2014: A losing legislative season for naturopaths, chiropractors and acupuncturists

2014: A losing legislative season for naturopaths, chiropractors and acupuncturists

In 2014, SFSBM's "Legislative Updates" tracked 35 bills impacting, for better or worse, CAM practitioners: naturopaths, chiropractors, acupuncturists, TCM and "alternative medicine practitioners."  It was a losing season for them, a winning season for us.  Let's review.

Naturopaths attempted to gain licensing with a broad scope of practice in 10 states. They want to be licensed as primary care physicians in all 50 states and their 2014 licensing bills reflected this desire.  They failed in 9. One bill, in New Jersey, remains pending because New Jersey is one of only 2 states (Virginia is the other) where 2014 bills carry over to the 2015 sessions.  Maryland did pass a licensing act, but it fell short of the PCP scope of practice (including drug prescribing privileges) naturopaths wanted.  Nor did they get their own regulatory board.  They will operate under the jurisdiction of the Maryland Board of Physicians.  In the 8 other states where licensing legislation was introduced, including New York, Pennsylvania, Michigan and Massachusetts, naturopathic licensing bills failed, and not for the first time.  

Naturopaths did get an expansion of their scope of practice in Connecticut, but, again, did not get prescribing privileges. In Arizona, they will now be able to practice "telemedicine," and in Utah, they will be able to perform minor office procedures and inject local anesthetics, nonscheduled prescription drugs and "natural substances" percutaneously in limited locations.  

On the other hand, a bill that would have eliminated important restrictions on naturopaths treating pediatric patients did not pass in Colorado, where they are barred from treating children under 2.  For patients under 8, they must advise parents about the CDC-recommended vaccination schedule, tell parents that they are not physicians, and advise them to have a relationship with a licensed pediatric health care provider. Those restrictions remain in place. A bill in Hawaii increased their continuing education requirements. 

 Chiropractors are already licensed in all 50 states but they want more. They didn't get it, for the most part, in 2014.  In Minnesota, chiropractors can now "detect" the non-existent "subluxation" with CAT and PET scans and MRIs.  They will also be able to use acupuncture with additional training.  Another victory for chiropractic, but not patients, was gained when an Oklahoma bill requiring chiropractors to obtain written consent from patients prior to cervical manipulation, disclosing risks and possible side effects, including the risk of stroke, failed. 

Otherwise, nothing much went their way.  New Mexico has the most liberal (by far) chiropractic practice act in the country.  Yet, even New Mexico has its limits.  A bill was introduced allowing certain chiropractors who had dubious additional education and training to prescribe, inject and dispense dangerous drugs if the chiropractic board, in consultation with, but not necessarily with the approval of, the pharmacy board, gave its ok.  The bill was "postponed indefinately" and died when the legislature adjourned. Bills to expand the chiropractic scope of practice didn't pass in Hawaii and Wisconsin either.  And a bill in Wisconsin did manage to increase their responsibilities to patients by requiring informed consent, although it uses a "reasonable chiropractor" (instead of a "reasonable patient") standard to determine what must be disclosed.

Chiropractors also attempted to limit the competition with a bill preventing physical therapists from performing joint manipulations (in California) and physical therapists (in Washington) struck back with a bill that specifically allows PTs to do the same.  It was a double loss for chiropractors and a double win for patients.  The California bill didn't pass; the Washington bill did.  Other attempts to improve the chiropractic bottom line failed as well.  A bill in Washington would have prevented "discrimination" against chiropractors and allowed them to perform physicals for school athletics and commercial drivers licenses.  A bill in New York would mandate that chiropractors perform scoliosis screening on students in the 3rd, 6th and 9th grades.  And a bill in Wisconsin would expand their scope of practice to include acupuncture. None of those bills passed. 

Acupuncture and TCM didn't accomplish much either in 2014.  The only bright spot was Pennsylvania, and even that was a mixed bag.  As it stands, an acupuncturist must refer a patient to a physician if he treats a patient's "condition" (undefined) for more than 60 days.  He must still do so under a new law that passed, but is exempt from the requirement if the patient does not present with a "condition" (still undefined). On the plus side, acupuncturists must now carry at least $1 million in liability insurance.

Other than that, the acupuncturists couldn't get anything favorable passed.  Not a practice act (Alabama), not a "review board" to consider whether they should be licensed (Louisiana), not a practice expansion (Arizona, Mississippi), not even a "commission on acupuncture and wellness" to consider how to "integrate" acupuncture into state health care.  Nor could they get a bill passed in California creating a "Traditional Chinese Medicine Traumatologist" certification.  What is "Traditional Chinese Medicine Traumatology," you ask?  It's a system of treating musculoskeletal conditions by stimulation of "acupressure points" to "open the body's defensive chi and stimulate energy movement in the meridians."  Let's give credit where credit is due.  Even the California Legislature saw through this one. Or maybe not.  Maybe they just ran out of time.  

Finally, the woo-iest of the woo practitioners couldn't eliminate restrictions on their practice in Colorado.  Last year, Colorado passed a bill letting pretty much anyone treat anybody with "alternative medicine."  As is true of the Colorado naturopathic licensing act, there are safeguards for children, so even if parents are credulous enough to see one of these practitioners, their opportunity to get their hands on the children is limited.  A bill to eliminate these restrictions didn't pass.  One wonders if Colorado is experiencing a bit of CAM buyer's remorse. 

It's been a winning legislative season for science-based medicine.  But don't get too comfy.  All 50 states will hold legislative sessions in 2015, and over half of those will carry over bills introduced in 2015 to 2016.  The naturopaths, chiropractors, acupuncturists and TCM practitioners will be at it again. We'll be watching.

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