BILL ANALYSIS                                                                                                                                                                                                    

          Revised





           ---------------------------------------------------------- 
          |Hearing Date:April 28, 2003    |Bill No:SB                |
          |                               |907                       |
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                    SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
                             Senator Liz Figueroa, Chair

                         Bill No:        SB 907Author:Burton
                    As Amended:April 22, 2003          Fiscal:Yes

          
          SUBJECT:  Naturopathic physicians
          
          SUMMARY:  Proposes a new state licensing program  
          "naturopathic physicians" or "naturopathic doctors" that  
          would include protection of various occupational titles and  
          a scope of practice for individuals with specified  
          education and training.

          Existing law:

          1)Establishes various boards and Bureau   s  within the  
            Department of Consumer Affairs (Department) that are  
            responsible for licensing and regulating persons  
            practicing various professions and occupations, including  
            various healing arts disciplines.

          2)Provides, pursuant to the Medical Practice Act, for the  
            licensing and regulation of persons with specified  
            education and training as "physicians and surgeons"  
            (physicians) by the Medical Board of California within  
            the Department.  Also, regulates the practice of medicine  
            in this state, and specifies that the physician's license  
            authorizes the holder to use drugs or devices in or upon  
            human beings and to sever or penetrate the tissue of  
            human beings and to use any and all other methods in the  
            treatment of diseases, injuries deformities, and other  
            physical and mental conditions.

          3)Prohibits persons who are not licensed as physicians or  
            surgeons from engaging in certain activities constituting  
            the practice of medicine absent authorization in another  
            state law (e.g., another practice act such as  





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            Chiropractic Initiative Act, the Physical Therapy Act,  
            etc.)

          4)Pursuant to provisions enacted  last year in SB 577   
            (Burton), provides that, notwithstanding any other law  
            including the Medical Practice Act, a person is not  in  
            violation of the provisions of the Medical Practice Act   
            which prohibit the unlicensed practice of medicine if:  

          a) The practitioner does not engage in the following  
            treatment activities  :
               (i) conducting surgery or any other procedure that  
               punctures the skin or         harmfully invades the  
               body, 
               (ii) prescribing or administering X-rays, 
               (iii) prescribing or administering legend drugs or  
               controlled substances,
               (iv) recommending the discontinuance of legend drugs  
               or controlled substances prescribed by an appropriate  
               licensed practitioner,
               (v) willfully diagnosing and treating a physical or  
               mental condition of any person under circumstances or  
               conditions that cause or create a risk of great bodily  
               harm, serious physical injury, mental illness, or  
               death, 
               (vi) sets fractures, treats lacerations or abrasions  
               through electrotherapy
               (vii) states, indicates or implies that he or she is a  
               physician, a surgeon, or a physician and surgeon, and  
               if   

            b) The practitioner makes  and gives a copy of specified  
          written disclosures  to 
               a client in language the client understands regarding  
          the practitioner's 
               education, training and qualifications; the  
          non-licensed/alternative nature 
               of the practitioner's treatment; and that neither the  
          practitioner nor his or 
              her services are licensed by the state.

          5)Does not  regulate the practice of naturopathy, or the use  
            of related titles or abbreviations related to  
            practitioners of naturopathy.

          6)Provides for the licensing and regulation of persons with  





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            specified education and training as "osteopathic  
            physicians and surgeons" the Osteopathic Medical Board of  
            California within the Department.

          7)Provides for the licensing of persons with specified  
            education and training as "licensed acupuncturists" or  
            "acupuncturists" by the Acupuncture Board within the  
            Department.

          8)Provides, pursuant to an Initiative Act, for the  
            licensing and regulation of persons with specified  
            education and training as "chiropractors" by the  
            California Board of Chiropractic Examiners as a  
            free-standing entity in state government. 

          This bill establishes, until July 1, 2009, the Naturopathic  
          Physicians Act (Act), to be administered by the Bureau of  
          Naturopathic Physicians (Bureau) which the bill would  
          create within the Department.

          Specifically, the bill  :

          1)Adds the proposed Bureau of Naturopathic Physicians to  
            various general provisions of the Business and  
            Professions Code that include the other licensing  
            entities in the Department; and requires the Bureau to  
            enforce and administer the provisions of the Act and to  
            adopt regulations to do so.

          2)Defines  various terms for purposes of the Act including  
            "Formulary," "Naturopathic physician," "Naturopathic  
            doctor," "Minor office procedures," and:  

          a) Defines  "naturopathy  " as:  "a philosophy of healing that  
            employs natural methods that may be used by naturopathic  
            physicians and other persons not licensed under this  
            chapter."  

          b) Defines  "naturopathic medicine  " as:  "a distinct and  
            comprehensive system of primary health care  practiced by  
            a naturopathic physician for the diagnosis, treatment,  
            and prevention of human health conditions, injuries, and  
            disease that employs natural therapies, therapeutic  
            substances, and education to promote and restore health  
            by supporting and stimulating the individual's  
            self-healing process." [emphasis added]





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          c) Defines  "naturopathic childbirth attendance  " as:  "the  
            specialty practice of natural childbirth by a  
            naturopathic physician that includes the management of  
            normal pregnancy, normal labor and delivery, and the  
            normal postpartum period, including normal newborn care."

