By Luna S.B. No. 476
74R4551 JMM-D
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 anesthesia, 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 is incidentally called into this state for consultation
5-27 with 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 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, before December 1, 1995, the person submits proof
8-1 to the department that the person:
8-2 (1) attended a naturopathic college and received a
8-3 doctorate degree in naturopathic medicine or naturopathy from the
8-4 college before May 1, 1994, and the college is subsequently
8-5 approved by the board;
8-6 (2) was in practice in this state before May 1, 1994,
8-7 that included providing health care services using natural
8-8 medicines or therapies to patients in this state on a regular and
8-9 ongoing basis; and
8-10 (3) is of good moral character.
8-11 (b) The board may prescribe a nationally developed standard
8-12 examination as part or all of the examination prescribed or
8-13 endorsed under Section 8(a) of this Act. The passing criteria for
8-14 the examination shall be determined by board rule. The board may
8-15 adopt other rules necessary to the administration of the
8-16 examination.
8-17 (c) The board shall set the fees for the examination,
8-18 reexamination of the entire examination, and reexamination of
8-19 separate components of the examination in amounts necessary to
8-20 cover the actual cost of the examination and the expenses of
8-21 administration.
8-22 SECTION 10. LICENSE FEES. A license to practice
8-23 naturopathic medicine issued on the basis of examination or issued
8-24 without examination based on a license granted in another state, a
8-25 territory of the United States, or the District of Columbia may be
8-26 issued and renewed on payment of the initial licensing fee and
8-27 biennial renewal fees as determined by the board. The amounts of
9-1 the fees may not be less than $100 or more than $500.
9-2 SECTION 11. LICENSE RENEWAL. (a) A license to practice
9-3 naturopathic medicine must be renewed biennially.
9-4 (b) To renew a license, each naturopathic physician must
9-5 submit to the department evidence of successful completion of the
9-6 required hours of continuing education from programs approved by
9-7 the board.
9-8 (c) The board shall adopt rules as to what constitutes an
9-9 approved program of continuing education and the manner in which
9-10 attendance at all approved courses, clinics, forums, lectures,
9-11 programs, or seminars is monitored, recorded, and submitted to the
9-12 department.
9-13 (d) The board may adopt other rules necessary to the
9-14 administration of license renewals.
9-15 SECTION 12. CONTINUING EDUCATION. (a) The total number of
9-16 required continuing education hours for all naturopathic physicians
9-17 is not less than 30 approved hours biennially. The number and type
9-18 of required continuing education hours for a naturopathic physician
9-19 certified in naturopathic obstetrics is not less than 15 approved
9-20 specialty hours in obstetrics or natural childbirth and not less
9-21 than 20 approved hours biennially for a total of not less than 35
9-22 approved hours biennially.
9-23 (b) A person who seeks to renew a license that expired
9-24 within the preceding year must comply with the continuing education
9-25 requirements for the regular renewal of the license. A person
9-26 seeking to renew a license that has been expired for more than one
9-27 year must present evidence of completion of not less than one-half
10-1 of the required hours of approved continuing education requirements
10-2 during the year preceding the date of the application for renewal.
10-3 SECTION 13. INACTIVE STATUS; RETIRED STATUS. (a) A license
10-4 holder seeking to place the person's license on inactive status
10-5 must notify the department at the time of renewal and pay a fee for
10-6 inactive status.
10-7 (b) The amount of the fee shall be set by the board except
10-8 the amount may not be less than $30 or more than $100.
10-9 (c) To activate a license on inactive status, the license
10-10 holder must pay the regular renewal fee and present evidence of
10-11 having completed not less than one-half of the required hours of
10-12 approved continuing education requirements during the year
10-13 preceding the date of the application for activation.
10-14 (d) A license holder seeking to place a license on retired
10-15 status must notify the department at the time of renewal. A
10-16 license on retired status may not be reactivated.
10-17 (e) A license holder who holds a license that is on inactive
10-18 or retired status may not practice naturopathic medicine.
10-19 SECTION 14. SPECIALTY PRACTICE. (a) A naturopathic
10-20 physician may not practice naturopathic obstetrics or acupuncture
10-21 without first obtaining a certificate of specialty practice. The
10-22 board shall adopt rules to certify naturopathic physicians for
10-23 specialty practice.
