BILL ANALYSIS
AB 1444
Page 1
Date of Hearing: April 17, 2001
ASSEMBLY COMMITTEE ON HEALTH
Helen Thomson, Chair
AB 1444 (Maddox) - As Amended: April 4, 2001
POLICY QUESTIONS :
1)Should developing nutritional and dietary treatments,
therapeutic diets, or developing or providing medical
nutritional therapy without an express grant of authority be
prohibited?
2)Should the title of "dietitian" be eliminated?
3)Should nutritional professionals be specifically authorized to
provide "medical nutritional therapy" upon referral by a
health care provider?
4)Should the title of "dietetic technician, registered" be
established?
5)Should the ordering of medical laboratory tests related to
nutritional therapeutic treatments be added to the list of
services defined as "medical nutritional therapy?"
SUBJECT : Nutritional advice.
SUMMARY : Prohibits developing nutritional and dietary
treatments, therapeutic diets, or developing or providing
medical nutrition therapy, without an express grant of
authority. Eliminates the title of "dietitian." Authorizes a
nutritional professional to provide "medical nutrition therapy"
upon referral by a health care provider. Establishes the title
of "dietetic technician, registered" (DTR), and lists the
requirements for someone who is allowed to represent themselves
as a DTR. Adds the ordering of medical laboratory tests related
to nutritional therapeutic treatments to the list of services
defined as "medical nutritional therapy." Authorizes DTRs to
perform certain duties. Specifically, this bill :
1) Prohibits developing nutritional and dietary treatments,
therapeutic diets, or developing or providing medical
nutrition therapy, without an express grant of authority by
making it punishable by imprisonment in the county jail for
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not exceeding one year or in the state prison.
2) Eliminates the title of "dietitian" and provisions of
law describing the qualifications a dietician must meet and
allowing reimbursement to a dietitian.
3) Establishes the title of DTR.
4)Requires a person representing themselves as a DTR to be 18
years of age or older and possess all of the following:
a) Appropriate academic requirements and receipt of an
associate's degree or higher from a college or university
accredited by the Western Association of Schools and
Colleges or other regional accreditation agency;
b) Satisfactory completion of the dietetic technician
program requirements by an accredited public or private
agency or institution recognized by Department of Health
Services (DHS) including not less than 450 hours of
supervised clinical experience;
c) Satisfactory completion of an examination administered
by a public or private agency or institution recognized by
DHS to administer the examination; and,
d) Satisfactory completion of the continuing education
requirements established by a public or private agency or
institution recognized by DHS.
1) Makes it a misdemeanor for someone who does not satisfy
the criteria of this bill to:
a) Use in connection with his or her name, or place of
business, the words, "dietetic technician, registered" or
the letters "DTR";
b) Use insignia indicating or implying that the person is a
DTR; and,
c) Represent in any way, orally, in writing, in print, or
by sign, directly or by implication, that he or she is a
DTR.
1) Defines the existing services a registered dietitian can
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provide under current law under referral by a health care
provider authorized to prescribe dietary treatments, as
"medical nutrition therapy."
2) Expands the existing services a registered dietitian can
provide under referral to include ordering medical
laboratory tests related to nutritional therapeutic
treatments, and accepting or transmitting verbal or
electronically transmitted orders or standards of protocol
from the health care provider to implement therapeutic
treatments. Includes these additional services within the
definition of "medical nutrition therapy."
3) Permits a nutritional professional with a master's or
higher degree in a field covering clinical nutrition
sciences, from a college or university accredited by a
regional accreditation agency to provide "medical nutrition
therapy" upon referral by a health care provider.
4) Permits a DTR who meets the requirements of this bill to
assist in the implementation or monitoring of "medical
nutritional therapy" under the direct supervision of a
registered dietitian (RD). Prohibits a DTR from developing
nutritional or dietary therapy or treatments.
5) Defines "direct supervision" to mean that the
supervising RD is to be physically available to the DTR for
consultation whenever it is required.
6) Prohibits an RD from supervising more than two DTRs at
one time in the implementation or monitoring of "medical
nutritional therapy."
7) Adds the services of a "nutrition professional" to the
list of services a disability insurance policy may provide
payment for only if rendered pursuant to a method of
treatment prescribed by a physician and removes the
services of a "dietician" from this list.
8) Provides that nothing in this bill requires a disability
insurer to automatically pay for services provided by a
nutritional professional.
9) Makes the provisions of this bill operative on July 1,
2003.
