March 30, 2020
On March 17, 2020, CMTBC made a strong recommendation to RMTs that they cease practice for a two-week period and re-evaluate the situation at the end of that period. At that time, it was not clear whether physical distancing measures would remain in force past the two-week period.
It is now clear that these measures will extend well beyond two weeks.
On March 23, 2020, Dr. Henry issued a letter of expectation to regulated health professionals, including RMTs (PDF). The first expectation in the letter is that “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.”
The College’s careful review of the March 23, 2020 letter from Dr. Henry concluded that CMTBC must maintain its position that RMTs should not practice, until otherwise notified. Factors that have informed this position include:
Read CMTBC’s March 24 news story to review guidance provided to RMTs about Dr. Henry’s letter. RMTs may contact CMTBC for guidance regarding an “allowable exception” in a case where an RMT considers that treatment of a patient would fully meet Dr. Henry’s criteria – as specified in her March 23rd letter – for “emergent, urgent and/or essential care… to avert or avoid negative [patient] outcomes”.
On March 27, 2020, Dr. Henry presented COVID-19 modelling scenarios for BC that show that public health measures have reduced the rate of growth of COVID-19 cases in BC. However, Dr. Henry emphasized that there continue to be steady increases in community transmission cases and concern about outbreaks, and she and BC Health Minister Adrian Dix asked every person in British Columbia to be “100% committed to physical distancing” and stated that “we must be united in this one goal.”
This is a critical time in BC’s response to the COVID-19 pandemic. CMTBC reiterates its strong recommendation that RMTs not practice unless and until otherwise notified.
As the Provincial Health Officer provides new guidance, CMTBC will interpret that guidance for RMTs. Please check the College’s website regularly for updates.
March 27, 2020
On March 26, 2020, BC’s Minister of Public Safety and Solicitor General Mike Farnworth announced he is issuing a series of ministerial orders under the Emergency Program Act.
These orders cover a wide variety of areas, including consumer protections, goods and services distribution (supply chain), travel, municipal enforcement, and coordination with local governments.
The Minister’s announcement included a “list of essential services in B.C. during COVID-19 pandemic”. That list includes health services deemed essential; one of the paragraphs on that list reads as follows:
“other health services and caregivers (e.g., physicians, dentists, psychiatrists, psychologists, mid-level practitioners, nurses and assistants, infection-control and quality-assurance personnel, pharmacists, physical and occupational therapists and assistants, social workers, mental-health and substance-use workers, including peer support workers, speech pathologists, diagnostic and therapeutic technicians and technologists, counsellors, chiropractors, naturopaths, dentists, crisis centres, outreach workers, overdose and harm-reduction services, meal programs; …”
Some RMTs have contacted CMTBC to ask why massage therapy is not on the essential services list. CMTBC does not know the answer, and has requested clarification from the Ministry of Health and from the Ministry of Public Safety and Solicitor General. We will communicate what we learn.
However, it appears that some RMTs may also be interpreting being on the essential services list as meaning that members of those professions are now able to provide services without any restrictions or limitations. While the College is requesting greater clarity, CMTBC sees no reason to interpret the above list as overriding or superseding the Provincial Health Officer’s letter of expectation to health professionals dated March 23, 2020 (PDF). The core message of Dr. Henry’s letter is that health services delivered by regulated health professionals in community settings, meaning outside the primary- or secondary-care public system, and which cannot be delivered while maintaining physical distancing, can only be delivered if they constitute emergency or essential care, as defined by Dr. Henry.
CMTBC interpreted Dr. Henry’s requirements specifically in the RMT context and provided guidance for RMTs who seek “allowable exceptions”. Please see the College’s news story of March 24 to review the guidance provided to RMTs.
March 27, 2020
A number of RMTs have contacted the College to make suggestions about continuing education credit (CEC) requirements, such as fee relief, or the modification or elimination of CEC requirements entirely. CMTBC recognizes the financial hardship and uncertainty that RMTs are currently facing. At the same time, the College must also factor in additional considerations, including its own viability and financial stability, whether a proposed change is one that can easily be implemented, fairness to all RMTs, and the medium and long-term consequences of any particular course of action.
In the present context – with governments regularly announcing various types of new emergency measures – it is natural to expect that CMTBC is also able to make rapid changes to its existing programs or requirements. However, while CMTBC has done its best to communicate new and critical information quickly, the College operates within a legal framework that requires some changes to be made at the committee or Board level. The College must also follow legal requirements for the drafting, approval, notice, and posting of any proposed new bylaws. Where possible, we will try to accelerate these processes, but we cannot bypass certain fundamental requirements. Please understand that an absence of immediate news on an issue does not mean that it is not being considered, or that work is not being done. Any decisions will be communicated to registrants promptly.
