BILL ANALYSIS
Revised
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|Hearing Date:April 28, 2003 |Bill No:SB |
| |907 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: SB 907Author:Burton
As Amended:April 22, 2003 Fiscal:Yes
SUBJECT: Naturopathic physicians
SUMMARY: Proposes a new state licensing program
"naturopathic physicians" or "naturopathic doctors" that
would include protection of various occupational titles and
a scope of practice for individuals with specified
education and training.
Existing law:
1)Establishes various boards and Bureau s within the
Department of Consumer Affairs (Department) that are
responsible for licensing and regulating persons
practicing various professions and occupations, including
various healing arts disciplines.
2)Provides, pursuant to the Medical Practice Act, for the
licensing and regulation of persons with specified
education and training as "physicians and surgeons"
(physicians) by the Medical Board of California within
the Department. Also, regulates the practice of medicine
in this state, and specifies that the physician's license
authorizes the holder to use drugs or devices in or upon
human beings and to sever or penetrate the tissue of
human beings and to use any and all other methods in the
treatment of diseases, injuries deformities, and other
physical and mental conditions.
3)Prohibits persons who are not licensed as physicians or
surgeons from engaging in certain activities constituting
the practice of medicine absent authorization in another
state law (e.g., another practice act such as
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Chiropractic Initiative Act, the Physical Therapy Act,
etc.)
4)Pursuant to provisions enacted last year in SB 577
(Burton), provides that, notwithstanding any other law
including the Medical Practice Act, a person is not in
violation of the provisions of the Medical Practice Act
which prohibit the unlicensed practice of medicine if:
a) The practitioner does not engage in the following
treatment activities :
(i) conducting surgery or any other procedure that
punctures the skin or harmfully invades the
body,
(ii) prescribing or administering X-rays,
(iii) prescribing or administering legend drugs or
controlled substances,
(iv) recommending the discontinuance of legend drugs
or controlled substances prescribed by an appropriate
licensed practitioner,
(v) willfully diagnosing and treating a physical or
mental condition of any person under circumstances or
conditions that cause or create a risk of great bodily
harm, serious physical injury, mental illness, or
death,
(vi) sets fractures, treats lacerations or abrasions
through electrotherapy
(vii) states, indicates or implies that he or she is a
physician, a surgeon, or a physician and surgeon, and
if
b) The practitioner makes and gives a copy of specified
written disclosures to
a client in language the client understands regarding
the practitioner's
education, training and qualifications; the
non-licensed/alternative nature
of the practitioner's treatment; and that neither the
practitioner nor his or
her services are licensed by the state.
5)Does not regulate the practice of naturopathy, or the use
of related titles or abbreviations related to
practitioners of naturopathy.
6)Provides for the licensing and regulation of persons with
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specified education and training as "osteopathic
physicians and surgeons" the Osteopathic Medical Board of
California within the Department.
7)Provides for the licensing of persons with specified
education and training as "licensed acupuncturists" or
"acupuncturists" by the Acupuncture Board within the
Department.
8)Provides, pursuant to an Initiative Act, for the
licensing and regulation of persons with specified
education and training as "chiropractors" by the
California Board of Chiropractic Examiners as a
free-standing entity in state government.
This bill establishes, until July 1, 2009, the Naturopathic
Physicians Act (Act), to be administered by the Bureau of
Naturopathic Physicians (Bureau) which the bill would
create within the Department.
Specifically, the bill :
1)Adds the proposed Bureau of Naturopathic Physicians to
various general provisions of the Business and
Professions Code that include the other licensing
entities in the Department; and requires the Bureau to
enforce and administer the provisions of the Act and to
adopt regulations to do so.
2)Defines various terms for purposes of the Act including
"Formulary," "Naturopathic physician," "Naturopathic
doctor," "Minor office procedures," and:
a) Defines "naturopathy " as: "a philosophy of healing that
employs natural methods that may be used by naturopathic
physicians and other persons not licensed under this
chapter."
b) Defines "naturopathic medicine " as: "a distinct and
comprehensive system of primary health care practiced by
a naturopathic physician for the diagnosis, treatment,
and prevention of human health conditions, injuries, and
disease that employs natural therapies, therapeutic
substances, and education to promote and restore health
by supporting and stimulating the individual's
self-healing process." [emphasis added]
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c) Defines "naturopathic childbirth attendance " as: "the
specialty practice of natural childbirth by a
naturopathic physician that includes the management of
normal pregnancy, normal labor and delivery, and the
normal postpartum period, including normal newborn care."
