Connecticut advisory panel debates removing referral and education rules for spinal manipulation

A Connecticut Department of Public Health advisory committee spent the meeting weighing a request from the state Physical Therapy Association to remove two statutory requirements tied to grade‑5 (high‑velocity, low‑amplitude) spinal manipulation: the requirement that a patient be referred by a licensed provider and the statute’s 40‑hour/manual‑therapy specification for that procedure.

Joseph Gorbicki, speaking for the PT Association, said the technique “is part of every doctor physical therapy curriculum” and is required by national accreditation standards. He told the committee the maneuver is performed without a referral in 48 other states and that modern DPT programs and mandatory continuing education already ensure competence and patient safety.

Opponents urged caution. Matt Pagano, who reviewed historical practice‑act changes, questioned whether current education levels justified removing century‑old statutory safeguards: “I just find it a little strange that originally, in the interest of patient safety, these restrictions were made part of the practice act 19 years ago,” he said, noting differences between older specialty pathways and current DPT training. Mary Claire Capetta, a physical therapist who spoke in favor of standards but cautioned on interpretation of risks, said adverse events are “extraordinarily rare” and mainly appear in case reports, but she agreed exam and history taking are essential to avoid harm.

Several physicians and clinicians listed potential severe, though uncommon, complications tied to manipulation — including vertebral compression fracture, vascular events, worsening myelopathy and missed infections or metastatic disease — and pressed the committee to preserve a risk‑based framework if statutory language is changed. Anthony Yoder of the American College of Physicians asked how clinicians trained before routine DPT curricula would be handled; Kelly Coleman of the Connecticut Athletic Trainers Association and others asked the PT Association to provide proposed statutory text to clarify whether the request seeks to remove a manipulation‑specific continuing‑education requirement or to strike broader education provisions.

Committee members also pointed to statutory teeth already in place. The chair read the law aloud during the meeting: the statute currently requires either an American Physical Therapy Association specialist certification in orthopedic physical therapy or proof of completion of 40 hours of manual‑therapy coursework that includes grade‑5 spinal manipulation; referrals must come from specified licensed providers (physician, podiatrist, naturopath, chiropractor, dentist or APRN).

Supporters framed the request as an access and cost issue. Gorbicki and other PT speakers said allowing direct access for routine cases can speed guideline‑based care for patients with acute low‑back pain and reduce unnecessary appointments. “Under our current scope of practice … I have to stop and say, I’m sorry, I can’t provide that guideline‑based care,” one PT clinician said, describing delays caused by the referral requirement.

The committee did not complete discussion of the second request — allowing physical therapists to evaluate and treat injured workers under workers’ compensation without referral — and members flagged that workers' compensation is governed by a different statutory framework and may be outside the Department of Public Health’s purview. The chair scheduled a follow‑up meeting for Nov. 21 and asked stakeholders to circulate proposed statutory language and any supporting evidence before that session.

Actions and procedural votes during the meeting were limited to internal business. A motion to postpone approval of the meeting minutes failed on a roll call; the committee then approved the draft minutes with multiple ayes and at least two recorded abstentions. The substantive requests from the PT Association were discussed but not decided; the committee asked for clearer proposed language and additional materials before the next meeting.