2013 -- S 0905

=======

LC02423

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

____________

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NATUROPATHIC PHYSICIANS

     Introduced By: Senator Roger Picard

     Date Introduced: May 02, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS"

1-2

is hereby amended by adding thereto the following chapter:

1-3

     CHAPTER 40.2

1-4

NATUROPATHIC PHYSICIANS

1-5

     5-40.2-1. Definitions. -- (a) As used in this chapter:

1-6

     (1) "Approved naturopathic medical college" means a college which grants a degree of

1-7

doctor of naturopathic medicine or doctor of naturopathy:

1-8

     (i) Is accredited by the Council of Naturopathic Medical Education, its successor or other

1-9

accrediting agency recognized by the United States Department of Education;

1-10

     (ii) A naturopathic medical education program in the United States providing the degree

1-11

of Doctor of Naturopathy or Doctor of Naturopathic Medicine. Such program shall offer

1-12

graduate-level full-time didactic and supervised clinical training and shall be accredited, or has

1-13

achieved candidacy status for accreditation by the Council on Naturopathic Medical Education

1-14

("CNME") or an equivalent federally recognized accrediting body for naturopathic medical

1-15

programs also recognized by the North American Board of Naturopathic Examiners ("Board").

1-16

Additionally, the program shall be an institution, or part of an institution of higher education that

1-17

is either accredited or is a candidate for accreditation by a regional or national institutional

1-18

accrediting agency recognized by the United States Secretary of Education; or

1-19

     (iii) A degree granting college or university that, prior to the existence of the CNME,

1-20

offered a full-time structured curriculum in basic sciences and supervised patient care comprising

2-1

a doctoral naturopathic medical education; such course, as a prerequisite to graduation therefrom,

2-2

having been not less than one hundred thirty-two (132) weeks in duration and which required

2-3

completion within a period of not less than thirty-five (35) months; such college of naturopathic

2-4

medicine shall have been reputable and in good standing in the judgment of the board; and if still

2-5

in existence has current programmatic accreditation by the CNME or federally recognized

2-6

equivalent accrediting agency;

2-7

     (iv) A diploma granting, degree-equivalent college or university, that if in Canada and

2-8

prior to accreditation by the CNME, had provincial approval for participation in government

2-9

funded student aid programs, and that offered a full-time structured curriculum in basic sciences

2-10

and supervised patient care comprising a doctoral naturopathic medical education; such course, as

2-11

a prerequisite to graduation therefrom, having been not less than one hundred thirty-two (132)

2-12

weeks in duration and shall require completion within a period of not less than thirty-five (35)

2-13

months; such college of liberal arts and naturopathic medicine having been reputable and in good

2-14

standing in the judgment of the board and accreditation by the CNME or federally recognized

2-15

equivalent accrediting agency. Additionally, this college or university currently has provincial

2-16

approval for participation in government funded student aid programs.

2-17

     (v) A diploma granting, degree-equivalent college or university in Canada that offers

2-18

graduate-level full-time didactic and supervised clinical training and shall be accredited, or has

2-19

achieved candidacy status for accreditation by the CNME or an equivalent federally recognized

2-20

accrediting body for naturopathic medical programs also recognized by the board. Additionally,

2-21

this college or university has provincial approval for participation in government funded student

2-22

aid programs.

2-23

     (2) "Disciplinary action" means any action taken by an administrative law officer

2-24

established against a licensee or applicant on a finding of unprofessional conduct by the licensee

2-25

or applicant. Disciplinary action includes issuance of warnings and all sanctions including denial,

2-26

suspension, revocation, limitation or restriction of licenses and other similar limitations.

2-27

     (3) "Natural" means present in, produced by, or derived from nature.

2-28

     (4) "Naturopathic medicine" or "the practice of naturopathic medicine" means a system

2-29

of health care that utilizes education, natural medicines and natural therapies to support and

2-30

stimulate a patient's intrinsic self-healing processes and to prevent, diagnose and treat human

2-31

health conditions and injuries. In connection with such system of health care, an individual

2-32

licensed under this chapter may:

2-33

     (i) Administer or provide for preventative and therapeutic purposes nonprescription

2-34

medicines, topical medicines, botanical medicines, homeopathic medicines, counseling,

3-1

hypnotherapy, nutritional and dietary therapy, naturopathic physical medicine, therapeutic

3-2

devices, barrier devices for contraception, and prescription medicines authorized by this chapter

3-3

or by the formulary established under subsection 5-40.2-5(c) of this title.

