THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY PETRARCA, SIPTROTH, HENNESSEY, BEYER, BRIGGS, EACHUS, FLECK, FREEMAN, HARHAI, JOSEPHS, W. KELLER, KULA, MAHER, MUNDY, PASHINSKI, PAYTON, READSHAW, ROHRER, K. SMITH, SOLOBAY, STABACK, WANSACZ, WHEATLEY, WHITE AND YOUNGBLOOD, JUNE 29, 2009

REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, JUNE 29, 2009  

AN ACT

Licensing and regulating the practice of naturopathic medicine;

imposing penalties; and making an appropriation.

TABLE OF CONTENTS

Chapter 1.  Preliminary Provisions

Section 101.  Short title.

Section 102.  Declaration of policy.

Section 103.  Definitions.

Chapter 3.  Board

Section 301.  Powers and duties of board.

Chapter 5.  Licensure

Section 501.  Qualifications for licensure.

Section 502.  License status and continuing education.

Section 503.  Examinations.

Section 504.  Reciprocity.

Chapter 7.  Practice of Naturopathic Medicine

Section 701.  Scope of practice.

Chapter 9.  Administration and Enforcement

Section 901.  Refusal, suspension and revocation of licenses.

Section 902.  Reinstatement of license.

Section 903.  License renewal; records and fees.

Section 904.  Duty of licensee.

Section 905.  Other professions.

Section 906.  Unlawful practice.

Section 907.  Violation of act.

Chapter 21.  Miscellaneous Provisions

Section 2101.  Appropriation and repayment.

Section 2102.  Regulations.

Section 2103.  Effective date.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

CHAPTER 1

PRELIMINARY PROVISIONS

Section 101.  Short title.

This act shall be known and may be cited as the Naturopathic

Medicine Act.

Section 102.  Declaration of policy.

The General Assembly finds and declares as follows:

(1)  The practice of naturopathic medicine in this

Commonwealth is declared to affect the public health, safety

and welfare and to be subject to regulation and control in

the public interest.

(2)  It is a matter of public interest that naturopathic

doctors and the practice of naturopathic medicine merit the

confidence of the public, that only qualified persons be

authorized to practice naturopathic medicine in this

Commonwealth and that no person shall practice naturopathic

medicine without a valid existing license to do so.

(3)  The General Assembly recognizes that naturopathic

doctors comprise a distinct health care profession that

affects the public health, safety and welfare and increases

freedom of choice in health care.

(4)  This act shall be liberally construed to best carry

out these subjects and purposes.

Section 103.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Board."  The State Board of Chiropractic.

"Bureau."  The Bureau of Professional and Occupational

Affairs.

"Commissioner."  The Commissioner of Professional and

Occupational Affairs.

"Department."  The Department of State of the Commonwealth.

"Minor office procedures."  The methods for the repair and

care incidental to superficial lacerations and abrasions,

superficial lesions and the removal of foreign bodies located in

the superficial tissues.

"Naturopathic doctor."  A practitioner of naturopathic

medicine who has been properly licensed for that purpose by the

State Board of Chiropractic.

"Naturopathic medicine."  A system of primary health care for

the prevention, diagnosis and treatment of human health

conditions, injury and disease; the promotion or restoration of

health; and the support and stimulation of a patient's inherent

self-healing process through patient education and the use of

naturopathic therapies and therapeutic substances.

CHAPTER 3

BOARD

Section 301.  Powers and duties of board.

The board has the following powers and duties:

(1)  To pass upon the qualifications and fitness of

applicants for licenses and reciprocal licenses and to

promulgate regulations requiring applicants to pass

examinations relating to qualifications as a prerequisite to

the issuance of a license.

(2)  To promulgate regulations not inconsistent with this

act and only as necessary to carry out this act.

(3)  To examine, deny, approve, issue, revoke, suspend or

renew licenses of naturopathic doctors under this act and to

conduct hearings in connection with those powers and duties.

