BILL ANALYSIS
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UNFINISHED BUSINESS
Bill No: SB 907
Author: Burton (D)
Amended: 8/25/03
Vote: 21
SENATE BUSINESS & PROFESSIONS COMMITTEE : 4-2, 4/28/03
AYES: Figueroa, Cedillo, Machado, Murray
NOES: Aanestad, Brulte
NO VOTE RECORDED: Vincent
SENATE APPROPRIATIONS COMMITTEE : 10-3, 5/19/03
AYES: Alpert, Bowen, Burton, Escutia, Johnson, Karnette,
Machado, Murray, Poochigian, Speier
NOES: Battin, Aanestad, Ashburn
SENATE FLOOR : 21-13, 5/22/03
AYES: Alarcon, Alpert, Bowen, Burton, Cedillo, Chesbro,
Ducheny, Dunn, Figueroa, Florez, Karnette, Kuehl,
Machado, Murray, Ortiz, Perata, Sher, Soto, Torlakson,
Vasconcellos, Vincent
NOES: Aanestad, Ackerman, Ashburn, Battin, Brulte, Denham,
Hollingsworth, Knight, Margett, McClintock, Morrow,
Oller, Poochigian
NO VOTE RECORDED: Escutia, Johnson, McPherson, Romero,
Scott, Speier
ASSEMBLY FLOOR : 62-9, 8/28/03 - See last page for vote
SUBJECT : Naturopathic doctors
SOURCE : California Association of Naturopathic
Physicians
CONTINUED
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DIGEST : This bill establishes, until July 1, 2009, the
Naturopathic Doctors Act (Act), to be administered by the
State Bureau of Naturopathic Medicine (Bureau), which this
bill creates within the State Department of Consumer
Affairs (DCA).
Assembly Amendments make numerous changes, including, (1)
specifying that the moneys in the Naturopathic Doctor's
Fund (Fund) are available to the Bureau only upon
appropriation by the Legislature, (2) appropriating all
money other than specified revenue received and credited to
the Fund in the 2003-04 fiscal year to the Bureau to
implement the Act's provisions, (3) requiring DCA to
certify that sufficient funds are available prior to
implementation, (4) requiring the Bureau, the Contractors'
State License Board and the State Structural Pest Control
Board to obtain fingerprints from a licensing applicant to
conduct a criminal history check, and (5) incorporating
additional changes in Section 13401.5 of the Corporations
Code proposed by AB 123 (Cohn) to avoid chaptering out
problems.
ANALYSIS :
This bill:
1. Requires the Bureau to enforce and administer the
provisions of this bill and to adopt regulations to
carry out the Act and to approve a naturopathic medical
education program (NMEP) accredited by the Council on
Naturopathic Medical Education (CNME) or an equivalent
federally recognized accrediting body for the
naturopathic medical profession that meets specified
criteria, including a minimum of 4,100 total hours in
basic and clinical sciences, naturopathic philosophy,
naturopathic modalities and naturopathic medicine.
2. Requires a NMEP 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
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institutional accrediting agency recognized by the
United States Secretary of Education and CNME, or an
equivalent federally recognized accrediting body for
naturopathic doctor education.
3. Requires the Director of DCA to establish an advisory
council consisting of nine members that include three
persons who are licensed or have met the requirements
for licensure as a California licensed naturopathic
doctor.
4. Provides that the Governor shall appoint five members to
the advisory council, the Senate Rules Committee shall
appoint two members, and the Speaker of the Assembly
shall appoint two members as set forth in the bill.
5. Provides that the Bureau shall establish a naturopathic
formulary advisory committee that includes physicians
and surgeons, pharmacists and naturopathic doctors from
clinical and academic settings and report back to the
Legislature not later than 1/1/06 regarding the
prescribing and furnishing authority of a naturopathic
doctor.
6. Requires the Bureau to establish a naturopathic
childbirth attendance advisory committee to issue
recommendations concerning the practice of naturopathic
childbirth attendance based upon a review of medical
education and training and submit recommendations to the
Legislature by January 1, 2006.
