Senate Bill No. 538

Introduced by Senator Block

February 26, 2015

An act to amend Sections 3640 and 3640.5 of the Business and Professions Code, relating to naturopathic doctors.

LEGISLATIVE COUNSEL’S DIGEST

SB 538, as introduced, Block. Naturopathic doctors.

(1) Existing law, the Naturopathic Doctors Act, provides for the licensure and regulation of naturopathic doctors by the Naturopathic Medicine Committee in the Osteopathic Medical Board of California. Existing law authorizes a naturopathic doctor to perform certain tasks, including physical and laboratory examinations for diagnostic purposes, and to order diagnostic imaging studies, as specified.

This bill would revise and recast those provisions and would expressly authorize a naturopathic doctor to order, perform, review, and interpret the results of diagnostic procedures commonly used by physicians and surgeons in general practice and to dispense, administer, order, prescribe, provide, furnish, or perform parenteral therapy and minor procedures, among other duties. The bill would include cervical routes of administration among the authorized routes of administration. The bill would define terms for those purposes.

(2) Existing law, the California Uniform Controlled Substances Act, classifies controlled substances into 5 designated schedules, with the most restrictive limitations generally placed on controlled substances classified in Schedule I, and the least restrictive limitation generally placed on controlled substances classified in Schedule V.

Existing law states that nothing in the Naturopathic Doctors Act or any other law shall be construed to prohibit a naturopathic doctor from furnishing or ordering drugs when, among other requirements, the naturopathic doctor is functioning pursuant to standardized procedure, as defined, or protocol developed and approved, as specified, and the Naturopathic Medicine Committee has certified that the naturopathic doctor has satisfactorily completed adequate coursework in pharmacology covering the drugs to be furnished or ordered. Existing law requires that the furnishing or ordering of drugs by a naturopathic doctor occur under the supervision of a physician and surgeon. Existing law also authorizes a naturopathic doctor to furnish or order controlled substances classified in Schedule III, IV, or V of the California Uniform Controlled Substances Act, but limits this authorization to those drugs agreed upon by the naturopathic doctor and physician and surgeon as specified in the standardized procedure. Existing law further requires that drugs classified in Schedule III be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician.

This bill would instead provide that nothing in the provisions governing naturopathic doctors or any other law shall be construed to prohibit a naturopathic doctor from furnishing, prescribing, administering, or ordering drugs and would make a conforming change to the scope of the certification duties of the Naturopathic Medicine Committee. The bill would delete the other provisions described above restricting the authority of naturopathic doctors to furnish or order drugs, including the requirements that the naturopathic doctor function pursuant to a standardized procedure, or furnish or order drugs under the supervision of a physician and surgeon.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 3640 of the Business and Professions
Code is amended to read:

begin delete

3640.  

(a) A naturopathic doctor may order and perform
physical and laboratory examinations for diagnostic purposes,
including, but not limited to, phlebotomy, clinical laboratory tests,
speculum examinations, orificial examinations, and physiological
function tests.

(b) 

end delete

begin insert

begin insert 3640. end insert   

end insert

begin insert (a) end insert begin insert   end insert A naturopathic doctor may order begin insert , perform, review,
and interpret the results of end insert diagnostic begin delete imaging studies, including
X-ray, ultrasound, mammogram, bone densitometry, and others,
consistent with naturopathic training as determined by the
committee, but shall refer the studies to an appropriately licensed
health care professional to conduct the study and interpret the
results. end delete begin insert procedures commonly used by physicians and surgeons in
general practice, including: end insert

begin insert

(1) Venipuncture.

end insert begin insert

(2) Physical and orificial examinations.

end insert begin insert

(3) Electrocardiograms.

end insert begin insert

(4) Diagnostic imaging technique consistent with the practice
of naturopathic medicine.

end insert begin insert

(5) Phlebotomy.

end insert begin insert

(6) Clinical laboratory test and examinations, as described in
subdivision (e).

end insert begin insert

(7) Obtaining samples of human tissue, consistent with the
practice of naturopathic medicine.

end insert begin delete

(c)

end delete

begin insert (b) end insert  A naturopathic doctor may dispense, administer, order,
prescribe, begin delete and furnish end delete begin insert provide, furnish, end insert or perform the following:

(1) Food, extracts of food, nutraceuticals, vitamins, amino acids,
minerals, enzymes, botanicals and their extracts, botanical
medicines, homeopathic medicines, all dietary supplements and
nonprescription drugs as defined by the federal Food, Drug, and
Cosmetic Act, consistent with the routes of administration
identified in subdivision (d).

(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.

(3) Devices, including, but not limited to, therapeutic devices,
barrier contraception, and durable medical equipment begin insert consistent
with naturopathic training as determined by the committee end insert .

