SECTIONS 3640-3645 - California Statutes

BUSINESS AND PROFESSIONS CODE

SECTION 3640-3645

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
committee, 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, and
prescribe 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, 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) Repair and care incidental to superficial lacerations and
abrasions, except suturing.
(6) Removal of foreign bodies located in the superficial tissues.
(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 committee 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.
(g) The authority to use all routes for furnishing prescription
drugs as described in Section 3640.5 shall be consistent with the
oversight and supervision requirements of Section 2836.1.

3640.1. The committee shall make recommendations to the Legislature
not later than January 1, 2007, regarding the potential development
of scope and supervision requirements of a naturopathic doctor for
the performance of minor office procedures. The committee shall
consult with physicians and surgeons and licensed naturopathic
doctors in developing the findings and recommendations submitted to
the Legislature.

3640.2. Notwithstanding any other provision of law, a naturopathic
assistant may do all of the following:
(a) Administer medication only by intradermal, subcutaneous, or
intramuscular injections and perform skin tests and additional
technical support services upon the specific authorization and
supervision of a licensed naturopathic doctor. A naturopathic
assistant may also perform all these tasks and services in a clinic
licensed pursuant to subdivision (a) of Section 1204 of the Health
and Safety Code upon the specific authorization of a naturopathic
doctor.
(b) Perform venipuncture or skin puncture for the purposes of
withdrawing blood upon specific authorization and under the
supervision of a licensed naturopathic doctor if prior thereto the
naturopathic assistant has met the educational and training
requirements for medical assistants as established in Section 2070. A
copy of any related certificates shall be retained as a record by
each employer of the assistant.
(c) Perform the following naturopathic technical support services:
(1) Administer medications orally, sublingually, topically,
vaginally, or rectally, or by providing a single dose to a patient
for immediate self-administration. Administer medication by
inhalation if the medications are patient-specific and have been or
will be repetitively administered to the patient. In every instance,
prior to administration of medication by the naturopathic assistant,
the naturopathic doctor shall verify the correct medication and
dosage.
(2) Apply and remove bandages.
(3) Collect by noninvasive techniques and preserve specimens for
testing, including urine, sputum, semen, and stool.
(4) Assist patients to and from a patient examination room or
examination table.
(5) As authorized by the naturopathic doctor, provide patient
information and instructions.
(6) Collect and record patient data, including height, weight,
temperature, pulse, respiration rate, and blood pressure, and basic
information about the presenting and previous conditions.
(7) Perform simple laboratory and screening tests customarily
performed in a medical office.
(d) Perform additional naturopathic technical support services
under the regulations and standards established by the committee. The
committee shall, prior to the adoption of any regulations, request
recommendations regarding these standards from appropriate public
agencies, including, but not limited to, the Osteopathic Medical
Board of California, the Medical Board of California, the Board of
Registered Nursing, the Board of Vocational Nursing and Psychiatric
Technicians of the State of California, the Laboratory Field Services
division of the State Department of Public Health, and the Physical
Therapy Examining Committee. The Naturopathic Medicine Committee
shall also request recommendations regarding these standards from
associations of medical assistants, physicians, and others, as
appropriate, including, but not limited to, the Osteopathic
Physicians and Surgeons of California, the California Medical
Association, the California Society of Medical Assistants, and the
California Medical Assistants' Association. Nothing in this
subdivision shall be construed to supersede or modify that portion of
the Administrative Procedure Act that relates to the procedure for
the adoption of regulations set forth in Article 5 (commencing with
Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of
the Government Code.

3640.3. (a) Nothing in this chapter shall be construed as
authorizing the licensure of naturopathic assistants. Nothing in this
chapter shall be construed as authorizing the administration of
local anesthetic agents by a naturopathic assistant. Nothing in this
chapter shall be construed as authorizing the Naturopathic Medicine
Committee to adopt any regulations that violate the prohibitions on
diagnosis or treatment in Section 2052.
(b) Nothing in this chapter shall be construed as authorizing a
naturopathic assistant to perform any clinical laboratory test or
examination for which he or she is not authorized under Chapter 3
(commencing with Section 1200).
(c) Notwithstanding any other provision of law, a naturopathic
assistant may not be employed for inpatient care in a licensed
general acute care hospital as defined in subdivision (a) of Section
1250 of the Health and Safety Code.

3640.5. Nothing in this chapter or any other provision of law shall
be construed to prohibit a naturopathic doctor from furnishing or
ordering drugs when all of the following apply:
(a) The drugs are furnished or ordered by a naturopathic doctor in
accordance with standardized procedures or protocols developed by
the naturopathic doctor and his or her supervising physician and
surgeon.
(b) The naturopathic doctor is functioning pursuant to
standardized procedure, as defined by subdivisions (a), (b), (d),
(e), (h), and (i) of Section 2836.1 and paragraph (1) of subdivision
(c) of Section 2836.1, or protocol. The standardized procedure or
protocol shall be developed and approved by the supervising physician
and surgeon, the naturopathic doctor, and, where applicable, the
facility administrator or his or her designee.
(c) The standardized procedure or protocol covering the furnishing
of drugs shall specify which naturopathic doctors may furnish or
order drugs, which drugs may be furnished or ordered under what
circumstances, the extent of physician and surgeon supervision, the
method of periodic review of the naturopathic doctor's competence,
including peer review, and review of the provisions of the
standardized procedure.
(d) The furnishing or ordering of drugs by a naturopathic doctor
occurs under physician and surgeon supervision. Physician and surgeon
supervision shall not be construed to require the physical presence
of the physician, but does include all of the following:
(1) Collaboration on the development of the standardized
procedure.
(2) Approval of the standardized procedure.
(3) Availability by telephonic contact at the time of patient
examination by the naturopathic doctor.
(e) For purposes of this section, a physician and surgeon shall
not supervise more than four naturopathic doctors at one time.
(f) Drugs furnished or ordered by a naturopathic doctor may
include Schedule III through Schedule V controlled substances under
the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
shall be further limited to those drugs agreed upon by the
naturopathic doctor and physician and surgeon as specified in the
standardized procedure. When Schedule III controlled substances, as
defined in Section 11056 of the Health and Safety Code, are furnished
or ordered by a naturopathic doctor, the controlled substances shall
be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician. A copy of
the section of the naturopathic doctor's standardized procedure
relating to controlled substances shall be provided upon request, to
a licensed pharmacist who dispenses drugs, when there is uncertainty
about the naturopathic doctor furnishing the order.
(g) The committee 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
committee shall establish the requirements for satisfactory
completion of this subdivision.
(h) 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 both of the
following:
(1) Ordering a drug in accordance with the standardized procedure.
(2) Transmitting an order of a supervising physician and surgeon.
(i) 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.
(j) Notwithstanding any other provision of law, the following
apply:
(1) A drug order issued pursuant to this section shall be treated
in the same manner as a prescription of the supervising physician.
(2) All references to prescription in this code and the Health and
Safety Code shall include drug orders issued by naturopathic
doctors.
(3) 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.