3-4

     (ii) Use diagnostic procedures commonly used by physicians in general practice,

3-5

including physical and orificial examinations, electrocardiograms, diagnostic imaging techniques,

3-6

phlebotomy, clinical laboratory tests and examinations, and physiological function tests.

3-7

     (5) "Naturopathic physical medicine" means the use of the physical agents of air, water,

3-8

heat, cold, sound and light, and the physical modalities of naturopathic manipulation and

3-9

mobilization therapy, electrotherapy, biofeedback, diathermy, ultraviolet light, ultrasound,

3-10

hydrotherapy and exercise. Naturopathic medicine does not include the practice of physical

3-11

therapy, physical rehabilitation or chiropractic.

3-12

     (6) "Naturopathic physician" means a person who practices naturopathic medicine and is

3-13

licensed under this chapter.

3-14

     (7) "Prescription medicine" means any human drug, including finished dosage forms and

3-15

active ingredients, required by federal law or regulation to be dispensed only by prescription.

3-16

     (8) "Topical medicines" mean topical analgesics, anesthetics, antiseptics, scabicides,

3-17

antifungals, antibacterials, and cryo-agents.

3-18

     5-40.2-2. Prohibitions and penalties. -- (a) No person shall perform any of the following

3-19

acts:

3-20

     (1) Practice naturopathic medicine in this state without a valid license issued in

3-21

accordance with this chapter except as provided in section 5-40.2-3;

3-22

     (2) Use, in connection with the person's name, any letters, words or insignia indicating or

3-23

implying that the person is a naturopathic physician unless the person is licensed in accordance

3-24

with this chapter. A person licensed under this chapter may use the designations "N.D.

3-25

(naturopathic doctor)," "NMD (naturopathic medical doctor)," "doctor of naturopathic medicine,"

3-26

"naturopathic doctor," "doctor of naturopathy" or "naturopathic physician."

3-27

     (b) A person licensed under this chapter shall not perform any of the following acts:

3-28

     (1) Prescribe, dispense, or administer any prescription medicines except those medicines

3-29

authorized by this chapter.

3-30

     (2) Use for therapeutic purposes, any device regulated by the United States Food and

3-31

Drug Administration (FDA) that has not been approved by the FDA.

3-32

     (c) A person who violates any of the provisions of this section shall be subject to the

3-33

penalties provided in section 5-40.2-11.

4-34

     5-40.2-3. Exemptions. -- (a) Nothing in this chapter shall be construed to prohibit any of

4-35

the following:

4-36

     (1) The practice of a profession by a person, who is licensed, certified or registered under

4-37

other laws of this state and is performing services within the authorized scope of practice of that

4-38

profession.

4-39

     (2) The practice of naturopathic medicine by a person duly licensed to engage in the

4-40

practice of naturopathic medicine in another state, territory or the District of Columbia who is

4-41

called into this state for consultation with a naturopathic physician licensed under this chapter.

4-42

     (3) The practice of naturopathic medicine by a student enrolled in an approved

4-43

naturopathic medical college. The performance of services shall be pursuant to a course of

4-44

instruction and under the supervision of an instructor, who shall be a naturopathic physician

4-45

licensed in accordance with this chapter.

4-46

     (4) The use or administration of over-the-counter medicines or other nonprescription

4-47

agents, regardless of whether the over-the-counter medicine or agent is on the naturopathic

4-48

formulary.

4-49

     (b) The provisions of this chapter, relating to the practice of naturopathic medicine, shall

4-50

not be construed to limit or restrict in any manner the right of a practitioner of another health care

4-51

profession from carrying on in the usual manner any of the functions related to that profession.

4-52

     5-40.2-4. Reporting contagious and infectious diseases; Death certificates. --

4-53

Naturopathic physicians are subject to the provisions of the general laws relating to contagious

4-54

and infectious diseases and the issuance of birth and death certificates.

4-55

     5-40.2-5. Director, Duties. -- (a) The director of the department of health ("director"),

4-56

with the advice of the advisor appointees, shall:

4-57

     (1) Provide general information to applicants for licensure as naturopathic physicians;

4-58

     (2) Administer fees collected under this chapter;

4-59

     (3) Administer examinations;

4-60

     (4) Explain appeal procedures to naturopathic physicians and applicants for licensure and

4-61

complaint procedures to the public;

4-62

     (5) Receive applications for licensure under this chapter, issue and renew licenses and

4-63

revoke, suspend, reinstate or condition licenses as ordered by an administrative law officer; and

4-64

     (6) Refer all disciplinary matters to an administrative law officer.

