10 February 2023

Below is my summary of the key discussions and decisions made at today's regular business meeting of the Board of Naturopathy, which regulates the practice of naturopathic medicine. (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.)

Nonsurgical Cosmetic Procedures Rule-Making
Dr. Amira Ahdut provided a very brief update that a CR-102 has been filed to re-open rule-making on nonsurgical cosmetic procedures (limited this time to botulinum toxin). The Board is accepting comment on this topic beginning today and will hold a public rule-making session at its next regular business meeting on Friday, May 12, 2023. You can submit comments to the Board by emailing naturopathy@doh.wa.gov.

Continuing Education Rule-Making
The Board engaged in a lengthy conversation about how to best move forward with this rule-making effort. The issue at hand is that there have been four Board members (Drs. Chad Aschtgen, Krystal Richardson, and Elias Kass; and Public Member Brooke Fotheringham) interested in serving on the subcommittee considering these rules. Because a meeting of 4 Board members is a quorum of our 7-member regulatory Board, this subcommittee cannot meet or engage in discussion on the topic without holding public meetings subject to all of the requirements of the Open Public Meetings Act (OPMA). Ms. Fotheringham proposed that all meetings on this topic should be public and Dr. Kass agreed due to the high level of interest in this rule-making. Attorneys Luke Eaton and Bill Kellington provided perspective that holding some meetings in relative private of a small subcommittee is very common and would not reduce transparency or public involvement, but would simply allow a smaller group to hash out finer details provided through public comment and petition that would then be discussed in public by the full Board. Mr. Eaton also pointed out that this rule-making was all done in public over many many years. After a lot of back and forth - with some Board members submitting that every conversation about this needs to be done with public feedback and other Board members wondering if there would be any new information brought forward during public sessions on the topic considering the incredible amount of information that has been gathered over many years of this rule-making - Dr. Richardson removed herself from the subcommittee so that there would no longer be an issue with quorum and the need for the OPMA requirements. With that, the CE rule-making subcommittee was determined to be Drs. Aschtgen and Kass and Public Member Fotheringham. They will be working with staff to set up a public rule-making session as soon as possible. The Board was reminded by staff that they have a legislative deadline of January 1, 2024, to complete rule-making on health equity training for the profession.

Legislative Updates Relevant to the Board
Dr. Krystal Richardson has been attending meetings on behalf of the Board to receive legislative updates that may be relevant to the profession. Several interstate compact bills and several scope expansion bills, including Senate Bill 5411, which would expand and modernize the scope of practice of naturopathic physicians, have been highlighted at these inter professional meetings. When faced with opposition from other attendees on naturopathic scope expansion, Dr. Richardson has pointed out that naturopathic physicians are recognized primary care providers in Washington and that we need this expanded scope in order to better meet the needs of our patients.

Reproductive Health Care in Naturopathic Medical Practice
The WANP submitted an inquiry last summer about whether vasectomies are within naturopathic scope of practice, based on questions from our membership after the Dobbs decision by the Supreme Court. At the November 2022 regular Board meeting, the Board provided its recommendation that naturopathic physicians interested in providing this care consult with their personal attorneys because current statute is silent on the issue and the Board is therefore unable to weigh in on the matter. The Washington State Medical Association (WSMA) then submitted their own letter to the Board of Naturopathy requesting that they change the prior response to explicitly state that vasectomies are not currently within the scope of practice of naturopathic physicians. The Board convened a subcommittee of Drs. Amira Ahdut and Krystal Richardson to work with Attorney Luke Eaton to develop a response to the WSMA's inquiry, which will be presented to and voted on by the Board at the May 2023 regular Board meeting.

The WANP maintains that the Board of Naturopathy did its due diligence in reviewing existing statute and advising the profession that statute is silent and therefore that the Board cannot weigh in on the matter. We further maintain that, like in-clinic abortion, routine vasectomy is a primary care service that patients should be able to access. Some 35% of vasectomies are done in the primary care setting by family practice physicians and not in urology offices or surgical suites. We absolutely agree with the WSMA's statement that "whoever performs a vasectomy should have the appropriate medical training to address all known complications, during and after surgery, to ensure patient safety." We just happen to adamantly disagree with the WSMA's implication that naturopathic physicians are incapable of being appropriately trained. (In fact, there are many naturopathic physicians who are well-trained on this procedure and who perform it without incident as part of routine naturopathic primary care practice in other states.)

Use of NMD Credentials in Washington is Not Allowed
The Board of Naturopathy is asked on occasion whether naturopathic physicians can use the credentials "NMD" instead of "ND" in Washington State. The Board gave an opinion in May 2019, which it affirmed today, that naturopathic physicians should avoid using the credentials "NMD" while practicing in Washington State.

Ketamine Therapy is NOT in Legal Scope of Practice of NDs in Washington
The Board received an inquiry about acceptable training programs in administering ketamine therapy. Ketamine is a Schedule III controlled substance, which is NOT within the current scope of practice of naturopathic physicians licensed in Washington. Naturopathic physicians in Washington cannot administer ketamine therapy, regardless of their training in the therapy. Any naturopathic physicians prescribing or administering ketamine in Washington are practicing outside of their legal scope and are subject to federal, state, and local law enforcement and risk losing their license to practice medicine.

There are currently 1,632 active naturopathic physician licenses in Washington State. There are currently 15 active Colon Hydrotherapist credentials.

The Board of Naturopathy has received 2 applications for the vacant Public Member position. Drs. Amira Ahdut, Chad Aschtgen, and Joanne Hillary will work with staff to review the applications and make a recommendation to the Governor's Office.

Role of Board of Naturopathy
Since November 2021, the Board has had "stem cell harvesting through liposuction and bone marrow aspiration" listed as a "Future Business" item, pending a "formal Attorney General opinion." Attorney Luke Eaton engaged the Board in an in-depth conversation about the role of the Board and the process of seeking a "formal Attorney General opinion." Pointing to RCW 18.36A.160, Mr. Eaton suggested that the role of the Board is not to define or interpret scope of practice, outside of providing technical advice or clarification based firmly in statute. He advised that it is well within the Board's right to respond to scope inquiries with a recommendation to seek private legal counsel, rather than tasking Board members and attorneys to craft responses that may not be upheld in a court of law. Dr. Elias Kass asked a clarifying question that was on all of our minds, which was how the Board is expected to determine discipline for doctors accused of practicing outside of scope if the Board cannot determine/interpret scope. Mr. Eaton responded that expert testimony by expert witnesses should be relied on in disciplinary cases. The ultimate recommendation by Mr. Eaton was that the Board consider having a larger conversation about its role and how it should handle scope inquiries in the future, in order to establish a consistent response process that falls within the duties listed in RCW.

Beyond that, the Board voted unanimously to rescind their request for a "formal Attorney General opinion" on the topic of stem cell harvesting, based on the information shared by Mr. Eaton. Drs. Amira Ahdut and Elias Kass will work with Mr. Eaton to develop a response to this original inquiry.

Next Meeting
The Board of Naturopathy will next meet on Friday, May 12, 2023, at 8:30 am. This meeting is expected to be hybrid with a webinar option and a physical location to be announced.

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

~Angela Ross, ND - WANP Executive Director