By: Luna S.B. No. 476
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the regulation of the practice of naturopathic
1-2 medicine; providing penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. PURPOSE. The legislature finds that a
1-5 significant number of the citizens of this state are turning to
1-6 naturopathic medicine for their health care needs and declares that
1-7 naturopathic medicine is a distinct health care profession that
1-8 affects the public health, safety, and welfare and provides the
1-9 public with freedom of choice in health care. The purpose of this
1-10 Act is to provide standards for the licensing and regulation of
1-11 naturopathic physicians to protect the public health, safety, and
1-12 welfare and to provide a means of identifying qualified
1-13 naturopathic physicians.
1-14 SECTION 2. DEFINITIONS. In this Act:
1-15 (1) "Acupuncture" means the insertion of acupuncture
1-16 needles into specific points on the skin to treat human disease and
1-17 impairment and to relieve pain.
1-18 (2) "Approved naturopathic medical college" means a
1-19 college or program granting the degree of doctor of naturopathic
1-20 medicine or doctor of naturopathy that:
1-21 (A) is accredited by the Council on Naturopathic
1-22 Medical Education or other accrediting agency if recognized by the
1-23 federal government;
1-24 (B) has candidate for accreditation status with
2-1 the accrediting agency; or
2-2 (C) has been approved by the board after the
2-3 college or program was investigated and found to meet education
2-4 standards equivalent to those established by the accrediting
2-5 agency.
2-6 (3) "Board" means the Texas Board of Health.
2-7 (4) "Department" means the Texas Department of Health.
2-8 (5) "Homeopathic preparations" means medicines
2-9 prepared according to the Homeopathic Pharmacopeia of the United
2-10 States.
2-11 (6) "Minor surgery" means the use of operative,
2-12 electrical, or other methods for the surgical repair and care
2-13 incidental to superficial lacerations and abrasions, superficial
2-14 lesions, and the removal of foreign bodies located in superficial
2-15 tissues and the use of antiseptics and local anesthetics in
2-16 connection with these methods. The term does not include general
2-17 or spinal anesthesia, major surgery, surgery of the body cavities,
2-18 or specialized surgeries, including plastic surgery or surgery
2-19 involving the eyes, tendons, ligaments, or major blood vessels.
2-20 (7) "Natural antibiotics" means antimicrobial,
2-21 antifungal, and antiprotozoal agents that are naturally occurring
2-22 substances or manufactured substances that are substantially
2-23 identical to the naturally occurring substances.
2-24 (8) "Naturopathic medicine" means a system of primary
2-25 health care practiced by naturopathic physicians for the
2-26 prevention, diagnosis, and treatment of human health conditions,
2-27 injuries, and diseases that uses education, natural medicines, and
3-1 therapies to support and stimulate the individual's intrinsic
3-2 self-healing processes.
3-3 (9) "Naturopathic obstetrics" means obstetrics and
3-4 natural childbirth. The term includes the use of natural
3-5 obstetrical medicines, ophthalmic antibiotics, obstetrical
3-6 emergency medicines, and minor surgery including episiotomies, but
3-7 does not include the use of forceps delivery, general or spinal
3-8 anesthesia, cesarean section, or induced abortion.
3-9 (10) "Naturopathic physician" means a person
3-10 authorized and licensed to practice naturopathic medicine under
3-11 this Act.
3-12 (11) "Naturopathic physical medicine" means the
3-13 therapeutic use of the physical agents of air, water, heat, cold,
3-14 sound, light, and electromagnetic nonionizing radiation and the
3-15 physical modalities of electrotherapy, diathermy, ultraviolet
3-16 light, ultrasound, hydrotherapy, naturopathic manipulative therapy,
3-17 and therapeutic exercise.
3-18 (12) "Topical medicines" means topical analgesics,
3-19 anesthetics, antiseptics, scabicides, antifungals, and
3-20 antibacterials.