(4)  To conduct hearings upon complaints concerning

violations of this act and the regulations promulgated under

this act and to seek the prosecution and enjoinder of

violations.

(5)  To promulgate regulations establishing requirements

for continuing education under this act.

(6)  To expend money necessary to the proper carrying out

of its assigned duties.

(7)  To submit annually to the Consumer Protection and

Professional Licensure Committee of the Senate and the

Professional Licensure Committee of the House of

Representatives a report containing a description of the

types of complaints received, status of the cases, board

action which has been taken and length of time from the

initial complaint to final board resolution.

(8)  To submit annually to the Appropriations Committee

of the Senate and the Appropriations Committee of the House

of Representatives, within 15 days after the Governor has

submitted a budget to the General Assembly, a copy of the

budget request for the upcoming fiscal year which the board

previously submitted to the department.

CHAPTER 5

LICENSURE

Section 501.  Qualifications for licensure.

(a)  Applicants.--An applicant shall be considered to be

qualified for a license if the applicant submits proof

satisfactory to the board of all of the following:

(1)  The applicant is of good moral character.

(2)  The applicant has completed a doctorate level

naturopathic medical program which is accredited or from an

accredited college recognized by the United States Department

of Education.

(3)  The applicant has passed a competency-based national

naturopathic licensing examination administered by the North

American Board of Naturopathic Examiners or successor agency

that has been nationally recognized to administer a

naturopathic examination that represents Federal standards of

education and training.

(4)  The application is accompanied by the application

fee as established by the board by regulation.

(5)  The applicant is not addicted to the habitual use of

alcohol, narcotics or other habit-forming drugs.

(6)  (i)  The applicant has not been convicted of a

felony under the act of April 14, 1972 (P.L.233, No.64),

known as The Controlled Substance, Drug, Device and

Cosmetic Act, or of an offense under the laws of another

jurisdiction which, if committed in this Commonwealth,

would be a felony under The Controlled Substance, Drug,

Device and Cosmetic Act, unless the following apply:

(A)  At least ten years have elapsed from the

date of conviction.

(B)  The applicant satisfactorily demonstrates to

the board that the applicant has made significant

progress in personal rehabilitation since the

conviction and that licensure of the applicant should

not be expected to create a substantial risk of harm

to the public or a substantial risk of further

criminal violations.

(C)  The applicant otherwise satisfies the

qualifications required under this act.

(ii)  As used in this paragraph, the term "convicted"

includes a judgment, admission of guilt or a plea of nolo

contendere, or receiving probation without verdict,

disposition in lieu of trial or an accelerated

rehabilitative disposition of the disposition of felony

charges.

(7)  The applicant has not been convicted of an offense

under the law of another jurisdiction which, if committed in

this Commonwealth, would constitute a sexual offense or a

felony. Compliance with this paragraph must be documented by

a report of criminal history record information from the

Pennsylvania State Police or by a statement from the

Pennsylvania State Police that its central repository

contains no information relating to the applicant. The costs

associated with the report or statement shall be paid by the

applicant.

(b)  Transferability.--A license and a temporary practice

permit are not transferable.

Section 502.  License status and continuing education.

(a)  Duration of license.--A license shall be renewable on a

biennial basis. The biennial expiration date shall be

established by regulation of the board. Application for renewal

of a license shall biennially be forwarded to an individual

holding a current license prior to the expiration date of the

current renewal biennium.

(b)  Procedure.--To renew a license, a licensee must do all

of the following:

(1)  File a renewal application with the board. The

license must provide all of the following:

(i)  Current certification to administer

cardiopulmonary resuscitation.

(ii)  Successful completion of a minimum of 24 hours

of continuing education in the field of naturopathic

medicine during the immediately preceding two years as

approved by the board.

(2)  Pay a fee established by regulation of the board.

