2004 Legislation
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SENATE BILL NO. 1300 – Naturopaths, licensure


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S1300.......................................by COMMERCE AND HUMAN RESOURCES
NATUROPATHS - Adds to existing law to provide licensure and regulation of
naturopathic medicine; to provide definitions; to require a license; to
define the scope of practice; to specify prohibitions; to specify
exemptions; to provide for the creation, powers and duties of the Board of
Naturopathic Medical Examiners; to provide for the establishment of the
Naturopathic Formulary Council; to specify fees; to provide qualifications
for licensure; to provide a restricted license for current practitioners of
naturopathic medicine; to provide licensure standards for out-of-state
applicants; to provide for investigation, hearings and subpoena powers; to
provide disciplinary actions; to provide for denial and revocation
procedure; and to provide enforcement penalties.
02/11    Senate intro - 1st rdg - to printing
02/12    Rpt prt - to Health/Wel

Bill Text

  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                       IN THE SENATE
                                    SENATE BILL NO. 1300
  1                                        AN ACT
 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
 20        54-5101.  LEGISLATIVE PURPOSE. To protect the public  health,  safety  and
 21    welfare  and  provide for state administrative supervision, licensure, regula-
 22    tion and disciplinary procedures, every person providing naturopathic  medical
 23    services  who meets and maintains the standards of practice and code of ethics
 24    as adopted by the board shall be licensed, unless otherwise exempted herein.
 25        54-5102.  DEFINITIONS. As used in this chapter, the following  terms  have
 26    the meanings as stated:
 27        (1)  "Approved naturopathic medical program" means:
 28        (a)  A course of study from a college or university granting the degree of
 29        doctor  of naturopathy or doctor of naturopathic medicine accredited by an
 30        accrediting agency recognized by the state or federal government; or
 31        (b)  A college or university granting the degree of doctor of naturopathy,
 32        or doctor of naturopathic medicine that has the status  of  candidate  for
 33        accreditation with the accrediting agency; or
 34        (c)  A  postgraduate  degree granting college or university of the healing
 35        arts approved by the examining board  and  state  or  federal  accrediting
 36        agency.  Such  college or university shall require a minimum of sixty (60)
 37        semester units for admission and a minimum of four thousand (4,000)  hours
 38        in  basic  and  clinical  sciences,  naturopathic philosophy, naturopathic
 39        modalities, and naturopathic medicine, of which not less than   two  thou-
 40        sand  (2,000)  hours  shall  be academic instruction and not less than two
 41        thousand (2,000) hours shall be  school  or  college  approved  supervised
  1        clinical  training.  The  college  or  university  shall  provide adequate
  2        instruction to maintain naturopathic medicine as a separate  and  distinct
  3        healing art.
  4        (2)  "Board"  means  the  board  of naturopathic medical examiners created
  5    pursuant to section 54-5107, Idaho Code.
  6        (3)  "Minor office procedures" means the methods for the repair  and  care
  7    incidental  to superficial lacerations and abrasions, superficial lesions lim-
  8    ited to warts and epitheliomas and the removal of foreign  bodies  located  in
  9    the superficial tissues.
 10        (4)  "Naturopathic formulary" means the list of natural medicines, nonpre-
 11    scription  and prescription, which naturopathic physicians use in the practice
 12    of their profession, as determined by the formulary council  and  reviewed  by
 13    the board.
 14        (5)  "Naturopathic formulary council" means that council comprised of mem-
 15    bers  appointed pursuant to this chapter to determine and authorize the formu-
 16    lary list.
 17        (6)  "Naturopathic medicine" means a distinct and comprehensive system  of
 18    primary  health  care practiced by naturopathic physicians for the prevention,
 19    diagnosis and treatment of human health  conditions,  injuries  and  diseases,
 20    that  uses  education,  natural medicines and therapies to promote and restore
 21    health by support and stimulation of the individual's self-healing processes.
 22        (7)  "Naturopathic  physician"  and  all   titles   defined   in   section
 23    54-5103(2),  Idaho  Code,  means  a person authorized and licensed to practice
 24    naturopathic medicine under this chapter.
