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SB1178 - 572R - H Ver
House Engrossed
Senate Bill
naturopathic
physicians; drug administration
State of Arizona
Senate
Fifty-seventh Legislature
Second Regular Session
2026
SENATE BILL 1178
AN
ACT
Amending sections 32-1501 and 32-1504,
Arizona Revised Statutes; relating to the naturopathic physicians medical
board.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Section 32-1501, Arizona Revised
Statutes, is amended to read:
START_STATUTE
32-1501.
Definitions
In this chapter, unless the context otherwise requires:
1. "Accepted therapeutic purpose" means
treatment of a disease, injury, ailment or infirmity that is competent and
generally recognized as safe and effective.
2. "Active license" means a current valid
license to practice naturopathic medicine.
3. "Adequate medical records" means
legible medical records containing, at a minimum, sufficient information to
identify the patient, support the diagnosis, describe the treatment, accurately
document the results, indicate advice and cautionary warning provided to the
patient and provide sufficient information for a similarly qualified
practitioner to assume continuity of the patient's care at any point in the
course of treatment.
4. "Approved clinical training program" or
"clinical training program" means a program for naturopathic medical
students in which the training occurred or is being conducted by or in
conjunction with an approved school of naturopathic medicine.
5. "Approved internship program" or
"internship" means that the program in which the training occurred or
is being conducted has been approved for internship training for physicians or
for graduates of a school of naturopathic medicine by the board or was approved
or accredited by an educational or professional association recognized by the
board or by another state's or country's licensing agency recognized by the
board.
6. "Approved postdoctoral training" or
"postdoctoral training" means that the program in which the training
occurred or is being conducted has been approved for specialty training or for
graduate medical education in naturopathic medicine by the board or approved or
accredited by an educational or professional association recognized by the
board or by another state's or country's licensing agency recognized by the
board.
7. "Approved preceptorship program" or
"preceptorship" means that the program in which the training occurred
or is being conducted has been approved for preceptorship training for
physicians or for graduates of a school of naturopathic medicine by the board
or was approved or accredited by an educational or professional association
recognized by the board or by another state's or country's licensing agency
recognized by the board.
8. "Approved school of naturopathic
medicine" or "school of naturopathic medicine" means a school,
college or university determined by the board to have
an
a degree-granting, doctoral-level naturopathic medical
educational
program that
meets standards prescribed by the council on
naturopathic medical education, or its successor agency, and that offers a
course of study
requires didactic and supervised clinical
training and
that, on successful completion, results in the awarding of
the degree of doctor of naturopathic medicine and whose course of study is
either
any
of the following:
(a) Accredited or a candidate for accreditation by
an accrediting agency recognized by the United States secretary of
education as a specialized accrediting agency for schools of naturopathic
medicine
the council on naturopathic medical education
or
its
a
successor
or
comparable accrediting agency
.
(b) Accredited or a candidate for
accreditation by an accrediting agency recognized by the council for higher
education accreditation or its successor.
(
b
) Provided by
an institution of higher education that is accredited or a candidate for
accreditation by an institutional accrediting agency recognized by the United
States secretary of education or the council for higher education accreditation,
or its successor, or any comparable federally recognized national quality-assurance
body.
(
c
) From a
diploma-granting, degree-equivalent institution of higher education
in Canada that offers a full-time, structured curriculum in basic
sciences and supervised patient care comprising a doctoral naturopathic medical
education that requires at least one hundred thirty-two weeks of
coursework to be completed within a period of thirty months, that is in good
standing with the board and that has programmatic accreditation by the council
on naturopathic medical education or a successor or comparable accrediting
agency.
9. "Board" means the naturopathic
physicians medical board.
10. "Chelation therapy" means an
experimental medical therapy to restore cellular homeostasis through the use of
intravenous, metal-binding and bioinorganic agents such as ethylene
diamine tetraacetic acid. Chelation therapy does not include experimental
therapy used to treat heavy metal poisoning.