3)Requires the Bureau to approve a naturopathic medical
education program accredited by the Council on
Naturopathic Medical Education (CNME) that has the
following minimum requirements:
a) For admission - requires applicants to have completed
three-quarters of the credits required for a bachelor's
degree from a regionally accredited or pre-accredited
college or university or equivalency, as determined by an
advisory council established by the director (see #5
below).
b) Program requirements - requires a minimum of 4100 total
hours in basic and clinical sciences, naturopathic
philosophy, naturopathic modalities, and naturopathic
medicine - with not less than 2500 hours of academic
instruction and not less than 1200 hours consisting of
supervised clinical training approved by the naturopathic
school.
4)Requires a naturopathic medical education program to
offer graduate-level, full-time studies and training
leading to a degree of Doctor of Naturopathy or Doctor of
Naturopathic Medicine, and to be offered by an
institution that is either accredited or is a candidate
for accreditation by a regional institutional accrediting
agency recognized by the U.S. Secretary of Education and
the Council on Naturopathic Medical Education, or an
equivalent federally recognized accrediting body for
naturopathic physical education.
For approval by the Bureau, requires a school located in
Canada or the U.S. to offer a full-time, doctoral-level,
naturopathic medical education program whose graduates
are eligible to apply to the Bureau for licensure and to
the North American Board of Naturopathic Examiners that
administers the naturopathic licensing exam.
5)Requires the Director of Consumer Affairs to establish an
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advisory council that includes three (3) persons who are
licensed or have met the requirements for licensure as a
California licensed naturopathic physician, and four (4)
public members.
6)Requires that applicants for licensure as a naturopathic
physician:
a) Not have committed an act or crime that constitutes
grounds for license denial generally under the Business
and Professions Code.
b) Have received a degree in naturopathic medicine from an
approved naturopathic medical school where the degree
substantially meets the educational requirements
specified for approved schools.
c) Pass the Naturopathic Physicians Licensing Examination
(NPLEX) or an equivalent approved by the North American
Board of Naturopathic Examiners, or in the absence
thereof, by a substantially equivalent exam administered
by the Bureau.
7)Permits the Bureau to grant a license to an applicant who
is licensed and in good standing as a naturopathic
physician in another state, jurisdiction, or territory in
the United States if the applicant has met the
requirements listed in # 6 above.
8)Permits the Bureau to grant a license to an applicant who
graduated from a naturopathic medical school prior to
1986 and passed a state naturopathic licensing
examination, but not necessarily the NPLEX. The
applicant must apply no later than December 31, 2007.
(Grandfather provision)
9)Permits the Bureau to grant a "provisional " license to an
applicant who meets the required educational standards,
but who has not passed the NPLEX or a state naturopathic
licensing exam. The license is valid for two years during
which time the provisional licensee shall pass the NPLEX
or another competency examination approved by the Bureau
and practice under the direct supervision of a licensed
naturopathic physician. Provides that a provisional
licensee may be granted a permanent ("full") license upon
completion of the provisional license period.
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10) Provide for biennial license renewal , and authorizes
the Bureau to provide by regulation for late renewals.
11) Mandatory continuing education (CE):
a) Requires 60 hours of approved continuing education (CE)
courses for biennial license renewal (except the first
renewal), including at least 20 hours in
pharmcotherapeutics, no more than 15 hours may be in
non-onsite types of educational settings (e.g.,
videotape), no more than 20 hours in any single topic,
and no more than 15 hours of the CE that is required for
the specialty in naturopathic childbirth specialty
certificate may apply towards the general 60 hour CE.
b) Provides that the CE requirements may be met through CE
course approved by the California Association of
Naturopathic Physicians (CANP - the bill sponsor), the
American Association of Naturopathic Physicians, the
Medical Board of California, the State Board of Pharmacy,
the State Board of Chiropractic Examiners, or other
courses approved by the Bureau.
12) Permits the Bureau, upon request, to grant an inactive
license to a licensee, and provides that the inactive
licensee may not engage in practice, is exempt from the
mandatory CE requirements, and requires an inactive
licensee to complete the mandatory CE for the previous
two year period and pays a reactivation fee.
13) Scope of Practice.
a) Provides that a licensed naturopathic physician may :
(i) Order and perform physical and laboratory
examinations for diagnostic purposes.
(ii) Order and perform diagnostic imaging studies,
including X-rays, mammograms, bone densitometry and
others consistent with naturopathic training as
determined by the Bureau, but must refer the studies to
an appropriately licensed health care professional to
conduct the study and interpret the results.