7 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. The applicant must apply no later than
December 31, 2007.
8 Requires a licensee to pass a recertifying examination
before the tenth anniversary of his or her initial
licensure pursuant to this bill and requires the Bureau
to establish standards and adopt an examination.
9. Requires 60 hours of approved continuing education (CE)
courses for biennial license renewal (except the first
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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 CE that is required for the
specialty in naturopathic childbirth specialty
certificate may apply toward the general 60 hour CE
requirement.
10.Provides that, pursuant to his or her scope of practice,
a licensed naturopathic doctor may:
A. Order and perform physical and laboratory
examinations for diagnostic purposes.
B. 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.
C. Dispense, administer, order, and prescribe or
perform the following: (1) food extracts,
nutraceuticals and vitamins, and (2) hot or cold
hydrotherapy, naturopathic physical medicine
inclusive of the manual use of massage, stretching,
resistance, or joint play examination but exclusive
of small amplitude movement at or beyond the end
range of normal joint motion, electromagnetic energy,
colon hydrotherapy, and therapeutic exercise.
D. Dispense, administer, prescribe or perform
devices, as specified, health education and health
counseling, repair and care incidental to superficial
lacerations, and abrasions, except suturing.
E. Remove foreign bodies located in superficial
tissues.
F. Use as routes of administration of treatment:
oral, nasal, auricular, ocular, rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous,
and intramuscular.
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11.Provides that the authority to use all routes for
furnishing prescriptions shall be consistent with the
oversight and supervision requirements of Section 2836.1
of the Business and Professions Code. Specifies the
circumstances under which a naturopathic doctor may
furnish or order drugs and those drugs that may be
furnished or ordered.
12.Prohibits a naturopathic doctor 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 or traditional Chinese medicine as an
acupuncturist.
13.Requires the Bureau to establish a subcommittee of the
advisory council composed of licensed naturopathic
doctors, 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.
14.Grants a naturopathic doctor the same authority and
responsibility as a medical physician with regard to
public health laws and reportable diseases.
15.Provides that the Act shall not be construed to
authorize a naturopathic doctor to practice medicine, to
limit the practice of other licensed persons when
engaged in their licensed practice, or limit an activity
that does not require licensure or is otherwise allowed
by law, including an activity authorized pursuant to
specified provisions of the medical practice act enacted
in SB 577 (Burton), Chapter 820, Statutes of 2002.
16.Provides that the Act shall not be construed to prevent
or restrict the practices, services or activities of
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other persons, as specified, including: (a) employees
of the federal government, (b) persons treating family
members in an emergency, (c) persons who make
recommendations or are engaged in the sale of food,
extracts of food, nutraceuticals, vitamins, amino acids,
minerals, enzymes, botanicals, homeopathic medicines,
dietary supplements, and nonprescription drugs, or other
products of nature, the sale of which is not otherwise
prohibited by law, (d) 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, (e) 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 doctor or, (f) students
enrolled in an approved naturopathic medical program
whose services are performed pursuant to a course of
instruction under the supervision of a naturopathic
doctor.
17.Provides that a naturopathic doctor 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.
18.Requires a licensed naturopathic doctor who uses the
term or designation "Dr." to further identify himself or
herself as a "Naturopathic Doctor," "Licensed
Naturopathic Doctor," "Doctor of Naturopathic Medicine,"
or "Doctor of Naturopathy," 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.
19.Makes it unprofessional conduct, subject to license
discipline, for a licensee to violate or assist or
conspire to violate any provision of the Act and
authorizes the Bureau to discipline a naturopathic
doctor for unprofessional conduct pursuant to the
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provisions of the Administrative Procedures Act
regarding disciplinary actions and hearings.
20.Makes violation of the Act's provisions a crime
punishable as a misdemeanor, punishable by a fine of up
to $5,000, or imprisonment in county jail for up to one
year.
21.Authorizes the Bureau to establish and collect fees and
expend revenues generated therefrom, but does not
appropriate any start-up funds or General Fund loans to
cover initial expenditures that the Bureau will be
required to make.