10-24 (b) To be certified in naturopathic obstetrics, a
10-25 naturopathic physician must:
10-26 (1) pass a specialty examination in obstetrics or
10-27 natural childbirth approved by the board;
11-1 (2) have completed at least 100 hours of course work,
11-2 internship, or preceptorship in obstetrics or natural childbirth
11-3 approved by the board; and
11-4 (3) have participated in at least 40 supervised
11-5 births, including prenatal and postnatal care, under the direct
11-6 supervision of a licensed naturopathic, medical, or osteopathic
11-7 physician with specialty training in obstetrics or natural
11-8 childbirth.
11-9 (c) The board may prescribe a national standardized
11-10 examination in obstetrics or natural childbirth as constituting the
11-11 specialty examination.
11-12 (d) To be certified in acupuncture, a naturopathic physician
11-13 must complete a program in acupuncture approved by the board that
11-14 includes not less than 500 hours of training in acupuncture,
11-15 including both didactic and clinical training, and pass a specialty
11-16 examination in acupuncture approved by the board. The board may
11-17 prescribe a national standardized examination in acupuncture as
11-18 constituting the specialty examination.
11-19 SECTION 15. USE OF TITLES; PENALTY; INJUNCTION. (a) A
11-20 naturopathic physician may use the title "naturopathic physician"
11-21 and the recognized abbreviation for the professional degree of
11-22 "N.D." A naturopathic physician has the exclusive right to use the
11-23 terms "naturopathic physician," "naturopath," "doctor of
11-24 naturopathic medicine," "doctor of naturopathy," "naturopathic
11-25 medicine," "naturopathic health care," "naturopathy," and "N.D."
11-26 (b) A person commits an offense if the person holds the
11-27 person out as a naturopathic physician or naturopath, suggests that
12-1 the person practices naturopathic medicine or naturopathy, or uses
12-2 the terms and abbreviation described by Subsection (a) of this
12-3 section without holding a license or while the person is on retired
12-4 or inactive status under this Act.
12-5 (c) An offense under Subsection (b) of this section is a
12-6 Class B misdemeanor.
12-7 (d) A person who violates this section may be enjoined by
12-8 the district court on petition by the board.
12-9 SECTION 16. DISCIPLINARY ACTIONS. A person licensed under
12-10 this Act who engages in the practice of naturopathic medicine in
12-11 violation of this Act or a rule adopted under this Act is subject
12-12 to disciplinary measures and may be subject to a refusal to renew
12-13 the person's license, the imposition of a limitation on the
12-14 person's license, or the revocation or suspension of the license.
12-15 SECTION 17. CONFORMING AMENDMENT. Section 3.06(b), Medical
12-16 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
12-17 amended to read as follows:
12-18 (b) This Act does not apply to:
12-19 (1) dentists, duly qualified and registered under the
12-20 laws of this state who confine their practice strictly to
12-21 dentistry;
12-22 (2) duly licensed optometrists who confine their
12-23 practice strictly to optometry as defined by law;
12-24 (3) duly licensed chiropractors who confine their
12-25 practice strictly to chiropractic as defined by law;
12-26 (4) registered or professional nurses and licensed
12-27 vocational nurses registered or licensed under the laws of this
13-1 state who confine their practice strictly within the provisions of
13-2 such applicable licensing Acts and the laws of this state;
13-3 (5) duly licensed podiatrists who confine their
13-4 practice strictly to podiatry as defined by law;
13-5 (6) duly licensed or certified psychologists who
13-6 confine their activities or practice strictly to psychology as
13-7 defined by law;
13-8 (7) duly licensed physical therapists who confine
13-9 their activities or practice strictly to physical therapy and who
13-10 are not in violation of any law relating to physical therapy
13-11 practice;
13-12 (8) commissioned or contract surgeons of the uniformed
13-13 services of the United States or in the Public Health Service in
13-14 the performance of their duties and not engaged in private
13-15 practice;
13-16 (9) any person furnishing medical assistance in case
13-17 of an emergency or disaster situation if no charge is made for the
13-18 medical assistance;
13-19 (10) a student in training in a medical school
13-20 approved by the board while performing the duties assigned in the
13-21 course of training, providing the duties are performed under the
13-22 supervision of a licensed practitioner, except that medical
13-23 residents, interns, and fellows shall be required to register and
13-24 be subject to the other applicable provisions of this Act;
13-25 (11) legally qualified physicians of other states
13-26 called in consultation but who have no office in Texas and who
13-27 appoint no place in this state for seeing, examining, or treating
14-1 patients; <or>
14-2 (12) licensed naturopathic physicians who confine
14-3 their practice strictly to naturopathic medicine as defined by law;
14-4 or
14-5 (13) any other activities that the board may designate
14-6 as exempt from the application of this Act.