 25        (8)  "Naturopathy" means a philosophy  of  healing  that  employs  natural
 26    modalities  that  may be utilized by naturopathic physicians and other persons
 27    not licensed pursuant to this chapter.
 28        54-5103.  LICENSE REQUIRED. (1) No person shall hold himself out to others
 29    as a naturopathic physician without first applying for and receiving a license
 30    to engage in that practice.
 31        (2)  A person holds himself or herself out to  others  as  a  naturopathic
 32    physician  when the person adopts or uses any or all of the following designa-
 33    tions:  "naturopathic  physician,"  "naturopathic   doctor,"   "physician   of
 34    naturopathic  medicine," "physician of natural medicine," "doctor of naturopa-
 35    thy," or its abbreviation, "N.D.," "doctor of naturopathic medicine,"  or  its
 36    abbreviation, "N.M.D.," which shall be restricted to persons graduated from an
 37    accredited  school  granting the "doctor of naturopathic medicine" degree, and
 38    licensed under this chapter. The terms "naturopath" and "naturopathy"  are  in
 39    the public domain.
 40        (3)  The  titles  and  terms  in  subsection  (2) of this section identify
 41    naturopathic physicians and  are  restricted  to  describing  and  identifying
 42    licensed practitioners.
 43        54-5104.  SCOPE  OF  PRACTICE.  (1)  Diagnostic procedures. A naturopathic
 44    physician  may  use  physical  and  laboratory  examinations  consistent  with
 45    naturopathic  education  and  training  for  diagnostic   purposes   including
 46    phlebotomy, clinical laboratory tests, speculum examinations and physiological
 47    function  tests. A naturopathic physician may order and perform diagnostic and
 48    imaging tests consistent with naturopathic education and training. All imaging
 49    and diagnostic tests not consistent with naturopathic education and  training,
 50    must  be  referred  for  performance  and  interpretation  by an appropriately
 51    licensed health care professional.
 52        (2)  Natural medicines. Naturopathic physicians  are  authorized  to  dis-
 53    pense, administer and prescribe:
  1        (a)  Nonprescription  substances,  including:  food,  extracts  of  foods,
  2        nutraceuticals,  vitamins,  minerals, amino acids, enzymes, botanicals and
  3        their extracts, and homeopathic medicines prepared according to the Homeo-
  4        pathic Pharmacopoeia of the United States, and all dietary supplements and
  5        nonprescription drugs as defined by the federal food, drug,  and  cosmetic
  6        act.
  7        (b)  Prescription substances determined by the formulary council.
  8        (3)  Therapies. A naturopathic physician may:
  9        (a)  Administer,  prescribe,  and  dispense  natural medicines and devices
 10        from the naturopathic formulary; and
 11        (b)  Perform minor office procedures pursuant to privileges granted by the
 12        board of naturopathic medical examiners; and
 13        (c)  Perform those therapies as trained  and  educated,  and  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), as amended, except as authorized by  this  chap-
 20    ter;
 21        (2)  Perform  surgical  procedures  except  those  minor office procedures
 22    authorized by this chapter;
 23        (3)  Practice or claim to practice as a medical  doctor,  osteopath,  den-
 24    tist,  podiatrist,  optometrist,  psychologist, advanced practice professional
 25    nurse, physician assistant, chiropractor, physical  therapist,  acupuncturist,
 26    or  any  other  health care professional not authorized in this chapter unless
 27    licensed by the state of Idaho to do so;
 28        (4)  Use general or spinal anesthetics;
 29        (5)  Administer ionizing radioactive substances for therapeutic purposes;
 30        (6)  Perform surgical procedures using a laser device;
 31        (7)  Induce or perform an abortion;
 32        (8)  Perform surgical procedures involving the eye, ear, tendons,  nerves,
 33    veins or arteries extending beyond superficial tissue;
 34        (9)  Surgically  remove  any  lesion  contemplated  to  be  suspicious  of
 35    malignancy  or  requiring surgical removal. Lesions requiring surgical removal
 36    shall be referred to an appropriately licensed health care professional.
