review and discussion of potential public safety issues arising from out-of-state applicants for licensure in Nevada who pass the National Physical Therapy Exam (NPTE) after five (5) or more attempts, with no practice experience. Discussion of possible probation or other remediation to address same.
Chairman Puentedura noted that in 2016, the FSBPT will have a lifetime limit of 6 attempts. He noted the Board will be able to deny seven or more attempts to an applicant based on that, but noted the Board is seeing applicants who apply here, are denied to sit for the test, apply in other jurisdiction and re-apply to this Board, having never practiced in their exam jurisdiction. He noted that the Board spends a lot of time, money and resources placing people on probation and monitory them. Chairman Puentedura noted if the applicant has practiced in the other state without problems for at least a year, then they come to Nevada and their license will go through without a problem. Chairman Puentedura noted that other jurisdictions may create their own exam to allow for someone to test for licensure. It was noted that such exams would be state-specific and not transferrable to any other licensing Board. The director noted that the probationary period works to ensure public protection, citing it was extra work and resources for the Board, but it was the best mechanism to support the licensee and protect the public. Chairman Puentedura noted that the FSBPT is working on licensure compacts, so if someone gets a license in UT, they can automatically work in NV, and that could provide that someone who has not practiced in years, and/or has never practiced in the US could work in NV under the UT license. No action was taken.
Item 7-Review and approval of minutes for Board meeting of February 17, 2015.
Motion to approve with grammatical changes: McKivigan.
Second: Menicucci.
Passes unanimously.
Item 8-Review and approval of executive session minutes for Board meeting of February 17, 2015.
Motion to approve: Menicucci.
Second: McKivigan.
Passes unanimously.
Item 9-Review and approval of Treasurer’s Report for period ending January 2015.
Motion to approve: Puentedura.
Second: Baum.
Passes unanimously.
Item 10-Review and approval of Profit and Loss Report for period ending January 2015.
Motion to approve: Baum.
Second: Smith.
Passes unanimously.
Item 11-Review and approval of Balance Sheet as of January 2015. Andrea, Jim
Motion to approve: Puentedura.
Second: Baum.
Passes unanimously.
Item 12-Review and approval of Treasurer’s Report for period ending February 2015.
Motion to approve: Puentedura.
Second: McKivigan.
Passes unanimously.
Item 13-Review and approval of Profit and Loss Report for period ending February 2015.
Motion to approve: Puentedura.
Second: McKivigan.
Passes unanimously.
Item 14-Review and approval of Balance Sheet as of February 2015.
Motion to approve: Smith.
Second: McKivigan.
Passes unanimously.
Item 15-Review and approval of Executive Director’s Report as of March 15, 2015.
Motion to approve: Puentedura.
Second: Smith.
Passes unanimously.
The director noted that licenses can be issued fairly quickly when the applicant follows the process, as noted by the application date vs. the licensure date on the report. Chairman Puentedura suggested placing the estimate of licensure on the Board’s site, noting what items are typical in delaying the application process. Chairman Puentedura noted he will be working the FCCPT Board and they have a lot of work lined up for him.
Item 16-Update of activities of Board office.
The director noted that the inspectors are performing the annual inspections and there will complaints filed for address change violations, failing to post licenses and other issues. The director noted she has begun preparing for the annual license renewals, and noted she continues to work with the lobbyist on a nearly daily basis.
Item 17-Review of files/ratification for licensure.
Motion to ratify: Menicucci.
Second: Puentedura.
Passes unanimously.
