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COVID-19 Information for Registrants

CMTBC interim guidelines for return to practice

CMTBC communications on COVID-19

COVID-19 screening results – do they belong in a patient’s health record?

July 9, 2020

RMTs have asked CMTBC what they should do with the results of COVID-19 pre-screening obtained the day before an appointment, and the in-person screen results obtained the day of a patient’s massage therapy appointment. Do these screening results constitute part of the patient health record? Check the new frequently asked question posted on July 7, 2020, for the answer to this and other questions about the interim guidelines for practice that reduce risk of transmission of the COVID-19 virus.

BC Enters Phase 3 of Restart Plan

June 24, 2020

On Wednesday June 24, 2020, Premier John Horgan announced that BC is in Phase 3.

BC’s Restart Plan confirms that the guidelines and extra safety precautions for sectors in Phase 2 are still in place. This includes registered massage therapy.

This means that CMTBC’s Interim Guidelines for Return to Practice remain in effect.

Regarding travel outside of BC, safety, vigilance, and discretion is required for domestic travel (e.g., to Alberta and east, or north to Yukon). The restriction of all non-essential travel at the international border between Canada and the U.S.A. remains in effect; it is extended to July 21, 2020.

Updated interim guidelines and FAQs for RMTs in practice – COVID-19 measures

May 29, 2020

Today CMTBC releases an updated version of its Interim Guidelines for Return to Practice, as well as new Frequently Asked Questions (FAQs) about the guidelines.

These updates are based on the feedback provided and questions asked by RMTs since the previous release of the Interim Guidelines on May 16, 2020. The updates also reflect evolving COVID-19 management measures and public health guidance.

The Interim Guidelines are created by CMTBC, assisted by a working group of RMTs and a team at CMTBC’s medical consultant (Iridia Medical) led by Dr. Allan Holmes, MD, FRCP.

Update to FAQs on CMTBC interim guidelines for return to practice

May 20, 2020

CMTBC has updated the Frequently Asked Questions that accompany the College’s Interim Guidelines for Return to Practice to address issues encountered by RMTs returning to practice during the week of May 19, 2020. The updates cover:

  • Mask use by RMTs and the impact of public health guidance issued on May 20, 2020
  • Informed consent requirements
  • Waivers and insurance issues

Read the updated FAQs on RMTs’ return to practice and the interim guidelines.

Provincial Health Officer releases letter about resumption of regulated health care services

May 15, 2020

On May 15, 2020, BC’s Provincial Health Officer, Dr. Bonnie Henry, released a letter to BC’s regulated health professionals (PDF), including RMTs.

The letter said: “BC is now in a position to ease restrictions on health care services beginning the week of May 19, 2020. This is not only to ensure that we avoid the unintended consequences of prolonged delay in access to health services, but to help bring society into a new normal until such time as an effective vaccine is available.”

Dr. Henry went on to state that one element of a safe return to practice is that regulatory colleges provide guidelines for return to practice: “Your respective regulatory colleges have developed a set of guiding principles to help you resume in-person care in both acute and community settings.”

The release of the letter coincides with CMTBC’s release of interim guidelines for return to practice.

RMTs’ return to practice – Interim guidelines

May 15, 2020
 

CMTBC’s interim guidelines are consistent with safety protocols set by WorkSafeBC and with the Provincial Health Officer’s message in a May 15, 2020 letter to BC health professionals (PDF) that “BC is now in a position to ease restrictions on health care services beginning the week of May 19, 2020”. CMTBC continues to refer registrants to BC Centre for Disease Control (BCCDC) – the interim guidelines for return to practice include resources provided by BCCDC, including posters that should be made available in RMTs’ clinics and other practice environments.

CMTBC has submitted the interim guidelines to BC’s Provincial Health Officer and to WorkSafeBC.

RMTs may begin now to prepare for a gradual return to practice from May 19 onward, by following the interim guidelines. Note that May 19 is not a hard date; no RMT should resume practice until they have developed and implemented their own re-opening plan that follows these guidelines.

