2017 -- H 5474

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LC001505

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - THE NATUROPATHIC PHYSICIANS

ACT OF 2017

     

     Introduced By: Representatives Keable, and Blazejewski

     Date Introduced: February 15, 2017

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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

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is hereby amended by adding thereto the following chapter:

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CHAPTER 36.1

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THE NATUROPATHIC PHYSICIANS ACT OF 2017

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     5-36.1-1. Short title.

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     This chapter shall be known and may be cited as "The Naturopathic Physicians Act of

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2017."

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     5-36.1-2. Definitions.

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     The following words and phrases as used in this chapter shall have the following

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meanings:

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

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doctor of naturopathic medicine or doctor of naturopathy; and

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     (i) Is accredited by the Council on Naturopathic Medical Education (CNME), its

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successor or other accrediting agency recognized by the United States Department of Education;

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or

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

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of doctor of naturopathy or doctor of naturopathic medicine. The program shall offer graduate-

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

 

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

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

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shall be an institution, or part of an institution of higher education that is either accredited or is a

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candidate for accreditation by a regional or national institutional accrediting agency recognized

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by the United States Secretary of Education; or

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

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

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

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

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

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

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

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equivalent accrediting agency; or

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

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

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

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

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

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

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

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standing in the judgment of the board; and, if still in existence, has current programmatic

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accreditation by the CNME or federally recognized equivalent accrediting agency. Additionally,

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the college or university currently has provincial approval for participation in government-funded

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student aid programs; or

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

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

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

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

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

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aid programs.

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     (2) "Board" means the North American Board of Naturopathic Examiners.

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     (3) "CNME" or "Council" means the Council on Naturopathic Medical Education.

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     (4) "Department" means the Rhode Island department of health.

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

 

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

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

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

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     (6) "Director" means the director of the Rhode Island department of health.

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

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

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

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

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health conditions and injuries.

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

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

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

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

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therapy, physical rehabilitation, or chiropractic.

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

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licensed pursuant to the provisions of this chapter.

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     5-36.1-3. Licensed naturopathic physicians - Allowable practices.

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     (a) A naturopathic doctor, in connection with such system of health care and licensed

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under this chapter, may:

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

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

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nutritional and dietary therapy, and naturopathic physical medicine authorized by this chapter.

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     (2) Order and perform physical and laboratory examinations consistent with naturopathic

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education and training, for diagnostic purposes, including, but not limited to, phlebotomy, clinical

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laboratory tests, orifical examinations, and physiological function tests.

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     (3) Order diagnostic imaging studies consistent with naturopathic training.

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     (4) Dispense, administer, order, and prescribe or perform the following:

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     (i) Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes,

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botanicals and their extracts, botanical medicines, homeopathic medicines, all dietary

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supplements and nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act.

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     (ii) Prescription substances as determined by the naturopathic formulary council.

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     (iii) Hot or cold hydrotherapy; naturopathic physical medicine; electromagnetic energy;

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colon hydrotherapy; and therapeutic exercise.

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     (iv) Devices, including but not limited to, therapeutic devices, barrier contraception, and

 

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durable medical equipment.

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     (v) Health education and health counseling.

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     (vi) Repair and care incidental to superficial lacerations and abrasions.

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     (vii) Removal of foreign bodies located in the superficial tissues.

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     (viii) Musculoskeletal manipulation consistent with naturopathic education and training.

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     (5) Utilize the routes of administration that include oral, nasal, auricular, ocular, rectal,

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vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular consistent with

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the education and training of a naturopathic doctor.

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     (6) Perform those therapies as trained and educated, and approved by the board.

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     5-36.1-4. Licensed naturopathic physicians. Non-allowable practices.

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     (a) A naturopathic doctor licensed under this chapter, shall not:

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     (1) Prescribe, dispense or administer any controlled substance or device identified in the

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Federal Controlled Substance Act, 21 U.S.C. sections 801 through 971(1988), as amended, except

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as authorized by this chapter;

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     (2) Perform surgical procedures except those minor office procedures authorized by this

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chapter;

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     (3) Practice or claim to practice as a medical doctor, osteopath, dentist, podiatrist,

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optometrist, psychologist, advanced practice professional nurse, physician assistant, chiropractor,

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physical therapist, acupuncturist, or any other health care professional not authorized by this

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chapter unless licensed as such;

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     (4) Use general or spinal anesthetics;

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     (5) Administer ionizing radioactive substances for therapeutic purposes;

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     (6) Perform surgical procedures using a laser device;

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     (7) Perform surgical procedures involving the eye, ear, tendons, nerves, veins or arteries

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extending beyond superficial tissue;

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     (8) Perform chiropractic adjustments or musculoskeletal manipulation;

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     (9) Perform acupuncture, unless licensed as an acupuncturist; or

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     (10) Practice naturopathic medicine in this state without a valid license.

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     5-36.1-5. Prohibitions and penalties.

