18 November 2022

Today's meeting of our profession's regulatory board was quite long - an indicator of how much good work the Board is doing to regulate, guide, and advance our profession in Washington. Below is my summary of the key discussions and decisions made at today's meeting. (Please note that this summary does not reflect official meeting minutes of the Board, which is a completely separate entity from the WANP. The reflections and notes below are my own and should not be assumed to represent the Board of Naturopathy in any way.)

Colon Hydrotherapist Certifications
The Department has approved 14 colon hydrotherapist certifications at this point.

Nonsurgical Cosmetic Procedures Rule-Making
The Board has renewed its efforts to move this rule-making forward and the subcommittee working on this issue recommended to the full Board that they advance a change to our statute (WAC 246-836-210) removing the exclusion for using botulinum toxin for cosmetic purposes. The recommendation avoided addressing other "inert substances" at this time and instead focused only on the use of botulinum toxin.

As part of introducing the topic, Board Chair Dr. Chad Aschtgen provided historical context of how the exclusion came to be included in our WAC. Of note, when the WANP passed its significant scope expansion bill in 2005 and earned prescriptive authority over all legend drugs for Washington-licensed naturopathic physicians, botulinum toxin was included in what the legislature approved. However, when the Board (then the Naturopathic Advisory Council) took on rule-making around the implementation of this bill, there was such opposition to naturopathic physicians using any medications for cosmetic purposes that the Board wrote in the exclusion that exists to present. Of course, much has changed for our profession since 2005 and the Board has been working on updating this rule as a reflection of such advancement.

Disappointingly, there are several people and organizations who have mischaracterized this update as an attempt to "expand naturopathic scope without the authority of the legislature." The reality is that the legislature already granted this scope in 2005 and it was this regulatory body that limited it. Therefore, it is well within the authority of the Board of Naturopathy to update the limitation based on current practice, research, and information.

There are also some individuals who argue that this rule-making should not advance due to the complexity involved in using botulinum toxin on and around the face. The rationale appears to be grounded in a completely unfounded belief that our profession cannot be trusted to "do no harm" and that our doctors are not only untrained but also untrainable. We absolutely disagree with these opinions and remind the community of two key facts: 1) Naturopathic physicians in Washington have had botulinum toxin in our scope for therapeutic use - generally involving injection in and around the face - since 2005. 2) Naturopathic physicians in several other advanced practice states have had botulinum toxin (and other substances) in their scope for therapeutic AND cosmetic use for years and the data pulled from regulatory authorities in those states revealed few if any complaints.

In addition to these realities, we recognize that the Uniform Disciplinary Act (UDA) governs all healthcare providers and prohibits any provider from performing any service that they are not trained to competency to perform - whether that service is within their legal scope or not. We trust that you all are following the rules and are doing everything you need to do to keep your patients as safe as possible. The relative lack of legal action against naturopathic physicians speaks to this.

The Board ultimately voted to advance the rule-making to allow naturopathic physicians to use botulinum toxin even for cosmetic purposes (with proper training, of course), with Drs. Amira Ahdut, Chad Aschtgen, Joanne Hillary, and Krystal Richardson voting in favor, and with Dr. Elias Kass and public member Brooke Fotheringham voting to keep our profession limited.

Please note: This is merely the FIRST step in a 3-part rule-making process. Naturopathic physicians will not be able to use botulinum toxin cosmetically unless or until all 3 parts of the rule-making are completed, at which point a date of effect will be provided.