Highlights from the interim guidelines include:

  • RMTs must develop a plan and share it with patients and colleagues prior to taking appointments.
  • The priority is to minimize risk of transmission of the virus that causes COVID-19.
  • Conduct a COVID-19 risk assessment for your practice environment.
  • Identify actions you will take to reduce the physical, non-treatment-related interactions amongst people in your practice environment.
  • Implement a training and communications plan for your co-workers, to ensure that safety measures and communications are consistent amongst your team members. Your patients need one message from your clinic: that they can confidently receive massage therapy because, of the steps you have taken to minimize risk.
  • You must renew informed consent because the context of care has changed because while it is possible to minimize the risk of viral transmission, it is not possible to eliminate risk.Pre-screening of patients, of RMT/s, and of co-workers for current health symptoms.

RMTs who choose not to return to practice are free to do so. There is no directive for RMTs to return to practice.

Please note that the interim guidelines contain many links to resources on external websites, which are being updated on a daily basis. CMTBC will make every effort to updates links in the guidelines. If you encounter a broken link, please email [email protected] to advise CMTBC.

The interim guidelines apply to CMTBC registrants in British Columbia. Registrants in other jurisdictions must follow guidance provided by the public health authorities in their jurisdiction, and comply with CMTBC Bylaws, Code of Ethics, and standards of practice including the Consent Standard of Practice.

Informed consent required

An important part of the return-to-practice guidelines is that RMTs must renew informed consent to comply with the Consent Standard of Practice. The standard states that “An RMT renews consent when the treatment approach changes for any reason, and revises the treatment plan or creates a new one.”

The treatment approach for all RMTs has changed. The context of care now includes minimizing the risk of transmission of the virus that causes COVID-19, and recognizing that there is some risk involved when patients receive massage therapy. Phase 2 (page 14 of BC’s Restart Plan) specifies that services may resume, but “under enhanced protocols”.

CMTBC’s interim guidelines for RMTs’ return to practice include an extensive pre-screening process followed by in-person screening that must include the patient voluntarily consenting to receive massage therapy, understanding the risk and potential benefit of providing care.

RMTs are required by the Consent Standard to obtain consent in writing. The College recommends you consider sanitizing pens if you are using paper, and sanitizing tablets/screens if you use digital charting and consent forms.

Resuming RMT practice in Phase 2

May 13, 2020

CMTBC has heard from a number of RMTs who have inquired whether they are permitted to resume practice on May 19, 2020.

BC’s Restart Plan (PDF – see page 14) stated that registered massage therapy, along with other community-based regulated health professions, would resume in Phase 2, which is from “mid-May onwards”, and “under enhanced protocols”.

The Plan did not set out a single specific start date for resumption of RMT practice, only that it had to be (1) on or after mid-May, and (2) with “enhanced protocols” in place.

CMTBC has developed  a return-to-practice protocol for RMTs, which is in the approval process and will be posted by the end of this week. RMTs will be required to implement the protocols and to create a return-to-practice plan that is specific to their treatment environment, incorporating the CMTBC guidelines.  Once they have done so, they may return to practice, provided that the guidelines continue to be followed carefully and consistently.

When ready, the protocol will be posted on CMTBC’s website.

Preparing for RMTs’ return to practice in Phase Two

May 6, 2020

Over the past couple of weeks, CMTBC has received an increasing volume of questions about the return to RMT practice: what it will look like, when it might happen, what RMTs will need to consider to prepare themselves and their practice environment, and what is being done at the College to prepare. 

These questions are realistic, and are especially relevant with the release May 6, 2020 of BC’s Restart Plan. RMTs are concerned about the well-being of their patients, and wish to return to their profession and ability to earn a living in their chosen profession. However, RMTs also remain understandably concerned about the risk of transmission of the SARS-CoV-2 virus.

So: how do RMTs return to practice, safely, for themselves and their patients?

CMTBC is hard at work on this difficult question. We engaged a medical consultant to advise and lead a working group of RMTs who are tasked to develop an effective and practical return to practice protocol which is now under development. The draft protocol will be submitted to BC’s Provincial Health Officer (PHO) for approval, prior to release. Ultimately, return to practice will occur under the guidance of the PHO.