3-21 SECTION 3. AUTHORIZED ACTIVITIES. (a) A person licensed as
3-22 a naturopathic physician under this Act may use for preventive and
3-23 therapeutic purposes the following medicines and therapies:
3-24 (1) food;
3-25 (2) food extracts;
3-26 (3) nutritional medicines;
3-27 (4) enzymes;
4-1 (5) digestive aids;
4-2 (6) whole gland thyroid;
4-3 (7) medicinal plant and animal substances;
4-4 (8) homeopathic preparations;
4-5 (9) natural antibiotics;
4-6 (10) immunizations;
4-7 (11) topical medicines;
4-8 (12) nonprescription medications;
4-9 (13) counseling and psychotherapy;
4-10 (14) hypnotherapy;
4-11 (15) biofeedback;
4-12 (16) dietary therapy;
4-13 (17) naturopathic physical medicine;
4-14 (18) acupuncture;
4-15 (19) therapeutic devices;
4-16 (20) barrier devices for contraception;
4-17 (21) naturopathic obstetrics; and
4-18 (22) minor surgery.
4-19 (b) A person licensed as a naturopathic physician under this
4-20 Act may use for diagnostic purposes:
4-21 (1) physical and orificial examinations;
4-22 (2) X-rays;
4-23 (3) electrocardiograms;
4-24 (4) ultrasound;
4-25 (5) phlebotomy;
4-26 (6) clinical laboratory tests and examinations;
4-27 (7) physiological function tests; and
5-1 (8) the noninvasive diagnostic procedures commonly
5-2 used by physicians in general practice.
5-3 SECTION 4. BOARD POWERS AND DUTIES. The board may adopt
5-4 rules authorizing the use by naturopathic physicians of other
5-5 diagnostic procedures and other natural medicines and therapies if
5-6 the procedures, medicines, and therapies are taught in approved
5-7 naturopathic medical colleges and are consistent with this Act.
5-8 SECTION 5. EXCEPTIONS. This Act does not:
5-9 (1) prevent any other professional who is licensed,
5-10 certified, or registered under the laws of this state from
5-11 providing services consistent with the professional's scope of
5-12 practice;
5-13 (2) apply to a student of naturopathic medicine who is
5-14 currently enrolled in an approved naturopathic medicine college and
5-15 who gratuitously diagnoses and treats disease under the direct
5-16 supervision of a naturopathic physician or other health care
5-17 practitioner regulated under the laws of this state if the
5-18 student's activities are within the scope of practice of the
5-19 supervising practitioner and are limited to activity consistent
5-20 with the scope of practice authorized by this Act; or
5-21 (3) apply to any naturopathic physician licensed in
5-22 another state, a territory of the United States, or the District of
5-23 Columbia, if the state, territory, or the District of Columbia
5-24 requires credentials equivalent to those of this Act, when the
5-25 physician is incidentally called into this state for consultation
5-26 with a naturopathic physician.
5-27 SECTION 6. PROHIBITED ACTS. A naturopathic physician may
6-1 not:
6-2 (1) prescribe, dispense, or administer any legend
6-3 drugs or controlled substances except those medicines authorized by
6-4 this Act;
6-5 (2) perform surgical procedures except those
6-6 procedures authorized by this Act;
6-7 (3) practice emergency medicine except as a samaritan
6-8 rendering gratuitous services in the case of emergency and except
6-9 for the care of minor injuries; or
6-10 (4) claim to practice medicine and surgery,
6-11 osteopathy, dentistry, podiatry, optometry, chiropractic, physical
6-12 therapy, or any other system or method of treatment not authorized
6-13 by this Act.
6-14 SECTION 7. DUTIES AND RESPONSIBILITIES. A naturopathic
6-15 physician has the same authority and responsibility as any other
6-16 licensed physician regarding public health laws, reportable
6-17 diseases and conditions, communicable disease control and
6-18 prevention, the recording of vital statistics, health and physical
6-19 examinations, competency examinations, and local boards of health,
6-20 except that the authority under this section is limited to activity
6-21 consistent with the scope of practice authorized by this Act.
