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H0695.................................................by HEALTH AND WELFARE
NATUROPATHS - Adds to existing law to provide for the regulation and
licensure of practitioners of naturopathic medicine; to define scope of
practice; to specify prohibitions; to specify exemptions; to provide for
the creation of the Board of Naturopathic Medical Examiners; to specify
powers and duties of the board; to provide establishment of the
Naturopathic Formulary Council; to specify fees; to provide qualifications
for licensure; to provide a restricted licensure of current practitioners
of naturopathic medicine; to provide license standards for out-of-state
applicants; to provide for investigation, hearings and subpoena powers; to
provide disciplinary action; to provide for denial and revocation
procedures; and to provide enforcement penalties.
02/13 House intro - 1st rdg - to printing
02/16 Rpt prt - to W/M
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-seventh Legislature Second Regular Session - 2004
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 695
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO NATUROPATHIC MEDICINE; AMENDING TITLE 54, IDAHO CODE, BY THE ADDI-
3 TION OF A NEW CHAPTER 51, TITLE 54, IDAHO CODE, TO PROVIDE A STATEMENT OF
4 LEGISLATIVE PURPOSE, TO PROVIDE DEFINITIONS, TO REQUIRE A LICENSE, TO
5 DEFINE SCOPE OF PRACTICE, TO SPECIFY PROHIBITIONS, TO SPECIFY EXEMPTIONS,
6 TO PROVIDE CREATION OF THE BOARD OF NATUROPATHIC MEDICAL EXAMINERS, TO
7 SPECIFY POWERS AND DUTIES OF THE BOARD, TO PROVIDE ESTABLISHMENT OF THE
8 NATUROPATHIC FORMULARY COUNCIL, TO SPECIFY FEES, TO PROVIDE QUALIFICATIONS
9 FOR LICENSURE, TO PROVIDE A RESTRICTED LICENSURE OF CURRENT PRACTITIONERS
10 OF NATUROPATHIC MEDICINE, TO PROVIDE LICENSE STANDARDS FOR OUT-OF-STATE
11 APPLICANTS, TO PROVIDE FOR INVESTIGATION, HEARINGS AND SUBPOENA POWERS, TO
12 PROVIDE DISCIPLINARY ACTION, TO PROVIDE FOR DENIAL OR REVOCATION PROCE-
13 DURE, TO PROVIDE ENFORCEMENT PENALTIES AND TO PROVIDE SEVERABILITY.
14 Be It Enacted by the Legislature of the State of Idaho:
15 SECTION 1. That Title 54, Idaho Code, be, and the same is hereby amended
16 by the addition thereto of a NEW CHAPTER, to be known and designated as Chap-
17 ter 51, Title 54, Idaho Code, and to read as follows:
18 CHAPTER 51
19 NATUROPATHIC PHYSICIANS LICENSING ACT
20 54-5101. PURPOSE. To protect the public health, safety and welfare and
21 provide for state administrative supervision, licensure, regulation and disci-
22 plinary procedures, every person providing naturopathic medical services who
23 meets and maintains the standards of practice and code of ethics as adopted
24 by the board shall be licensed, unless otherwise exempted herein, as provided
25 in this chapter.
26 54-5102. DEFINITIONS. As used in this chapter, the following terms have
27 the meanings as stated:
28 (1) "Approved naturopathic medical program" means:
29 (a) A course of study from a college or university granting the degree of
30 doctor of naturopathy or doctor of naturopathic medicine accredited by an
31 accrediting agency recognized by the state or federal government; or
32 (b) A college or university granting the degree of doctor of naturopathy,
33 or doctor of naturopathic medicine that meets all requirements of an
34 accrediting agency recognized by the state or federal government, and has
35 applied for and has been recognized as a candidate for accreditation with
36 the accrediting agency; or
37 (c) A postgraduate degree-granting college or university of the healing
38 arts approved by the board and state or federal accrediting agency. Such
39 college or university shall require a minimum of sixty (60) semester units
40 for admission and a minimum of four thousand (4,000) hours in basic and
41 clinical sciences, naturopathic philosophy, naturopathic modalities, and
2
1 naturopathic medicine, of which not less than two thousand (2,000) hours
2 shall be academic instruction and not less than two thousand (2,000) hours
3 shall be school or college approved supervised clinical training. The col-
4 lege or university shall provide adequate instruction to maintain
5 naturopathic medicine as a separate and distinct healing art.
