Download Safely Practicing in Unlicensed States.

The Practice of Naturopathic Medicine in Unlicensed States
First, you need to determine if the practice of Naturopathy or Naturopathic Medicine is considered “practicing medicine” in your state. If
it is, you have to be very careful. If not, you have a greater degree of leeway. An attorney can answer this question for you or you can try
and look over the statues yourself. I suggest a quick consult with your attorney.
Here are some basic guidelines based on the strictest state in the US, Florida. But, alwa ys be sure you have checked out what you plan to
do, anything you want to say, print or advertise, with an attorney for your specific state.
Category
IF Naturopathy / Naturopathic Medicine IS considered
practicing medicine in your state:
IF Naturopathy / Naturopathic Medicine IS NOT
considered practicing medicine in your state:
Title
You can use the title ND, Naturopath and Naturopathic Doctor
if it is for your bio, when you are lecturing or speaking to large
groups, as a listed member of state and national associations
and if you teach.
You can use the title ND, Naturopath and Naturopathic Doctor
if it is for your bio, when you are lecturing or speaking to large
groups, as a listed member of state and national associations
and if you teach. You may be able to use the title ND after
your name in relationship to your practice.
Your title, at no time, can be used to imply that you are
engaged in the practice of medicine. So, when working with a
patient or client, you cannot use Naturopathic Doctor,
although many NDs do and have done so for years (but not in
FL ).
You should not state that you are licensed in any state, other
than in your bio, because it implies that you have reciprocal
rights to practice in the state.
It is critical to avoid the use of any words that imply the
practice of medicine and/or naturopathy. Do not use the
term “Naturopathic” with or without “Medicine” and do not
use “Doctor” when referring to yourself except in your bio.
Healthcare consultant, practitioner or wellness
coach/consultant are all titles ND’s can use.
It is likely that you can use your title to imply you are
practicing Naturopathy or Naturopathic Medicine.
It is likely ok to state you are licensed in another state.
It is likely ok to use the term Naturopathic Medicine as well as
Naturopathic Doctor practicing Naturopathic Medicine.
Healthcare consultant, practitioner or wellness
coach/consultant are all titles ND’s can safely use.
Double check with your attorney on all these points.
Charting
Typically only the “S” is charted. No “O”, “A” or “P”. In place
of the “P” is a “LR” or Literature Review.
DO NOT use any language that implies diagnosis or treatment,
or the practice of medicine or naturopathy in general. The
words “evaluate, assess, recommendation, suggestion,
treatment, plan, protocol, prescription or exam” cannot be
used since they all suggest the practice of medicine.
Generally acceptable language includes “consultation, options
and choices.”
A previous diagnosis from a client’s licensed provider can be
used. Make note of the licensed practitioner’s name and
contact information somewhere in your chart notes. If a
client does not have a diagnosis, recommend that they seek
the care of a licensed practitioner in order to attain a
diagnosis. You can also make note of any condition a client
“thinks” they have and then advise them and chart that you
have advised them to see a licensed healthcare provider for
the correct assessment. Make sure items discussed are
charted.
Treatment Plans
Referrals
This can really vary from state to state and you are highly
encouraged to go over this with an attorney. It is absolutely
ok to chart the “S”. It may be ok to chart the other sections as
you normally would, but you might have to avoid certain
terms as in “prescribe”. You will also have to be careful what
you are giving opinion about and what you are making
recommendations about – for instance, you most likely cannot
diagnose a mainstream condition.
A previous diagnosis from a client’s licensed provider can be
used. Make note of the licensed practitioner’s name and
contact information somewhere in your chart notes. If a
client does not have a diagnosis, recommend that they seek
the care of a licensed practitioner in order to attain a
diagnosis. You can also make note of any condition a client
“thinks” they have and then advise them and chart that you
have advised them to see a licensed healthcare provider for
the correct assessment. Make sure items discussed are
charted.
You may talk about products and treatments that have helped
people with certain conditions. An appropriate statement
could read “Individuals previously diagnosed with “xyz”
condition have been helped by “xyz” product. These should be
given out with a written disclaimer that all recommendations
are to be discussed with a primary care physician before
implementing. See sample report. You may want to take it a
step further and fax or otherwise provide the PCP with a copy
of the report directly.
