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Michigan's Acupuncturist Registration Law, Historical Perspective and Recent Developments
In 2006 Governor Granholm signed the TCM acupuncturist registration bill, SB351, and Public Act 30 of 2006 was officially recognized by the Michigan Secretary of State's office on February 28, 2006. Public Act 30 of 2006 amended the Michigan Public Health Code to provide for the registration of TCM acupuncturists. The law took effect on July 1, 2006.
Registration is one of three levels of state regulation. Registration is the lowest level of state regulation of a profession with state certification and licensure constituting higher levels of official state regulation. Michigan's acupuncturist registration law is not a licensure law and does not provide licensure to acupuncturists as they frequently claim or post to their websites.
Michigan registration and regulation of TCM acupuncturists provides legal title (name) protection for the use of the words and titles "acupuncturist", "certified acupuncturist", and "registered acupuncturist" and any combination of terms and titles including the term acupuncturist. Michigan's acupuncturist registration law provides the right to use the legally protected term "acupuncturist" but does not restrict the use of the term "acupuncture".
Michigan registration of acupuncturists only applies to TCM NCCAOM acupuncturists and does not apply to practical or medical acupuncture technicians.
The Michigan acupuncture registration law provided title protection for TCM acupuncturists and it also provided regulatory oversight directed at registered acupuncturists and anyone using the term and title acupuncturist. The Michigan Board of Acupuncture working under the supervision and direction of the Michigan Department of Licensing and Regulatory Affairs conducts administrate activities related to the professional practices and conduct of acupuncturists.
If you are using the term and title acupuncturist and you are not registered to do so you are violating state law.
The Michigan acupuncturist registration law had many unintended legal and professional consequences for the TCM NCCAOM acupuncturists. One, consequence has been related to the Michigan Attorney Generals written opinions defining the practice of acupuncture as the practice of medicine and determining that anyone practicing acupuncture in Michigan, whether registered or unregistered, and who is not a licensed medical or osteopathic physician in Michigan, must work under medical delegation and supervision.
In 2007 the Michigan Medical Acupuncture Association working with Senator Wayne Kuiper's drafted a letter to then Michigan Attorney General Mike Cox that contained a series of questions that pertained to the practice of acupuncture and specifically the issue of physician delegation and supervision of acupuncturists and acupuncture technicians (anyone practicing needle acupuncture in Michigan).
On September 27th, 2007 the MMAA received a response letter (addressed to Senator Wayne Kuipers) from the Attorney General's office that outlined and clarified several issues pertaining to the practice of needle acupuncture in Michigan. The MMAA has provided this information and the practice requirements outlined in this AG letter to its membership along with the strong recommendation that anyone practicing needle acupuncture in Michigan adhere to the well-defined and specific requirements cited in the AG's letter.
In this letter the Attorney General indicates that needle acupuncture is the practice of Medicine as is defined by the Michigan Public Health Act, and that the practice of needle acupuncture by non-physicians requires physician delegation and supervision. The elements that constitute valid physician delegation and supervision are defined in the AG's letter to Senator Kuipers.
The MMAA continues to require, as a part of its code of professional ethics, that its members strictly conform to Michigan law and that they acquire medical delegation through a written, digital, or well documented verbal prescription or physicians order to perform acupuncture. Such documentation must be provided for ALL patients that receive needle acupuncture and this documentation must be maintained as part of the patient's medical record. What follows is an excerpt from the Michigan Public Health Code, Section 16215 of the Public Health Code which provides, in relevant part:
(1) Subject to subsections (2) to (6), a licensee who holds a license other than a health profession subfield license may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the licensee's profession and will be performed under the licensee's supervision. A licensee shall not delegate an act, task, or function under this section if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the licensee under this article. (2) Subject to subsection (1) and except as otherwise provided in this subsection and subsections (3) and (4), a licensee who is an allopathic physician or osteopathic physician and surgeon shall delegate an act, task, or function that involves the performance of a procedure that requires the use of surgical instrumentation only to an individual who is licensed under this article. A licensee who is an allopathic physician or osteopathic physician and surgeon may delegate an act, task or function described in this section to an individual who is not licensed under this article if the unlicensed individual is 1 or more of the following and is directly supervised by a licensed allopathic physician or osteopathic physician and surgeon who is physically present during the procedure: * * * (3) Subject to subsection (1), a licensee who is an allopathic physician or osteopathic physician and surgeon may delegate an act, task, or function as described in subsection (2) to an individual who is not licensed under this article and who is 1 of the following: (a) Performing acupuncture.
M.C.L. § 333.16215(1)-(3).
The second part of the Michigan Public Health code law requires medical supervision of non-physician lay persons and/or allied health personnel who perform needle acupuncture. There are many well established legal and medical precedents that pertain to the supervision of allied medical personnel within the health and medical field and these include the historical delegation to, and supervision of nurses, physical therapists, and medical assistants.
The Michigan Public Health Code, Section 333.16109 provides the following language regarding physician supervision:
(2) "Supervision," except as otherwise provided in this article, means the overseeing of or participation in the work of another individual by a health professional licensed under this article in circumstances where at least all of the following conditions exist:
(a) The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed health professional.
(b) The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records, and to further educate the supervised individual in the performance of the individual's functions.
The best means of insuring compliance with all of the requirements outlined above is to execute a written Delegation and Supervision agreement or contract with a medical or osteopathic physician holding a current and valid Michigan license to practice medicine.
Historically, the practice of physical therapy is an example of how allied health personnel have been supervised by medical physicians. Standard operating procedure required a written (prescription) or documented verbal order along with ongoing communication between the physical therapist and the physician which normally was executed through patient reports provided to the delegating physician on a consistent and ongoing basis as would be dictated by normal patient recordkeeping and accountability practices.
Recently, it has been bought to the attention of the MMAA that erroneous information pertaining to the above facts is being disseminated by the Michigan Department of Licensing and Regulatory Affairs (LARA). Individuals employed by LARA have been providing information that acupuncture is a licensed profession in Michigan. In the face of the actual law it is difficult to understand how employees of this department would not understand the regulatory law and the current status of acupuncture in Michigan. The MMAA is planning on reaching out to LARA and to attempt to rectify this situation.
In addition, some students of the Blue Heron Academy and members of the MMAA are reporting that they are receiving direct threats against their practice of acupuncture by registered acupuncturists. The MMAA is presently consulting with its legal representatives in Lansing regarding this matter. If you, as a member of the MMAA, have first-hand experiences related to practice discrimination or harassment by registered acupuncturists, please contact the MMAA administrative office immediately.
As a follow up to the issues presented in this membership communication the MMAA will be contacting you regarding the next membership meeting. As a member of the MMAA please make certain that our administrative office has your correct and current contact information.