(iii) Dispense, administer, and prescribe or perform:
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(1) Food, extracts, nutraceuticals, (2) Hot, cold,
hydrotherapy, massage, naturopathic manipulation,
electrical, sound, light, magnetic and electromagnetic
energy, colon hydrotherapy, and therapeutic exercise.
(iv) Dispense, administer, prescribe or perform devices
as specified, health education and health counseling,
repair and care incidental to superficial lacerations,
abrasions, and lesions.
(v) Remove foreign bodies located in superficial
tissues.
(vi) Use as routes of administration of treatment:
oral, nasal, auricular, ocular, rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous, and
intramuscular.
b) Prohibits a naturopathic physician from performing
specified functions including : administering therapeutic
ionizing radiation or radioactive substances, practicing
any other system of treatment unless otherwise licensed
to do so, administering general or spinal anesthesia,
performing an abortion, or performing any surgical
procedure involving tendons, nerves, veins, or arteries
extending beyond superficial tissue, or specialized
surgeries such as plastic surgery, eye surgery, or
surgery involving the body cavities.
14) Requires the Bureau to establish a subcommittee of the
advisory council composed of licensed naturopathic
physicians, pharmacists, and medical doctors, to
determine a naturopathic formulary based on review of the
naturopathic medical education and training, and
authorizes the Bureau, consistent with the findings of
the subcommittee to prescribe legend and controlled
substances except for specified intravenous drugs,
Schedule I & II controlled substances, cancer
chemotherapeutics, and antipsychotics.
15) Requires a naturopathic physician to document his or
her observations and treatments in patient records, and
maintain those records for at least 7 years.
16) Grants a naturopathic physician the same authority and
responsibility as a medical physician with regard to
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public health laws and reportable diseases.
17) Provides that the Act shall not be construed to
authorize a naturopathic physician to practice medicine,
to limit the practice of other licensed persons when
engaged in their licensed practice, or limit an activity
otherwise allowed by law including an activity authorized
pursuant to specified provisions of the medical practice
act (enacted last year in SB 577 - see # 3 under the
"Existing law" above.)
18) Provides that the Act shall not be construed to prevent
or restrict the practices, services or activities of
other persons, as specified, including: (i) employees of
the federal government, (ii) persons treating family
members in an emergency, (iii) persons engaged in the
sale of vitamins, foods, health foods, dietary
supplements, herbs, homeopathic remedies ,or other
products of nature, the sale of which is not otherwise
prohibited by law, (iv) persons engaged in good faith in
the practice of the religious tenets of any church or
religious belief without using prescription drugs, or
acting in good faith for religious reasons as a matter of
conscience or based on a personal belief, while obtaining
or providing information regarding health care and the
use of any product noted above, (v) persons who are
licensed to practice naturopathic medicine in another
state, territory, or the District of Columbia, if the
person is incidentally called into this state for
consultation with a naturopathic physician, or (vi)
students enrolled in an approved naturopathic medical
program whose services are performed pursuant to a course
of instruction under the supervision of a naturopathic
physician.
19) Naturopathic childbirth attendance. Provides that a
naturopathic physician may perform naturopathic
childbirth attendance if he or she has completed
additional training and has been granted a certificate of
specialty practice by the Bureau.
a) To obtain the specialty certificate , the naturopathic
physician must:
(i) Obtain a passing grade on the North American
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Registry of Midwives
Written Examination or an equivalent exam approved by
the Bureau.
(ii) Complete a midwifery or obstetrics specialty from
an approved
naturopathic medical educational program that includes
a minimum
of 200 hours in specified coursework, and an
internship or
preceptorship in naturopathic childbirth attendance.
(iii) Assist at a minimum of 50 births under the
supervision of a legal or
licensed practitioner in obstetrics or natural
childbirth attendance - 25 of
which must be supervised by a naturopathic physician.
(iv) Possess current certification in neonatal
resuscitation and
cardiopulmonary resuscitation.
