H.B. 202 Acupuncturist Licensing Amendments: transcript

Okay. So I have a person who's talking to me present who is online. Can he be on for the whole presentation?

Um, Jamie, hold on. I can tell you his last name. Just a second. I don't know if I can say his. It's Moha, I think.

Hi, Jamie. So, I just told him 10 minutes ago, he's presenting. So Lucky guy. Um, okay. So the purpose of this bill is to, um, open up licensure in Utah for acupuncture. Um, right now, if you want to be an acupuncturist, you have to go out of state for four years to get the certification. And if you're already a ha, if you already have a practice, say as a massage therapist or something like that, then you would have to leave your practice and all your clients for four years and then come back and start over. And so what what we're hoping to do is make it so that we can have the education here in Utah and, um, and allow people to keep their practice in whatever else they're, um, whatever, whatever other modality they're working in, and then be able to add to their income and also serve their patients better. So, um, there is a growing market. There's a national demand for acupuncture, and there's a projected 5% growth rate. And that trend is reflected in Utah. Um, a lot of acupuncturists in Utah work in private practices, uh, sometimes in collaboration with other providers like chiropractors or massage therapist. Um, the salary potential is anywhere from 89,000 to 104,000, um, per year. The, the key locations right now are Sandy Park City in Ogden. Um, I am going to let Jamie, who just did acupuncture on me on Friday. It was my first time ever and I thought I should try it before I presented, so I'm glad I did it Friday. So I'm gonna let Jamie, um, talk to you for just a couple of minutes and then we'll open up for questions. So go ahead, Jamie. You're on, uh, unmute.

Uh, I think I am unmuted. Can you hear me? Yes. Yes. Okay, perfect. Well, thank you, uh, chair, vice chair and members of the committee. Uh, my name is Jamie Moholy. I am a licensed acupuncturist practicing here in Utah. Um, and I'm here obviously to support HB 2 0 2. Um, this bill is primarily about creating jobs, uh, uh, creating workforce access, uh, allowing fair competition, and specifically keeping Utah talent in Utah. As the representative already mentioned, there are no acupuncture schools in the state of Utah, um, currently. And as a results, uh, anybody who wants to become licensed in this profession would have to leave the state for approximately four years, uh, complete schooling elsewhere and return home. Um, so as the representative already mentioned, we have, uh, I've met a number of massage therapists that are very interested. I've met a number of stay at home moms that are very interested, um, in, uh, pursuing acupuncture as a career. And they are simply unable to relocate out of state to pursue this career. Um, so, uh, that creates a major barrier to entry, which limits the number of practitioners available in Utah to meet an increasing demand for traditional medicine, especially for the treatment of chronic pain. Uh, acupuncture is very effective at chronic pain. Um, and it's, um, you know, my practice is I have a two month wait list in my practice alone, um, because the demand is so high. Um, we see this not just in Utah County where I'm located, but there's long wait lists in Salt Lake County as well, and there's limited provider availability. Um, so the profession itself, it's a viable small business career pathway. Um, acupuncture allows flexible scheduling, low overhead and independent practice so it can support both full-time practitioners like myself and part-time providers, including parents stay at home mothers, uh, who want a legitimate licensed side business that can also fit in with their family life. HP 2 0 2 is simple. It creates an alternative pathway to licensure that maintains the standards while allowing Utah to train, evaluate, and license practitioners within its own regulatory framework. It does not expand the scope of practice at all. It does not. It does maintain all standards for safety and efficacy, and it does maintain all consumer protections, um, that are usually in place for acupuncture. Uh, it also bolsters local control, create, improves market access, and allows individual opportunity for Utah residents, um, in addition to giving Utah residents more choices in how they pursue healthcare and how they pursue employment. Um, all in all, the bill has a very minimal fiscal impact, uh, and it relies almost entirely on D'S existing regulatory framework. Uh, for these reasons, I ask for your support in HB 2 0 2. Thank you.

Thank you. Jamie, tell them you're not in bed.

Uh, no, I'm, I'm on my couch. Uh, this Vertical, This rough.

So just wanna make sure we all knew. Yeah, yeah. Thank you very much. So without, we're open to questions.

Thank you, Mr. Chair. If I may just ask a couple, kind of a two-pronged question. Okay. What is the educational path to become an ACT acupuncturist, and what are the educational options here within the state?

Okay, I'm gonna let Jamie answer that question. Those questions. Did you hear them?

Yes, I did. Um, so presently there are no educational options within the state to become an acupuncturist. Uh, anyone who wants to become an acupuncturist would have to relocate to California, Washington, Oregon, uh, Texas. Uh, they would have to move out of state entirely to pursue education. Um, and as far as what the education, uh, consists of, uh, usually it is, um, a three to four year program. Um, and right now in the field, people are evaluating the length to see whether that's actually a good match for the prog, uh, for the field.

Thank you. If I may ask a follow up question. You bet. With this I'll being along the lines of licensure, has LER provided any insights or input into the proposal?

Yes. So actually they came to, we had a meeting with them and they, they were very favorable. They actually were hoping that this would pass as a stepping stone to something that they wanted to do. That's bigger next year. I was going to call them today, but I didn't get to it. So, so yeah, they, I have not heard any concerns on this at all.

Thank you. If I may chime in. I was, uh, I was in the meeting, this is, uh, Jeff Shumway. Is this right? Uhhuh? Yeah. Uh, I was in the meeting with Jeff and his team's committee, and, um, they were, uh, very much in support. Um, they, uh, in their recent review of the acupuncture profession, along with the other health professions that they were doing this past year, they found that, um, the educational requirements that were being required by the accreditation boards and the other, uh, organization, the out-of-state organizations, were, um, not promoting greater safety and efficacy. Um, and so they found that, um, they were totally aligned with the idea that, um, an alternative pathway would reduce educational bloat and would allow greater, um, greater access to the profession. So, uh, Jeff was gonna take the stand for us and say that, but, um, we didn't have the time.

Just real quick, based on that response, um, have you also talked to Dopel?

Yes. Okay. So that was LER you were talking about? Oh, I'm sorry. Yes, we did, we did talk to them as well. Okay. So we do have a license here. We sent, so we sent the bill to them and asked for their feedback. Is that right, Ronan? Did we send the bill to them? Okay. We talked about sending the bill to them, and we did not, I don't remember seeing any feedback.

You, Mr. Chair. So, um, my biggest concern with these types of bills is that we set the bar too high on this new path, and that we have to come back later and pull that bar down. So, um, okay. One of you, could you just tell me like how confident you are that this bar isn't too high and is creating just yet another barrier? Um, and so like, what, what were the, what were the thought, what was the thought process and establishing the levels of training that are included in your bill?

Okay. I am gonna let Jamie answer that.

Absolutely. Um, so I, um, obviously I went through the standard acupuncture education system, and I, um, I've been watching the field and there's, uh, a number of proposals, uh, into the accreditation boards that, uh, mirror the requirements that we put in. So essentially, um, acupuncture education is, um, uh, what we're looking at is creating basic safety and efficacy and having a very stripped down curriculum. Um, so in reality, the curriculum we're looking at, it's, um, it's not, uh, it's, it's comparable to what's seen, um, in other areas of the industry. And there's other people that, um, other owners of colleges that are suggesting that these are the minimum basic requirements, uh, for a competent practitioner. Um, yeah. Do, do you have a follow up question on that or?