4-65

     (b) Rules for naturopathic prescription medicine endorsement shall specifically address

4-66

and define scope and practice standards, including education requirements and maintaining

4-67

practice data and records, and shall require every licensed naturopathic physician seeking a

4-68

prescription medicine license endorsement to pass a test provided by the director and

5-1

administered in consultation with the department of health.

5-2

     (c) At least annually, the director, with the advice of the advisor appointees, shall review

5-3

and update the formulary of prescription medicines naturopathic physicians may use in a manner

5-4

consistent with their scope of practice and training, subject to the approval of the commissioner of

5-5

health. Non-natural substances found to be substantially safer in treatment or without which a

5-6

patient's primary care would be compromised may be added to the formulary. The formulary shall

5-7

include prescription medicines necessary for naturopathic practice.

5-8

     5-40.2-6. Advisor appointees. -- (a) The secretary of state shall appoint two (2)

5-9

naturopathic physicians licensed under this chapter to serve as advisors to the director in matters

5-10

relating to naturopathic physicians. They shall be appointed as set forth in this section and serve

5-11

at the pleasure of the secretary.

5-12

     (b) Appointees shall have at least three (3) years of experience as a naturopathic

5-13

physician during the period immediately preceding appointment and shall be actively practicing

5-14

naturopathic medicine and remain in good standing during incumbency.

5-15

     (c) The director shall seek the advice of the advisor appointees under this section in

5-16

carrying out the provisions of this chapter. The advisor appointees shall be entitled to

5-17

compensation and necessary expenses for attendance at any meetings called by the director for

5-18

this purpose.

5-19

     (d) When an advisor appointee is unable to serve as an administrative law officer by

5-20

reason of disqualification or necessary absence, the secretary of state may appoint a suitable

5-21

person to serve as the administrative law officer in lieu of the advisor appointee.

5-22

     (e) The initial advisors appointed under this chapter shall be naturopathic physicians, in

5-23

good standing, who are licensed as such in a state with at least equivalent standard for licensure,

5-24

and who have been engaged in the practice and/or instruction of naturopathic medicine for at least

5-25

three (3) years in this state.

5-26

     5-40.2-7. Eligibility for licensure. -- (a) To be eligible for licensure as a naturopathic

5-27

physician, an applicant shall satisfy all the following:

5-28

     (1) Have been granted a degree of doctor of naturopathic medicine, from a CNME

5-29

approved naturopathic medical college;

5-30

     (2) Be physically and mentally fit to practice naturopathic medicine with or without

5-31

reasonable accommodation;

5-32

     (3) Pass an examination approved by the director, such examination being a competency-

5-33

based national naturopathic licensing examination administered by the North American Board of

5-34

Naturopathic Examiners, or successor agency that has been nationally recognized to administer a

6-1

naturopathic examination and that represents federal standards of education and training. For

6-2

graduates of approved naturopathic schools as defined in subdivision 5-40.2-1(a)(1) eligibility for

6-3

licensure may be granted with evidence of successful passage of a board-approved state

6-4

competency examination or a Canadian provincial examination; and

6-5

     (4) Pass the naturopathic formulary examination administered by the director or the

6-6

director's designee.

6-7

     5-40.2-8. Application for licensure. -- A person shall apply for a license under this

6-8

chapter by filing with the director an application provided by the director accompanied by the

6-9

required fees and evidence of eligibility.

6-10

     5-40.2-9. Examination; Waiver of examination. -- (a) The director, or designee, shall

6-11

administer any examination required to obtain licensure in this state to applicants for licensure at

6-12

least twice each year if applications are pending. Examinations, administered by the director, and

6-13

the procedures of administration shall be fair and reasonable and shall be designed and

6-14

implemented to ensure that all applicants are granted a license if they demonstrate that they

6-15

possess minimal professional qualifications that are consistent with the public health, safety and

6-16

welfare. The examinations shall not be designed or implemented for the purpose of limiting the

6-17

number of licenses issued.

6-18

     5-40.2-10. Biennial license renewal; Continuing education. -- (a) The license to

6-19

practice naturopathic medicine shall be renewed every two (2) years by filing a renewal

6-20

application on a form provided by the director. The application shall be accompanied by the

6-21

required fee and evidence of compliance with subsection (b) of this section.

6-22

     (b) As a condition of renewal, a naturopathic physician shall complete a program of

6-23

continuing education, approved by the director, during the preceding two (2) years. The director

6-24

shall not require more than thirty (30) hours of continuing education biennially.