(c)  Inactive status.--A licensee may request an application

for inactive status. The application form must be completed and

returned to the board. Upon receipt of an application, the

individual shall be maintained on inactive status without fee

and shall be entitled to apply for licensure renewal at any

time. An individual who requests the board to activate the

individual's license and who has been on inactive status for a

period of five consecutive years must, prior to receiving an

active license, satisfy the requirements of the board's

regulations for ensuring continued education, including holding

current certification to administer cardiopulmonary

resuscitation and remitting the required fee. The board shall

promulgate regulations to carry into effect the provisions of

this subsection.

(d)  Reporting of multiple licensure.--A licensee who is also

licensed to practice naturopathic medicine in another

jurisdiction shall report this information to the board on the

biennial registration application. Any disciplinary action taken

in another jurisdiction shall be reported to the board on the

biennial registration application or within 90 days of final

disposition, whichever is sooner. Multiple licensures shall be

noted by the board on the licensee's record, and the other

licensing jurisdiction shall be notified by the board of any

disciplinary actions taken against the licensee in this

Commonwealth.

Section 503.  Examinations.

The board shall contract with a professional testing

organization for the examination of qualified applicants for

licensure. The board must approve the examination before it is

administered. All written, oral and practical examinations shall

be prepared and administered by a qualified and approved

professional testing organization in the manner prescribed for

written examinations by section 812.1 of the act of April 9,

1929 (P.L.177, No.175), known as The Administrative Code of

1929.

Section 504.  Reciprocity.

The board has the power to grant a reciprocal license to an

applicant who is licensed or certified as a naturopathic doctor

or similar practice in another state and has demonstrated

qualifications which equal or exceed those required under this

act in the determination of the board. No license shall be

granted under this section to an applicant unless the state in

which the applicant is licensed affords reciprocal treatment to

individuals who are residents of this Commonwealth and who are

licensed under this act.

CHAPTER 7

PRACTICE OF NATUROPATHIC MEDICINE

Section 701.  Scope of practice.

(a)  Scope.--If consistent with the education and training of

a naturopathic doctor, the following are deemed to be within the

scope of practice for a naturopathic doctor:

(1)  Order and perform physical and laboratory

examinations consistent with naturopathic education and

training, for diagnostic purposes, including phlebotomy,

clinical laboratory tests, orificial examinations and

physiological function tests.

(2)  Order diagnostic imaging studies consistent with

naturopathic training.

(3)  Dispense, administer, order, prescribe or perform

the following:

(i)  Foods, extracts of food, neutraceuticals,

vitamins, amino acids, minerals, enzymes, botanicals and

their extracts, botanical medicines, homeopathic

medicines, dietary supplements and nonprescription drugs

as defined by the Federal Food, Drug, and Cosmetic Act

(52 Stat. 1040, 21 U.S.C. § 301 et seq.).

(ii)  Hot and cold hydrotherapy, naturopathic

physical medicine, electromagnetic energy, colon

hydrotherapy and therapeutic exercise.

(iii)  Devices, including therapeutic devices,

barrier contraception and durable medical equipment.

(iv)  Health education and health counseling.

(v)  Repair and care incidental to superficial

lacerations and abrasions.

(vi)  Removal of foreign bodies located in the

superficial tissues.

(vii)  Musculoskeletal manipulation.

(4)  Utilize routes of administration that include oral,

nasal, auricular, ocular, rectal, vaginal, transdermal,

intradermal, subcutaneous, intravenous and intramuscular.

(b)  Prohibitions.--A naturopathic doctor licensed under this

act shall not:

(1)  Prescribe, dispense or administer any controlled

substance or device identified in the Controlled Substances

Act (Public Law 91-513, 84 Stat. 1236), except as authorized

by this act.

(2)  Perform surgical procedures except those minor

office procedures authorized by this act.

(3)  Practice or claim to practice as any other licensed

health care professional not authorized in this act unless

licensed as such.

(4)  Use general or spinal anesthetics.

(5)  Administer ionizing radioactive substances for

therapeutic purposes.

(6)  Perform surgical procedures using a laser device.

