By: Luna S.B. No. 1432 73R8986 JMM-F A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the regulation of the practice of naturopathic 1-3 medicine; providing penalties. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. PURPOSE. The legislature finds that a 1-6 significant number of the citizens of this state are turning to 1-7 naturopathic medicine for their health care needs and declares that 1-8 naturopathic medicine is a distinct health care profession that 1-9 affects the public health, safety, and welfare and provides the 1-10 public with freedom of choice in health care. The purpose of this 1-11 Act is to provide standards for the licensing and regulation of 1-12 naturopathic physicians to protect the public health, safety, and 1-13 welfare and to provide a means of identifying qualified 1-14 naturopathic physicians. 1-15 SECTION 2. DEFINITIONS. In this Act: 1-16 (1) "Acupuncture" means the insertion of acupuncture 1-17 needles into specific points on the skin to treat human disease and 1-18 impairment and to relieve pain. 1-19 (2) "Approved naturopathic medical college" means a 1-20 college or program granting the degree of doctor of naturopathic 1-21 medicine or doctor of naturopathy that: 1-22 (A) is accredited by the Council on Naturopathic 1-23 Medical Education or other accrediting agency if recognized by the 1-24 federal government; 2-1 (B) has candidate for accreditation status with 2-2 the accrediting agency; or 2-3 (C) has been approved by the board after the 2-4 college or program was investigated and found to meet education 2-5 standards equivalent to those established by the accrediting 2-6 agency. 2-7 (3) "Board" means the Texas Board of Health. 2-8 (4) "Department" means the Texas Department of Health. 2-9 (5) "Homeopathic preparations" means medicines 2-10 prepared according to the Homeopathic Pharmacopeia of the United 2-11 States. 2-12 (6) "Minor surgery" means the use of operative, 2-13 electrical, or other methods for the surgical repair and care 2-14 incidental to superficial lacerations and abrasions, superficial 2-15 lesions, and the removal of foreign bodies located in superficial 2-16 tissues and the use of antiseptics and local anesthetics in 2-17 connection with these methods. The term does not include general 2-18 or spinal anesthetics, major surgery, surgery of the body cavities, 2-19 or specialized surgeries including plastic surgery or surgery 2-20 involving the eyes, tendons, ligaments, or major blood vessels. 2-21 (7) "Natural antibiotics" means antimicrobial, 2-22 antifungal, and antiprotozoal agents that are naturally occurring 2-23 substances or manufactured substances that are substantially 2-24 identical to the naturally occurring substances. 2-25 (8) "Naturopathic medicine" means a system of primary 2-26 health care practiced by naturopathic physicians for the 2-27 prevention, diagnosis, and treatment of human health conditions, 3-1 injuries, and diseases that uses education, natural medicines, and 3-2 therapies to support and stimulate the individual's intrinsic 3-3 self-healing processes. 3-4 (9) "Naturopathic obstetrics" means obstetrics and 3-5 natural childbirth. The term includes the use of natural 3-6 obstetrical medicines, ophthalmic antibiotics, obstetrical 3-7 emergency medicines, and minor surgery including episiotomies, but 3-8 does not include the use of forceps delivery, general or spinal 3-9 anesthesia, cesarean section, or induced abortion. 3-10 (10) "Naturopathic physician" means a person 3-11 authorized and licensed to practice naturopathic medicine under 3-12 this Act. 3-13 (11) "Naturopathic physical medicine" means the 3-14 therapeutic use of the physical agents of air, water, heat, cold, 3-15 sound, light, and electromagnetic nonionizing radiation and the 3-16 physical modalities of electrotherapy, diathermy, ultraviolet 3-17 light, ultrasound, hydrotherapy, naturopathic manipulative therapy, 3-18 and therapeutic exercise. 3-19 (12) "Topical medicines" means topical analgesics, 3-20 anesthetics, antiseptics, scabicides, antifungals, and 3-21 antibacterials. 