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     (a) No person shall perform the following:

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

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accordance with this chapter.

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

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

 

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

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(naturopathic doctor), "N.M.D." (naturopathic medical doctor), "doctor of naturopathic

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

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

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

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authorized by this chapter.

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

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

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

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penalties provided in §5-36.1-14.

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     5-36.1-6. Exemptions.

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     (a) Nothing in this chapter shall be construed to prohibit any of the following:

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

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

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profession.

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

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

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

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

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

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

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licensed in accordance with this chapter.

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

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

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formulary.

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

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

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

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     5-36.1-7. Reporting contagious and infectious diseases – Death certificates.

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     Naturopathic physicians are subject to the provisions of the law relating to contagious

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

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     5-36.1-8. Oversight and duties by director of health.

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     The director of health, with the advice of the advisory appointees, shall:

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

 

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     (2) Administer fees collected under this chapter;

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     (3) Administer examinations;

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

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complaint procedures to the public;

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

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

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

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     5-36.1-9. Advisory appointees.

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     (a) The director shall appoint two (2) naturopathic physicians licensed under this chapter

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to serve as advisors to the director in matters relating to naturopathic physicians. They shall be

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appointed as set forth in this section and serve at the pleasure of the director. One of the initial

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appointments shall be for a term of three (3) years, and one of the initial appointments shall be for

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a term of two (2) years.

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     (b) The persons appointed pursuant to subsection (a) of this section shall have at least

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three (3) years of experience as a naturopathic physician during the period immediately preceding

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the appointment, and shall be actively practicing naturopathic medicine and remain in good

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standing during their period as advisors.

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

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

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

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this purpose.

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

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reason of disqualification or necessary absence, the director may appoint a suitable person to

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

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     5-36.1-10. Eligibility for licensure.

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     (a) To be eligible for licensure as a naturopathic physician, an applicant shall satisfy all

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the following:

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

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approved naturopathic medical college;

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

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reasonable accommodation; and

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

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

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

 

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

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graduates of approved naturopathic schools, eligibility for licensure may be granted with

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evidence of successful passage of a board-approved state competency examination or Canadian

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provincial examination.

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     5-36.1-11. Application for licensure.

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     A person shall apply for a license under this chapter by filing with the director an

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application provided by the director accompanied by the required fees and evidence of eligibility.

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     5-36.1-12. Examination – Waiver of examination.

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     The director, or designee, shall administer an examination required to obtain licensure in

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the state of Rhode Island to applicants for licensure at least two (2) times each year if applications

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are pending. Examinations administered by the director and the procedures of administration shall

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be fair and reasonable and shall be designed and implemented to ensure that all applicants are

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granted a license if they demonstrate that they possess minimal professional qualifications that

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are consistent with the public health, safety, and welfare. The examinations shall not be designed

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or implemented for the purpose of limiting the number of licenses issued.

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     5-36.1-13. Biennial license renewal–Continuing education.

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     (a) The license to practice naturopathic medicine shall be renewed every two (2) years by

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

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

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

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

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

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     5-36.1-14. Refusal or revocation of licensure - Complaints.

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     The following conduct, and conduct set forth by the department of health, by a person

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licensed under this chapter or an applicant for licensure constitutes unprofessional conduct:

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

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

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

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

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naturopathic physician as being acceptable under similar conditions and circumstances.

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     (3) Harassing, intimidating, or abusing a patient.

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

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

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

 

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the board.

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     (5) Abandonment of a patient.

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

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

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     (7) Sexual harassment of a patient.

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

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     (9) Willful misrepresentation in treatments.

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

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licensee is not trained to practice.

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

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     5-36.1-15. Refusal or revocation of a license - Process.

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

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and hearings, in its discretion refuse to grant a license provided in this chapter to any naturopathic

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

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ability of any naturopathic physician to practice naturopathic medicine, or who had been guilty

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of unprofessional conduct or conduct of a character likely to deceive or defraud the public, and

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

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naturopathic physician for like causes or for any fraud or deception committed in obtaining the

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license.

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

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

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

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

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

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taken.

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

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

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

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

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     5-36.1-16. Complaints.

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

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

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

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medicine, has been guilty of unprofessional conduct, or is mentally or physically unable to

 

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engage safely in the practice of naturopathic medicine.

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

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

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

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physically unable to engage safely in the practice of medicine.

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

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

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

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resulted in action by the division of the final disposition of the matter.

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

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

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to the superior court in the manner provided for in chapter 35 of title 42 ("Administrative

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Procedures Act").

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - THE NATUROPATHIC PHYSICIANS

ACT OF 2017

***

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     This act would establish procedures for the licensing of naturopathic physicians, and

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define the practice of naturopathic medicine. The practice would include the use of botanical and

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homeopathic medicines, as well as counseling and nutrition. The practice of naturopathic

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medicine would be subject to oversight by the director of the Rhode Island department of health.

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     This act would take effect upon passage.

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