Reference Title: naturopathic board

AN ACT
AMENDING SECTIONS 32-1501, 32-1504 AND 32-1523.01, ARIZONA REVISED STATUTES; RELATING TO THE NATUROPATHIC PHYSICIANS BOARD OF MEDICAL EXAMINERS.

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 32-1501, Arizona Revised Statutes, is amended to read:

32-1501 . Definitions

In this chapter, unless the context otherwise requires:

1. "Accepted therapeutic purpose" means treatment of a disease, injury, ailment or infirmity that is competent and generally recognized as safe and effective.

2. "Active license" means a current valid license to practice naturopathic medicine.

3. "Adequate medical records" means medical records containing sufficient information to identify the patient, the diagnosis and the treatment prescribed.

4. "Approved clinical training program" or "clinical training program" means a program for naturopathic medical students in which the training occurred or is being conducted by or in conjunction with an approved school of naturopathic medicine.

5. "Approved internship program" or "internship" means that the program in which the training occurred or is being conducted has been approved for internship training for physicians or for graduates of a school of naturopathic medicine by the board or was approved or accredited by an educational or professional association recognized by the board or by another state's or country's licensing agency recognized by the board.

6. "Approved postdoctoral training" or "postdoctoral training" means that the program in which the training occurred or is being conducted has been approved for specialty training or for graduate medical education in naturopathic medicine by the board or approved or accredited by an educational or professional association recognized by the board or by another state's or country's licensing agency recognized by the board.

7. "Approved preceptorship program" or "preceptorship" means that the program in which the training occurred or is being conducted has been approved for preceptorship training for physicians or for graduates of a school of naturopathic medicine by the board or was approved or accredited by an educational or professional association recognized by the board or by another state's or country's licensing agency recognized by the board.

8. "Approved school of naturopathic medicine" or "school of naturopathic medicine" means a school or college DETERMINED BY THE BOARD TO HAVE AN EDUCATIONAL PROGRAM THAT MEETS BOARD STANDARDS AS PRESCRIBED BY BOARD RULES, offering a course of study which, on successful completion, results in the awarding of the degree of doctor of naturopathic medicine and whose course of study is any of the following:

(a) Accredited or a candidate for accreditation by an accrediting agency recognized by the United States secretary of education as a specialized accrediting agency for schools of naturopathic medicine or its successor.

(b) Accredited or a candidate for accreditation by an accrediting agency recognized by the council for higher education accreditation or its successor.

(c) Certified, recognized or approved by another state's naturopathic licensing agency and the school is located in the jurisdiction of that licensing agency.

(d) Determined by the board to have an educational program that meets board standards as prescribed by board rules.

9. "Board" means the naturopathic physicians board of medical examiners.

10. "Completed application" means that the applicant paid the required fees and supplied all documents and information as requested by the board and in a manner acceptable to the board.

11. "Doctor of naturopathic medicine" means a natural person licensed to practice naturopathic medicine under this chapter.

12. "Letter of concern" means a nondisciplinary advisory letter that is issued by the board to a person who is regulated under this chapter and that states that while there is insufficient evidence to support disciplinary action the board believes that the person should modify or eliminate certain practices and that continuation of the activities that led to the information being submitted to the board may result in action against the person's license, certificate or registration.

13. "Letter of reprimand" means a disciplinary letter that is issued by the board and that informs a person who is regulated under this chapter that the person's conduct violates state or federal law but does not require the board to restrict the person's license, certificate or registration because the person's conduct did not result in harm to a patient or to the public.

14. "Medical assistant" or "naturopathic medical assistant" means a person who is certified by the board as a medical assistant, who assists a doctor of naturopathic medicine and who may perform delegated procedures commensurate with the assistant's education and training under the direct supervision of a doctor of naturopathic medicine. Procedures delegated to a medical assistant do not include diagnosing, designing or modifying established treatment programs or those procedures prohibited by the board or by this chapter.