3-22 SECTION 3. AUTHORIZED ACTIVITIES. (a) A person licensed as 3-23 a naturopathic physician under this Act may use for preventive and 3-24 therapeutic purposes the following medicines and therapies: 3-25 (1) food; 3-26 (2) food extracts; 3-27 (3) nutritional medicines; 4-1 (4) enzymes; 4-2 (5) digestive aids; 4-3 (6) whole gland thyroid; 4-4 (7) medicinal plant and animal substances; 4-5 (8) homeopathic preparations; 4-6 (9) natural antibiotics; 4-7 (10) immunizations; 4-8 (11) topical medicines; 4-9 (12) nonprescription medications; 4-10 (13) counseling and psychotherapy; 4-11 (14) hypnotherapy; 4-12 (15) biofeedback; 4-13 (16) dietary therapy; 4-14 (17) naturopathic physical medicine; 4-15 (18) acupuncture; 4-16 (19) therapeutic devices; 4-17 (20) barrier devices for contraception; 4-18 (21) naturopathic obstetrics; and 4-19 (22) minor surgery. 4-20 (b) A person licensed as a naturopathic physician under this 4-21 Act may use for diagnostic purposes: 4-22 (1) physical and orificial examinations; 4-23 (2) X-rays; 4-24 (3) electrocardiograms; 4-25 (4) ultrasound; 4-26 (5) phlebotomy; 4-27 (6) clinical laboratory tests and examinations; 5-1 (7) physiological function tests; and 5-2 (8) the noninvasive diagnostic procedures commonly 5-3 used by physicians in general practice. 5-4 SECTION 4. BOARD POWERS AND DUTIES. The board may adopt 5-5 rules authorizing the use by naturopathic physicians of other 5-6 diagnostic procedures and other natural medicines and therapies if 5-7 the procedures, medicines, and therapies are taught in approved 5-8 naturopathic medical colleges and are consistent with this Act. 5-9 SECTION 5. EXCEPTIONS. This Act does not: 5-10 (1) prevent any other professional who is licensed, 5-11 certified, or registered under the laws of this state from 5-12 providing services consistent with the professional's scope of 5-13 practice; 5-14 (2) apply to a student of naturopathic medicine who is 5-15 currently enrolled in an approved naturopathic medicine college and 5-16 who gratuitously diagnoses and treats disease under the direct 5-17 supervision of a naturopathic physician or other health care 5-18 practitioner regulated under the laws of this state if the 5-19 student's activities are within the scope of practice of the 5-20 supervising practitioner and are limited to activity consistent 5-21 with the scope of practice authorized by this Act; or 5-22 (3) apply to any naturopathic physician licensed in 5-23 another state, a territory of the United States, or the District of 5-24 Columbia, if the state, territory, or the District of Columbia 5-25 requires credentials equivalent to those of this Act, when the 5-26 physician incidentally called into this state for consultation with 5-27 a naturopathic physician. 6-1 SECTION 6. PROHIBITED ACTS. A naturopathic physician may 6-2 not: 6-3 (1) prescribe, dispense, or administer any legend 6-4 drugs or controlled substances except those medicines authorized by 6-5 this Act; 6-6 (2) perform surgical procedures except those 6-7 procedures authorized by this Act; 6-8 (3) practice emergency medicine except as a samaritan 6-9 rendering gratuitous services in the case of emergency and except 6-10 for the care of minor injuries; or 6-11 (4) claim to practice medicine and surgery, 6-12 osteopathy, dentistry, podiatry, optometry, chiropractic, physical 6-13 therapy, or any other system or method of treatment not authorized 6-14 by this Act. 6-15 SECTION 7. DUTIES AND RESPONSIBILITIES. A naturopathic 6-16 physician has the same authority and responsibility as any other 6-17 licensed physician regarding public health laws, reportable 6-18 diseases and conditions, communicable disease control and 6-19 prevention, the recording of vital statistics, health and physical 6-20 examinations, competency examinations, and local boards of health, 6-21 except that the authority under this section is limited to activity 6-22 consistent with the scope of practice authorized by this Act. 6-23 SECTION 8. LICENSE QUALIFICATIONS. (a) A person is 6-24 qualified to be licensed as a naturopathic physician if the person: 6-25 (1) is a graduate of an approved naturopathic medical 6-26 college; 6-27 (2) has passed an examination prescribed or endorsed 7-1 by the board covering the appropriate naturopathic subjects; and 7-2 (3) is of good moral character. 