14-7 SECTION 18. CONFORMING AMENDMENT. Section 6.06, Medical
14-8 Practices Act (Article 4495b, Vernon's Texas Civil Statutes), is
14-9 amended to read as follows:
14-10 Sec. 6.06. LICENSE REQUIRED; EXCEPTION. (a) Except as
14-11 provided by Subsection (b) of this section, a <A> person may not
14-12 practice acupuncture in this state unless the person holds a
14-13 license to practice acupuncture issued by the medical board under
14-14 this subchapter.
14-15 (b) A person licensed to practice naturopathic medicine may
14-16 engage in the practice of acupuncture without a license under this
14-17 subchapter.
14-18 SECTION 19. CONFORMING AMENDMENT. Section 3(a), Licensed
14-19 Professional Counselor Act (Article 4512g, Vernon's Texas Civil
14-20 Statutes), is amended to read as follows:
14-21 (a) Except as provided by Subsection (b) of this section,
14-22 this Act does not apply to:
14-23 (1) the activities and services of or use of an
14-24 official title by a person employed as a counselor by a federal,
14-25 state, county, or municipal agency or public or private educational
14-26 institution, if the person is performing counseling or
14-27 counseling-related activities within the scope of his employment;
15-1 (2) the activities and services of a student, intern,
15-2 or trainee in counseling pursuing a course of study in counseling
15-3 in a regionally accredited institution of higher education or
15-4 training institution, if these activities and services constitute a
15-5 part of the supervised course of study and the person is designated
15-6 a "counselor intern";
15-7 (3) the activities and services of a nonresident
15-8 rendered not more than 30 days during any year, if the person is
15-9 authorized to perform the activities and services under the law of
15-10 the state or country of his residence;
15-11 (4) the activities and services of members of other
15-12 professions licensed or certified by the state, such as physicians,
15-13 registered nurses, psychologists, certified social workers,
15-14 licensed marriage and family therapists, licensed chemical
15-15 dependency counselors, licensed naturopathic physicians, licensed
15-16 optometrists in the evaluation and remediation of learning or
15-17 behavioral disabilities associated with or caused by a defective or
15-18 abnormal condition of vision, Christian Science practitioners who
15-19 are recognized by the Church of Christ Scientist as registered and
15-20 published in the Christian Science Journal, or other recognized
15-21 religious practitioners performing counseling consistent with the
15-22 law of the state, their training, and any code of ethics of their
15-23 professions, if they do not represent themselves by any title or
15-24 description in the manner prescribed by Section 2 of this Act;
15-25 (5) the activities, services, titles, and descriptions
15-26 of persons licensed to practice law;
15-27 (6) the activities, services, titles, and descriptions
16-1 of persons employed as professionals or who are volunteers in the
16-2 practice of counseling for public and private nonprofit
16-3 organizations or charities who are accountable to the persons'
16-4 sponsoring organization and do not use the title or hold themselves
16-5 out to be licensed counselors;
16-6 (7) persons supervised by a physician and recognized
16-7 as physician assistants by the Texas State Board of Medical
16-8 Examiners, if the persons act strictly within their scope of
16-9 practice and do not use the titles covered by Section 15(b)(3) of
16-10 this Act; or
16-11 (8) persons owning, operating, or employed by a
16-12 certified career counseling service regulated under Chapter 222,
16-13 Acts of the 70th Legislature, Regular Session, 1987 (Article
16-14 5221a-8, Vernon's Texas Civil Statutes).
16-15 SECTION 20. EFFECTIVE DATE. This Act takes effect September
16-16 1, 1995.
16-17 SECTION 21. EMERGENCY. The importance of this legislation
16-18 and the crowded condition of the calendars in both houses create an
16-19 emergency and an imperative public necessity that the
16-20 constitutional rule requiring bills to be read on three several
16-21 days in each house be suspended, and this rule is hereby suspended.