GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

H	1 

HOUSE BILL 353*

Short Title:  Naturopathic License Required.	(Public)
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Sponsors: Representatives Easterling, Colton, Cunningham; Beall, Black, Brubaker, Cole, Culp, Decker, Flaherty, Gist, Holt, H. Hunter, James, Kennedy, Lemmond, Mitchell, Oldham, J. Preston, Stamey, Wainwright, and P. Wilson.
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Referred to:  Judiciary I.
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February 25, 1993

A BILL TO BE ENTITLED
AN ACT REGULATING THE PRACTICE OF NATUROPATHY.
The General Assembly of North Carolina enacts:
Section 1.  Chapter 90 of the General Statutes is amended by adding a new Article to read:
"ARTICLE 28.
"Naturopathy.
"§ 90-410.  Short title.
This Article shall be known as the North Carolina Naturopathic Practice Act.
"§ 90-411.  Purpose; license required.
(a)	The General Assembly finds that mandatory licensure of those engaged in the practice of naturopathy is necessary to ensure minimum standards of competency among naturopathic physicians and to protect the safety and health of the public.
(b)	No person shall engage in this State in the practice of naturopathic medicine, or advertise or represent himself as practicing naturopathic medicine, or adopt or use any title or description of services using the terms or abbreviations listed in subsection (c) without a license issued pursuant to the provisions of this Article, except as otherwise permitted herein.
(c)	Persons licensed pursuant to this Article shall use the title 'naturopathic physician' and the recognized abbreviation 'N.D.'.  Naturopathic physicians shall have the exclusive right to the use of the following terms:  'naturopathic physician', 'naturopathic doctor', 'naturopath', 'doctor of naturopathic medicine', 'doctor of naturopathy', 'naturopathic medical doctor', 'naturopathic medicine', 'naturopathic health care', 'naturopathy', 'N.D.', or 'N.M.D.'.
"§ 90-412.  Definitions.
As used in this Article, unless the context requires otherwise:
(1)	'Acupuncture' means the insertion of acupuncture needles into specific points on the skin to treat human disease and impairment and to relieve pain.
(2)	'Approved naturopathic medical college' means a college or program granting the degree of Doctor of Naturopathic Medicine or Doctor of Naturopathy that is approved by the Board and which:
a.	Is accredited by the Council of Naturopathic Medical Education or other accrediting agency recognized by the federal government.
b.	Has candidate for accreditation status with such agency.
c.	Has been investigated by the Board and found to meet education standards equivalent to those established by such agency.
(3)	'Board' means the Naturopathic Board of Examiners.
(4)	' Homeopathic preparations' means medicines prepared according to the Homeopathic Pharmacopoeia of the United States.
(5)	'Minor surgery' means the use of operative, electrical, or other methods for the surgical repair and care incidental to superficial lacerations and abrasions, superficial lesions, and the removal of foreign bodies located in the superficial tissues and the use of antiseptics and local anesthetics in connection with such methods, except that it shall not include general or spinal anesthetics, major surgery, surgery of the body cavities, or specialized surgeries such as plastic surgery, surgery involving the eye, or surgery of the hand when tendons are involved.
(6)	'Natural antibiotics' means antimicrobial, antifungal, and antiprotozal agents that are naturally occurring substances or manufactured substances that are substantially identical to such naturally occurring substances.
(7)	'Naturopathic medicine' means a system of primary health care practiced by naturopathic physicians for the prevention, diagnosis, and treatment of human health conditions, injuries, and diseases that uses education, natural medicines and therapies to support and stimulate the individual's intrinsic self-healing processes.
(8)	'Naturopathic childbirth' means natural childbirth which includes the use of natural obstetrical medicines, ophthalmic antibiotics, obstetrical emergency medicines, and minor surgery including episiotomies, but which does not include the use of forceps delivery, general or spinal anesthesia, and cesarean section, or induced abortions.
(9)	'Naturopathic physician' means a person authorized and licensed to practice naturopathic medicine under this Chapter.
(10)	'Naturopathic physical medicine' means the therapeutic use of the physical agents of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, ultrasound, hydrotherapy, naturopathic manipulative therapy, and therapeutic exercise.
(11)	'Topical medicines' means topical analgesics, anesthetics, antiseptics, scabicides, antifungals, and antibacterials.