(v) File with the Bureau a written plan for
consultation with other health
care providers, emergency transfer and transport of an
infant or maternity
patient or both to an appropriate health care facility
and access to
neonatal intensive care and obstetrical units or other
patient areas.
b) Requires completion of 30 hours of mandatory
continuing education every two years in naturopathic
childbirth, midwifery, or obstetrics, of which 15 hours
may be applied to the overall 60 hours of CE required for
license renewal.
c) Provides that disciplinary action taken against a
licensed naturopathic physician with a specialty
certificate that relates specifically to the practice of
naturopathic childbirth may suspend, revoke, condition or
restrict only the licensee's authority under the
specialty certificate instead of affecting the overall
license as a naturopathic physician.
d) Specifies that forceps delivery, general or spinal
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anesthesia, cesarean section delivery are not included
within the authority to perform a naturopathic childbirth
attendance.
e) Specifies additional functions or treatments that a
naturopathic physician who holds a specialty certificate
may administer, order, or perform, including postpartum
antihemorrhagic drugs, prohylactic opthalmic antibiotics,
local anesthetic medications, intravenous fluids as
specified, epinephrine for use in maternal anaphylaxis
pending emergency transport, equipment incidental to the
practice of naturopathic childbirth and to maternal care,
and minor office procedures including episiotomies.
f) Provides that disciplinary action taken against a
licensed naturopathic physician with a specialty
certificate that relates specifically to the practice of
naturopathic childbirth may suspend, revoke, condition or
restrict only the licensee's authority under the
specialty certificate instead of affecting the overall
license as a naturopathic physician.
g) Specifies that forceps delivery, general or spinal
anesthesia, cesarean section delivery are not included
within the authority to perform a naturopathic childbirth
attendance ; and requires that all complications of a
normal pregnancy be referred to an obstetrician or other
licensed physician as appropriate.
h) Specifies additional functions or treatments that a
naturopathic physician who holds a specialty certificate
may administer, order, or perform, including : postpartum
antihemorrhagic drugs, prohylactic opthalmic antibiotics,
local anesthetic medications, intravenous fluids as
specified, epinephrine for use in maternal anaphylaxis
pending emergency transport, equipment incidental to the
practice of naturopathic childbirth and to maternal care,
and minor office procedures including episiotomies.
i) Requires the naturopathic physician to disclose in
writing to the patient, certain information regarding the
qualifications of the licensee, a description of the
procedures , a copy of the written plan for consultation
and emergency transfer, and the status of liability
coverage of the licensee.
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20) Title protection. Requires a person to be licensed as
a naturopathic physician in order to :
a) Claim to be a naturopathic physician, licensed
naturopathic physician, naturopathic doctor, doctor of
naturopathic medicine, doctor of naturopathy, or
naturopathic medical doctor.
b) To use the abbreviation "N.D." or other similar titles
or letter to represent that he or she practices, or is
authorized to practice, or is able to practice
naturopathic medicine as a naturopathic physician.
c) Requires a licensed naturopathic physician who uses
the term or designation "Dr." to further identify himself
or herself as a "Naturopathic Physician" or "Naturopathic
Doctor," and prohibits the licensee from using any term
that tends to indicate the practice of medicine unless he
or she is otherwise licensed pursuant to other licensing
laws and thereby authorized to do so.
21) Makes it unprofessional conduct, subject to license
discipline, for a licensee to violate or assist or
conspire to violate any provision of the Naturopathic
Physicians Act; and authorizes the Bureau to discipline a
naturopathic physician for unprofessional conduct
pursuant to the provisions of the Administrative
Procedures Act regarding disciplinary actions and
hearings.
22) Makes violation of the Act's provisions a crime
punishable as a misdemeanor, punishable by a fine of up
to $5000 or imprisonment in county jail for up to one
year, or both.
23) Provides for the regulation of naturopathic
corporations in a similar manner as medical corporations
are regulated pursuant to provisions of the Medical
Practice Act; and authorizes the Bureau to adopt and
enforce regulations necessary to carry out this
regulation.
24) Authorizes the Bureau to establish and collect fees and
expend revenues generated therefrom ( see the Fiscal
Effect section below for details.)
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25) Requires the Bureau to prepare a report required of all
state licensing programs at least 22 months before they
are to become inoperative (generally referred to as a
"sunset report"), and provide it to the Joint Legislative
Sunset Review Committee no later than September 1, 2007
FISCAL EFFECT: Unknown.
This bill has been keyed as a fiscal bill by Legislative
Counsel.
There would be costs to initially establish the new
licensing program and to continue its operation and
administration of the Act through July 1, 2009. These
costs are expected to be offset and paid for from licensing
fees collected from prospective licensees (applicants for
licensure) and then licensees (once licenses have been
issued.)
The bill provides that the Bureau shall establish the
amount of the fee assessed to conduct the activities of the
Bureau, including the amount of the fees for applicant
licensure, licensure examination, licensure renewal, later
renewal, and childbirth certification. The bill does not ,
as yet, specify any range or maximum limit for any or all
of these various authorized fees - as is typical of
virtually all other state licensing acts. Once the author
and proponents have a better idea of what the costs will be
to establish and operate the new licensing program, the
bill should be amended to either specify the amounts of the
various fees and/or establish maximum fee limits at a level
that will cover the costs of the proposed licensure scheme.