7-3 (b) A person is qualified to be licensed as a naturopathic 7-4 physician without examination if: 7-5 (1) the applicant is licensed to practice naturopathic 7-6 medicine or naturopathy in another state, a territory of the United 7-7 States, or the District of Columbia under conditions and 7-8 circumstances that the board finds to be comparable to the 7-9 requirements of this state for obtaining a license to practice 7-10 naturopathic medicine and the state, the territory, or the District 7-11 of Columbia requires the successful completion of a professional 7-12 examination for the issuance of such a license; 7-13 (2) the applicant has graduated from an approved 7-14 naturopathic medical college or, if the applicant was licensed 7-15 before a date designated by board rule, the applicant graduated 7-16 from a college approved by the board after the college was 7-17 investigated and found to meet the acceptable education standards 7-18 in existence at the time of the applicant's graduation; and 7-19 (3) the applicant produces evidence satisfactory to 7-20 the board that the applicant holds a valid, unsuspended, and 7-21 unrevoked license, has been actively engaged in the practice of 7-22 naturopathic medicine or naturopathy for not less than one year, 7-23 and is of good moral character. 7-24 SECTION 9. EXAMINATION. (a) A person may sit for the 7-25 examination prescribed or endorsed by the board under Section 8(a) 7-26 of this Act and be eligible for licensure on the passage of the 7-27 examination if, not later than the 90th day after the effective 8-1 date of this Act, the person submits proof to the department that 8-2 the person: 8-3 (1) attended a naturopathic college and received a 8-4 doctorate degree in naturopathic medicine or naturopathy from the 8-5 college before May 1, 1992, and the college is subsequently 8-6 approved by the board; 8-7 (2) was in practice in this state before May 1, 1992, 8-8 that included providing health care services using natural 8-9 medicines or therapies to patients in this state on a regular and 8-10 ongoing basis; and 8-11 (3) is of good moral character. 8-12 (b) The board may prescribe a nationally developed standard 8-13 examination as part or all of the examination prescribed or 8-14 endorsed under Section 8(a) of this Act. The passing criteria for 8-15 the examination shall be determined by board rule. The board may 8-16 adopt other rules necessary to the administration of the 8-17 examination. 8-18 (c) Fees for the examination, reexamination of the entire 8-19 examination, and reexamination of separate components of the 8-20 examination shall be set by the board in amounts necessary to cover 8-21 the actual cost of the examination and the expenses of 8-22 administration. 8-23 SECTION 10. LICENSE FEES. A license to practice 8-24 naturopathic medicine issued on the basis of examination or issued 8-25 without examination based on a license granted in another state, a 8-26 territory of the United States, or the District of Columbia may be 8-27 issued and renewed on payment of the initial licensing fee and 9-1 biennial renewal fees as determined by the board. The amounts of 9-2 the fees may not be less than $100 or more than $500. 9-3 SECTION 11. LICENSE RENEWAL. (a) A license to practice 9-4 naturopathic medicine must be renewed biennially. 9-5 (b) To renew a license, each naturopathic physician must 9-6 submit to the department evidence of successful completion of the 9-7 required hours of continuing education from programs approved by 9-8 the board. 9-9 (c) The board shall adopt rules as to what constitutes an 9-10 approved program of continuing education and the manner in which 9-11 attendance at all approved courses, clinics, forums, lectures, 9-12 programs, or seminars is monitored, recorded, and submitted to the 9-13 department. 9-14 (d) The board may adopt other rules necessary to the 9-15 administration of license renewals. 9-16 SECTION 12. CONTINUING EDUCATION. (a) The total number of 9-17 required continuing education hours for all naturopathic physicians 9-18 is not less than 30 approved hours biennially. The number and type 9-19 of required continuing education hours for a naturopathic physician 9-20 certified in naturopathic obstetrics is not less than 15 approved 9-21 specialty hours in obstetrics or natural childbirth and not less 9-22 than 20 approved hours biennially for a total of not less than 35 9-23 approved hours biennially. 9-24 (b) A person who seeks to renew a license that expired 9-25 within the preceding year must comply with the continuing education 9-26 requirements for the regular renewal of the license. A person 9-27 seeking to renew a license that has been expired for more than one 10-1 year must present evidence of completion of not less than one-half 10-2 of the required hours of approved continuing education requirements 10-3 during the year preceding the date of the application for renewal. 