GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	1 

SENATE BILL 422*

Short Title:  Acupuncture License Required.	(Public)
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Sponsors: Senators Seymour, Blackmon, Hunt, Marshall; Martin of Pitt, Speed, Richardson, Ballance, Lee, Martin of Guilford, Soles, Tally, Carpenter, Walker, Perdue, Jordan, Gulley, and Allran.
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Referred to:  Hold for New Licensing Rept. (G.S. 120-149).
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February 25, 1993

A BILL TO BE ENTITLED
AN ACT REGULATING THE PRACTICE OF ACUPUNCTURE.
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 30.
"Practice of Acupuncture.
"§ 90-450.  Purpose.
It is the purpose of this Article to promote the health, safety, and welfare of the people of North Carolina by establishing an orderly system of acupuncture licensing and to provide a valid, effective means of establishing licensing requirements without undue financial burden to the people of North Carolina, through use of a national certifying board which has been established to certify the competency of acupuncturists.
"§ 90-451.  Definitions.
As used in this Article, unless the context requires otherwise:
(1)	'Acupuncture' means a form of health care developed from traditional and modern Chinese medical concepts that employs acupuncture diagnosis and treatment, and adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.
(2)	'Board' means the Acupuncture Licensing Board.
(3)	'Practice of acupuncture' means the insertion of acupuncture needles and the application of moxibustion to specific areas of the human body based upon acupuncture diagnosis as a primary mode of therapy.  Adjunctive therapies within the scope of acupuncture may include manual, mechanical, thermal, electrical, and electromagnetic treatment, and the recommendation of herbs, dietary guidelines, and therapeutic exercise.
"§ 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; or
(3)	A chiropractor licensed pursuant to Article 8 of this Chapter.
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.
"§ 90-453.  Acupuncture Licensing Board.
(a)	The Acupuncture Licensing Board shall consist of five members, one appointed by the Governor and four by the General Assembly.  The four members appointed by the General Assembly must be licensed to practice acupuncture in this State.  The persons initially appointed to those positions need not be licensed at the time of selection, but must meet all the qualifications for a license.  The member appointed by the Governor must be a layperson who is not employed in a health care profession.
(b)	Of the members to be appointed by the General Assembly, two shall be appointed upon the recommendation of the Speaker of the House of Representatives and two shall be appointed upon the recommendation of the President Pro Tempore of the Senate.
(c)	The member appointed initially by the Governor shall serve a term ending on June 30, 1994.  Of the General Assembly's initial appointments upon the recommendation of the Speaker of the House of Representatives, one shall serve a term ending June 30, 1995, and the other shall serve a term ending June 30, 1996.  Of the General Assembly's initial appointments upon the recommendation of the President Pro Tempore of the Senate, one shall serve a term ending June 30, 1995, and the other shall serve a term ending June 30, 1996.  After the initial appointments, all members shall be appointed for terms of three years beginning on July 1.  No person may serve more than two consecutive full terms as a member of the Board.
(d)	At the Board's first meeting each year after the new members have been appointed, the members shall choose one member to chair the Board for the year and another to serve as secretary.  No person may chair the Board for more than five consecutive years.
(e)	The Board shall meet at least once each year within 45 days after the appointment of the new members.  The Board shall meet at other times as needed to perform its duties.
(f)	Members of the Board are entitled to compensation and to reimbursement for travel and subsistence as provided in G.S. 93B-5.
"§ 90-454.  Powers and duties of Board.
(a)	The Board is authorized to:
(1)	Issue, suspend, and revoke licenses, collect fees, investigate violations of this Article, and otherwise administer the provisions of this Article.
(2)	Adopt rules to implement the provisions of this Article.
(3)	Establish requirements for and approve schools of acupuncture in this State, the requirements for which shall be at least as stringent as the core curricula standards of the Council of College of Acupuncture.
(4)	Adopt rules concerning continuing education programs and continuing education requirements for license renewal.
(5)	Issue advisory opinions interpreting this Article.
(6)	Sue to enjoin violations of G.S. 90-347.  An injunction may be issued even though no person has yet been injured as a result of the unauthorized practice.
(7)	Adopt and use a seal to authenticate official documents of the Board.
(8)	Employ such personnel as may be needed to carry out its functions, and purchase, lease, rent, sell, or otherwise dispose of personal and real property for the operations of the Board.
(9)	Expend funds as necessary to carry out the provisions of this Article from revenues generated by fees collected under this Article and interest earned thereon.
"§ 90-455.  Qualifications for license; renewal.
(a)	To receive a license to practice acupuncture, a person must successfully complete:
(1)	A licensing examination administered or approved by the Board;
(2)	A three-year postgraduate acupuncture college or training program approved by the Board; and
(3)	The Clean Needle Technique Course offered by the Council of Colleges of Acupuncture and Oriental Medicine.
(b)	The Board shall waive the requirements of subsection (a) and shall grant a license to practice acupuncture to a resident applicant who presents evidence satisfactory to the Board no later than December 31, 1994, of successful completion of training at an approved acupuncture college or a Board-approved apprenticeship or tutorial program.
(c)	The license to practice acupuncture must be renewed every two years.  To renew a license, a person must complete 40 hours of Board-approved Continuing Education Units (CEU) within each renewal period.
"§ 90-456.  Prohibited activities.
The Board may deny, suspend, or revoke a license, require remedial education, or issue a letter of reprimand, if a licensed acupuncturist or applicant:
(1)	Engages in false or fraudulent conduct which demonstrates an unfitness to practice acupuncture, including:
a.	Misrepresentation in connection with an application for a license or an investigation by the Board;
b.	Attempting to collect fees for services which were not performed;
c.	False advertising, including guaranteeing that a cure will result from an acupuncture treatment; or
d.	Dividing, or agreeing to divide, a fee for acupuncture 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 acupuncture;
b.	Delegating professional responsibilities to a person the acupuncturist knows or should know is not qualified to perform; or
c.	Failing to exercise proper control over unlicensed personnel working with the acupuncturist 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;
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 acupuncturist/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 acupuncture.
(7)	Negligently fails to practice acupuncture 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.
"§ 90-457.  Fees.
The Board may charge fees not to exceed:
(1)	Five hundred dollars ($500.00) for the issuance of an initial license.
(2)	One hundred dollars ($100.00) for application fees and examination fees.
(3)	Three hundred dollars ($300.00) for renewal of a license.
(4)	Seventy-five dollars ($75.00) as an additional amount for late renewal of a license.
(5)	The cost of administering the examination.
"§ 90-458.  Use of titles and display of license.
(a)	The titles 'Licensed Acupuncturist' and 'Acupuncturist' may be used by, and only by, persons licensed under this Article.  Possession of a license under this Article does not by itself entitle a person to identify himself or herself as a doctor or physician.
(b)	Each person licensed to practice acupuncture shall post the license in a conspicuous location at the person's place of practice.
"§ 90-459. Third-party reimbursements.
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 acupuncture by a licensed acupuncturist in accordance with the provisions of Article 30 of this Chapter."
Sec. 3.  This act is effective upon ratification.