More details will be forthcoming when the full PHO-approved protocol is released, but here are a few early indicators and factors for RMTs to consider:

  • PPE: The College has received many questions about personal protective equipment (PPE). However, PPE is unlikely to play a significant role in RMTs’ return to practice. BC’s Ministry of Health (MOH) presented an image of an “inverted pyramid” of the hierarchy of controls, which places PPE at the bottom in terms of importance. (See the Hierarchy of Controls on page 25 of the MOH’s COVID-19 Going Forward presentation.) All other factors matter more: physical distancing being the most important for all in-clinic non-treatment interactions, followed by regular handwashing and cleaning of contact surfaces. Screening, trust, communication and consent will also be critically important elements. Cloth masks may be indicated for portions of the treatment – details will be provided at a later date – but PPE is otherwise unlikely to play a significant role.
  • Practice environment: In keeping with the importance of physical distancing, RMTs should consider how they can modify their practice environments to promote 6’ separation at all times and for all interactions other than actual treatment. Examples to consider and experiment with include – and are not limited to – one-way traffic flow in hallways and through doors (where possible), tape or other physical markers on floors, signage on walls, figuring out what to do about blind corners and washrooms (areas of inadvertent close contact), different ways to safely open and close doors, and contactless payment (including electronic payment either before or after treatment).
  • Screening, consent, and communication: RMTs will be screening patients both at the time of booking and again on the day of the appointment to ensure that there are no current symptoms. Nonetheless, return to practice in advance of either a vaccine or an effective treatment for COVID-19 will involve some added risk, and requires both intelligent risk mitigation and consideration of one’s own – and one’s patients’ — risk tolerance. RMTs should consider how to manage consent discussions with their patients, taking into account the reality of COVID-19, and the potential risk of viral transmission. RMTs who have not yet taken CMTBC’s Boundaries and Consent online course are strongly encouraged to do so before returning to practice – it is currently free, thanks to joint funding by CMTBC and the RMTBC.

Return to practice is likely to be a gradual process, subject to limits and restrictions that may vary as conditions continue to change. 

CMTBC made a strong recommendation for RMTs to cease practice on March 24, 2020, supported by the PHO’s letter of March 23, 2020 (PDF), but did not order RMTs to stop. Similarly, CMTBC will not “order” RMTs back to work. The expectation will be that RMTs who return to practice will adhere to guidance and protocols released by CMTBC and by the PHO. However, some RMTs may assess the risk as unacceptable, and may choose not to return to practice until conditions have further improved.

The decision to return to practice will be a matter of individual judgment. Unfortunately, CMTBC cannot comment on if, when, and how the decision to return to practice will impact CERB and other government financial benefits – these are factors that each individual RMT will have to assess in terms of the impacts on them personally. Similarly, insurance considerations must be considered by each RMT, both in terms of coverage for any potential COVID-19-related claims and – where applicable – the impact of home-based practice on coverage.

CMTBC remains committed to working with its counterpart health regulators, as well as with the Ministry of Health and the Provincial Health Office to enable a safe return to practice for RMTs. Please continue to check CMTBC’s website, including the COVID-19 Information for Registrants page, for updates and new information.

New CMTBC/RMTBC partnership eliminates fee for Boundaries and Consent online course

April 23, 2020

The College of Massage Therapists of BC (CMTBC) is pleased to announce a joint funding agreement with the Registered Massage Therapists’ Association of BC (RMTBC) that will enable registered massage therapists (RMTs) to complete the College’s mandatory Boundaries and Consent course free of charge – a savings of $100 for every RMT in BC.

The agreement for the two organizations to split the cost of delivering the online course reflects a ground-breaking collaboration between the College and the Association during extraordinary times. It recognizes the challenging financial situation for RMTs across BC who have temporarily ceased practice as a result of the COVID-19 pandemic, in accordance with the Provincial Health Officer’s expectations for regulated health professionals.

“Thanks to this partnership, all RMTs will now be able to fulfil the mandated education requirement around boundaries and consent regardless of their financial situation,” explains Eric Wredenhagen, CMTBC Registrar & CEO.

The Boundaries and Consent course guides RMTs through the standards of practice for maintaining professional boundaries and obtaining informed consent from patients. Consisting of eight modules and more than 100 clinical scenarios, the course helps bridge the gap between theory and practice.