15. "Medically incompetent" means a person who is licensed, certified or registered pursuant to this chapter and who lacks sufficient naturopathic medical knowledge or skills, or both, to a degree that is likely to endanger the health of patients.

16. "Naturopathic medical student" means a person who is enrolled in a course of study at an approved school of naturopathic medicine.

17. "Naturopathic medicine" means medicine as taught in approved schools of naturopathic medicine and in clinical, internship, preceptorship and postdoctoral training programs approved by the board and practiced by a recipient of a degree of doctor of naturopathic medicine licensed pursuant to this chapter.

18. "Nurse" means a person licensed pursuant to chapter 15 of this title.

19. "Physician" means a doctor of naturopathic medicine licensed pursuant to this chapter.

20. "Practice of naturopathic medicine" means a medical system of diagnosing and treating diseases, injuries, ailments, infirmities and other conditions of the human mind and body including by natural means, drugless methods, nonsurgical methods, devices, physical, electrical, hygienic and sanitary measures and all forms of physiotherapy PHYSICAL AGENTS AND MODALITIES .

21. "Specialist" means a physician who has successfully completed approved postdoctoral training, who is certified by a specialty board of examiners recognized by the board and who is certified by the board to practice the specialty pursuant to this chapter.

22. "Unprofessional conduct" includes the following, whether occurring in this state or elsewhere:

(a) Intentionally disclosing a professional secret or intentionally disclosing a privileged communication except as either of these may otherwise be required by law.

(b) Any dishonorable conduct reflecting unfavorably on the profession.

(c) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case conviction by any court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission of the felony or misdemeanor.

(d) Habitual intemperance in the use of alcohol or any substance abuse.

(e) The illegal use of any narcotic or hypnotic drugs, or illegal substances.

(f) Conduct that the board determines is gross malpractice, repeated malpractice or any malpractice resulting in the death of a patient.

(g) Impersonating another doctor of naturopathic medicine or any other practitioner of the healing arts.

(h) Falsely acting or assuming to act as a member, an employee or an authorized agent of the board.

(i) Procuring or attempting to procure a license or a certificate pursuant to this chapter by fraud, by misrepresentation or by knowingly taking advantage of the mistake of another person or agency.

(j) Having professional connection with or lending one's name to enhance or continue the activities of an illegal physician or an illegal practitioner of any healing art.

(k) Representing that a manifestly incurable disease, injury, ailment or infirmity can be permanently cured, or falsely or fraudulently representing that a curable disease, injury, ailment or infirmity can be cured within a stated time.

(l) Offering, undertaking or agreeing to cure or treat a disease, injury, ailment or infirmity by a secret means, method, treatment, medicine, substance, device or instrumentality.

(m) Refusing to divulge to the board upon demand the means, method, treatment, medicine, substance, device or instrumentality used in the treatment of a disease, injury, ailment or infirmity.

(n) Giving or receiving, or aiding or abetting the giving or receiving of, rebates, either directly or indirectly.

(o) Knowingly making any false or fraudulent statement, written or oral, in connection with the practice of naturopathic medicine or any naturopathic treatment method.

(p) Immorality or misconduct that tends to discredit the naturopathic profession.

(q) Refusal, revocation or suspension of a license by any other state, district or territory of the United States or any other country, unless it can be shown that such was not occasioned by reasons which relate to the ability to safely and skillfully practice as a doctor of naturopathic medicine or to any act of unprofessional conduct in this paragraph.

(r) Any conduct or practice which is contrary to recognized standards of ethics of the naturopathic profession, any conduct or practice which does or might constitute a danger to the health, welfare or safety of the patient or the public, or any conduct, practice or condition which does or might impair the ability to safely and skillfully practice as a doctor of naturopathic medicine.

(s) Failure to observe any federal, state, county or municipal law relating to public health as a physician in this state.

(t) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any of the provisions of this chapter or board rules.