FILES FOR REVIEW/RATIFICATION:
Physical Therapists
LAST / FIRST / CRED# / ISSUED / APPLIEDWelch / Lacey / 3088 / 1 /13/2015 / 12/16/2014
Waite / David / 3089 / 1 /28/2015 / 11/14/2014
Johnson / Amanda / 3090 / 2 /10/2015 / 1 /5 /2015
Smyth / Emma / 3091 / 2 /3 /2015 / 11/3 /2014
Dougherty / Thomas / 3092 / 2 /3 /2015 / 6 /6 /2014
Toberman / Brett Robert / 3093 / 2 /10/2015 / 12/9 /2014
Wood / Brandon / 3094 / 2 /10/2015 / 3 /5 /2014
Able / Kymberli / 3095 / 2 /19/2015 / 2 /12/2015
Branch / Nicholas Jeffrey / 3096 / 2 /19/2015 / 1 /12/2015
Trager / Richard / 3097 / 2 /19/2015 / 2 /2 /2015
Elton / Steven / 3098 / 2 /19/2015 / 1 /21/2015
Powell / Brady / 3099 / 2 /20/2015 / 12/5 /2014
Delic / Ana / 3100 / 2 /26/2015 / 8 /7 /2014
Kurian / Jibu / 3101 / 2 /27/2015 / 11/4 /2014
Leon / Annette / 3102 / 2 /27/2015 / 1 /13/2015
Sran / Bhupinderjit / 3103 / 3 /5 /2015 / 8 /28/2014
Frohlich / Christina / 3104 / 3 /5 /2015 / 1 /26/2015
Apostol / Mark / 3105 / 3 /5 /2015 / 2 /20/2015
Lee / Jessie Yen-yi / 3106 / 3 /5 /2015 / 2 /23/2015
Bhagat / Radhika Anirudh / 3107 / 3 /16/2015 / 11/18/2014
Yager / Alison / 3108 / 3 /16/2015 / 1 /15/2015
Physical Therapist’s Assistants
LAST / FIRST / CRED# / ISSUED / APPLIEDPeter / Kyla / A-0787 / 1 /28/2015 / 12/8 /2014
Ganitano / Bryan / A-0788 / 1 /28/2015 / 12/9 /2014
Fields / Sarah / A-0789 / 1 /28/2015 / 12/4 /2014
Neubert / Vanessa / A-0790 / 1 /28/2015 / 5 /15/2014
Riske / Jennifer Marie / A-0791 / 1 /28/2015 / 12/2 /2014
Riske / Danielle / A-0792 / 1 /28/2015 / 12/2 /2014
Gatton / Penelope / A-0793 / 1 /28/2015 / 12/2 /2014
Callahan / Matthew Villasanta / A-0794 / 1 /28/2015 / 5 /29/2014
Plaza / Kristoffer / A-0795 / 1 /28/2015 / 5 /20/2014
Franco / Ricardo / A-0796 / 1 /28/2015 / 11/7 /2014
Ubina / Kim / A-0797 / 1 /28/2015 / 12/2 /2014
Schmidt / Amanda / A-0798 / 2 /3 /2015 / 12/9 /2014
Duffy / Patrick Charles / A-0799 / 2 /3 /2015 / 12/4 /2014
Jourdan-Smith / Cynthia / A-0800 / 2 /10/2015 / 1 /9 /2015
Gonzalez / Rady / A-0801 / 2 /10/2015 / 12/4 /2014
Greer / Neil Anthony-Evan / A-0802 / 2 /19/2015 / 2 /13/2015
Shoemaker / Benjie / A-0803 / 2 /19/2015 / 12/30/2014
Krebs / Lynsie Olivia / A-0804 / 2 /26/2015 / 12/5 /2014
Item 18-Consideration of courses recommended by the Advisory Committee on Continuing Education at their meetingsofJanuary 20, 2015 and March 3, 2015 through July 31, 2016.
Motion to approve as recommended: McKivigan.
Second: Menicucci.
Passes unanimously.