March 24, 2020
On March 23, 2020, BC’s Provincial Health Officer, Dr. Bonnie Henry, issued a letter to BC health professionals (PDF) setting out “expectations for all regulated health professionals in British Columbia”. This letter also addresses RMTs, who as registrants of CMTBC are regulated health professionals in British Columbia.
CMTBC has heard from a number of RMTs who are uncertain about the meaning of Dr. Henry’s March 23 letter, given that CMTBC issued a “strong recommendation” to cease practice on March 17 and subsequently, after obtaining specific direction and clarification directly from Dr. Henry, CMTBC conveyed the “cease practice” order to RMTs on March 21, 2020.
CMTBC interprets Dr. Henry’s March 23 letter of expectation as superseding (for RMTs) her order of March 21, 2020, as it is directed to all BC health professionals, which includes RMTs. The letter directs that “all non-essential and elective services involving direct physical contact with patients … should be reduced to minimal levels” but adds that this is subject to “allowable exceptions”.
These “allowable exceptions” involve “time-sensitive circumstances” and “emergent, urgent, and/or essential care to avert or avoid negative patient outcomes”. If such care is to be provided, the health professional “must assess and screen patients for symptoms of COVID-19”. If the patient is suspected or confirmed to have COVID-19, Dr. Henry states that “health professionals must use infection control practices including as appropriate personal protective equipment.”
In paragraph 4 of her letter, Dr. Henry sets out a number of “principles” that health professionals must consider – together with guidance from their regulatory college – when they determine whether patient care is permitted. Patient care may occur if it is an “allowable exception” to the directive to minimize non-essential and elective treatment.
One of the principles set out by Dr. Henry is the “harm principle”, which asks health professionals to “limit harm wherever possible, taking into account all available alternatives, and the balance of differential benefits and burdens that result.” For RMTs, this means considering the risk of harm that would be created by providing treatment and weighing that risk against the risk that would be caused by withholding treatment.
After careful review of the March 23, 2020 letter, CMTBC’s position continues to be that RMTs should not practice under any circumstances, until otherwise notified. The risk of transmission of the COVID-19 coronavirus appears to be significant, and transmission can happen either from the patient to the massage therapist or vice-versa. Given the serious and potentially fatal consequences of COVID-19 infection, it is difficult to see how the harm principle justifies massage therapy either before a treatment for COVID-19 is developed or before transmission risk is substantially lower than it appears to be at present. Further, CMTBC is of the view that RMTs may not be in possession of what would be considered appropriate personal protective equipment in the circumstances.
RMTs who believe they are in circumstances justifying an allowable exception due to a potential negative outcome to a patient serious enough to justify the risk of harm, may contact CMTBC at [email protected] for further guidance.
Circumstances will continue to change and CMTBC’s position may evolve, especially as new guidance is provided by the Provincial Health Officer.
CMTBC has also received a number of inquiries from RMTs about “telehealth”, i.e. the delivery of health services by means of online or video communication between a patient and a health professional. CMTBC understands that RMTs communicate with their patients by a variety of means and for a variety of reasons, including the provision of services that are adjuncts to massage therapy treatment. To be clear, there is no concern about RMTs communicating with existing patients in this way, or charging patients for such communications, provided they are not billed as massage therapy.
However, CMTBC’s position has been that massage therapy itself (as distinct from adjuncts to care such as homecare), as defined in the Massage Therapists Regulation, cannot be delivered by online means, because it does not meet the Regulation’s definition of “massage therapy”. CMTBC understands that other professions with different scopes of practice, such as the physical therapy profession, are permitted to use telehealth as a care delivery modality. Such permission, however, is subject to qualifications and limitations, and is based on principles developed and agreed upon with counterpart regulators in other Canadian jurisdictions.
CMTBC has committed to continuing to research and study the telehealth issue, and to bring it to the Board for discussion. However, this will be a complex process and will necessarily require some time, so a final decision should not be expected in the immediate future.
March 23, 2020
Provincial Health Officer Dr. Bonnie Henry has issued an important update for regulated health professionals in BC, including RMTs.
The update, issued March 23, 2020, provides expectations for health professionals regulated under the Health Professions Act when providing patient care in community settings.