I, I do. Mr. Chairman, if I may follow up. Yeah. So, um, so the, the beauty of this is that people could still stay here and work here and get this training while they're, while they're working. Yeah. So who do we have in Utah that's capable? Do we have the capacity, um, does Rocky Mountain need to have a program in acupuncture do this? Or how do they, who's the, who are the trainers to make this happen? Yeah.

Um, so essentially, uh, the regulation that the bill is proposing would be identical to the way that massage schools are regulated. So it would be, which, uh, Doppel already is approving massage schools. So it's, uh, essentially there's, right now Doppel has the massage and acupuncture board that licenses massage therapists licenses, acupuncturists. They also have a, a section that, uh, oversees massage schools and approves curriculums for massage schools. Um, we would simply be having that same board approve the curriculum for acupuncture schools. So essentially anybody would be able to start an acupuncture school provided that they, uh, offer protection for the students from the department of, uh, consumer Protection, uh, and that they meet the requirements. And the school is approved by doppel. So it's a free market for the schools as well.

Great. Thank you, Mr. Chair. We have a new chair. Okay.

Alright. Thank you, Mr. Vice chair. So I'm looking at the National Certification Board, the N-C-B-A-H-M, and their educational requirements show, uh, 705 hours, 870 hours, uh, on acupuncture. Um, and so I'm curious, you, you've got an OR in the bill, so you do the national certification board, acupuncture, herbal medicine, or so, so the board has, you know, the 800 hours, 700 hours, but then the, OR is submit evidence of completing a curriculum that is at least two years, 450 hours of instruction, 75 hours, you know, 500 hours of instruction. How does someone, I mean, they, they submit anything? I mean, is there any kind of certification? They just submit it on their own? 'cause if you're going through the board, the board has their certification process and the eligibility and all the rest. So I'm trying to, I'm trying to break down the OR process. Okay.

Jamie, go ahead and answer that.

Um, this actually is something I'm a little less clear on because this has to do with how the bill is written. So, um, this is, I believe, if I am understanding correctly, representative, that your question is, um, with these, this other curriculum, uh, what is the approval process for that curriculum? How do you demonstrate that you have completed the program? How do you demonstrate competency? I guess that's the question. Is that right? Representative?

I, yeah, just a couple things. I mean, the hours are different than the national board that's referenced, and so, you know where those standards came from, and then who would certify it. So if it's not the national board who actually certifies it, and how do we know that they're competent to certify this or path?

And is it okay for me to consult the drafting attorney?

Oh, I thought it Ronan, you didn't draft it. You're not the attorney. Yeah. See, I don't know who all the attorneys are and the analysts are. Sorry, I don't have you guys all straight yet. Tyler. So it was Tyler. Okay. Um, yeah, I don't know where he got the language. That was just

Okay. And, and the other question I had was on the National board site, it doesn't say anything specific about East Asian Medical Theory. It just goes into acupuncture. And so I'm not sure why we would single out East Asian Medical Theory if it's acupuncture that's not East Asian. Is that not Okay? Uh,

Yeah. So that's a very easy question to answer actually. So the NCCO, or now they're called the N-C-B-A-H-M, it used to be called the NCCM. They, uh, simply administer a test. They're basically a testing organization. The organization that sets the requirements for education is, uh, acom, um, so A-C-A-H-M. And they have requirements that State East Asian medical theory, all of that. Um, so it's, um, yeah, it's, it's simply mirroring, uh, there's a proposal into ACOM to revise their requirements right now. And we directly took all of our language from that proposal.

Okay. Yeah, I, I think I'm looking at that site and I'm, I'm not seeing that, but that, uh, I guess we can sort that out. The other, the other thing is just, uh, grammatical on line 48, you've got meets any other requirements the division makes by rule, the division makes in accordance with that. Probably need to take out the division makes, you've got a duplicate there. So Line 48 something Yeah. On line 48. Okay. But we can do that later, but yeah. Okay. I'm just, yeah, I'm still concerned about the OR path, but that's

Okay. Um, Chime in. Well, we're, we're happy to look at that and I can meet with Tyler and figure out where that came from. Yeah.

Um, representative Cha would, would it be helpful for me to chime in about our, what I believe our goal was in writing it that way? Yeah, I'm, do, would you guys like to know what the, uh, objective was?

Uh, so, um, as I mentioned earlier, the, the outcome that we're looking for is that, uh, DOPL and review a curriculum and approve the curriculum. So the oversight is through DOPL in exactly the same way that the massage, that massage therapy is regulated. Um, where, um, the, they look at a massage school curriculum and they can say, this meets our requirements for licensure. Um, and that, that would be the oversight. So that's, um, there's a board of the acupuncture and massage. There's a committee on the acupuncture and massage board that does exactly this. Um, and the people on that board, um, you know, they have experience in the field and experience looking at these sorts of curriculums.

Uh, I did have one. Are there, uh, myself. Are, are, are there any schools right now that are looking to get into this, uh, business and, and start, uh, teaching? Or are there, uh, have you heard of about any interests? Or is this is just, hey, this is here

Now you can do Well, there is interest. There is interest. I'm not aware of any specific schools right now, but I know that there, that the, the field is growing right now, and I think that bringing it to Utah is a really great idea because we have a lot of people here who, who could expand their talents and we can keep them here. So I, I think that there would be interest.

Yeah. I, uh, first time I had it done was by a physical, uh, therapist and it was, it was life changing. It was, it was very good. I think they used different vernacular, they call it dry needling or whatever, but it was pretty much the same thing, and it was great.

Yeah. Thank you, Mr. Chair. One, one quick question I have for you. Um, under the qualifications, uh, for this alternative path, um, you have kind of as a third catchall that they meet any other requirement the division makes by rule. And, you know, there's, there's a couple other, uh, areas of the bill where you give some rulemaking authority in terms of, um, an examination. Um, what essentially telling them they get the doppel gets to decide whatever examination has to be passed. And then in, in four above also establishing procedures to collect a patient's informed consent. So I, I Uintah look at some of the other licensing sections to say is this, is this normal that we would give such broad authority to the licensing division and not actually state in the statute. And I, you know, based on, you know, some quick research here, it, it didn't seem like it, this seems to be pretty broad. So can you speak to why we want to give the division so much broad rulemaking authority?

I cannot, I don't, I don't know how it's normally done. This is the first time I've ever run a bill like this, but Jamie, do you have any insights on that?

Um, my sense is, um, essentially kind of aligned with the ethic of it, of just saying that we want Utah to be in charge of what's safe and effective in Utah, and we want, uh, we don't want outside, um, organizations, um, you know, essentially limiting what's, what's practicable in Utah. Um, so I think we just wanted to give doppel all the authority that it needs, uh, is probably why there's so much, um, so much authority there. Um, but I don't if it would, um, yeah, I mean, I, I don't think it's as, uh, critical to the bill. I just, um, I think that's more to assuage any concerns that, um, there would be, um, under regulation by Doppel. So,

So if, if there's more of a standard that we can use, I'm not opposed to changing it to the industry standard or the Doppel standard or whatever the standard is. I just don't know what the standard is.

