Regulation of homeopathy and homeopathic doctors in Arizona

Arizona has new legislation affecting homeopathic physicians.

Homeopaths are regulated differently in various states, although the issue for lay homeopathic practitioners is unlicensed medical practice. For MD's (medical doctors) and DO's (osteopathic doctors), licensure to practice in Arizona is through the Arizona Homeopathic and Integrated Medicine Board.

Here are some definitions from the statute:

32-2901. Definitions

In this chapter, unless the context otherwise requires:

1. "Acupuncture" means a medical therapy in which ailments are diagnosed and treated by the specific application of needles, heat or physical and electromagnetic impulses or currents to specific anatomic points on the body through any of the following:

(a) The diagnosis and treatment of ailments according to the systematic principles of traditional Asian medicine.

(b) The diagnosis and treatment of pain, neuromuscular disorders and other ailments based on the body's biophysics and neuroanatomic structure.

(c) The use of devices to determine the biologic electrical response pattern of acupuncture points as a guide to diagnose bodily ailments and to guide the prescription of homeopathic substances, orthomolecular therapy or pharmaceutical medicine.

2. "Adequate records" means legible medical records that contain at a minimum sufficient information to identify the patient, support the diagnosis, document the treatment, accurately describe the results, indicate advice, cautionary warnings and informed consent discussions with the patient and provide sufficient information for another licensed health care practitioner to assume continuity of the patient's care and to continue or modify the treatment plan.

3. "Approved internship" means that the applicant has completed training in a hospital that was approved for internship, fellowship or residency training by the council on medical education in hospitals of the American medical association, the association of American medical colleges, the royal college of physicians and surgeons of Canada, the American osteopathic association or any board approved similar body in the United States or Canada that approves hospitals for internship, fellowship or residency training.

4. "Approved school of medicine" means a school or college that offers a course of study that on successful conclusion results in a degree of doctor of medicine or doctor of osteopathy and that offers a course of study that is approved or accredited by the association of American medical colleges, the association of Canadian medical colleges, the American medical association, the American osteopathic association or any board approved similar body in the United States or Canada that accredits this course of study.

5. "Board" means the board of homeopathic medical examiners.

6. "Chelation therapy" means an experimental medical therapy to restore cellular homeostasis through the use of intravenous, metal-binding and bioinorganic agents such as ethylene diamine tetraacetic acid. Chelation therapy is not an experimental therapy if it is used to treat heavy metal poisoning.

7. "Controlled substance" means a drug or substance or a drug's or substance's immediate precursor that is defined or listed in title 36, chapter 27, article 2.

8. "Drug" means a medication or substance that is any of the following:

(a) Recognized in the official compendia or for which standards or specifications are prescribed in the official compendia.

(b) Intended for use in the diagnosis, cure, mitigation, treatment or prevention of human diseases.

(c) Articles other than food that are intended to affect the structure or function of the human body.

9. "Homeopathic medication" means a substance of animal, vegetable or mineral origin that is prepared according to homeopathic pharmacology and that is given usually in a homeopathic microdosage.

10. "Homeopathic microdosage" means a substance prepared so that it is diluted from ten to the minus one to ten to the minus ten thousandth or higher of its original concentration.

11. "Homeopathy" means a system of medicine that employs homeopathic medication in accordance with the principle that a substance that produces symptoms in a healthy person can cure those symptoms in an ill person.

12. "Immediate family" means a person's spouse, natural or adopted children, parents and siblings and the natural or adopted children, parents and siblings of the person's spouse.

13. "Letter of concern" means an advisory letter to notify a physician that, while there is insufficient evidence to support disciplinary action, the board believes the physician should modify or eliminate certain practices.

14. "Licensee" means a homeopathic physician licensed under this chapter.

15. "Medical assistant" means an unlicensed person who has completed an educational program approved by the board, who assists in a homeopathic practice under the supervision of a doctor of homeopathy and who performs delegated procedures commensurate with the assistant's education and training but who does not diagnose, interpret, design or modify established treatment programs or violate any statute.

