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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:

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

is hereby amended by adding thereto the following chapter:

CHAPTER 36.1

LICENSURE OF NATUROPATHY ACT OF 2017

     5-36.1-1. Short title.

     This chapter shall be known and may be cited as "License of Naturopathy Act of 2017."

     5-36.1-2. Definitions.

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

meanings:

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

naturopathy; and:

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

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

or

     (ii) Is accredited by any other organization approved by the board of licensure of

naturopathy;

     (2) "Board" means the board of licensure of naturopathy.

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

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

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

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

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

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

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

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

     (8) "Naturopathic health care" or "the practice of naturopathic health care" means a

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

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

conditions and injuries.

     (9) "Doctor of naturopathy" means a person who practices naturopathic health care and is

licensed pursuant to the provisions of this chapter.

     5-36.1-3. Scope of practice.

     (a) A license authorizes a licensee, consistent with naturopathic education and training

and competence demonstrated by passing the doctor of naturopathy licensing examination, to:

     (1) Order and perform physical and laboratory examinations for diagnostic purposes;

     (2) Dispense or order natural substances of mineral, animal, or botanical origin, including

food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and

their extracts, botanical substances, homeopathic substances, and all dietary supplements and

nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act that use various

routes of administration, including oral, nasal, auricular, ocular, rectal, vaginal, transdermal;

     (3) Administer natural substances of mineral, animal, or botanical origin, including food,

extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their

extracts, botanical substances, homeopathic substances, and all dietary supplements and

nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act using transdermal

routes of administration;

     (4) Administer or perform hot or cold hydrotherapy, electromagnetic energy, and

therapeutic exercise for the purpose of providing basic therapeutic care services, except that if a

referral to another licensed provider is appropriate for ongoing rehabilitation or habilitation

services, the doctor of naturopathy shall make the referral;

     (5) Provide health education and health counseling; and

     (6) Perform naturopathic musculoskeletal mobilization.

     (b) If a doctor of naturopathy is engaged in the private practice of naturopathy in the

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state, the doctor of naturopathy shall display the license obtained pursuant to this section

conspicuously in each office where the doctor of naturopathy is engaged in practice.

     5-36.1-4. Penalty for misrepresentation.

     No person who is not licensed as a doctor of naturopathy may use the title of "doctor of

naturopathy" or hold themselves out as a doctor of naturopathy. Any person who violates the

provisions of this section shall be punished by a fine of not less than two hundred dollars ($200)

nor more than five hundred dollars ($500), nor more than one year imprisonment, or by both the

fine and imprisonment.

     5-36.1-5. Prohibited acts.

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

     (1) Prescribe, dispense, or administer any legend medications or substances controlled

pursuant to the federal Controlled Substances Act 21 U.S.C. §812 and chapter 28 of title 21;

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

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

     (3) Perform surgical procedures;

     (4) Practice or claim to practice as a medical doctor or physician, a doctor of osteopathic

medicine, a primary care doctor, a primary care practitioner, a primary care provider, a primary

care naturopath, a dentist, a podiatrist, an optometrist, a psychologist, an advanced practice

registered nurse, a physician assistant, a chiropractor, a physical therapist, an acupuncturist, or

any other health care professional unless licensed under this title;

     (5) Use general regional or spinal anesthetics or procedural sedation;

     (6) Administer ionizing radioactive substances for therapeutic or diagnostic purposes;

     (7) Perform chiropractic adjustments or manipulations that include high–velocity thrusts

at or beyond the end range of normal joint motion unless the licensee is also a licensed

chiropractor;

     (8) Perform acupuncture unless the licensee is also a licensed acupuncturist;

     (9) Advise patients regarding prescription drugs beyond possible dietary supplement/herb

- prescription drug interactions;

     (10) Practice naturopathy in this state without a valid license issued in accordance with

this chapter; or

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

or implying that the person is a doctor of naturopathy unless the person is licensed in accordance

with this chapter. A person licensed under this chapter may use the designations "DN" for doctor

of naturopathy.

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     5-36.1-6. Exemptions.

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

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

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

profession.

     (2) The practice of naturopathy by a student enrolled in approved naturopathic training.

The performance of services shall be pursuant to a course of instruction and under the supervision

of an instructor, who shall be a doctor of naturopathy licensed in accordance with this chapter.

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

agents,

     5-36.1-7. Reporting contagious and infectious diseases.

     Doctors of naturopathy are subject to the provisions of the law relating to contagious and

infectious diseases.

     5-36.1-8. Board of licensure -- Creation.

     Within the division of professional regulation established in the department of health

pursuant to chapter 26 of this title there shall be created a board of licensure for doctor of

naturopathy.

     5-36.1-9. Board of licensure.

     (a) The director of the department of health, with the approval of the governor, shall

appoint a board consisting of five (5) persons, all residents of the state, to constitute a board of

licensure for naturopathy with the duties, powers, and authority as stated in this chapter, and that

board shall be composed of the following:

     (1) Two (2) members who shall be licensed physicians under chapter 37 of title 5 who

have been actively engaged in the practice of medicine;

     (2) One member who is a representative of the general public not employed in any

health-related field; and

     (3) Two (2) members who shall be doctors of naturopathy meeting the qualifications for

licensure under this chapter.

     (b) Members shall be appointed for terms of three (3) years each with no member serving

more than two (2) consecutive terms.

     (c) In their initial appointment, the director shall designate the members of the board of

licensure as follows: three (3) members to serve for terms of three (3) years; and two (2) members

to serve for a term of two (2) years.

     (d) The director of the department of health may remove any member of the board for

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cause.

     (e) Vacancies shall be filled for the unexpired portion of any term in the same manner as

the original appointment.

     5-36.1-10. Board of licensure – Powers and duties.