10-4 SECTION 13. INACTIVE STATUS; RETIRED STATUS. (a) A 10-5 licensee seeking to place a license on inactive status must notify 10-6 the department at the time of renewal and pay a fee for inactive 10-7 status. 10-8 (b) The amount of the fee shall be set by the board except 10-9 the amount may not be less than $30 or more than $100. 10-10 (c) To activate a license on inactive status, the licensee 10-11 must pay the regular renewal fee and present evidence of having 10-12 completed not less than one-half of the required hours of approved 10-13 continuing education requirements during the year preceding the 10-14 date of the application for activation. 10-15 (d) A licensee seeking to place a license on retired status 10-16 must notify the department at the time of renewal. A license on 10-17 retired status may not be reactivated. 10-18 (e) A licensee who holds a license that is on inactive or 10-19 retired status may not practice naturopathic medicine. 10-20 SECTION 14. SPECIALTY PRACTICE. (a) A naturopathic 10-21 physician may not practice naturopathic obstetrics and acupuncture 10-22 without first obtaining a certificate of specialty practice. The 10-23 board shall adopt rules to certify naturopathic physicians for 10-24 specialty practice. 10-25 (b) To be certified in naturopathic obstetrics, a 10-26 naturopathic physician must: 10-27 (1) pass a specialty examination in obstetrics or 11-1 natural childbirth approved by the board; 11-2 (2) have not less than 100 hours of course work, 11-3 internship, or preceptorship in obstetrics or natural childbirth 11-4 approved by the board; and 11-5 (3) have participated in at least 40 supervised 11-6 births, including prenatal and postnatal care, under the direct 11-7 supervision of a licensed naturopathic, medical, or osteopathic 11-8 physician with specialty training in obstetrics or natural 11-9 childbirth. 11-10 (c) The board may prescribe a national standardized 11-11 examination in obstetrics or natural childbirth as constituting the 11-12 specialty examination. 11-13 (d) To be certified in acupuncture, a naturopathic physician 11-14 must complete a program in acupuncture approved by the board that 11-15 includes not less than 500 hours of training in acupuncture, 11-16 including both didactic and clinical training, and pass a specialty 11-17 examination in acupuncture approved by the board. The board may 11-18 prescribe a national standardized examination in acupuncture as 11-19 constituting the specialty examination. 11-20 SECTION 15. USE OF TITLES; PENALTY; INJUNCTION. (a) A 11-21 naturopathic physician may use the title "naturopathic physician" 11-22 and the recognized abbreviation for the professional degree of 11-23 "N.D." A naturopathic physician has the exclusive right to use the 11-24 terms "naturopathic physician," "naturopath," "doctor of 11-25 naturopathic medicine," "doctor of naturopathy," "naturopathic 11-26 medicine," "naturopathic health care," "naturopathy," and "N.D." 11-27 (b) A person commits an offense if the person holds the 12-1 person out as a naturopathic physician or naturopath, suggests that 12-2 the person practices naturopathic medicine or naturopathy, or uses 12-3 the terms and abbreviation described by Subsection (a) of this 12-4 section without being licensed or on retired or inactive status 12-5 under this Act. 12-6 (c) An offense under Subsection (b) of this section is a 12-7 Class B misdemeanor. 12-8 (d) A person in violation of this section may be enjoined by 12-9 the district court on petition by the board. 12-10 SECTION 16. DISCIPLINARY ACTIONS. A person licensed under 12-11 this Act who engages in the practice of naturopathic medicine in 12-12 violation of this Act or a rule adopted under this Act is subject 12-13 to disciplinary measures and may be subject to the person's license 12-14 being denied, refused renewal, limited, revoked, or suspended. 12-15 SECTION 17. EFFECTIVE DATE. This Act takes effect September 12-16 1, 1993. 12-17 SECTION 18. EMERGENCY. The importance of this legislation 12-18 and the crowded condition of the calendars in both houses create an 12-19 emergency and an imperative public necessity that the 12-20 constitutional rule requiring bills to be read on three several 12-21 days in each house be suspended, and this rule is hereby suspended.