California Senate Bill 538, which would liberalize naturopathic prescribing privileges, is now in its eighth version, having been amended — once again — in the Assembly just this past week. Since introduction last year, SB 538 has seesawed between substantial expansion of naturopathic scope of practice and near-defeat, indicative of the controversy that exists over just what naturopaths should be allowed to do in their practices.
Under current law, naturopaths can prescribe drugs only under medical or osteopathic physician supervision. If the drug is on California's Schedule III, IV or V list, further restrictions apply. (Scheduled drugs have a higher potential for abuse and it is illegal to possess them without a prescription.) As originally introduced, physician supervision would have been removed altogether. As well, naturopaths would have been able to perform and interpret (not just order) diagnostic imaging studies, use parenteral therapy, and perform minor office surgery. Those privileges were substantially pared as the bill moved through the legislative process. Physician supervision over some prescribing was restored and other practice expansions eliminated. At one point, the bill was voted down in an Assembly committee, only to be granted reconsideration.
In the version prior to the current one, physician supervision was maintained, but only for one year. Supervision was waived if the naturopath had completed a "residency," even if no drug prescribing was included in training, or the naturopath had practiced in one of the handful of states where they have prescription privileges.
The current version restores physician supervision over Schedule III and IV drugs pursuant to a standardized procedure or protocol. "When there is uncertainty about the naturopathic doctor furnishing the order," a pharmacist can demand the naturopath's physician-approved standardized procedure or protocol. Also restored is periodic review of the naturopath's competence by the supervising physician.
As Britt Hermes explains in her recent article in Forbes, "Are California Lawmakers Gullible Enough To Allow Naturopaths To Prescribe Drugs?," naturopaths want to get rid of physician supervision because enough MDs and DOs don't want to take on that role. Malpractice insurers are unwilling to cover physician supervision. So, the unwillingness of physicians and their malpractice carriers to take on the risk of supervision is a justification for increasing the patient risk by removing their supervision?
Unfortunately, as with previous iterations of SB 538, naturopaths would be able to independently prescribe non-scheduled (excluding chemotherapy) and Schedule V drugs after one year of physician supervision, except where waived due to "residency" or prescribing privileges in another state.
Hermes uses her insider's knowledge of naturopathic education and training to argue that naturopaths should not be allowed to prescribe at all. As she points out in her Forbes article, naturopaths have fewer classroom hours in pharmacology than physician assistants, who can practice only under physician supervision. This pales in comparison to the time naturopaths spend learning pseudoscience like homeopathy in school. Naturopathic clinical training, which must be crammed into their four years of school, includes little, if any, opportunity to prescribe. The handful of so-called naturopathic "residencies" do not remediate the problem as they suffer from the same lack of opportunity.
SB 538 specifically allows naturopaths to independently prescribe natural and synthetic hormones, the necessity of which will undoubtedly be identified through bogus diagnostic testing. Under current law, they can prescribe vitamins, minerals, glutathione, botanicals and homeopathic remedies and administer these substances IV, among other routes of administration, giving them the authority to inject patients with unproven concoctions of vitamins, minerals and other substances, like Myers cocktails. However, the bill limits them to substances "chemically identical to those for sale without a prescription."
California law currently requires the Naturopathic Medicine Committee of the state Osteopathic Medical Board to "certify that the naturopathic doctor has satisfactorily completed adequate coursework in pharmacology" to prescribe. That requirement remains under SB 538, although existing regulations can be met with only 48 hours of coursework, which can be completed at a naturopathic school. There is no test to determine actual competency to prescribe.
The bill now goes to its third reading before the Assembly. If it passes, SB 538 will have to go back to the Senate for approval because the Assembly version is different than the bill passed by the Senate. All of this must occur in less than two weeks, as the California legislature is set to adjourn on August 31st.