2018 Colorado Revised Statutes
Title 12 - Professions and Occupations
Health Care
Article 37.3 - Naturopathic Doctors
§ 12-37.3-105. Practice of naturopathic medicine by naturopathic doctors - exclusions - protected activities - rules
(1) The practice of naturopathic medicine by a naturopathic doctor includes the following:
(a) The prevention and treatment of human injury, disease, or conditions through education or dietary or nutritional advice, and the promotion of healthy ways of living;
(b) The use of physical examinations and the ordering of clinical, laboratory, and radiological diagnostic procedures from licensed or certified health care facilities or laboratories for the purpose of diagnosing and evaluating injuries, diseases, and conditions in the human body;
(c) (I) Obtaining, dispensing, administering, ordering, or prescribing, as specified, medicines listed in the naturopathic formulary, which includes:
(A) Obtaining, administering, or dispensing epinephrine to treat anaphylaxis;
(B) Obtaining and dispensing barrier contraceptives, excluding intrauterine devices;
(C) Obtaining and administering oxygen, but only for emergency use;
(D) Obtaining and administering vitamins B6 and B12;
(E) Obtaining, administering, or dispensing substances that are regulated by the federal food and drug administration but that do not require a prescription order to be dispensed; and
(F) Obtaining and administering vaccines, in accordance with the ACIP guidelines, for patients who are at least eighteen years of age.
(II) A naturopathic doctor may obtain medications described in subparagraph (I) of this paragraph (c) from a manufacturer, wholesaler, or in-state prescription drug outlet registered or licensed by the state board of pharmacy pursuant to article 42.5 of this title. An entity that provides a medication described in subparagraph (I) of this paragraph (c) to a naturopathic doctor in accordance with this section, and that relies in good faith upon the registration information provided by the naturopathic doctor, is not subject to liability for providing the medication.
(d) Performing minor office procedures.
(2) A naturopathic doctor shall not:
(a) Prescribe, dispense, administer, or inject a controlled substance or device identified in the federal "Controlled Substances Act", 21 U.S.C. sec. 801 et seq., as amended;
(b) Perform surgical procedures, including surgical procedures using a laser device;
(c) Use general or spinal anesthetics, other than topical anesthetics;
(d) Administer ionizing radioactive substances for therapeutic purposes;
(e) Treat a child who is less than two years of age, unless the naturopathic doctor:
(I) Provides to the parent or legal guardian of the child a copy of the most recent immunizations schedule recommended by the advisory committee on immunization practices to the centers for disease control and prevention in the federal department of health and human services and recommends that the parent or legal guardian follow the immunizations schedule;
(II) (A) On or after March 26, 2015, except as provided in sub-subparagraph (B) of this subparagraph (II), demonstrates in each year in which the naturopathic doctor treats a child under two years of age, successful completion of five hours per year of education or practicum training solely related to pediatrics in accordance with continuing professional competency requirements approved by the director pursuant to section 12-37.3-108, which includes subject matter related to recognizing a sick infant and when to refer an infant for more intensive care.
(B) If, pursuant to paragraph (f) of this subsection (2), a naturopathic doctor treats children who are two years of age or older but less than eight years of age and successfully completes three hours per year of education or practicum training solely related to pediatrics as required by subparagraph (II) of paragraph (f) of this subsection (2), the naturopathic doctor is required only to successfully complete an additional two hours per year of education or practicum training solely related to pediatrics to comply with the requirements of sub-subparagraph (A) of this subparagraph (II).
(III) (A) Develops and executes a written collaborative agreement with a licensed physician who is a pediatrician or family physician, which agreement includes the duties and responsibilities of each party as part of the collaborative agreement according to each party's standard of care and practice act, a process for consulting with and referring to a licensed physician to facilitate the effective treatment of children under two years of age, and other provisions as may be established by the director by rule. The naturopathic doctor and the licensed physician shall keep the written collaborative agreement on file and, upon request by the director, for naturopathic doctors, or by the Colorado medical board, for licensed physicians, shall provide a copy of the agreement to the director or board, as applicable.
