License Naturopathic Doctors

Section 1. Legislative intent. 1. The legislature recognizes that in spite of advances in science and technology that have resulted in the American healthcare system excelling at triage and in responding to acute emergent conditions, there is an epidemic of chronic disease and an unacceptable degree of iatrogenic disease in America. The legislature recognizes that the economics of healthcare and the pursuit of scientific advancement have led to an occupational preference among physicians for specialization, resulting in a shortage of primary care physicians. The legislature finds that licensure of the profession of naturopathic medicine favorably addresses such problems, and agrees with U.S. Senate Resolution 221 of the 113th Congress in finding that naturopathic doctors are skilled in preventing and treating chronic disease; that naturopathic medicine is a safe, effective, and affordable means of health care; and that licensure of naturopathic doctors helps address the shortage of primary care physicians in the United States, while also providing people with more choice in health care.

2. The legislature recognizes that naturopathic medicine, although encompassing primary and secondary care services, including many of the same diagnostic tools and assessment techniques as the medical profession, and having certain Hippocratic principles in common with the medical profession, is not part of the profession of medicine as contem-

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD09636-01-7

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plated by article 131 of the education law, and intends that naturopathic medicine be a distinct profession with its own state board.

3. The legislature recognizes that naturopathic medicine is a modern, evolved form of naturopathy that is practiced by naturopathic doctors; that the early form, today sometimes called traditional naturopathy, is characterized by its vitalistic philosophy, and by its foundation of hygiene and nature cure (i.e., the use of natural agents such as air, light, water, food, and herbs to stimulate the body's own natural healing powers); and that such early form is practiced in some states by traditional naturopaths without licensure, by lay persons in their own self care, and to some extent in health spas. This bill is not intended to change the legality or illegality of activities relating to such hygiene and nature cure; nor to limit the scope of naturopathic medicine to such traditional naturopathy.

4. The legislature recognizes that the naturopathic doctor has a primary mission of facilitating optimum health and wellness for patients of any age; relies on the scientific method in implementing vitalistic, functional, and evidence-based strategies for assessing and treating patients; and works with patients of good or ill health having acute and chronic conditions, including serious medical conditions.

5. The legislature intends that the authorized activities within the scope of practice of a naturopathic doctor are those activities within the meanings of naturopathic assessment, common office procedures, physical naturopathy, approved substances, approved routes of administration, and noninvasive naturopathic therapies, as per sections sixtyeight hundred fifty and sixty-eight hundred fifty-one of article 138 of the education law as proposed in this act. For naturopathic doctors having the injection therapy privilege the authorized activities further include injection therapy, as per section sixty-eight hundred fifty-four of article 138 of the education law, as proposed in this act. The scope of such practice activities however are limited by section sixty-eight hundred fifty-five of article 138 of the education law, as proposed in this act, which provides boundaries of professional competence. The legislature provides a list of broad clinical objectives included within the meaning of "facilitating optimum health and wellness," as defined in section sixty-eight hundred fifty-one of article 138 of the education law as proposed in this act, which list, while relevant to professional conduct, is not intended to expand upon the authorized activities. The legislature intends that invasive procedures other than diagnostic imaging be impermissible, and that the definitions of the terms "invasive procedures" and "noninvasive" be construed independent of each other.

6. The legislature intends that the education qualification for naturopathic medicine emphasizes the basic sciences and clinical sciences, such as has been established by the Council on Naturopathic Medical Education (CNME) and the Association of Accredited Naturopathic Medical Colleges (AANMC), and so distinguish over traditional naturopathy.

7. The legislature intends that the education qualification for naturopathic medicine insofar as including a substantial equivalent of a program of naturopathic medicine registered with the department require that such substantial equivalent, among other factors determined by the department, also require that the substantial equivalent emphasize the naturopathic principles and the therapeutic order in clinical training, such as in programs accredited by the Council on Naturopathic Medical Education (CNME) or in the naturopathic medical programs offered by the Association of Accredited Naturopathic Medical Colleges (AANMC), and so distinguish over a doctoral degree in medicine or osteopathy.

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8. The legislature intends that the professional conduct of the naturopathic doctor be informed by the naturopathic principles and the therapeutic order, and so distinguish over professional conduct for the practice of the profession of medicine.

9. The legislature recognizes that in the practice of naturopathic medicine the healing power of nature principle is viewed as being an inherent property in a living organism to heal itself, and is an acknowledgment that synergy results from the coordination of the many chemical and physical reactions of the living system through varied and circuitous feedback pathways making the whole function as more than the sum of its parts. The number of reactions and the resulting complexity and synergy is viewed in the profession of naturopathic medicine as being why treatment of a given physiological process may result in unforeseen nonlocal consequences, including iatrogenic disease; and is why naturopathic doctors investigate and treat the patient as a whole living system, find and remove the cause, and prefer less invasive therapies and substances with fewer side effects. It also is why the naturopathic doctor prefers to intervene early to prevent occurrence of disease.

10. The legislature intends that licensed naturopathic doctors, while being permitted to practice in solo and among other naturopathic doctors, also be permitted to practice naturopathic medicine in many of the current patient care venue types in the healthcare system; that there be referral among naturopathic doctors, physicians, and other health care providers as based on the interests of the patient; and that integrative care settings and the advancement of public health and safety be realized through collaboration among naturopathic doctors, physicians, and other health care providers.

