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 3640 of the Business and Professions
2Code is amended to read:
(a) A naturopathic doctor may order and perform
4physical and laboratory examinations for diagnostic purposes,
5including, but not limited to, phlebotomy, clinical laboratory tests,
6speculum examinations, orificial examinations, and physiological
A naturopathic doctor may order diagnostic
begin delete imaging studies, including
P3 1X-ray, ultrasound, mammogram, bone densitometry, and others,
2consistent with naturopathic training as determined by the
3committee, but shall refer the studies to an appropriately licensed
4health care professional to conduct the study and interpret the
18 A naturopathic doctor may dispense, administer, order,
begin delete and furnishend delete or perform the following:
20(1) Food, extracts of food, nutraceuticals, vitamins, amino acids,
21minerals, enzymes, botanicals and their extracts, botanical
22medicines, homeopathic medicines, all dietary supplements and
23nonprescription drugs as defined by the federal Food, Drug, and
24Cosmetic Act, consistent with the routes of administration
25identified in subdivision (d).
26(2) Hot or cold hydrotherapy; naturopathic physical medicine
27inclusive of the manual use of massage, stretching, resistance, or
28joint play examination but exclusive of small amplitude movement
29at or beyond the end range of normal joint motion; electromagnetic
30energy; colon hydrotherapy; and therapeutic exercise.
31(3) Devices, including, but not limited to, therapeutic devices,
32barrier contraception, and durable medical equipment.
34(4) Health education and health counseling.
35(5) Repair and care incidental to superficial lacerations and
36abrasions, except suturing.
37(6) Removal of foreign bodies located in the superficial tissues.end delete
P4 1 A naturopathic doctor may utilize routes of administration
2that include oral, nasal, auricular, ocular, rectal, vaginal,
3transdermal, intradermal, subcutaneous, intravenous, and
6 The committee may establish regulations regarding ocular
7or intravenous routes of administration that are consistent with the
8education and training of a naturopathic doctor.
10 Nothing in this section shall exempt a naturopathic doctor
11from meeting applicable licensure requirements for the performance
12of clinical laboratory tests, including the requirements imposed
13under Chapter 3 (commencing with Section 1200).
Section 3640.5 of the Business and Professions Code
28 is amended to read:
Nothing in this chapter or any other
begin delete provision ofend delete
30 law shall be construed to prohibit a naturopathic doctor from
begin delete orend delete ordering drugs begin delete when
32all of the following apply:end delete
33(a) The drugs are furnished or ordered by a naturopathic doctor
34in accordance with standardized procedures or protocols developed
35by the naturopathic doctor and his or her supervising physician
37(b) The naturopathic doctor is functioning pursuant to
38standardized procedure, as defined by subdivisions (a), (b), (d),
39(e), (h), and (i) of Section 2836.1 and paragraph (1) of subdivision
40(c) of Section 2836.1, or protocol. The standardized procedure or
P5 1protocol shall be developed and approved by the supervising
2physician and surgeon, the naturopathic doctor, and, where
3applicable, the facility administrator or his or her designee.
4(c) The standardized procedure or protocol covering the
5furnishing of drugs shall specify which naturopathic doctors may
6furnish or order drugs, which drugs may be furnished or ordered
7under what circumstances, the extent of physician and surgeon
8supervision, the method of periodic review of the naturopathic
9doctor’s competence, including peer review, and review of the
10provisions of the standardized procedure.
11(d) The furnishing or ordering of drugs by a naturopathic doctor
12occurs under physician and surgeon supervision. Physician and
13surgeon supervision shall not be construed to require the physical
14presence of the physician, but does include all of the following:
15(1) Collaboration on
the development of the standardized
17(2) Approval of the standardized procedure.
18(3) Availability by telephonic contact at the time of patient
19examination by the naturopathic doctor.
20(e) For purposes of this section, a physician and surgeon shall
21not supervise more than four naturopathic doctors at one time.
23 Drugs furnished or ordered by a
naturopathic doctor may
24include Schedule III through Schedule V controlled substances
25under the California Uniform Controlled Substances Act
begin delete (end deleteDivision
2610 (commencing with Section 11000) of the Health and Safety
begin delete27 Code) and shall be further limited to those drugs agreed upon by
28the naturopathic doctor and physician and surgeon as specified in
29the standardized procedure. When Schedule III controlled
30 substances, as defined in Section 11056 of the Health and Safety
31Code, are furnished or ordered by a naturopathic doctor, the
32controlled substances shall be furnished or ordered in accordance
33with a patient-specific protocol approved by the treating or
34supervising physician. A copy of the section of the naturopathic
35doctor’s standardized procedure relating to controlled substances
36shall be provided upon request, to a licensed pharmacist who
37dispenses drugs, when there is uncertainty about the naturopathic
38doctor furnishing the order.end delete
P6 1 The
begin delete has certifiedend delete that the naturopathic
2doctor has satisfactorily completed adequate coursework in
3pharmacology covering the drugs to be furnished or ordered under this section. The committee shall
5establish the requirements for satisfactory completion of this
8 Use of the term “furnishing” in this section, in health
9facilities defined in subdivisions (b), (c), (d), (e), and (i) of Section
101250 of the Health and Safety Code, shall include
begin delete both of the
begin delete(1)end delete begin delete end delete begin deleteOrderingend delete a begin delete drug in accordance with .
13the standardized procedureend delete
14(2) Transmitting an order of a supervising physician and
17 For purposes of this section, “drug order” or “order” means
18an order for medication which is dispensed to or for an ultimate
19user, issued by a naturopathic doctor as an individual practitioner,
20within the meaning of Section 1306.02 of Title 21 of the Code of
23 Notwithstanding any other provision of law, the
25(1) A drug order issued pursuant to this section shall be treated
26in the same manner as a prescription of the supervising physician.
28 All references to prescription in this code and the Health
29and Safety Code shall include drug orders issued by naturopathic
32 The signature of a naturopathic doctor on a drug order issued
33in accordance with this section shall be deemed to be the signature
34of a prescriber for purposes of this code and the Health and Safety