"§ 90-413.  Scope of practice.
(a)	Naturopathic physicians may use for preventive and therapeutic purposes the following natural medicines and therapies:  food, food extracts, vitamins, minerals, enzymes, digestive aids, whole gland thyroid, plant substances, homeopathic preparations, natural antibiotics, immunizations, topical medicines, counseling, hypnotherapy, biofeedback, dietary therapy, naturopathic physical medicine, therapeutic devices, barrier devices for contraception, and minor surgery.
(b)	Naturopathic physicians may use for diagnostic purposes the following: physical and orificial examinations, X rays, electrocardiograms, ultrasound, phlebotomy, clinical laboratory tests and examinations, and physiological function tests.
(c)	Naturopathic physicians may prescribe nonprescription medications and therapeutic devices or use noninvasive diagnostic procedures commonly used by physicians in general practice.
(d)	Naturopathic physicians shall not:
(1)	Prescribe, dispense, or administer any controlled substances except those natural medicines authorized by this Chapter.
(2)	Perform surgical procedures except those procedures authorized by this Chapter.
(3)	Practice emergency medicine except as a good samaritan rendering gratuitous services in the case of emergency and except for the care of minor injuries.
(4)	Practice or claim to practice medicine and surgery, osteopathy, dentistry, podiatry, optometry, chiropractic, physical therapy, or any other system or method of treatment not authorized in this Chapter.
"§ 90-414.  Exemptions.
(a)	Nothing in this Chapter shall be construed to prohibit or to restrict:
(1)	The practice of a profession by individuals who are licensed, certified, or registered under other laws of this State who are performing services within their authorized scope of practice.
(2)	The practice of naturopathic medicine by an individual employed by the government of the United States while the individual is engaged in the performance of duties prescribed by the laws and regulations of the United States.
(3)	The practice by a naturopathic physician duly licensed in another state, territory, or the District of Columbia when incidentially called into this State for consultation with a licensed physician.
(4)	The practice of naturopathic medicine by students enrolled in an approved naturopathic medical college.  The performance of services shall be pursuant to a course of instruction or assignments from an instructor and under the supervision of the instructor who is licensed as a naturopathic physician pursuant to this Chapter.
(b)	A resident of this State may become licensed under this Chapter without meeting the requirements of G.S. 90-417(a)(1) by filing an application and affidavit with the Board, within six months of the effective date of this act, attesting that the applicant:
(1)	Is not licensed as a health care provider under any other law of this State;
(2)	Derives the majority of his income from the practice of naturopathic medicine; and
(3)	Has practiced naturopathy, in a manner acceptable to the Board, for at least three years immediately prior to the effective date of this act.
To become licensed under this subsection, an applicant must also meet the requirements of G.S. 90-417(a)(2), (3), (4), and (5).
"§ 90-415.  Naturopathic Board of Examiners.
(a)	There shall be a Naturopathic Board of Examiners consisting of three members, selected as follows:
(1)	Two naturopathic physicians appointed by the Governor, each of whom shall:
a.	Be a graduate of an approved naturopathic college;
b.	Be licensed in this State as a naturopath; and
c.	Have three years' experience in the practice of naturopathy immediately prior to appointment.
(2)	One public member appointed by the Governor, who shall:
a.	Be a resident of this State for five years immediately preceding appointment;
b.	Be unaffiliated with and have no financial or other interest in a school of medicine, health care institution, or any person practicing any form of healing or treatment of bodily or mental ailments; and
c.	Demonstrate an interest in the health problems in this State.
(b)	Of the initial appointments, the Governor shall designate one naturopathic physician for a six-year term of office, one naturopathic physician for a four-year term of office, and one public member for a two-year term of office.  Their successors shall serve six-year terms.  No member may serve more than two complete consecutive six-year terms.  The Governor may remove a member for malfeasance, misfeasance, or dishonorable conduct.
(c)	Board members and Board personnel are not liable for any act done or proceeding undertaken or performed in good faith and in furtherance of the purposes of this Article.
(d)	The Board shall meet at least semiannually.  In addition, the Board may hold special meetings as it deems necessary.
(e)	Two members of the Board constitute a quorum for the transaction of business.
(f)	The Board shall receive compensation in accordance with the provisions of G.S. 93B-5.
