July 2011: Compromise, Progressive Legislation and Draft Language

By Gene McGill, Director of State Government Relations

The AANP’s legislative focus is for “full scope of practice” licensure in all 50 states. Unfortunately, very few (if any) legislative initiatives will ever get signed into law without compromise. In working with our state organizations, we emphasize this fact routinely. For some, it is a very hard pill to swallow (no pun intended). State organizations and their boards alone are solely responsible for the content of legislation. The AANP is keenly aware of this as we work with our state organizations on legislation. When reviewing legislation, we look at the particular state, the legislation as drafted, the sponsors, and our opposition in order to develop a strategy with you for success.

We are regularly asked, “To which amendments should we agree or not agree?” Again, there is no simple answer. Is there room for additional negotiation? Is the issue critical to the medical society or just a road block to stall a vote? One thing is for certain: legislation is fluid--very fluid--right up to the final vote.  We recently saw just how fluid it can be with the influence of the medical society in New York state. 
Negotiating with the intent of going back to the legislature for more at a later date is not necessarily a bad idea. This concept of progressive legislation has proved successful in many of our licensed states. It allows for licensed states to expand their scope while reinforcing the value of naturopathic medicine to the legislature and developing critical relationships. This concept, however, is not an excuse to yield to all pressures against our legislation just to get something passed. In the end, a bad bill is a bad bill. Substandard legislation at the state level gives our detractors justification and negatively impacts both your national creditability and the efforts of other states working toward licensure.

As you look to move legislation forward, recognize there are some issues that the AANP will not negotiate. Your education standards, title, and the ability to diagnose and treat are non-negotiable.  Supervision is another area that requires extreme caution.
The AANP plays a supporting role in the state licensing process. Final decisions are the purview of a given state’s Board of Directors. Having said that, AANP model legislation and consultation is available to all states seeking licensure or expansion of scope of practice.

Here is an example of what you should see in your initial draft of any legislation:
Establish a State Board of Naturopathic Medicine:  The Board will consist of (#) Naturopathic Physicians and (#) Consumer Members appointed by the Governor.
The Board issues licenses to qualified applicants, enforces disciplinary action, adopts a code of ethics, and adopts a Formulary recommended by the Naturopathic Formulary Council.
Establish Criteria for Issuing Naturopathic Medical License: Beginning (#), a license to practice naturopathic medicine in (#) would be issued to individuals with a doctorate in naturopathic medicine from a naturopathic medical program accredited by the Council on Naturopathic Medical Education (CNME) and after passing the Naturopathic Licensing Examination issued by the North American Board of Naturopathic Medical Examiners (NABNE). Individuals who are not licensed by the Board may not use the title “Doctor of Naturopathic Medicine” or similar titles and may not represent themselves to the public by titles that are restricted for use by persons who are licensed.
Define Scope of Practice for Naturopathic Medicine: 
  1. Practice in the scope of a primary care physician
  2. Perform physical examinations and order laboratory/imaging tests for diagnostic purposes
  3. Dispense, administer, order, and prescribe natural-based therapies, dietary supplements, and prescription drugs determined by the Formulary Council
  4. Administer hydrotherapy and naturopathic physical medicine (including naturopathic musculoskeletal manipulation)
  5. Perform minor office procedures involving repair and care of superficial lacerations, abrasions, lesions and removal of foreign bodies in superficial tissue
  6. Use routes of administration including oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous and intramuscular
Establish the Naturopathic Formulary Council: The Naturopathic Formulary Council will consist of (#) Naturopathic Physicians, (#) Licensed Pharmacists, and (#) Licensed Physician from a list of nominees provided by the State Board of Physicians, all appointed by the Board of Naturopathic Medicine. 
The Council will establish a Naturopathic Formulary for use by Licensed Naturopathic Physicians keeping within the scope of natural and prescription medicines covered by approved naturopathic medical programs.

The AANP remains committed to you to work with you on legislation, to offer advice and keep you informed on legislative happenings in other states.  Remember: licensure is everyone’s business. Being an advocate includes being an advocate tor the profession.