          3)Requires the Bureau to approve  a naturopathic medical  
            education program  accredited by the Council on  
            Naturopathic Medical Education (CNME) that has the  
            following minimum requirements:

          a) For admission - requires applicants to have completed  
            three-quarters of the credits required for a bachelor's  
            degree from a regionally accredited or pre-accredited  
            college or university or equivalency, as determined by an  
            advisory council established by the director (see #5  
            below).

          b) Program requirements - requires a minimum of 4100 total  
            hours in basic and clinical sciences, naturopathic  
            philosophy, naturopathic modalities, and naturopathic  
            medicine - with not less than 2500 hours of academic  
            instruction and not less than 1200 hours consisting of  
            supervised clinical training approved by the naturopathic  
            school.

          4)Requires a naturopathic medical education program to  
            offer graduate-level, full-time studies and training  
            leading to a degree of Doctor of Naturopathy or Doctor of  
            Naturopathic Medicine, and to be offered by an  
            institution that is either accredited or is a candidate  
            for accreditation by a regional institutional accrediting  
            agency recognized by the U.S. Secretary of Education and  
            the Council on Naturopathic Medical Education, or an  
            equivalent federally recognized accrediting body for  
            naturopathic physical education.

          For approval by the Bureau, requires a school located in  
            Canada or the U.S. to offer a full-time, doctoral-level,  
            naturopathic medical education program whose graduates  
            are eligible to apply to the Bureau for licensure and to  
            the North American Board of Naturopathic Examiners that  
            administers the naturopathic licensing exam.

          5)Requires the Director of Consumer Affairs to establish an  





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            advisory council  that includes three (3) persons who are  
            licensed or have met the requirements for licensure as a  
            California licensed naturopathic physician, and four (4)  
            public members. 

          6)Requires that applicants for licensure  as a naturopathic  
            physician:

          a) Not have committed an act or crime that constitutes  
            grounds for license denial generally under the Business  
            and Professions Code.

          b) Have received a degree in naturopathic medicine from an  
            approved naturopathic medical school where the degree  
            substantially  meets the educational requirements  
            specified for approved schools.

          c) Pass the Naturopathic Physicians Licensing Examination  
            (NPLEX) or an equivalent approved by the North American  
            Board of Naturopathic Examiners, or in the absence  
            thereof, by a substantially equivalent exam administered  
            by the Bureau.

          7)Permits  the Bureau to grant a license  to an applicant who  
            is licensed and in good standing as a naturopathic  
            physician in another state, jurisdiction, or territory in  
            the United States if the applicant has met the  
            requirements listed in # 6 above.

          8)Permits  the Bureau to grant a license to an applicant who  
            graduated from a naturopathic medical school prior to  
            1986 and passed a state naturopathic licensing  
            examination,  but  not necessarily the NPLEX.  The  
            applicant must apply no later than December 31, 2007.  
            (Grandfather provision)

          9)Permits the Bureau to grant a "provisional  " license  to an  
            applicant who meets the required educational standards,  
            but who has not passed the NPLEX or a state naturopathic  
            licensing exam. The license is valid for two years during  
            which time the provisional licensee shall pass the NPLEX  
            or another competency examination approved by the Bureau  
            and practice under the direct supervision of a licensed  
            naturopathic physician.  Provides that a provisional  
            licensee may be granted a permanent ("full") license upon  
            completion of the provisional license period.  





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          10) Provide for biennial license renewal , and authorizes  
            the Bureau to provide by regulation for late renewals.

          11)  Mandatory continuing education  (CE):

          a) Requires 60 hours of approved continuing education (CE)  
            courses for biennial license renewal (except the first  
            renewal), including at least 20 hours in  
            pharmcotherapeutics, no more than 15 hours may be in  
            non-onsite types of educational settings (e.g.,  
            videotape), no more than 20 hours in any single topic,  
            and no more than 15 hours of the CE that is required for  
            the specialty in naturopathic childbirth specialty  
            certificate may apply towards the general 60 hour CE.

          b) Provides that the CE requirements may be met through CE  
            course approved by the California Association of  
            Naturopathic Physicians (CANP - the bill sponsor), the  
            American Association of Naturopathic Physicians, the  
            Medical Board of California, the State Board of Pharmacy,  
            the State Board of Chiropractic Examiners, or other  
            courses approved by the Bureau.

          12) Permits the Bureau, upon request, to grant an inactive  
            license to a licensee, and provides that the inactive  
            licensee may not engage in practice, is exempt from the  
            mandatory CE requirements, and requires an inactive  
            licensee to complete the mandatory CE for the previous  
            two year period and pays a reactivation fee.

          13) Scope of Practice.

          a) Provides that a licensed naturopathic physician may  :

               (i) Order and perform physical and laboratory  
          examinations for diagnostic purposes.

              (ii) Order and perform diagnostic imaging studies,  
            including X-rays, mammograms, bone densitometry and  
            others consistent with naturopathic training as  
            determined by the Bureau, but must refer the studies to  
            an appropriately licensed health care professional to  
            conduct the study and interpret the results. 

