wa-law.org > bill > 2023-24 > SB 5411 > Original Bill
The legislature finds that:
Naturopathic physicians, licensed under chapter 18.36A RCW since 1987 and chapter 18.36 RCW since 1919, are recognized as primary care providers in both statute and rule, and have served in this role for many years through private health plans, in apple health (medicaid), and with the Indian health service systems.
Washington has a shortage of primary care services that poses a significant risk to public health resulting in increased human suffering and increased costs. The coronavirus pandemic has added strain on an already overburdened health care system, further exposing the need to empower primary care providers to practice to the full scope of their training.
In some areas, naturopathic physicians are the only available health care providers. As such, they need authority for all appropriate primary care services consistent with their education and patient populations. This act supports better patient care, prevents duplication of services, reduces emergency department visits, and is more cost-effective for patients, health plans, and state agencies.
Naturopathic medical training emphasizes behavioral health, counseling, and lifestyle medicine in addition to conventional medical diagnostics and treatments, including pharmaceutical prescriptions. Many patients seek care with naturopathic physicians in order to stop taking or lower their doses of prescription medications. Most controlled substances cannot be stopped without a careful dosage taper. Enabling naturopathic physicians to practice to the full extent of their training, to include authority to prescribe and deprescribe controlled substances, allows them to play a more significant role in addressing the ongoing opioid and benzodiazepine crises facing our communities.
The legislature first granted naturopathic physicians limited prescriptive authority in 1987 and expanded this in 2005 to include all legend drugs and limited controlled substances in Schedules III through V of the uniform controlled substances act. Licensed naturopathic physicians in neighboring states currently have prescriptive authority beyond what those in Washington have. Licensed naturopathic physicians have demonstrated competence and safety in prescribing controlled substances both here and in surrounding states.
This act recognizes the board of naturopathy (established by the legislature in 2011), and its role in rule making for determination of specific clinical parameters and educational requirements in the same manner as other boards and commissions with primary care authority.
Subject to the requirements of this section, a naturopathic physician may prescribe and administer legend drugs and controlled substances contained in Schedules II through V of the uniform controlled substances act, chapter 69.50 RCW, as necessary in the practice of naturopathy.
A naturopathic physician who prescribes controlled substances shall register with the department to access the prescription monitoring program established in chapter 70.225 RCW.
By rule, the board shall establish education and training requirements related to prescribing legend drugs and controlled substances. A naturopathic physician may prescribe and administer drugs pursuant to subsection (1) of this section only if he or she satisfies the education and training requirements established by the board.
A naturopathic physician may sign and attest to any certificates, cards, forms, or other required documentation that a physician may sign, so long as it is within the naturopathic physician's scope of practice. This includes, but is not limited to, disability determinations, physician orders for life-sustaining treatment, hospice orders, student athletic forms, guardianships, powers of attorney, and similar legal documents.
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
"Board" means the board of naturopathy created in RCW 18.36A.150.
"Colon hydrotherapist" means a person certified under this chapter to perform colon hydrotherapy pursuant to an affiliation with one or more naturopaths.
"Colon hydrotherapy" means the performance of enemas or colonic irrigation.
"Common diagnostic procedures" means the use of venipuncture consistent with the practice of naturopathic medicine, commonly used diagnostic modalities consistent with naturopathic practice, health history taking, physical examination, radiography, examination of body orifices excluding endoscopy, laboratory medicine, and obtaining samples of human tissues, but excluding incision or excision beyond that which is authorized as a minor office procedure.
"Department" means the department of health.
"Educational program" means an accredited program preparing persons for the practice of naturopathic medicine.
"Homeopathy" means a system of medicine based on the use of infinitesimal doses of medicines capable of producing symptoms similar to those of the disease treated, as listed in the homeopathic pharmacopeia of the United States.
"Hygiene and immunization" means the use of such preventative techniques as personal hygiene, asepsis, public health, and immunizations, to the extent allowed by rule.
"Manual manipulation" or "mechanotherapy" means manipulation of a part or the whole of the body by hand or by mechanical means.
"Minor office procedures" means primary care services; procedures incident thereto of superficial lacerations, lesions, minor injuries, and the removal of foreign bodies located in superficial structures, not to include the eye; and the use of antiseptics and topical or local anesthetics in connection therewith. "Minor office procedures" also includes injections and topical applications of substances consistent with the practice of naturopathic medicine and in accordance with rules established by the board.