11. "Completed application" means that the
applicant paid the required fees and supplied all documents and information as
requested by the board and in a manner acceptable to the board.
12. "Controlled substance" means a drug,
substance or immediate precursor in schedules I through V of title 36, chapter
27, article 2 or the rules adopted pursuant to title 36, chapter 27, article 2.
13. "Direct supervision" means that a
physician who is licensed pursuant to this chapter or chapter 13, 17 or 29 of
this title:
(a) Is physically present and within sight or sound
of the person supervised and is available for consultation regarding procedures
that the physician has authorized and for which the physician remains
responsible.
(b) Has designated a person licensed pursuant to
this chapter or chapter 13, 17 or 29 of this title to provide direct
supervision in the physician's absence.
14. "Doctor of naturopathic medicine" or
"doctor" means a natural person who is licensed to practice
naturopathic medicine under this chapter.
15. "Drug" has the same meaning prescribed
in section 32-1901 but does not include:
(a) Intravenous administration of legend drugs,
except for:
(i) Vitamins, chelation therapy
,
antibiotics, antivirals, antifungals
and drugs used in emergency
resuscitation and stabilization.
(ii) Minerals.
(iii) Nutrients. For the purposes of this item,
"nutrient" means a substance that provides nourishment for growth or
metabolism and that is manufactured and supplied for intravenous use by a
manufacturer registered with the United States food and drug administration or
compounded by a pharmacy licensed by the Arizona state board of pharmacy.
(b) Controlled substances listed as schedule I or II
controlled substances as defined in the federal controlled substances act of
1970 (21 United States Code section 802), except morphine, any drug that
is reclassified from schedule III to schedule II after January 1, 2014 and any
homeopathic preparations that are also controlled substances.
(c) Cancer chemotherapeutics classified as legend
drugs.
(d) Antipsychotics.
16. "General supervision" means that the
physician is available for consultation regarding procedures that the physician
has authorized and for which the physician remains responsible.
17. "Legend drug" means any drug that is
defined by section 503(b) of the federal food, drug, and cosmetic act and under
which definition its label is required to bear the statement "Rx
only".
18. "Letter of concern" means a
nondisciplinary advisory letter that is issued by the board to a person who is
regulated under this chapter and that states that while there is insufficient
evidence to support disciplinary action the board believes that the person
should modify or eliminate certain practices and that continuation of the
activities that led to the information being submitted to the board may result
in action against the person's license, certificate or registration.
19. "Letter of reprimand" means a
disciplinary letter that is issued by the board and that informs a person who
is regulated under this chapter that the person's conduct violates state or
federal law but does not require the board to restrict the person's license,
certificate or registration because the person's conduct did not result in harm
to a patient or to the public.
20. "Limit" means taking a nondisciplinary
action that alters the physician's practice or professional activities if the
board determines that there is evidence that the physician is or may be
mentally or physically unable to safely engage in the practice of medicine.
21. "Medical assistant" or
"naturopathic medical assistant" means a person who is certified by
the board as a medical assistant, who assists a doctor of naturopathic medicine
and who may perform delegated procedures that are commensurate with the
assistant's education and training under the direct supervision of a doctor of
naturopathic medicine and that do not include diagnosing, designing or
modifying established treatment programs or those procedures prohibited by the
board or by this chapter.
22. "Medically incompetent" means a person
who is licensed, certified or registered pursuant to this chapter and who lacks
sufficient naturopathic medical knowledge or skills, or both, to a degree that
is likely to endanger the health of patients.
23. "Natural substance" means a
homeopathic, botanical, nutritional or other supplement that does not require a
prescription pursuant to federal law before it is prescribed, dispensed or
otherwise furnished to a patient and that is prescribed by a physician who is
licensed pursuant to this chapter to enhance health, prevent disease or treat a
medical condition diagnosed by the physician.
24. "Naturopathic medical student" means a
person who is enrolled in a course of study at an approved school of
naturopathic medicine.
