Overview of Naturopathic Regulation
Colorado Department of Regulatory Agencies
October 14, 2005
The legal status of naturopathy varies from state to state. In some states, the practice of naturopathy, though not regulated, is protected through court rulings or attorney general opinions. In most states, naturopathic physician status is unprotected or unclear. Two states, Florida and Nevada, have repealed regulation of this profession. Nevada ceased licensing naturopathic physicians in 1987 (in Nevada naturopathic physicians were required to be supervised by medical doctors). Although naturopathic licensing in Florida was discontinued in 1959, there are still laws and a board regulating those naturopaths still practicing. Florida allows naturopathic physicians licensed prior to program termination dates to continue to practice. In Tennessee and in South Carolina, the practice of naturopathy is illegal. Tennessee law, for example, provides that the practice of naturopathy is a Class B misdemeanor, but renders this prohibition inapplicable to "persons who comply with the regulatory laws of the state with respect to the practice of the various healing arts." Without a similar textual qualification, however, a South Carolina statute prohibits the practice of naturopathy and subjects offenders to a fine not to exceed $500 or imprisonment for a period not exceeding one year, or both.
The multiplicity of therapies and techniques that typically comprise the statutory definition of naturopathy may often fall within the scope of practice for other professions. The Montana Naturopathic Practice Act expressly acknowledges this fact by recognizing that many of the therapies used by naturopathic physicians, such as the use of nutritional supplements, herbs, foods, homeopathic preparations, and such physical forces as heat, cold, water, touch, and light, are not the exclusive privilege of naturopathic physicians, and their use, practice, prescription, or administration by persons not licensed to practice naturopathic medicine is not prohibited by this practice act.
Currently, 15 states and the District of Columbia license naturopathic physicians: Alaska, Arizona, California, Connecticut, Florida, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. In several states, licensed naturopathic physicians must also qualify for a certificate to practice natural childbirth, acupuncture, or to dispense a natural substance or device. The following highlights the regulatory programs found in the 15 states.
Alaska's law places several restrictions on the practice of naturopathy. A person who practices naturopathy may not prescribe a prescription drug, perform surgery, or use the word "physician" as a title. There are currently 36 licensed naturopathic doctors in Alaska.
Arizona's Naturopathic Physicians Board of Medical Examiners (Arizona Board) was established in 1935. Arizona remains the state with the third highest number of licensed naturopathic physicians (400). The Arizona Board has the statutory authority to adopt rules for recognizing naturopathic specialties. The Arizona Board has approved training programs in four specialty areas and has issued certificates to at least 16 naturopaths in the specialty of family medicine. Additionally, the Arizona Board has assembled a formulary of more than 460 items that naturopathic physicians may dispense including both prescription drugs and some controlled substances. In 2000, the Arizona Board underwent a performance audit. The review concluded that terminating the Arizona Board would not significantly harm the public’s health and safety since the practice of medicine would continue to be regulated by the Allopathic Board of Medical Examiners. Naturopaths could continue to perform many traditional activities, but would no longer be allowed to act as primary medical care providers. However, the review further stated that terminating the Arizona Board could harm the public’s welfare by potentially limiting access to alternative medical care. Subsequently, there was no action taken by the Arizona legislature to repeal the Arizona Board.
California's Bureau of Naturopathic Medicine (Bureau) within the Department of Consumer Affairs was established to administer the Naturopathic Doctor’s Act and was authorized to collect fees and receive license applications beginning January 1, 2004. This act authorizes the creation of an advisory committee comprised of three licensed naturopathic doctors, three licensed physicians, and three public members. The committee’s first meeting was convened on December 13, 2004. Additionally, a naturopathic formulary advisory committee was formed and a naturopathic childbirth attendance advisory committee was created to issue recommendations concerning the practice of naturopathic childbirth attendance. The scope of practice for licensed naturopathic doctors includes diagnosis and treatment of patients, including the authority to order lab tests and prescribe most drugs subject to supervision of a medical or osteopathic physician. Licensed naturopathic doctors may perform minor procedures, such as treating lacerations and removing moles and growths. The program began accepting license applications in January 2005. Currently there are 129 licensed naturopathic doctors in California.
Connecticut's law, which was enacted in 1920, does not allow licensed naturopathic physicians to perform minor surgery, prescribe drugs, or practice obstetrics and gynecology. The statute requires that naturopathic physicians maintain professional liability insurance. There are currently 196 licensed naturopaths in Connecticut.
District of Columbia
In May 2004, final approval was given to the Naturopathic Medicine Licensing Amendment Act of 2004 to license naturopathic physicians as primary care providers. The act recognized naturopathic physicians who have completed four-years of naturopathic medical college training and successfully passed the NPLEX. Prior to the passage of this act, the District of Columbia had a registration program for naturopaths. A person registered to practice naturopathy was entitled to use the title “Doctor of Naturopathy.” The only requirements for registration were that applicants must be at least 18 years of age and not have been convicted of a crime of moral turpitude that bears directly on the applicant’s fitness to be registered. The practice specifically excluded the use of x-rays, performing any surgical procedure, injecting any substance into a person by needle, or performing any invasive procedure. As of September 2005, the District of Columbia had not promulgated any rules or issued any licenses.
