1-1 By: Luna S.B. No. 476
1-2 (In the Senate - Filed February 6, 1995; February 8, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; April 27, 1995, reported favorably, as amended, by the
1-5 following vote: Yeas 6, Nays 0; April 27, 1995, sent to printer.)
1-6 COMMITTEE AMENDMENT NO. 1 By: Moncrief
1-7 Amend S.B. No. 476 by inserting in Section 17 a new Subdivision (8)
1-8 to Section 3.06(b) and renumbering the following subdivisions
1-9 accordingly:
1-10 (8) duly licensed athletic trainers who confine their
1-11 activities to the functions of an athletic trainer;
1-12 COMMITTEE AMENDMENT NO. 2 By: Moncrief
1-13 Amend S.B. No. 476 in Section 8 of the bill (introduced version,
1-14 page 7, between lines 23 and 24; committee printing page 4, between
1-15 lines 13 and 14), by adding Subsections (c) and (d) to read as
1-16 follows:
1-17 (c) A person is qualified to be licensed under this Act
1-18 without examination if the person:
1-19 (1) is a resident of the state;
1-20 (2) is 18 years of age or older;
1-21 (3) held the person out to the public as a naturopath
1-22 or naturopathic physician before January 1, 1995;
1-23 (4) is not licensed as a health care provider under
1-24 any other law in this state;
1-25 (5) derives the majority of the person's earned income
1-26 from the practice of naturopathic medicine; and
1-27 (6) applies for a license under this subsection on or
1-28 before January 1, 1996.
1-29 (d) A person licensed under Subsection (c) of this section
1-30 may practice naturopathic medicine only within a scope of practice
1-31 that reflects the limits of the person's training and experience.
1-32 The board may adopt rules providing for limitations on the practice
1-33 of a person under this subsection and prescribing methods by which
1-34 a person licensed under Subsection (c) of this section is
1-35 identified as a person whose practice is limited.
1-36 A BILL TO BE ENTITLED
1-37 AN ACT
1-38 relating to the regulation of the practice of naturopathic
1-39 medicine; providing penalties.
1-40 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-41 SECTION 1. PURPOSE. The legislature finds that a
1-42 significant number of the citizens of this state are turning to
1-43 naturopathic medicine for their health care needs and declares that
1-44 naturopathic medicine is a distinct health care profession that
1-45 affects the public health, safety, and welfare and provides the
1-46 public with freedom of choice in health care. The purpose of this
1-47 Act is to provide standards for the licensing and regulation of
1-48 naturopathic physicians to protect the public health, safety, and
1-49 welfare and to provide a means of identifying qualified
1-50 naturopathic physicians.
1-51 SECTION 2. DEFINITIONS. In this Act:
1-52 (1) "Acupuncture" means the insertion of acupuncture
1-53 needles into specific points on the skin to treat human disease and
1-54 impairment and to relieve pain.
1-55 (2) "Approved naturopathic medical college" means a
1-56 college or program granting the degree of doctor of naturopathic
1-57 medicine or doctor of naturopathy that:
1-58 (A) is accredited by the Council on Naturopathic
1-59 Medical Education or other accrediting agency if recognized by the
1-60 federal government;
1-61 (B) has candidate for accreditation status with
1-62 the accrediting agency; or
1-63 (C) has been approved by the board after the
1-64 college or program was investigated and found to meet education
1-65 standards equivalent to those established by the accrediting
1-66 agency.
1-67 (3) "Board" means the Texas Board of Health.
1-68 (4) "Department" means the Texas Department of Health.
2-1 (5) "Homeopathic preparations" means medicines
2-2 prepared according to the Homeopathic Pharmacopeia of the United
2-3 States.
2-4 (6) "Minor surgery" means the use of operative,
2-5 electrical, or other methods for the surgical repair and care
2-6 incidental to superficial lacerations and abrasions, superficial
2-7 lesions, and the removal of foreign bodies located in superficial
2-8 tissues and the use of antiseptics and local anesthetics in
2-9 connection with these methods. The term does not include general
2-10 or spinal anesthesia, major surgery, surgery of the body cavities,
2-11 or specialized surgeries, including plastic surgery or surgery
2-12 involving the eyes, tendons, ligaments, or major blood vessels.