Thank you. Yeah, Mr. Chair, I don't know if we have anyone from Doppel who's here or might be able to speak to this, but it, it does seem maybe a little bit out of the norm to give such broad making authority. Got I

Yeah. Thanks. Just one, one last bite at the apple here. Um, c could you speak to, to injuries? What, what's the potential harm from acupuncture? I mean, that, that, obviously, you know, it doesn't happen all the time, but to know the severity of potential injury, to know what it is that we're authorizing. Could you speak to that?

Yes. Um, and this is something that Jeff was, Jeff Shumway was specifically gonna talk about. Um, if you took the stand for us, um, there's essentially two, uh, really only two major adverse events from acupuncture. The first, um, is a pneumothorax. So you puncture a lung if you are, um, placing needles recklessly. The second injury, uh, is no longer a concern with the use of single use sterile needles, which has been standard since the eighties. Um, and that was, uh, hepatitis infection or other, um, bloodborne pathogen. So, uh, there have been no reports of hepatitis infection using sterile single use needles as we use. So that's a non-issue. The only issue that does come up is, um, pneumothorax. Um, and essentially, uh, it's so infrequent and so rare by properly trained acupuncturists that it's hard to find reports. Most of the reports are, um, people untrained people, you know, in rural areas, uh, providing acupuncture when they shouldn't be. Um, it is, uh, speaking from experience, it is extremely hard. Um, just knowing basic anatomy, it's extremely hard to cause a pneumothorax.

Uh, are, are the single use needles? I mean, I don't see that in this code. Is that required somewhere that,

Uh, it's simply you can only buy single use sterile needles. It's not, um, the reusable needles are no longer manufactured.

Thank you. Vice chair and members of the committee. Um, my name is Tuesday Wasserman. I am a licensed acupuncturist in the state of Colorado. I have been licensed in Washington states and New York states. I have been, um, an acupuncture educator for 10 years, and I was the formal director of the program at Pacific College of Health and Science. Currently, I am, um, a staff member at the N-C-C-A-O-M, or as previously recognized as now the N-C-B-A-H-M. And we're the organization that manages the testing and certification for licensed acupuncturist in the United States. Um, um, being a Colorado resident, I absolutely appreciate rural access, rural training and ensuring that, um, the public has proper care to acupuncture. Um, there are a few points that I heard that I would like to clarify, including when it comes to national standards. Currently, the N-C-C-A-O-M board exams or certifications are required in 46 states and the District of Columbia. When we met with Director Shwe, I had, um, a different understanding of their opinion and recommendation. My understanding was that dole's recommendation for alternative pathways to licensure was to utilize N-C-B-A-H-M, the apprenticeship route, which does require some formal education in addition to apprentice apprenticeship for certification. And the reason for that being acupuncture is very different than massage. Massage is a nine month program hands-on where they're not using invasive tools, where acupuncture is an invasive medical procedure where not only do we have the risk of puncturing organs, but also of permanent nerve damage. And, um, I do agree that pneumothorax is very rare when performed by qualified licensed acupuncturist, but the term qualified licensed acupuncturist, uh, across the country represents, is, um, that term has to do with acupuncturists having the proper education in anatomy in physiology. And you'll notice with certification that also requires supervised clinical training hours and supervised clinic practice. And so when someone, um, is certified by N-C-C-A-O-M, they have four examinations that they pass, including acupuncture and point location regarding safety, including, um, foundations of herbal medicine, which is the East Asian component you're talking about. And that's the theory acupuncturists use to diagnose and treat according to the pathologies. Uh, patient may be entering in. Um, and then there's also the biomedicine module, which of course is the most important module for understanding pathways when it comes to appropriate referrals, when it comes to safety, when it comes to OSHA and bloodborne diseases and communicable diseases. Um, and the most important when it comes to public safety is recognizing those red flags. Certainly when I've lived in rural communities, we have one or two local doctors, and sometimes that's the acupuncturist and needing to recognize when pain is related to cancer as opposed to typical low back pain. So we can make appropriate referrals. That is part of when what one gets in the standard ACOM education approved schools. Um, and so when it comes to approving schools, it is not a state level approval. There are, there is regional accreditation, but all acupuncture schools and education are approved by acom, the Accreditation Commission for Acupuncture, because it is a specialized, um, training and niche training. And while I recognize there are no schools in Utah, there are more than 50 acupuncture schools in the country. Um, and so when it comes to access, my biggest concern with this bill is appropriate access to a qualified practitioner who is going to ensure public safety and not cause harm. It's true that we have a very safe, um, record as acupuncturist, but that's because licensure across the country requires graduating from an ACOM accredited school. There are very few pathways to the apprenticeship route. We've actually seen more and more states phasing them out due to safety concerns than adding them back. So when we met with Doppel, my understanding was they were going to recommend a pathway for the apprenticeship route to licensure. So that N-C-C-A-O-M certification is still attainable. They, um, anyone who goes through this path of apprenticeship has some formal education, it's limited to one year instead of four years, but they have demonstrated that they have the appropriate supervision, the appropriate training, and then by passing that certification that they are, um, not going to be a risk or a danger to the public. And so, I, I would like to hear more from DI Director Sheway on this and LERs recommendations personally. Okay. And I'm available if you have any questions. Thank you.

All right. Can you hear me okay? Yes. Okay. Thank you. Um, my name is, uh, Ty Hal Liu. I'm a licensed acupuncturist here in Salt Lake City, Utah. I've been practicing here for 18 years, and my family has been here for 50 years in Utah. My father was one of the first licensed acupuncturists in Utah from Taiwan. But my, my main concern about it is to keep the, the, the same level of certification that, uh, N-C-C-O-M offers that level, and that, that, uh, the same hours and everything, all that N-C-C-O-M, uh, requires. The reason is, if we lower that, then just that educational competency, all of that becomes lower. I'm all for, like, having schools here. I, I get a lot of people calling if we, if we teach acupuncture, if we have schools, anything like that. I've actually been a, a mentor or like a, a preceptor with this, A-N-C-C-O-M. I've had, uh, people that came to my clinic have followed me, uh, for clinical training and to be able to have enough clinical training to take the N-C-C-O-M test. And so I think that is the most important thing, is that, uh, that we keep that standard. That is the standard. I've, I, I also served on the DAPO licensing board for seven years, and that was always the standard that we had with education and competency to keep that as the competency for, for licensure. And, you know, if we were to have schools and, and to develop a school, which I think is actually would be really good, is to, to develop one that has that same, uh, educational requirements as what a COM and N-C-C-O-M, uh, they, that they require. And so that's what I, I think that is what is most important just on education and safety. And, and I echo what on Tuesday, uh, uh, mentioned from the N-C-C-O-M too.

Yeah. Uh, so what's your assessment of, um, the availability of acupuncturists in the state of Utah right now? Do we have just the right amount, not enough or, uh, too many There?

So there are more and more. There's a, I think last I've seen from and heard from Doppel, there's around 100 to 150 or 60 that are licensed, but not all of them are practicing. There are those that either practice outta the state, there's licensed with Utah, or some that aren't open. I do think, um, there could be more licensed acupuncturists in that could be hired by like, either clinics or even hospitals and, and that being integrated, um, um, I, you know, we, we get a lot of patients from all over the state. And so sometimes like areas such as, uh, like in the rural areas, tremont up in that area, there aren't as many. And so they would need more, uh, areas like down in like, uh, sub like, price area, those type of areas. Those rural, more of the rural areas, there probably needs more there. Um, but we're still a small group. Like, there's not a lot. And so, and that's where we, as licensed acupuncturists, we also need to be unified to help build it. And I do think, uh, having a school and as to is an appropriate thing, but has to have those educational standards. And, you know, some of my thoughts have been like even having a school up at the University of Utah or working with them, or, or down in Provo, some of the, the, they have an osteopath school down there. You know, just things like that. But because starting a private school is, you know, there's a lot of things you gotta do. And of course, the upfront, the funding and all of that too. But, um, but I think if there was a school, there would be more licensed acupuncturists. There'll be opportunities to expand the profession, to grow the profession, to help with the education, um, and also to have people have like, jobs in, you know, like full-time careers in even like hospitals or clinics or if you wanna start your own clinic.

