A bill that would allow patients direct access to physical therapists without a referral neared final approval Wednesday when the state House endorsed it 65-33.

The measure, Senate Bill 291, now returns to the state Senate for consideration of changes made in the House.

If the Senate goes along with the modifications, the measure would be sent to the governor. Otherwise, a House-Senate negotiating committee will try to resolve the differences.

Rep. Harvey LeBas, D-Ville Platte, sponsor of the proposal, said it is time for a change in the medical rules.

“Give the citizens of Louisiana a choice by removing the barriers and by empowering the patient,” LeBas told the House.

Under current rules, patients have to obtain a referral from a licensed doctor to see a physical therapist.

LeBas’ bill would allow them to see a physical therapist first.

If the patient fails to show improvement within 30 business days, the physical therapist would have to refer the patient to another health care provider.

Backers contend the legislation would put Louisiana in line with practices in other states.

They also argue the law here is one of the most restrictive in the nation.

Orthopedists, who usually do the referrals, have disputed this information.

Opponents of the bill also have warned that allowing patients to see a physical therapist first could mean serious health problems would be missed.

State Rep. Frank Hoffmann, R-West Monroe, said a doctor told him of a patient who, if he had seen a physical therapist initially, likely would have become a paraplegic because of a serious health problem.

“If it happens just once out of a thousand, that is a real problem,” Hoffmann said.

The chief critics of the bill, as they were in the House committee that approved the bill, were Reps. Katrina Jackson, D-Monroe, and Marcus Hunter, D-Monroe.

They offered several amendments that LeBas said would weaken or gut his bill, including one to require that physical therapists carry additional medical malpractice insurance.

That effort failed 15-81.

Others were defeated by similar, lopsided margins.

LeBas, a pharmacist, said 20 percent of physical therapists who graduate yearly in Louisiana leave the state because of restricted access.

Voting for direct access to physical therapists (65): Reps. Abramson, Adams, Amedee, Anders, Armes, Bacala, Bagley, Bagneris, Berthelot, Billiot, Bouie, Broadwater, C. Brown, T. Brown, Carpenter, R. Carter, Cromer, Davis, DeVillier, Dwight, Emerson, Falconer, Gisclair, Glover, Hall, J. Harris, Havard, Henry, Hensgens, Hilferty, Hollis, Horton, Howard, Huval, Ivey, James, Jenkins, R. Johnson, Jones, Jordan, T. Landry, LeBas, Leger, Leopold, Lopinto, Marcelle, McFarland, D. Miller, G. Miller, Montoucet, Moreno, Pearson, Pierre, Pugh, Pylant, Reynolds, Schexnayder, Schroder, Shadoin, Smith, Talbot, Thibaut, White, Willmott and Zeringue.

Voting against SB291 (33): Speaker Barras and Reps. Abraham, Carmody, G. Carter, S. Carter, Chaney, Connick, Coussan, Cox, Danahay, Edmonds, Foil, Franklin, Guinn, L. Harris, Hazel, Hill, Hoffmann, Hunter, Jackson, Jefferson, M. Johnson, N. Landry, Lyons, Mack, Magee, Jay Morris, Jim Morris, Pope, Price, Richard, Seabaugh and Stokes.

Absent and not voting (7): Reps. Bishop, Gaines, Garofalo, Hodges, Miguez, Norton and Simon.

Follow Will Sentell on Twitter, @WillSentell. For more coverage of Louisiana government and politics, follow our Politics blog at http://blogs.the advocate.com/politicsblog/.