2017 -- H 5474 SUBSTITUTE A

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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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LICENSURE OF NATUROPATHY 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 "License of Naturopathy Act of 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 college" means a college which grants a degree of doctor of

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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 accredited by any other organization approved by the board of licensure of

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naturopathy;

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

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     (3) "CNME" or "Council" is 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 health care" or "the practice of naturopathic health care" means a

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

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

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conditions and injuries.

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

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licensed pursuant to the provisions of this chapter.

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     5-36.1-3. Scope of practice.

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

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

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

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

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

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

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

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

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

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

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

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

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routes of administration;

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

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

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

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services, the doctor of naturopathy shall make the referral;

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     (5) Provide health education and health counseling; and

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     (6) Perform naturopathic musculoskeletal mobilization.

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     (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

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

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     5-36.1-4. Penalty for misrepresentation.

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

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

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

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

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fine and imprisonment.

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     5-36.1-5. Prohibited acts.

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

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

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

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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) Perform surgical procedures;

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

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

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

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

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any other health care professional unless licensed under this title;

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

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

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

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

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chiropractor;

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

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

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- prescription drug interactions;

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

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this chapter; or

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

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

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

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of naturopathy.

 

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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 naturopathy by a student enrolled in approved naturopathic training.

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

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

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

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agents,

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

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

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infectious diseases.

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

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

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

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naturopathy.

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     5-36.1-9. Board of licensure.

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

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

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

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board shall be composed of the following:

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

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have been actively engaged in the practice of medicine;

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

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health-related field; and

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

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licensure under this chapter.

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

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more than two (2) consecutive terms.

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

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

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

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

 

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cause.

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

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the original appointment.

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

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

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

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

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

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

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

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

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

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

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

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or repeal them.

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

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

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least one regular meeting is held each year.

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

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

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

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criteria stated by this chapter.

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

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

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chapter or regulations adopted under this chapter.

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

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

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members.

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

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

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

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

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members shall serve without compensation.

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     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

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following:

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

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college;

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

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accommodation;

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     (3) Pass an examination approved by the board;

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

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

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the following:

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

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collaboration and consultation agreement;

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

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other licensed health care providers; and

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

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

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36.1-3.

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     5-36.1-13. 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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     5-36.1-14. Biennial license renewal – Continuing education.

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

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

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

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     (b) As a condition of renewal, a doctor of naturopathy 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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     5-36.1-15. Unprofessional conduct.

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

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

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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

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similar conditions and circumstances.

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

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     (5) 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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     (6) Abandonment of a patient.

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     (7) 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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     (8) Sexual harassment of a patient.

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

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     (10) Willful misrepresentation in treatments.

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

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trained to practice.

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     5-36.1-16. 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 hearing, in its discretion, refuse to grant the license provided for in this chapter to any doctor

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

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

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

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

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committed in obtaining the 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 against

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the licensee has been served or disciplinary action against that person has been 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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     5-36.1-17. 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 doctor of naturopathy is, or may be,

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

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

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naturopathy

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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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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 naturopathy.

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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.

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     5-36.1-18. Informed consent and disclosure.

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

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disclosure statement containing the following information:

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

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

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

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

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

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providers.

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

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provided by a properly credentialed physician specialist.

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

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

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

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

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     5-36.1-19. Severability.

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

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

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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

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

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

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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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