BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1446|
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UNFINISHED BUSINESS
Bill No: SB 1446
Author: Negrete McLeod (D)
Amended: 8/22/12
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
SENATE FLOOR : 37-0, 5/17/12
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De Le�n, DeSaulnier, Dutton,
Emmerson, Evans, Fuller, Gaines, Hancock, Harman,
Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Walters, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Runner, Strickland, Vargas
ASSEMBLY FLOOR : 74-4, 8/27/12 - See last page for vote
SUBJECT : Healing arts: naturopathic doctors
SOURCE : California Naturopathic Doctors Association
Naturopathic Medicine Committee
DIGEST : This bill allows naturopathic doctors (NDs) to
independently prescribe and administer vitamins, minerals,
amino acids, glutathione, botanicals and their extracts,
homeopathic medicines, electrolytes, sugars, and diluents,
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as specified.
Assembly Amendments require a ND, in order to qualify for
intravenous (IV) therapy administration, to demonstrate
that he/she has complied with specified requirements,
including the successful completion of specified coursework
by a provider approved by the Naturopathic Medicine
Committee (NMC), and clarify the types substances a ND may
prescribe and administer.
ANALYSIS :
Existing law:
1. The Naturopathic Doctors Act provides for the licensure
and regulation of NDs by the NMC under the Osteopathic
Medical Board of 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.
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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, IV and intramuscular (IM). (BPC Section
3640(d))
6. Authorizes the NMC 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.
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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.
This bill:
1. Allows NDs to independently prescribe and administer
vitamins, minerals, amino acids, glutathione, botanicals
and their extracts, homeopathic medicines, electrolytes,
sugars, and diluents that may be administered utilizing
routes of administration allowed under current law for
NDs, only when such substances are chemically identical
to those for sale without a prescription.
2. Requires an ND, in order to qualify to administer IV
therapy in his/her practice pursuant to existing law, to
demonstrate that he/she has a current California ND
license and has completed a qualifying course on IV
therapy from a course provider approved by the NMC.
3. Requires the qualifying course to consist of a minimum
of 25 classroom hours on IV administration through
injection of applicable naturopathic formulary
substances, of which at least 14 classroom hours shall
be identified as practicum. At a minimum, the
qualifying course shall have covered all of the
following topics:
A. Evaluation of laboratory results, including, but
not limited to, the fluid status, cardiovascular
status, and kidney function of the patient;
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B. The use of IV fluids, including, but not limited
to, osmolarity calculations, diluents, and admixtures
pertinent to IV therapeutics;
C. Sterile techniques and admixing;
D. Vein and site selection, site preparation, and
insertion techniques;
E. Complications with therapies, nutrient and drug
interactions, errors and adverse reactions, reporting
errors to appropriate agencies, error prevention, and
follow-up with patient complications;
F. Emergency protocols, management, and referral;
G. Pharmacology, indications, preparation, and IV
administration of vitamins, minerals, amino acids,
glutathione, botanicals and their extracts,
homeopathic medicines, electrolytes, sugars, and
diluents;
H. Practicum, including, but not limited to, the
following:
(1) Observation of at least 10 IV setups,
including administration and management; and,
(2) Successful completion of at least 10 IV
setups, including administration and management;
and,
I. Successful completion of an examination with 70%
or greater correct answers to a minimum of 50
questions, where 10% or more of the questions have
direct content to the California formulary.
4. Defines, for the purposes of the qualifying course
required by this bill, one classroom hour as 50 minutes
out of each 60-minute segment, which may include time
devoted to examinations. No credit shall be granted for
distance education, including, but not limited to,
correspondence courses, Internet courses, or video or
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remote television offerings.
5. Allows the NMC to establish regulations regarding IV
administration that are consistent with the education
and training of an ND.
6. Makes conforming and technical changes.
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
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
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doctors' offices during their education program.
2, Licensure. In 2003, California became the 13th state to
recognize naturopathic medicine and license NDs. The
NMC 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.: Yes
Local: No
According to the Assembly Appropriations Committee, minor,
absorbable costs to the NMC of the Osteopathic Medical
Board of California to incorporate this bill's provisions
and requirements into regulations related to NDs'
administration of IV substances. These regulations are
currently being drafted; thus, this bill's provisions will
not add significant costs.
SUPPORT : (Verified 8/28/12)
California Naturopathic Doctors Association (co-source)
Naturopathic Medicine Committee (co-source)
OPPOSITION : (Verified 8/28/12)
California Medical Association
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Osteopathic Physicians & Surgeons of California
ARGUMENTS IN SUPPORT : According to the author's office,
this bill clarifies the original intent of the Naturopathic
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."
ASSEMBLY FLOOR : 74-4, 8/27/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Bonilla, Bradford, Brownley, Butler,
Charles Calderon, Campos, Carter, Cedillo, Chesbro,
Conway, Cook, Davis, Dickinson, Donnelly, Eng, Feuer,
Fletcher, Fong, Furutani, Beth Gaines, Galgiani, Garrick,
Gatto, Gordon, Gorell, Grove, Hagman, Halderman, Hall,
Harkey, Hayashi, Roger Hern�ndez, Hill, Huber, Hueso,
Huffman, Jeffries, Jones, Knight, Lara, Logue, Bonnie
Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell,
Monning, Morrell, Nestande, Nielsen, Norby, Perea, V.
Manuel P�rez, Portantino, Silva, Skinner, Smyth, Solorio,
Swanson, Torres, Valadao, Wagner, Wieckowski, Williams,
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Yamada, John A. P�rez
NOES: Buchanan, Fuentes, Olsen, Pan
NO VOTE RECORDED: Block, Blumenfield
JJA:k 8/28/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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