(7)  Perform surgical procedures involving the eye, ear,

tendons, nerves, veins or arteries extending beyond

superficial tissue.

(8)  Perform chiropractic adjustments or musculoskeletal

manipulation.

(9)  Perform acupuncture, unless licensed as an

acupuncturist by the Commonwealth.

CHAPTER 9

ADMINISTRATION AND ENFORCEMENT

Section 901.  Refusal, suspension and revocation of licenses.

(a)  Grounds.--The board may refuse, suspend, revoke, limit

or restrict a license or reprimand a licensee for any of the

following:

(1)  Being convicted under Federal law, under the law of

any state or under the law of any foreign jurisdiction of an

offense of moral turpitude or of an offense which, if

committed in this Commonwealth, would constitute a sexual

offense or a felony. As used in this paragraph, the term

"convicted" includes a finding or verdict of guilt, an

admission of guilt or a plea of nolo contendere or receiving

probation without verdict, disposition in lieu of trial or an

accelerated rehabilitative disposition in the disposition of

felony charges.

(2)  Being found to have engaged in immoral or

unprofessional conduct. In proceedings based on this

paragraph, actual injury to the patient need not be

established. As used in this paragraph, the term

"unprofessional conduct" includes:

(i)  a departure from or failure to conform to the

standards of acceptable and prevailing practice; and

(ii)  sexual exploitation of a patient.

(3)  Violating standards of professional practice or

conduct adopted by the board.

(4)  Presenting false credentials or documents or making

a false statement of fact in support of the applicant's

application for a license.

(5)  Submitting a false or deceptive biennial renewal to

the board.

(6)  Having a license suspended, revoked or refused or

receiving other disciplinary action by the proper licensing

authority of any other jurisdiction.

(7)  Violating a regulation promulgated by the board,

including standards of professional practice and conduct or

violating an order of the board previously entered in a

disciplinary proceeding.

(8)  Failing to refer a patient to a physician when the

patient is presenting a contradiction to naturopathic

medicine.

(9)  Incompetence, negligence or misconduct in carrying

out the practice of naturopathic medicine.

(10)  Practicing beyond the licensee's defined scope of

practice.

(11)  Knowingly aiding, assisting, hiring or advising

someone in the unlawful practice of naturopathic medicine.

(12)  Being unable to practice with reasonable skill and

safety by reason of illness; drunkenness; excessive use of

drugs, narcotics, chemicals or any other type of material; or

as a result of any mental or physical condition. In enforcing

this paragraph, the board, upon probable cause, has authority

to compel a licensee to submit to a mental or physical

examination by a physician approved by the board. Failure of

a licensee to submit to an examination when directed by the

board, unless the failure is due to circumstances beyond the

licensee's control, shall constitute an admission of the

allegations against the licensee, consequent upon which a

default and final order may be entered without the taking of

testimony or presentation of evidence. A licensee affected

under this paragraph shall, at reasonable intervals as

determined by the board, be afforded an opportunity to

demonstrate that the licensee can resume competent practice

with reasonable skill and safety.

(b)  Board action.--If the board finds that the license or

application for license may be refused, revoked, restricted or

suspended under the terms of subsection (a), the board may do

any of the following:

(1)  Deny the application for license.

(2)  Administer a public reprimand.

(3)  Revoke, suspend, limit or otherwise restrict a

license.

(4)  Require a licensee to submit to the care, counseling

or treatment of a physician designated by the board.

(5)  Restore a suspended license and impose any

disciplinary or corrective measure which it might originally

have imposed.

(c)  Administrative Agency Law.--Actions of the board under

subsections (a) and (b) are subject to 2 Pa.C.S. Chs. 5 Subch. A

(relating to practice and procedure of Commonwealth agencies)

and 7 Subch. A (relating to judicial review of Commonwealth

agency action).