              (iii) Dispense, administer, and prescribe or perform:  





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            (1) Food, extracts, nutraceuticals, (2) Hot, cold,  
            hydrotherapy, massage, naturopathic manipulation,  
            electrical, sound, light, magnetic and electromagnetic  
            energy, colon hydrotherapy, and therapeutic exercise. 

              (iv) Dispense, administer, prescribe or perform devices  
            as specified, health education and health counseling,  
            repair and care incidental to superficial lacerations,  
            abrasions, and lesions. 

              (v) Remove foreign bodies located in superficial  
            tissues. 

              (vi) Use as routes of administration of treatment:   
            oral, nasal, auricular, ocular, rectal, vaginal,  
            transdermal, intradermal, subcutaneous, intravenous, and  
            intramuscular.

              b) Prohibits a naturopathic physician from performing  
            specified functions including  :  administering therapeutic  
            ionizing radiation or radioactive substances, practicing  
            any other system of treatment unless otherwise licensed  
            to do so, administering general or spinal anesthesia,  
            performing an abortion, or performing any surgical  
            procedure involving tendons, nerves, veins, or arteries  
            extending beyond superficial tissue, or specialized  
            surgeries such as plastic surgery, eye surgery, or  
            surgery involving the body cavities. 

          14) Requires the Bureau to establish  a subcommittee of the  
            advisory council  composed of licensed naturopathic  
            physicians, pharmacists, and medical doctors, to  
            determine a naturopathic formulary based on review of the  
            naturopathic medical education and training, and  
            authorizes the Bureau, consistent with the findings of  
            the subcommittee to prescribe legend and controlled  
            substances except for specified intravenous drugs,  
            Schedule I & II controlled substances, cancer  
            chemotherapeutics, and antipsychotics.

          15) Requires a naturopathic physician to document his or  
            her observations and treatments in patient records, and  
            maintain those records for at least 7 years.

          16) Grants a naturopathic physician the same authority and  
            responsibility as a medical physician with regard to  





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            public health laws and reportable diseases.

          17) Provides that the Act shall not be construed to   
            authorize a naturopathic physician to practice medicine,  
            to limit the practice of other licensed persons when  
            engaged in their licensed practice, or limit an activity  
            otherwise allowed by law including an activity authorized  
            pursuant to specified provisions of the medical practice  
            act (enacted last year in SB 577 - see # 3 under the  
            "Existing law" above.)

          18) Provides that the Act shall not be construed to prevent  
            or restrict  the practices, services or activities of  
            other persons, as specified, including:  (i) employees of  
            the federal government, (ii) persons treating family  
            members in an emergency, (iii) persons engaged in the  
            sale of vitamins, foods, health foods, dietary  
            supplements, herbs, homeopathic remedies ,or other  
            products of nature, the sale of which is not otherwise  
            prohibited by law, (iv) persons engaged in good faith in  
            the practice of the religious tenets of any church or  
            religious belief without using prescription drugs, or  
            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 noted above, (v) persons who are  
            licensed to practice naturopathic medicine in another  
            state, territory, or the District of Columbia, if the  
            person is incidentally called into this state for  
            consultation with a naturopathic physician, or (vi)  
            students enrolled in an approved naturopathic medical  
            program whose services are performed pursuant to a course  
            of instruction under the supervision of a naturopathic  
            physician. 

          19)  Naturopathic childbirth attendance.   Provides that a  
            naturopathic physician may perform naturopathic  
            childbirth attendance  if he or she has completed  
            additional training and has been granted a certificate of  
            specialty practice by the Bureau. 

          a) To obtain the specialty certificate  , the naturopathic  
            physician must:  


               (i) Obtain a passing grade on the North American  





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          Registry of Midwives
                Written Examination or an equivalent exam approved by  
          the Bureau.

               (ii) Complete a midwifery or obstetrics specialty from  
          an approved 
               naturopathic medical educational program that includes  
          a minimum 
               of 200 hours in specified coursework, and an  
          internship or 
               preceptorship in naturopathic childbirth attendance.

               (iii) Assist at a minimum of 50 births under the  
          supervision of a legal or 
               licensed practitioner in obstetrics or natural  
          childbirth attendance - 25 of 
               which must be supervised by a naturopathic physician.

               (iv) Possess current certification in neonatal  
          resuscitation and 
               cardiopulmonary resuscitation. 