2-13 (7) "Natural antibiotics" means antimicrobial,
2-14 antifungal, and antiprotozoal agents that are naturally occurring
2-15 substances or manufactured substances that are substantially
2-16 identical to the naturally occurring substances.
2-17 (8) "Naturopathic medicine" means a system of primary
2-18 health care practiced by naturopathic physicians for the
2-19 prevention, diagnosis, and treatment of human health conditions,
2-20 injuries, and diseases that uses education, natural medicines, and
2-21 therapies to support and stimulate the individual's intrinsic
2-22 self-healing processes.
2-23 (9) "Naturopathic obstetrics" means obstetrics and
2-24 natural childbirth. The term includes the use of natural
2-25 obstetrical medicines, ophthalmic antibiotics, obstetrical
2-26 emergency medicines, and minor surgery including episiotomies, but
2-27 does not include the use of forceps delivery, general or spinal
2-28 anesthesia, cesarean section, or induced abortion.
2-29 (10) "Naturopathic physician" means a person
2-30 authorized and licensed to practice naturopathic medicine under
2-31 this Act.
2-32 (11) "Naturopathic physical medicine" means the
2-33 therapeutic use of the physical agents of air, water, heat, cold,
2-34 sound, light, and electromagnetic nonionizing radiation and the
2-35 physical modalities of electrotherapy, diathermy, ultraviolet
2-36 light, ultrasound, hydrotherapy, naturopathic manipulative therapy,
2-37 and therapeutic exercise.
2-38 (12) "Topical medicines" means topical analgesics,
2-39 anesthetics, antiseptics, scabicides, antifungals, and
2-40 antibacterials.
2-41 SECTION 3. AUTHORIZED ACTIVITIES. (a) A person licensed as
2-42 a naturopathic physician under this Act may use for preventive and
2-43 therapeutic purposes the following medicines and therapies:
2-44 (1) food;
2-45 (2) food extracts;
2-46 (3) nutritional medicines;
2-47 (4) enzymes;
2-48 (5) digestive aids;
2-49 (6) whole gland thyroid;
2-50 (7) medicinal plant and animal substances;
2-51 (8) homeopathic preparations;
2-52 (9) natural antibiotics;
2-53 (10) immunizations;
2-54 (11) topical medicines;
2-55 (12) nonprescription medications;
2-56 (13) counseling and psychotherapy;
2-57 (14) hypnotherapy;
2-58 (15) biofeedback;
2-59 (16) dietary therapy;
2-60 (17) naturopathic physical medicine;
2-61 (18) acupuncture;
2-62 (19) therapeutic devices;
2-63 (20) barrier devices for contraception;
2-64 (21) naturopathic obstetrics; and
2-65 (22) minor surgery.
2-66 (b) A person licensed as a naturopathic physician under this
2-67 Act may use for diagnostic purposes:
2-68 (1) physical and orificial examinations;
2-69 (2) X-rays;
2-70 (3) electrocardiograms;
3-1 (4) ultrasound;
3-2 (5) phlebotomy;
3-3 (6) clinical laboratory tests and examinations;
3-4 (7) physiological function tests; and
3-5 (8) the noninvasive diagnostic procedures commonly
3-6 used by physicians in general practice.
3-7 SECTION 4. BOARD POWERS AND DUTIES. The board may adopt
3-8 rules authorizing the use by naturopathic physicians of other
3-9 diagnostic procedures and other natural medicines and therapies if
3-10 the procedures, medicines, and therapies are taught in approved
3-11 naturopathic medical colleges and are consistent with this Act.