"Naturopath" or "naturopathic physician" mean an individual licensed under this chapter.
"Naturopathic medicines" means vitamins; minerals; botanical medicines; homeopathic medicines; hormones; and other nutrients, compounds, and natural substances consistent with naturopathic medical practice .
"Nutrition and food science" means the prevention and treatment of disease or other human conditions through the use of foods, water, herbs, roots, bark, or natural food elements.
"Physical modalities" means use of physical, chemical, electrical, and other modalities including, but not limited to, heat, cold, air, light, water in any of its forms, sound, massage, durable medical equipment, and therapeutic exercise.
"Radiography" means the ordering, but not the interpretation, of radiographic diagnostic and other imaging studies and the taking and interpretation of standard radiographs.
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"Suggestion" means techniques including but not limited to counseling, biofeedback, and hypnosis.
Naturopathic medicine is the practice by naturopathic physicians of the art and science of the diagnosis, prevention, and treatment of disorders of the body by stimulation or support, or both, of the natural processes of the human body. A naturopathic physician is responsible and accountable to the consumer for the quality of naturopathic care rendered.
The practice of naturopathic medicine includes manual manipulation (mechanotherapy), the prescription, administration, dispensing, and use, except for the treatment of malignancies, of nutrition and food science, physical modalities, minor office procedures, homeopathy, naturopathic medicines, legend and nonlegend drugs and controlled substances contained in Schedules II through V of the uniform controlled substances act, chapter 69.50 RCW, hygiene and immunization, contraceptive devices, common diagnostic procedures, and suggestion; however, nothing in this chapter shall prohibit consultation and treatment of a patient in concert with a practitioner licensed under chapter 18.57 or 18.71 RCW. No person licensed under this chapter may employ the term "chiropractic" to describe any services provided by a naturopathic physician under this chapter.
It shall be unlawful for any person to sell, deliver, or possess any legend drug except upon the order or prescription of a physician under chapter 18.71 RCW, an osteopathic physician and surgeon under chapter 18.57 RCW, an optometrist licensed under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a naturopathic physician under chapter 18.36A RCW, a veterinarian under chapter 18.92 RCW, a commissioned medical or dental officer in the United States armed forces or public health service in the discharge of his or her official duties, a duly licensed physician or dentist employed by the veterans administration in the discharge of his or her official duties, a registered nurse or advanced registered nurse practitioner under chapter 18.79 RCW when authorized by the nursing care quality assurance commission, a pharmacist licensed under chapter 18.64 RCW to the extent permitted by drug therapy guidelines or protocols established under RCW 18.64.011 and authorized by the commission and approved by a practitioner authorized to prescribe drugs, a physician assistant under chapter 18.71A RCW when authorized by the Washington medical commission, or any of the following professionals in any province of Canada that shares a common border with the state of Washington or in any state of the United States: A physician licensed to practice medicine and surgery or a physician licensed to practice osteopathic medicine and surgery, a physician licensed to practice naturopathic medicine, a dentist licensed to practice dentistry, a podiatric physician and surgeon licensed to practice podiatric medicine and surgery, a licensed advanced registered nurse practitioner, a licensed physician assistant, or a veterinarian licensed to practice veterinary medicine: PROVIDED, HOWEVER, That the above provisions shall not apply to sale, delivery, or possession by drug wholesalers or drug manufacturers, or their agents or employees, or to any practitioner acting within the scope of his or her license, or to a common or contract carrier or warehouse operator, or any employee thereof, whose possession of any legend drug is in the usual course of business or employment: PROVIDED FURTHER, That nothing in this chapter or chapter 18.64 RCW shall prevent a family planning clinic that is under contract with the health care authority from selling, delivering, possessing, and dispensing commercially prepackaged oral contraceptives prescribed by authorized, licensed health care practitioners: PROVIDED FURTHER, That nothing in this chapter prohibits possession or delivery of legend drugs by an authorized collector or other person participating in the operation of a drug take-back program authorized in chapter 69.48 RCW.
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A violation of this section involving the sale, delivery, or possession with intent to sell or deliver is a class B felony punishable according to chapter 9A.20 RCW.
A violation of this section involving possession is a misdemeanor.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.