The bill also provides that all fees collected by the
Bureau shall be paid into the State Treasury and credited
to the Naturopathic Physicians Fund, created by the bill,
and are available for expenditure by the Bureau upon
appropriation by the Legislature.
COMMENTS:
1.Author's Amendment: The Author's staff indicate that the
Author will offer amendments to remove the use of the
term "naturopathic physician" from all provisions of the
bill, including deleting it as a protected title by the
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bill.
This resolves one of several major concerns that the
California Medical Association has raised regarding this
bill.
2.Technical Amendment.
a. On page 3, line 27, following "boards" insert: ",
Bureaus , "
3.Drafting Concerns and Recommended Amendment.
b. On page 10, line 19, after the word "shall," insert the
following: " have met the requirements of Section 3631. "
On line 19, strike, "pass the NPLEX or," and strike lines
20 to 24. This will clarify that applicants who receive
a provisional license must pass a naturopathic licensing
examination within two years to be licensed as a
naturopathic physician.
4.Purpose. This bill is sponsored by the California
Association of Naturopathic Physicians (CANP) to provide
licensure of health practitioners who have acquired
specified education and training in naturopathy and
allopathic medicine. According to the author, the bill
establishes scope of practice and standards specific to
those particular persons,, and would authorize them to
practice under a broader scope than that authorized under
the author's SB 577 enacted last year.
[As noted in #3 under Existing Law at the beginning of this
analysis, SB 577 provides that a practitioner who
provides health care to a client is not guilty of the
unlawful, unlicensed practice of medicine, so long as
that practitioner does not engage in specified treatment
activities and makes specified disclosures regarding the
treatments being offered and the practitioner's
qualifications, including that the state has not licensed
either the practitioner nor the provision of his or her
services. The scope of practice in this bill for the
proposed licensed naturopathic physicians, specifically
includes those prohibited treatment activities and would
not require licensed naturopathic physicians to make the
disclosures required under SB 577.]
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5.Background. In the early part of this century,
California permitted the practice of naturopathy and
licensed and regulated "drugless practitioners" under
provisions of the Medical Practice Act. These
practitioners practiced in contrast to the practice of
so-called "allopathic" medicine or "allopathy" (which is
defined as therapy with remedies that produce effects
differing from those of the disease treated.) With the
rise and increased licensure of allopathic medical
physicians, California abolished the licensing of
"drugless practitioners, but permitted existing licensees
to continue to practice until 1998 when their licensing
provisions in the Medical Practice Act were repealed (SB
1981, Greene, Chapter 736) - as there were no longer any
licensed drugless practitioners left.
There have been several, unsuccessful attempts since then
to license or regulate the practice of naturopathy or
naturopathic medicine. Proponents of those efforts view
naturopathy as an alternative or complimentary system of
healthcare to that currently available and provided by
state licensed health care practitioners, especially
"allopathic" physicians and surgeons. These efforts have
included AB 3038 (Rosenthal - 1980), AB 2241 (Murray -
1993), SB 1166 (Watson - 1993), SB 1566 (Watson - 1994),
and SB 1059 (Johannessen.) Most of this previous
legislation would have enacted a formal state licensure
scheme for the practice of naturopathic medicine, and
regulated the use of related professional titles by
practitioners. (SB 1059 would have required the
Department of Consumer Affairs to study and report to the
Legislature regarding the need and appropriateness for
the state to license the practice of naturopathy, but
that billed failed passage in Senate Appropriations
Committee.)
So efforts to enact licensure for naturopathy or
naturopathic medicine have not been successful. They
failed in part due to opposition from other licensed
health care practitioners such as physicians and
surgeons, and in part due to disagreements among the
various exponents of naturopathy as to its definition,
scope, educational and training requirements, need for
licensure, and limitations on the use of professional
titles.
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Essentially, there have been two major divisions of
supporters of naturopathy: (1) those that believe it is
an adjunct to improved healthful functioning and
well-being, but not a diagnostic form of treatment for
particular diseases or ailments; and, (2) those who
believe it is an alternative or complimentary system for
diagnosing and treating human diseases. Opposition from
currently licensed health care practitioners, especially
physicians licensed by the Medical Board, questioned the
efficacy of the naturopathic system of treatment and
argued that its treatment premises and modalities have
not been proven to be valid through scientific,
"double-blind" studies.
