History Of The Board

History of NC Board of Physical Therapy Examiners

By Constance W. Peake, PT, Ben F. Massey, Jr., PT & Kathy O. Arney, PT Updated – August 30, 2024

The North Carolina General Assembly adopted the first North Carolina Physical Therapy Practice Act in 1951 to regulate the practice of physical therapy by registered physical therapists (RPTs). The State Examining Committee of Physical Therapists with 1 MD and 4 PT members was empowered to make rules, to pass upon the qualifications of applicants for registration; to prepare and conduct examinations and determine who passes. A physical therapist had to be 21 years old, of good moral character, a high school graduate and graduated from an approved PT school. The law provided for reciprocity. It protected the title RPT, associated words and insignia. A licensee could be disciplined for being habitually drunk or addicted to narcotics, obtaining registration under fraud or being guilty of an act derogatory to the standing and morals of the profession.

A 1959 revision to the Practice Act included exemption from licensure for graduate students in special PT courses, licensure of foreign-trained therapists and adoption of a procedure for uniform revocation of licenses. The Committee was increased to 7 members by adding 2 physical therapist assistants and provided for licensure rather than registration.

A 1969 revision allowed for PTA licensure, both for graduates of approved schools and on-the-job trained aides. The age requirement for physical therapists was removed. Foreign-trained applicants were required to complete a course of instruction substantially equivalent to the U.S. trained applicant and to have proficiency in the English language.

In 1969, Constance W. Peake, PT, was hired to serve as the Board’s first Executive Secretary. In 1976, the Board adopted Rules pursuant to the Administrative Procedures Act, which have been amended periodically. These rules have been amended several times since then. In 1977, the Board entered into a contract arrangement with an attorney to provide legal counsel.

By a revision in 1979 to the Practice Act, the name of the regulatory authority was changed to the North Carolina Board of Physical Therapy Examiners. The licensing of aides as PTAs by equivalency was terminated. A definition of the aide as an unlicensed person was added as were grounds for disciplinary action and a provision for enjoining illegal practices.

In 1982 a public member was placed on the Board.

A 1985 revision replaced the requirement of physician referral for patient treatment with a provision for direct access. To accommodate uniform testing dates, a provision was added to allow a recent graduate to be granted a permit to work as a PTG or PTAG under the immediate supervision of a licensee; however, with the advent of computer-based testing, this provision was eliminated in 1998.

In January, 1987, the Board joined the Federation of State Boards of Physical Therapy as a Charter Member.

In 1991, the Board secured its first leased office space in Durham, NC.

In 1994, the Board appointed a Joint Task Force with the North Carolina Physical Therapy Association to address Supervision issues, an outgrowth of which was the Board’s publication of Practice Under Pressure.

In 1995, the Board established its Investigative Committee to address complaints against licensees.

In 1996, after 26 years of dedicated service, Constance W. Peake, Executive Secretary, retired. Ben F. Massey, Jr., PT, was hired as the Executive Director to replace Ms. Peake. That same year, North Carolina became one of the first states to move from paper and pencil examinations to computer-based testing. In 1999, the Practice Act was revised to accommodate a fee increase and the Board relocated its office in Durham, NC.

In 2002, extensive changes in the Board’s rules to define and describe the nature of physical therapy practice in North Carolina were approved by the NC Rules Review Commission (RRC) and the NC General Assembly (GA).

In 2003, a restructuring of the Board’s rule related to a physical therapist’s scope of practice was also approved by the RRC and the GA.

In 2004, the Board conducted 5 forums across the state (Asheville, Charlotte, Greensboro, Greenville, and Wilmington). The topics of the forums were continuing competence, jurisprudence examination, animal rehabilitation, spinal manipulation, professional corporations, and requirement of post baccalaureate education for foreign educated physical therapists. Straw polls were taken at each forum and there was overwhelming support for a change in the Practice Act that would give the Board statutory authority to require continuing competence / continuing education. Also in 2004, the Board clarified its rule that requires post baccalaureate education for foreign educated physical therapists who graduate after January 1, 2003.