"§ 90-416.  Powers and duties of the Board.
(a)	The Board shall:
(1)	Establish reasonable fees for examination, licensure, and license renewal, subject to the following maximum amounts:
Examination	$ 100.00
Licensure	200.00
License Renewal	150.00
Late Renewal Penalty	50.00.
(2)	Maintain an accurate account of all receipts, expenditures, and refunds granted under this Chapter.
(3)	Maintain a record of its acts and proceedings, including the issuance, refusal, renewal, suspension, or revocation of licenses.
(4)	Maintain a roster of all naturopathic physicians licensed under this Chapter which indicates:
a.	The name of the licensee;
b.	His current professional office address;
c.	The date of issuance and the number of his license;
d.	Whether the licensee is in good standing.
(5)	Keep all applications for licensure as a permanent record.
(6)	Keep all examination records including written examination records and tape recordings of the questions and answers in oral exams.
(7)	Adopt and use a seal, the imprint of which, together with the signatures of the chairman or vice-chairman and the secretary-treasurer of the Board, shall evidence its official acts.
(8)	Annually compile and publish a directory.
(9)	Adopt rules concerning the following:
a.	Standards and criteria for approval of colleges or programs granting the degree of Doctor of Naturopathic Medicine or Doctor of Naturopathy;
b.	Standards defining the scope of practice of naturopathic physicians licensed pursuant to G.S. 90-414(b), based on the licensee's training and experience;
c.	Naturopathic health care;
d.	Naturopathic medical assistants who assist naturopathic physicians, including the qualification of naturopathic medical assistants who are not otherwise licensed by law;
e.	Continuing education programs and requirements; and
f.	Certification of naturopathic physicians for specialty practice.
(10)	Adopt any other rules which are necessary or proper for the administration of this Article.
(b)	The Board may:
(1)	Employ an executive secretary and other permanent or temporary personnel as it deems necessary to carry out the purposes of this Article and designate their duties.
(2)	Appoint qualified personnel to administer any part or all of any examination provided for under this Chapter.
(3)	Rent, lease, or purchase office space, supplies, and equipment for the operation of the Board.
(4)	Authorize expenditures deemed necessary to carry out the provisions of this Article from the fees which it collects, but in no event shall expenditures exceed the revenues of the Board during any fiscal year.
"§ 90-417.  Qualification for licensure.
(a)	To be eligible for a license to practice naturopathic medicine, the applicant shall:
(1)	Be a graduate of an approved naturopathic medical college and pass a competency-based examination prescribed by the Board covering the appropriate naturopathic subjects.
(2)	Possess a good moral and professional reputation.
(3)	Be physically and mentally fit to practice naturopathic medicine.
(4)	Not have had a license to practice naturopathic medicine or naturopathy refused, revoked, or suspended by any other state or country for reasons which relate to the applicant's ability to skillfully and safely practice naturopathic medicine.
(5)	File an application and pay the licensing fees.
(b)	To obtain a license to practice naturopathy by reciprocity, the applicant shall:
(1)	Qualify under subsection (a), except that no written examination shall be required; and
(2)	Be licensed to practice naturopathic medicine by another state or the District of Columbia, provided that the jurisdiction from which the license was obtained requires a written examination which is substantially equivalent to the written examination required by the Board of this State.
"§ 90-418.  Natural childbirth and acupuncture specialty certification.
(a)	No naturopathic physician shall practice naturopathic childbirth or acupuncture without first obtaining a certificate of specialty practice.
(b)	To be certified in naturopathic childbirth, a naturopathic physician must:
(1)	Pass a specialty examination in natural childbirth approved by the Board.
(2)	Have at least 100 hours of course work, internship, or preceptorship in obstetrics or natural childbirth approved by the Board.
(3)	Have participated in 40 supervised births, including prenatal and postnatal care, under the direct supervision of a licensed naturopathic, medical, or osteopathic physician with specialty training in obstetrics or natural childbirth.  The Board may prescribe a national standardized examination in natural childbirth as constituting the specialty examination.
(c)	To be certified in acupuncture, a naturopathic physician must:
(1)	Complete a program in acupuncture approved by the Board that includes at least 500 hours of training in acupuncture, including both didactic and clinical training; and
(2)	Pass a specialty examination in acupuncture approved by the Board.  The Board may prescribe a national standardized examination in acupuncture as constituting the specialty examination.
