CAMLAW: Complementary and Alternative Medicine Law Blog

Naturopathic Physicians Win California Licensure

California became the 13th state to allow graduates of accredited institutions to practice to the full extent of their education and training in naturopathic medicine.

This new law established the Bureau of Naturopathic Medicine within California's Department of Consumer Affairs.

A Licensed naturopathic physician (N.D.) attends a four-year graduate level naturopathic medical school and is educated in all of the same basic sciences as an M.D. but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology, and counseling (to encourage people to make lifestyle changes in support of their personal health). A naturopathic physician takes rigorous professional board exams so that he or she may be licensed by a state or jurisdiction as a primary care general practice physician.

Currently, 13 states, the District of Columbia, and the US territories of Puerto Rico and the US Virgin Islands have licensing laws for naturopathic doctors. In these states, naturopathic doctors are required to graduate from a four-year, residential naturopathic medical school and pass and extensive postdoctoral board examination (NPLEX) in order to receive a license. Licensed naturopathic physicians must fulfill state-mandated continuing education requirements annually, and will have a specific scope of practice defined by their state's law. The states that currently have licensing laws for naturopathic physicians are:

Alaska
Arizona
California
Connecticut
District of Columbia
Hawaii
Kansas
Maine
Montana
New Hampshire
Oregon
Utah
Vermont
Washington
US Territories: Puerto Rico and Virgin Islands

The new law is codified in the California Business & Professions Code, 3610 et seq. (Naturopathic Doctors Act). 3613 sets forth the definition of "Naturopathic medicine" as: "a distinct and comprehensive system of primary health care practiced by a naturopathic doctor for the diagnosis, treatment, and prevention of human health conditions, injuries, and disease."

According to the legislation, a "naturopathic doctor" ... "means a person who holds an active license issued pursuant to this chapter." Under subsection (e), "Naturopathy" means "a noninvasive system of health practice that employs natural health modalities, substances, and education to promote health."

The law defines naturopathic scope of practice as follows:

3640. (a) A naturopathic doctor may order and perform physical and
laboratory examinations for diagnostic purposes, including, but not
limited to, phlebotomy, clinical laboratory tests, speculum
examinations, orificial examinations, and physiological function
tests.
(b) A naturopathic doctor may order diagnostic imaging studies,
including X-ray, ultrasound, mammogram, bone densitometry, and
others, consistent with naturopathic training as determined by the
bureau, but shall refer the studies to an appropriately licensed
health care professional to conduct the study and interpret the
results.
(c) A naturopathic doctor may dispense, administer, order, and
prescribe or perform the following:
(1) Food, extracts of food, nutraceuticals, vitamins, amino acids,
minerals, enzymes, botanicals and their extracts, botanical
medicines, homeopathic medicines, all dietary supplements and
nonprescription drugs as defined by the federal Food, Drug, and
Cosmetic Act.
(2) Hot or cold hydrotherapy; naturopathic physical medicine
inclusive of the manual use of massage, stretching, resistance, or
joint play examination but exclusive of small amplitude movement at
or beyond the end range of normal joint motion; electromagnetic
energy; colon hydrotherapy; and therapeutic exercise.
(3) Devices, including, but not limited to, therapeutic devices,
barrier contraception, and durable medical equipment.
(4) Health education and health counseling.
(5) Repair and care incidental to superficial lacerations and
abrasions, except suturing.
(6) Removal of foreign bodies located in the superficial tissues.
(d) A naturopathic doctor may utilize routes of administration
that include oral, nasal, auricular, ocular, rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous, and
intramuscular.
(e) The bureau may establish regulations regarding ocular or
intravenous routes of administration that are consistent with the
education and training of a naturopathic doctor.
(f) Nothing in this section shall exempt a naturopathic doctor
from meeting applicable licensure requirements for the performance of
clinical laboratory tests.
(g) The authority to use all routes for furnishing prescription
drugs as described in Section 3640.5 shall be consistent with the
oversight and supervision requirements of Section 2836.1.

The law also provides for the bureau to make recommendations to the Legislature by January 1, 2006, "regarding the potential development
of scope and supervision requirements of a naturopathic doctor for
the performance of minor office procedures." The bureau is required to "consult with physicians and surgeons and licensed naturopathic doctors in developing the findings and recommendations submitted to the Legislature."

The law's prohibitions include the following:

3642. A naturopathic doctor may not perform any of the following
functions:
(a) Prescribe, dispense, or administer a controlled substance or
device identified in Sections 801 to 971, inclusive, of Title 21 of
the United States Code, except as authorized by this chapter.
(b) Administer therapeutic ionizing radiation or radioactive
substances.
(c) Practice or claim to practice any other system or method of
treatment beyond that authorized by this chapter, for which licensure
is required, unless otherwise licensed to do so.
(d) Administer general or spinal anesthesia.
(e) Perform an abortion.
(f) Perform any surgical procedure.
(g) Perform acupuncture or traditional Chinese and oriental
medicine, including Chinese herbal medicine, unless licensed as an
acupuncturist as defined in subdivision (c) of Section 4927.

3643. This chapter may not be construed to authorize a naturopathic
doctor to practice medicine, as defined under Chapter 5 (commencing
with Section 2000), except as specifically authorized in this
chapter.

The prohibition against practicing (conventional) medicine is standard, as are prohibitions against practicing other licensed professions. Notably, the law offers title licensure, as reflected in the following language:

3643.5. (a) This chapter may not be construed to limit the practice
of a person licensed, certified, or registered under any other
provision of law relating to the healing arts when the person is
engaged in his or her authorized and licensed practice.
(b) This chapter may not be construed to limit an activity that
does not require licensure or is otherwise allowed by law, including
the practice of naturopathy, when performed consistent with Sections
2053.5 and 2053.6.

