Naturopathic doctors: scope of practice., the official text

An act to amend Sections 3640, 3640.5, and 3686 of, and to repeal Section 3640.7 of, the Business and Professions Code, and to amend Section 11150 of the Health and Safety Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST

Existing law, the Naturopathic Doctors Act, provides for the licensure and regulation of naturopathic doctors by the California Board of Naturopathic Medicine. Existing law repeals the act on January 1, 2027.
This bill would extend operation of the act until an unspecified date.
Existing law defines naturopathic medicine and authorizes a naturopathic doctor to perform specific health care functions. Existing law authorizes a naturopathic doctor to dispense, administer, order, prescribe, and furnish or perform, among other things, repair and care incidental to superficial lacerations and abrasions, except suturing, and the removal of foreign bodies located in the superficial tissues.
This bill would, instead, authorize a naturopathic doctor to dispense, administer, order, prescribe, and furnish or perform minor office procedures, defined, in part, to mean care and operative procedures relative to lacerations, skin lesions, and abrasions, the incision and drainage of abscesses, and the trephination of subungual hematomas, among other specified procedures.
Existing law authorizes a naturopathic doctor to furnish or order drugs, including Schedule III to Schedule V, inclusive, controlled substances, under specified circumstances, including, among others, that the drugs are furnished or ordered under the supervision of a physician and surgeon and in accordance with standardized procedures or protocols developed by the naturopathic doctor and their supervising physician and surgeon and that the board has certified that the naturopathic doctor has completed coursework in pharmacology, as specified. Existing law authorizes a naturopathic doctor to independently prescribe and administer other specified drugs.
This bill would revise and recast the above-described authorizations to instead authorize a naturopathic doctor to furnish, order, or prescribe drugs, including, among others, Schedule II to Schedule V, inclusive, controlled substances, and would remove the supervision and standardized procedure requirements. The bill would make conforming changes.

The people of the State of California do enact as follows:

SECTION 1.
Section 3640 of the Business and Professions Code is amended to read:
3640.
(a) A naturopathic doctor may order and perform physical and laboratory examinations for diagnostic purposes, including, but not limited to, phlebotomy, clinical laboratory tests, speculum examinations, orificial examinations, and physiological function tests.
(b) A naturopathic doctor may order diagnostic imaging studies, including X-ray, ultrasound, mammogram, bone densitometry, and others, consistent with naturopathic training as determined by the board, but shall refer the studies to an appropriately licensed health care professional to conduct the study and interpret the results.
(c) A naturopathic doctor may dispense, administer, order, prescribe, and furnish or perform the following:
(1) Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, botanical medicines, homeopathic medicines, all dietary supplements, and nonprescription drugs as defined by the Federal Food, Drug, and Cosmetic Act (21 U.S.C. Sec. 301 et seq.) consistent with the routes of administration identified in subdivision (d).
(2) Hot or cold hydrotherapy; naturopathic physical medicine inclusive of the manual use of massage, stretching, resistance, or joint play examination but exclusive of small amplitude movement at or beyond the end range of normal joint motion; electromagnetic energy; colon hydrotherapy; and therapeutic exercise.
(3) Devices, including, but not limited to, therapeutic devices, barrier contraception, and durable medical equipment.
(4) Health education and health counseling.
(5) Minor office procedures. For purposes of this paragraph, “minor office procedure” means any of the following:
(A) Care and operative procedures relative to lacerations, skin lesions, and abrasions.
(B) The incision and drainage of abscesses.
(C) The trephination of subungual hematomas.
(D) The removal of foreign bodies.
(E) The topical and parenteral use of local anesthetic solutions, their adjuncts, and diluents.
(F) Obtaining samples of superficial human tissue by means of biopsy, consistent with the practice of naturopathic medicine.
(d) A naturopathic doctor may utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular.
(e) The board may establish regulations regarding ocular or intravenous routes of administration that are consistent with the education and training of a naturopathic doctor.
(f) Nothing in this section shall exempt a naturopathic doctor from meeting applicable licensure requirements for the performance of clinical laboratory tests, including the requirements imposed under Chapter 3 (commencing with Section 1200).

SEC. 2.
Section 3640.5 of the Business and Professions Code is amended to read:
3640.5.
(a) A naturopathic doctor may furnish, order, or prescribe drugs, including, but not limited to, any of the following, provided they comply with the requirements of subdivision (b):
(1) Legend drugs, including Schedule II to Schedule V, inclusive, controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).
(2) Epinephrine to treat anaphylaxis.
(3) Natural and synthetic hormones.
(4) Vitamins, minerals, amino acids, glutathione, botanicals and their extracts, homeopathic medicines, electrolytes, sugars, and diluents that may be administered utilizing routes of administration, pursuant to subdivision (d) of Section 3640, only when such substances are chemically identical to those for sale without a prescription.
(b) The board has certified that the naturopathic doctor has satisfactorily completed adequate coursework in pharmacology covering the drugs to be furnished or ordered under this section. The board shall establish the requirements for satisfactory completion of this subdivision.
(c) Use of the term “furnishing” in this section, in health facilities defined in subdivisions (b), (c), (d), (e), and (i) of Section 1250 of the Health and Safety Code, shall include
ordering or furnishing a drug in accordance with the standardized procedure.
(d) For purposes of this section, “drug order” or “order” means an order for medication which is dispensed to or for an ultimate user, issued by a naturopathic doctor as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations.
(e) Notwithstanding any other law, both of the following apply:
(1) All references to prescription in this code and the Health and Safety Code shall include drug orders issued by naturopathic doctors.
(2) The signature of a naturopathic doctor on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.

SEC. 3.
Section 3640.7 of the Business and Professions Code is repealed.

SEC. 4.
Section 3686 of the Business and Professions Code is amended to read:
3686.
This chapter shall remain in effect only until January 1, ____, and as of that date is repealed.

SEC. 5.
Section 11150 of the Health and Safety Code is amended to read:
11150.
No person other than a physician, dentist, podiatrist, or veterinarian, or naturopathic doctor acting pursuant to Section 3640.5 of the Business and Professions Code, or pharmacist acting within the scope of a project authorized under Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of Division 107 or within the scope of Section 4052.1, 4052.2, or 4052.6 of the Business and Professions Code, a registered nurse acting within the scope of a project authorized under Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of Division 107, a certified nurse-midwife acting within the scope of Section 2746.51 of the Business and Professions Code, a nurse practitioner acting within the scope of Section 2836.1 of the Business and Professions Code, a physician assistant acting within the scope of a project authorized under Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of Division 107 or Section 3502.1 of the Business and Professions Code, or an optometrist acting within the scope of Section 3041 of the Business and Professions Code, or an out-of-state prescriber acting pursuant to Section 4005 of the Business and Professions Code shall write or issue a prescription.