6 (2) "Board" means the board of naturopathic medical examiners created
7 pursuant to section 54-5107, Idaho Code.
8 (3) "Minor office procedures" means the methods for the repair and care
9 incidental to superficial lacerations and abrasions, superficial lesions lim-
10 ited to warts and epitheliomas and the removal of foreign bodies located in
11 the superficial tissues.
12 (4) "Naturopathic formulary" means the list of natural medicines which
13 naturopathic physicians use in the practice of their profession, as determined
14 by the formulary council and reviewed by the board.
15 (5) "Naturopathic formulary council" means that council comprised of mem-
16 bers appointed pursuant to this chapter to determine and authorize the formu-
17 lary list.
18 (6) "Naturopathic medicine" means a distinct and comprehensive system
19 of primary health care practiced by naturopathic physicians for the preven-
20 tion, diagnosis and treatment of human health conditions, injuries and dis-
21 eases, that uses education, natural medicines and therapies to promote and
22 restore health by support and stimulation of the individual's self-healing
23 processes.
24 (7) "Naturopathic physician" and all titles defined in section 54-5103
25 (2), Idaho Code, means a person authorized and licensed to practice
26 naturopathic medicine pursuant to this chapter.
27 (8) "Naturopathy" means a philosophy of healing that employs natural
28 modalities that may be utilized by naturopathic physicians and other persons
29 not licensed under this chapter.
30 54-5103. LICENSE REQUIRED. (1) The terms "naturopath" and "naturopathy"
31 are public domain, however, no person shall practice or hold himself out to
32 others, as a naturopathic physician without first applying for and receiving a
33 license to engage in that practice.
34 (2) A person holds himself out to others as a naturopathic physician when
35 such person adopts or uses any title or description including "naturopathic
36 physician," "naturopathic doctor," "physician of naturopathic medicine,"
37 "physician of natural medicine," "doctor of naturopathy," or its abbrevia-
38 tion, "N.D.," "doctor of naturopathic medicine," or its abbreviation "N.M.D."
39 Unless a person has graduated from an accredited school granting the
40 "doctor of naturopathic medicine" degree, abbreviated as "N.M.D.," and is
41 licensed under this chapter, neither the title nor the abbreviation may be
42 used.
43 (3) The titles and terms in subsection (2) of this section identify
44 naturopathic physicians and are restricted to describing and identifying
45 licensed practitioners.
46 54-5104. SCOPE OF PRACTICE. (1) Diagnostic procedures. A naturopathic
47 physician may use physical and laboratory examinations consistent with
48 naturopathic education and training for diagnostic purposes including
49 phlebotomy, clinical laboratory tests, speculum examinations and physiological
50 function tests. A naturopathic physician may order diagnostic and imaging
51 tests consistent with naturopathic education and training. All diagnostic
52 tests, including an electrocardiogram, must be referred to a physician
53 licensed pursuant to chapter 18, title 54, Idaho Code, for performance and
3
1 interpretation.
2 (2) Natural medicines. Naturopathic physicians are authorized to dis-
3 pense, administer and prescribe: (a) nonprescription substances, including
4 food, extracts of foods, nutraceuticals, vitamins, minerals, enzymes,
5 botanicals and their extracts, and homeopathic medicines prepared according to
6 the Homeopathic Pharmacopoeia of the United States, and all dietary supple-
7 ments and nonprescription substances as defined by the federal food, drug, and
8 cosmetic act; and (b) prescription substances authorized by the formulary
9 council.
10 (3) Therapies. A naturopathic physician may: (a) administer, prescribe,
11 and dispense, natural medicine and devices from the naturopathic formulary;
12 and (b) perform minor office procedures pursuant to privileges granted by the
13 naturopathic board of examiners; and (c) perform therapies as approved by
14 board rule.