6-22 SECTION 8. LICENSE QUALIFICATIONS. (a) A person is
6-23 qualified to be licensed as a naturopathic physician if the person:
6-24 (1) is a graduate of an approved naturopathic medical
6-25 college;
6-26 (2) has passed an examination prescribed or endorsed
6-27 by the board covering the appropriate naturopathic subjects; and
7-1 (3) is of good moral character.
7-2 (b) A person is qualified to be licensed as a naturopathic
7-3 physician without examination if:
7-4 (1) the applicant is licensed to practice naturopathic
7-5 medicine or naturopathy in another state, a territory of the United
7-6 States, or the District of Columbia under conditions and
7-7 circumstances that the board finds to be comparable to the
7-8 requirements of this state for obtaining a license to practice
7-9 naturopathic medicine and the state, the territory, or the District
7-10 of Columbia requires the successful completion of a professional
7-11 examination for the issuance of a license;
7-12 (2) the applicant has graduated from an approved
7-13 naturopathic medical college or, if the applicant was licensed
7-14 before a date designated by board rule, the applicant graduated
7-15 from a college approved by the board after the college was
7-16 investigated and found to meet the acceptable education standards
7-17 in existence at the time of the applicant's graduation; and
7-18 (3) the applicant produces evidence satisfactory to
7-19 the board that the applicant holds a valid, unsuspended, and
7-20 unrevoked license, has been actively engaged in the practice of
7-21 naturopathic medicine or naturopathy for not less than one year,
7-22 and is of good moral character.
7-23 (c) A person is qualified to be licensed under this Act
7-24 without examination if the person:
7-25 (1) is a resident of the state;
7-26 (2) is 18 years of age or older;
7-27 (3) held the person out to the public as a naturopath
8-1 or naturopathic physician before January 1, 1995;
8-2 (4) is not licensed as a health care provider under
8-3 any other law in this state;
8-4 (5) derives the majority of the person's earned income
8-5 from the practice of naturopathic medicine; and
8-6 (6) applies for a license under this subsection on or
8-7 before January 1, 1996.
8-8 (d) A person licensed under Subsection (c) of this section
8-9 may practice naturopathic medicine only within a scope of practice
8-10 that reflects the limits of the person's training and experience.
8-11 The board may adopt rules providing for limitations on the practice
8-12 of a person under this subsection and prescribing methods by which
8-13 a person licensed under Subsection (c) of this section is
8-14 identified as a person whose practice is limited.
8-15 SECTION 9. EXAMINATION. (a) A person may sit for the
8-16 examination prescribed or endorsed by the board under Subsection
8-17 (a) of Section 8 of this Act and be eligible for licensure on the
8-18 passage of the examination if, before December 1, 1995, the person
8-19 submits proof to the department that the person:
8-20 (1) attended a naturopathic college and received a
8-21 doctorate degree in naturopathic medicine or naturopathy from the
8-22 college before May 1, 1994, and the college is subsequently
8-23 approved by the board;
8-24 (2) was in practice in this state before May 1, 1994,
8-25 that included providing health care services using natural
8-26 medicines or therapies to patients in this state on a regular and
8-27 ongoing basis; and
9-1 (3) is of good moral character.
9-2 (b) The board may prescribe a nationally developed standard
9-3 examination as part or all of the examination prescribed or
9-4 endorsed under Subsection (a) of Section 8 of this Act. The
9-5 passing criteria for the examination shall be determined by board
9-6 rule. The board may adopt other rules necessary to the
9-7 administration of the examination.
9-8 (c) The board shall set the fees for the examination,
9-9 reexamination of the entire examination, and reexamination of
9-10 separate components of the examination in amounts necessary to
9-11 cover the actual cost of the examination and the expenses of
9-12 administration.