25. "Naturopathic medicine" means medicine
as taught in approved schools of naturopathic medicine and in clinical,
internship, preceptorship and postdoctoral training programs approved by the
board and practiced by a recipient of a degree of doctor of naturopathic
medicine
who is
licensed pursuant to this chapter.
26. "Nurse" means a person who is licensed
pursuant to chapter 15 of this title.
27. "Physician" means a doctor of
naturopathic medicine who is licensed pursuant to this chapter.
28. "Practice of naturopathic medicine"
means a medical system of diagnosing and treating diseases, injuries, ailments,
infirmities and other conditions of the human mind and body, including by
natural means, drugless methods, drugs, nonsurgical methods, devices, physical,
electrical, hygienic and sanitary measures and all forms of physical agents and
modalities.
29. "Restrict" means taking a disciplinary
action that alters the physician's practice or professional activities if the
board determines that there is evidence that the physician is or may be
medically incompetent or guilty of unprofessional conduct.
30. "Specialist" means a physician who has
successfully completed approved postdoctoral training, who is certified by a
specialty board of examiners recognized by the board and who is certified by
the board to practice the specialty pursuant to this chapter.
31. "Unprofessional
conduct" includes the following, whether occurring in this state or
elsewhere:
(a) Intentionally
disclosing a professional secret or intentionally disclosing a privileged
communication except as either of these may otherwise be required by law.
(b) Engaging in any dishonorable conduct reflecting
unfavorably on the profession.
(c) Committing a felony, whether or not involving
moral turpitude, or a misdemeanor involving moral turpitude. In
either case conviction by any court of competent jurisdiction or a plea of no
contest is conclusive evidence of the commission of the felony or misdemeanor.
(d) Habitual intemperance in the use of alcohol or
any substance abuse.
(e) Engaging in the illegal use of any narcotic or
hypnotic drugs, or illegal substances.
(f) Engaging in conduct that the board determines is
gross malpractice, repeated malpractice or any malpractice resulting in the
death of a patient.
(g) Impersonating another doctor of naturopathic
medicine or any other practitioner of the healing arts.
(h) Falsely acting or assuming to act as a member,
an employee or an authorized agent of the board.
(i) Procuring or attempting to procure a license or
a certificate pursuant to this chapter by fraud, by misrepresentation or by
knowingly taking advantage of the mistake of another person or agency.
(j) Having professional connection with or lending
one's name to enhance or continue the activities of an illegal physician or an
illegal practitioner of any healing art.
(k) Representing that a manifestly incurable
disease, injury, ailment or infirmity can be permanently cured, or falsely or
fraudulently representing that a curable disease, injury, ailment or infirmity
can be cured within a stated time.
(l) Offering, undertaking or agreeing to cure or
treat a disease, injury, ailment or infirmity by a secret means, method,
treatment, medicine, substance, device or instrumentality.
(m) Refusing to divulge to the board on demand the
means, method, treatment, medicine, substance, device or instrumentality used
in the treatment of a disease, injury, ailment or infirmity.
(n) Giving or receiving, or aiding or abetting the
giving or receiving of, rebates, either directly or indirectly.
(o) Knowingly making any false or fraudulent
statement, written or oral, in connection with the practice of naturopathic
medicine or any naturopathic treatment method.
(p) Engaging in immorality or misconduct that tends
to discredit the naturopathic profession.
(q) Having a license refused, revoked or suspended
by any other state, district or territory of the United States or any other
country, unless it can be shown that this action was not due to reasons that
relate to the ability to safely and skillfully practice as a doctor of
naturopathic medicine or to any act of unprofessional conduct in this
paragraph.
(r) Engaging in any conduct or practice that is
contrary to recognized standards of ethics of the naturopathic profession, any
conduct or practice that does or might constitute a danger to the health,
welfare or safety of the patient or the public, or any conduct, practice or
condition that does or might impair the ability to safely and skillfully
practice as a doctor of naturopathic medicine.