Continuing Education Rule-Making
The Board attempted to consider only one aspect of this rule-making effort, which was whether or not ACCME-accredited courses/organizations should be considered "Category 1" for Washington-licensed NDs. Unfortunately, the Board could not even engage in this discussion, as new Board member Dr. Elias Kass sought to derail the conversation and undo work that has been done by previous Board members. Dr. Kass opined that all requirements for naturopathic-specific continuing education should be eliminated on the basis that there is no way to "define" naturopathic medicine and therefore naturopathic continuing education. Attorney Luke Eaton corrected this assertion by pointing out that, in fact, naturopathic medicine is defined by statute. When the consideration of the philosophical question of whether physicians who specialize in naturopathic medicine should be required to take a certain amount of continuing education in their field of specialty (which is the rule not the exception for other conventional healthcare providers and for naturopathic physicians licensed in advanced scope areas), Dr. Hillary noted the importance of our profession retaining connection to our core identity and principles and weighed in that requiring a mere third of our credits to be focused in naturopathic medicine is quite reasonable. This seems to reflect the consensus opinion of the Board up to present, but it was clear that this conversation was not going to progress during this meeting. Dr. Ahdut moved to table the discussion to allow the subcommittee to work out additional details and that motion was unanimously approved by the Board. Moving forward, Drs. Chad Aschtgen, Richardson, and Kass, and public member Brooke Fotheringham will serve as the CE rule-making subcommittee.

Dry Needling Guideline UpdateWe were saddened to learn that our colleagues at the Washington Acupuncture and Eastern Medicine Association (WAEMA) sent out intentionally misleading messaging about this guideline update prior to today's meeting. Their completely false and inaccurate assertion was that the Board would be considering an expansion of naturopathic scope to include Dry Needling and they riled up their members to increase anger, frustration, and divisiveness where there simply doesn't need to be any.

The fact is that "dry needling" has been in the scope of naturopathic physicians in Washington for well over a decade. As Attorney Luke Eaton so eloquently pointed out at the beginning of this agenda item (paraphrased): "This is a guideline update, NOT a rule-making session. This is NOT an expansion of existing scope. This is NOT a license for NDs to call themselves acupuncturists or to say that they perform acupuncture. This does NOT grant free rein to naturopathic physicians to perform dry needling without adequate training - the Uniform Disciplinary Act still applies. This is simply an update to a guideline published by this Board in 2012."

After brief commentary from leadership at WAEMA, the Board voted unanimously to approve the updated guideline on "Naturopathic Physicians performing dry needling", which can be found HERE.

Reproductive Health Care in Naturopathic Medical PracticeWe were incredibly grateful to receive such a thoughtful response from the Board to our inquiry as to whether in clinic (aka "surgical") abortion and vasectomy care are within current naturopathic scope. We submitted this inquiry along with requests for the Board to formally petition the FDA for inclusion as authorized prescribers of mifepristone and for the Board to be prepared to update its existing telemedicine guideline to protect naturopathic physicians providing care under upcoming "Safe Haven" laws for abortion care and gender-affirming healthcare (GAHC).

Shortly after submitting our requests to the Board, we learned that the FDA was not the source of the problem in restricting naturopathic physicians from becoming authorized prescribers of mifepristone; rather, this prohibition is due to the drug manufacturers themselves. Therefore, we officially rescinded our request for the Board to formally petition the FDA for inclusion and we at the WANP are working directly with the drug manufacturers on this issue.

After considering current statute relating to abortion care and to naturopathic scope, the Board reached an opinion that in clinic abortion is considered surgery (rather than a minor office procedure) and that it is therefore NOT within naturopathic scope in Washington, as currently defined. The Board reiterated that this is NOT a formal opinion by the Attorney General's Office, so we (the WANP) will be meeting with our legislative partners on this topic and determining best next steps to ensure that appropriately trained naturopathic physicians who desire to provide this care are able to do so.

Regarding vasectomy care, the Board acknowledged that state statute does not provide any clarification on this procedure and the Board is therefore unable to provide an opinion on whether it is within current naturopathic scope of practice. Their official recommendation is for individual practitioners to consult their personal attorneys and malpractice insurance providers to determine the risks and benefits of offering this care.

Public Board Member Position Remains OpenOur regulatory Board remains short one public member. If you know anyone who is NOT a healthcare provider of any kind, who does not benefit directly from a relationship with a healthcare provider, and who would be a champion of our profession and our medicine, please have them complete the Governor Appointed Application on the Board of Naturopathy website.

Please direct any questions, comments, or concerns about this summary directly to me at executive@wanp.org.

~Angela Ross, ND - WANP Executive Director