Florida’s licensing authority for naturopathic physicians was abolished in 1959 and licensees who were licensed at that time were allowed to continue practicing naturopathic medicine. Draft legislation proposed by the Florida Naturopathic Physician Association was introduced in 2004 to reestablish regulation of naturopathic medicine through licensure and to create the Board of Naturopathic Medicine within the Department of Health. A 2004 Sunrise Report on Proposed Licensure of Naturopathic Physicians, by the Florida House of Representatives, Committee on Health Care, concluded that while there is evidence for support of licensure based on the existence of accredited training programs and licensure examinations, there is no documented evidence of substantial risk from not licensing naturopathic physicians. Moreover, there is potential risk from licensing naturopathic physicians and allowing them to provide a broad range of primary care services.
Hawaii has regulated naturopathic physicians since 1925. There are currently 81 licensed naturopaths. Originally, the Board of Health was responsible for conducting examinations and issuing licenses. In 1969, the regulation was transferred to the Department of Regulatory Agencies, now the Department of Commerce and Consumer Affairs. The regulation of naturopathy was reviewed in 1978 and 1985, with continued regulation recommended in both instances.
Idaho became the 15th state in 2005 to create a licensure program for naturopathic physicians. The legislation is a full scope and title protection act. The law requires the creation of a formulary council to determine pharmaceutical privileges for naturopathic physicians.
Kansas passed legislation during the 2002 legislative session to regulate the practice of naturopathic medicine. The bill, signed into law in May 2003, provides registration for naturopathic doctors, rather than licensing, yet requires educational and testing requirements. Naturopathic medicine is defined to include such procedures as venipuncture, naturopathic acupuncture, and minor office procedures. Naturopathic doctors may not perform surgery, practice obstetrics, administer ionizing radiation or prescribe, dispense or administer any controlled substances or any prescription-only drugs except those listed on the naturopathic formulary adopted by the Kansas board.
Maine’s Board of Complimentary Health Care Providers regulates 19 naturopathic doctors. Naturopathic doctors have the exclusive right to the use of the terms “naturopathic doctors,” “naturopathic,” “naturopath,” “doctor of naturopathic medicine,” “Doctor of Naturopathy,” “naturopathic medicine,” “naturopathic health care,” “naturopathy,” and “N.D.” Use of the term “physician” by a licensee is prohibited. Naturopathic Doctors have a limited scope of prescriptive authority.
Montana’s Naturopathic Health Care Practice Act was enacted in 1991 to regulate lay midwives and naturopathic physicians. Naturopathic physicians are authorized to perform minor surgery, attend a natural childbirth if in possession of a certificate of specialty practice, and prescribe certain drugs as established by the natural substance formulary list. When the program first began there were only five licensed naturopathic physicians in the state, however, as of August 2005, there were 66.
New Hampshire’s Naturopathic Health Care Practice Act was enacted in 1994. Specialty certificates in naturopathic childbirth and acupuncture are offered. Doctors of naturopathic medicine with specialty certification in naturopathic childbirth are authorized to use oxytocin and pitocin. There are currently 36 licensed naturopathic physicians in New Hampshire.
Oregon first began licensing naturopathic physicians in 1927, although they were able to practice before then under an exemption in the Osteopathic Practice Act. The total number of licensed naturopathic physicians in Oregon equals 636, ranking second for licensees in a state. Oregon also has the most encompassing law as practitioners are allowed to prescribe drugs, perform minor surgery, and practice natural childbirth with a certificate of special competency.
Utah’s Naturopathic Physicians Licensing Board was created in 1996. The board currently issues five different categories of licenses: naturopath, naturopath including surgery/obstetrics, naturopathic physician, temporary naturopathic physician, and naturopathic controlled substance. In order to perform naturopathic childbirth, a licensee must satisfy the standards of the American College of Naturopathic Obstetricians or its successor.
Vermont’s licensed naturopathic physicians may order, prescribe, dispense, and administer certain medications of mineral, animal, or botanic origin and must adhere to the Naturopathic Physician Formulary Rules promulgated by the Vermont Department of Health. Licensees may not practice naturopathic childbirth unless they have obtained a special endorsement that requires specific education; training; passage of an examination; and actual childbirth assistance, participation, and observation.
Washington has regulated naturopathic physicians since 1919, as part of its law created to regulate professions engaged in "drugless healing." The law was substantially amended in 1988 to reflect the current practice of naturopathic physicians. The total number of licensed naturopathic physicians in Washington is 650, ranking first for licensees in a state.
This article was extracted from the Sunrise Review of Naturopathic Physicians, published by the Colorado Department of Regulatory Agencies' Office of Policy, Research and Regulatory Reform in October 2005.
This article was posted on November 20, 2005.