(s) Failing to observe any federal, state, county or
municipal law relating to public health as a physician in this state.
(t) Violating or attempting to violate, directly or
indirectly, or assisting in or abetting the violation of, or conspiring to
violate this chapter or board rules.
(u) Committing false, fraudulent, deceptive or
misleading advertising or advertising the quality of a medical or health care
service by a physician or by the physician's staff, employer or representative.
(v) Failing or refusing to maintain adequate medical
records on a patient or failing or refusing to make medical records in the
physician's possession promptly available to another physician or health care
provider who is licensed pursuant to chapter 7, 8, 13, 15, 17 or 29 of this
title on request and receipt of proper authorization to do so from the patient,
a minor patient's parent, the patient's legal guardian or the patient's
authorized representative or failing to comply with title 12, chapter 13, article
7.1.
(w) Referring a patient to a diagnostic or treatment
facility or prescribing goods and services without disclosing in writing to the
patient that the physician has a pecuniary interest in the facility, goods or
services to which the patient is referred or prescribed. This
subdivision does not apply to a referral by one physician or practitioner to
another physician or practitioner within a group of physicians or practitioners
practicing together.
(x) Engaging in sexual intimacies with a patient in
the course of direct treatment.
(y) Failing to dispense drugs and devices in
compliance with article 4 of this chapter.
(z) Administering, dispensing or prescribing any
drug or a device for other than an accepted therapeutic purpose.
(aa) Falsely representing or holding oneself out as
being a specialist or representation by a doctor of naturopathic medicine or
the doctor's staff, employer or representative that the doctor is boarded or
board certified if this is not true or that standing is not current.
(bb) Delegating professional duties and
responsibilities to a person if the person has not been approved or qualified
by licensure or by certification to perform these duties or responsibilities.
(cc) Failing to appropriately supervise a
naturopathic medical student, a nurse, a medical assistant, a health care
provider or a technician who is employed by or assigned to the physician during
the performance of delegated professional duties and responsibilities.
(dd) Using experimental forms of diagnosis or
treatment without adequate informed consent of the patient or the patient's
legal guardian and without conforming to experimental criteria, including
protocols, detailed records, periodic analysis of results and periodic review
by a medical peer review committee as approved by the United States food and
drug administration or its successor agency.
(ee) Failing to furnish information in a timely
manner to the board or investigators or representatives of the board if this
information is legally requested by the board and failing to allow properly
authorized board personnel on demand to examine and have access to documents,
reports and records maintained by the physician that relate to the physician's
medical practice or medically related activities.
(ff) Failing to report in writing to the board
evidence that a person who is licensed, certified or registered pursuant to
this chapter is or may be medically incompetent, guilty of unprofessional
conduct or mentally or physically unable to safely practice or assist in the
practice of naturopathic medicine.
(gg) Conducting or engaging in an internship or
preceptorship in naturopathic medicine without being approved and registered by
the board for that internship or preceptorship.
(hh) Signing a blank, undated or predated
prescription form.
(ii) Engaging in conduct that the board determines
is gross negligence, repeated negligence or negligence resulting in harm or
death to a patient.
(jj) Knowingly making a false or misleading
statement in oral testimony to the board on a form required by the board or in
written correspondence to the board, including attachments to that
correspondence.
(kk) The failure of a physician who is the chief
medical officer, the executive officer or the chief of staff of an internship,
a preceptorship or a clinical training program to report in writing to the
board that the privileges of a doctor of naturopathic medicine, a naturopathic
medical student or a medical assistant have been denied, limited, revoked or
suspended because that doctor's, student's or assistant's actions appear to
indicate that the person is or may be medically incompetent, is or may be guilty
of unprofessional conduct or is or may be unable to safely engage or assist in
the practice of naturopathic medicine.