9-13 SECTION 10. LICENSE FEES. A license to practice
9-14 naturopathic medicine issued on the basis of examination or issued
9-15 without examination based on a license granted in another state, a
9-16 territory of the United States, or the District of Columbia may be
9-17 issued and renewed on payment of the initial licensing fee and
9-18 biennial renewal fees as determined by the board. The amounts of
9-19 the fees may not be less than $100 or more than $500.
9-20 SECTION 11. LICENSE RENEWAL. (a) A license to practice
9-21 naturopathic medicine must be renewed biennially.
9-22 (b) To renew a license, each naturopathic physician must
9-23 submit to the department evidence of successful completion of the
9-24 required hours of continuing education from programs approved by
9-25 the board.
9-26 (c) The board shall adopt rules as to what constitutes an
9-27 approved program of continuing education and the manner in which
10-1 attendance at all approved courses, clinics, forums, lectures,
10-2 programs, or seminars is monitored, recorded, and submitted to the
10-3 department.
10-4 (d) The board may adopt other rules necessary to the
10-5 administration of license renewals.
10-6 SECTION 12. CONTINUING EDUCATION. (a) The total number of
10-7 required continuing education hours for all naturopathic physicians
10-8 is not less than 30 approved hours biennially. The number and type
10-9 of required continuing education hours for a naturopathic physician
10-10 certified in naturopathic obstetrics is not less than 15 approved
10-11 specialty hours in obstetrics or natural childbirth and not less
10-12 than 20 approved hours biennially for a total of not less than 35
10-13 approved hours biennially.
10-14 (b) A person who seeks to renew a license that expired
10-15 within the preceding year must comply with the continuing education
10-16 requirements for the regular renewal of the license. A person
10-17 seeking to renew a license that has been expired for more than one
10-18 year must present evidence of completion of not less than one-half
10-19 of the required hours of approved continuing education requirements
10-20 during the year preceding the date of the application for renewal.
10-21 SECTION 13. INACTIVE STATUS; RETIRED STATUS. (a) A license
10-22 holder seeking to place the person's license on inactive status
10-23 must notify the department at the time of renewal and pay a fee for
10-24 inactive status.
10-25 (b) The amount of the fee shall be set by the board except
10-26 the amount may not be less than $30 or more than $100.
10-27 (c) To activate a license on inactive status, the license
11-1 holder must pay the regular renewal fee and present evidence of
11-2 having completed not less than one-half of the required hours of
11-3 approved continuing education requirements during the year
11-4 preceding the date of the application for activation.
11-5 (d) A license holder seeking to place a license on retired
11-6 status must notify the department at the time of renewal. A
11-7 license on retired status may not be reactivated.
11-8 (e) A license holder who holds a license that is on inactive
11-9 or retired status may not practice naturopathic medicine.
11-10 SECTION 14. SPECIALTY PRACTICE. (a) A naturopathic
11-11 physician may not practice naturopathic obstetrics or acupuncture
11-12 without first obtaining a certificate of specialty practice. The
11-13 board shall adopt rules to certify naturopathic physicians for
11-14 specialty practice.
11-15 (b) To be certified in naturopathic obstetrics, a
11-16 naturopathic physician must:
11-17 (1) pass a specialty examination in obstetrics or
11-18 natural childbirth approved by the board;
11-19 (2) have completed at least 100 hours of course work,
11-20 internship, or preceptorship in obstetrics or natural childbirth
11-21 approved by the board; and
11-22 (3) have participated in at least 40 supervised
11-23 births, including prenatal and postnatal care, under the direct
11-24 supervision of a licensed naturopathic, medical, or osteopathic
11-25 physician with specialty training in obstetrics or natural
11-26 childbirth.
11-27 (c) The board may prescribe a national standardized
12-1 examination in obstetrics or natural childbirth as constituting the
12-2 specialty examination.
12-3 (d) To be certified in acupuncture, a naturopathic physician
12-4 must complete a program in acupuncture approved by the board that
12-5 includes not less than 500 hours of training in acupuncture,
12-6 including both didactic and clinical training, and pass a specialty
12-7 examination in acupuncture approved by the board. The board may
12-8 prescribe a national standardized examination in acupuncture as
12-9 constituting the specialty examination.