16. "Medical incompetence" means the lack of sufficient medical knowledge or skill by a licensee to a degree that is likely to endanger a patient's health. Medical incompetence includes the range of knowledge expected for basic licensure as a medical or osteopathic physician in any professional regulatory jurisdiction of the United States and additional knowledge of homeopathic treatments and modalities expected of physicians licensed under this chapter.

17. "Minor surgery" means surgical procedures that are conducted by a licensee in an outpatient setting and that involve the removal or repair of lesions or injuries to the skin, mucous membranes and subcutaneous tissues, the use of topical, local or regional anesthetic agents, the treatment by stabilizing or casting nondisplaced and uncomplicated fractures of the extremities and diagnostic endoscopies of the intestinal tract, nasopharynx and vagina. Minor surgery also includes an uncomplicated vasectomy, diagnostic aspiration of joints and subcutaneous cysts, therapeutic injections of muscular trigger points, tendons, ligaments and scars and the subcutaneous implantation of medical therapeutic agents. Minor surgery may also include those procedures prescribed by the board by rule. Minor surgery does not include the use of general, spinal or epidural anesthesia, the opening of body cavities, the repair of blood vessels and nerves or the biopsy by incision, excision or needle aspiration of internal organs, the breast or the prostate.

18. "Neuromuscular integration" means musculoskeletal therapy that uses any combination of manual methods, physical agents and physical medicine procedures and devices to improve physiological function by normalizing body structure.

19. "Nutrition" means the recommendation by a licensee of therapeutic or preventative dietary measures, food factor concentrates, fasting and cleansing regimens and the rebalancing by a licensee of digestive system function to correct diseases of malnutrition, to resolve conditions of metabolic imbalance and to support optimal vitality.

20. "Orthomolecular therapy" means therapy to provide the optimum concentration of substances normally present in the human body such as vitamins, minerals, amino acids and enzymes. Orthomolecular therapy includes the diagnosis of ailments or physiologic stresses that occur as a result of genetic or environmental influences as well as acquired or inherited allergy and hypersensitivity responses.

21. "Pharmaceutical medicine" means a drug therapy that uses prescription-only and nonprescription pharmaceutical agents as well as medicinal agents of botanical, biological or mineral origin and that is based on current scientific indications or traditional or historical usage indications.

22. "Practice of homeopathic medicine" means the practice of medicine in which a person purports to diagnose, treat or correct real or imagined human diseases, injuries, ailments, infirmities and deformities of a physical or mental origin and includes acupuncture, chelation therapy, homeopathy, minor surgery, neuromuscular integration, nutrition, orthomolecular therapy and pharmaceutical medicine.

23. "Preceptorship" means an extended period of individual study with one or more experienced homeopathic physicians or institutions.

24. "Prescription-only drug" does not include a controlled substance but does include:

(a) A drug that is generally regarded by medical experts to be unsafe if its use and dosage are not supervised by a medical practitioner.

(b) A drug that is approved for use under the supervision of a medical practitioner pursuant to the federal new drug application law or section 32-1962.

(c) A potentially harmful drug if its labeling does not contain full directions for its use by the patient.

(d) A drug that is required by federal law to bear on its label the following words: "Caution: Federal law prohibits dispensing without prescription."

25. "Professional negligence" means any of the following:

(a) That a licensee administers treatment to a patient in a manner that is contrary to accepted practices and that harms the patient if it can be shown to the board's satisfaction that accepted practices are inherently less hazardous.

(b) That a licensee commits an act of unprofessional conduct or displays an unreasonable lack of professional skill or fidelity.

(c) That a licensee's negligence, carelessness or disregard of established principles or practice results in a patient's injury, unnecessary suffering or death.

26. "Special purpose licensing examination" means an examination developed by the national board of medical examiners on behalf of the federation of state medical boards for use by state licensing boards to test the basic medical competence of physicians who are applying for licensure and who have been in practice in another jurisdiction of the United States and to determine the competence of a physician under investigation by a state licensing board.