Hi, sorry about that delay. Can you hear me now? Yes. Thank you. I'm Sharon Lockhart. I'm an acupuncturist in late 10. I've had a practice there for 17 years. Um, in our profession, we do undergraduate degree, and then a graduate degree in either Chinese medicine, which means we're trained in acupuncture and herbs, or a graduate degree in acupuncture. And then we sit for a national board exam that tests our qualifications to pass that. And as Tuesday Wasserman suggested or added, that's, that's, um, in 46 states in this country go by that national suggestion of hours of education and that board exam. The other states either have their own exam or do not have a licensure. So like California has their own exam, Hawaii and, uh, New Mexico, all of the other states, including Utah, go by with the National Association accreditation. According to the hours that this bill is suggesting, it's less than one third of the hours that the National Board exam suggests that we do. It's not enough education, in my opinion. It's not, not not enough education. In my professional opinion. I've been doing this job for over 20 years Here in Utah. We do have acupuncturists, plenty of acupuncturists that are doing acupuncture. We also have chiropractors who are practicing acupuncture, and we have physical therapists who are offering dry needling. So patients do have access to dry needling, acupuncture through, uh, acupuncturist and, uh, physical therapist. I do have concerns about the safety of the hours of this. It's also, Utah would be the, the first state in the country to cheapen the level of education hours. All of the other states go by a national certification. So I would ask you for the personal safety and the esteem of our education and field to vote no on this bill. It would be fine, in my opinion, to bring on a school here in the state of Utah. That'd be great, but at least keep it to the national hours. This is less than one third of the national suggestion of education. Thank you so much.

Yeah. Thank you, Mr. Chair. So you mentioned that there are plenty of acupuncture. What's, what's the wait time currently for you? A patient, a new patient to get an appointment with you?

I see new patients all of the time. I did. Um, yeah, I've never had a, a waiting period, so

Like, just I could get an appointment with you tomorrow. Yes. Okay. Great. Thank you, Mr. Chair.

Please do. I, I would invite you to come in so you can experience it. It works for a lot of things.

Hi, everyone. Jeff Shumway, director of the Office of Professional Licensure Review. Uh, I'm happy to answer any questions from the, from the committee. I'm sorry, I wasn't there in person.

Thank you, Mr. Vice Chair. Uh, uh, Mr. Sheway, thank you for being here. Appreciate it. Um, okay. So it's very clear in this bill starting with line, uh, 40, um, what the, uh, hours would be required and, uh, representative is that, that those are the hours required for a license here in Utah based on this bill, right?

Well, based on the bill, yeah.

Okay. So my question is, we just heard from a, a practitioner that she thought the hours were way too low. Uh, can you tell us where we're at, uh, Jeff with ler, and are we putting this in, uh, cosmetology or some other place?

Yeah, so, so one clarification. So this is not, we did have a conversation with Representative Schier and, and some others around this, but this is not an LER related bill.

No, I understand that, but I was just curious.

Uh, yeah. So in our recommendation, we are making some recommendations around acupuncture. I think the, the most important thing to say on this is The safety issues that we should be regulating as a state around acupuncture really are two things. One of those is clean needling. So that's just cross contamination, infection, things like that. And the second is around depth. So if you go too deep in certain areas of the body, you can, um, you can puncture organs, right? And that's really the concern. So the state's interest in licensure is always to set a minimum bar for safety. And for us, in doing our review of acupuncture, it became clear those were the two items where you really need safety. Um, my reaction to this, from what I understand of the bill, and again, I, I have not looked at the bill since, you know, since it came out. We had those initial discussions where they asked for our input. Um, I think it's interesting and a reasonable thing to ask if you can teach those safety elements in a shorter course than is required right now in statute and rule. I think that's a reasonable thing to ask. I will speak separate from acupuncture. There is a dynamic in healthcare licensure where, um, from professional pressure and other things, we see, uh, the highest possible degree required. And that represents more, I think, the aspiration for effectiveness and education by the profession, rather than the minimum based on safety. So I think it's a reasonable question to ask if you can educate someone to be safe in less than a bachelor's and a master's degree. I don't know if that answered your question directly.

Yeah, I think so. Um, so I'm going to take kind of what you said, Mr. Sheway, back to the sponsor on these hours that you've indicated. Did were, are they reduced from where it is currently, or,

So there isn't a program in Utah currently For licensure.

Right. So, um, So where are they, where are they all getting licensed? And you, you,

They go out of state And they get

an out-of-state license mm-hmm. That we honor here.

You, that's right. Okay. Yeah. So this is a, a new kind of program, and we were just wanting to implement it in Utah.

Okay. How did you come up with those hours?

So while you were out, we were trying to, to figure out

If you haven't already covered it.

No, we didn't. We didn't. I am not exactly sure, um, where the drafting attorney got the hours. I can comment on the hours, certainly. Okay. Could do you, do you mind if, um, Jamie comments? Yeah.

Um, so there is, um, within the acupuncture community, um, people have been noticing that the hour requirements are creating massive economic disparities where the N-C-C-O-M is making, uh, ample income. The colleges are making ample income, and the students tend to be left with dramatic student debt as a result of the very, very, um, uh, the, the requirements that are put onto the colleges, uh, and put onto the students by the N-C-C-O-M and acom. Um, there are people in the acupuncture community, some of them running accredited programs through ACOM that, you know, that can get N-C-C-O-M, um, certified graduates that are introducing alternative education pathways to acom. So they're working within the system to modify the requirements. Um, these requirements are taken directly from those proposals, which are working to revise the educational requirements through ACOM through N-C-C-O-M. Um, so there is, there the proposal, um, the hours come directly from the, uh, founders of an active acupuncture college that is graduating N-C-C-O-M certified students, uh, or practitioners. And, um, they're simply finding that they don't need the 1950 hours, um, that are required by acom. I would like to also comment that it is not one third of the hours that, uh, we have, uh, it's only a few hundred hours less, and most of those hours have to do with, um, uh, with just the, uh, detail of, um, of sciences. It's not a reduction in the anatomy requirements. It's not a reduction in needling safety. It's not a reduction in disease transmission. It's just a question of if we are unable to order EKGs and lab tests, do we need to learn about EKGs and lab tests? So the, um, it's a, it's a question that's being looked at in the field very actively, and our requirements come from leaders in the field, uh, that we're mirroring directly. So

Is, is it your opinion, uh, then based on what, uh, Mr. Shumway was saying earlier about safety and our desire to issue licenses here in the state of Utah, make sure everybody's safe, do you feel like these hours are gonna be reflective of what needs to be done to make sure patients and our citizens here in Utah are safe?