Finally, last year, SB 577 authorized practitioners of
naturopathy and other forms of complimentary or
alternative (to allopathy) healing methods to practice
without being in violation of the current medical
practice licensing law (the Medical Practice Act), so
long as the practitioners did not engage in specified
types of treatment activities and if they also provided
their clients with specified written disclosures as to
their credentials, type of treatments offered, and the
fact that neither they, nor their treatments were
licensed by the state.
While enactment of SB 577, was seen as opening up access to
practitioners of non-allopathic healing methods and the
patients who seek their services, it did not formally
license these practitioners and, as noted, still
precluded them from offering certain treatment methods
that were viewed as singularly "allopathic" in nature.
The proponents of the current bill obtain education and
training in both naturopathic and allopathic healing
methods and seek licensure so that they may offer both,
including some of the treatment procedures not permitted
to non-licensed physicians, chiropractors, and other
licensed healing arts practitioners.
Currently, there are 11 other states and one U.S. Territory
that license or specifically regulate naturopathic
doctors in some fashion: Alaska, Arizona, Connecticut,
Hawaii, Maine, Montana, New Hampshire, Oregon, Utah,
Vermont, Washington and Puerto Rico. The scopes of this
regulation and practice vary from jurisdiction to
jurisdiction.
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6.Arguments in Support. The sponsor, the California
Association of Naturopathic Physicians (CANP) supports
licensure for naturopathic physicians because it believes
that such licensure will improve consumer access to safe
and effective complimentary and alternative medicine
therapies in addition to allopathic ones, and because it
will provide for licensure consistent with the
naturopathic physician's education and training, and
their scope of practice in other jurisdictions. Thus it
is argued, that the bill will allow these practitioners
to practice to the fullest extent of their training. CANP
also believes that the bill is a title act that will not
restrict the scope of legal practice by other health care
practitioners, licensed or unlicensed, and permit the
public continued access to any legal practitioner.
California Citizens for Health Freedom supports the bill,
arguing that licensing of naturopathic practitioners will
increase citizens right of choice, help enhance the
health/medical services in California, reduce the rising
cost of health care, assist in meeting the crisis of a
decline in primary care physicians, increase the
professional resources of experts to the growing
nutritional industry in California, and set the stage for
a university specializing in naturopathic medicine to be
open in California in the near future.
The Council on Naturopathic Medical Education (CNME), which
accredits schools of naturopathic medicine, supports the
bill stating that licensing will help ensure that
patients know the doctor they are seeing has been
thoroughly trained at a four-year naturopathic medical
school which is all important to making correct diagnoses
and prescribing effective treatments. CNME argues that
people with little or no clinical training are practicing
as "naturopaths" in states that do not regulate
naturopathic medicine.
National College of Naturopathic Medicine (Oregon) supports
the bill stating that it will ensure accountability that
physician-level doctors be licensed and regulated in the
most populous state in the United States. The college
argues that the public deserves comparable (to allopathic
medicine) regulatory standards for naturopathic
physicians who are primary care providers, and that since
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one out of four Americans seek or utilize natural
medicine, the passage of the bill would improve access to
natural health care. Further, the college argues that
the bill will improve public safety since, at present,
California has no standards to inform consumers whether
their naturopathic physician has completed a four-year,
graduate-level naturopathic medical school, passed
standard board exams, and meets federally recognized
standards of education and professional accountability.
And like the sponsor, the college argues that the bill
clearly defines the scope of professional practice
consistent with the training of the licensee.
American Specialty Health Plans (ASHP) also supports this
bill. ASHP is a Knox-Keene licensed Specialty Health
Plan in California that offers complementary health care
benefits including chiropractic, acupuncture, massage
therapy, dietetics and naturopathy in those states where
licensure of these specialties has been enacted. ASHP
states that the bill will allow Californians the right to
access qualified Naturopathic Physicians as the citizens
in 12 other states (including one U.S. Territory) enjoy.
ASHP believes that the proposed licensing will ensure
public safety and accountability to appropriately trained
and examined applicants for licensure - and that
consumers deserve comparable regulatory standards and
oversight mechanisms for all health care providers,
including naturopathic physicians.
The bill is also supported by the North American Board of
Naturopathic Examiners (which administers the national
naturopathic physician examination - the NPLEX,) the
University of Bridgeport - College of
Naturopathic Medicine, the American Holistic Health
Association, the American Association for Health Freedom,
and others.
7.Arguments in Opposition. The California Chiropractic
Association (CCA) strongly opposes the bill stating that
there is no need for the bill. CCA argues that the bill
creates a new class of health care providers who are not
adequately trained for the scope of practice contained in
the bill and that the bill will cost the state money.
