Oregon bill shows full impact of allowing naturopaths to practice primary care

Oregon bill shows full impact of allowing naturopaths to practice primary care

The American Association of Naturopathic Physicians has reached its nationwide goal of full primary care physician scope of practice for naturopathic "doctors" in only one state: Oregon. But Oregon naturopaths have discovered that merely expanding their scope of practice act to make them the putative equal of an MD or DO primary care practitioner (albeit a 3-year residency and over 15,000 hours short in education and training) didn't get them where they wanted.

A health care practitioner's scope of practice is established in a discrete statute referred to as a "practice act." These laws usually describe the qualifications for licensing, what sort of body will regulate them, what they can and cannot do in practice, grounds for discipline, and like matters. But, typically, there are many other references to health care practitioners scattered throughout the corpus of a state's laws. These laws cover, for example, what type of practitioner can perform school physicals or examine children for signs of abuse.

Thus, while Oregon's naturopathic practice act may give naturopaths the broadest scope of practice in the country, other of the state's laws don't include them as practitioners who can legally do the things they want to do. So, this year, compliant Oregon legislators have introduced several bills to close the gap. One would allow naturopaths and chiropractors to return student athletes to play following a concussion. Another would allow naturopaths to perform office surgery, the scope of which will be determined solely by the Oregon naturopathic board.

But the bill I'd like to focus on here is one that clearly illuminates what it really means to fulfill the AANP's goals: Senate Bill 856, which passed in the Senate and is now before the House Health Care Committee. The bill would include naturopathic "physicians," as Oregon allows naturopaths to call themselves, in a number of state statutes which formerly authorized only science-based practitioners, like MDs, DOs, DPMs and nurse practitioners, to perform certain functions.

As Laura Farr, Executive Director of the Oregon Association of Naturopathic Physicians, testified before a legislative committee, SB 856 doesn't expand naturopathic scope of practice.

"Our scope . . . has evolved significantly over the years . . .Unfortunately, hundreds of statutes other than the one governing naturopathic scope of practice have not been updated to match the practice scope of naturopathic physicians. SB 856 would fix that."

She's right. SB 856 would "fix that," and, in doing so, brings into chilling focus just exactly what it means to license naturopaths as primary care physicians.  As such, it is a cautionary tale for legislators in other states who are hearing the naturopathic sales pitch for licensing. This is what they really want. Here's just a sampling of what naturopaths would be allowed to do if SB 856 becomes law:

  • Decide whether an incompetent patient meets the requirements for refusing further treatment at the end of life
  • Sign off on a patient's refusing life-sustaining treatment
  • Examining children in protective custody
  • Examining people with mental illness and developmental disabilities
  • Providing emergency care
  • Administration of medicine in schools
  • Verification of physician for leave after patient's bone marrow transplant
  • Health assessments for children in special education services

At a hearing on the bill, a special education teacher testified in favor of it. The teacher was evaluating a 5-year-old child for autistic spectrum disorder eligibility for the Portland school district. Under state law, the child needed a document signed by a physician, nurse practitioner or physician's assistant, citing any suspected or known physical, health or medical conditions. The teacher said the child had been seen by a naturopathic doctor for several years who has documented the child's developmental history as well as his own history of concerns. However, the naturopath was not authorized under state law to sign the child's health assessment. The teacher lamented the fact that the child would have to see a real medical doctor for evaluation under state law.

Former naturopath Britt Hermes has detailed how naturopaths exploit autistic children and their parents with dubious tests indicating an equally dubious need for dietary supplements, which the naturopath then sells to the parent. Any ethical naturopath who suspects a child may be on the autism spectrum should refer the child to a pediatrician. But they don't. Naturopaths arrogantly maintain they have the education and training to manage autistic spectrum children, even though it is entirely possible that they've never seen a single example during their woefully inadequate training. Oregon's current requirement that the child have contact with reality-based medical practitioner means there is some chance he will get a proper medical evaluation and evidence-based care. That won't happen if naturopaths are allowed to sign off on health assessments.

SB 856 gives the public the false impression that naturopaths are properly educated and trained to perform the important tasks the bill would allow them to do, like examining mentally and developmentally impaired patients and managing end-of-life care. They are not. Their schools don't even properly prepare them to practice rudimentary primary care. Giving naturopaths the authority to manage patients with complicated health problems can only exacerbate the already unfortunate situation in Oregon.

Points of Interest 04/30/2017
Points of Interest 04/29/2017