15 54-5105. PROHIBITIONS. A naturopathic physician shall not:
16 (1) Prescribe, dispense or administer any controlled substance or device
17 identified under the controlled substance act, chapter 27, title 37, Idaho
18 Code, or identified in the federal controlled substance act, 21 U.S.C. sec-
19 tions 801 through 971 (1988), except as authorized by this chapter;
20 (2) Perform surgical procedures except those minor office procedures
21 authorized by this chapter;
22 (3) Practice or claim to practice as a medical doctor, osteopath, den-
23 tist, podiatrist, optometrist, advanced practice professional nurse, physician
24 assistant, chiropractor, physical therapist, acupuncturist, or any other
25 health care professional not authorized in this chapter unless licensed by the
26 state of Idaho to do so;
27 (4) Use general or spinal anaesthetics;
28 (5) Administer ionizing radioactive substances for therapeutic purposes;
29 (6) Perform surgical procedures using a laser device;
30 (7) Perform or procure an unlawful abortion or aid or abet the performing
31 of an unlawful abortion;
32 (8) Perform surgical procedures involving the eye or ear;
33 (9) Perform any surgical procedure involving tendons, nerves, veins or
34 arteries extending beyond superficial tissue;
35 (10) Remove any lesion contemplated to be suspicious of malignancy or
36 requiring surgical removal. Lesions requiring surgical removal shall be
37 referred to a physician licensed pursuant to chapter 18, title 54, Idaho Code.
38 (11) Nothing in this chapter shall negate previous court decisions or cur-
39 rent Idaho Code.
40 54-5106. EXEMPTIONS. This chapter is not intended to prohibit or
41 restrict:
42 (1) The practice of a profession by individuals who are licensed, certi-
43 fied or registered under other laws of this state and are performing services
44 within the authorized scope of practice; or
45 (2) The practice of naturopathic medicine by an individual employed by
46 the federal government while the individual is engaged in the performance of
47 duties prescribed by the laws and regulations of the United States; or
48 (3) An individual rendering aid to a family member or in an emergency,
49 when no fee or other consideration for the service is charged, received,
50 expected or contemplated; or
51 (4) A person engaged in the sale of vitamins, health foods, dietary sup-
52 plements, herbs, or other products of nature, the sale of which is not other-
53 wise prohibited under state or federal law; or
4
1 (5) A person engaged in good faith for religious reasons as a matter of
2 conscience or based on a personal belief; or
3 (6) A person who administers treatment or provides advice regarding the
4 human body and its functions that:
5 (a) Does not use legend drugs or prescription drugs in such practice;
6 (b) Does not recommend the discontinuance of prescribed drugs;
7 (c) Uses natural elements such as air, heat, water and light;
8 (d) Only uses class I or class II nonprescription, approved, medical
9 devices as defined in section 513 of the federal food, drug, and cosmetic
10 act;
11 (e) Uses only vitamins, minerals, herbs, homeopathics, natural food prod-
12 ucts and their extracts, and nutritional supplements;
13 (f) Does not perform surgery;
14 (g) Requires each person receiving services to sign a declaration of
15 informed consent which includes an overview of the health care provider's
16 education which states that the health care provider is not licensed under
17 this chapter.
18 (7) The practice by a naturopathic physician duly licensed in another
19 state, territory or the District of Columbia when that naturopathic physician
20 is incidentally called into this state for consultation with a licensed physi-
21 cian; or
22 (8) The practice of naturopathic medicine by students enrolled in an
23 approved naturopathic medical program. Services shall be performed pursuant to
24 a course of instruction or assignments from an instructor and under the super-
25 vision and observation of the instructor.
26 54-5107. BOARD OF NATUROPATHIC MEDICAL EXAMINERS. (1) There is hereby
27 established in the department of self-governing agencies, bureau of occupa-
28 tional licenses, the board of naturopathic medical examiners. Members thereof
29 shall be appointed by the governor.
30 (2) The board shall consist of five (5) members, four (4) of whom shall
31 be licensed pursuant to this chapter and one (1) of whom shall be a member of
32 the public with an interest in the rights of consumers of naturopathic physi-
33 cian services.