The update does not apply to regulated health professionals when providing patient care in designated facilities or institutions regulated by the Hospital Act, the Health Authorities Act, the Community Care and Assisted Living Act, the Mental Health Act, or other relevant Acts.
The first expectation listed in the update reads as follows: “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.”
This is consistent with guidance provided to RMTs by Dr. Henry and CMTBC. On March 21, 2020, Dr. Henry ordered that personal services businesses involving close physical contact must close effective immediately. After CMTBC confirmed with Dr. Henry that the order applies to RMTs working in the community, the College communicated to all BC RMTs that they must immediately cease practice.
Dr. Henry’s update outlines allowable exceptions and other expectations of regulated health professionals.
CMTBC is reviewing the update from Dr. Henry and will issue further communications to registrants providing more guidance and information. Check the College website daily for updates, as the situation with COVID-19 is fluid. CMTBC will provide registrants with the most relevant and factual information available.
In her news briefing today, British Columbia’s Provincial Health Officer, Dr. Bonnie Henry, ordered that all personal services businesses involving close physical contact, such as “massage parlors”, must close effective immediately.
CMTBC immediately sought clarification as to whether this order applied to CMTBC registrants.
Dr. Henry clarified directly to CMTBC that her order applies to “RMTs working in the community”. Effectively, that means all BC RMTs must immediately cease practice as of today, March 21, 2020. Any upcoming appointments must be cancelled, and no massage therapy treatment can be delivered until further notice.
RMTs are encouraged to communicate this order to any and all fellow registrants with whom they are in contact.
CMTBC will continue to monitor this situation and will issue further communications as needed. CMTBC continues to operate and will respond to incoming communications as best it can. We appreciate your patience and ask if possible that you contact us by email rather than phone: this enables us to respond more efficiently as staff are working remotely at this time.
This communication is being kept brief due to its urgency. CMTBC expects to issue further communications in the coming week.
March 19, 2020
Standard First Aid and CPR-C (SFA/CPR-C) – extensions for recertification
RMTs whose SFA/CPR-C certification expires before the end of May 2020 are asked to send an email to [email protected] with the subject line, “SFA/CPR-C expiring, unable to recertify/COVID-19” and your full name. CMTBC will retain your email on file. SFA/CPR-C training must be completed hands-on, not online or via webinar. If such training is unavailable to you at this time, CMTBC expects you to recertify once training is again available, and to update your registrant profile accordingly.
“Telehealth” and online options
Can RMTs provide telehealth services (over online/webinar platforms) to their patients and bill for those services as an RMT? The short answer to both questions is “no”.
RMTs’ scope of practice is defined by BC’s Ministry of Health in the Massage Therapists Regulation, from which this is excerpted:
(a) assessment of soft tissue and joints of the body, and
(b) treatment and prevention of physical dysfunction, injury, pain and disorders of soft tissue and joints of the body by manipulation, mobilization and other manual methods.
The words “manual methods” define the profession.
CMTBC recognizes the role of assessment, clinical history, therapeutic exercise, and treatment plans as adjunctive and necessary supports of therapeutic interventions using hands-on, “manual methods”.
Stand-alone services via Skype/Facetime/telehealth/other do not constitute massage therapy as defined in the Regulation, and cannot be offered or billed as massage therapy.
Quality Assurance (QA) and continuing education credits
The current QA reporting Cycle 12 ends October 31, 2020. All RMTs are required to complete the online course on the two new practice standards, on boundaries and consent. Course completion results in 10 CECs. RMTs who require additional CECs and have not yet completed them have two options: to wait and see if practical education courses that are being cancelled/postponed will be rescheduled when it is safe to do so, or complete their CECs via online course offerings. CMTBC’s approved activities list includes many online course offerings; select “professional development” in the search engine bar (default is set to “All”).
Will extensions be provided to the quality assurance reporting cycle, which ends October 31, 2020?
At this time, CMTBC does not anticipate providing a general extension. Many RMTs have already completed their CEC requirements, some are mid-way through completion, and others have yet to begin. Reminder: RMTs who completed CMTBC’s QA survey, administered in the winter of 2018-2019, obtained 7 CECs for doing so, and all RMTs are required to complete CMTBC’s online course on the Boundaries and Consent practice standards, which provided 10 CECs. Please visit the Registrant Portal to confirm how many CECs you need to complete for Cycle 12. This information is provided on the registrant dashboard.
How many CECs do you need?
Your personal Registrant Dashboard in the portal provides this information. You can also read details about the calculation of required CECs on the Continuing Education Credits page.