(d)  Temporary suspension.--The board shall temporarily

suspend a license under circumstances as determined by the board

to be an immediate and clear danger to the public health and

safety. The board shall issue an order to that effect without a

hearing, but upon notice to the licensee concerned at the

licensee's last known address, which must include a written

statement of all allegations against the licensee. Subsection

(c) shall not apply to temporary suspension. Upon issuance of an

order under this subsection, the board shall commence formal

action to suspend, revoke or restrict the license as otherwise

provided for in this act. All actions shall be taken promptly.

Within 30 days following the issuance of an order temporarily

suspending a license, the board shall conduct a preliminary

hearing to determine that there is a prima facie case supporting

the suspension. The licensee whose license has been temporarily

suspended may be present at the preliminary hearing and may be

represented by counsel, cross-examine witnesses, inspect

physical evidence, call witnesses, offer evidence and testimony

and make a record of the proceedings. If it is determined that

there is not a prima facie case, the suspended license shall be

immediately restored. The temporary suspension shall remain in

effect until vacated by the board, but in no event longer than

180 days.

(e)  Automatic suspension.--

(1)  A license shall automatically be suspended upon the

legal commitment of a licensee to an institution because of

mental incompetence from any cause upon filing with the board

a certified copy of the commitment.

(2)  A license shall automatically be suspended upon

conviction of a felony under the act of April 14, 1972 (P.L.

233, No. 64), known as The Controlled Substance, Drug, Device

and Cosmetic Act, or conviction of an offense under the laws

of another jurisdiction, which, if committed in this

Commonwealth, would be a felony under The Controlled

Substance, Drug, Device and Cosmetic Act. As used in this

paragraph, the term "conviction" includes a judgment, an

admission of guilt or a plea of nolo contendere.

(3)  Automatic suspension under this section shall not be

stayed pending an appeal.

(4)  Reinstatement of a license shall be made under

section 902.

(5)  Subsection (c) shall not apply to automatic

suspension.

Section 902.  Reinstatement of license.

Unless ordered to do so by a court of competent jurisdiction,

the board shall not reinstate the license of an individual which

has been revoked. An individual whose license has been revoked

may reapply for a license after a period of at least five years

but must meet all of the licensing requirements of this act.

Section 903.  License renewal; records and fees.

(a)  Records.--A record of all licensees shall be kept in the

office of the board and shall be open to public inspection and

copying upon payment of a reasonable fee for copying the record.

(b)  Fees.--

(1)  All fees required under this act shall be fixed by

the board by regulation. If the revenue raised by fees, fines

and civil penalties imposed under this act are not sufficient

to meet expenditures over a two-year period, the board shall

increase those fees by regulation so that the projected

revenues will meet or exceed projected expenditures.

(2)  If the bureau determines that the fees established

by the board under paragraph (1) are inadequate to meet the

minimum enforcement efforts required by this act, the bureau,

after consultation with the board, shall increase the fees by

regulation in an amount so that adequate revenues are raised

to meet the required enforcement effort.

Section 904.  Duty of licensee.

A licensee shall refer a patient to a physician when the

patient is presenting a contraindication to the practice of

naturopathic medicine.

Section 905.  Other professions.

Nothing in this act shall be construed as preventing,

restricting or requiring licensure of any of the following

activities:

(1)  The practice of a profession by an individual who is

licensed, certified or registered by a Commonwealth agency

under other law and who is performing services or advertising

within the authorized scope of practice.

(2)  The practice of naturopathic medicine by an

individual employed by the Federal Government while the

individual is engaged in the performance of duties under

Federal law.

(3)  The practice of naturopathic medicine by an

individual licensed, registered or certified in another

jurisdiction when incidentally called into this Commonwealth

to teach a course related to the practice of naturopathic

medicine or to consult with a licensee.

Section 906. Unlawful practice.

(a)  General rule.--An individual may not practice

naturopathic medicine or hold himself out as a naturopathic

doctor unless licensed by the board.

