First Substitute S.B. 193

Senator J. Stuart Adams proposes the following substitute bill:


             1     
NATUROPATHIC PRACTICE ACT AMENDMENTS

             2     
2014 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: J. Stuart Adams

             5     
House Sponsor: Michael S. Kennedy

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill modifies the Naturopathic Physician Practice Act by amending definitions and
             10      membership of a naturopathic formulary advisory peer committee.
             11      Highlighted Provisions:
             12          This bill:
             13          .    permits a naturopath to administer certain percutaneous injections;
             14          .    adds a licensed physician to the naturopathic formulary advisory peer committee;
             15      and
             16          .    makes technical changes.
             17      Money Appropriated in this Bill:
             18          None
             19      Other Special Clauses:
             20          None
             21      Utah Code Sections Affected:
             22      AMENDS:
             23           58-71-102 , as last amended by Laws of Utah 2012, Chapter 117
             24           58-71-202 , as last amended by Laws of Utah 2005, Chapter 73
             25     


             26      Be it enacted by the Legislature of the state of Utah:
             27          Section 1. Section 58-71-102 is amended to read:
             28           58-71-102. Definitions.
             29          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             30          [(2)] (1) "Acupuncture" has the same [definition as] meaning as described under the
             31      definition of the "practice of acupuncture" in Section 58-72-102 .
             32          [(1)] (2) "Administrative penalty" means a monetary fine imposed by the division for
             33      acts or omissions determined to constitute unprofessional or unlawful conduct, as a result of an
             34      adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
             35      Procedures Act.
             36          (3) "Board" means the Naturopathic Physicians Licensing Board created in Section
             37      58-71-201 .
             38          (4) "Diagnose" means:
             39          (a) to examine in any manner another person, parts of a person's body, substances,
             40      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             41      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             42      condition;
             43          (b) to attempt to conduct an examination or determination described under Subsection
             44      (4)(a);
             45          (c) to hold oneself out as making or to represent that one is making an examination or
             46      determination as described in Subsection (4)(a); or
             47          (d) to make an examination or determination as described in Subsection (4)(a) upon or
             48      from information supplied directly or indirectly by another person, whether or not in the
             49      presence of the person making or attempting the diagnosis or examination.
             50          (5) "Local anesthesia" means an agent, whether a natural medicine or prescription drug,
             51      which:
             52          (a) is applied topically or by injection [in superficial tissues] associated with the
             53      performance of minor office procedures;
             54          (b) has the ability to produce loss of sensation at the site of minor office procedures;
             55      and
             56          (c) does not cause loss of consciousness or produce general sedation.


             57          (6) "Medical naturopathic assistant" means an unlicensed individual working under the
             58      direct and immediate supervision of a licensed naturopathic physician and engaged in specific
             59      tasks assigned by the licensed naturopathic physician in accordance with the standards and
             60      ethics of the profession.
             61          (7) (a) "Minor office procedures" means:
             62          (i) the use of operative, electrical, or other methods for repair and care of superficial
             63      lacerations, abrasions, and benign lesions;
             64          (ii) removal of foreign bodies located in the superficial tissues, excluding the eye or
             65      ear; [and]
             66          (iii) the use of antiseptics and local anesthetics in connection with minor office surgical
             67      procedures[.]; and
             68          (iv) if approved by the United States Food and Drug Administration, percutaneous
             69      injection into skin, tendons, ligaments, muscles, and joints with:
             70          (A) local anesthetics and nonscheduled prescription medications; and
             71          (B) natural substances.
             72          (b) "Minor office procedures" does not include:
             73          (i) general or spinal anesthesia;
             74          (ii) office procedures more complicated or extensive than those set forth in Subsection
             75      (7)(a);
             76          (iii) procedures involving the eye; or
             77          (iv) any office procedure involving tendons, nerves, veins, or arteries.
             78          (8) "Natural medicine" means:
             79          (a) food, food extracts, dietary supplements as defined by the federal Food, Drug, and
             80      Cosmetics Act, all homeopathic remedies, and plant substances that are not designated as
             81      prescription drugs or controlled substances;
             82          (b) over-the-counter medications;
             83          (c) other nonprescription substances, the prescription or administration of which is not
             84      otherwise prohibited or restricted under federal or state law;
             85          (d) prescription drugs:
             86          (i) that, except as provided in Subsection (8)(e), are not controlled substances as
             87      defined in Section 58-37-2 ;


             88          (ii) the prescription of which is consistent with the competent practice of naturopathic
             89      medicine; and
             90          (iii) the prescription of which is approved by the division in collaboration with the
             91      naturopathic formulary advisory peer committee; and
             92          (e) testosterone, if the testosterone is:
             93          (i) bio-identical;
             94          (ii) designed to be:
             95          (A) administered topically, for transdermal absorption; or
             96          (B) absorbed across the mucosal membranes of the mouth; and
             97          (iii) prescribed or administered, in accordance with the requirements of federal and
             98      state law, solely for the purpose of treating a patient with a low testosterone level in order to
             99      restore the patient to a normal testosterone level.
             100          (9) (a) "Naturopathic childbirth" means uncomplicated natural childbirth assisted by a
             101      naturopathic physician, and includes the use of:
             102          (i) natural medicines; and
             103          (ii) uncomplicated episiotomy.
             104          (b) "Naturopathic childbirth" does not include the use of:
             105          (i) forceps delivery;
             106          (ii) general or spinal anesthesia;
             107          (iii) caesarean section delivery; or
             108          (iv) induced labor or abortion.
             109          (10) "Naturopathic mobilization therapy":
             110          (a) means manually administering mechanical treatment of body structures or tissues
             111      for the purpose of restoring normal physiological function to the body by normalizing and
             112      balancing the musculoskeletal system of the body;
             113          (b) does not mean manipulation or adjustment of the joints of the human body beyond
             114      the elastic barrier; and
             115          (c) does not include manipulation as [defined] used in Title 58, Chapter 73,
             116      Chiropractic Physician Practice Act.
             117          (11) (a) "Naturopathic physical medicine" means the use of the physical agents of air,
             118      water, heat, cold, sound, light, and electromagnetic nonionizing radiation, and the physical