New RMTs who first registered on or after November 1, 2019 are not required to obtain CECs in Cycle 12.
Registration Examination updates
If you are a student at a recognized massage therapy education program in BC and wonder about timing of the next registration examinations, please refer to the Exam Dates & Locations webpage.
Stay in contact with your education program during the period of isolation and closures. Please know that CMTBC does not regulate education programs; we regulate the profession of RMTs. CMTBC does not instruct the education programs on closures, timing, or other operations.
Financial Relief for RMTs
Some RMTs have asked whether CMTBC will be providing general financial relief to RMTs in the form of fee waivers or reductions, either for registration fees or online course fees. While we understand that this is a time of financial hardship for RMTs, CMTBC is not in a position to do this. CMTBC budgets and plans on an annual basis, and sets registration fees at the level required to cover the cost of operations. Aside from the examination and entry-to-practice process, which is paid for by exam and application fees, CMTBC’s only source of funding is registrant fees. The cost of the online Boundaries and Consent course covers the licence fee per user that CMTBC is required to pay, as well as the cost of preparing and hosting the course.
March 19, 2020
Due to COVID-19 and the need to maintain social distancing, CMTBC’s office is closed to the public until further notice.
CMTBC operations continue. Staff are working remotely, and will continue to respond to incoming messages and queries. We appreciate your patience as we continue to adapt to changing circumstances and a higher than usual number of enquiries.
Many RMTs have asked CMTBC for advice as to whether they should continue to practice in light of COVID-19. The College does not have the legal authority to mandate practice closures or direct RMTs to cease practice. We continue to follow public health principles and guidance provided by BC’s Provincial Health Officer, Dr. Bonnie Henry to inform our advice to registrants and the public.
To date, our advice has been that registrants and clinic owners should do their own risk assessment and determine what is best for individuals, patients and staff.
Today, in light of numerous developments of March 16 and 17, CMTBC now strongly recommends that registered massage therapists who are able to do so suspend practice for a two-week period, effective immediately, and re-evaluate the situation at the end of that period.
While there is no question that massage therapy is a highly beneficial health care modality, it is not a primary or essential health care service. This is an important consideration at this time, when resources are being repurposed and prepared for delivery of extended emergency services.
Whether the benefits of massage therapy treatment outweigh the current risks of providing that treatment is still a matter for the judgment of the individual RMT, informed by the overriding imperative to act in the best interests of your patients at all times. At the current time, CMTBC’s view is that in most cases the risks of providing or receiving treatment (for both the patient and for the therapist) will likely outweigh the benefits.
The College recognizes that decisions being made with respect to COVID-19 come with consequences: personal, financial and ethical. Our recommendation to suspend practice is not made lightly, and we recognize that it may create serious financial hardship for some. Our understanding, based on today’s announcements, is that both the provincial and federal governments are coordinating on numerous issues, including financial relief measures that may be of assistance. More news can be expected in the coming days.
CMTBC will continue to share updates and to make information available on our website’s dedicated COVID-19 Information page. We will also respond to communications from RMTs as best we can, though we appreciate your patience as the volume of those communications continues to increase.
Registrar and CEO, CMTBC
March 16, 2020
Many RMTs have asked CMTBC whether the COVID-19 pandemic means that all massage therapy practice should be suspended. This is a complex question that calls for the application of public health principles to the practice of massage therapy. Also, CMTBC as a regulator does not have the legal authority to order RMTs to cease practice. CMTBC’s approach is that it will both relay and follow the guidance provided by BC’s Provincial Health Officer, Dr. Bonnie Henry, M.D.
CMTBC has created a one-stop information webpage, COVID-19 Information for Registrants. This page will be updated regularly, and CMTBC will continue to send updates by e-blast to its 5,000+ registrants.
Some RMTs have asked CMTBC to speak independently and perhaps in advance of public health directives. Instead, CMTBC has asked whether either the Ministry of Health or the Provincial Health Officer can provide guidance specific to touch-intensive health professions such as massage therapy, in which at least some public health directives (e.g. “social distancing”) cannot be observed due to the nature of the treatment.
CMTBC will share any public health guidance that is provided. In the interim, each RMT has an individual choice to make as a health professional. CMTBC understands the challenges – financial, ethical, and personal – of the choice to work or not to work in this climate. CMTBC’s Code of Ethics is a tool that may help guide RMTs in their decision-making process.