34 (3) Appointments to the board shall be made by the governor from nomina-
35 tions received from professional naturopathic physician associations, who
36 shall nominate at least two (2) but no more than four (4) persons qualified
37 for each position to be filled.
38 (4) All members of the board shall be residents of the state of Idaho for
39 the duration of their appointment and shall have been residents of the state
40 of Idaho for a minimum of three (3) years immediately preceding appointment.
41 (5) The initial four (4) licensed naturopathic physician members of the
42 board shall be persons with at least two (2) years of experience in the prac-
43 tice of naturopathic medicine who are eligible to become licensed pursuant to
44 this chapter.
45 (6) The initial board shall be appointed for staggered terms, the longest
46 of which shall not exceed five (5) years. After the initial appointments, all
47 terms shall be five (5) years and a member may be appointed for a second term.
48 No member shall serve more than two (2) terms. In the event of death, resigna-
49 tion or removal of any member before the expiration of the term to which
50 appointed, the vacancy shall be filled for the unexpired portion of the term
51 in the same manner as the original appointment.
52 (7) The governor may remove any member of the board for cause, prior to
53 the expiration of the member's appointment.
54 (8) The board, within thirty (30) days after its appointment, and at
5
1 least annually thereafter, shall hold a meeting and elect a chairman. The
2 board may hold additional meetings on the call of the chair or at the written
3 request of any two (2) members of the board. The board may appoint such com-
4 mittees as it considers necessary to carry out its duties. A majority of the
5 board shall constitute a quorum.
6 54-5108. POWERS AND DUTIES OF THE BOARD. The board shall have the author-
7 ity to:
8 (1) Determine the qualifications of persons applying for licensure pursu-
9 ant to this chapter and define, by rule, the appropriate scope of naturopathic
10 medicine in this state, provided however, that the scope of practice may not
11 exceed that defined in sections 54-5102(6) and 54-5104, Idaho Code;
12 (2) Grant approval for naturopathic childbirth attendance privileges to
13 those licensees who apply, provided that such applicant can document training
14 and experience equal to or greater than that required by the rules of the
15 Idaho board of nursing pursuant to section 54-1404, Idaho Code, and that the
16 applicant meets the practice standards governing hospital privileges and
17 supervising physicians established by the Idaho board of nursing and the
18 applicant holds hospital privileges or performs such procedures under the
19 supervision of an M.D.;
20 (3) Establish special competency certification requirements for licensees
21 as deemed necessary by action of the board;
22 (4) Adopt rules that govern action limiting the scope of practice of a
23 licensee;
24 (5) Hire and appoint employees, including an executive director, investi-
25 gators, attorneys, consultants and independent hearing examiners;
26 (6) Adopt such rules as are necessary for the administration of this
27 chapter, including standards of professional conduct;
28 (7) Conduct investigations and examinations and hold hearings;
29 (8) Collect fees and other funds as prescribed by this chapter;
30 (9) Contract, sue and be sued, and pursue other matters lawful in this
31 state relating to naturopathic medicine;
32 (10) Provide such other services and perform such other functions as are
33 necessary and desirable to fulfill its purposes;
34 (11) Establish by rule examination standards for licensure and when exami-
35 nations will be provided;
36 (12) Establish a minimum amount and type of continuing education to be
37 required annually for each naturopathic physician seeking licensure renewal;
38 (13) Limit the performance of minor office procedures to physicians who
39 have graduated from an approved naturopathic medical college or have certifi-
40 cation as an "advanced emergency medical technician - ambulance" as set forth
41 in section 56-1012(4)(d), Idaho Code.
42 54-5109. NATUROPATHIC FORMULARY COUNCIL ESTABLISHED. There is hereby
43 established a naturopathic formulary council, which is separate and distinct
44 from the board, to be composed of five (5) members. One (1) member shall be a
45 member of the board of naturopathic medical examiners, appointed by the board.
46 One (1) member shall be a naturopathic physician licensed under this chapter,
47 appointed by the board. One (1) member shall be a pharmacist licensed under
48 chapter 17, title 54, Idaho Code, appointed by the board of naturopathic exam-
49 iners from a list of nominees provided by the Idaho state board of pharmacy.