(b)  Title.--An individual who holds a license or is

maintained on inactive status may use the title "Licensed

Naturopathic Doctor" and the abbreviation "N.D." No other

individual may use the title "Licensed Naturopathic Doctor" or

hold himself out to others as a naturopathic doctor. This

subsection includes advertising as a naturopathic doctor and

adopting or using any title or description, including

naturopathic doctor, naturopath, doctor of naturopathic

medicine, naturopathic health care, naturopathic medicine or a

derivative of those terms and their related abbreviations, which

implies directly or indirectly that naturopathic services are

being provided.

(c)  Employment.--An individual, corporation, partnership,

firm or other entity may not employ an individual in

naturopathic medicine unless the individual is licensed by the

board.

(d)  Terminology.--A business entity may not utilize in

connection with a business name or activity the words

naturopathic doctor, naturopath, doctor of naturopathic

medicine, naturopathic health care, naturopathic medicine or a

derivative of those terms and their related abbreviations, which

imply directly or indirectly that naturopathic services are

being provided, unless the services of the business are provided

by licensees.

(e)  Injunction.--Unlawful practice may be enjoined by the

courts upon petition of the commissioner or the board. In a

proceeding under this section, it shall not be necessary to show

that an individual has been injured. If the court finds that the

respondent has violated this section, it shall enjoin the

respondent from practicing until the respondent has been

licensed. Procedure in such cases shall be the same as in any

other injunction suit.

(f)  Remedy cumulative.--The injunctive remedy provided in

this section shall be in addition to any other civil or criminal

prosecution and punishment.

Section 907.  Violation of act.

(a)  General rule.--A person that violates a provision of

this act or a regulation of the board commits a misdemeanor of

the third degree and shall, upon conviction, be sentenced to pay

a fine of not more than $1,000 or to imprisonment for not more

than six months for the first violation and to pay a fine of not

more than $2,000 or to imprisonment for not less than six months

or more than one year, or both, for each subsequent violation.

(b)  Civil penalty.--In addition to any other civil remedy or

criminal penalty provided for in this act, the board, by a vote

of the majority of the maximum number of the authorized

membership of the board or by a vote of the majority of the

qualified and confirmed membership or a minimum of five members,

whichever is greater, may levy a civil penalty of up to $1,000

on any of the following:

(1)  A naturopathic doctor who violates a provision of

this act.

(2)  A person that employs a naturopathic doctor in

violation of this act.

(3)  An individual who holds himself out as a licensee

without being properly licensed as provided in this act.

(4)  The responsible officers or employees of a

corporation, partnership, firm or other entity that violates

a provision of this act.

(c)  Administrative Agency Law.--Action of the board under

subsection (b) is subject to 2 Pa.C.S. Chs. 5 Subch. A (relating

to practice and procedure of Commonwealth agencies) and 7 Subch.

A (relating to judicial review of Commonwealth agency action).

CHAPTER 21

MISCELLANEOUS PROVISIONS

Section 2101.  Appropriation and repayment.

(a)  Appropriation.--The sum of $85,000, or as much thereof

as may be necessary, is hereby appropriated from the

Professional Licensure Augmentation Account to the department

for the payment of costs associated with processing licenses and

renewing licenses, for the operation of the board and for other

costs associated with this act.

(b)  Repayment.--The appropriation shall be repaid by the

board to the Professional Licensure Augmentation Account within

three years of the beginning of issuance of licenses by the

board.

Section 2102.  Regulations.

The board shall promulgate regulations to carry out this act.

Publication of the final-form regulations under this section

shall take place within 18 months of the effective date of this

section. The board shall report, within 60 days of the effective

date of this section, and every 30 days thereafter, on the

status of the regulations to the Consumer Protection and

Professional Licensure Committee of the Senate and the

Professional Licensure Committee of the House of

Representatives.

Section 2103.  Effective date.

This act shall take effect as follows:

(1)  Chapter 3 and this chapter shall take effect

immediately.

(2)  The remainder of this act shall take effect in two

years.