11. Naturopathic doctors add to the health care system by bringing their naturopathic approach to patient care; and by bringing their expertise on the determinants of health, diet and nutrient therapy, phytotherapy, therapeutic use of physical agents, and drug/herb drug/nutrient interactions. Therefore, to improve the public health, safety and welfare of its citizens, the legislature finds it is desirable to regulate the profession of naturopathic medicine, and intends that admission to practice and regulation of such practice, including professional conduct, shall be supervised by the board of regents and administered by the state education department, assisted by a state board of naturopathic medicine.

§ 2. The education law is amended by adding a new article 138 to read as follows:

ARTICLE 138

NATUROPATHIC MEDICINE Section 6850. Introduction.

6851. Definitions.

6852. Definition of the practice of naturopathic medicine.

6853. Title and designation.

6854. Injection therapy and injection therapy privilege.

6855. Boundaries of professional competence.

6856. State board for naturopathic medicine.

6857. Qualifications for licensure.

6858. Special conditions.

6859. Exempt persons and exemptions.

6860. Limited residency permits.

6861. Limited permits.

6862. Mandatory continuing education.

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§ 6850. Introduction. This article applies to the licensure and regulation of naturopathic doctors to practice naturopathic medicine in this state. The general provisions for all professions contained in article one hundred thirty, as added by chapter nine hundred eighty-seven of the laws of nineteen hundred seventy-one, of this title apply to this article.

§ 6851. Definitions. For the purposes of this article:

1. "Approved CLIA waived tests" mean laboratory tests categorized under the federal clinical laboratory improvement act (CLIA) of 1988 as being waived tests, and which are identified by the department upon the recommendation of the board, and updated as needed or upon triennial review, as being appropriate in the practice of naturopathic medicine.

2. "Approved routes of administration" means oral, sublingual, nasal, auricular, ocular, rectal, vaginal, and transdermal. For naturopathic doctors having injection therapy privilege under section sixty-eight hundred fifty-four of this article, "approved routes of administration" further include injection routes, namely, intravenous, intramuscular, subcutaneous, and intradermal.

3. "Approved substances" means over-the-counter substances; food concentrates, food extracts, and other dietary ingredients; vitamins, minerals, and other dietary supplements; botanical and homeopathic preparations; and a limited formulary of legend drugs. The limited formulary of legend drugs includes thyroid hormones, estrogen hormones, progesterone hormone, DHEA, and homeopathic preparations of homeopathic drugs listed in the official homeopathic pharmacopoeia of the United States. For naturopathic doctors having injection therapy privilege under section sixty-eight hundred fifty-four of this article, the limited formulary further includes immunizations and injectable forms of the approved substances. Legend drugs in the limited formulary may be administered and prescribed, and the other approved substances and homeopathic preparations may be administered, prescribed, and dispensed.

4. "Board" means the state board for naturopathic medicine.

5. "Common office procedures" means administering approved CLIA waived tests; administering ultrasonographic and thermographic imaging; prescribing, installing, removing, and adjusting barrier contraceptive devices; procedures for treating superficial lacerations and abrasions and for the removal of foreign bodies located in superficial structures not to include the eye, excluding by incision and suturing; administering cryotherapy, ligation, and fulguration; administering approved substances via approved routes of administration; procedures for obtaining samples of bodily fluids, bodily excretions, bodily secretions, and bodily tissues; and other procedures for assessment or therapy that are noninvasive. Common office procedures for obtaining samples are limited to: venipuncture and phlebotomy, PAP smear, scraping, and for hair cutting.

6. "Controlled substance" means controlled substances as defined in the federal controlled substances act.

7. "Diagnostic imaging" means radiography, tomography, magnetic resonance imaging, ultrasonography, and thermography, and excludes nuclear medicine, fluoroscopy, and radiological procedures for treating a medical condition.

8. "Dietary ingredient" means a dietary ingredient as defined in the Federal Dietary Supplement Health and Education Act of 1994 (DSHEA).

9. "Dietary supplement" means a dietary supplement as defined in the Federal Dietary Supplement Health and Education Act of 1994 (DSHEA).

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10. "Drug" means a drug as defined in the Federal Food, Drug, and Cosmetic Act, 21 USC 321.

11. "Facilitating optimum health and wellness" means facilitating the establishment and maintenance of a healthy patient lifestyle and nutritional foundation; educating the patient about their circumstances of health and illness and steps for establishing and maintaining optimum health and wellness; facilitating and augmenting self-healing processes; supporting and modulating physiological processes; supporting and correcting integrity of anatomical structures; identifying and removing underlying causes of illness; and identifying, preventing, mitigating, monitoring, and treating illness.

12. "Food" means food as defined in the Federal Food, Drug, and Cosmetic Act, 21 USC 321.

13. "Illness" means pain, injury, deformity, syndrome, disease, or other unhealthy condition.

14. "Invasive procedure" means any medical procedure in which bone, viscera, the eyeball, the inner ear, the dorsal body cavity, or the ventral body cavity is penetrated by a physical device or by ionizing radiation above background levels.

15. "Injection therapy" means the injection of approved substances.

16. "Injection therapy privilege" means the scope of practice privilege to practice injection therapy, in accordance with regulations promulgated by the commissioner.