             119      modalities of electrotherapy, acupuncture, diathermy, ultraviolet light, ultrasound,
             120      hydrotherapy, naturopathic mobilization therapy, and exercise.
             121          (b) "Naturopathic physical medicine" does not include the practice of physical therapy
             122      or physical rehabilitation.
             123          (12) "Practice of naturopathic medicine" means:
             124          (a) a system of primary health care for the prevention, diagnosis, and treatment of
             125      human health conditions, injuries, and diseases that uses education, natural medicines, and
             126      natural therapies, to support and stimulate the patient's intrinsic self-healing processes:
             127          (i) using naturopathic childbirth, but only if:
             128          (A) the licensee meets standards of the American College of Naturopathic
             129      Obstetricians (ACNO) or its successor as determined by the division in collaboration with the
             130      board; and
             131          (B) the licensee follows a written plan for naturopathic physicians practicing
             132      naturopathic childbirth approved by the division in collaboration with the board, which
             133      includes entering into an agreement with a consulting physician and surgeon or osteopathic
             134      physician, in cases where the scope of practice of naturopathic childbirth may be exceeded and
             135      specialty care and delivery is indicated, detailing the guidelines by which the naturopathic
             136      physician will:
             137          (I) refer patients to the consulting physician; and
             138          (II) consult with the consulting physician;
             139          (ii) using naturopathic mobilization therapy;
             140          (iii) using naturopathic physical medicine;
             141          (iv) using minor office procedures;
             142          (v) prescribing or administering natural medicine;
             143          (vi) prescribing medical equipment and devices, diagnosing by the use of medical
             144      equipment and devices, and administering therapy or treatment by the use of medical devices
             145      necessary and consistent with the competent practice of naturopathic medicine;
             146          (vii) prescribing barrier devices for contraception;
             147          (viii) using dietary therapy;
             148          (ix) taking and using diagnostic x-rays, electrocardiograms, ultrasound, and
             149      physiological function tests;


             150          (x) taking of body fluids for clinical laboratory tests and using the results of the tests in
             151      diagnosis;
             152          (xi) taking of a history from and conducting of a physical examination upon a human
             153      patient; and
             154          (xii) prescribing and administering natural medicines and medical devices, except a
             155      naturopathic physician may only administer:
             156          (A) a prescription drug, as defined in Section 58-17b-102 , in accordance with
             157      Subsection (8)(d); and
             158          (B) local anesthesia that is not a controlled substance, and only in the performance of
             159      minor office procedures;
             160          (b) to maintain an office or place of business for the purpose of doing any of the acts
             161      described in Subsection (12)(a), whether or not for compensation; or
             162          (c) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
             163      treatment of human diseases or conditions, in any printed material, stationery, letterhead,
             164      envelopes, signs, or advertisements, the designation "naturopathic physician," "naturopathic
             165      doctor," "naturopath," "doctor of naturopathic medicine," "doctor of naturopathy,"
             166      "naturopathic medical doctor," "naturopathic medicine," "naturopathic health care,"
             167      "naturopathy," "N.D.," "N.M.D.," or any combination of these designations in any manner that
             168      might cause a reasonable person to believe the individual using the designation is a licensed
             169      naturopathic physician.
             170          (13) "Prescribe" means to issue a prescription:
             171          (a) orally or in writing; or
             172          (b) by telephone, facsimile transmission, computer, or other electronic means of
             173      communication as defined by division rule.
             174          (14) "Prescription device" means an instrument, apparatus, implement, machine,
             175      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             176      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             177      and dispensed by or through a person or entity licensed under this chapter or exempt from
             178      licensure under this chapter.
             179          (15) "Prescription drug" means a drug that is required by federal or state law or rule to
             180      be dispensed only by prescription or is restricted to administration only by practitioners.


             181          (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-71-501 .
             182          (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-71-502 , and
             183      as may be further defined by division rule.
             184          Section 2. Section 58-71-202 is amended to read:
             185           58-71-202. Naturopathic formulary peer committee.
             186          (1) The division shall establish a naturopathic formulary advisory peer committee
             187      under Subsection 58-1-203 (1)(f) to make recommendations to the board for the naturopathic
             188      formulary which shall:
             189          (a) consist of noncontrolled legend medications deemed appropriate for the scope of
             190      practice of naturopathic physicians; and
             191          (b) include all homeopathic remedies.
             192          (2) The committee shall consist of five members:
             193          (a) one naturopathic physician who is a member of the board;
             194          (b) [three] two naturopathic physicians who are not members of the board; [and]
             195          (c) one licensed pharmacist who is also a pharmacognosist[.]; and
             196          (d) one physician licensed under Chapter 67, Utah Medical Practice Act, or Chapter 68,
             197      Utah Osteopathic Medical Practice Act.
             198          (3) The committee members shall:
             199          (a) be appointed by the director of the division;
             200          (b) be appointed and serve in accordance with Section 58-1-201 , except as those
             201      provisions are modified by this section; and
             202          (c) serve without compensation, travel costs, or per diem for their services.
             203          (4) The committee and the division may seek input from other licensing boards.


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