(u) False, fraudulent, deceptive or misleading advertising or advertising the quality of a medical or health care service by a physician or by the physician's staff, employer or representative.

(v) Failing or refusing to maintain adequate medical records on a patient or failing or refusing to make medical records in the physician's possession promptly available to another physician or health care provider who is licensed pursuant to chapter 7, 8, 13, 15, 17 or 29 of this title on request and receipt of proper authorization to do so from the patient, a minor patient's parent, the patient's legal guardian or the patient's authorized representative or failing to comply with title 12, chapter 13, article 7.1.

(w) Referring a patient to a diagnostic or treatment facility or prescribing goods and services without disclosing in writing to the patient that the physician has a pecuniary interest in the facility, goods or services to which the patient is referred or prescribed. This subdivision does not apply to a referral by one physician or practitioner to another physician or practitioner within a group of physicians or practitioners practicing together.

(x) Sexual intimacies with a patient in the course of direct treatment.

(y) Failing to dispense natural substances and devices in compliance with article 4 of this chapter.

(z) Administering, dispensing or prescribing any natural substance or a device for other than an accepted therapeutic purpose.

(aa) Falsely representing or holding oneself out as being a specialist or representation by a doctor of naturopathic medicine or the doctor's staff, employer or representative that the doctor is boarded or board certified if this is not true or that standing is not current.

(bb) Delegating professional duties and responsibilities to a person if the person has not been approved or qualified by licensure or by certification to perform these duties or responsibilities.

(cc) Failing to appropriately supervise a naturopathic medical student, a nurse, a medical assistant, a health care provider or a technician employed by or assigned to the physician during the performance of delegated professional duties and responsibilities.

(dd) Using experimental forms of diagnosis or treatment without adequate informed consent of the patient or the patient's legal guardian and without conforming to experimental criteria including protocols, detailed records, periodic analysis of results and periodic review by a medical peer review committee as approved by the federal food and drug administration or its successor agency.

(ee) Failing to furnish information in a timely manner to the board or investigators or representatives of the board if this information is legally requested by the board and failing to allow properly authorized board personnel on demand to examine and have access to documents, reports and records maintained by the physician that relate to the physician's medical practice or medically related activities.

(ff) Failing to report in writing to the board evidence that a person licensed, certified or registered pursuant to this chapter is or may be medically incompetent, guilty of unprofessional conduct or mentally or physically unable to safely practice or assist in the practice of naturopathic medicine.

(gg) Conducting or engaging in an internship, preceptorship or clinical training program in naturopathic medicine without being approved and registered by the board for that internship, preceptorship or clinical training program.

(hh) Signing a blank, undated or predated prescription form.

(ii) Conduct that the board determines is gross negligence, repeated negligence or negligence resulting in harm or death to a patient.

(jj) Knowingly making a false or misleading statement in oral testimony to the board on a form required by the board or in written correspondence to the board, including attachments to that correspondence.

(kk) The failure of a physician who is the chief medical officer, the executive officer or the chief of staff of an internship, a preceptorship or a clinical training program to report in writing to the board that the privileges of a doctor of naturopathic medicine, a naturopathic medical student or a medical assistant have been denied, limited, revoked or suspended because that doctor's, student's or assistant's actions appear to indicate that the person is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be unable to safely engage or assist in the practice of naturopathic medicine.

(ll) Action taken against a doctor of naturopathic medicine by a licensing or regulatory board in another jurisdiction due to that doctor's mental or physical inability to engage safely in the practice of medicine, the doctor's medical incompetence or for unprofessional conduct as defined by that licensing or regulatory board and that corresponds directly or indirectly to an act of unprofessional conduct prescribed by this subdivision PARAGRAPH . The action taken may include refusing, denying, revoking or suspending a license, otherwise limiting, restricting or monitoring a licensee or placing a licensee on probation by that licensing or regulatory board.