In 2005, the Board addressed issues of supervision; iontophoresis and phonophoresis; and the Foreign Educated Physical Therapist (requirements for education and English language requirement). The Board developed processes to expedite and assist victims of hurricane disasters with the licensure process. At the NCPTA annual conference, the Board sponsored two presentations (continuing competence and mock investigative committee meeting).

In 2006, changes in the Board’s rules that clarify the educational requirements of the Foreign Educated Physical Therapist (FEPT) and documentation requirements for PTs and PTAs were approved by the RRC and the GA. In addition, the GA adopted legislation that added the following section to the North Carolina Physical Therapy Practice Act:

90-270.26. Powers of the Board. The Board shall have the following general powers and duties: (3a) Establish mechanisms for assessing the continuing competence of licensed physical therapists or physical therapist assistants to engage in the practice of physical therapy, including approving rules requiring licensees to periodically, or in response to complaints or incident reports, submit to the Board: (i) evidence of continuing education experiences; (ii) evidence of minimum standard accomplishments; or (iii) evidence of compliance with other Board-approved measures, audits, or evaluations; and specify remedial actions if necessary or desirable to obtain license renewal or reinstatement;

To address this legislation, the Board developed a 3-year strategic plan that included hosting 12 statewide forums for licensees to provide input, and appointed a 7-member Advisory Committee to study various options available for continuing competence and to make recommendations to the Board regarding rules for implementation. Additionally, in 2006, the Board developed a Jurisprudence Exercise for applicants that became effective on January 1, 2007. Lastly, the Board entered into an Agreement with the North Carolina Board of Nursing (BON) that would offer physical therapy licensees the opportunity to seek eligibility for enrollment in the treatment programs administered by the BON for practitioners who are impaired as a result of chemical dependency.

In 2007, the Board’s Executive Director and Attorney conducted 11 statewide forums to solicit input regarding proposed rules for continuing competence. The Advisory Panel on Continuing Competence began the process of drafting rules for submission to the Board for its consideration. Staff publicized newly adopted rules regarding documentation of patient notes.

In 2008, the Board adopted rules for continuing competence that were submitted to the RRC in November and December, 2008. The rules, as amended by RRC, were adopted and took effect on January 1, 2009. The Board contracted with a consultant for continuing competence to assist with implementation of the newly adopted rules. In October, 2008, it conducted its first of seven statewide educational programs on implementation of continuing competence.

In 2009, the Board implemented its rules for Continuing Competence. The requirement over a 2-year period is 30 points for physical therapists and 20 points for physical therapist assistants. There are 12 categories for licensees to earn points. The Board developed an online reporting form that allowed licensees to enter their continuing competence activities into the Board’s database. In addition to dedicating a specific site on the Board’s website to explain the new requirements, staff conducted statewide educational programs and dedicated its Newsletter to continuing competence. Additionally, the Board’s consultant for continuing competence responded to 2,000+ emails and telephone calls. In its efforts to continue to increase efficiencies, the Board continued to concentrate its efforts with the use of technology, which resulted in 97% of licensees renewing their licenses online.

In 2010, the Board adopted a Position Statement on Intramuscular Manual Therapy (Dry Needling). In response to a directive from the Governor and the North Commission Ethics Commission, the Board instituted additional training and education of its members in monitoring and avoiding the appearance of conflicts of interest, prohibition on use of public position for private gain, and filing of statements of economic interests.

In 2011, in response to a change in Federation of State Boards of Physical Therapy (FSBPT) policy that began requiring “fixed-date-testing” for applicants taking the National Physical Therapy Examination (NPTE), the Board reviewed its rules and adopted a policy that will allow students to take the NPTE before graduation provided that the program director certifies that graduation is assured. The Board initiated its first audits of 309 licenses who failed to complete continuing competence by the deadline of December 31, 2010. The Board hosted the FSBPT’s Annual Conference in Charlotte, NC. Representatives of the Board met with the North Carolina Veterinary Medical Board to reinforce the limitation of the practice of physical therapy to treatment of human beings. The Board joined with the NC Medical Board, NC Board of Nursing, and the NC Board of Pharmacy by filing an amicus brief in an important antitrust case.