3-12 SECTION 5. EXCEPTIONS. This Act does not:
3-13 (1) prevent any other professional who is licensed,
3-14 certified, or registered under the laws of this state from
3-15 providing services consistent with the professional's scope of
3-16 practice;
3-17 (2) apply to a student of naturopathic medicine who is
3-18 currently enrolled in an approved naturopathic medicine college and
3-19 who gratuitously diagnoses and treats disease under the direct
3-20 supervision of a naturopathic physician or other health care
3-21 practitioner regulated under the laws of this state if the
3-22 student's activities are within the scope of practice of the
3-23 supervising practitioner and are limited to activity consistent
3-24 with the scope of practice authorized by this Act; or
3-25 (3) apply to any naturopathic physician licensed in
3-26 another state, a territory of the United States, or the District of
3-27 Columbia, if the state, territory, or the District of Columbia
3-28 requires credentials equivalent to those of this Act, when the
3-29 physician is incidentally called into this state for consultation
3-30 with a naturopathic physician.
3-31 SECTION 6. PROHIBITED ACTS. A naturopathic physician may
3-32 not:
3-33 (1) prescribe, dispense, or administer any legend
3-34 drugs or controlled substances except those medicines authorized by
3-35 this Act;
3-36 (2) perform surgical procedures except those
3-37 procedures authorized by this Act;
3-38 (3) practice emergency medicine except as a samaritan
3-39 rendering gratuitous services in the case of emergency and except
3-40 for the care of minor injuries; or
3-41 (4) claim to practice medicine and surgery,
3-42 osteopathy, dentistry, podiatry, optometry, chiropractic, physical
3-43 therapy, or any other system or method of treatment not authorized
3-44 by this Act.
3-45 SECTION 7. DUTIES AND RESPONSIBILITIES. A naturopathic
3-46 physician has the same authority and responsibility as any other
3-47 licensed physician regarding public health laws, reportable
3-48 diseases and conditions, communicable disease control and
3-49 prevention, the recording of vital statistics, health and physical
3-50 examinations, competency examinations, and local boards of health,
3-51 except that the authority under this section is limited to activity
3-52 consistent with the scope of practice authorized by this Act.
3-53 SECTION 8. LICENSE QUALIFICATIONS. (a) A person is
3-54 qualified to be licensed as a naturopathic physician if the person:
3-55 (1) is a graduate of an approved naturopathic medical
3-56 college;
3-57 (2) has passed an examination prescribed or endorsed
3-58 by the board covering the appropriate naturopathic subjects; and
3-59 (3) is of good moral character.
3-60 (b) A person is qualified to be licensed as a naturopathic
3-61 physician without examination if:
3-62 (1) the applicant is licensed to practice naturopathic
3-63 medicine or naturopathy in another state, a territory of the United
3-64 States, or the District of Columbia under conditions and
3-65 circumstances that the board finds to be comparable to the
3-66 requirements of this state for obtaining a license to practice
3-67 naturopathic medicine and the state, the territory, or the District
3-68 of Columbia requires the successful completion of a professional
3-69 examination for the issuance of a license;
3-70 (2) the applicant has graduated from an approved
4-1 naturopathic medical college or, if the applicant was licensed
4-2 before a date designated by board rule, the applicant graduated
4-3 from a college approved by the board after the college was
4-4 investigated and found to meet the acceptable education standards
4-5 in existence at the time of the applicant's graduation; and
4-6 (3) the applicant produces evidence satisfactory to
4-7 the board that the applicant holds a valid, unsuspended, and
4-8 unrevoked license, has been actively engaged in the practice of
4-9 naturopathic medicine or naturopathy for not less than one year,
4-10 and is of good moral character.
4-11 SECTION 9. EXAMINATION. (a) A person may sit for the
4-12 examination prescribed or endorsed by the board under Subsection
4-13 (a) of Section 8 of this Act and be eligible for licensure on the
4-14 passage of the examination if, before December 1, 1995, the person
4-15 submits proof to the department that the person:
4-16 (1) attended a naturopathic college and received a
4-17 doctorate degree in naturopathic medicine or naturopathy from the
4-18 college before May 1, 1994, and the college is subsequently
4-19 approved by the board;
4-20 (2) was in practice in this state before May 1, 1994,
4-21 that included providing health care services using natural
4-22 medicines or therapies to patients in this state on a regular and
4-23 ongoing basis; and
4-24 (3) is of good moral character.