3644. This chapter does not prevent or restrict the practice,
services, or activities of any of the following:
(a) A person licensed, certified, or otherwise recognized in this
state by any other law or regulation if that person is engaged in the
profession or occupation for which he or she is licensed, certified,
or otherwise recognized.
(b) A person employed by the federal government in the practice of
naturopathic medicine while the person is engaged in the performance
of duties prescribed by laws and regulations of the United States.
(c) A person rendering aid to a family member or in an emergency,
if no fee or other consideration for the service is charged,
received, expected, or contemplated.
(d) A person who makes recommendations regarding or is engaged in
the sale of food, extracts of food, nutraceuticals, vitamins, amino
acids, minerals, enzymes, botanicals and their extracts, botanical
medicines, homeopathic medicines, dietary supplements, and
nonprescription drugs or other products of nature, the sale of which
is not otherwise prohibited under state or federal law.
(e) A person engaged in good faith in the practice of the
religious tenets of any church or religious belief without using
prescription drugs.
(f) A person acting in good faith for religious reasons as a
matter of conscience or based on a personal belief, while obtaining
or providing information regarding health care and the use of any
product described in subdivision (d).
(g) A person who provides the following recommendations regarding
the human body and its function:
(1) Nonprescription products.
(2) Natural elements such as air, heat, water, and light.
(3) Class I or class II nonprescription, approved medical devices,
as defined in Section 360c of Title 21 of the United States Code.
(4) Vitamins, minerals, herbs, homeopathics, natural food products
and their extracts, and nutritional supplements.
(h) A person who is licensed in another state, territory, or the
District of Columbia to practice naturopathic medicine if the person
is incidentally called into this state for consultation with a
naturopathic doctor.
(i) A student enrolled in an approved naturopathic medical program
whose services are performed pursuant to a course of instruction
under the supervision of a naturopathic doctor.

3645. (a) This chapter permits, and does not restrict the use of,
the following titles by persons who are educated and trained as any
of the following:
(1) "Naturopath."
(2) "Naturopathic practitioner."
(3) "Traditional naturopathic practitioner."
(b) This chapter permits, and does not restrict, the education of
persons as described in paragraphs (1) to (3), inclusive, of
subdivision (a). Those persons are not required to be licensed under
this chapter.

ALSO SEE

3640.5. Nothing in this chapter or any other provision of law shall
be construed to prohibit a naturopathic doctor from furnishing or
ordering drugs when all of the following apply:
(a) The drugs are furnished or ordered by a naturopathic doctor in
accordance with standardized procedures or protocols developed by
the naturopathic doctor and his or her supervising physician and
surgeon.
(b) The naturopathic doctor is functioning pursuant to
standardized procedure, as defined by subdivisions (a), (b), (d),
(e), (h), and (i) of Section 2836.1 and paragraph (1) of subdivision
(c) of Section 2836.1, or protocol. The standardized procedure or
protocol shall be developed and approved by the supervising physician
and surgeon, the naturopathic doctor, and, where applicable, the
facility administrator or his or her designee.
(c) The standardized procedure or protocol covering the furnishing
of drugs shall specify which naturopathic doctors may furnish or
order drugs, which drugs may be furnished or ordered under what
circumstances, the extent of physician and surgeon supervision, the
method of periodic review of the naturopathic doctor's competence,
including peer review, and review of the provisions of the
standardized procedure.
(d) The furnishing or ordering of drugs by a naturopathic doctor
occurs under physician and surgeon supervision. Physician and surgeon
supervision shall not be construed to require the physical presence
of the physician, but does include all of the following:
(1) Collaboration on the development of the standardized
procedure.
(2) Approval of the standardized procedure.
(3) Availability by telephonic contact at the time of patient
examination by the naturopathic doctor.
(e) For purposes of this section, a physician and surgeon shall
not supervise more than four naturopathic doctors at one time.
(f) Drugs furnished or ordered by a naturopathic doctor may
include Schedule III through Schedule V controlled substances under
the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
shall be further limited to those drugs agreed upon by the
naturopathic doctor and physician and surgeon as specified in the
standardized procedure. When Schedule III controlled substances, as
defined in Section 11056 of the Health and Safety Code, are furnished
or ordered by a naturopathic doctor, the controlled substances shall
be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician. A copy of
the section of the naturopathic doctor's standardized procedure
relating to controlled substances shall be provided upon request, to
a licensed pharmacist who dispenses drugs, when there is uncertainty
about the naturopathic doctor furnishing the order.
(g) The committee has certified that the naturopathic doctor has
satisfactorily completed adequate coursework in pharmacology covering
the drugs to be furnished or ordered under this section. The
committee shall establish the requirements for satisfactory
completion of this subdivision.
(h) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include both of the
following:
(1) Ordering a drug in accordance with the standardized procedure.
(2) Transmitting an order of a supervising physician and surgeon.
(i) For purposes of this section, "drug order" or "order" means an
order for medication which is dispensed to or for an ultimate user,
issued by a naturopathic doctor as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.
(j) Notwithstanding any other provision of law, the following
apply:
(1) A drug order issued pursuant to this section shall be treated
in the same manner as a prescription of the supervising physician.
(2) All references to prescription in this code and the Health and
Safety Code shall include drug orders issued by naturopathic
doctors.
(3) The signature of a naturopathic doctor on a drug order issued
in accordance with this section shall be deemed to be the signature
of a prescriber for purposes of this code and the Health and Safety
Code.


For information on the various types of licensure available, see Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives.

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173