9 February 2024
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.)
Board Structure and ProceduresAssistant Attorney General Luke Eaton offered the Board a presentation entitled "Conducting Board Meetings: A guide to board structure and procedures." Among the questions that were addressed in this presentation was the issue of Board members whose terms have expired and whether they can continue actively serving - including voting on matters in front of the Board. Referencing statute, Mr. Eaton was unequivocal that appointees are allowed to continue to serve fully (including their attendance being counted to establish quorum and their ability to vote) until a replacement has been appointed - no matter when their term technically expired.
Mr. Eaton also reminded the Board that the Governor's Handbook is a resource for Board members, who are tasked with advising the governor, the legislature, and state agencies. Per the handbook, Board members are expected to attend all Board meetings, to come to meetings and conversations prepared, and to serve the public interest rather than individual or personal agendas. To be effective, the Board must work together to achieve consensus decisions. Board members are urged to consider all available evidence before reaching a decision, to communicate well with each other and actively participate in group discussion, to be willing to work with the whole group in making decisions, and to recognize that compromise is often necessary to reach consensus. The Board was reminded that the authority to act is granted to the Board as a whole and not to individual Board members.
Mr. Eaton clarified that Department of Health staff are there to serve as a resource to the Board and that the assistant attorney general (multiple levels below the Attorney General) is there to ensure that any actions taken by the Board are within its statutory authority. The AAG helps ensure the Board has no conflicts of interest and reviews regulations when the Board is drafting new documents or revising existing ones.
Board members were reminded that any and all emails pertaining to their work on the Board of Naturopathy are subject to public records disclosure and that they as individuals will likely be viewed as representing the Board even when that is not their intention. Individual Board members cannot make unilateral decisions or take action without the support of the full Board. Board members are also prohibited from using their membership on the Board to create a personal platform.
Board members inquired about obtaining DOH-specific email addresses to create clearer boundaries in Board communications and were advised that interactions among Board members by text are also subject to public records disclosure laws.
Board members requested clarification on how Board members are appointed and removed from the Board. Mr. Eaton provided that all Board members are appointed by the Governor and serve entirely at the Governor's discretion. The Governor can remove an appointee for misfeasance, malfeasance, or nonfeasance, but Mr. Eaton acknowledged this has been a rare occurrence. Board members can also leave the Board voluntarily. Board members are not and cannot be elected to the regulatory board and they are allowed to remain as a full Board member until their replacement is appointed. It is not uncommon for Board members to remain beyond their term expiration because this is a volunteer position and it can be very challenging to find people willing to serve in this capacity. The statute is clear: "[Board] members hold their office until their successor is appointed."
Substantial Equivalency Committee and Jurisprudence ExamBrandon Williams, Project Manager, provided a brief overview of what has changed and what is needed from the Board. Second Substitute House Bill (SSHB) 1724 was passed during the 2023 Legislative Session, giving licensing boards authority to waive certain licensure requirements for all professions regulated by DOH if the state in which the applicant is currently licensed has been determined to have substantially equivalent licensing requirements. (For example, Washington State would not have to get transcripts, exam scores, etc., for an applicant who has already been through all of that in a state that has "substantial equivalency".)
As of the November 2023 Board of Naturopathy meeting, the requirement in Washington State for new applicants to have completed Washington's jurisprudence examination remained a barrier to having "substantial equivalency" with any other states - especially because the new law states that all exams must be waived. Additionally, no other state has a Washington-specific jurisprudence exam. Therefore, the Board needs to take action to remove the jurisprudence examination as a requirement for initial licensure in Washington.
Mr. Williams highlighted sections of the relevant Washington Administrative Code (WAC) that would need to be amended by the Board to align it with SSHB 1724:
- WAC 246-836-020 Requirements for licensure. The Board would need to edit/remove the requirements to provide transcripts, verify exams, or take the Washington jurisprudence exam.
- WAC 246-836-040 Jurisprudence examinations. The Board would need to remove this as a requirement for licensure.
Board members sought clarification of how this has been done by other professions and were advised that the Board has an option to state that the Washington jurisprudence examination is so important for initial licensure that there are no states with substantially equivalent licensure requirements, but that most other healthcare professions have opted to move the requirement to pass the jurisprudence exam to continuing education rather than as a requirement for licensure. In terms of process, Mr. Williams shared that the DOH compiles an initial list of potentially substantially equivalent states and then brings that list to the Board for review and a vote. Drs. Chad Aschtgen and Joanne Hillary previously volunteered to serve on this committee and are happy to review the list of potential states prior to the next Board meeting.
The Board then engaged in a lengthy discussion about where to include the jurisprudence examination and how to avoid opening up the entirety of WAC 246-836-080 Continuing competency program, given the challenges the Board has faced in reaching consensus on other rule petitions related to that WAC. Ultimately, Dr. Aschtgen moved to amend both WAC 246-836-020 and WAC 246-836-040 to remove the requirement for the jurisprudence exam but not to make any amendments to WAC 246-836-080 at this time. The motion was seconded and all Board members were in favor except for Dr. Elias Kass, who abstained. Drs. Aschtgen and Hillary will work with DOH staff on the amendment language.