               (v) File with the Bureau a written plan for  
          consultation with other health 
               care providers, emergency transfer and transport of an  
          infant or maternity 
               patient or both to an appropriate health care facility  
          and access to 
               neonatal intensive care and obstetrical units or other  
          patient areas.

            b) Requires completion of 30 hours of mandatory  
            continuing education every two years in naturopathic  
            childbirth, midwifery, or obstetrics, of which 15 hours  
            may be applied to the overall 60 hours of CE required for  
            license renewal.

            c) Provides that disciplinary action taken against a  
            licensed naturopathic physician with a specialty  
            certificate that relates specifically to the practice of  
            naturopathic childbirth may suspend, revoke, condition or  
            restrict only the licensee's authority under the  
            specialty certificate instead of affecting the overall  
            license as a naturopathic physician.

            d) Specifies that forceps delivery, general or spinal  





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            anesthesia, cesarean section delivery are not included  
            within the authority to perform a naturopathic childbirth  
            attendance.

            e) Specifies additional functions or treatments that a  
            naturopathic physician who holds a specialty certificate  
            may administer, order, or perform, including postpartum  
            antihemorrhagic drugs, prohylactic opthalmic antibiotics,  
            local anesthetic medications, intravenous fluids as  
            specified, epinephrine for use in maternal anaphylaxis  
            pending emergency transport, equipment incidental to the  
            practice of naturopathic childbirth and to maternal care,  
            and minor office procedures including episiotomies.

            f) Provides that disciplinary action taken against a  
            licensed naturopathic physician with a specialty  
            certificate that relates specifically to the practice of  
            naturopathic childbirth may suspend, revoke, condition or  
            restrict only the licensee's authority under the  
            specialty certificate instead of affecting the overall  
            license as a naturopathic physician.

            g) Specifies that forceps delivery, general or spinal  
            anesthesia, cesarean section delivery are not included  
            within  the authority to perform a naturopathic childbirth  
            attendance  ; and requires that all complications of a  
            normal pregnancy be referred to an obstetrician or other  
            licensed physician as appropriate.

            h) Specifies additional functions or treatments that a  
            naturopathic physician who holds a specialty certificate  
            may administer, order, or perform, including  : postpartum  
            antihemorrhagic drugs, prohylactic opthalmic antibiotics,  
            local anesthetic medications, intravenous fluids as  
            specified, epinephrine for use in maternal anaphylaxis  
            pending emergency transport, equipment incidental to the  
            practice of naturopathic childbirth and to maternal care,  
            and minor office procedures including episiotomies.

            i) Requires the naturopathic physician to disclose in  
            writing to the patient, certain information regarding the  
            qualifications of the licensee, a description of the  
            procedures , a copy of the written plan for consultation  
            and emergency transfer, and the status of liability  
            coverage of the licensee.
            





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          20) Title protection.  Requires a person to be licensed as  
            a naturopathic physician in order to  :

          a) Claim to be a naturopathic physician, licensed  
            naturopathic physician, naturopathic doctor, doctor of  
            naturopathic medicine, doctor of naturopathy, or  
            naturopathic medical doctor.

          b) To use the abbreviation "N.D." or other similar titles  
            or letter to represent that he or she practices, or is  
            authorized to practice, or is able to practice  
            naturopathic medicine as a naturopathic physician.

            c) Requires a licensed naturopathic physician who uses  
            the term or designation "Dr." to further identify himself  
            or herself as a "Naturopathic Physician" or "Naturopathic  
            Doctor," and prohibits the licensee from using any term  
            that tends to indicate the practice of medicine unless he  
            or she is otherwise licensed pursuant to other licensing  
            laws and thereby authorized to do so.
  
          21) Makes it unprofessional conduct, subject to license  
            discipline, for a licensee to violate or assist or  
            conspire to violate any provision of the Naturopathic  
            Physicians Act; and authorizes the Bureau to discipline a  
            naturopathic physician for unprofessional conduct  
            pursuant to the provisions of the Administrative  
            Procedures Act regarding disciplinary actions and  
            hearings.

          22) Makes violation of the Act's provisions a crime  
            punishable as a misdemeanor, punishable by a fine of up  
            to $5000 or imprisonment in county jail for up to one  
            year, or both.

          23) Provides for the regulation of naturopathic  
            corporations in a similar manner as medical corporations  
            are regulated pursuant to provisions of the Medical  
            Practice Act; and authorizes the Bureau to adopt and  
            enforce regulations necessary to carry out this  
            regulation.

          24) Authorizes the Bureau to establish and collect fees and  
            expend revenues generated therefrom ( see the Fiscal  
            Effect section below for details.)






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          25) Requires the Bureau  to prepare a report required of all  
            state licensing programs at least 22 months before they  
            are to become inoperative (generally referred to as a  
            "sunset report"), and provide it to the Joint Legislative  
            Sunset Review Committee no later than September 1, 2007

          FISCAL EFFECT:  Unknown.

          This bill has been keyed as a fiscal bill by Legislative  
          Counsel.

          There would be costs to initially establish the new  
          licensing program and to continue its operation and  
          administration of the Act through July 1, 2009.  These  
          costs are expected to be offset and paid for from licensing  
          fees collected from prospective licensees (applicants for  
          licensure) and then licensees (once licenses have been  
          issued.)      

          The bill provides that the Bureau shall establish the  
          amount of the fee assessed to conduct the activities of the  
          Bureau, including the amount of the fees for applicant  
          licensure, licensure examination, licensure renewal, later  
          renewal, and childbirth certification.  The bill does not  ,  
          as yet, specify any range or maximum limit for any or all  
          of these various authorized fees - as is typical of  
          virtually all other state licensing acts.  Once the author  
          and proponents have a better idea of what the costs will be  
          to establish and operate the new licensing program, the  
          bill should be amended to either specify the amounts of the  
          various fees and/or establish maximum fee limits at a level  
          that will cover the costs of the proposed licensure scheme.   
           

