current breast massage laws in Washington state
(This section of this webpage was last updated in July, 2016 and is still current as of Sept, 2016.)
In Washington State there are currently no breast massage or draping rules which specifically govern massage therapists within the RCW laws (written by the legislature) or WAC rules (written by the Board of Massage within the Department of Health).
The following rules for draping and touching the breasts
apply to all health care providers licensed by the Department of
Health. These rules are located in code for the Department of Health, Standards
of Professional Conduct, Sexual Misconduct.
A health care provider shall not engage, or attempt to engage, in
sexual misconduct with a current patient, client, or key party, inside
or outside the health care setting. Sexual misconduct shall constitute
grounds for disciplinary action. Sexual misconduct includes but is not
limited to: …
(b) Touching the breasts, genitals, anus or any
sexualized body part except as consistent with accepted community
standards of practice for examination, diagnosis and treatment and
within the health care practitioner's scope of practice;
(h) Not providing the patient or client a gown or draping except as may be necessary in emergencies;
The rules mention "accepted
community standards of practice for examination, diagnosis and
treatment within the health care practitioner's scope of practice."
There are various opinions within the massage community of what
constitutes acceptable breast massage. There are no officially agreed
upon community standards for breast massage by massage therapists.
I interpret the quoted passage to mean that the full breast and chest massage I offer
my clients, and the full breast massage I receive from other massage
therapists, is legal.
all Washington Administrative Code rules for massage therapists
are currently being reviewed & updateD by the board of massage.
rules for breast massage are being written.
(This section of this webpage was last updated in September, 2016.)
what has been done so far?
In late 2014 the Washington State Board of Massage began the process of comprehensively reviewing and updating the complete set of WAC rules (Washington Administrative Code) that govern the massage profession in Washington State. They started by filing a CR-101, a notification of intent to update the rules chapter for 246-830-Massage Practitioner. Since that time the Board has met in person every other month and has spent two or more hours at each meeting reviewing, discussing, and updating a draft of the rules.
As part of this process the Board has drafted rules which define specific guidelines for breast massage. In creating this draft the Board has worked hard to keep therapeutic breast massage legal and available for those who want it and can benefit from it, while also providing protection for massage consumers who do not wish to have their breasts included in a massage.
Many massage therapists and massage consumers have provided extensive written input to the Board of Massage to support keeping massage of the full chest and breast legal for consumers who choose it. Thank you all from the depths of my heart for writing those letters to the Board! They have made a difference.
At their September 9, 2016 Board meeting, after much consideration and exploration of various options for regulating full chest and breast massage during the past year, the Board agreed upon the following requirements for therapeutic breast massage.
Prior to massage of the breasts and/or full chest:
- The client must provide fully informed written consent .
- The massage therapist must obtain16 or more hours of in person education in breast massage.
- If the nipple and/or areola are to be included in the massage, one of these two conditions must be met: (1) the client presents a written prescription from a licensed health care provider OR (2) the client signs specific consent for massage of the full chest/breast specifically inclusive of nipples and areola.
See the full detailed wording of the draft in the following section on this page.
additional steps before the proposed draft can become law
The Board has expressed intent to have the draft of all WAC rules for massage therapy they are working on completed, approved, and implemented by mid 2017.
Once the Board finalizes their draft of proposed updates to the WAC rules, they will file a CR-102 (Proposed Rule Making) with the Office of the Code Reviser.
Once the CR-102 is filed, a 6 month clock starts to tick. During this
time the Department of Health will provide interested parties an opportunity to submit formal
comments on the proposed rules, either in person at public hearings or
in writing or online. The Board of Massage will consider all input received and may then further update the draft. If the Board makes substantial changes to the draft, they will need to file a new CR-102 to again provide interested parties an opportunity to submit
formal comments on the revised rules draft.
After the Board has finalized the draft they will file the final adopted
rule language with the Office of the Code Advisor via
the publication of the Rule-Making Order (CR-103) form.
Although the draft of the entire WAC massage rules are currently being
reviewed as a unit, if some sections are substantially modified following the filing of a CR-102 while other sections are minimally modified if at all, the Board may separate
the rules draft into sections, allowing some rules to move forward and be implemented as law with a CR-103 while other rules are delayed for further review and another CR-102 and comment period prior to be adopted as law.
Until a CR-103 form is filed to finalize the adoption of the new rules, it remains possible for the drafted rules to be further modified.
would you like to be informed and/or involved
in the Breast massage rules Update process?
To receive updates from the Board of Massage about upcoming Board meetings, actions the Board takes, and invitations to submit comments on the rules during upcoming stages of the rules update process, add your contact information to the Massage Board Interested Parties List.
Submit comments about massage rules to the Board of Massage by emailing MassageRulesComments@doh.wa.gov.
Sample Letter to the board of massage
If you agree with the breast massage rules as drafted at the September 9, 2016 Board meeting (see
below), please send the Board a letter of support for these rules. Receiving many similar letters can maximize the chance that the breast massage rules will adopted in their current form, and will not be degraded in the remaining steps of the rules review and modification process described above.
sample letter which you may freely use or plagiarize. Email your letter to MassageRulesComments@doh.wa.gov.
Dear Washington Board of Massage,
you for your work drafting breast massage rules which both keep
therapeutic full chest breast massage available for clients or patients
who choose to receive it while also protecting clients or patients who
do not wish to receive it.
I approve of the rules as they were drafted at the September 9, 2016 Board meeting.
I especially thank you for removing requirements for a client to have a medically diagnosed condition and/or a referral or prescription from a licensed health care provider in order to receive massage of their full chest and breasts.
draft of the Washington State Rules for Breast massage
AS UPDATED AT THE SEPTEMBER 9, 2016 BOARD MEETING
(note: This draft has not yet been approved into law.)
FROM THE DEFINITIONS SECTION:
(7) “Breast massage” means the specific and deliberate manipulation of breast tissue. Massage of the surrounding chest and shoulder muscles such as massage of the sternum is not considered breast massage.
THE BREAST MASSAGE RULE:
WAC 246-830-xxx Breast massage.
(1) Prior to performing breast massage, a massage practitioner must:
(a) Acquire a prior signed written consent. The written consent for breast massage may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed. The written consent must:
(i) Be maintained with the client or patient’s records,
(ii) Include a statement that the client or patient may discontinue the treatment at any time for any reason;
(iii) If the client or patient is under 18 years of age, prior written consent must be obtained from a parent or legal guardian; and
(iv) Include a statement that the client or patient has the option to have a witness present, and that the witness must be provided by the client or patient.
(b) Use appropriate draping techniques as identified in WAC 246-830-xxx (draping section);
(2) In addition to the requirements identified in subsection 1, to perform any massage to the breast, a licensed massage therapist shall maintain evidence of the completion of at least 16 specialized in person contact hours as training in breast massage beyond the minimum competencies, which includes but is not limited to, breast anatomy and physiology, pathology, indications, contraindications, therapeutic treatment techniques, draping, appropriate therapist-client or patient boundaries, expected outcomes, and client or patient safety related to breast massage.
(3) In addition to the requirements in subsection 1, prior to performing a massage of the nipples and areoli, a massage practitioner must obtain additional documentation including but not limited to:
(a) A written prescription or referral from a licensed medical health care provider for this specific treatment; or
(b) Additional written and signed consent from the client or patient or patient for massage of the nipple and areoli.