3640.7. Notwithstanding the requirements of Section 3640.5 or any
other provision of this chapter, a naturopathic doctor may
independently prescribe epinephrine to treat anaphylaxis and natural
and synthetic hormones.

3641. (a) A naturopathic doctor shall document his or her
observations, diagnosis, and summary of treatment in the patient
record. Patient records shall be maintained for a period of not less
than seven years following the discharge of the patient. The records
of an unemancipated minor shall be maintained until at least one year
after the minor has reached 18 years of age or seven years following
the discharge of the minor, whichever is longer.
(b) A naturopathic doctor shall have the same authority and
responsibility as a licensed physician and surgeon with regard to
public health laws, including laws governing reportable diseases and
conditions, communicable disease control and prevention, recording
vital statistics, and performing health and physical examinations
consistent with his or her education and training.

3642. A naturopathic doctor may not perform any of the following
functions:
(a) Prescribe, dispense, or administer a controlled substance or
device identified in Sections 801 to 971, inclusive, of Title 21 of
the United States Code, except as authorized by this chapter.
(b) Administer therapeutic ionizing radiation or radioactive
substances.
(c) Practice or claim to practice any other system or method of
treatment beyond that authorized by this chapter, for which licensure
is required, unless otherwise licensed to do so.
(d) Administer general or spinal anesthesia.
(e) Perform an abortion.
(f) Perform any surgical procedure.
(g) Perform acupuncture or traditional Chinese and Asian medicine,
including Chinese herbal medicine, unless licensed as an
acupuncturist as defined in subdivision (c) of Section 4927.

3643. This chapter may not be construed to authorize a naturopathic
doctor to practice medicine, as defined under Chapter 5 (commencing
with Section 2000), except as specifically authorized in this
chapter.

3643.5. (a) This chapter may not be construed to limit the practice
of a person licensed, certified, or registered under any other
provision of law relating to the healing arts when the person is
engaged in his or her authorized and licensed practice.
(b) This chapter may not be construed to limit an activity that
does not require licensure or is otherwise allowed by law, including
the practice of naturopathy, when performed consistent with Sections
2053.5 and 2053.6.

3644. This chapter does not prevent or restrict the practice,
services, or activities of any of the following:
(a) A person licensed, certified, or otherwise recognized in this
state by any other law or regulation if that person is engaged in the
profession or occupation for which he or she is licensed, certified,
or otherwise recognized.
(b) A person employed by the federal government in the practice of
naturopathic medicine while the person is engaged in the performance
of duties prescribed by laws and regulations of the United States.
(c) A person rendering aid to a family member or in an emergency,
if no fee or other consideration for the service is charged,
received, expected, or contemplated.
(d) A person who makes recommendations regarding or is engaged in
the sale of food, extracts of food, nutraceuticals, vitamins, amino
acids, minerals, enzymes, botanicals and their extracts, botanical
medicines, homeopathic medicines, dietary supplements, and
nonprescription drugs or other products of nature, the sale of which
is not otherwise prohibited under state or federal law.
(e) A person engaged in good faith in the practice of the
religious tenets of any church or religious belief without using
prescription drugs.
(f) A person acting in good faith for religious reasons as a
matter of conscience or based on a personal belief, while obtaining
or providing information regarding health care and the use of any
product described in subdivision (d).
(g) A person who provides the following recommendations regarding
the human body and its function:
(1) Nonprescription products.
(2) Natural elements such as air, heat, water, and light.
(3) Class I or class II nonprescription, approved medical devices,
as defined in Section 360c of Title 21 of the United States Code.
(4) Vitamins, minerals, herbs, homeopathics, natural food products
and their extracts, and nutritional supplements.
(h) A person who is licensed in another state, territory, or the
District of Columbia to practice naturopathic medicine if the person
is incidentally called into this state for consultation with a
naturopathic doctor.
(i) A student enrolled in an approved naturopathic medical program
whose services are performed pursuant to a course of instruction
under the supervision of a naturopathic doctor.

3645. (a) This chapter permits, and does not restrict the use of,
the following titles by persons who are educated and trained as any
of the following:
(1) "Naturopath."
(2) "Naturopathic practitioner."
(3) "Traditional naturopathic practitioner."
(b) This chapter permits, and does not restrict, the education of
persons as described in paragraphs (1) to (3), inclusive, of
subdivision (a). Those persons are not required to be licensed under
this chapter.