12-10 SECTION 15. USE OF TITLES; PENALTY; INJUNCTION. (a) A
12-11 naturopathic physician may use the title "naturopathic physician"
12-12 and the recognized abbreviation for the professional degree of
12-13 "N.D." A naturopathic physician has the exclusive right to use the
12-14 terms "naturopathic physician," "naturopath," "doctor of
12-15 naturopathic medicine," "doctor of naturopathy," "naturopathic
12-16 medicine," "naturopathic health care," "naturopathy," and "N.D."
12-17 (b) A person commits an offense if the person holds the
12-18 person out as a naturopathic physician or naturopath, suggests that
12-19 the person practices naturopathic medicine or naturopathy, or uses
12-20 the terms and abbreviation described by Subsection (a) of this
12-21 section without holding a license or while the person is on retired
12-22 or inactive status under this Act.
12-23 (c) An offense under Subsection (b) of this section is a
12-24 Class B misdemeanor.
12-25 (d) A person who violates this section may be enjoined by
12-26 the district court on petition by the board.
12-27 SECTION 16. DISCIPLINARY ACTIONS. A person licensed under
13-1 this Act who engages in the practice of naturopathic medicine in
13-2 violation of this Act or a rule adopted under this Act is subject
13-3 to disciplinary measures and may be subject to a refusal to renew
13-4 the person's license, the imposition of a limitation on the
13-5 person's license, or the revocation or suspension of the license.
13-6 SECTION 17. CONFORMING AMENDMENT. Subsection (b), Section
13-7 3.06, Medical Practice Act (Article 4495b, Vernon's Texas Civil
13-8 Statutes), is amended to read as follows:
13-9 (b) This Act does not apply to:
13-10 (1) dentists, duly qualified and registered under the
13-11 laws of this state who confine their practice strictly to
13-12 dentistry;
13-13 (2) duly licensed optometrists who confine their
13-14 practice strictly to optometry as defined by law;
13-15 (3) duly licensed chiropractors who confine their
13-16 practice strictly to chiropractic as defined by law;
13-17 (4) registered or professional nurses and licensed
13-18 vocational nurses registered or licensed under the laws of this
13-19 state who confine their practice strictly within the provisions of
13-20 such applicable licensing Acts and the laws of this state;
13-21 (5) duly licensed podiatrists who confine their
13-22 practice strictly to podiatry as defined by law;
13-23 (6) duly licensed or certified psychologists who
13-24 confine their activities or practice strictly to psychology as
13-25 defined by law;
13-26 (7) duly licensed physical therapists who confine
13-27 their activities or practice strictly to physical therapy and who
14-1 are not in violation of any law relating to physical therapy
14-2 practice;
14-3 (8) duly licensed athletic trainers who confine their
14-4 activities to the functions of an athletic trainer;
14-5 (9) commissioned or contract surgeons of the uniformed
14-6 services of the United States or in the Public Health Service in
14-7 the performance of their duties and not engaged in private
14-8 practice;
14-9 (10) <(9)> any person furnishing medical assistance in
14-10 case of an emergency or disaster situation if no charge is made for
14-11 the medical assistance;
14-12 (11) <(10)> a student in training in a medical school
14-13 approved by the board while performing the duties assigned in the
14-14 course of training, providing the duties are performed under the
14-15 supervision of a licensed practitioner, except that medical
14-16 residents, interns, and fellows shall be required to register and
14-17 be subject to the other applicable provisions of this Act;
14-18 (12) <(11)> legally qualified physicians of other
14-19 states called in consultation but who have no office in Texas and
14-20 who appoint no place in this state for seeing, examining, or
14-21 treating patients; <or>
14-22 (13) <(12)> licensed naturopathic physicians who
14-23 confine their practice strictly to naturopathic medicine as defined
14-24 by law; or
14-25 (14) any other activities that the board may designate
14-26 as exempt from the application of this Act.