"§ 90-419.  License renewal and continuing education.
The license to practice naturopathic medicine shall be renewed biennially.  When renewing a license, each naturopathic physician shall submit to the Board evidence of successful completion of the requisite hours of continuing education approved by the Board.  The Board shall not require more than 30 hours of continuing education biennially.
"§ 90-420.  Disciplinary action.
The Board may deny, suspend, or revoke a license, require remedial education, or issue a letter of reprimand, if a licensed naturopath or applicant:
(1)	Engages in false or fraudulent conduct which demonstrates an unfitness to practice naturopathy, including:
a.	Misrepresentation in connection with an application for a license or an investigation by the Board; or
b.	Attempting to collect fees for services which were not performed; or
c.	False advertising, including guaranteeing that a cure will result from a naturopathic treatment; or
d.	Dividing, or agreeing to divide, a fee for naturopathic services with anyone for referring the patient.
(2)	Fails to exercise proper control over one's practice by:
a.	Aiding an unlicensed person in practicing naturopathy;
b.	Delegating professional responsibilities to a person the naturopath knows or should know is not qualified to perform; or
c.	Failing to exercise proper control over unlicensed personnel working with the naturopath in the practice.
(3)	Fails to maintain records in a proper manner by:
a.	Failing to keep written records describing the course of treatment for each patient; or
b.	Refusing to provide to a patient upon request records that have been prepared for or paid for by the patient; or
c.	Revealing personally identifiable information about a patient, without consent, unless otherwise allowed by law.
(4)	Fails to exercise proper care for a patient, including:
a.	Abandoning or neglecting a patient without making reasonable arrangements for the continuation of care; or
b.	Exercising, or attempting to exercise, undue influence within the naturopath/patient relationship by making sexual advances or requests for sexual activity, or making submission to such conduct a condition of treatment.
(5)	Displays habitual substance abuse or mental impairment to such a degree as to interfere with the ability to provide effective treatment.
(6)	Is convicted or pleads guilty or no contest to any crime which demonstrates an unfitness to practice naturopathy.
(7)	Negligently fails to practice naturopathy with the level of skill recognized within the profession as acceptable under such circumstances.
(8)	Willfully violates any provision of this Article or rule of the Board.
(9)	Has had a license denied, suspended, or revoked in another jurisdiction for any reason which would be grounds for such action in this State.
"§ 90-421.  Enforcement; injunctive relief.
(a)	Any person not licensed pursuant to this Article, or not otherwise exempted hereunder, who
(1)	Engages in the practice of naturopathic medicine;
(2)	Advertises, represents, or holds himself out as a naturopathic physician or as practicing naturopathic medicine; or
(3)	Uses a title listed in G.S. 90-411
shall be guilty of a misdemeanor, punishable by a fine, imprisonment, or both in the discretion of the court.
(b)	The Board may make application to superior court for an order enjoining a violation of this Article, and upon a showing by the Board that a person has violated or is about to violate this Article, the court may grant an injunction or restraining order, or take other appropriate action.
"§ 90-422.  Third-party reimbursement.
Nothing in this Article shall be construed to require direct third-party reimbursement to persons licensed under this Article."
Sec. 2.  G.S. 90-18 reads as rewritten:
"§ 90-18.  Practicing without license; practicing defined; penalties.
No person shall practice medicine or surgery, or any of the branches thereof, nor in any case prescribe for the cure of diseases unless he shall have been first licensed and registered so to do in the manner provided in this Article, and if any person shall practice medicine or surgery without being duly licensed and registered, as provided in this Article, he shall not be allowed to maintain any action to collect any fee for such services. The person so practicing without license shall be guilty of a misdemeanor, and upon conviction thereof shall be fined not less than fifty dollars ($50.00) nor more than one hundred dollars ($100.00), or imprisoned at the discretion of the court for each and every offense.
Any person shall be regarded as practicing medicine or surgery within the meaning of this Article who shall diagnose or attempt to diagnose, treat or attempt to treat, operate or attempt to operate on, or prescribe for or administer to, or profess to treat any human ailment, physical or mental, or any physical injury to or deformity of another person: Provided, that the following cases shall not come within the definition above recited:
(1)	The administration of domestic or family remedies in cases of emergency.