I absolutely believe that this is a completely safe number of hours. Um, we have hundreds of hours of training in point location in anatomy. Um, you know, we, we are making, uh, we're making sure that the people are graduating with a mature and deep understanding of the procedure of needling, uh, for sure.

Thank you. Thank you.

Oh, yeah. My question Was for Jeff, he can't do it tomorrow. Can we do it next week? Right. Okay. I was thinking, uh, I just forgot that rep, Mr. Sheway is still on board online because we got off on another tangent here. So, uh, Mr. Sheway, um, could you, uh, tell us this proposal is an alternative path. How does it compare to our other goals of making sure that we're working within a competency based framework and not requiring excessive hours and excessive, um, irrelevant requirements? Is this, is this consistent with, are other stated goals that way?

I'll be honest, I'm not sure if I have a great answer for you. You know, as, as, as we've talked about in the past, um, in theory, we like the idea of competency based licensing in practice, it's sometimes hard to administer. So I don't, we did not come to, in our review of acupuncture a great answer on how we might apply competency-based, um, assessment to licensure of acupuncture.

Okay. Great. Thank you. I just

wanna thank you point out, Mr. Chair, if that's okay, um, for Mr. Shumway that the bill has not changed since we talked to him.

Yes, I do. For, uh, Mr. Shumway, appreciate the work that Doppel does. Um, so this committee sponsored HR two that passed the house chamber enter committee, that, that any new, um, licensure would have to sunrise through you and your process first. So this obviously is after the fact, but if this was brought to your, to Doppel, to, um, to Sunrise and to create all the, the statutes and all the rules and recommendations, I think that's, that's what I'm asking you is does this fit in the parameter of what you would end up recommending this, you know, moving forward or, or, or not?

Well, at, at first Reed, I don't believe this would meet the requirement for a sunrise, only because the scope of practice is already protected under the existing acupuncture license. And so in that sense, I don't think it would require, from our perspective that sunrise, if we were approached by a legislator to look at this, we would do that review. And I think we would do, you know, a lot of the questions that have been asked, here are the questions we would ask exactly, where is the safety concern and how does that tie to the training? And are they adequately covered in that training? Do we have exemplars in other parts of the, of the nation or in the world we could point to, to say this is safe? That those are the kinds of, uh, analyses we would do on it.

And so, one more follow up. So do you feel like this one language gives you the authority that you need in rulemaking to be able to, to propose and, and have that in, in your rules?

Well, I, I cannot speak to that. I mean, the rulemaking authority goes to the division, meaning Doppel as a separate office in ler. We intentionally are separate enough from Doppel that we, um, can comment on their operations and their rulemaking. We're not a part of them. So that would be more appropriate for Mark Steinle. I'm sorry to pass the buck, but I don't want to answer on his behalf.

Thank you, Mr. Vice-Chair. I'm going to, uh, make a motion to hold the bill. And the reason representative is there's just a lot of questions here. Uh, we have some new numbers here. Uh, I, I think we need to get more direction from Doppel and perhaps from Mr. Sheway, from ler. Um, we've had, uh, good, uh, comments from practitioners, uh, kind of on both sides of the, the spectrum. So I'm gonna make a, a motion to hold and see if we can work some more of these out. I'm not opposed to the bill at all, but I just think it's probably time to just maybe cool it a little bit and kind of work through a little bit more. Okay. Uh, and that's my motion.

Thank, thank you, Mr. Chair. I support the motion, um, like the, the chair mentioned. I think this is probably the step in the right direction. I, I'd like to see us move towards more deregulation and like Mr. Sheway said, ensure there are licensing requirements, meet the, the minimum standards for health and safety, um, and not be overly burdensome in the way that we are doing that. I, but I, I kinda share the concern that I, I have no idea if this is still too burdensome, if it's not burdensome enough. Um, so as you prepare information to come back into this committee, whether it's this session or you work on it in the interim, and then come back, I'd love to, uh, get a sense of the rest of the United States. How would these requirements compare to other states, um, uh, requirements for licensure. And, um, and then just, uh, I, I raised some concerns earlier about the, the, uh, grant of wide rulemaking procedure. I, I think if we spend a little more time on the bill and making sure that it's right, then we could probably curtail that rulemaking authority. 'cause we wouldn't need it. We would feel comfortable that, uh, what we've put in the statute is sufficient. So those are my thoughts.

May I ask a Question? Uh, uh, Or no? Um, I can ask him after.

Yeah, I, I'd like to speak against the motion to hold only because I'm ready to vote yes. To move the bill out. Um, I don't have any concerns. I mean, it's honestly, the, this is a profession where the risk of harm is minimal. It's like massage therapy. The, the, the risks are theoretical. They're not practical. It's basically, it just doesn't happen. And the benefit is huge. So from a consumer perspective, the benefit is huge. The risk is small. Why make it hard for people who are ready and willing to learn the profession to get in the profession? So I'm, I'm ready to move the bill out as it is today. So I would speak against the motion to hold. Thank you.

Thank you, Mr. Chair. I support the motion to hold. There are still questions in my opinion, we do not want to continue this debate on the house floor. We just don't, let's finish it up in here and get it ready.

So I just wanna say that I don't think you're ever gonna have all of the answers that you want. This is a new program. This is something that hasn't been tried anywhere else before. It's an effort to be innovative and to, to, um, just to help create a situation where we can have more people who are getting the education that they need in order to enter this field without the burdensome over education. And we, all of us who have gone to universities know what it's like to take a whole bunch of class classes you didn't need, and to pay extra money to do that, and to take extra time out of your life to do that. So I would actually prefer to move the bill forward, but I will honor the will of the committee. So thank you.

Thank you. And, uh, I can appreciate your comments, uh, representative. Um, and I think that's why we feel like we should, uh, make a motion to hold is because, uh, I'm not sure we know that these are the right hours. I'm not saying it's burdensome or not burdensome. I just don't think we know yet. And so that will be something that we can help you work with on that. And, uh, if we can do it quickly, we can bring you back in and try and get the bill passed. And, uh, okay. So that's kind of where I'm at. Thank you, Mr. Vice

Thank you, Mr. Speaker and Committee. Thank you for inviting us back. I have a co-presenter who is online, Lisa Lander. Um, we are very quickly going to cover the concerns that were raised last time with this bill. One of them was the safety issue, and then where did the hours come from. I also have Hannah Online who is going to tell her own personal experience with trying to get acupuncture education. And we're gonna go very fast. So if you wanna bring Lisa on, we'll start with her.