“The course addresses fundamental issues for RMT practice, and supports the College’s mandate to protect the wellbeing of British Columbians through the regulation of RMTs and ensure registrants deliver safe, ethical, and effective treatment to their patients,” says Mr. Wredenhagen.

“We’re very happy to be supporting our profession as it supports the pandemic response,” says Gordon MacDonald, Executive Director of RMTBC.

All RMTs with practising and non-practising status are required to complete the Boundaries and Consent course. RMTs who have already completed the course will receive a $100 credit towards their next CMTBC registration renewal fee.

RMTs are encouraged to enrol in the course in a timely manner to ensure adequate time is available to complete the course before the October 31, 2020 deadline. Once enrolled, RMTs have eight weeks to complete the course. Visit CMTBC Online Courses for details.

For questions and feedback please contact:

About the partners

As mandated by BC’s Health Professions Act, CMTBC regulates the profession of massage therapy in the public interest to ensure that RMTs in BC deliver safe, ethical, and effective treatment. Approximately 5,300 RMTs are registered to practice in BC.

RMTBC serves its members and leads the profession by fostering excellence in practice, education and research. Approximately 3,100 RMTs are RMTBC members.

COVID-19: Questions and Answers about RMT practice

April 21, 2020

The following is a consolidation of questions that CMTBC has recently received from RMTs, and CMTBC’s responses. Our continuing goal is to keep registrants and the public as well informed as possible as the situation with COVID-19 continues to unfold.

Question: Do RMTs provide an “essential service”? Why, for example, are physical therapists (PTs) and chiropractors on the BC essential services list, but not RMTs?

Answer: CMTBC appreciates that a degree of confusion has followed some of the government’s public announcements, including the two “essential services” lists released by the Ministry of Public Safety & Solicitor General (MPSSG).

While CMTBC always considered that the lists released by MPSSG included all regulated health professions, including massage therapy, any remaining ambiguity was put to rest by Dr. Bonnie Henry’s order of April 16, 2020 regarding personal services establishments (PDF). That order clearly stated that personal services “do not include health services provided by a registrant of a college of a health profession designated under the Health Professions Act.”

Question: If RMTs are an essential service, why can’t they be at work right now?

Answer: Because designation as an essential service does not cancel the requirement for physical distancing, except in urgent or emergency circumstances, such as the requirement to deliver essential primary health care.

For RMTs, the key guidance is still provided by Dr. Henry’s letter of March 23, 2020 (PDF), in which she communicates the expectation that health professionals who deliver services “involving direct physical contact with patients” reduce those services to “minimal levels … until further notice”. That expectation is still in effect.

Question: But didn’t Dr. Henry say that some people could start to go back to work in mid-May?

Answer: She did. However, the initial priorities of the Ministry of Health include, for example, resuming cancelled surgeries, and providing acute primary care. In a Global TV online town hall held on the evening of April 20, Dr. Henry said professions such as massage therapy, chiropractic, and dentistry would be part of the “next phase” of the Provincial Health Office’s planning, and emphasized that “we’re not at the point yet where we can let down our guard.”

Also, both on April 20 and at her April 21 briefing, Dr. Henry made it clear that practice of such professions would not look the same, and that part of the PHO’s work will involve providing appropriate profession-specific guidance for a restricted, controlled return to practice. While we have no specific timeline for this to happen, it is unlikely to happen before the end of May, and perhaps not even before the end of June. As we learn more, we will provide updates. Please continue to check CMTBC’s COVID-19 Information for Registrants page regularly.

Question: What is CMTBC doing right now?

Answer: CMTBC is in regular and frequent contact with other health regulators. Together with the other regulators, with the Ministry of Health and with the Provincial Health Office, CMTBC is implementing a coordinated COVID-19 response.

We have begun work on a “return to practice” protocol in conjunction with our fellow health regulators and the Provincial Health Office. We are also in contact with our counterpart massage therapy regulators in other regulated Canadian provinces to learn what we can (and share what we know) about responses to the COVID-19 pandemic.

In addition to this and other COVID-19 related work, CMTBC’s regular work continues in investigations, inquiry and discipline; development of a new quality assurance program; regular board and committee meetings; development of new practice standards; entry-to-practice processes including completion of the March 2020 exam administration; and early planning for 2021 (challenging, but necessary).