(2)	The practice of dentistry by any legally licensed dentist engaged in the practice of dentistry and dental surgery.
(3)	The practice of pharmacy by any legally licensed pharmacist engaged in the practice of pharmacy.
(4)	The practice of medicine and surgery by any surgeon or physician of the United States army, navy, or public health service in the discharge of his official duties.
(5)	The treatment of the sick or suffering by mental or spiritual means without the use of any drugs or other material means.
(6)	The practice of optometry by any legally licensed optometrist engaged in the practice of optometry.
(7)	The practice of midwifery as defined in G.S. 90-178.2.
(8)	The practice of chiropody by any legally licensed chiropodist when engaged in the practice of chiropody, and without the use of any drug.
(9)	The practice of osteopathy by any legally licensed osteopath when engaged in the practice of osteopathy as defined by law, and especially G.S. 90-129.
(10)	The practice of chiropractic by any legally licensed chiropractor when engaged in the practice of chiropractic as defined by law, and without the use of any drug or surgery.
(11)	The practice of medicine or surgery by any reputable physician or surgeon in a neighboring state coming into this State for consultation with a resident registered physician.  This proviso shall not apply to physicians resident in a neighboring state and regularly practicing in this State.
(12)	Any person practicing radiology as hereinafter defined shall be deemed to be engaged in the practice of medicine within the meaning of this Article. 'Radiology' shall be defined as, that method of medical practice in which demonstration and examination of the normal and abnormal structures, parts or functions of the human body are made by use of X ray. Any person shall be regarded as engaged in the practice of radiology who makes or offers to make, for a consideration, a demonstration or examination of a human being or a part or parts of a human body by means of fluoroscopic exhibition or by the shadow imagery registered with photographic materials and the use of X rays; or holds himself out to diagnose or able to make or makes any interpretation or explanation by word of mouth, writing or otherwise of the meaning of such fluoroscopic or registered shadow imagery of any part of the human body by use of X rays; or who treats any disease or condition of the human body by the application of X rays or radium. Nothing in this subdivision shall prevent the practice of radiology by any person licensed under the provisions of Articles 2, 7, 8, and 12A of this Chapter.
(13)	Any act, task or function performed by an assistant to a person licensed as a physician by the Board of Medical Examiners when
a.	Such assistant is approved by and annually registered with the Board as one qualified by training or experience to function as an assistant to a physician, except that no more than two assistants may be currently registered for any physician, and
b.	Such act, task or function is performed at the direction or under the supervision of such physician, in accordance with rules and regulations promulgated by the Board, and
c.	The services of the assistant are limited to assisting the physician in the particular field or fields for which the assistant has been trained, approved and registered;
	Provided that this subdivision shall not limit or prevent any physician from delegating to a qualified person any acts, tasks or functions which are otherwise permitted by law or established by custom.
(14)	The practice of nursing by a registered nurse engaged in the practice of nursing and the performance of acts otherwise constituting medical practice by a registered nurse when performed in accordance with rules and regulations developed by a joint subcommittee of the Board of Medical Examiners and the Board of Nursing and adopted by both boards.
(15)	The practice of naturopathy by a licensed naturopath under the provisions of Article 28 of this Chapter."
Sec. 3.  If a bill entitled "AN ACT REGULATING THE PRACTICE OF ACUPUNCTURE" has been enacted, G.S. 90-452, as created by said act, reads as rewritten:
"§ 90-452.  Practice of acupuncture without license prohibited.
(a)	It is unlawful to practice acupuncture without a license issued pursuant to this Article.  This restriction does not apply, however, to the following:
(1)	A physician licensed pursuant to Article I of this Chapter;
(2)	A student practicing acupuncture under the direct supervision of a licensed acupuncturist as part of a course of study approved by the Board; 
(3)	A chiropractor licensed pursuant to Article 8 of this Chapter; or
(4)	A naturopath licensed pursuant to Article 28 of this Chapter and certified by the Board of Naturopathic Examiners as an acupuncture specialist.
It is also unlawful to advertise or otherwise represent oneself as qualified or authorized to practice acupuncture without having the license required by this Article.
(b)	A violation of this section is a misdemeanor punishable by imprisonment for up to two years, a fine, or both."
Sec. 4.  This act is effective upon ratification.