50 One (1) member shall be a physician licensed under chapter 18, title 54,
51 Idaho Code, appointed by the board of naturopathic examiners from a list of
52 nominees provided by the Idaho state board of medicine. One (1) member shall
53 be a person appointed by the board from a list of nominees provided by the
6
1 Idaho state board of medicine and the Idaho state board of pharmacy. The for-
2 mulary list may not authorize the use of any substance beyond the scope of
3 natural substances and devices covered by approved naturopathic education and
4 training and existing naturopathic formularies, or board approved continuing
5 education. Naturopathic physicians are authorized to dispense, administer and
6 prescribe substances derived from or substantially similar in molecular struc-
7 ture or function to natural sources. The list will be reviewed annually by the
8 council, or at any time at the request of the board. Immediately upon adoption
9 or revision of the formulary, the council shall transmit the approved formu-
10 lary to the board, which shall adopt the formulary by temporary rule. Nothing
11 herein shall allow a naturopathic physician to dispense, administer or pre-
12 scribe any legend drug as defined in section 54-1705(27), Idaho Code, or pre-
13 scription device unless such legend drug or prescription device is specifi-
14 cally included in the naturopathic formulary by applicable scientific and
15 chemical name for drugs, and by specific medical description for devices.
16 54-5110. FEES. (1) All fees received under the provisions of this chapter
17 shall be paid to the department of self-governing agencies, bureau of occupa-
18 tional licenses, and deposited to the state treasury to the credit of the
19 occupational licenses fund. All costs and expenses incurred under the provi-
20 sions of this chapter shall be a charge against and paid from said fund. In no
21 case shall any salary, expense or other obligation of the board be charged
22 against the general fund.
23 (2) The board, by rule, may impose the following fees up to the amounts
24 listed below:
25 (a) License fee...................................................$500
26 (b) Renewal fee...................................................$500
27 (c) Late renewal penalty fee......................................$100
28 (d) Duplicate license fee.........................................$ 50
29 (e) Reinstatement fee.............................................$ 50
30 54-5111. QUALIFICATIONS FOR LICENSURE. To be eligible for a license to
31 practice naturopathic medicine in the state of Idaho, the applicant shall:
32 (1) Be a graduate of an approved naturopathic medical program in accor-
33 dance with section 54-5102(1), Idaho Code, and pass or have passed a
34 competency-based examination approved by the board covering the appropriate
35 naturopathic subjects, including basic and clinical sciences;
36 (2) Possess a good ethical and professional reputation;
37 (3) Be physically and mentally capable of safely practicing naturopathic
38 medicine with or without reasonable accommodation;
39 (4) Have never had a license to practice naturopathic medicine refused,
40 revoked or suspended by any other state or country for reasons that relate to
41 the applicant's ability to skillfully and safely practice naturopathic medi-
42 cine unless that license has been restored to good standing by that state or
43 country; and
44 (5) File a board approved application and pay the licensing fees.
45 54-5112. RESTRICTED LICENSURE OF CURRENT PRACTITIONERS OF NATUROPATHIC
46 MEDICINE. (1) Any practitioner who cannot prove sufficient education and
47 training to be licensed as required in section 54-5102(1)(a), (b) or (c),
48 Idaho Code, but who can:
49 (a) Provide evidence of four thousand (4,000) hours of board approved
50 basic science and clinical naturopathic training and education;
51 (b) Comply with section 54-5111(2) through (4), Idaho Code;
52 (c) Provide evidence that he has held himself out as a naturopathic phy-
7
1 sician for the past five (5) years and has received a majority of his
2 income from said practice, may be eligible for a restricted license
3 granted by the board under such rules as the board may adopt with a scope
4 of practice limited to that determined by the board to be justified and in
5 accordance with such practitioner's education and training. A restricted
6 license shall exclude minor office procedures, dispensing prescription
7 substances contained in the naturopathic formulary, and diagnostic and
8 imaging tests. Each person receiving health care services from practitio-
9 ners granted a restricted license must sign a declaration of informed con-
10 sent, approved and provided by the board, which states the scope of each
11 practitioner's practice.
