Hello again, today’s scenario focuses on a large health and wellness center that integrates IV therapies and deploys a naturopathic doctor (ND) supervising nurses.

I’m Michael H. Cohen, founding attorney of Cohen Healthcare Law Group. We help healthcare industry clients like you, navigate healthcare and FDA legal issues so you can launch, or grow and scale your healthcare business.

Let’s start with the statutory definition of ND so we can understand what an ND can and can’t do.  In California, for one example, Business & Professions Code Section 3613(c) defines “naturopathic medicine” as: “a distinct and comprehensive system of primary health care practiced by a naturopathic doctor for the diagnosis, treatment, and prevention of human health conditions, injuries, and diseases.”

NDs, as primary care providers trained and licensed to diagnose and treat conditions and diseases, are allowed to perform a wide variety of services, including: Perform physical exams; Order lab tests as well as diagnostic imaging studies; Dispense, order, prescribe, and furnish or perform a variety of procedures including dietary supplements, and nonprescription drugs (as defined under federal law), as long as consistent with routes of administration designated by law.

As long as services are within the ND’s scope of practice: “A naturopathic doctor may utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular.”  There you go, TMI.

The statute also sets forth requirements for the ND to qualify to administer IV therapy, and the requirements for documentation in the patient record.

The important glitch here to notice, is that the ND Act does not authorize a naturopathic doctor to practice “conventional medicine.”  More specifically, Business & Professions Code Section 3642 sets forth certain activities prohibited to the naturopathic doctor, like prescribing, dispensing, or administering a controlled substance, except as authorized. And the supervision by an MD or DO for ordering drugs, reliance on standardized procedures or protocols, and availability of the supervising physician by telephone.

There are a few exceptions, like the use of an epi pen, prescription of hormones, and use of botanicals.

By comparison, in contrast, a registered nurse may dispense drugs or a device, only upon an order by a licensed physician and surgeon, or a certified nurse-midwife, nurse practitioner, or physician assistant.

The ND Act in California does not authorize Naturopathic Doctors to write orders for or supervise registered nurses, physician, or medical assistants (That might surprise you!).

Aiding and abetting unlicensed persons in the practice of naturopathic medicine in California and assisting in the violation or conspiring to assist in violating the ND Act are defined as unprofessional conduct, the same as violating the medical practice act.

The bottom line is that even if an MD runs the overall center, the ND has to strictly follow certain rules, otherwise the MD could be at risk for aiding and abetting unlicensed conventional medical practice.

Nurses, as mentioned, they got to follow standardized procedures, and there are legal rules that spell out at least 11 different components that standardized procedures have to contain.

Thanks again for watching. Please contact us with your questions. We have helped so many healthcare industry clients just like you build their dream.  We look forward to working with you on your journey to success!