(ll) Having action taken against a doctor of
naturopathic medicine by a licensing or regulatory board in another
jurisdiction due to that doctor's mental or physical inability to engage safely
in the practice of naturopathic medicine or the doctor's medical incompetence
or for unprofessional conduct as defined by that licensing or regulatory board
and that corresponds directly or indirectly to an act of unprofessional conduct
prescribed by this paragraph. The action taken may include refusing,
denying, revoking or suspending a license, otherwise limiting, restricting or
monitoring a licensee or placing a licensee on probation by that licensing or
regulatory board.
(mm) Having sanctions imposed by an agency of the
federal government, including restricting, suspending, limiting or removing a
person from the practice of naturopathic medicine or restricting that person's
ability to obtain financial remuneration.
(nn) Violating any formal order, probation, consent
agreement or stipulation issued or entered into by the board pursuant to this
chapter.
(oo) Refusing to submit to a body fluid examination
pursuant to a board investigation of alleged substance abuse by a doctor of
naturopathic medicine.
(pp) Charging a fee for services not rendered or
dividing a professional fee for patient referrals among health care providers
or health care institutions or between these providers and institutions or a
contractual arrangement that has this effect.
(qq) Obtaining a fee by fraud, deceit or
misrepresentation.
(rr) Charging or collecting a clearly excessive
fee. In determining whether a fee is clearly excessive, the board
shall consider the fee or range of fees customarily charged in this state for
similar services, in light of modifying factors such as the time required, the
complexity of the service and the skill required to perform the service
properly. This subdivision does not apply if there is a clear
written contract for a fixed fee between the physician and the patient that was
entered into before the service was provided.
(ss) With the exception of heavy metal poisoning,
using chelation therapy in the treatment of arteriosclerosis or as any other
form of therapy without adequate informed patient consent and without
conforming to generally accepted experimental criteria, including protocols,
detailed records, periodic analysis of results and periodic review by a medical
peer review committee.
(tt) Using a controlled substance unless it is
prescribed by another physician for use during a prescribed course of
treatment.
(uu) Prescribing, dispensing or administering
anabolic androgenic steroids for other than therapeutic purposes.
(vv) Except in an emergency or urgent care
situation, prescribing or dispensing a controlled substance to a member of the
naturopathic physician's immediate family.
(ww) Prescribing, dispensing or furnishing a
prescription medication or a prescription-only device as defined in
section 32-1901 to a person unless the licensee first conducts a physical
examination of that person or has previously established a doctor-patient
relationship. The physical examination may be conducted through
telehealth as defined in section 36-3601 unless the examination is for
the purpose of obtaining a written certification from the physician for the
purposes of title 36, chapter 28.1. This subdivision does not apply
to:
(i) A licensee who provides temporary patient
supervision on behalf of the patient's regular treating licensed health care
professional.
(ii) An emergency medical situation as defined in
section 41-1831.
(iii) Prescriptions written to prepare a patient for
a medical examination.
(iv) Prescriptions written or prescription
medications issued for use by a county or tribal public health department for
immunization programs or emergency treatment or in response to an infectious
disease investigation, a public health emergency, an infectious disease
outbreak or an act of bioterrorism. For the purposes of this item,
"bioterrorism" has the same meaning prescribed in section 36-781.
(v) Prescriptions written or antimicrobials
dispensed to a contact as defined in section 36-661 who is believed to
have had significant exposure risk as defined in section 36-661 with
another person who has been diagnosed with a communicable disease as defined in
section 36-661 by the prescribing or dispensing physician.
(vi) Prescriptions written by a licensee through a
telehealth program that is covered by the policies and procedures adopted by
the administrator of a hospital or outpatient treatment center.
(xx) If medical treatment is considered experimental
or investigational, failing to include in a patient's record a consent to
treatment document that is signed by the patient or the patient's parent or
legal guardian and that indicates that the patient or the patient's parent or
legal guardian has been informed of the risk of any treatment to be provided
and the expected cost of that treatment.