     (a) The board shall administer and coordinate the provisions of this chapter, evaluate the

qualifications of applicants, supervise any examination of applicants deemed necessary,

recommend to the director the commencement of disciplinary hearings in accordance with

chapter 35 of title 42 and the provisions of this chapter, and investigate persons engaging in

practices which violate the provisions of this chapter. The board shall investigate all persons and

agencies engaging in practices which violate the provisions in this chapter.

     (b) The board shall conduct hearings of a non-disciplinary nature and shall keep the

records and minutes that are necessary to an orderly dispatch of business.

     (c) The board, with the approval of the director of the department of health, shall adopt

rules and regulations necessary to carry into effect the provisions of this chapter and may amend

or repeal them.

     (d) Regular meetings of the board shall be held at any time and places that the board

prescribes and special meetings shall be held upon the call of the chairperson; provided, that at

least one regular meeting is held each year.

     (e) The conferral or enumeration of specific powers in this chapter shall not be construed

as a limitation of the general powers conferred by this section.

     (f) The board shall recommend to the director for registration those persons meeting the

criteria stated by this chapter.

     (g) The board shall recommend to the director the revocation or suspension of the

registration of any doctor of naturopathy who does not conform to the requirements of this

chapter or regulations adopted under this chapter.

     (h) The board shall approve programs for continuing naturopathic education.

     5-36.1-11. Board of licensure – Organization and meetings – Compensation of

members.

     The board shall elect its own chairperson annually and shall meet at the call of the

administrator, the chairperson or upon the request of two (2) or more members of the board. A

quorum shall consist of at least three (3) members present, one of whom must be a doctor of

naturopathy. The board shall approve programs for continuing naturopathic education. Board

members shall serve without compensation.

     5-36.1-12. Qualifications for licensure.

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     (a) To be eligible for licensure as a doctor of naturopathy, an applicant shall satisfy all the

following:

     (1) Have been granted a degree of doctor of naturopathy from an approved naturopathy

college;

     (2) Be physically and mentally fit to practice naturopathy with or without reasonable

accommodation;

     (3) Pass an examination approved by the board;

     (4) Have in place a written collaboration and consultation agreement with a physician

licensed under chapter 37 of title 5. The collaboration and consultation agreement shall include

the following:

     (i) The name and license number of the physician with whom the applicant has a

collaboration and consultation agreement;

     (ii) A statement that the applicant will refer patients to and consult with physicians and

other licensed health care providers; and

     (iii) A statement that the applicant will require patients to sign a consent form that states

that the applicant’s practice of naturopathy is limited to the scope of practice identified in §5-

36.1-3.

     5-36.1-13. Application for licensure.

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

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

     5-36.1-14. Biennial license renewal – Continuing education.

     (a) The license to practice naturopathy shall be renewed every two (2) years by filing a

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

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

     (b) As a condition of renewal, a doctor of naturopathy shall complete a program of

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

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

     5-36.1-15. Unprofessional conduct.

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

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

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

     (2) Failure to conform to the provisions of the collaboration and consultation agreement.

     (3) Acts of gross misconduct in the practice of their profession or gross or repeated

malpractice or the failure to practice naturopathy with the level of care, skill, and treatment that is

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recognized by a reasonably prudent similar doctor of naturopathy as being acceptable under

similar conditions and circumstances.

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

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

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

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

the board.

     (6) Abandonment of a patient.

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

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

     (8) Sexual harassment of a patient.

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

     (10) Willful misrepresentation in treatments.

     (11) Practicing naturopathy in an area or areas of specialty in which the licensee is not

trained to practice.

     5-36.1-16. Refusal or revocation of a license -- Process.

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

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

of naturopathy who has violated any of the laws of the state affecting the ability of any doctor of

naturopathy to practice naturopathy, or who had been guilty of unprofessional conduct or conduct

of a character likely to deceive or defraud the public, and may, after notice and hearing, revoke or

suspend any license issued or granted by it for like causes or for any fraud or deception

committed in obtaining the license.

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

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

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

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

the licensee has been served or disciplinary action against that person has been taken.

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

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

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

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

     5-36.1-17. Complaints.

     (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 doctor of naturopathy is, or may be,

medically or legally incompetent, engaged in the unauthorized practice of naturopathy, guilty of

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

naturopathy

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

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

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

physically unable to engage safely in the practice of naturopathy.

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

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

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

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

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

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

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

     5-36.1-18. Informed consent and disclosure.

     Prior to initiating treatment by a doctor of naturopathy each patient must read and sign a

disclosure statement containing the following information:

     (1) Rhode Island does not recognize doctors of naturopathy as primary care providers and

a doctor of naturopathy is not responsible for the overall medical care of any patient.

     (2) Naturopathic care is intended only as an adjunct to, and not a substitute for, medical

care from a physician, physician assistant (PA), or advanced practice registered nurse (APRN),

and doctors of naturopathy shall coordinate patient care with physicians and other health care

providers.

     (3) Patients are urged to have a primary care provider and to have all specialty care

provided by a properly credentialed physician specialist.

     (4) Doctors of naturopathy are not licensed to prescribe drugs or to advise patients

regarding prescription drugs beyond possible dietary supplement/herb – prescription drug

interactions. All questions regarding prescription medications should be directed to the prescriber

or to the patient’s primary care provider or licensed registered pharmacist.

     5-36.1-19. Severability.

     The provisions of this chapter are severable and if any of the provisions of this chapter

are held unconstitutional by any court of competent jurisdiction, the decision of that court does

not affect or impair any of the remaining provisions.

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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

***

     This act would establish procedures for the licensing of doctors of naturopathy, who

provide health care utilizing natural substance and therapies. Doctors of naturopathy would be

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

     This act would take effect upon passage.

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