CCA states that the specified naturopathic education is
not sufficient to support the authority granted proposed
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licensees by the bill, since most of the areas such as
pharmacology, gynecology, primary care, etc. that
naturopaths claim to learn, each generally require a
separate four-year degree.
In particular, CCA objects to the inclusion of
"manipulation" (referred to in the bill as "naturopathic
manipulation") pointing out that while the practice of
manipulation has been shown to be safe in the hands of
highly skilled doctors of chiropractic, it requires over
4000 hours of education to become a chiropractor. CCA
believes that patients can be harmed if naturopaths are
allowed to diagnose and treat conditions in which they
have little training. CCA also argues that the bill is
not fiscally supportable in that it would require the
creation of a licensing bureau and program in the
Department of Consumer Affairs to license only the 65
people anticipated who could qualify for licensure at the
present time.
The California Academy of Family Physicians (CAFP) opposes
the bill unless it is amended. CAFP argues that
expanding the scope of practice for naturopaths raises
questions about the quality of care, the evidence basis
for courses of treatment, health outcomes and medical
liability. CAFP believes the scope of practice proposed
for naturopathic physicians is too broad, and includes
treatments that appropriately belong in the scope of
practice for medical doctors, doctors of osteopathy, and
in some cases nurses. CAFP has requested that author
amend the bill to: 1) remove any reference to
naturopaths as "physicians" (see proposed author's
amendment to do this) and, 2) provide no authority to
naturopaths to prescribe drugs, perform minor surgical
procedures,perform childbirth, or order X-rays,
mammograms or other diagnostic imaging studies.
The California Medical Association (CMA) opposes the bill
unless it is amended. CMA states that while it believes
that a title act and licensure of naturopath would
significantly improve their ability to practice
naturopathy, it believes that the bill should be amended
to ensure that the public is not misled into believing
that naturopaths have the same level of training as a
primary care physician licensed pursuant to the Medical
Practice Act. CMA requests that the bill be amended to
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delete any reference to "physician", as it believes
naturopathic education and training is not sufficient to
allow them to function as family physicians and to
distinguish a minor ailment from a medical emergency.
CMA also requests that the provisions that allow for
prescribing authority, performance of minor surgical
procedures and
childbirths also needs to be deleted again citing its
belief that naturopaths have insufficient education and
training to perform those things as proposed in the bill.
The American College of Obstetricians and Gynecologists
(ACOG) also opposes the bill unless it is amended. ACOG
is concerned that permitting naturopaths to manage
obstetrical care places the health of the woman and the
infant at increased risk of harm. ACOG states pregnancy,
even when it is normal, can develop serious health
complications that can arise without warning, and that
naturopaths do not have the training to handle these
types of acute, life-threatening medical conditions.
ACOG states its concerns are like those of the CMA, and
specifically wants the bill amended to remove obstetrical
care from the proposed scope of practice of naturopaths.
The Coalition for Natural Health opposes the bill arguing
that the expanded range of services that would be
authorized, and which go beyond what has been permitted
under SB 577 enacted last year, constitute the practice
of medicine. The Coalition believes that the education
and training of the proposed "naturopathic physicians" is
inadequate to perform the functions contained in their
proposed scope of practice that go beyond what has been
permitted by SB 577.
Further, the Coalition states that the bill will have a
negative impact in that it requires establishing a new
licensing program for just a few practitioners, and that
to become operational, the new program will either have
to borrow money or secure a loan of an unspecified amount
from the General Fund. In addition, the Coalition argues
that the bill will grant primary care status to the
proposed new licensees, placing them in a position to be
gatekeepers to real medical doctors and create the
expectation that initial and continuing medical
competence is assured which it believes is untrue.
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The Coalition argues that the bill is not about patient
access or care, but intended to serve the parochial
self-interest of certain practitioners and the particular
schools from which they have obtained their education.
It believes that licensing of these practitioners as
proposed would have the detrimental effect of putting
other actively practicing naturopaths out of business,
eliminating access by patients to their services, and
destroying the progress California made last year when it
enacted SB 577, legalizing many alternative health
treatment modalities.
The California Naturopathic Association (CNA) also opposes
the bill stating that it will displace over 1000
"traditional" naturopaths (those who do not employ the
allopathic treatment modalities authorized in the bill)
in favor of fewer than 60 "naturopathic physicians" who
could qualify for licensure under the bill. CNA states
that in every state where naturopathic physicians are
licensed, traditional naturopaths, nor other licensed
practitioners, can practice as naturopaths. CNA also
notes that the training of the proposed licensed
naturopathic physicians in specific naturopathic
practices is extremely small, about 650 hours.