          The bill also provides that all fees collected by the  
          Bureau shall be paid into the State Treasury and credited  
          to the Naturopathic Physicians Fund, created by the bill,  
          and are available for expenditure by the Bureau upon  
          appropriation by the Legislature. 

          COMMENTS:
          
          1.Author's Amendment:  The Author's staff indicate that the  
            Author will offer amendments to remove the use of the  
            term "naturopathic physician" from all provisions of the  
            bill, including deleting it as a protected title by the  





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            bill.  
          This resolves one of several major concerns that the  
            California Medical Association has raised regarding this  
            bill.

          2.Technical Amendment.  

          a.  On page 3, line 27, following "boards" insert:  ",  
             Bureaus  , "

          3.Drafting Concerns and Recommended Amendment.  
          
          b.  On page 10, line 19, after the word "shall," insert the  
            following:  "  have met the requirements of Section 3631.  "   
            On line 19, strike, "pass the NPLEX or," and strike lines  
            20 to 24.  This will clarify that applicants who receive  
            a provisional license must pass a naturopathic licensing  
            examination within two years to be licensed as a  
            naturopathic physician. 


          4.Purpose.  This bill is sponsored  by the California  
            Association of Naturopathic Physicians (CANP) to provide  
            licensure of health practitioners who have acquired  
            specified education and training in naturopathy and  
            allopathic medicine.  According to the author, the bill  
            establishes scope of practice and standards specific to  
            those particular persons,, and would authorize them to  
            practice under a broader scope than that authorized under  
            the author's SB 577 enacted last year.

          [As noted in #3 under Existing Law at the beginning of this  
            analysis, SB 577 provides that a practitioner who  
            provides health care to a client is not guilty of the  
            unlawful, unlicensed practice of medicine, so long as  
            that practitioner does not engage in specified treatment  
            activities and makes specified disclosures regarding the  
            treatments being offered and the practitioner's  
            qualifications, including that the state has not licensed  
            either the practitioner nor the provision of his or her  
            services.  The scope of practice in this bill for the  
            proposed licensed naturopathic physicians, specifically  
            includes those prohibited treatment activities and would  
            not require licensed naturopathic physicians to make the  
            disclosures required under SB 577.]






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          5.Background.  In the early part of this century,  
            California permitted the practice of naturopathy and  
            licensed and regulated "drugless practitioners" under  
            provisions of the Medical Practice Act.  These  
            practitioners practiced in contrast to the practice of  
            so-called "allopathic" medicine or "allopathy" (which is  
            defined as therapy with remedies that produce effects  
            differing from those of the disease treated.)  With the  
            rise and increased licensure of allopathic medical  
            physicians, California abolished the licensing of  
            "drugless practitioners, but permitted existing licensees  
            to continue to practice until 1998 when their licensing  
            provisions in the Medical Practice Act were repealed (SB  
            1981, Greene, Chapter 736) - as there were no longer any  
            licensed drugless practitioners left. 

          There have been several, unsuccessful attempts since then  
            to license or regulate the practice of naturopathy or  
            naturopathic medicine.  Proponents of those efforts view  
            naturopathy as an alternative or complimentary system of  
            healthcare to that currently available and provided by  
            state licensed health care practitioners, especially  
            "allopathic" physicians and surgeons.  These efforts have  
            included AB 3038 (Rosenthal - 1980), AB 2241 (Murray -  
            1993), SB 1166 (Watson - 1993), SB 1566 (Watson - 1994),  
            and SB 1059 (Johannessen.)  Most of this previous  
            legislation would have enacted a formal state licensure  
            scheme for the practice of naturopathic medicine, and  
            regulated the use of related professional titles by  
            practitioners.  (SB 1059 would have required the  
            Department of Consumer Affairs to study and report to the  
            Legislature regarding the need and appropriateness for  
            the state to license the practice of naturopathy, but  
            that billed failed passage in Senate Appropriations  
            Committee.)

          So efforts to enact licensure for naturopathy or  
            naturopathic medicine have not been successful.  They  
            failed in part due to opposition from other licensed  
            health care practitioners such as physicians and  
            surgeons, and in part due to disagreements among the  
            various exponents of naturopathy as to its definition,  
            scope, educational and training requirements, need for  
            licensure, and limitations on the use of professional  
            titles.






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          Essentially, there have been two major divisions of  
            supporters of naturopathy: (1) those that believe it is  
            an adjunct to improved healthful functioning and  
            well-being, but not a diagnostic form of treatment for  
            particular diseases or ailments; and, (2) those who  
            believe it is an alternative or complimentary system for  
            diagnosing and treating human diseases.  Opposition from  
            currently licensed health care practitioners, especially  
            physicians licensed by the Medical Board, questioned the  
            efficacy of the naturopathic system of treatment and  
            argued that its treatment premises and modalities have  
            not been proven to be valid through scientific,  
            "double-blind" studies.