Provider Performed Microscopic Procedures (PPMP) Licensing ChangesJessica Holloway, Program Manager, provided an update on licensing changes related to amendments to WAC 246-338-020. She shared that Washington's Medical Test Site program was recently audited by the federal CLIA program, which determined that naturopathic physicians are not listed in federal rule as authorized lab directors or testing personnel for PPMP. As part of the renewal process for Washington State, CLIA is requiring that NDs are removed from this WAC. DOH has opened rule-making to comply with this requirement and there will be an open public comment period until April 4, with a rule-making hearing on that date.
WANP's Executive Director Angela Ross, ND, shared more about the efforts the WANP has made on this both within Washington State and through approaching CLIA and its advisory committee - thus far to no avail.
In response to a question by Dr. Aschtgen, Ms. Holloway clarified that any Medical Test Site license that has already been issued prior to the rule going into effect will not be removed, but that all of these licenses will expire on 30 June 2025, after which time NDs will not be able to perform PPMP in office. Any new applications for MTS/PPMP licenses will not be approved for NDs after the rule is in effect. Naturopathic physicians will still be able to obtain CLIA waivers, but those do not allow for PPMP. The DOH will be reaching out to those providers that currently have PPMP licenses as well as to the entire profession to keep them apprised.
Business Plan/NewsletterPublic member Brooke Fotheringham moved to create a subcommittee of Drs. Joanne Hillary, Elias Kass, and Krystal Richardson to work on developing a business plan for the Board. The motion passed unanimously.
Dr. Chad Aschtgen moved to create a subcommittee of Drs. Joanne Hillary and Krystal Richardson to work with DOH staff to create a regular newsletter from the Board. The motion passed unanimously.
Continuing Education Rulemaking PetitionA petition was submitted to the Board to consider amending WAC 246-836-080 Continuing competency program to "combine Category 1 and Category 2 into a single category and to remove the WANP and AANP as beneficiaries of income from CME production." The reason for the change listed on the petition was "WANP and AANP have a fiduciary interest in limiting CME from other sources and the BON is mandating these two private receive monetary benefit from the above law" [sic].
The Board was advised that it could accept the petition and open rule making on WAC 246-836-080 or it could deny the petition and provide an explanation that the Board is already planning to reopen this rule at a future time.
Ms. Fotheringham moved to request an extension on responding to the petitioner but, after a brief discussion attempting to clarify what the extension would be, the motion was withdrawn in favor of simply responding to the petitioner that this rule-making effort is already in the Board's future business.
Dr. Kass moved to respond to the petitioner that the Board plans to take this issue up in the future. The motion passed unanimously.
The Board discussed this petition again under the "Future Business" agenda item at the end of the meeting, with Dr. Aschtgen pointing out the the petitioner suggests that only 2 organizations - the WANP and AANP - are authorized to provide continuing education. He noted that the WAC actually identifies 6 organizations with authority to offer and/or approve continuing education for naturopathic physicians under Category 1. Dr. Aschtgen also inquired as to the appropriateness of the petitioner explicitly alleging a conflict of interest present for Dr. Aschtgen, based on the WANP conferring an award in 2019 recognizing Dr. Aschtgen's long service on the Board of Naturopathy, his work creating residency opportunities for naturopathic physicians, and his work with various professional organizations including the Oncology Association of Naturopathic Physicians (OncANP) and the American Association of Naturopathic Physicians (AANP). Mr. Eaton advised that state ethics laws specifically state that certificates and awards do not create a conflict of interest for Board appointees. Dr. Richardson agreed that receiving an award for outstanding service to the community/profession should not be considered a conflict of interest for Board members and reminded participants that Board members are appointed by the Governor, not elected by the profession. She noted that the goal is to have a diverse group of people with widespread views of what is good for the profession. She highlighted that healthy conflict and debate is always good for the profession, but that the Board's purpose is not to agree with the profession but rather to protect the public. Mr. Eaton offered that unfounded accusations of ethical violations are not productive and emphasized again that there is a specific exemption for certificates and awards and that these do not amount to conflicts of interest.
StatisticsAs of this meeting, there are 1,637 active naturopathic physician licenses.
Board of Naturopathy RecruitmentEverything is on pause right now due to the legislature being in session. The Board has submitted applicant packets to the Governor's office for review and Executive Director of the Board, James Chaney, has been trying to urge new appointments.
Botox Training Requirements ClarificationRachel Phipps, Program Manager for the Board, shared that the program has received several questions on the training requirements for nonsurgical cosmetic use of botulinum toxin. Questions have specifically been about the number of hours required. Thus far, Ms. Phipps has responded by restating the rules and advising that there is not a specific hour requirement, but instead clarity about what must be included in training.
Dr. Amira Ahdut opined that licensees need to obtain whatever amount of training is necessary to enable them to provide this service safely, competently, and in compliance with standards of care. The Board was in agreement, determining that no changes are needed to the WAC.
Informed Consent for ProceduresThe Board was advised that some disciplinary boards have requirements that informed consent be in writing rather than verbally and that this came up recently during a disciplinary proceeding. The Board was asked whether there was interest in developing policy specifying informed consent for naturopathic physicians in Washington.
The Board had a brief discussion and ultimately agreed to include some clarification or guidance in a newsletter rather than creating a new guideline or rule on this topic.
Please direct any questions about this summary to me at executive@wanp.org
~Angela Ross, ND | Executive Director, WANP