 37    Nothing in this chapter shall negate previous court decisions or current Idaho
 38    Code.
 39        54-5106.  EXEMPTIONS.  This  chapter  is  not  intended  to  prohibit   or
 40    restrict:
 41        (1)  The  practice of a profession by individuals who are licensed, certi-
 42    fied or registered under other laws of this state and are performing  services
 43    within the authorized scope of practice; or
 44        (2)  The  practice  of  naturopathic medicine by an individual employed by
 45    the federal government while the individual is engaged in the  performance  of
 46    duties prescribed by the laws and regulations of the United States; or
 47        (3)  An  individual  rendering  aid to a family member or in an emergency,
 48    when  no fee or other consideration for  the  service  is  charged,  received,
 49    expected or contemplated; or
 50        (4)  A  person engaged in the sale of vitamins, health foods, dietary sup-
 51    plements, herbs, or other products of nature, the sale of which is not  other-
 52    wise prohibited under state or federal law; or
 53        (5)  A  person  engaged in good faith for religious reasons as a matter of
  1    conscience or based on a personal belief; or
  2        (6)  A person who administers treatment or provides advice  regarding  the
  3    human body and its functions who:
  4        (a)  Does not use legend drugs or prescription drugs in such practice;
  5        (b)  Does not recommend the discontinuance of prescribed drugs;
  6        (c)  Uses natural elements such as air, heat, water and light;
  7        (d)  Only uses class I or II nonprescription, approved, medical devices as
  8        defined in section 513 of the federal food, drug, and cosmetic act;
  9        (e)  Uses  only vitamins, minerals, herbs, natural food products and their
 10        extracts, and nutritional supplements;
 11        (f)  Does not perform surgery;
 12        (g)  Requires each person receiving services  to  sign  a  declaration  of
 13        informed  consent which includes an overview of the health care provider's
 14        education and states that the health care provider is not  licensed  under
 15        this chapter.
 16        (7)  The  practice  by  a  naturopathic physician duly licensed in another
 17    state, territory or the District of Columbia when that naturopathic  physician
 18    is incidentally called into this state for consultation with a licensed physi-
 19    cian; or
 20        (8)  The  practice  of  naturopathic  medicine  by students enrolled in an
 21    approved naturopathic medical program. Services shall be performed pursuant to
 22    a course of instruction or assignments from an instructor and under the super-
 23    vision and observation of the instructor.
 24        54-5107.  BOARD OF NATUROPATHIC MEDICAL EXAMINERS.  (1)  There  is  hereby
 25    established  in  the  department of self-governing agencies, bureau of occupa-
 26    tional licenses, the board of naturopathic medical examiners. Members  thereof
 27    shall be appointed by the governor.
 28        (2)  The  board  shall consist of five (5) members, four (4) of whom shall
 29    be licensed pursuant to this chapter and one (1) of whom shall be a member  of
 30    the  public with an interest in the rights of consumers of naturopathic physi-
 31    cian services.
 32        (3)  Appointments to the board shall be made by the governor from  nomina-
 33    tions  received  from  the  Idaho  association of naturopathic physicians, who
 34    shall nominate two (2) persons qualified for each position to be filled.
 35        (4)  All members of the board shall be  naturopathic  physicians  licensed
 36    pursuant  to  this chapter, practicing within the state of Idaho for the dura-
 37    tion of their appointment and shall have been practitioners within  the  state
 38    of Idaho for a minimum of three (3) years immediately preceding appointment.
 39        (5)  The  initial  four (4) licensed naturopathic physician members of the
 40    board shall be persons with at least two (2) years of experience in the  prac-
 41    tice  of naturopathic medicine who are eligible to become licensed pursuant to
 42    this chapter.
 43        (6)  The initial board shall be appointed for staggered terms, the longest
 44    of which shall not exceed five (5) years. After the initial appointments,  all
 45    terms shall be five (5) years and a member may be appointed for a second term.
 46    No  member  shall  serve more than  two (2) consecutive terms. In the event of
 47    death, resignation or removal of any member before the expiration of the  term
 48    to  which  appointed, the vacancy shall be filled for the unexpired portion of
 49    the term in the same manner as the original appointment.