This situation is unprecedented and fluid. CMTBC appreciates that RMTs are looking for guidance at a time when making any decision comes with both risks and costs.
Differentiating between “essential” and “non-essential” health services is not black and white, though it plays a role in decision-making. CMTBC’s position is that there is no requirement for any RMT to continue to provide massage therapy services.
A list of frequently asked questions is currently being compiled. While we have done our best to keep up with incoming questions; please understand however that we may not be able to answer each question individually.
Thank you for your understanding as we all navigate the complexities and uncertainties of the current situation.
Deadlines and timelines
We are aware that some RMTs are currently unable to schedule recertification for SFA/CPR-C prior to expiry of their existing certification. This will be addressed: please check the COVID-19 Information for Registrants web page in the near future for further details. If your SFA/CPR-C expires in the next two months, please send an email to [email protected], subject line “SFA/CPR-C expiring, unable to recertify/COVID-19” and include your name in the subject line.
The same applies to CEC deadlines and timelines; we are aware that many continuing education courses have been cancelled and may be impossible to reschedule. Please consult the approved activities list, which includes many courses that are available online.
March 15, 2020
RMTs are advised to read the latest guidance on COVID-19 (coronavirus) from the Provincial Health Officer, Dr. Bonnie Henry. Read the March 15, 2020 letter from Dr. Bonnie Henry (PDF).
What this means for RMTs
CMTBC will continue to update registrants by email and the College website. RMTs are encouraged to update their email contact in the Registrant Portal, and confirm that CMTBC’s emails are arriving in the inbox and not caught by spam filters.
As a health regulatory college, CMTBC will continue to follow the lead set by BC’s Provincial Health Officer, Dr. Bonnie Henry.
March 13, 2020
Provincial Health Officer Dr. Bonnie Henry has issued an important letter to BC health care workers, clarifying and explaining her advice on travel in the context of the COVID-19 pandemic, and what it means for health care workers and patients. Read the March 13, 2020 letter from Dr. Bonnie Henry (PDF).
If you are an RMT regulated by CMTBC with a patient who may have been exposed to the coronavirus that causes COVID-19 or has symptoms of COVID-19, what are the appropriate infection control protocols to follow, and what are the reporting obligations with this patient?
BC health regulatory colleges, including CMTBC, are receiving an increasing number of these questions from registrants. The following are general guidelines to keep in mind.
The most important resource for BC health practitioners is the BC Centre for Disease Control (BCCDC) website, which offers guidance to health professionals on COVID-19 that is updated on an ongoing basis. The Public Health Agency of Canada website also has detailed information on COVID-19 for health professionals, including the interim national case definition for coronavirus disease.
Both the BCCDC and Public Health Agency of Canada websites provide guidance on infection control.
The BCCDC website advises that anyone concerned that they may have been exposed to the novel coronavirus that causes COVID-19, or are experiencing symptoms of COVID-19, should contact their primary care provider, local public health office, or call 811. If a patient is concerned about potential exposure or is experiencing symptoms, ask them if they have taken the above steps. If not, encourage them to make the call immediately and follow medical advice.
BCCDC advises that the overall risk to Canadians from COVID-19 is low, and the best protection is to take the same precautions as you would during cold and flu season: wash your hands often with soap and water; cover your mouth and nose when coughing or sneezing; avoid others who are unwell; and stay home when you are sick.
The Public Health Agency of Canada also provides advice on being prepared for COVID-19, for individuals, communities (including information on social distancing measures), schools and daycares, and workplaces.
March 3, 2020
CMTBC has received questions from RMTs about the COVID-19 (coronavirus) outbreak and how to respond as health practitioners. So far, questions have fallen into two main categories:
The most important authority for all RMTs to be aware of and to consult is the Centre for Disease Control (BCCDC) website, and specifically the BCCDC webpage for health professionals.
The BCCDC offers guidance to health professionals that is updated on an ongoing basis, including links to the Public Health Agency of Canada website, which sets out case definition and testing guidelines.
Both of the above websites provide guidelines on infection control.
CMTBC has not been advised that it is mandatory for RMTs to screen their patients. However, if the RMT chooses to ask appropriate screening questions, and the patient provides an affirmative response, the RMT should ask if the patient has reported him- or herself to the health authority that corresponds to the patient’s primary place of residence.
If a patient advises that they have not reported themselves to their local health authority, the RMT should encourage the patient to do so.
If a patient who provides an affirmative initial response has reported, or indicates that they will report, no further action is required at this time by the RMT other than to note and retain a written record of their communication with the patient.