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Senate of Pennsylvania
Session of 2017 - 2018 Regular Session

MEMORANDUM

Posted: June 29, 2017 04:25 PM
From: Senator John C. Rafferty, Jr. and Sen. Jay Costa
To: All Senate members
Subject: Naturopathic Doctors - Licensing and Scope of Practice Expansion
 
In the near future, I plan to introduce legislation which would license Naturopathic Doctors under the State Board of Medicine as well as expand the scope of practice for licensed Naturopathic Doctors. This bill does not amend the "Medical Practice Act" to include the licensure requirement. The bill provides for title protection and limited practice protection.

Last session, the legislature passed legislation (HB 516) requiring the registration of Naturopathic Doctors. However, the legislature failed to take up the licensure and expanded scope of practice in the final version of the bill. Therefore, I plan to offer legislation which will incorporate provisions for the expanded scope of practice as well as establishing licensure requirements.

Naturopathic physical medicine means treating the body with means which include therapeutic exercise, physical agents such as air, water, heat, cold, etc. and physical modalities such as magnetic therapy, ultrasound, electromagnetic energy, colon hydrotherapy, infrared and low-level laser light. Naturopathic therapies include foods, topical medicines, vitamins, amino acids, and plant substances.

Naturopathic medical education program requirements include a minimum of 4,100 hours in basic and clinical sciences, naturopathic philosophy, naturopathic modalities and naturopathic medicine. Those in the U.S. must offer doctoral-level, full-time programs. Graduates must be eligible for state licensure and eligible to apply to the North American Board of Naturopathic Examiners for the examination.

Requirements for licensure include a doctorate-level degree in naturopathic medicine, passing the exam administered by the North American Board of Naturopathic Examiners, completing the board's application and passing a criminal background check. Renewal requires 50 hours of continuing education every two years, 10 of which must be in pharmacology. Renewal also requires current CPR certification. A licensed naturopathic doctor must maintain liability insurance at $1,000,000 per occurrence or claim made. A licensed naturopathic doctors must refer a patient to a physician if the patient is presenting a contraindication to the naturopathic medical practice. Reciprocity is permitted.

Our scope of practice language will contain the following provisions which would permit a naturopathic doctor to:
  • Order and perform physical and laboratory examinations
  • Order diagnostic imaging studies
  • Dispense, administer, order, prescribe or perform naturopathic therapies; naturopathic physical medicine; devices, including therapeutic devices, durable medical equipment and barrier contraception; health education and counseling; behavioral medicine; botanical medicine; nutritional counseling; vitamin and mineral supplements; naturopathic musculoskeletal therapy and homeopathic medicine
  • Utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous and intramuscular.

A licensed naturopathic doctor may not:
  • Prescribe, dispense or administer legend drugs
  • Perform surgical procedures
  • Practice or claim to practice as any other licensed health care professional unless licensed to do so
  • Use general or spinal anesthetics
  • Administer ionizing radioactive substances
  • Perform chiropractic adjustments, including grade 5 mobilization and manipulation
  • Perform acupuncture
  • Perform physical therapy

The following are exempted from the licensure requirement:
  • The practice of a profession by a licensed individual.
  • The practice of naturopathic medicine by an individual employed by the Federal Government
  • The practice of naturopathic medicine by an individual licensed in another state and incidentally called into the Commonwealth to teach or consult.
  • The use, recommendation or practice by an individual not licensed by the board so long as the individual does not hold himself out as a naturopathic doctor or a provider of naturopathic medicine.

Naturopathic Doctors work side by side with medical doctors to provide integrative care and routinely consult with MDs on drug-herb interactions and natural alternatives to conventional care. In Pennsylvania, hospitals have already begun to integrate the services of Naturopathic Doctors. The Cancer Treatment Centers of America in Philadelphia currently has Naturopathic Doctors (N.D.’s) on staff to provide integrative care for its patients. U.P.M.C. Shadyside Hospital has a center for integrative medicine with two N.D.’s on staff and Hershey Medical Center has some of its students shadow with Naturopathic Doctors.

Licensure of Naturopathic Doctors would give Pennsylvania residents a choice in their health care and provide for an integrative model of healthcare. The patients of Pennsylvania Naturopathic Doctors deserve access to the care their doctors can provide and the State of Pennsylvania needs quality care providers who will reduce the burden of chronic disease.



Introduced as SB834