4-25 (b) The board may prescribe a nationally developed standard
4-26 examination as part or all of the examination prescribed or
4-27 endorsed under Subsection (a) of Section 8 of this Act. The
4-28 passing criteria for the examination shall be determined by board
4-29 rule. The board may adopt other rules necessary to the
4-30 administration of the examination.
4-31 (c) The board shall set the fees for the examination,
4-32 reexamination of the entire examination, and reexamination of
4-33 separate components of the examination in amounts necessary to
4-34 cover the actual cost of the examination and the expenses of
4-35 administration.
4-36 SECTION 10. LICENSE FEES. A license to practice
4-37 naturopathic medicine issued on the basis of examination or issued
4-38 without examination based on a license granted in another state, a
4-39 territory of the United States, or the District of Columbia may be
4-40 issued and renewed on payment of the initial licensing fee and
4-41 biennial renewal fees as determined by the board. The amounts of
4-42 the fees may not be less than $100 or more than $500.
4-43 SECTION 11. LICENSE RENEWAL. (a) A license to practice
4-44 naturopathic medicine must be renewed biennially.
4-45 (b) To renew a license, each naturopathic physician must
4-46 submit to the department evidence of successful completion of the
4-47 required hours of continuing education from programs approved by
4-48 the board.
4-49 (c) The board shall adopt rules as to what constitutes an
4-50 approved program of continuing education and the manner in which
4-51 attendance at all approved courses, clinics, forums, lectures,
4-52 programs, or seminars is monitored, recorded, and submitted to the
4-53 department.
4-54 (d) The board may adopt other rules necessary to the
4-55 administration of license renewals.
4-56 SECTION 12. CONTINUING EDUCATION. (a) The total number of
4-57 required continuing education hours for all naturopathic physicians
4-58 is not less than 30 approved hours biennially. The number and type
4-59 of required continuing education hours for a naturopathic physician
4-60 certified in naturopathic obstetrics is not less than 15 approved
4-61 specialty hours in obstetrics or natural childbirth and not less
4-62 than 20 approved hours biennially for a total of not less than 35
4-63 approved hours biennially.
4-64 (b) A person who seeks to renew a license that expired
4-65 within the preceding year must comply with the continuing education
4-66 requirements for the regular renewal of the license. A person
4-67 seeking to renew a license that has been expired for more than one
4-68 year must present evidence of completion of not less than one-half
4-69 of the required hours of approved continuing education requirements
4-70 during the year preceding the date of the application for renewal.
5-1 SECTION 13. INACTIVE STATUS; RETIRED STATUS. (a) A license
5-2 holder seeking to place the person's license on inactive status
5-3 must notify the department at the time of renewal and pay a fee for
5-4 inactive status.
5-5 (b) The amount of the fee shall be set by the board except
5-6 the amount may not be less than $30 or more than $100.
5-7 (c) To activate a license on inactive status, the license
5-8 holder must pay the regular renewal fee and present evidence of
5-9 having completed not less than one-half of the required hours of
5-10 approved continuing education requirements during the year
5-11 preceding the date of the application for activation.
5-12 (d) A license holder seeking to place a license on retired
5-13 status must notify the department at the time of renewal. A
5-14 license on retired status may not be reactivated.
5-15 (e) A license holder who holds a license that is on inactive
5-16 or retired status may not practice naturopathic medicine.
5-17 SECTION 14. SPECIALTY PRACTICE. (a) A naturopathic
5-18 physician may not practice naturopathic obstetrics or acupuncture
5-19 without first obtaining a certificate of specialty practice. The
5-20 board shall adopt rules to certify naturopathic physicians for
5-21 specialty practice.
5-22 (b) To be certified in naturopathic obstetrics, a
5-23 naturopathic physician must:
5-24 (1) pass a specialty examination in obstetrics or
5-25 natural childbirth approved by the board;
5-26 (2) have completed at least 100 hours of course work,
5-27 internship, or preceptorship in obstetrics or natural childbirth
5-28 approved by the board; and
5-29 (3) have participated in at least 40 supervised
5-30 births, including prenatal and postnatal care, under the direct
5-31 supervision of a licensed naturopathic, medical, or osteopathic
5-32 physician with specialty training in obstetrics or natural
5-33 childbirth.