In 2012, based on input from the general public, licensees, and the Board’s Investigative Committee, the Board adopted a recommendation of the Board’s Task Force on Rules Revision to begin the process of repealing 3 rules and amending 14 other rules. On October 23, 2012, the Board posted the proposed revision on its website. In addition to having a designated period to accept written comments from the general public, it conducted a Public Hearing on December 6, 2012. At its meeting on September 13, 2012, the Board appointed a Task Force to study the issue of whether to require a Supervised Clinical Practice Program for Foreign Educated Physical Therapists (FEPTs).On December 14, 2012, the Board reached a milestone of having 10,000 active licensees.

In 2013, the North Carolina General Assembly amended the Practice Act to include the following provisions:

• Allows the Board to establish or participate in programs for chemical or alcohol addiction or abuse or mental health problems.
• Allows the Board to purchase its own building.
• Allows for licensure of FEPTA’s.
• Allows an exemption for PT’s & PTA’s who are accompanying an athletic team or performing arts company from licensure requirement.
• Allows for exemption for PT’s & PTA’s assisting in disasters.
• Allows the Board to request the NC Dept of Justice to perform criminal background checks.

In addition, twenty-five (25) Board’s rules were amended for the following reasons:

• Editorial changes as recommended by attorneys at the Rules Review Commission.
• Compliance with G.S. 93B-2(d) – Suspension of Authority to Expend Funds.
• Compliance with G.S. 105-249.2 to allow eligible members of the United States Armed Services to be exempt from renewal requirements.
• For safety and security purposes, a new rule is being proposed that will allow licensees to wear a name badge displaying only their first name.
• Clarification of the responsibilities of the physical therapist.
• Allow Board to utilize and recognize changes in technology such as verifying or authenticating licensees in other States /Jurisdictions electronically and receive payments for services electronically.
• Clarification of definitions.
• Clarification and modification of continuing competence requirements.
• Elimination of a category of discipline (Reprimand) that is obsolete.
• Clarification of Rules related to Prohibited Actions that could lead to Disciplinary Action.

In March, 2014, auditors from the State Auditor’s Office conducted an audit by reviewing policies and procedures for compliance related to the licensing process, investigations process and online database. In December, in response to a legislative mandate for review of licensure boards, the Program Evaluation Division (PED) of the Joint Legislative Program Oversight Committee presented its Final Report entitled, “Occupational Licensing Agencies Should not be Centralized, but Stronger Oversight is Needed.” Throughout the year, the Board had responded to surveys and met with the PED to describe the functions of the Board Of the fifty-five (55) Licensing Boards, the PED made recommendations regarding twenty-two (22) Boards; however, no specific recommendations were made regarding the PT Board. In December, the Board submitted 20 rules for consideration by the Rules Review Commission at its meeting on January 15, 2015.

On January 15, 2015, the Rules Review Commission voted unanimously to approve 19 rules submitted by the Board to become effective on February 1, 2015. The RRC did not approve the Board’s proposed rule on training standards for dry needling.

In June 2016, the Board, in response to a request from the North Carolina Acupuncture Licensing Board, issued a declaratory ruling on dry needling. On August 16, 2016, Ben F. Massey, Jr., PT, MA, Executive Director retired from daily operations. After a national search, Kathy O. Arney, PT, MA was selected by the Board as Executive Director and Deborah J. Ragan, PT, DPT was selected as Deputy Director. During the fall of 2016, the Board office implemented an online complaint form and provided public self-service access to disciplinary actions imposed by the Board.