(yy) When issuing a written certification as defined
in section 36-2801, failing or refusing to include in the adequate
medical records of a patient a copy of all of the following:
(i) The medical records relied on by the physician
to support the diagnosis or confirmed diagnosis of the patient's debilitating
medical condition.
(ii) The written certification.
(iii) The patient's profile on the Arizona board of
pharmacy controlled substances prescription monitoring program database.
(zz) Dispensing a schedule II controlled substance
that is an opioid.
END_STATUTE
Sec. 2. Section 32-1504, Arizona Revised Statutes, is amended to read:
START_STATUTE
32-1504.
Powers and duties
A. The board shall:
1. Adopt rules that are necessary or proper for the
administration of this chapter.
2. Administer and enforce all provisions of this
chapter and all rules adopted by the board under the authority granted by this
chapter.
3. Adopt rules regarding the qualifications of
medical assistants who assist doctors of naturopathic medicine and shall
determine the qualifications of medical assistants who are not otherwise
regulated.
4. Adopt rules for the approval of schools of
naturopathic medicine. The board may incorporate by reference the
accrediting standards for naturopathic medical schools published by accrediting
agencies recognized by the United States department of education or recognized
by the council for higher education accreditation.
5. Adopt rules relating to clinical, internship,
preceptorship and postdoctoral training programs, naturopathic graduate medical
education and naturopathic continuing medical education
programs. The rules for naturopathic continuing medical education
programs shall require at least ten hours each year
to be
directly
related to pharmacotherapeutics.
In addition to the
ten hours of continuing medical education that is directly related to
pharmacotherapeutics, a doctor who wishes to administer intravenous antibiotics,
antivirals and antifungals shall complete both of the following:
(
a
) As a
prerequisite to certification, board-approved coursework for
certification that provides a comprehensive understanding of the fundamentals
and clinical applications of intravenous therapy that includes the basics of
intravenous therapy, indications and contraindications, intravenous therapy
techniques, complications and management, specialized applications and evidence-based
practice.� A doctor who has completed equivalent board-approved
coursework is not required to take the additional coursework specified in this
subdivision.
(
b
) A two-hour
continuing medical education program to receive certification to administer
intravenous antibiotics, antivirals and antifungals.
6. Periodically inspect and evaluate clinical,
internship, preceptorship and postdoctoral training programs and naturopathic
graduate medical education programs and randomly evaluate naturopathic
continuing medical education programs.
7. Adopt rules relating to the dispensing of natural
substances, drugs and devices.
8. Adopt rules
necessary for the safe administration of intravenous nutrients
and
drugs
. These rules shall identify and exclude substances that
do not meet the criteria of nutrients suitable for intravenous administration.
9. Adopt and use a seal.
10. Have the full and free exchange of information
with the licensing and disciplinary boards of other states and countries and
with the American association of naturopathic physicians, the Arizona
naturopathic medical association, the association of naturopathic medical
colleges, the federation of naturopathic medical licensing boards and the
naturopathic medical societies of other states, districts and territories of
the United States or other countries.
B. The board may:
1. Adopt rules that prescribe annual continuing
medical education for the renewal of licenses issued under this chapter.
2. Employ permanent or temporary personnel it deems
necessary to carry out the purposes of this chapter and designate their duties.
3. Adopt rules relating to naturopathic medical
specialties and determine the qualifications of doctors of naturopathic
medicine who may represent or hold themselves out as being specialists.
4. If reasonable cause exists to believe that the
competency of an applicant or a person who is regulated by the board is in
question, require that person to undergo any combination of physical, mental,
biological fluid and laboratory tests.
5. Be a dues paying member of national organizations
that support licensing agencies in their licensing and regulatory duties and
pay the travel expenses involved for a designated board member or the executive
director to represent the board at the annual meeting of these organizations.
6. Adopt rules for conducting licensing examinations
required by this chapter.
7. Delegate to the executive director the board's
authority pursuant to sections 32-1509 and 32-1551.
END_STATUTE