5-34 (c) The board may prescribe a national standardized
5-35 examination in obstetrics or natural childbirth as constituting the
5-36 specialty examination.
5-37 (d) To be certified in acupuncture, a naturopathic physician
5-38 must complete a program in acupuncture approved by the board that
5-39 includes not less than 500 hours of training in acupuncture,
5-40 including both didactic and clinical training, and pass a specialty
5-41 examination in acupuncture approved by the board. The board may
5-42 prescribe a national standardized examination in acupuncture as
5-43 constituting the specialty examination.
5-44 SECTION 15. USE OF TITLES; PENALTY; INJUNCTION. (a) A
5-45 naturopathic physician may use the title "naturopathic physician"
5-46 and the recognized abbreviation for the professional degree of
5-47 "N.D." A naturopathic physician has the exclusive right to use the
5-48 terms "naturopathic physician," "naturopath," "doctor of
5-49 naturopathic medicine," "doctor of naturopathy," "naturopathic
5-50 medicine," "naturopathic health care," "naturopathy," and "N.D."
5-51 (b) A person commits an offense if the person holds the
5-52 person out as a naturopathic physician or naturopath, suggests that
5-53 the person practices naturopathic medicine or naturopathy, or uses
5-54 the terms and abbreviation described by Subsection (a) of this
5-55 section without holding a license or while the person is on retired
5-56 or inactive status under this Act.
5-57 (c) An offense under Subsection (b) of this section is a
5-58 Class B misdemeanor.
5-59 (d) A person who violates this section may be enjoined by
5-60 the district court on petition by the board.
5-61 SECTION 16. DISCIPLINARY ACTIONS. A person licensed under
5-62 this Act who engages in the practice of naturopathic medicine in
5-63 violation of this Act or a rule adopted under this Act is subject
5-64 to disciplinary measures and may be subject to a refusal to renew
5-65 the person's license, the imposition of a limitation on the
5-66 person's license, or the revocation or suspension of the license.
5-67 SECTION 17. CONFORMING AMENDMENT. Subsection (b), Section
5-68 3.06, Medical Practice Act (Article 4495b, Vernon's Texas Civil
5-69 Statutes), is amended to read as follows:
5-70 (b) This Act does not apply to:
6-1 (1) dentists, duly qualified and registered under the
6-2 laws of this state who confine their practice strictly to
6-3 dentistry;
6-4 (2) duly licensed optometrists who confine their
6-5 practice strictly to optometry as defined by law;
6-6 (3) duly licensed chiropractors who confine their
6-7 practice strictly to chiropractic as defined by law;
6-8 (4) registered or professional nurses and licensed
6-9 vocational nurses registered or licensed under the laws of this
6-10 state who confine their practice strictly within the provisions of
6-11 such applicable licensing Acts and the laws of this state;
6-12 (5) duly licensed podiatrists who confine their
6-13 practice strictly to podiatry as defined by law;
6-14 (6) duly licensed or certified psychologists who
6-15 confine their activities or practice strictly to psychology as
6-16 defined by law;
6-17 (7) duly licensed physical therapists who confine
6-18 their activities or practice strictly to physical therapy and who
6-19 are not in violation of any law relating to physical therapy
6-20 practice;
6-21 (8) commissioned or contract surgeons of the uniformed
6-22 services of the United States or in the Public Health Service in
6-23 the performance of their duties and not engaged in private
6-24 practice;
6-25 (9) any person furnishing medical assistance in case
6-26 of an emergency or disaster situation if no charge is made for the
6-27 medical assistance;
6-28 (10) a student in training in a medical school
6-29 approved by the board while performing the duties assigned in the
6-30 course of training, providing the duties are performed under the
6-31 supervision of a licensed practitioner, except that medical
6-32 residents, interns, and fellows shall be required to register and
6-33 be subject to the other applicable provisions of this Act;
6-34 (11) legally qualified physicians of other states
6-35 called in consultation but who have no office in Texas and who
6-36 appoint no place in this state for seeing, examining, or treating
6-37 patients; <or>
6-38 (12) licensed naturopathic physicians who confine
6-39 their practice strictly to naturopathic medicine as defined by law;
6-40 or
6-41 (13) any other activities that the board may designate
6-42 as exempt from the application of this Act.