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EXISTING LAW :
1)Specifies that someone is not prohibited from providing
nutritional advice or giving advice concerning proper
nutrition.
2)Defines nutritional advice as the giving of information as to
the use and role of food and ingredients, including dietary
supplements.
3)Requires a person in commercial practice providing nutritional
advice or giving advice concerning proper nutrition to post in
an easily visible and prominent place a statement that state
law specifically does not authorize any person, other than one
who is a licensed health practitioner, to state that any
product might cure any disease, disorder, or condition.
4)Establishes the titles "dietitian" and "registered dietitian"
and lists the requirements needed for someone to represent
that they are a "dietitian" and "registered dietitian". Makes
it a misdemeanor for someone to represent they are a
"dietitian" or "registered dietitian" without meeting the
requirements established by law.
5)Allows registered dietitians to provide nutritional and
dietary counseling, conduct nutritional and dietary
assessments, and develop nutritional and dietary treatments,
upon referral by a health care provider authorized to
prescribe dietary treatments.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL : According to the author, the law
pertaining to registered dietitians is nearly 20 years old,
and has become obsolete and inadequate in several ways. The
existence of DTRs needs to be recognized, and their lawful
scope of practice defined. The author argues it has become
apparent that far too many non-professionals are violating the
law (health food store clerks, health club and spa staff,
etc.), so it makes sense to state more clearly what is against
the law. This bill is also needed to clarify the scope of
practice of nutritional professionals.
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The author adds that the title of "dietitian" is confusing and
needs to be removed since there is nothing in the law that
allows them to do anything more than any lay person. Also, it
needs to be clear that a person with a bachelor's degree, who
is not a RD, cannot perform either medical nutritional
therapy, or use titles that can be misleading as to their
authorization to perform medical nutritional therapy.
2)SUPPORT . The sponsor of this bill, the California Dietetic
Association (CDA), argues that this bill clarifies the law
governing RDs, and recognizes an emerging category of
professional dietetic technicians who are already practicing
in health facilities in California. This bill will state
clearly that it is a violation of the medical practice act for
anyone to provide advice for the purpose of prevention,
treatment, or curing of disease, disorder, deformity, pain or
other condition, unless authorized by law to do so. CDA
states that this bill will also adopt the phrase "medical
nutritional therapy" to describe the various activities
already authorized by law. This bill also clarifies the law
with regard to nutritional professionals by explicitly
authorizing them to provide medical nutrition therapy.
Numerous members of CDA state that this bill will update and
modernize existing law to better reflect the medical and
technical changes that have occurred in the practice of
dietetics and nutrition.
Loma Linda University states that this bill will facilitate the
dissemination of accurate, timely and appropriate nutritional
advice for the citizens of California by those qualified to do
so.
3)OPPOSITION . The California Citizens for Health and Freedom
argues that this bill is written against the freedom of access
to citizens and the liberty for highly trained and competent
professionals to practice in California.
The California Naturopathic Association (CNA) argues that
practitioners such as Naturopaths, Naturopathic Physicians,
Clinical Nutritionists, Homeopaths and Herbologists have been
advising consumers for over 100 years in precisely how certain
foods can heal specific problems. CNA argues that now that the
medical profession sees how important nutrition is for
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healing, the dietitians want to own it for themselves and
prohibit anyone else from using it.
Numerous certified nutritionists argue that they currently stay
within the scope of offering information on nutrition and this
bill will limit them from counseling clients on nutrition.
Many people in California need nutritional counseling in
California, and giving them only limited access to RDs would
be irresponsible.
4)COMMENT . Under existing law the unlawful practice of medicine
is punishable by imprisonment where there are circumstances or
conditions which cause or create risk of great bodily harm,
serious physical or mental illness, or death. This bill would
make developing nutritional and dietary treatments,
therapeutic diets, or developing or providing medical
nutritional therapy without an express grant of authority
punishable by imprisonment even in circumstances or conditions
which do not cause or create risk of great bodily harm,
serious physical or mental illness, or death. Should
providing medical nutrition therapy without authorization,
even in circumstances or conditions that do not cause or
create risk of great bodily harm, serious physical or mental
illness, or death be punishable by imprisonment?
REGISTERED SUPPORT / OPPOSITION :
Support
California Dietetic Association (sponsor)
Certified Board of Nutrition Specialists
Loma Linda University
Numerous members of CDA
Opposition
California Citizens for Health Freedom
California Naturopathic Association
Numerous certified nutritionists
Analysis Prepared by : David Gonzalez / HEALTH / (916) 319-2097