          Finally, last year,  SB 577 authorized practitioners of  
            naturopathy and other forms of complimentary or  
            alternative (to allopathy) healing methods to practice  
            without being in violation of the current medical  
            practice licensing law (the Medical Practice Act), so  
            long as the practitioners did not engage in specified  
            types of treatment activities and if they also provided  
            their clients with specified written disclosures as to  
            their credentials, type of treatments offered, and the  
            fact that neither they, nor their treatments were  
            licensed by the state.

          While enactment of SB 577, was seen as opening up access to  
            practitioners of non-allopathic healing methods and the  
            patients who seek their services, it did not formally  
            license these practitioners and, as noted, still  
            precluded them from offering certain treatment methods  
            that were viewed as singularly "allopathic" in nature.   
            The proponents of the current bill obtain education and  
            training in both naturopathic and allopathic healing  
            methods and seek licensure so that they may offer both,  
            including some of the treatment procedures not permitted  
            to non-licensed physicians, chiropractors, and other  
            licensed healing arts practitioners.

          Currently, there are 11 other states and one U.S. Territory  
            that license or specifically regulate naturopathic  
            doctors in some fashion:  Alaska, Arizona, Connecticut,  
            Hawaii, Maine, Montana, New Hampshire, Oregon, Utah,  
            Vermont, Washington and Puerto Rico.  The scopes of this  
            regulation and practice vary from jurisdiction to  
            jurisdiction. 





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          6.Arguments in Support.  The sponsor, the  California  
            Association of Naturopathic Physicians  (CANP) supports  
            licensure for naturopathic physicians because it believes  
            that such licensure will improve consumer access to safe  
            and effective complimentary and alternative medicine  
            therapies in addition to allopathic ones, and because it  
            will provide for licensure consistent with the  
            naturopathic physician's education and training, and  
            their scope of practice in other jurisdictions.  Thus it  
            is argued, that the bill will allow these practitioners  
            to practice to the fullest extent of their training. CANP  
            also believes that the bill is a title act that will not  
            restrict the scope of legal practice by other health care  
            practitioners, licensed or unlicensed, and permit the  
            public continued access to any legal practitioner.  

           California Citizens for Health Freedom  supports the bill,  
            arguing that licensing of naturopathic practitioners will  
            increase citizens right of choice, help enhance the  
            health/medical services in California, reduce the rising  
            cost of health care, assist in meeting the crisis of a  
            decline in primary care physicians, increase the  
            professional resources of experts to the growing  
            nutritional industry in California, and set the stage for  
            a university specializing in naturopathic medicine to be  
            open in California in the near future.

           The Council on Naturopathic Medical Education  (CNME), which  
            accredits schools of naturopathic medicine, supports the  
            bill stating that licensing will help ensure that  
            patients know the doctor they are seeing has been  
            thoroughly trained at a four-year naturopathic medical  
            school which is all important to making correct diagnoses  
            and prescribing effective treatments.  CNME argues that  
            people with little or no clinical training are practicing  
            as "naturopaths" in states that do not regulate  
            naturopathic medicine.

           National College of Naturopathic Medicine (Oregon) supports  
            the bill stating that it will ensure accountability that  
            physician-level doctors be licensed and regulated in the  
            most populous state in the United States.  The college  
            argues that the public deserves comparable (to allopathic  
            medicine) regulatory standards for naturopathic  
            physicians who are primary care providers, and that since  





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            one out of four Americans seek or utilize natural  
            medicine, the passage of the bill would improve access to  
            natural health care.  Further, the college argues that  
            the bill will improve public safety since, at present,  
            California has no standards to inform consumers whether  
            their naturopathic physician has completed a four-year,  
            graduate-level naturopathic medical school, passed  
            standard board exams, and meets federally recognized  
            standards of education and professional accountability.   
            And like the sponsor, the college argues that the bill  
            clearly defines the scope of professional practice  
            consistent with the training of the licensee.

           American Specialty Health Plans  (ASHP) also supports this  
            bill.  ASHP is a Knox-Keene licensed Specialty Health  
            Plan in California that offers complementary health care  
            benefits including chiropractic, acupuncture, massage  
            therapy, dietetics and naturopathy in those states where  
            licensure of these specialties has been enacted.  ASHP  
            states that the bill will allow Californians the right to  
            access qualified Naturopathic Physicians as the citizens  
            in 12 other states (including one U.S. Territory) enjoy.   
            ASHP believes that the proposed licensing will ensure  
            public safety and accountability to appropriately trained  
            and examined applicants for licensure - and that  
            consumers deserve comparable regulatory standards and  
            oversight mechanisms for all health care providers,  
            including naturopathic physicians.

          The bill is also supported by  the North American Board of  
            Naturopathic Examiners  (which administers the national  
            naturopathic physician examination - the NPLEX,) the  
            University of Bridgeport - College of 

          Naturopathic Medicine, the American Holistic Health  
            Association, the American Association for Health Freedom,  
            and others.

          7.Arguments in Opposition.   The California Chiropractic  
            Association  (CCA) strongly opposes the bill stating that  
            there is no need for the bill.  CCA argues that the bill  
            creates a new class of health care providers who are not  
            adequately trained for the scope of practice contained in  
            the bill and that the bill will cost the state money.   
            CCA states that the specified naturopathic education is  
            not sufficient to support the authority granted proposed  





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            licensees by the bill, since most of the areas such as  
            pharmacology, gynecology, primary care, etc. that  
            naturopaths claim to learn, each generally require a  
            separate four-year degree.