6-43 SECTION 18. CONFORMING AMENDMENT. Section 6.06, Medical
6-44 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), is
6-45 amended to read as follows:
6-46 Sec. 6.06. LICENSE REQUIRED; EXCEPTION. (a) Except as
6-47 provided by Subsection (b) of this section, a <A> person may not
6-48 practice acupuncture in this state unless the person holds a
6-49 license to practice acupuncture issued by the medical board under
6-50 this subchapter.
6-51 (b) A person licensed to practice naturopathic medicine may
6-52 engage in the practice of acupuncture without a license under this
6-53 subchapter.
6-54 SECTION 19. CONFORMING AMENDMENT. Subsection (a), Section
6-55 3, Licensed Professional Counselor Act (Article 4512g, Vernon's
6-56 Texas Civil Statutes), is amended to read as follows:
6-57 (a) Except as provided by Subsection (b) of this section,
6-58 this Act does not apply to:
6-59 (1) the activities and services of or use of an
6-60 official title by a person employed as a counselor by a federal,
6-61 state, county, or municipal agency or public or private educational
6-62 institution, if the person is performing counseling or
6-63 counseling-related activities within the scope of his employment;
6-64 (2) the activities and services of a student, intern,
6-65 or trainee in counseling pursuing a course of study in counseling
6-66 in a regionally accredited institution of higher education or
6-67 training institution, if these activities and services constitute a
6-68 part of the supervised course of study and the person is designated
6-69 a "counselor intern";
6-70 (3) the activities and services of a nonresident
7-1 rendered not more than 30 days during any year, if the person is
7-2 authorized to perform the activities and services under the law of
7-3 the state or country of his residence;
7-4 (4) the activities and services of members of other
7-5 professions licensed or certified by the state, such as physicians,
7-6 registered nurses, psychologists, certified social workers,
7-7 licensed marriage and family therapists, licensed chemical
7-8 dependency counselors, licensed naturopathic physicians, licensed
7-9 optometrists in the evaluation and remediation of learning or
7-10 behavioral disabilities associated with or caused by a defective or
7-11 abnormal condition of vision, Christian Science practitioners who
7-12 are recognized by the Church of Christ Scientist as registered and
7-13 published in the Christian Science Journal, or other recognized
7-14 religious practitioners performing counseling consistent with the
7-15 law of the state, their training, and any code of ethics of their
7-16 professions, if they do not represent themselves by any title or
7-17 description in the manner prescribed by Section 2 of this Act;
7-18 (5) the activities, services, titles, and descriptions
7-19 of persons licensed to practice law;
7-20 (6) the activities, services, titles, and descriptions
7-21 of persons employed as professionals or who are volunteers in the
7-22 practice of counseling for public and private nonprofit
7-23 organizations or charities who are accountable to the persons'
7-24 sponsoring organization and do not use the title or hold themselves
7-25 out to be licensed counselors;
7-26 (7) persons supervised by a physician and recognized
7-27 as physician assistants by the Texas State Board of Medical
7-28 Examiners, if the persons act strictly within their scope of
7-29 practice and do not use the titles covered by Section 15(b)(3) of
7-30 this Act; or
7-31 (8) persons owning, operating, or employed by a
7-32 certified career counseling service regulated under Chapter 222,
7-33 Acts of the 70th Legislature, Regular Session, 1987 (Article
7-34 5221a-8, Vernon's Texas Civil Statutes).
7-35 SECTION 20. EFFECTIVE DATE. This Act takes effect September
7-36 1, 1995.
7-37 SECTION 21. EMERGENCY. The importance of this legislation
7-38 and the crowded condition of the calendars in both houses create an
7-39 emergency and an imperative public necessity that the
7-40 constitutional rule requiring bills to be read on three several
7-41 days in each house be suspended, and this rule is hereby suspended.
7-42 * * * * *