A number of other organizations and many individuals, some
of whom currently practice in California as naturopathic
doctors or naturopaths oppose the bill (see list below
under Support and Opposition.) These opponents variously
argue that the bill will: (a) endanger the public by
granting the proposed licensees the authority to perform
treatments for which they are not adequately educated or
trained, (b) unreasonably grant a monopoly to just a few
practitioners by giving them exclusive authority to use
naturopathic title, thereby disenfranchising the other
naturopathic practitioners, and reducing rather than
increasing the public's access to naturopathic
treatments, and
(c) impose an unnecessary financial burden on the State
of California to establish a licensing program for just a
few practitioners.
Opponents question the bill's reliance on the educational
standards specified in the bill. They state that the
CNME which accredits naturopathic schools, and whose
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accreditation is accepted by the provisions of the bill,
is no longer recognized by the United States Department
of Education (USDE) as an accreditation body for schools
seeking participation in federal programs; notably
student loan programs. The opponents further state, that
even during the years when the CNME was recognized by the
USDE, it never fully complied with federal requirements
which ultimately led to the withdrawal of the USDE
recognition.
Additionally, opponents note that the faculty at the
naturopathic medical schools have few medical doctors on
their staff, with most of the faculty listing only a
degree from that particular school as their
qualification. And one of the schools that would qualify
under the bill's provisions, currently only is a
"candidate" for accreditation and has had extensive
operational problems over the years.
The opponents emphasize that naturopathic treatments can
now legally be provided to the public by practitioners
pursuant to SB 577, who must disclose to their patients
their education and training, the nature of their
proposed treatment modalities, and the fact that they are
not licensed by the state, nor are the treatment measures
they employ. This required disclosure is believed to
enable practitioners to distinguish themselves from other
practitioners by revealing their own credentials to
practice, and informs the public so that it can make a
reasonable decision about what care they want and who
they want to have care for them.
8.Title protection issue. This bill protects, or in
essence, "copyrights" the certain professional titles or
abbreviations: "naturopathic physician" ( to be deleted by
the Author's amendments ), "licensed naturopathic
physician" ( also to be deleted ) "naturopathic doctor,"
"doctor of naturopathic medicine," "doctor of
naturopathy," "naturopathic medical doctor," and "N.D."
Some of these titles and abbreviations are terms of
current and long-standing usage by a host of naturopathic
health practitioners, only a few of whom have the type
and amount of education that is required by this bill to
continue to use those terms.
Title protection is not legally required as part of a state
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regulatory scheme for a profession or occupation, though
it frequently is provided for in California's current
regulatory statutes. Generally, and in this case, the
rationale is so that practitioners with specified
education and training will be distinguishable from
others. If licensing is deemed to be necessary, and if
exclusive use of a title or titles is deemed to be a
necessary part of that licensure to protect the public
beyond what is currently available to them to ascertain a
practitioner's credentials and training then
consideration could be given to narrowing that title
protection perhaps to a term such as " licensed
naturopathic doctor ." Such a term is not currently used
by practitioners of naturopathy or medicine, and it
clearly delineates the distinguishing feature of the
particular group of practitioners that would be
"licensed" by the state through this bill. Other
California professional or occupational regulatory
statutes use similar title protection that contains the
word "licensed" or "certified" as a method of
distinguishing practitioners who have met specified
education, training, experience and examination
requirements from those who have not.
SUPPORT AND OPPOSITION:
Support : California Association of Naturopathic Physicians
(CANP - Sponsor)
Council on Naturopathic Medical Education (CNME)
National College of Naturopathic Medicine
American Specialty Health Plans (ASHP)
California Citizens for Health Freedom
American Holistic Health Association
University of Bridgeport (Connecticut)
American Association for Health Freedom (AAHF)
North American Board of Naturopathic Examiners
(NABNE)
(14) Naturopathic doctors
Oppose Unless Amended : California Medical Association
(CMA)
California Academy of
Family Physicians (CAFP)
American College of
Obstetricians and Gynecologists
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Opposition : California Chiropractic Association (CCA)
Coalition for Natural Health
American Naturopathic Medical Association (ANMA)
California Naturopathic Association (CNA)
International College of Naturopathy
American Naturopathic Association (ANA)
Consumer Alliance for Consumer Protection
(7) Naturopathic doctors
(136) Chiropractors
(203) Individuals
Consultant:Jay J. DeFuria