Panel rejects new prescribing authority for naturopathic physicians
By Neal P. Goswami
VERMONT PRESS BUREAU | September 23,2013
MONTPELIER — A set of rules proposed by the Secretary of State’s Office of Professional Regulation to revise the prescribing authority of naturopathic physicians has been rejected, at least temporarily, by a legislative panel.
The Administrative Rules Committee, following a hearing Thursday, rejected the proposal by OPR after finding that procedural mistakes were made during the rule-making process.
The proposed new rules are the result of recent changes to a law governing naturopathic physicians, who typically use natural, holistic remedies to treat patients. They are currently granted limited prescribing authority in Vermont.
The Vermont Legislature passed Act 116 last year revising the prescribing authority of naturopathic physicians, who are not considered medical doctors. The law created a special license endorsement authorizing them to prescribe, dispense, and administer prescription medicines. It eliminates the formulary in place that currently allows naturopaths to prescribe some medications.
A “formulary” is a list of drugs the practitioner is allowed to prescribe based on his or her education and training.
Vermont Medical Society Executive Vice President Paul Harrington said the proposed rules would allow naturopathic physicians to prescribe all drugs, including narcotics, without limitation. The society does not believe they have the education or clinical experience to be granted that authority, he said.
Mike Jawer, director of government and public affairs for the American Association of Naturopathic Physicians, said the scope of practice for naturopaths varies from state to state. Vermont, however, is among a handful of states that grant broad powers.
“Vermont is not unique. It’s in a class with several other states as far as having a pretty wide scope (of practice),” he said.
Naturopaths do receive education and training on prescribing medications, Jawer said, but they tend to focus on natural healing agents instead.
“They do train in naturopathic medical school to be able to dispense medications, and in effect do practice as primary care physicians. They don’t always get that opportunity in every state,” he said.
According to the AANP website, naturopaths treat all medical conditions, including cancer.
Vermont Health Commissioner Dr. Harry Chen said Friday the proposed rules would not expand the scope of practice for naturopaths in Vermont. Although the formulary that limits their prescribing authority is being removed, naturopaths will still only be able to prescribe medications within their current scope of practice.
“This is not expanding the scope of practice for naturopaths. Naturopaths have their own scope of practice and they’re professionals,” he said. “They are trained and educated to do certain things. What we expect, just like we expect with dentists or podiatrists, is that they are going to practice within their scope.”
So, Chen said, a naturopath could prescribe pain medications if they were properly trained but would be “more likely to turn to other modalities.”
According to Act 116, once rules are approved a license endorsement to prescribe medication will be available in Vermont to naturopaths who pass a naturopathic pharmacology exam. The law required the director of OPR to consult with and receive recommendations from Chen on rules regulating the endorsement.
Act 116 also required a report by OPR to include specific findings on whether naturopathic physicians receive “sufficient academic training in pharmacology and clinical training” to safely prescribe a full range of drugs. The report was to be done in consultation with clinical pharmacists and pharmacologists, as well as the University of Vermont College of Medicine.
Curtis Benjamin, counsel for OPR, told the Administrative Rules Committee Thursday that the office’s report found that naturopathic physicians should be allowed to prescribe medication “within their scope of practice.”
However, he also told the committee that clinical pharmacists were not consulted as the law required because he was unaware there was a difference between pharmacists and clinical pharmacists. Still, Benjamin said the report created by OPR included requisite information from medical professionals.
“That group was consulted with, other than that clinical pharmacist piece,” he said. “I believe we have received comments from these professionals and taken them into consideration.
Lawmakers were skeptical. Committee Chairman Sen. Mark MacDonald, D-Orange, commended Benjamin on his “skillful arguments,” but said administrations often try to convince the panel that oversights in the rule-making process are not a problem.
“That’s what they do. That’s why we’re here,” MacDonald said.
Benjamin told the committee that the Vermont Medical Society was willing to withdraw its objection to the new rules if a committee was created to review and meet the requirements of Act 116. The committee was to include two naturopathic physicians, two medical doctors, a clinical pharmacist and a patient.
“The Vermont Medical Society … and (Health Commissioner Harry Chen) believe this is the best way to move forward,” he told the committee.
Madeline Mongan, vice president of policy for VMS, told the committee that VMS was willing to move forward with the proposed committee, but still had significant concerns with the rules, including the examination in place for naturopaths to obtain a prescribing license endorsement.
“There is an exam in effect right now and we have, just, incredible concerns about that exam,” Mongan said.
Chen, despite the committee’s rejection of the rules based on procedure, said he believes OPR’s report addressed the Legislature’s request.
“Their report certainly outlined the process and I certainly think it’s consistent with the intent of the Legislature,” Chen said.
Sen. Peg Flory, R-Rutland, the most outspoken member of the committee on Thursday, made the motion Thursday to reject the proposed rules and require OPR to complete its report as called for in Act 116.
“I’m trying to figure out where the harm would be in waiting until that’s done. I can see where the harm would be in allowing this, inappropriately, perhaps,” Flory said. “I have high hopes that this group will be able to come forward next year or whenever with a mechanism that we can approve and not worry whether we made a mistake.”