In June 2017, the North Carolina General Assembly voted to enact the Physical Therapy Licensure Compact enabling North Carolina PT licensees to participate in privileges to practice physical therapy in other participating states after receiving a privilege from the Compact Commission. The Compact is scheduled to become effective January 1, 2018.

On August 25, 2017, the Acupuncture Board filed a notice of appeal of the August 2 ruling. The appeal was taken to the North Carolina Supreme Court. The case was heard before the North Carolina Supreme Court in April, 2018. The NC Supreme Court issued a ruling December 8, 2018 noting that the Board is able to make decisions about its scope of practice and affirming the Board’s Declaratory Ruling that trigger point dry needling is within the PT scope of practice in NC.

On August 16, 2018 after more than 25 years in Durham, the Board office was relocated to 8300 Health Park, Suite 233 in Raleigh, North Carolina, which is over 20 miles closer to the seat of government and the North Carolina General Assembly.

In order to expedite the application process for licensure and leverage technology to realize efficiencies, an online application process was introduced in March, which enabled the Board to include a question on applications about employee misclassification in response to legislative mandates and facilitate licensure and permitting for military members, their spouses and veterans.

Throughout the year, North Carolina participated in the PT Compact Commission with Kathy Arney, as delegate and Vice-Chair. Further, nationally, the Federation of State Boards of Physical Therapy (FSBPT) named NCBPTE a 2018 Excellence in Regulation award winner. NCBPTE has maintained the highest 5-Star rating since the inception of the rating system in addition to other accomplishments. Three staff members and Board Chair David Reed serve on FSBPT Committees and Task Forces. David Reed was also honored with an Outstanding Service Award for the second time in 2018.

In 2019, online licensure applications were updated to include required FBI fingerprinting and criminal background checks for initial licensure applicants to comply with the Physical Therapy Licensure Compact statute. The Board began issuing PT Compact privileges to eligible licensees from other states on July 1, 2019, thus facilitating access to physical therapy services for NC citizens and licensure portability for physical therapy licensees. In order to provide additional online services and access to information regarding physical therapy to the public, the Board increased the information technology staff.

In compliance with the state Administrative Procedures Act (NCGS 150B) on May 1, 2019, the Board concluded a multiple year “Periodic Rules Review process” by successfully readopting Board rules considered necessary with substantive public interest. All Board existing rules were reviewed with the opportunity for public comment. The next periodic review with be conducted on a 10-year cycle. The Board also complied with Session Law 2019-91 mandating expedited licensure processes for military members, spouses and veterans. Information describing those efforts was posted on the Board website.

On October 1, 2019 change to the NC Physical Therapy Practice Act adopted by the NC General Assembly became effective. The definition of “physical therapy” in 90-270.90 was modernized from “...Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, manipulation of the spine unless prescribed by a physician licensed to practice medicine in North Carolina, or medical diagnosis of disease.” To “...Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, the practice of chiropractic, as defined by G.S. 90-143, or medical diagnosis of disease.” in changes advocated for by the American Physical Therapy Association of North Carolina and others.

In December 2019, the Board Attorney, John M. Silverstein of Satisky and Silverstein, announced his transition as primary counsel for the Board after almost 43 years of dedicated service. His consistency in providing advice to the Board on standards of physical therapy practice, disciplinary actions, interpretation of state law and Board rules and guidance on legal matters have allowed the North Carolina Board of Physical Therapy Examiners to make enduring, reasonable and thoughtful decisions. In March, after a successful request for proposal process Attorney David C. Gadd, a Partner at Satisky and Silverstein was selected as the Board’s Independent Counsel. His tenure at the Board began March 12, 2020 concurrent with COVID-19 and the need for unprecedented decision-making for the Board.

The defining event of 2020, the worldwide pandemic of COVID-19, shaped regulatory activity for the Board. During the North Carolina State of Emergency, the NC PT Practice Act, Governor’s Executive Orders and legislative mandates issued beginning in March, required the Board respond by determining ways to sustain office functions to support the essential physical therapy workforce and maintain its mission to maintain minimum standards for the practice of physical therapy to protect the safety and welfare of the citizens of North Carolina.