 50        (7)  The governor may remove any member of the board for cause,  prior  to
 51    the expiration of the member's term.
 52        (8)  The  board,  within  thirty  (30)  days after its appointment, and at
 53    least annually thereafter, shall hold a meeting  and  elect  a  chairman.  The
 54    board  may hold additional meetings on the call of the chair or at the written
  1    request of any two (2) members of the board. The board may appoint  such  com-
  2    mittees  as  it considers necessary to carry out its duties. A majority of the
  3    board shall constitute a quorum.
  4        54-5108.  POWERS AND DUTIES OF THE BOARD. The board shall have the author-
  5    ity to:
  6        (1)  Determine the qualifications of persons applying for licensure pursu-
  7    ant to this chapter and define, by rule, the appropriate scope of naturopathic
  8    medicine in this state, provided however, that the scope of practice  may  not
  9    exceed that defined in section 54-5104, Idaho Code;
 10        (2)  Grant  approval  for naturopathic childbirth attendance privileges to
 11    those licensees who apply, provided that such applicant can document  training
 12    and  experience  equal  to  or  greater than that required by the rules of the
 13    Idaho board of nursing, pursuant to section 54-1404, Idaho Code, and that  the
 14    applicant  meets  the  practice  standards  governing  hospital privileges and
 15    supervising physicians established by the Idaho  board  of  nursing,  and  the
 16    applicant  holds  hospital  privileges  or  performs such procedures under the
 17    supervision of an M.D. or D.O.;
 18        (3)  Establish special competency certification requirements for licensees
 19    as deemed necessary by action of the board;
 20        (4)  Adopt rules that govern action limiting the scope of  practice  of  a
 21    licensee;
 22        (5)  Hire and appoint employees, including an executive director, investi-
 23    gators, attorneys, consultants and independent hearing examiners;
 24        (6)  Adopt  such  rules  as  are  necessary for the administration of this
 25    chapter, including standards of professional conduct;
 26        (7)  Conduct investigations and examinations and hold hearings;
 27        (8)  Collect fees and other funds as prescribed by this chapter;
 28        (9)  Contract, sue and be sued, and pursue other matters  lawful  in  this
 29    state relating to naturopathic medicine;
 30        (10) Provide  such  other services and perform such other functions as are
 31    necessary and desirable to fulfill its purposes;
 32        (11) Establish by rule examination standards for licensure and when  those
 33    examinations will be provided;
 34        (12) Establish  a  minimum  amount  and kind of continuing education to be
 35    required annually for each naturopathic physician seeking licensure renewal;
 36        (13) Limit the performance of minor office procedures  to  physicians  who
 37    have  graduated  from  an approved naturopathic medical college or have up-to-
 38    date certification of equivalent training.
 39        54-5109.  NATUROPATHIC FORMULARY  COUNCIL  ESTABLISHED.  There  is  hereby
 40    established  a  naturopathic formulary council, which is separate and distinct
 41    from the board, to be composed of five (5) members. Two (2) members  shall  be
 42    naturopathic  physicians licensed  under this chapter, appointed by the board.
 43    Three (3) members shall be pharmacists licensed under chapter  17,  title  54,
 44    Idaho  Code,  appointed  by the board of naturopathic medical examiners from a
 45    list of nominees provided by the Idaho state board of pharmacy.  It  shall  be
 46    the  duty  of  the naturopathic formulary council to establish a formulary for
 47    use by naturopathic physicians, and immediately upon adoption or  revision  of
 48    the formulary, the council shall transmit the approved formulary to the board,
 49    which  shall  adopt  the  formulary  by  temporary rule. The formulary will be
 50    reviewed annually by the council, or at any time at the request of the  board.
 51    The  formulary  list  may  not  go  beyond  the scope of natural medicines and
 52    devices covered by approved naturopathic education and training  and  existing
 53    naturopathic   formularies,   or  board  approved  continuing  education.  The
  1    naturopathic formulary shall not include medicines and devices that are incon-
  2    sistent with the training provided by approved naturopathic medical  colleges.
