BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1446|
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THIRD READING
Bill No: SB 1446
Author: Negrete McLeod (D)
Amended: 5/14/12
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 7-0, 5/7/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Wyland
NO VOTE RECORDED: Strickland, Vargas
SUBJECT : Healing arts: naturopathic doctors
SOURCE : California Naturopathic Doctors Association
Naturopathic Medicine Committee
DIGEST : This bill authorizes a naturopathic doctor (ND)
to furnish nutraceuticals, vitamins, amino acids, and
minerals, among other substances, and to independently
prescribe nutraceuticals, vitamins, amino acids, and
minerals, among other substances, that require a
prescription because they are injectable solutions
administered by intramuscular or intravenous routes.
ANALYSIS :
Existing law:
1. The Naturopathic Doctors Act provides for the licensure
and regulation of NDs by the Naturopathic Medicine
Committee under the Osteopathic Medical Board of
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California. (Business and Professions Code (BPC)
Section 3640 et seq.)
2. Authorizes a ND to order and perform physical and
laboratory examinations for diagnostic purposes. (BPC
Section 3640(a))
3. Authorizes a ND to order diagnostic imaging studies
consistent with naturopathic training, as long as the
studies are referred to an appropriately licensed health
care professional to conduct the study and interpret the
results. (BPC Section 3640(b))
4. Authorizes a ND to perform various tasks, including
dispensing, administering, ordering, and prescribing
specified substances, as defined by the federal Food,
Drug, and Cosmetic Act (FDCA) including: (BPC Section
3640(c))
A. Food, extracts of food, nutraceuticals, vitamins,
amino acids, minerals, enzymes, botanicals and their
extracts, botanical medicines, homeopathic medicines,
all dietary supplements and nonprescription drugs a
defined by the FDCA.
B. Hot or cold hydrotherapy; naturopathic physical
medicine, electromagnetic energy, colon hydrotherapy
and therapeutic exercise.
C. Therapeutic devices, barrier contraception and
durable medical equipment.
D. Health and education counseling.
E. Repair of incidental to superficial lacerations
and abrasions except suturing.
F. Removal of foreign bodies located in superficial
tissues.
5. Authorizes a ND to use specified routes of
administration, including oral, nasal, auricular,
ocular, rectal, vaginal, transdermal, intradermal,
subcutaneous, intravenous (IV) and intramuscular (IM).
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(BPC Section 3640(d))
6. Authorizes the Naturopathic Medicine Committee to
establish regulations regarding ocular or IV routes of
administration that are consistent with the education
and training of a ND. (BPC Section 3640(e))
7. Authorizes NDs to independently prescribe epinephrine to
treat anaphylaxis and natural and synthetic hormones.
(BPC Section 3640.7)
8. Authorizes NDs to furnish or order drugs including
Schedule III to V Controlled Substances under the
supervision of a medical doctor. (BPC Section 3640.5)
9. Specifies that a drug, including a homeopathic drug, is
not safe for use except under the supervision of a
practitioner licensed by law to administer such drug,
and may be dispensed only upon an oral or written
prescription of a practitioner licensed to administer
such drug. (21 United States Code Section 353)
10.Restricts NDs from performing any of the following
functions: (BPC Section 3642)
A. Prescribe, dispense or administer a controlled
substance except as authorized.
B. Administer therapeutic ionizing radiation or
radioactive substances.
C. Practice or claim to practice any other system or
method of treatment for which licensure is required,
unless otherwise licensed to do so.
D. Administer general or spinal anesthesia.
E. Perform an abortion.
F. Perform any surgical procedure.
G. Perform acupuncture or traditional Chinese and
Asian medicine, unless also licensed in California as
an acupuncturist.
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This bill:
1. Clarifies that NDs are permitted to prescribe
non-prescription substances that become prescription
substances due to route of administration, via IV or IM
routes.
2. Authorizes a naturopathic doctor to furnish
nutraceuticals, vitamins, amino acids, and minerals,
among other substances.
Background
History of Naturopathic Medicine . In 1901, the American
School of Naturopathy was opened in Manhattan, New York.
Its approach emphasized diet, exercise, physical medicine,
herbs and homeopathy as ways to improve and maintain
health. By 1925, there were approximately 2500
practitioners of naturopathic medicine and more than 12
schools. As a result, many states enacted regulations
regarding the practice of naturopathic medicine.
Naturopathic medicine experienced a decline in popularity
from the post World War II era until the 1970s as most
health care was focused on the traditional medical model.
In the 1970s, interest in holistic and alternative health
care increased leading to an expansion of naturopathic
medicine educational programs and state licensure.
Naturopathic medicine includes the combination of a variety
of natural medicines and treatments. NDs practice
integrative medicine and are primary health care providers
who are clinically trained in both natural and conventional
approaches to medicine. NDs also write prescriptions for
pharmaceuticals and refer patients to conventional
physicians and specialists as needed. NDs are also
permitted to administer substances via various routes of
administration.
1. Education. Currently, 16 states, the District of
Columbia, and the territories of Puerto Rico and the
Virgin Islands license NDs. All states that license NDs
require graduation from a course of study offered
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through a college approved by the examining
jurisdiction. NDs have limited opportunities to
complete hospital residencies, but perform at least 1500
hours of clinical rotations at clinics and private
doctors' offices during their education program.
2, Licensure. In 2003, California became the 13th state to
recognize naturopathic medicine and license NDs. The
Naturopathic Medicine Committee which is under the
Osteopathic Medical Board of California licenses and
regulates NDs. Over 500 ND licenses have been issued in
California to date. To be eligible for licensure in
California, an applicant must have graduated from one of
six approved naturopathic medical schools accredited by
the Council on Naturopathic Medical education. An
applicant is also required to pass a standardized
licensing examination used in all states that license
NDs, the Naturopathic Physicians Licensing Examination.
NDs take board examinations after two and four years.
3. Scope of Practice. The scope of practice for NDs
include diagnosis and treatment of patients, the
authority to order lab tests and prescribe most drugs
subject to supervision of a medical or osteopathic
physician. NDs may perform minor procedures, such as
treating lacerations and removing moles and growths. In
11 states, NDs are also permitted to administer
substances via IV and IM routes of administration.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 5/14/12)
California Naturopathic Doctors Association (co-source)
Naturopathic Medicine Committee (co-source)
OPPOSITION : (Verified 5/14/12)
California Medical Association
Osteopathic Physicians & Surgeons of California
ARGUMENTS IN SUPPORT : According to the author's office,
this bill clarifies the original intent of the Naturopathic
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Doctors Act by specifying that NDs may independently
prescribe natural substances (such as vitamins, minerals
and amino acids) that only require a prescription when they
are administered via IV or IM routes. The co-sponsors
indicate that this bill does not alter the scope of
practice for NDs and removes any confusion about the
ability of a ND to serve patients, e.g.: "A naturopathic
doctor would be able to administer an intramuscular vitamin
B12 shot to an elderly patient with anemia due to B12
deficiency."
ARGUMENTS IN OPPOSITION : The California Medical
Association (CMA) opposes this bill. They indicate: "While
we recognize the role of naturopathic doctors in the health
care system, we remain concerned about the consistency and
depth of their education and training when it comes to
pharmaceuticals and related drugs. In order to
independently prescribe or administer any drug, physicians
receive a minimum of four years of medical school, followed
by three to seven years of residency. Residency programs
are an essential part of medical education, providing
professional training under the supervision of senior
physician educators." The CMA also notes that they are
concerned that this legislation will open the door for
"future expansions into pharmacology."
JJA:kc 5/16/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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