The Board's website is: http://www.azhomeopathbd.az.gov/.

Note that some persons are not affected by the regulation:

32-2911. Persons and acts not affected by chapter

This chapter does not prevent:

1. The practice of any other method, system or science of healing by a person who is licensed pursuant to the laws of this state if that person is acting within the scope of that license.

2. The practice by homeopathic physicians discharging their duties while members of the armed forces of the United States or other federal agencies.

3. A person from administering a lawful domestic or family remedy, health food or health food supplement to that person's immediate family members.

4. A person from administering over-the-counter homeopathic remedies in the course of providing medical assistance in an emergency.

5. The practice of any of the healing arts offered by this state's Indian tribes.

6. The practice of religion, treatment by prayer or the laying on of hands as a religious rite or ordinance.

7. Any act competently performed by a physician assistant that is within the scope of that person's duties.

8. A physician licensed in any state, district or territory of the United States from infrequently consulting with a person licensed under this chapter or acting pursuant to an invitation by a legitimate sponsor to visit this state to promote professional education through lectures, clinics or demonstrations if that visiting physician does not open an office, meet with patients or receive calls relating to the practice of homeopathic medicine outside of the sponsoring institution's facilities and programs.

9. The independent practice of acupuncture as a traditional Asian healing art.

This statute does not refer to unlicensed energy healers and homeopaths. Read subsection 1 again carefully: "1. The practice of any other method, system or science of healing by a person who is licensed pursuant to the laws of this state if that person is acting within the scope of that license."

In evaluating legal issues relating to non-licensed (or unlicensed) practitioners of complementary and alternative medicine (CAM) therapies, such as homeopathy; Reiki, EFT (Emotional Freedom Technique), Polarity Therapy, Therapeutic Touch, Healing Touch, and other forms of energy healing; and non-medical hypnotherapy and guided imagery; one must look to legal definitions of:

* the practice of medicine

* the practice of psychology

* the practice of acupuncture and traditional oriental medicine

* the practice of massage therapy

* any statutes providing leeway for unlicensed practitioners of CAM or the healing arts.

For example, consider these statutes in Arizona:

Medicine

ARS 32-1401: 22. "Practice of medicine" means the diagnosis, the treatment or the correction of or the attempt or the holding of oneself out as being able to diagnose, treat or correct any and all human diseases, injuries, ailments, infirmities, deformities, physical or mental, real or imaginary, by any means, methods, devices.

ARS 32-1421: 3 (exemptions). The practice of religion, treatment by prayer or the laying on of hands as a religious rite or ordinance. [n/a]

Behavioral Health

32-3251: 6. "Practice of behavioral health" means the practice of marriage and family therapy, professional counseling, social work and substance abuse counseling pursuant to this chapter.

8. "Practice of professional counseling" means the professional application of mental health, psychological and human development theories, principles and techniques to:
(a) Facilitate human development and adjustment throughout the human life span.
(B) Assess and facilitate career development.
(c) Treat interpersonal relationship issues and nervous, mental and emotional disorders that are cognitive, affective or behavioral.
(d) Manage symptoms of mental illness.
(e) Assess, appraise, evaluate, diagnose and treat individuals, couples, families and groups through the use of psychotherapy.

Massage Therapy
32:4221: This chapter does not apply to:... 6. When the customer is fully clothed, the practice of techniques that are specifically intended to affect the human energy field.

The only way to find this last exemption was to either read the entire massage therapy statute (and hone in on exemptions), or, search for a term such as "energy" (and weed out all the physical energy references to find the one energy healing reference).

Our law office represents many healers, including licensed health professionals and non-licensed practitioners. Many people call wanting to know if we can simply 'review a consent,' as if it were like pulling chips out of the vending machine. It is important to do thorough research to assess all the potential sources of risk, while guiding healers cost-effectively and appropriately to maximize their sense of mission while minimizing potential legal trouble.