14-27 SECTION 18. CONFORMING AMENDMENT. Section 6.06, Medical
15-1 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
15-2 amended to read as follows:
15-3 Sec. 6.06. LICENSE REQUIRED; EXCEPTION. (a) Except as
15-4 provided by Subsection (b) of this section, a <A> person may not
15-5 practice acupuncture in this state unless the person holds a
15-6 license to practice acupuncture issued by the medical board under
15-7 this subchapter.
15-8 (b) A person licensed to practice naturopathic medicine may
15-9 engage in the practice of acupuncture without a license under this
15-10 subchapter.
15-11 SECTION 19. CONFORMING AMENDMENT. Subsection (a), Section
15-12 3, Licensed Professional Counselor Act (Article 4512g, Vernon's
15-13 Texas Civil Statutes), is amended to read as follows:
15-14 (a) Except as provided by Subsection (b) of this section,
15-15 this Act does not apply to:
15-16 (1) the activities and services of or use of an
15-17 official title by a person employed as a counselor by a federal,
15-18 state, county, or municipal agency or public or private educational
15-19 institution, if the person is performing counseling or
15-20 counseling-related activities within the scope of his employment;
15-21 (2) the activities and services of a student, intern,
15-22 or trainee in counseling pursuing a course of study in counseling
15-23 in a regionally accredited institution of higher education or
15-24 training institution, if these activities and services constitute a
15-25 part of the supervised course of study and the person is designated
15-26 a "counselor intern";
15-27 (3) the activities and services of a nonresident
16-1 rendered not more than 30 days during any year, if the person is
16-2 authorized to perform the activities and services under the law of
16-3 the state or country of his residence;
16-4 (4) the activities and services of members of other
16-5 professions licensed or certified by the state, such as physicians,
16-6 registered nurses, psychologists, certified social workers,
16-7 licensed marriage and family therapists, licensed chemical
16-8 dependency counselors, licensed naturopathic physicians, licensed
16-9 optometrists in the evaluation and remediation of learning or
16-10 behavioral disabilities associated with or caused by a defective or
16-11 abnormal condition of vision, Christian Science practitioners who
16-12 are recognized by the Church of Christ Scientist as registered and
16-13 published in the Christian Science Journal, or other recognized
16-14 religious practitioners performing counseling consistent with the
16-15 law of the state, their training, and any code of ethics of their
16-16 professions, if they do not represent themselves by any title or
16-17 description in the manner prescribed by Section 2 of this Act;
16-18 (5) the activities, services, titles, and descriptions
16-19 of persons licensed to practice law;
16-20 (6) the activities, services, titles, and descriptions
16-21 of persons employed as professionals or who are volunteers in the
16-22 practice of counseling for public and private nonprofit
16-23 organizations or charities who are accountable to the persons'
16-24 sponsoring organization and do not use the title or hold themselves
16-25 out to be licensed counselors;
16-26 (7) persons supervised by a physician and recognized
16-27 as physician assistants by the Texas State Board of Medical
17-1 Examiners, if the persons act strictly within their scope of
17-2 practice and do not use the titles covered by Section 15(b)(3) of
17-3 this Act; or
17-4 (8) persons owning, operating, or employed by a
17-5 certified career counseling service regulated under Chapter 222,
17-6 Acts of the 70th Legislature, Regular Session, 1987 (Article
17-7 5221a-8, Vernon's Texas Civil Statutes).
17-8 SECTION 20. EFFECTIVE DATE. This Act takes effect September
17-9 1, 1995.
17-10 SECTION 21. EMERGENCY. The importance of this legislation
17-11 and the crowded condition of the calendars in both houses create an
17-12 emergency and an imperative public necessity that the
17-13 constitutional rule requiring bills to be read on three several
17-14 days in each house be suspended, and this rule is hereby suspended.