Yeah. Thank you. Can you hear me? Yes. Okay. Uh, my name's Lisa Ter, and I'm a licensed acupuncturist and the founder of a non-profit accredited acupuncture school in Oregon, the Oregon College of Community Acupuncture. Before I founded a school, I was an employer of acupuncturists and a cooperative with other employers. We started our own school because we wanted to try every possible strategy to contain costs for students. When we started in 2014, our program had the lowest number of hours required for entry level, which was 1,905. But over time, we realized we could trim the curriculum further. We recently proposed a 1,350 hour entry level program to our accreditor, which is the same number of hours that HB 2 0 2 is proposing. So I wanted to give some context for those hours. If you look at many different kinds of healthcare trainings, there's a consistent requirement for 500 hours of supervised clinical internship. And in our experience, 500 hours of internship is sufficient. The clinical internship is where the core learning happens. Patients are always the best teachers. So then it's a matter of figuring out how many didactic classroom hours are required to get students ready for that internship. And for instruction in acupuncture diagnosis, treatment, and required and, and related techniques, 450 classroom hours is sufficient. In addition, we require students to take two semesters of anatomy and physiology, and we also include classes in red flag referrals and communication with biomedical providers so that students understand when they need to refer out for safety reasons for a total of 225 hours for biomedical topics. Overall, it works out to the 500 hour internship. Takes up about 40% of the program with didactic classes taking up the remaining 60%. And the goal is to get students to the point that they can practice safely and competently without supervision. Teaching acupuncture safety does not require thousands of hours. It's actually quite straightforward to address important topics like needling depth, clean needle technique, bloodborne pathogens, and possible adverse events. The most important part of teaching safety actually happens within the supervised internship when students get hands-on experience in safe practice. I'd like to address the role of the Nick Balm credentialing exams from my perspective as both a school founder and employer. In fact, we have a student in our program who will graduate this year, who has a job waiting for her at an acupuncture clinic in Salt Lake City. And I can testify that unfortunately, the Nic Balm credentialing process functions only as a barrier for her and for her employer. Those tests do not measure the most important skills and competencies that she acquired in our program. While the intention behind the Nic Balm exams may be public safety, the impact is anti-competitive. I know multiple acupuncture employers, including my own clinic, who've had to wait to fill positions because qualified candidates had to spend up to a year along with thousands of dollars to go through the Nic Balm credentialing process. So, thank you for considering licensing law reform for acupuncturists in Utah.

Thank you, Lisa. Thank you, Lisa. And can we have Hannah tell her experience quickly as the, the rest of our presentation, and then we'll go to

Hi, um, my name is Hannah Gortman, and I'm a licensed acupuncturist in Utah who supports HB 2 0 2. Um, I believe this bill will make acupuncture schooling more accessible without affecting safety standards. In 2019, I moved to Salt Lake City from Ohio, specifically for an acupuncture job, and I have stayed here since. The thing is, after graduating from school, I couldn't find an employer that offered an acupuncture job with a salary, health insurance pay time off. It's a pretty rare thing in the acupuncture world, but I happen to find it here in Utah at a really great clinic. Acupuncture is a viable career. The demand out there in the public is there, but the structure for graduates to succeed is not the bill. This bill makes meaningful changes to set the stage for more graduates who are not burdened by so much debt and are ready to enter directly into jobs and start helping people in the community feel better. A note about the Nick Balm test to, um, reinforce kind of what Lisa said, while they're well intentioned, they act as a significant hurdle. As an example, while I was a manager at the acupuncture clinic, I moved here for, we had two prospective employees who were done with school ready to practice. And while we wanted to hire them, we couldn't because they needed to complete them Nick Balm exams. And due to the cost of the three exams, the time intensive reality of having to study for them, it took each of them more than a year to complete. In that time, they could have been working at our clinic with this bill outlining dapo, the ability to craft an entry-level exam, focusing on safety, clean needle practices. I'm confident newly licensed acupuncturist in Utah would be practicing in a competent and safe manner. Thank you so much.

Thank you, Hannah. Thank you. That's our presentation.

Thank you, Mr. Chair. If I may ask a question. When a student completes the program and becomes licensed, what degree do they have? Is it a bachelor's? Is it a master's? Is it a certificate?

I'm gonna let, what's that terminal degree called? Lisa, can you go ahead and answer that, please?

Absolutely. I can speak to, um, in, in general, there are different, depending on the school, um, at this time, the, the general requirement for entry level is a master's level program. Um, and so some schools actually provide master's degrees. My school provides a master's level certificate, but 1,350 hours is pretty consistent with master's level training.

Thank you, Mr. Chair. I, I have a question. Well, a couple questions if I might. Um, why are, why are we deleting the current standard that we have in statute, or at least from your sub, from your first bill to

Sub? Oh, from the first sub. Um, because we had questions about whether that was transferred directly from the massage therapy code. Okay. And we had questions about how applicable that was to acupuncture. So we reframed it specifically for acupuncture. Okay.

And how do you prove the hours? How do you prove that you've complet the eight completed, the hours, the hours Go to Doppel? Or who would that go to?

Um, Lisa, do you have the answer for that question? Doppel oversees this, so they would have to do, they would have to do the verification, but do you, do you have an answer for that?

Every state is different. In Oregon, we are overseen by, um, the Higher Education Coordinating Commission. So the school has to have a license. And in order to have our license, we have to be, we have to be compliant with, you know, consistent hours. And the program is consistent. I do have somebody who has the answer who is online. Would you like them to answer or

Jamie Moha ball. Jamie Moha.

Yes. Um, so in the state of Utah, it's, uh, it would be very similar to the way that massage therapy is regulated in that DOPPEL approves the curriculum.

Oh, sorry. Yes, I'm in, uh, I thought you might remember me from last time. Sorry. Uh, I am an acupuncturist in the state of Utah, um, and I've, um, I've been working closely with Representative ch on this bill,

Sorry. Uh, my name is Jam. She Moha Bali. And I have a lot of nicknames, so.

Thank you, Mr. Chair. I may ask a follow up question to the previous one we just had for the program. What is the name of the accreditation body that oversees these programs

Nationally? It's the Accreditation Commission for Acupuncture and Herbal Medicine.

Thank you. Would that, would that apply to the state of Utah as well, or is there a specific regional or specialty accreditation?

My understanding is that the goal of HB 2 0 2 is to shift that responsibility to doppel, which I would endorse. I think that makes a lot of sense.

Okay, great. Yeah. Hi, I am Ryan Hofer. Um, I'm a naturopathic doctor in Oregon, and I am also a board member of the Oregon College of Community Acupuncture. Um, so I was really, um, excited when I learned about this bill. I want to give some, I guess, pragmatic considerations. Um, currently orca, um, the Oregon College of Community Acupuncture is, um, graduating licensed acupuncturist for under 25,000. That's the tuition we try to stay under, because we think that's realistic first year net income for a new acupuncturist. Um, and you can contrast this with master's degrees that cost a hundred thousand dollars at, um, other programs. Um, in the recent RISE committee, the Department of Education predicted that, uh, 98% of alternative medicine master's students, so these are acupuncture students, 98% of these students are in programs that will fail the July, 2027, do no harm earnings test, where they compare master's degrees earnings with bachelor degree earnings. So 98% of students are in programs that will fail. That will mean those programs will need to, um, well, they'll, they'll, they're in danger of having their federal student loans, uh, cut off. Um, so we're looking at a real crisis in the training pipeline. And so, um, this bill would allow, um, sensible, uh, some innovation towards sensible, affordable credentials so that there's not a big, um, scramble and gap in the training pipeline for licensed acupuncturists.

Hello. Good afternoon.

Confirmation you guys can hear me. It sounds like you can. We got you. My name is Andy Zamore. I'm with Diplomat of Acupuncture, and I came across this, uh, this new bill that's coming across, and I'm opposed to it. And I would like to let, uh, give my experience to the reason why I'm opposed to this bill, um, further lessening our education in acupuncture. I don't think it's gonna be something that's gonna help the acupuncture. Uh, uh, well, not just business, but the acupuncture of field is, is gonna make it probably gonna lessen the field a little bit more. What I'm coming across through my experience is clients getting acupuncture from people with less hours than the Master's program and the N-C-C-U-M, um, have recommended. And the stories that I come from are mostly like injuries. We're having clinicians with left with less hours performing, acupuncture, injuring, uh, uh, patients, which is, uh, a big, it's a big in my book because acupuncture, as I know it, it through my experience is one of the few modalities out there that can help people with any type of drug addictions or people who have suffered from, uh, chronic pain. Having been able to find that, that relief from it. If you give, if these people go to inexperienced acupuncturist, they're gonna think that acupuncture isn't as effective, whereas opposed to someone who spent

Okay. I think you can hear me now.