12 (2) Nothing in this section is to be construed to allow any naturopathic
13 physician embraced by this section to increase his scope of practice without
14 appropriate additional education, training, and testing approved by the board.
15 (3) Applications must be submitted to the board within one hundred eighty
16 (180) days from the date on which this chapter takes effect, and payment of
17 the licensing fees must accompany the application. Failure of persons cur-
18 rently practicing naturopathic medicine in this state to apply for licensure
19 within the one hundred eighty (180) day period, and the continuation of prac-
20 tice after that date, shall cause such persons to be subject to prosecution
21 under section 54-5117, Idaho Code.
22 54-5113. LICENSE STANDARDS FOR OUT-OF-STATE APPLICANTS. The board shall
23 establish by rule the standards for licensure of applicants licensed in
24 another jurisdiction. However, the standards for endorsement of licensure
25 shall not be less than those required for licensure in the state of Idaho.
26 54-5114. INVESTIGATION -- HEARING -- SUBPOENA. (1) The board shall inves-
27 tigate, or cause to be investigated, all complaints made to it and all cases
28 of noncompliance with this chapter.
29 (2) The board may conduct hearings to assist with investigations, to
30 determine whether grounds exist for suspension, revocation or denial of a
31 license or to fulfill its responsibilities under this chapter as the board
32 otherwise determines necessary.
33 (3) The board may subpoena witnesses, administer oaths in any hearing or
34 disciplinary proceedings and compel, by subpoena duces tecum, the production
35 of papers and records.
36 54-5115. DISCIPLINARY ACTION. The board may suspend, revoke or refuse to
37 issue or renew a license on any of the following grounds:
38 (1) The employment of fraud or deceit in obtaining a license under this
39 chapter or in connection with services rendered as a naturopathic physician;
40 (2) A legal finding of mental incompetence;
41 (3) Aiding or abetting a person, not duly licensed under this chapter, in
42 claiming to be a naturopathic physician;
43 (4) Any negligence, incompetence or misconduct in the performance of
44 naturopathic medicine;
45 (5) Conviction of any felonious crime, which constitutes a crime of moral
46 turpitude;
47 (6) Practicing as a naturopathic physician when physical or mental abili-
48 ties are impaired by the use of controlled substances or other drugs, chemi-
49 cals or alcohol;
50 (7) Failure of the individual practitioner to maintain his or her profes-
51 sional premises in a clean and sanitary condition;
52 (8) Any person licensed in accordance with this chapter whose scope of
8
1 practice has been limited by the board pursuant to section 54-5104, Idaho
2 Code, and who performs any act not authorized in his or her limited scope of
3 practice, which constitutes the practice of naturopathic medicine;
4 (9) Any other good cause relevant to qualifications to practice
5 naturopathic medicine;
6 (10) Findings that a licensee's practice is unconventional in the absence
7 of demonstrable harm to a patient and the patient has signed a waiver to the
8 effect that the treatment or device is considered unconventional.
9 54-5116. LICENSE DENIAL OR REVOCATION PROCEDURE. Where the board proposes
10 to refuse to issue or renew a license, or proposes to revoke or suspend a
11 license, opportunity for a hearing shall be pursuant to the provisions of
12 chapter 52, title 67, Idaho Code.
13 54-5117. ENFORCEMENT PENALTIES. (1) A person who violates any provision
14 of this chapter shall, upon conviction, be guilty of a misdemeanor.
15 (2) The board may seek injunction against any person who practices
16 naturopathic medicine in violation of this chapter and may, in the event a
17 permanent injunction is entered against such person or plea or verdict is
18 entered in any criminal matter, impose a civil penalty in the amount of all
19 costs and fees incurred by the board in prosecuting the matter.
20 54-5118. SEVERABILITY. If any provision of this act or its application to
21 any person or circumstance is held invalid, the remainder of the act or the
22 application of the provision to other persons or circumstances is not
23 affected.
STATEMENT OF PURPOSE
RS 14007
To provide for licensure for practitioners of Naturopathy.
FISCAL IMPACT
No general fund impact.
Contact
Name: Rep. Bill Sali
Phone: 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE H 695