Naturopathic doctors are hoping the 12th time will be the charm as they push again for a bill licensing their practice, but healers from other traditional or natural disciplines worry they'll be squeezed out of the practices they've spent years training for and building.
The bill would give patients a way to distinguish between naturopathic doctors -- N.D.s -- who attended four-year accredited programs and those with mail-order degrees and would open the door for insurance reimbursement. Proponents say the only people who will be negatively affected are those calling themselves naturopathic doctors who don't meet the requirements.
Kelly Parcell, a Boulder naturopathic doctor and vice president of the Colorado Association of Naturopathic Doctors, said the bill is a matter of public safety.
"When somebody hears the term doctor, there is an expectation of that person's level of education and accountability," she said. "We're trained as doctors to practice medicine. People are coming to us for diagnosis and treatment. It's appropriate that we be licensed."
Opponents of the bill believe the wording opens up a gray area in the law where one didn't exist before, one that competitors could exploit to send cease-and-desist letters to healers without the resources to defend themselves.Bharat Vaidya, an ayurvedic practitioner with a home-based practice in Superior, said that as an immigrant he's particularly worried about inadvertently running afoul of the law."Everybody will have problems if this bill passes," he said. "I pray to God Almighty that in this land of the free, we will retain our freedom to each practice our own particular art."The concern centers around how the wording of one clause will interact with the definitions of scope of practice for N.D.s and M.D.sHere's the break-down: Colorado law defines the practice of medicine to include diagnosing, treating or preventing any human disease or condition, by just about any means available, as well as prescribing drugs and performing surgery. The scope is so broad that it encompasses many activities also performed by alternative or traditional healers, but unless someone is harmed, it's rare for someone to be accused of practicing medicine without a license.The bill defines a scope of practice for N.D.s that includes diagnosing, treating and preventing disease, but through the use of natural medicines, exercise, diet and "other modalities" that promote the body's self-healing processes.
The N.D. scope of practice has a lot of overlap with what other types of healers do. The bill contains an exemption for those who don't claim to be N.D.s. It says other healers can "advis(e) in the use of a therapy, including herbal medicine, homeopathy, nutrition or other ... therapy" in the N.D. scope of practice as long as it is otherwise "within their lawful rights."
Susan Bernhardt, an attorney who studies ayurvedic medicine and is working with the Colorado Ayurvedic Medicine Association, said "advising in the use of a therapy" might not include other activities healers use, while "within their lawful rights" is hopelessly vague.
"I have no idea how to find out if an activity is within my lawful rights," she said. "The exemption needs to be as broad as the definition (of naturopathy)."Kim Green, president of the Colorado Citizens for Health Freedom, which has consistently opposed efforts to license naturopaths, said the language has the potential to squeeze other healers between the N.D. and M.D. scope of practice, leaving them unable to use any of their traditional therapies.It's an argument that seems to exasperate the bill's chief sponsor, Rep. Jim Riesberg, a Greeley Democrat. He's gone to naturopaths for various health problems, and he wants them to have the legitimacy that comes with licensing. Licensing also would provide more protection for patients, he said. He's sponsored similar bills before, but the pushback from other natural healers has killed it every time."If you don't call yourself an N.D., then you won't have a problem with this bill," he said. "I've tried to convince them, but they won't believe it."Raising anxiety, the state created a three-member physician panel last year to investigate cases of practicing medicine without a license. While it's primarily concerned with physicians who don't have proper licensing, there could be more enforcement against traditional healers.COLORAMA, the ayurvedic medical association, has proposed an amendment that would remove the "lawful rights" language and make it clear that everything in the N.D. scope of practice is available to other practitioners, as long as they're not claiming to be N.D.s."If the clause is really innocuous, then take it out," said Ben Lipman, known as Varadaan, a Boulder practitioner of ayurvedic medicine and president of COLORAMA.Riesberg said if other healing professions want similar protections, he'd be happy to consider a registration or licensing bill for them.Under current law, plumbers and electricians, cosmetologists and massage therapists, hunting guides and therapists all have some sort of licensing or registration requirement. But practitioners of traditional Chinese medicine, ayurveda, Tibetan medicine, herbalism and other alternative healing arts don't.Registration is a controversial notion among natural healers. Vaidya would like to see registration. Ayurvedic practitioners are regulated in Great Britain, where he also received a medical degree, and he thinks it works well.Lipman prefers a self-policing system of certification, one of which the national ayurvedic medical association is working on. It would allow clients to know that their practitioner has met the educational criteria considered appropriate within a particular community.Green's organization is adamantly opposed to registration. She said that registration and licensing inevitably leads to rising prices and turf wars.Indeed, the N.D. licensing bill wouldn't allow naturopaths to engage in manipulations, which many naturopaths currently do. Manipulations belong to the chiropractors.Parcell noted that many alternative healers already are operating within scopes of practice set aside for physical therapists, massage therapists and athletic trainers. If cease-and-desist letters come, it won't be because of the naturopathy bill."They overlook the word 'and,'" she said. "It's people who want to call themselves naturopathic doctors and who practice within that scope."Boulder N.D. Janine Malcolm said the biggest benefit of licensing would go to patients, who are much more likely to be reimbursed by their insurance providers. She also thinks it will give more legitimacy to the discipline.She said driving other practitioners out of practice or out of town is the last thing she wants. Malcolm, who teaches at Naropa University and the Northwest Institute of Medical Herbalism, has practitioners from other fields speak to her classes, and she refers patients to experts in other fields."I love herbalists," she said. "I send people to herbalists. My only interest is in helping my clients get reimbursement from their insurance companies."