(mm) Sanctions imposed by an agency of the federal government, including restricting, suspending, limiting or removing a person from the practice of naturopathic medicine or restricting that person's ability to obtain financial remuneration.

(nn) Violating any formal order, probation, consent agreement or stipulation issued or entered into by the board pursuant to this chapter.

(oo) Refusing to submit to a body fluid examination pursuant to a board investigation of alleged substance abuse by a doctor of naturopathic medicine.

(pp) Charging a fee for services not rendered or dividing a professional fee for patient referrals among health care providers or health care institutions or between these providers and institutions or a contractual arrangement that has this effect.

(qq) Obtaining a fee by fraud, deceit or misrepresentation.

(rr) Charging or collecting a clearly excessive fee. In determining if a fee is clearly excessive the board shall consider the fee or range of fees customarily charged in this state for similar services, in light of modifying factions FACTORS such as the time required, the complexity of the service and the skill required to perform the service properly. This subdivision does not apply if there is a clear written contract for a fixed fee between the physician and the patient that was entered into before the service was provided.

Sec. 2. Section 32-1504, Arizona Revised Statutes, is amended to read:

32-1504 . Powers and duties

A. The board shall:

1. Adopt rules that are necessary or proper for the administration of this chapter.

2. Administer and enforce all provisions of this chapter and all rules adopted by the board under the authority granted by this chapter.

3. Adopt rules regarding naturopathic medical assistants who assist a doctor of naturopathic medicine, and the board shall determine the qualifications of naturopathic medical assistants who are not otherwise licensed by law. The board may also adopt rules for the voluntary certification of these naturopathic medical assistants.

3. ADOPT RULES REGARDING THE QUALIFICATIONS OF MEDICAL ASSISTANTS WHO ASSIST DOCTORS OF NATUROPATHIC MEDICINE AND DETERMINE THE QUALIFICATIONS OF MEDICAL ASSISTANTS WHO ARE NOT OTHERWISE LICENSED BY LAW.

4. ADOPT RULES FOR THE APPROVAL OF SCHOOLS OF NATUROPATHIC MEDICINE. THE BOARD MAY INCORPORATE BY REFERENCE THE ACCREDITING STANDARDS FOR NATUROPATHIC MEDICAL SCHOOLS PUBLISHED BY ACCREDITING AGENCIES RECOGNIZED BY THE UNITED STATES DEPARTMENT OF EDUCATION OR RECOGNIZED BY THE COUNCIL FOR HIGHER EDUCATION ACCREDITATION.

5. ADOPT RULES RELATING TO CLINICAL, INTERNSHIP, PRECEPTORSHIP AND POSTDOCTORAL TRAINING PROGRAMS, NATUROPATHIC GRADUATE MEDICAL EDUCATION AND NATUROPATHIC CONTINUING MEDICAL EDUCATION PROGRAMS.

6. PERIODICALLY INSPECT AND EVALUATE SCHOOLS OF NATUROPATHIC MEDICINE, CLINICAL, INTERNSHIP, PRECEPTORSHIP AND POSTDOCTORAL TRAINING PROGRAMS, NATUROPATHIC GRADUATE MEDICAL EDUCATION PROGRAMS AND RANDOMLY EVALUATE NATUROPATHIC CONTINUING MEDICAL EDUCATION PROGRAMS.

4. 7. Adopt rules relating to the dispensing of natural substances and devices including requiring a doctor of naturopathic medicine to be certified and registered by the board before dispensing a natural substance or device .

5. 8. Adopt and use a seal.

6. Adopt rules relating to standards for naturopathic medical education for approving naturopathic medical schools, internship, preceptorship or clinical training programs in naturopathic medicine, naturopathic graduate medical education and naturopathic continuing medical education.

7. 9. Adopt rules for conducting licensing examinations required by this chapter.