(B) The naturopathic doctor shall provide to the director the name and license number of the licensed physician and shall ensure that the information filed with the director is current. The director shall make the information available to the Colorado medical board and the naturopathic medicine advisory committee.
(C) Nothing in this subparagraph (III) permits the independent practice of medicine, as defined in section 12-36-106 (1) and (2), by a naturopathic doctor.
(D) Nothing in this subparagraph (III): Limits the ability of a naturopathic doctor to make an independent judgment; requires supervision by a licensed physician; precludes the use of professional judgment or variation according to the needs of the child under two years of age; imposes liability on a licensed physician, in developing or signing a collaborative agreement, for the actions of the naturopathic doctor in treating a child under two years of age; imposes liability on a naturopathic doctor, in developing or signing a collaborative agreement, for the actions of the licensed physician in consulting regarding the treatment of a child less than two years of age; or requires the naturopathic doctor and licensed physician to be practicing in the same community or in close proximity to each other in order to enter into a collaborative agreement.
(IV) Requires the child's parent or legal guardian to sign an informed consent that:
(A) Discloses that the naturopathic doctor is registered pursuant to this article;
(B) Discloses that the naturopathic doctor is not a physician licensed pursuant to article 36 of this title;
(C) Recommends that the child have a relationship with a licensed pediatric health care provider; and
(D) If the child has a relationship with a licensed pediatric health care provider, requests permission from the parent or legal guardian for the naturopathic doctor to attempt to develop and maintain a collaborative relationship with the licensed pediatric health care provider, as defined by director rules; or if the child does not have a relationship with a licensed pediatric health care provider, on the child's first visit, refers the child to at least one licensed pediatric health care provider, physician, or advanced practice nurse who cares for pediatric patients to provide a medical home for the child, with ongoing communication and relationship between the naturopathic doctor and the licensed pediatric health care provider, physician, or advanced practice nurse; and
(V) Complies with rules adopted by the director regarding the training required by subparagraph (II) of this paragraph (e) and referral to and communication with licensed pediatric health care providers, physicians, or advanced practice nurses as required by sub-subparagraph (D) of subparagraph (IV) of this paragraph (e), to ensure the safety of clients who are under two years of age;
(f) Treat a child who is two years of age or older but less than eight years of age, unless the naturopathic doctor:
(I) Provides to the parent or legal guardian of the child a copy of the most recent immunizations schedule recommended by the advisory committee on immunization practices to the centers for disease control and prevention in the federal department of health and human services and recommends that the parent or legal guardian follow the immunizations schedule;
(II) Demonstrates successful completion of three hours per year of education or practicum training solely related to pediatrics in accordance with continuing professional competency requirements approved by the director pursuant to section 12-37.3-108; and
(III) Requires the child's parent or legal guardian to sign an informed consent that:
(A) Discloses that the naturopathic doctor is registered pursuant to this article;
(B) Discloses that the naturopathic doctor is not a physician licensed pursuant to article 36 of this title;
(C) Recommends that the child have a relationship with a licensed pediatric health care provider; and
(D) If the child has a relationship with a licensed pediatric health care provider, requests permission from the parent or legal guardian for the naturopathic doctor to attempt to develop and maintain a collaborative relationship with the licensed pediatric health care provider, as defined by director rules;
(g) Engage in or perform the practice of medicine, surgery, or any other form of healing except as authorized by this article;
(h) Practice obstetrics;
(i) Perform spinal adjustment, manipulation, or mobilization, but this paragraph (i) does not prohibit a naturopathic doctor from practicing naturopathic physical medicine as described in section 12-37.3-102 (12)(b); or
(j) Recommend the discontinuation of, or counsel against, a course of care, including a prescription drug that was recommended or prescribed by another health care practitioner licensed in this state, unless the naturopathic doctor consults with the health care practitioner who recommended the course of care.