Changes to Cycle 12 and a new option for continuing education activities

April 7, 2020

Two changes will be introduced to CMTBC’s Quality Assurance program to address challenges faced by RMTs due to the COVID-19 pandemic.

Extension of most continuing education requirements by one year

An extension to Cycle 12 will be made as follows:

  • The deadline to earn continuing education credits (CECs) by completing activities approved for Cycle 12 has been extended from October 31, 2020 to October 31, 2021.
  • The Boundaries and Consent online course (required for all RMTs) must still be completed by October 31, 2020. CMTBC is presently exploring deferral and other options for the course cost. Any final decision will take into consideration those RMTs who have already paid for and/or completed the online course, and any changes will be applied fairly to all registrants.

New category of continuing education activities

  • CMTBC’s Quality Assurance Committee has approved Webinar-PE (practical education) as a new category. Course approval criteria for the new Webinar-PE category are being finalized at this time. Details and an approval form will be available as soon as they are ready. CMTBC will consider existing PE courses as well as new PE courses for the Webinar-PE format – we request your patience while the approval criteria are finalized.
  • Both in-person Practical Education (PE) courses and Webinar-PE (practical education delivered via webinar in real-time) options will be available until the end of the extension of Cycle 12, namely, October 31, 2021.

RMTs and course providers are asked to be patient and to allow CMTBC to finalize the details. Further information will be provided as soon as possible.

COVID-19: CMTBC recommendation that RMTs suspend practice continues until further notice

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:

  • The impossibility of maintaining physical distancing during massage therapy.
  • The significant risk of transmission of the COVID-19 coronavirus, which can happen either from the patient to the massage therapist or vice-versa, during services involving direct physical contact.
  • The fact that RMTs may not be in possession of what would be considered appropriate personal protective equipment.

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.

Essential services during COVID-19 pandemic

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.

CMTBC continuing education credit requirements

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.

Further guidance to RMTs following the Provincial Health Officer’s update to regulated health professionals

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.

Can RMTs practice?

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.

Telehealth

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.

Provincial Health Officer Dr. Bonnie Henry issues expectations for regulated health professionals during COVID-19 pandemic

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.

Read the update from Dr. Bonnie Henry (PDF).

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.

Provincial Health Officer Dr. Bonnie Henry orders massage therapy services to cease immediately

 
March 21, 2020

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.

FAQs: Impact of COVID-19 on regulatory requirements

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. 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.

CMTBC office closed to the public

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.

CMTBC issues recommendation to suspend practice

 
March 17, 2020

Dear Registrants,

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.

Eric Wredenhagen
Registrar and CEO, CMTBC

CMTBC statement on whether RMTs should suspend all practice in the face of the COVID-19 (coronavirus) pandemic

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

  • Standard First Aid and CPR-C
  • Quality Assurance and continuing education credits

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.

Latest guidance on COVID-19 from Provincial Health Officer for health care workers

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

  • RMTs who return from travel outside Canada are asked to self-isolate at home for 14 days. This is also referred to as social distancing. It includes daily monitoring of signs and symptoms like fever, cough, or difficulty breathing for these 14 days. People who have self-isolated can return to normal activities after 14 days if they have not developed any symptoms.
  • To be clear, BC’s Provincial Health Officer has asked health care workers who return from travel outside Canada and are not essential to the delivery of patient care to self-isolate at home for 14 days. CMTBC interprets this to include RMTs, and asks RMTs to consider this request in the context of the Code of Ethics, which provides guidance on ethical issues.
  • The office of the Provincial Health Officer must attend to priorities in an ever-changing environment. If RMTs and/or their patients or other citizens need information about COVID-19, they are asked not to call the Provincial Health Officer, but to look for information on the following websites:

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. 

Information to registrants on COVID-19 (coronavirus)

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.

CMTBC statement on COVID-19 (coronavirus)

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:

  • What are the appropriate infection control protocols that an RMT should follow?
  • What, if any, obligation does an RMT have regarding a patient who gives a positive response to COVID-19 screening questions?

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.

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