6-25

     5-40.2-11. Refusal or revocation of licensure; Complaints. -- (a) The following

6-26

conduct, and conduct set forth by the department of health, by a person licensed under this

6-27

chapter or an applicant for licensure constitutes unprofessional conduct:

6-28

     (1) Failing to use a complete or accurate title in professional activity.

6-29

     (2) Repeated acts of immorality or repeated acts of gross misconduct in the practice of his

6-30

or her profession or gross or repeated malpractice or the failure to practice naturopathic medicine

6-31

with that level of care, skill, and treatment that is recognized by a reasonably prudent similar

6-32

naturopathic physician as being acceptable under similar conditions and circumstances.

6-33

     (3) Harassing, intimidating or abusing a patient.

7-34

     (4) Agreeing with any other person or organization, or subscribing to any code of ethics

7-35

or organizational bylaws, when the intent or primary effect of that agreement, code or bylaw is to

7-36

restrict or limit the flow of information concerning alleged or suspected unprofessional conduct to

7-37

the board.

7-38

     (5) Abandonment of a patient.

7-39

     (6) Gross overcharging for professional services on repeated occasions, including filing

7-40

of false statements for collection of fees for which services were not rendered.

7-41

     (7) Sexual harassment of a patient.

7-42

     (8) Engaging in an inappropriate sexual act with a patient.

7-43

     (9) Willful misrepresentation in treatments.

7-44

     (10) Practicing naturopathic medicine in an area or areas of specialty in which the

7-45

licensee is not trained to practice.

7-46

     (11) Violation of any of the laws of the state involving moral turpitude.

7-47

     (b) Refusal or Revocation of a License.-

7-48

     (1) The division of professional regulation of the department of health may, after notice

7-49

and hearings, in its discretion refuse to grant the license provided for in this chapter to any

7-50

naturopathic physician who has violated any of the laws of the state involving moral turpitude or

7-51

affecting the ability of any naturopathic physician to practice naturopathic medicine, or who had

7-52

been guilty of unprofessional conduct or conduct of a character likely to deceive or defraud the

7-53

public, and may, after notice and hearing, revoke or suspend any license issued or granted by it

7-54

for like causes or for any fraud or deception committed in obtaining the license.

7-55

     (2) The division of professional regulation of the department of health may refuse to

7-56

accept the return of a license tendered by the subject of a disciplinary investigation and may

7-57

notify relevant state, federal and local agencies and appropriate bodies in other states of the status

7-58

of any pending or completed disciplinary case against the licensee, provided that notice of

7-59

charges against the licensee has been served or disciplinary action against that person has been

7-60

taken.

7-61

     (3) The division of professional regulation of the department of health shall serve a copy

7-62

of its decision or ruling upon any person whose certificate has been revoked or refused.

7-63

     (c) The burden of proof in a disciplinary action shall be on the state to show by a

7-64

preponderance of the evidence that the person has engaged in unprofessional conduct.

7-65

     (d) Complaints. -

7-66

     (1) Any person may report to the division of professional regulation in writing any

7-67

information the person has reason to believe indicates that a naturopathic physician is or may be

7-68

medically or legally incompetent, engaged in the unauthorized practice of naturopathic medicine,

8-1

guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice

8-2

of naturopathic medicine.

8-3

     (2) Upon receiving a credible complaint or report concerning a licensee, or on its own

8-4

motion, the division of professional regulation may investigate any evidence that appears to show

8-5

a licensee may be medically incompetent, guilty of unprofessional conduct, or mentally or

8-6

physically unable to engage safely in the practice of naturopathic medicine.

8-7

     (3) Within ten (10) days of receipt thereof, the division of professional regulation shall

8-8

acknowledge receipt of all reports required by this section and any complaint against a licensee.

8-9

Within ten (10) days thereafter, the division shall inform any person or entity whose report or

8-10

complaint has resulted in action by the division, of the final disposition of the matter.

8-11

     (4) Any person aggrieved by the decision or ruling of the department of health, or of the

8-12

division of professional regulation, in regard to any of the provisions of this chapter, may appeal

8-13

to the superior court in the manner provided for in chapter 35 of title 42.

8-14

     SECTION 2. This act shall take effect upon passage.

=======

LC02423

=======

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NATUROPATHIC PHYSICIANS

***

9-1

     This act would provide for the licensing and regulation of naturopathic physicians.

9-2

     This act would take effect upon passage.

=======

LC02423

=======