Measures taken included:

• implementing NC PT Practice Act requirements to issue temporary exemptions from licensure during the state of emergency to PT licensees from other US jurisdictions enabling them to practice physical therapy in NC,
• maintaining presence in the office with reduced staff and enabling the majority of the staff to work remotely,
• maintaining all licensure, investigatory functions and Board meeting and decision-making capabilities
• communicating with 21 academic PT and PTA educational programs in NC to understand, consider and respond to their unique challenges in the workforce training pipeline and how application and licensure processes could be expedited,
• responding to the NC Governor and legislative requests for consideration of “flexibility” in regulation by adjusting processes for applicant’s exam eligibility, alternative methods for receiving documentation, case-by-case decisions regarding applicant hardships to minimize barriers to licensure and FBI Criminal Background Check requirement process changes,
• responding to questions from licensees and the public with resources and information about physical therapy practice and licensee abilities during the pandemic,
• implementing an online portal to enable efficient issuance of exemptions from licensure as allowed by NC PT Practice Act,
• maintaining public access to physical therapy services through continued compliance with the PT Licensure Compact requirements and issuing PT Compact privileges to practice in NC,
• Board approval of an “Alternative Approval Pathway” for assuring future qualified National Physical Therapy Exam applicants can be made eligible in a streamlined manner via temporary rules approved by the NC Rules Review Commission,
• Transitioning from a primarily paper-based licensure system to a primarily electronic system to streamline licensure processes through the efforts of Board staff including Licensing Specialists, Administrative and Information Technology staff, and
• Provided information and updates on the Boards website regarding answers to scope of practice questions, telehealth and resources for licensees during the state of emergency.

Modifications put into place in 2020 for the pandemic have remained in place to date in 2021. In the second half of 2020 additional ‘regulatory flexibility” efforts were considered by the Board. It considered and subsequently posted information and resources on the Board website.

• Physical therapist licensees’ participation in vaccination efforts for the public. Vaccinations are not considered within the scope of PT practice; however, a licensee could obtain appropriate education, training and comply with other NC statutes to perform vaccinations outside of their PT license.

Licensees were also encouraged to volunteer and offer assistance toward any efforts to mitigate the pandemic.

• Several fees were suspended during the state of emergency including licensee contact information listings and exam retake fees.
• In preparation for the license renewal period (November 1 – January 31) the Board staff:
• Implemented a fully redesigned website and
• implemented 100% paperless, contactless payment options for licensees choosing to renew, which included modified workforce questions consistent with the national PT Minimum Data Set.
• The information collected during renewals is critical in providing data to stakeholders involved in understanding, researching, analyzing and forecasting physical therapy workforce planning. Aggregate, de-identified data is available, to entities who are granted approval by the Board, directly from the SHEPS Center at the University of North Carolina at Chapel Hill, the repository for state healthcare licensure board workforce data.

• Other 2020 highlights included:
  • Participation in the Alternate Approval Pathway (AAP) for the National Physical Therapy Exam eligibility for applicants who are or expected to be graduated from a CAPTE Accredited Physical Therapy or Physical Therapist Assistant educational program. This has significantly shortened the exam eligibility timeframe for applicants and eased the administrative burden to PT and PTA programs in NC. The AAP also evaluates and approves special accommodations for exam testing through a fully ADA compliant process via a third party.
  • Board implementation of a Public Protection Task Force (PPTF) to address scope of practice issues that are evolving with education and technology advances, risks and harms in PT practice and provide recommendations to the Board on topics addressed.

In 2021, the NC State of Emergency continued and the Board continued COVID-19 regulatory flexibilities continued.