8. 10. Have the full and free exchange of information with the licensing and disciplinary boards of other states and countries and with the American board of naturopathic medical specialties, the Arizona naturopathic medical association, the association of naturopathic medical colleges, the federation of naturopathic medical licensing boards and the naturopathic medical societies of other states, districts and territories of the United States or other countries.

B. The board may:

1. Adopt rules that prescribe annual continuing medical education for the renewal of licenses issued under this chapter.

2. Employ permanent or temporary personnel it deems necessary to carry out the purposes of this chapter and designate their duties.

3. Adopt rules relating to naturopathic medical specialties and determine the qualifications of doctors of naturopathic medicine who may represent or hold themselves out as being specialists.

4. If reasonable cause exists to believe that an applicant's competency is in question, require an applicant for licensure to undergo any combination of physical, mental, blood and laboratory tests.

5. Be a dues paying member of national organizations that support licensing agencies in their licensing and regulatory duties and pay the travel expenses involved for a designated board member or the executive director to represent the board at the annual meeting of these organizations.

Sec. 3. Section 32-1523.01, Arizona Revised Statutes, is amended to read:

32-1523.01 . Foreign graduates; additional qualifications

A. An applicant for a license to practice as a doctor of naturopathic medicine who received naturopathic medical training from an institution outside of the United States or Canada and who is not licensed by any other state, district or territory of the United States shall meet all of the following requirements:

1. Be a graduate of an approved school of naturopathic medicine.

2. Have successfully completed an internship, preceptorship or A clinical training program in naturopathic medicine .

3. Possess a good moral and professional reputation.

4. Be physically and mentally fit to practice as a doctor of naturopathic medicine.

5. Not be guilty of an act of unprofessional conduct or any other conduct which is grounds for refusal, suspension or revocation of a license under this chapter.

6. Not have had a license to practice any profession refused, revoked or suspended by any other state, district or territory of the United States or another country for reasons which relate to his THAT PERSON'S ability to skillfully and safely practice as a doctor of naturopathic medicine.

7. Successful completion of HAVE SUCCESSFULLY COMPLETED either a two year internship training program approved by the board or a postdoctoral training program approved by the board.

B. The applicant shall file a complete application and pay the required fees as provided in section 32-1527 and, in addition, shall pay for any costs incurred by the board for investigations or verification of an applicant's credentials and qualifications.

C. The applicant shall pass the examination as required pursuant to section 32-1525, subsection B.

D. The board may:

1. Require the applicant to submit credentials or other written or oral proof that he THE APPLICANT meets the requirements of this section.

2. Make investigations it deems proper to adequately determine the qualifications of the applicant.

Sec. 4. Reporting requirement; inspections; appropriation; purpose; reversion

A. The executive director of the naturopathic physicians board of medical examiners shall report to the president of the senate, the speaker of the house of representatives, the governor and the office of the ombudsman citizen's aide office every six months from the effective date of this act regarding the implementation and adoption of rules adopted by the board.

B. The sum of $50,000 is appropriated from the naturopathic physicians board of medical examiners fund, established in section 32-1505, Arizona Revised Statutes, for the purpose of conducting the inspections required in section 32-1504, Arizona Revised Statutes. The board may employ one full-time employee for this purpose. Expenditures for the purposes of this subsection shall be reported to the joint legislative budget committee at the end of each fiscal year.

C. All monies remaining unexpended and unencumbered on July 1, 2001 from the appropriation made in subsection B of this section reverts to the naturopathic physicians board of medical examiners fund established in section 32-1505, Arizona Revised Statutes.

Sec. 5. Delayed repeal

Section 4 of this act regarding the reporting requirement and inspections is repealed from and after June 30, 2001.

Sec. 6. Emergency

This act is an emergency measure that is necessary to preserve the public peace, health or safety and is operative immediately as provided by law.

APPROVED BY THE GOVERNOR MAY 18, 1999.

FILED IN THE OFFICE OF THE SECRETARY OF STATE MAY 18, 1999.