(4) Health education and health counseling.

begin delete

(5) Repair and care incidental to superficial lacerations and
abrasions, except suturing.

end delete begin delete

(6) Removal of foreign bodies located in the superficial tissues.

end delete begin insert

(5) Parenteral therapy.

end insert begin insert

(6) Minor procedures.

end insert begin delete

(d)

end delete

begin insert (c) end insert  A naturopathic doctor may utilize routes of administration
that include oral, nasal, auricular, ocular, begin insert cervical, end insert rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous, and
intramuscular.

begin delete

(e)

end delete

begin insert (d) end insert  The committee may establish regulations regarding ocular
or intravenous routes of administration that are consistent with the
education and training of a naturopathic doctor.

begin delete

(f)

end delete

begin insert (e) end insert  Nothing in this section shall exempt a naturopathic doctor
from meeting applicable licensure requirements for the performance
of clinical laboratory tests, including the requirements imposed
under Chapter 3 (commencing with Section 1200).

begin insert

(f) For purposes of this section:

end insert begin insert

(1) “Minor procedures” means care and operative procedures
relative to superficial laceration, lesions, and abrasions, and the
removal of foreign bodies located in superficial structures and
aspiration of joints, and the topical and parenteral use of
substances consistent with the practice of naturopathic medicine,
in accordance with rules established by the Naturopathic Medicine
Committee.

end insert begin insert

(2) “Parenteral therapy” means the administration of
substances by means other than through the gastrointestinal tract,
including intravenous, subcutaneous and intramuscular,
intravenous and other areas of the body excluding the ventral and
dorsal body cavities.

end insert

SEC. 2.  

Section 3640.5 of the Business and Professions Code
is amended to read:

3640.5.  

begin insert (a) end insert begin insert   end insert Nothing in this chapter or any other begin delete provision of end delete
law shall be construed to prohibit a naturopathic doctor from
furnishing begin delete or end delete begin insert , prescribing, administering, or end insert ordering drugs begin delete when
all of the following apply: end delete begin insert . end insert

begin delete

(a) The drugs are furnished or ordered by a naturopathic doctor
in accordance with standardized procedures or protocols developed
by the naturopathic doctor and his or her supervising physician
and surgeon.

(b) The naturopathic doctor is functioning pursuant to
standardized procedure, as defined by subdivisions (a), (b), (d),
(e), (h), and (i) of Section 2836.1 and paragraph (1) of subdivision
(c) of Section 2836.1, or protocol. The standardized procedure or
protocol shall be developed and approved by the supervising
physician and surgeon, the naturopathic doctor, and, where
applicable, the facility administrator or his or her designee.

(c) The standardized procedure or protocol covering the
furnishing of drugs shall specify which naturopathic doctors may
furnish or order drugs, which drugs may be furnished or ordered
under what circumstances, the extent of physician and surgeon
supervision, the method of periodic review of the naturopathic
doctor’s competence, including peer review, and review of the
provisions of the standardized procedure.

(d) The furnishing or ordering of drugs by a naturopathic doctor
occurs under physician and surgeon supervision. Physician and
surgeon supervision shall not be construed to require the physical
presence of the physician, but does include all of the following:

(1) Collaboration on the development of the standardized
procedure.

(2) Approval of the standardized procedure.

(3) Availability by telephonic contact at the time of patient
examination by the naturopathic doctor.

(e) For purposes of this section, a physician and surgeon shall
not supervise more than four naturopathic doctors at one time.

(f)

end delete

begin insert (b) end insert  Drugs furnished or ordered by a naturopathic doctor may
include Schedule III through Schedule V controlled substances
under the California Uniform Controlled Substances Act begin delete ( end delete Division
10 (commencing with Section 11000) of the Health and Safety begin delete Code) and shall be further limited to those drugs agreed upon by
the naturopathic doctor and physician and surgeon as specified in
the standardized procedure. When Schedule III controlled
substances, as defined in Section 11056 of the Health and Safety
Code, are furnished or ordered by a naturopathic doctor, the
controlled substances shall be furnished or ordered in accordance
with a patient-specific protocol approved by the treating or
supervising physician. A copy of the section of the naturopathic
doctor’s standardized procedure relating to controlled substances
shall be provided upon request, to a licensed pharmacist who
dispenses drugs, when there is uncertainty about the naturopathic
doctor furnishing the order. end delete begin insert Code. end insert

begin delete

(g)

end delete

begin insert (c) end insert  The committee begin delete has certified end delete begin insert shall certify end insert that the naturopathic
doctor has satisfactorily completed adequate coursework in
pharmacology covering the drugs to be furnished begin insert , prescribed,
administered, end insert or ordered under this section. The committee shall
establish the requirements for satisfactory completion of this
subdivision.

begin delete

(h)

end delete

begin insert (d) end insert  Use of the term “furnishing” in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of Section
1250 of the Health and Safety Code, shall include begin delete both of the
following: end delete

begin delete (1) end delete begin delete   end delete begin delete Ordering end delete begin insert ordering and furnishing end insert a begin delete drug in accordance with
the standardized procedure end delete begin insert drug end insert .

begin delete

(2) Transmitting an order of a supervising physician and
surgeon.

end delete begin delete

(i)

end delete

begin insert (e) end insert  For purposes of this section, “drug order” or “order” means
an order for medication which is dispensed to or for an ultimate
user, issued by a naturopathic doctor as an individual practitioner,
within the meaning of Section 1306.02 of Title 21 of the Code of
Federal Regulations.

begin delete

(j)

end delete

begin insert (f) end insert  Notwithstanding any other provision of law, begin insert both of end insert the
following begin insert shall end insert apply:

begin delete

(1) A drug order issued pursuant to this section shall be treated
in the same manner as a prescription of the supervising physician.

end delete begin delete

(2)

end delete

begin insert (1) end insert  All references to prescription in this code and the Health
and Safety Code shall include drug orders issued by naturopathic
doctors.

begin delete

(3)

end delete

begin insert (2) end insert  The signature of a naturopathic doctor on a drug order issued
in accordance with this section shall be deemed to be the signature
of a prescriber for purposes of this code and the Health and Safety
Code.