Recommend for approval –
Provider / Course / Type / CE Units for renewal purpose / CE Units for all other purposes / Unit TypeAcademy of Lymphatic Studies / Complete Lymphedema Certification / On-Site / 1.5 / 9 / Clinical
Advanced Healthcare / Dynamic Core Activities to Promote Functional Outcomes / On-Site Lecture, Demonstration & Lab / 0.4 / 0.4 / Clinical
Allied Health Education / ABC's of Treatment Strategies for Upper Extremity Instabilities (Live Webinar) / Live Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / ABC's of Treatment Strategies for Upper Extremity Instabilities (On-Demand Webinar) / On-Demand Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / Parkinson's Disease: What it is and How it is Managed (Live Webinar) / Live Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / Parkinson's Disease: What it is and How it is Managed (On-Demand Webinar) / On-Demand Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / Treatment of Common Orthopedic Foot and Ankle Injuries and Disorders (Live Webinar) / Live Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / Treatment of Common Orthopedic Foot and Ankle Injuries and Disorders (On-Demand Webinar) / On-Demand Webinar / 0.2 / 0.2 / Clinical
Allied Health Education / Amputee Gait: Analysis and Treatment Internet / Internet On demand self Study / 1.5 / 2 / Clinical
Allied Health Education / Amputee Gait: Analysis and Treatment Live Webinar / Live Webinar / 1.5 / 2 / Clinical
Allied Health Education / Medical Screening for the Rehabilitative Therapist Internet / Internet On Demand / 1.5 / 2 / Clinical
Allied Health Education / Medical Screening for the Rehabilitative Therapist Live Webinar / Live Webinar / 1.5 / 2 / Clinical
Allied Health Education / The Future of Neurologic Rehabilitation: Translating the Latest Research into a Clinical Application Internet / Internet / 1.5 / 2 / Clinical
Allied Health Education / The Future of Neurologic Rehabilitation: Translating the Latest Research into a Clinical Application Live Webinar / Live Webinar / 1.5 / 2 / Clinical
APTA / Using Quality and Outcomes Measures to Market Your Practice / Online / 0.1 / 0.1 / Clinical
APTA / Aquatic Physical Therapy Competency Course: Historical Perspective of Aquatic Physical Therapy / Internet / 0.1 / 0.1 / Clinical
APTA / Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling and Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial / Home Study / 0.2 / 0.2 / Clinical
APTA / Functional Outcomes after Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation / Home Study / 0.2 / 0.2 / Clinical
APTA / Management and Prevention of Bone Stress Injuries in Long-Distance Runners / Home Study / 0.2 / 0.2 / Clinical
APTA / Management Strategies for Osteochondritis Dissecans of the Knee in the Skeletally Immature Athlete / Home Study / 0.2 / 0.2 / Clinical
APTA / Recommendations for Physical Therapists on the Treatment of Lumbopelvic Pain During Pregnancy: A Systematic Review / Home Study / 0.2 / 0.2 / Clinical
APTA / Understanding the Health Insurance Marketplace / Internet / 0.2 / 0.2 / Non-Clinical
APTA / Disease Management Models for Physical Therapists: Focus on Diabetes and Cardiovascular Disease / Internet / 0.2 / 0.2 / Clinical
APTA / Self-Reported Knee Function Can Identify Athletes Who Fail Return-to-Activity Criteria up to 1 Year After Anterior Cruciate Ligament Reconstruction: A Delware-Oslo ACL Cohort Study / Home-Study / 0.2 / 0.2 / Clinical
APTA / Using Data Analytics to Work Smarter in Your Healthcare Setting / Internet / 0.2 / 0.2 / Clinical
APTA / Validity of the Thessaly Test in Evaluating Meniscal Tears Compared with Arthroscopy: A Diagnostic Accuracy Study / Home-Study / 0.2 / 0.2 / Clinical
APTA / Aquatic Physical Therapy Course: Aquatic Physics / Internet / 0.25 / 0.25 / Clinical
APTA / Peer Review / Internet / 0.5 / 0.5 / Non-Clinical
APTA / 2014 State Policy & Payment Forum-Payment Plus Track / On-Site / 0.8 / 1.3 / Non-Clinical
APTA / Navigating the Payment Maze to Reduce Denials and Minimize Risks-Internet / Internet / 0.8 / 0.8 / Non-Clinical
APTA / Navigating the Payment Maze to Reduce Denials and Minimize Risks-On-Site / On-Site / 0.8 / 0.8 / Non-Clinical
APTA / Certificate in Aquatic Physical Therapy Clinical (PT) / On-Site & Internet Blended / 1.5 / 2 / Clinical
APTA / Aquatic Clinical Applications: Pool Course / On-Site / 1.5 / 2.6 / Clinical
APTA / Certificate in Aquatic Physical Therapy Clinical (PTA) / On-Site & Internet Blended / 1.5 / 4.5 / Clinical
At Home Seminars, LLC / Muscle Energy Techniques, 4th Edition: Module 1 / Home Study, Internet / 1.5 / 1.5 / Clinical
At Home Seminars, LLC / Muscle Energy Techniques, 4th Edition: Module 2 / Home Study, Internet / 1.5 / 1.5 / Clinical