Sorry about that. My name is Kim Darger, and I'm in St. George, Utah, but I grew up on the Wasatch front. Alright, Go, go ahead. Okay. Um, yeah, I'm in a Utah resident. I've received acupuncture treatment for several decades now, and so I feel like I have firsthand knowledge of the difference that a highly skilled practitioner can make. And I'm here because I'm concerned about the proposed legislation that would lower the requirements for performing acupuncture in Utah. Um, several years ago, I was, you know, experiencing a significant nerve pain event, and I was receiving acupuncture. And before placing the needle, the practitioner was being describing exactly how precise the location needed to be and the depth and everything, and the structures that were nearby. And that was when I realized how much training and anatomical knowledge needed to go into this. And over the years since I have realized that it's not just putting needles into the body. It is a whole complex medical system that requires a strong understanding of anatomy, physiology, diagnosis, and Chinese medical theory. And because the needles are inserted at certain depths and locations, you can do long-term harm if they're improperly placed. But my question is, if educational requirements are lowered, how will we as patients readily know the difference between someone with thousands of hours of medical training and someone was significantly less? Honestly, most patients will reasonably assume they're receiving care from someone fully trained. And if the treatments don't work, because the training just isn't there, it doesn't just affect that person. It risks undermining the entire profession.

Thank you very much. Can you hear me? Yes. Okay. Thank you very much. Um, Mr. Vice chair and members of the committee, my name is Tuesday Wasserman. I'm a licensed acupuncturist and a practitioner. I'm here on behalf of N-C-B-A-H-M. Um, but beyond that, I have worked in hospital settings in neurology and orthopedic rehabilitation, labor and delivery and oncology. And I have significant concerns about the safety of reducing education standards. By half of that, which REC is recommended by acom, the current accrediting body for schools currently, there is no pathway to accreditation through ACOM with this legislation or for certification. This, again, it's half the standards for certification that would demonstrate safety competency and that ability to cause no harm. And my concern is that acupuncture can cause things such as permanent nerve damage, um, injury to the lungs and organs. And with that risk then, um, like Kim was saying, the harm to the public. You have increased costs increase in people applying for disability, unable to return to work, and beyond that healthcare standards, um, for us, it's all about public safety and protecting the public in Utah. So if you have any questions, I'm here. Thank you.

Speed there. And audio. Hi, I am Pete Meyer. I am a citizen of Weber County. Um, I'm here in opposition of the bill proposed in the house. I have received acupuncture over the years, and I am with the last caller with, you know, do no harm. We need an oversight, and you need state oversight, board certified acupuncturist doing this kind of work on patients. There is a lot of things that can go wrong accidentally with needling the depth, like other callers have said. And we need board certified acupuncturists operating in healthcare in the state of Utah. So I'm opposed to this house. Bill, thank you very much.

Elaine. Um, sorry, my name isn't Ty. Somehow my computer was signed into his, I am, uh, the office manager at Master Lu Health Center. Um, I'm also a patient at, uh, we at Master Lu Health Center. I hope that doesn't confuse things.

Uh, my name is Ty Hall. Lou, I'm in, I'm in Salt Lake City, Utah. I'm a licensed acupuncturist, and I did, um, I did testify the last time as well, but, um, I really think I opposed to HB 2 0 2, uh, I really think that, um, the training level needs to be at the high standards for safety. Not only does the acupuncture, like if you have undertrained acupuncturists doing the acupuncture, you can have pneumothorax. Of course, that's one of the things that can lead to death. But also things like nerve damage. You can have, um, muscle tissue damage. Uh, you can also do things like incorrect diagnosis causing somebody to go into labor, uh, when, and having a miscarriage if you are to do things improper. And so we need those higher standards plus portability. If, if we have lower standards and they're not able to sit for the national board exam and someone wants to move out of Utah, they won't be able to get licensed in anywhere else because of the portability. And we have that national standards for a reason.

Thank you, Mr. Vice Chair. Uh, thank you for coming to testify today. If the, if this legislation did have a training requirement that matched the American College of Acupuncture, would you be supportive of it?

So it has to match the, um, has to be accredited with our national accrediting body, with the, the acupuncture accrediting college. It used to be A-C-C-A-L-M. And they, they're the ones that accredits all the universities and colleges across the us, including the one that, um, Lisa that just that they, they run the college up in Oregon, and so they have to get accredited by that. And, but the thing is also, they have to have the standards of the national board exam standards, too. And so there's two different, like the two different accrediting bodies that are nationally, uh, accredit, you know, third party accrediting the colleges and universities as well as the taking the national board exams. And you have to have those hours to take the national board exam. You have to at least have 1,905 hours to be Able to sit for that exam.

So, I'm sorry, sir. So my question is simply yes or no. If these requirements match those national accreditation to be able to sit for those board exams to get certified through that national accreditation, would you be supportive of this bill

On par? If it, if it, I, I would, if it is, if it sits for, if it has those standards. Okay. Thank you. If it's bill those standards, it cannot, I would oppose that.

No, not at all. So, PTs with the dry needling, they've only gone through 54 hours of training. And there's actually been documented cases, um, of, of people having pneumothoraxes, uh, a lot of nerve damage. Uh, just with an un just in inadequate training and learning how the needle, how deep the angles, especially with the deep needle, like a lot of the PTs will do the deep needling. And, and there, there have been pneumothoraxes in that sense and a lot of nerve damage and injuries. And so they only go through that 54 hours of, of needling training.

Hello, It is now. Hello? Hello. Okay. Hi. My name is Michael Berger. I'm a licensed acupuncturist here in Salt Lake City. Uh, been here for 13 years. I'm also licensed in the state Of Florida where, hello? Apologies. Go ahead. Oh, Uh, licensed in the state of Florida where I'm an acupuncture physician. Note the title. We are regulated by the medical board as other states are about six states in the nation are regulated by the medical boards as it should be here, in my opinion. I'm also a subject matter expert for the last 10 years representing the, the na, our National Certification Board that was referenced by Tuesday and by Ty Hal. Um, I was trained entirely in China. I had 10 years of education. I work for the Utah Youths Football team, and I also work for the VA hospital treating our, our great veterans. I'm strongly opposed to this bill. I've been in hospital sittings and treated up to a hundred patients a day in China, where most of the physicians there are also required to pass a medical doctor exam. These hours are insufficient, in my opinion. There are many, many other kinds of dangers besides needling. There are many non needling consequences. There can be misdiagnosis, there can be disease progression, there can be mistakes in diagnosis that lead to even fatalities. So I'm strongly opposed to this. I also was the former president of our association here. We have about 40 people that have been communicating on our list here locally. None of us were even aware of this other organization that was started by Mr. Ani, um, that he purports to be the, um, acupuncture Association of Utah. I don't know if he has any members. None of us were ever contacted and consulted. So thank you. That's my opinion. Thanks for having me.