          In particular, CCA objects to the inclusion of  
            "manipulation" (referred to in the bill as "naturopathic  
            manipulation") pointing out that while the practice of  
            manipulation has been shown to be safe in the hands of  
            highly skilled doctors of chiropractic, it requires over  
            4000 hours of education to become a chiropractor.  CCA  
            believes that patients can be harmed if naturopaths are  
            allowed to diagnose and treat conditions in which they  
            have little training.  CCA also argues that the bill is  
            not fiscally supportable in that it would require the  
            creation of a licensing bureau and program in the  
            Department of Consumer Affairs to license only the 65  
            people anticipated who could qualify for licensure at the  
            present time.

           The California Academy of Family Physicians  (CAFP) opposes  
            the bill unless it is amended.  CAFP argues that  
            expanding the scope of practice for naturopaths raises  
            questions about the quality of care, the evidence basis  
            for courses of treatment, health outcomes and medical  
            liability.  CAFP believes the scope of practice proposed  
            for naturopathic physicians is too broad, and includes  
            treatments that appropriately belong in the scope of  
            practice for medical doctors, doctors of osteopathy, and  
            in some cases nurses.  CAFP has requested that author  
            amend the bill to:  1) remove any reference to  
            naturopaths as "physicians" (see proposed author's  
            amendment to do this) and, 2) provide no authority to  
            naturopaths to prescribe drugs, perform minor surgical  
            procedures,perform childbirth, or order X-rays,  
            mammograms or other diagnostic imaging studies.

           The California Medical Association  (CMA) opposes the bill  
            unless it is amended.  CMA states that while it believes  
            that a title act and licensure of naturopath would  
            significantly improve their ability to practice  
            naturopathy, it believes that the bill should be amended  
            to ensure that the public is not misled into believing  
            that naturopaths have the same level of training as a  
            primary care physician licensed pursuant to the Medical  
            Practice Act.  CMA requests that the bill be amended to  





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            delete any reference to "physician", as it believes  
            naturopathic education and training is not sufficient to  
            allow them to function as family physicians and to  
            distinguish a minor ailment from a medical emergency.   
            CMA also requests that the provisions that allow for  
            prescribing authority, performance of minor surgical  
            procedures and 

          childbirths also needs to be deleted again citing its  
            belief that naturopaths have insufficient education and  
            training to perform those things as proposed in the bill.

           The American College of Obstetricians and Gynecologists   
            (ACOG) also opposes the bill unless it is amended.  ACOG  
            is concerned that permitting naturopaths to manage  
            obstetrical care places the health of the woman and the  
            infant at increased risk of harm.  ACOG states pregnancy,  
            even when it is normal, can develop serious health  
            complications that can arise without warning, and that  
            naturopaths do not have the training to handle these  
            types of acute, life-threatening medical conditions.   
            ACOG states its concerns are like those of the CMA, and  
            specifically wants the bill amended to remove obstetrical  
            care from the proposed scope of practice of naturopaths.

           The Coalition for Natural Health  opposes the bill arguing  
            that the expanded range of services that would be  
            authorized, and which go beyond what has been permitted  
            under SB 577 enacted last year, constitute the practice  
            of medicine.  The Coalition believes that the education  
            and training of the proposed "naturopathic physicians" is  
            inadequate to perform the functions contained in their  
            proposed scope of practice that go beyond what has been  
            permitted by SB 577.

          Further, the Coalition states that the bill will have a  
            negative impact in that it requires establishing a new  
            licensing program for just a few practitioners, and that  
            to become operational, the new program will either have  
            to borrow money or secure a loan of an unspecified amount  
            from the General Fund.  In addition, the Coalition argues  
            that the bill will grant primary care status to the  
            proposed new licensees, placing them in a position to be  
            gatekeepers to real medical doctors and create the  
            expectation that initial and continuing medical  
            competence is assured which it believes is untrue.





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                                                                     Page 20




          The Coalition argues that the bill is not about patient  
            access or care, but intended to serve the parochial  
            self-interest of certain practitioners and the particular  
            schools from which they have obtained their education.   
            It believes that licensing of these practitioners as  
            proposed would have the detrimental effect of putting  
            other actively practicing naturopaths out of business,  
            eliminating access by patients to their services, and  
            destroying the progress California made last year when it  
            enacted SB 577, legalizing many alternative health  
            treatment modalities.  

           The California Naturopathic Association  (CNA) also opposes  
            the bill stating that it will displace over 1000  
            "traditional" naturopaths (those who do not employ the  
            allopathic treatment modalities authorized in the bill)  
            in favor of fewer than 60 "naturopathic physicians" who  
            could qualify for licensure under the bill.  CNA states  
            that in every state where naturopathic physicians are  
            licensed, traditional naturopaths, nor other licensed  
            practitioners, can practice as naturopaths.  CNA also  
            notes that the training of the proposed licensed  
            naturopathic physicians in specific naturopathic  
            practices is extremely small, about 650 hours.