• Continued remote work of licensing staff, supported by those remaining in the office.
• Continued modernization of office operations toward electronic and away from paper dependent processes, for example, Application character references, transcript acceptance, photos are available electronically and real-time application status page updates for applicant review.
• At the end of the year the Board office reopened to the public and in-person Board meetings for public attendance.
• A new updated Board website was developed and implemented in the summer/fall of 2021. It is mobile friendly on all platforms and requires less clicks to obtain access to information and applications. All pages were thoroughly reviewed and revised/condensed as necessary without sacrificing required information.
• The PPTF continued to work on priority scope of practice topics, namely the ability to order imaging, the need for informed consent, and training rules for dry needling. All topics continue to be active to date.
• In the summer of 2021, the Board office successfully completed an audit by the NC SBI on current policies and procedures for handling the Criminal History Record Information (CHRI) received from them by mail on all initial applicants for PT/PTA licensure in NC.

In 2022, the state of emergency in NC was lifted on August 15, 2022. The Board is allowing all current applicants to have an expiration date of August 15, 2023 if the application was started during the pandemic.

• The Board office migrated successfully to Microsoft Office 365, thus improving communications, electronic application processing and information storage.
• The revival application process for all lapsed licenses was revised for consistency, efficiency and ensure compliance with Board Rules for all revival types. The jurisprudence 1 exercise will be required for all revival applicants to refamiliarize themselves with current NC PT Practices and Rules.
• During the summer of 2022, the Board computer servers were compromised. The NC Cyber Security Task Force worked diligently with the Board IT staff to reduce and prevent further compromises and to implement additional security measures throughout all IT systems. The Board approved a measure to allow the North Carolina Department of Information Technology to oversee Board IT systems. Additional training continues for all Board staff and Board members about proper use of Board IT equipment and software. The Board transitioned to a .gov platform and began moving the server information to the Cloud. As a final preventative measure, all licensees and interested parties were given free access to IDX, a software security service for individuals to monitor any personal information that may have been released as part of the compromise.
• Ellen Roeber, PT, DPT became the new Deputy Director for the Board upon the retirement of Deborah Ragan, PT, DPT on August 31, 2022.
• Live webinars have been implemented successfully to answer licensee questions about the renewal process and any issues with the continuing competence online summary report. These were held two times and were well received by those who attended. It was also posted on the website and will be the beginning of an online webinar library on the website on various topics regarding application or licensee issues, and scope of practice topics.

In 2023:

• The Board office successfully completed an on-site FBI audit on current handling of Criminal History Record Information (CHRI).
• The ED and DD continue conducting on-site and remotely hosted presentations to NC PT/PTA students educating them on various regulatory issues and successful licensure application completion.

In 2024:

• The Board office staff expanded to eleven plus one IT contractor.
• The IT staff facilitated file migration to the cloud, as well as enhanced electronic security and monitoring with third party assistance. Completed migration to Linux to lower the Board’s cloud footprint and reduce costs.
• Continued automation by implementation and refinement of a “personal dashboard” for use by licensees on the Board website and instituted self-service license verification.
• Scope of Practice Questions and Board Position Statements
  • Significant increase in number of topics addressed via the Public Protection Task Force. Use of P.E.E.R. review process established by the Board in 2019.
  • Areas addressed include emerging practice, questions from licensees and interested parties, and staff. Responses can be found on the Board website.
• Increased educational outreach to licensees through monthly newsletters and webinar series on the Board website.
• Staff continued presentations to PT/PTA program students and updated and added new educational video resources to the Board website

Updates to Board Disciplinary Actions are listed below:

Number of Disciplinary Actions imposed by the Board since 1996 (as of 05-25-23)
Year	Total
1996 - 2000	38
2001-2010	88
2011-2020	92	(29 related to continuing competence)
2021	03	(1 related to continuing competence)
2022	01	(0 related to continuing competence; 1 Voluntary surrender - not disciplinary action)
2023	02	(1 Voluntary surrender - not disciplinary action)
2024	01	(1 Voluntary surrender - not disciplinary action)
Total	225	(30 related to continuing competence)

NC BOARD OF PHYSICAL THERAPY EXAMINER MEMBERS

1952 - Present

Updated:   August 30, 2024