22.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.
Comments
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's office, this bill establishes
scope of practice and standards specific to those
particular persons, and authorizes them to practice under a
broader scope than currently authorized.
This bill protects the title "Doctor of Naturopathic
Medicine," "Doctor of Naturopathy," "Naturopathic doctor,"
and the professional abbreviation "N.D." It is currently
illegal to use these titles in a clinical setting. Under
the Medical Practice Act no one may represent himself or
herself as "doctor" unless they are licensed to practice a
medical art. 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. This bill leaves the
terms "naturopath" and "naturopathy" in the public domain
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so that graduates of naturopathic vocational programs or
correspondence courses can describe their practice. This
bill establishes standards that must be met in order to
qualify for licensure. Applicants must show that they have
met educational requirements and have competency by passing
board exams. Licensees must meet ongoing CE requirements
and be recertified every 10 years following initial
licensure. This bill creates a Bureau under DCA that is
fiscally neutral and self-funded. No loan from the General
Fund is required.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: Yes
According to the Assembly Third Reading analysis, DCA
estimates first-year costs of $90,000 and annual ongoing
costs of $145,000, funded through fees, assuming one
full-time staff person and a 30 percent time executive
officer. Fee-supported costs to the State Department of
Justice for criminal offender record information background
checks for Bureau employees and licensees. Assuming 215
individuals in the first year, a cost of $12,000. Ongoing
costs depends upon employee turnover and the number of
applicants for licensure.
SUPPORT : (Verified 8/29/03)
California Association of Naturopathic Physicians (source)
American Specialty Health Plans
Congress of California Seniors
University of Bridgeport College of Naturopathic Medicine
Several individuals
OPPOSITION : (Verified 8/29/03)
American College of Obstetricians and Gynecologists
American Naturopathic Medical Association
California Academy of Family Physicians
California Acupuncture Center
California Alliance for Consumer Protection
California Chiropractic Association
California Medical Association
Chinese Medicine and Acupuncture Association
Coalition for Natural Health
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Doctor's Research Inc.
United California Practitioners of Chinese Medicine
Numerous individuals
ARGUMENTS IN SUPPORT : 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 this bill
will allow these practitioners to practice to the fullest
extent of their training. CANP also believes that this
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.
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 this bill will allow Californians the right to
access qualified Naturopathic Physicians as the citizens in
12 other states (including one United States 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.
ARGUMENTS IN OPPOSITION : The Coalition for Natural
Health (prior version) opposes this bill, arguing that the
expanded range of services that would be authorized
constitutes the practice of medicine. The Coalition
believes that the education and training of naturopathic
doctors is inadequate to perform the functions contained in
their proposed scope of practice, and it argues that this
bill is not about patient access or care, but is intended
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to serve the parochial self-interest of certain
practitioners and the particular schools from which they
have obtained their education. The Coalition believes the
licensing of these practitioners as proposed by this bill
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 (Burton),
Chapter 820, Statutes of 2002, which legalized many
alternative health treatment modalities.
ASSEMBLY FLOOR :
AYES: Aghazarian, Bates, Benoit, Berg, Bermudez, Bogh,
Calderon, Canciamilla, Chan, Chavez, Chu, Cohn, Corbett,
Correa, Diaz, Dutra, Dymally, Frommer, Garcia, Goldberg,
Hancock, Harman, Haynes, Jerome Horton, Shirley Horton,
Houston, Jackson, Keene, Kehoe, Koretz, Laird, Leno,
Levine, Lieber, Liu, Longville, Lowenthal, Maldonado,
Maze, McCarthy, Montanez, Mullin, Nakano, Nation, Negrete
McLeod, Nunez, Oropeza, Pacheco, Parra, Pavley, Reyes,
Ridley-Thomas, Salinas, Simitian, Spitzer, Steinberg,
Vargas, Wiggins, Wolk, Wyland, Yee, Wesson
NOES: Campbell, Cox, Dutton, La Suer, Matthews, Mountjoy,
Nakanishi, Richman, Strickland
CP:mel 8/29/03 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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