Thanks. Hello, my name's Amanda Valenti, and I'm a licensed acupuncturist here in the state of Utah. Uh, I've been in private practice for 10 years, and I've also worked in oncology for the majority of my career. I'd like to briefly share a real patient experience that shows why medical training matters in this case. I oppose this bill clearly. Um, I had a patient that came to me with generalized low back pain during a standard orthopedic exam called a straight leg graze. I ruled out common causes like disc herniation and nerve impingement. After my exams came back negative, I decided not to treat him. And instead, I referred him out for immediate imaging. The image, the MRI revealed, he had advanced metastatic bone cancer. His back pain was not muscular. His spine had been breaking from cancer. Without proper diagnostic education, this could have been treated as a routine back pain with no relief. More importantly, his cancer diagnosis could have been delayed. Licensed acupuncturists work as people's primary care providers, and they are trained to assess, recognize red flags, and refer when something is out of our scope. I oppose this bill for many reasons, but I think that sharing these firsthand experiences about our patients and the cases that we do see on a regular basis can help you to see why it's so important that we have extensive training. Thank you.

You so much. I'm Sharon Lockhart. I'm a licensed acupuncturist in Layton. I've had a clinic in Layton, Davis County since 2005. I strongly oppose this bill. This brings down the training requirements. It's bypassing. Sorry. Will you bring the, your mic a little bit closer? Oh, yeah. Can you hear me now? Yes. Okay. So, I'm Sharon Lockhart. I'm an acupuncturist in Layton, Utah since 2005. I strongly oppose this bill. It brings down the, the requirements for training in the state of Utah will make state of Utah the least amount of training required in this state. This bill is bypassing the national certification, the national certification that attest that we all have to take to, to practice in 46 states is a reasonable exam. Three other states have their own exams, California, New Mexico, and Hawaii, which are much more astringent, much more difficult examinations. This bill is bypassing a national exam to make sure that they're trained. So there's nothing in here for the exam. It is, it's gonna be confusing to the public. They're not gonna know who is medically trained and who is not. There are no jobs here for acupuncturist, none. Zero. You can go on Indeed right now and look for yourself zero jobs. So that means when we have to start our own practice. So when you're in practice, you might be by yourself. And if there's a medical emergency, you may not know what to do unless you've had real medical training and acupuncture or Oriental medicine. Um, just like Ty House said, it's not just that you can nick a nerve, permanent damage. You can cause a miscarriage in a pregnant woman. A pregnant woman who may not know that her baby is at risk, could get acupuncture from an unqualified, uh, practitioner and suffer a miscarriage. There could be legal ramifications from people being injured, losing their babies. Thank you for your time.

I moved that we adopt the first substitute.

Yeah, I would. I I do appreciate everyone's comments. Um, and I understand there are some concerns, but at the end of the day, uh, we're talking about a, an opportunity for people in our state to be able to gain skills and to be able to help people. And so, why overcomplicate it? Why make it so burdensome? I read through this, I talked with the sponsor. I think this is a fair compromise. I I do have one change that I would like to make. So if this is adopted, I have an amendment. But in general, I, I'm, I've come a long way on this topic, and I, I think this is a reasonable way of dealing with it. So I would appreciate adopting the first sub.

Yes. I, I, are you asking if I agree with the amendment?

Um, no. I think the sub, well, just that the substitute is a better, um, iteration of the program than the original, just because we made changes from, it was massage therapy code, and now this is specific to acupuncture. Uh,

Okay. So there was mention of a pro of people getting certified with fewer hours. There is no program in the US for certifying acupuncturists with fewer hours than the accredited programs that these people have mentioned. The only thing they could be referring to is chiropractors and physical therapists who are doing this as a second layer on, on their chiropractic or physical therapy. Acupuncture is inherently very safe. It is not super easy to hurt people. The proposed program focuses on safety and accurate procedure, and includes 71% of the hours, not 50% as, as was stated in some of the comments, but with much less cost. Accreditation with existing schools costs hundreds of thousands of dollars. There is a demand here for acupuncture. We are putting this under doppel. And the, the, the, the program will be approved by Doppel. And I think this is an opportunity for Utah to innovate and, and set an example of innovation and, um, and help a struggling, uh, modality to succeed. So, thank you for your time.

I'll waive on this motion. Okay.

Thank you. I'd like to move the amendment that's in my name.

Yeah, just so that the committee, in case you can't see what it does, it, it replaces the word East Asian with the word relevant. Uh, so in describing medical theory, not everybody who, uh, is practicing acupuncture is interested in traditional Chinese medicine. That may not be relevant to everybody, but medical theory is important. So this would allow the student and the school to agree on what type of medical theory is appropriate, whether that's West, western tradition, Chinese medicine, or something else. And so that simple change would, um, create more options for more opportunity for people.

I'm all out of order here, I guess. So we've adopted yourself. I'm, I'm fine. I don't need to say anymore. Thank you. Okay.

Waive as well. Okay.

Thank you, Mr. Chair. I move to favorably recommend.

I think, uh, I think collectively have already understand exactly what we're trying to do here. So I, I'll waive anything further comes,

Yeah, I, uh, appreciate the presentation and the additional information that was shared here today. I think that was helpful to, to hear a little bit more about how they came to the hours. Um, I still am just a little concerned about, uh, you know, ensuring that we've done enough research to know where those lines need to be set. I just, I don't feel assured at, at this point. I think it's something that is, uh, really ripe for review by LER and that they could look at this and come back with recommendations and that we could come and adopt those recommendations. And if maybe that they, they, uh, agree with, um, where this bill is going. It could be that maybe they think we need more hours. Like we heard from many of the public comments and many emails I've received over the last little while. It could be that they think it's even less than's required, but I just, I think there's more work that needs to be done here.

Am I allowed to respond?

So I was gonna say what Representative Teuscher said, I appreciate your work on this. This is actually a, uh, I think a good option to get LER involved and see if they can come back with some professional recommendations.

Okay. Just so you know, LER was involved. They sat in the meeting with me as we were writing the sub, and, and they were helping to suggest the hours and the options and, and the way to lay it all out. So, um, they were involved. Okay. If that helps.

Thank you, Mr. Chair. So, yes, absolutely. So, opular has had done a, in 2025 LER did a periodic review of acupuncture. Uh, and so they shared that report with me, uh, and I have reviewed that very carefully. Um, and I feel like that the, the provisions in this bill are consistent with opal's recommendations. They don't have a position of support or oppose on the bill, but they did provide the, the re the report to help guide this along. The, the, the most important part to me of the report is that acupuncture, relative to all healthcare proficient, is on the extremely safe end. I mean, as with anything, something could go wrong, but, uh, the, the odds in the probability of something seriously going wrong are very, very minimal. And therefore, the most important things are things like appropriate boundaries between the provider and the patient. So, inappropriate touching, proper draping there. Those are far more, um, important than the actual techniques themselves in terms of protecting patient safety. So I think this build is actually a great job of implementing LERs the recommendations from their review. It does focus on proper, uh, consent draping boundaries. Also, the techniques are all covered. And so I'm fairly com comfortable with the, um, provisions that are outlined here. Um, and perhaps, you know, in some world it maybe could be done with fewer hours, but I think this is strikes a good balance. 800, 850 hours is just a little over four months. So it's a reasonable timeframe for people to get that training. So with that, I would encourage the committee to support this bill at this time.