          A number of other organizations and many individuals, some  
            of whom currently practice in California as naturopathic  
            doctors or naturopaths oppose the bill (see list below  
            under Support and Opposition.)  These opponents variously  
            argue that the bill will: (a) endanger the public by  
            granting the proposed licensees the authority to perform  
            treatments for which they are not adequately educated or  
            trained, (b) unreasonably grant a monopoly to just a few  
            practitioners by giving them exclusive authority to use  
            naturopathic title, thereby disenfranchising the other  
            naturopathic practitioners, and reducing rather than  
            increasing the public's access to naturopathic  
                                                                                           treatments, and
            (c) impose an unnecessary financial burden on the State  
            of California to establish a licensing program for just a  
            few practitioners.

            Opponents question the bill's reliance on the educational  
            standards specified in the bill.  They state that the  
            CNME which accredits naturopathic schools, and whose  





                                                                     SB 907
                                                                     Page 21



            accreditation is accepted by the provisions of the bill,  
            is no longer recognized by the United States Department  
            of Education (USDE) as an accreditation body for schools  
            seeking participation in federal programs; notably  
            student loan programs.  The opponents further state, that  
            even during the years when the CNME was recognized by the  
            USDE, it never fully complied with federal requirements  
            which ultimately led to the withdrawal of the USDE  
            recognition.

            Additionally, opponents note that the faculty at the  
            naturopathic medical schools have few medical doctors on  
            their staff, with most of the faculty listing only a  
            degree from that particular school as their  
            qualification.  And one of the schools that would qualify  
            under the bill's provisions, currently only is a  
            "candidate" for accreditation and has had extensive  
            operational problems over the years.

            The opponents emphasize that naturopathic  treatments can  
            now legally be provided to the public by practitioners  
            pursuant to SB 577, who must disclose to their patients  
            their education and training, the nature of their  
            proposed treatment modalities, and the fact that they are  
            not licensed by the state, nor are the treatment measures  
            they employ.  This required disclosure is believed to  
            enable practitioners to distinguish themselves from other  
            practitioners by revealing their own credentials to  
            practice, and informs the public so that it can make a  
            reasonable decision about what care they want and who  
            they want to have care for them.  

          8.Title protection issue.    This bill protects, or in  
            essence, "copyrights" the certain professional titles or  
            abbreviations: "naturopathic physician" (  to be deleted by  
            the Author's amendments  ), "licensed naturopathic  
            physician" (  also   to be deleted ) "naturopathic doctor,"  
            "doctor of naturopathic medicine," "doctor of  
            naturopathy," "naturopathic medical doctor," and "N.D."   
            Some of these titles and abbreviations are terms of  
            current and long-standing usage by a host of naturopathic  
            health practitioners, only a few of whom have the type  
            and amount of education that is required by this bill to  
            continue to use those terms.

          Title protection is not legally required as part of a state  





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                                                                     Page 22



            regulatory scheme for a profession or occupation, though  
            it frequently is provided for in California's current  
            regulatory statutes.  Generally, and in this case, the  
            rationale is so that practitioners with specified  
            education and training will be distinguishable from  
            others.  If licensing is deemed to be necessary, and if  
            exclusive use of a title or titles is deemed to be a  
            necessary part of that licensure to protect the public  
            beyond what is currently available to them to ascertain a  
            practitioner's credentials and training then  
            consideration could be given to narrowing that title  
            protection perhaps to a term such as "  licensed  
            naturopathic doctor  ."  Such a term is not currently used  
            by practitioners of naturopathy or medicine, and it  
            clearly delineates the distinguishing feature of the  
            particular group of practitioners that would be  
            "licensed" by the state through this bill.  Other  
            California professional or occupational regulatory  
            statutes use similar title protection that contains the  
            word "licensed" or "certified" as a method of  
            distinguishing practitioners who have met specified  
            education, training, experience and examination  
            requirements from those who have not.

          SUPPORT AND OPPOSITION:
          
           Support  : California Association of Naturopathic Physicians  
                  (CANP - Sponsor)
                  Council on Naturopathic Medical Education (CNME)
                  National College of Naturopathic Medicine
                  American Specialty Health Plans (ASHP)
                  California Citizens for Health Freedom
                  American Holistic Health Association
                  University of Bridgeport (Connecticut)
                  American Association for Health Freedom (AAHF)
                  North American Board of Naturopathic Examiners  
                  (NABNE)
                 (14) Naturopathic doctors

            Oppose Unless Amended  :   California Medical Association  
                     (CMA)
                                            California Academy of  
                     Family Physicians (CAFP)
                                              American College of  
                  Obstetricians and Gynecologists   






                                                                     SB 907
                                                                     Page 23



          Opposition  :  California Chiropractic Association (CCA)
                    Coalition for Natural Health
                    American Naturopathic Medical Association (ANMA)
                    California Naturopathic Association (CNA)
                    International College of Naturopathy
                    American Naturopathic Association (ANA)
                    Consumer Alliance for Consumer Protection
                    (7) Naturopathic doctors
                    (136) Chiropractors
                    (203) Individuals
                    


          Consultant:Jay J. DeFuria