(3) (a) A naturopathic doctor has the same authority and is subject to the same responsibilities as a licensed physician under public health laws pertaining to reportable diseases and conditions, communicable disease control and prevention, and recording of vital statistics and health and physical examinations, subject to the limitations of the scope of practice of a naturopathic doctor as specified in this article.
(b) Before conducting an initial examination of a patient, a naturopathic doctor shall obtain the patient's informed consent to the examination, evidenced by a written statement in a form prescribed by the director and signed by both the patient and the naturopathic doctor. The statement must:
(I) Disclose that the naturopathic doctor is not a medical doctor or physician licensed under article 36 of this title 12;
(II) Recommend that the patient have a relationship with a medical doctor or licensed physician;
(III) Indicate that the naturopathic doctor will attempt to develop and maintain a collaborative relationship with the patient's licensed physician, if the patient has a relationship with a licensed physician; and
(IV) Disclose that the naturopathic doctor is registered and not licensed.
(c) A naturopathic doctor shall communicate and cooperate with a patient's other health care providers, if any, to ensure that the patient receives coordinated care.
(d) A naturopathic doctor shall refer a patient to another health care professional if the patient's needs are beyond the naturopathic doctor's scope of knowledge and practice.
(4) This article does not prevent or restrict the practice, services, or activities of:
(a) A person who is licensed, certified, or registered to practice a profession or occupation pursuant to this title and who engages in activities that are within the lawful scope of practice for the profession or occupation for which the person is licensed, certified, or registered;
(b) A person who practices natural health care, provides natural health care services, or advises and educates in the use of natural health care products, as long as the person does not:
(I) Diagnose injuries or diseases;
(II) Prescribe medicines as authorized for registrants pursuant to paragraph (c) of subsection (1) of this section or a prescription drug or controlled substance or device identified in the federal "Controlled Substances Act", 21 U.S.C. sec. 801 et seq., as amended; or
(III) Perform minor office procedures as authorized for registrants pursuant to paragraph (d) of subsection (1) of this section;
(c) A person who sells vitamins, health foods, dietary supplements, herbs, or other natural products, if not otherwise prohibited by state or federal law, and who sells or provides information about the products;
(d) A person who provides truthful and nonmisleading information regarding natural health care products or services;
(e) A person employed by the federal government who practices naturopathic medicine while the person is engaged in the performance of his or her duties;
(f) A person who is licensed or otherwise authorized to practice as a naturopathic doctor in another state or district in the United States who is consulting with a naturopathic doctor in this state as long as the consultation is limited to examination, recommendation, or testimony in litigation;
(g) A student enrolled in an approved naturopathic medical college who practices naturopathic medicine if the performance of services is pursuant to a course of instruction or assignments from and under the supervision of an instructor who is a naturopathic doctor or a licensed professional in the field in which he or she is providing instruction;
(h) A person who administers a domestic or family remedy to oneself or a member of his or her immediate family based on religious or health beliefs; or
(i) A person who renders aid in an emergency when no fee or other consideration of value for the services is charged, received, expected, or contemplated.
(5) Except as provided in subsection (4) of this section, a person who is not registered under this article shall not:
(a) Diagnose injury, disease, ailment, infirmity, deformity, pain, or other condition of the human body;
(b) Dispense, administer, order, or prescribe medicines as authorized for registrants pursuant to paragraph (c) of subsection (1) of this section; or
(c) Use the title "Naturopathic Doctor", or "Doctor of Naturopathy" or the abbreviation "N.D."
(6) Many therapies used by naturopathic doctors, such as the use of nutritional supplements, herbs, foods, homeopathic preparations, and physical forces such as heat, cold, water, touch, and light, are not the exclusive privilege of naturopathic doctors, and this article does not prohibit the use or practice of those therapies by a person who is not registered under this article to practice naturopathic medicine.
(7) As used in this section, "licensed pediatric health care provider" means a licensed physician or advanced practice nurse who treats children.