It is likely you can give a Naturopathic Treatment plan – but
be careful in making any recommendations about medications
without asking them to consult with their PCP.
Technically you can not make referrals since referrals are
recommendations between licensed health care providers. In
You may be able to make referrals to licensed healthcare
professionals as well as to other types of health professionals.
To be safe, you can follow the guidelines in the box to the left
– but an attorney will let you know what you can do in regards
to providing treatment plans.
fact, licensed providers can get reprimanded for accepting
referrals from non-licensed practitioners.
Double check with your attorney.
You can, however, make recommendations of who you would
refer them to – as long as it is in the report you furnish them
which they are supposed to discuss with their PCP.
Malpractice
Insurance
Informed
Consent
Lab Tests
Physical Exam
Malpractice insurance in a licensed state will not cover
activities in an unlicensed state. It is normal business practice
to carry business liability insurance for an office, however, this
is not malpractice insurance. Malpractice insurance covers a
licensed doctor who is practicing medicine in the jurisdiction
in which he or she is licensed. Although there are two
companies that market malpractice insurance for ND’s in
unlicensed states, the AANP has sought legal advice on this
and it does not appear to be relevant to carry this without a
recognized scope.
It is suggested that ND’s use an informed consent form to
inform clients that ND’s are not licensed to and are not
practicing medicine. At this time, there is no confirmation that
the use of an informed consent form would protect ND’s in
any court of law.
Ordering lab tests and performing physical exams is
considered practicing medicine because they are used for
diagnosing conditions. Therefore, you cannot legally order
labs or perform physical exams. ND’s attempting to order labs
are vulnerable to action against them. Clients should be
referred to their medical providers for lab tests and physical
exams. Clients can order their own labs for informational
purposes from places like Great Plains lab, ZRT,
www.anylabtest.com or www.directlabs.com since they have
in-house doctors.
No.
Malpractice insurance in a licensed state will not cover
activities in an unlicensed state. It is normal business practice
to carry business liability insurance for an office, however, this
is not malpractice insurance. Malpractice insurance covers a
licensed doctor who is practicing medicine in the jurisdiction
in which he or she is licensed. Although there are two
companies that market malpractice insurance for ND’s in
unlicensed states, the AANP has sought legal advice on this
and it does not appear to be relevant to carry this without a
recognized scope.
Also helpful to use an informed consent form that NDs are
licensed. It may facilitate communication between
Naturopathic Doctors and their clients regarding the services
that are not provided by ND’s in the state and the importance
of maintaining medical care with a primary care physician.
May be able to open provider accounts at local hospital
laboratories or other Lab company. May not use the results to
make a mainstream diagnosis, but could use lab tests to refer
them back to their PCP with a suspicion of “XYZ”.
It should be clearly stated in the law as to whether you can
order lab tests or not. Check with your attorney.
Maybe, have this checked out. It depends on how the medical
practice act in your state is written. Some states you can,
Use of
Naturopathic
Modalities
Naturopathic Doctors can provide information (ex., results of
studies) regarding nutrition, nutritional supplements,
homeopathic remedies (ex. provings for educational
purposes) and botanical medicines (research and traditional
uses).
some you cannot.
It varies so much by state that I will not even attempt to say
what you can and can not do in regards to these modalites.
Check with your attorney.
Naturopathic Doctors in unlicensed states cannot usually use
prescriptive therapies or perform hydrotherapy, office
procedures, injections and/or naturopathic physical medicine.
At no time can an ND touch a person, do any exam,
assessment, test or treatment. Remember, ND’s are sources
of information but not medical practitioners in those states
Some final thoughts regardless of whether you practice in an licensed or unlicensed state:
 The phrase “Board Certified” is not accurate unless you are certified within one of our naturopathic specialties, such as Onc ology
or Obstetrics. Taking NPLEX does not constitute “board certified." If you are in an unlicensed state, this should only be listed in
your bio since it would imply rights to practice in a state.
 Maintaining the most current research available on different natural products or natural therapies allows you to conduct
literature reviews with clients desiring consultations for their varying health conditions.