  3    Nothing herein shall allow a naturopathic physician to dispense, administer or
  4    prescribe  any  legend  drug as defined in section 54-1705(27), Idaho Code, or
  5    legend device unless such prescription drug or legend device  is  specifically
  6    included in the naturopathic formulary.
  7        54-5110.  FEES. (1) All fees received under the provisions of this chapter
  8    shall  be paid to the department of self-governing agencies, bureau of occupa-
  9    tional licenses, and deposited to the state treasury  to  the  credit  of  the
 10    occupational  licenses  fund. All costs and expenses incurred under the provi-
 11    sions of this chapter shall be a charge against and paid from said fund. In no
 12    case shall any salary, expense or other obligation of  the  board  be  charged
 13    against the general fund.
 14        (2)  The  board,  by rule, may impose the following fees up to the amounts
 15    listed below:
 16        (a)  License fee...................................................$500.00
 17        (b)  Renewal fee...................................................$500.00
 18        (c)  Late renewal penalty..........................................$100.00
 19        (d)  License by endorsement........................................$500.00
 20        (e)  Duplicate license.............................................$ 50.00
 21        (f)  Reinstatement fee.............................................$ 50.00
 22        54-5111.  QUALIFICATIONS FOR LICENSURE. To be eligible for  a  license  to
 23    practice naturopathic medicine in the state of Idaho, the applicant shall:
 24        (1)  Be  a  graduate of an approved naturopathic medical program in accor-
 25    dance with  section  54-5102(1),  Idaho  Code,  and  pass  or  have  passed  a
 26    competency-based  examination  approved  by the board covering the appropriate
 27    naturopathic subjects, including basic and clinical sciences;
 28        (2)  Possess a good, ethical and professional reputation;
 29        (3)  Be physically and mentally capable of safely practicing  naturopathic
 30    medicine with or without reasonable accommodation;
 31        (4)  Have  never  had a license to practice naturopathic medicine refused,
 32    revoked or suspended by any other state or country for reasons that relate  to
 33    the  applicant's  ability to skillfully and safely practice naturopathic medi-
 34    cine unless that license has been restored to good standing by that  state  or
 35    country; and
 36        (5)  File a board approved application and pay the licensing fees.
 38    (1) Any practitioner who cannot prove sufficient education and training to  be
 39    licensed    as  required in section 54-5102(1)(a), (b) or (c), Idaho Code, but
 40    who can:
 41        (a)  Provide evidence of four thousand (4,000)  hours  of  board  approved
 42        basic science and clinical naturopathic education and training;
 43        (b)  Comply with section 54-5111(2) through (4), Idaho Code;
 44        (c)  Pass  or  have passed a competency examination approved by the board;
 45        and
 46        (d)  Document practicing as a naturopathic physician in the state of Idaho
 47        for the past five (5) years;
 48    may be eligible for a restricted license granted by the board under such rules
 49    as the board may adopt with a scope of practice limited to that determined  by
 50    the board to be justified and in accordance with such practitioners' education
 51    and training. A restricted license shall exclude minor office procedures, dis-
 52    pensing  prescription  substances contained in the naturopathic formulary, and
  1    diagnostic and imaging tests. Each person receiving health care services  from
  2    practitioners granted a restricted license must sign a declaration of informed
  3    consent,  approved by the board, which states the scope of each practitioner's
  4    practice.
  5        (2)  Nothing in this section is to be construed to allow any  naturopathic
  6    physician  to  increase their scope of practice without appropriate additional
  7    education, training and testing approved by the board.
  8        (3)  Applications must be submitted to the board within one hundred eighty
  9    (180) days from the date on which this chapter takes effect,  and  payment  of
 10    the  licensing  fees  must  accompany the application. Failure of persons cur-
 11    rently practicing naturopathic medicine in this state to apply  for  licensure
 12    within  the one hundred eighty (180) day period, and the continuation of prac-
 13    tice after that date, shall cause such persons to be  subject  to  prosecution
 14    under section 54-5117, Idaho Code.
 16    shall establish by rule the standards for licensure of applicants licensed  in
 17    another  jurisdiction.  However,  the  standards  for endorsement of licensure
 18    shall not be less than those required for licensure in the state of Idaho.
 19        54-5114.  INVESTIGATION -- HEARING -- SUBPOENA. (1) The board shall inves-
 20    tigate, or cause to be investigated, all complaints made to it and  all  cases
 21    of noncompliance with this chapter.
 22        (2)  The  board  may  conduct  hearings  to assist with investigations, to
 23    determine whether grounds exist for suspension,  revocation  or  denial  of  a
 24    license  or  to  fulfill  its responsibilities under this chapter as the board
 25    determines necessary.
 26        (3)  The board may subpoena witnesses, administer oaths in any hearing  or
 27    disciplinary  proceedings  and compel, by subpoena duces tecum, the production
 28    of papers and records.
 29        54-5115.  DISCIPLINARY ACTION. The board may suspend, revoke or refuse  to
 30    issue or renew a license on any of the following grounds:
 31        (1)  The  employment  of fraud or deceit in obtaining a license under this
 32    chapter or in connection with services rendered as a naturopathic physician;
 33        (2)  A legal finding of mental incompetence;
 34        (3)  Aiding or abetting a person, not duly licensed under this chapter, in
 35    claiming to be a naturopathic physician;
 36        (4)  Any negligence, incompetence or  misconduct  in  the  performance  of
 37    naturopathic medicine;
 38        (5)  Conviction of any felonious crime, which constitutes a crime of moral
 39    turpitude;
 40        (6)  Practicing as a naturopathic physician when physical or mental abili-
 41    ties  are  impaired by the use of controlled substances or other drugs, chemi-
 42    cals or alcohol;
 43        (7)  Failure of the individual practitioner to maintain his or her profes-
 44    sional premises in a clean and sanitary condition;
 45        (8)  Any person licensed in accordance with this chapter  whose  scope  of
 46    practice  has  been  limited  by  the board pursuant to section 54-5104, Idaho
 47    Code, and who performs any act not authorized in his or her limited  scope  of
 48    practice, which constitutes the practice of naturopathic medicine; or
 49        (9)  Any   other  good  cause,  relevant  to  qualifications  to  practice
 50    naturopathic medicine.
 51    The board may not suspend, revoke or refuse to issue or renew a license  based
 52    on the findings that a licensee's practice is unconventional in the absence of
  1    demonstrable  harm  to  a  patient  and the patient has signed a waiver to the
  2    effect that the treatment or device is considered unconventional.
  3        54-5116.  LICENSE DENIAL OR REVOCATION PROCEDURE. Where the board proposes
  4    to refuse to issue or renew a license, or proposes  to  revoke  or  suspend  a
  5    license,  opportunity  for  a  hearing  shall be pursuant to the provisions of
  6    chapter 52, title 67, Idaho Code.
  7        54-5117.  ENFORCEMENT PENALTIES. (1) A person who violates  any  provision
  8    of this chapter shall, upon conviction, be guilty of a misdemeanor.
  9        (2)  The  board  may  seek  an injunction against any person who practices
 10    naturopathic medicine in violation of this chapter and may, in  the   event  a
 11    permanent  injunction  is  entered  against  such person or plea or verdict is
 12    entered in any criminal matter, impose a civil penalty in the  amount  of  all
 13    costs and fees incurred by the board in prosecuting the matter.
 14        54-5118.  SEVERABILITY. If any provision of this act or its application to
 15    any  person  or  circumstance is held invalid, the remainder of the act or the
 16    application of  the  provision  to  other  persons  or  circumstances  is  not
 17    affected.

Statement of Purpose / Fiscal Impact

                       STATEMENT OF PURPOSE
                            RS 13813C1

There are a significantly growing number of residents of the State
of Idaho who choose natural health care.  Naturopathic medicine is
a distinct health care profession.  The purpose of this legislation
is to provide standards of practice and education, a code of ethics
for practitioners, state administrative supervision, licensure,
regulation and disciplinary procedures for every person providing
naturopathic medical services in the state.

                          FISCAL IMPACT

There is no fiscal impact to the general fund.

Name:     Larry Benton
Phone:    461-2000
          Robert L. Geddes

STATEMENT OF PURPOSE/FISCAL NOTE                      S 1300