Scope of practice for naturopathic doctors eroding in Alaska.
To most of the rest of the country, Alaska seems very remote. Sometimes larger economic forces will experiment with new ideas in this tucked-away backwater. For example, in 2006 the American Medical Association (AMA) spent millions of dollars developing a huge document called the Scope of Practice Partnership (SOPP). This enormous document has one sole purpose: to stamp out any growth of health-care professions outside the conventional AMA/FDA-endorsed model. So-called alternative health care is becoming big enough business that the politically oriented conventional docs are getting more abrasive in their push back.
In 2009, the Alaska Association of Naturopathic Physicians had the dubious honor of being the first group of NDs attacked by SOPP. NDs in Alaska have been sporadically attempting to modernize our scope of practice law for two decades. Luckily for us, this SOPP attack did not work so well, since the nasty tome had a lot of ridiculously outdated information about naturopaths. The Alaska legislators involved in considering scope expansion were mostly underwhelmed by this heavy-handed power play. However, the ND bill did not progress because the bulk of last session was taken up with decoupling the oil and gas taxation structures. This current session, the state AMA lobby is employing a different strategy: attack and malign the president of the ND state association.
I have been targeted in a malicious prosecution case which started in 2008 when a Juneau surgeon "reported" me for trigger point therapy, a technique that is allowed in ND scope of practice in Alaska and in all states licensing NDs. I had actually referred a patient to him who wasn't improving optimally with the injection technique. Instead of a normal collegiate response, which would have been calling to discuss the patient with me, this arrogant bully chose to report me to the state law enforcement agency. The state didn't like my using procaine as part of the mix in the trigger point solution, so I stopped. Procaine is biologically identical to a combination of two B vitamins; a mild analgesic in which use I was trained over 20 years ago. Nonetheless, it is a prescription substance, and the language of the ND law is ambiguous. The language of the ND law needs clarification, but meanwhile I'm basically being treated as a criminal until I can change the statute (through legislation) or change the regulation (through an administrative trial) so that these two parts of the law governing the ND profession are not in contradiction.
During the 2008 investigation that followed the unfounded complaint filed by this surgeon, the state agents did a sweep of local pharmacies and found that I had written scripts for bioidentical hormones, which I and most other NDs in the state have done safely and effectively since our licensure in 1986. The Alaska statutes for NDs say that we "may not give, dispense or recommend in practice a prescription drug." But the regulations, which qualify and expound upon the very terse "boilerplate"' statutes, state that if the medicine is not a controlled substance (such as a narcotic) and is derived from a natural substance, then NDs may prescribe such substances. The bureaucrats have a different idea about interpreting the language of our law than do the professionals (naturopathic physicians and their pharmacists). Nonetheless, I stopped writing scripts in 2008, to the chagrin of many patients. The case was dropped.
Last spring (March 2011) when the Alaska ND scope modernization bill was moving along in legislature, my case mysteriously reopened with no new accusations,
I now face either a hugely expensive trial to clarify the language of the law in order to establish that neither I nor my colleagues in Alaska have practiced criminally since 1993, when the regulations were developed, or accept a punitive "consent agreement" which drastically curtails my practice even further. It is deeply stressful to face this dilemma: the proverbial rock and hard place.
For nearly 30 years, NDs in Alaska have offered safe, effective services that distinguish them from "conventional" doctors in a number of important ways. We don't go to drugs as a first line of therapy. We offer nutritional IVs. We dispense natural glandulars and bioidentical hormones preferentially over synthetic analogs. We use medical herbs and give a great deal of in-depth nutritional advice. NDs in Alaska have practiced since 1993 as though the regulation providing exceptions to the "may not prescribe" statute actually had meaning. Today, our pharmacists have succumbed to pressure by the AMA lobby to no longer allow us access to bioidenticals or even IV nutrients! Many of our patients will suffer greatly! The state of Alaska bureaucrats have no answer for us when we present them with this horrible moral dilemma. We are not being sanctioned because of causing harm. There has never been a malpractice suit against a naturopathic doctor in Alaska. The sanctions risk causing harm. This is 100% about a "turf war" perpetrated by the politically oriented, old-school MDs.
Bureaucratically, NDs have been compromised in Alaska because our regulators at the Division of Occupational Licensing don't really understand what we do. They seem to play favorites with the AMA doctors. The role of administrative overseers in any professional regulating agency should be to ensure that the professionals have the proper credentials to "hang out their shingle." It is not the role of the regulating agency to favor one group of professionals. However, the Division of Occupational Licensing, which is under the Department of Commerce and Economic Development, has clearly been favoring the AMA lobby. This is in direct violation of consumer rights.
In reaching out to colleagues across the country, I have received a flood of e-mails expressing outrage, dismay, and encouragement. Many other NDs (and nurses and dental hygienists and optometrists and chiropractors, etc.) have been vilified and persecuted at the hands of AMA bullies. Join me in coming together to explore legislative, administrative, and activist options to stop the harassment, and to promote freedom of choice in health care. If you are a consumer of wellness medicine, and appreciate having real health care (not just drug-based disease management) as an option for yourself and your family, please contact me at www.DrEmilyKane.com to learn about directing your voice to protect freedom of choice in health care.
If you are a naturopathic physician who has been bullied by your state's AMA lobby, please contact me at Dremilykane@gmail.com so that we can give our legal team as much evidence as possible to document this illegal turf-war behavior nationwide.
If you know journalists or radio show hosts who would be interested in a freedom of choice in health-care story, please direct them my way.
The basic message here is that all naturopathic physicians across the whole country need a full scope law. Rural and urban citizens alike deserve access to high-quality naturopathic care. Our disease-management system is bankrupting us, literally and figuratively. The federal injunctions in the Affordable Care Act call for empowering low-tech health-care providers and for meaningful focus, not just lip service, on preventive approaches to wellness. Naturopathic physicians are a small but potent resource for fixing what ails our country's health-care crisis.
Currently, naturopathic physicians in Alaska are being denied full scope practice both by administrative bureaucrats and by legislators susceptible enough to AMA lobbyists to hinder forward movement. The Alaska legislators have been educated year after year about the training and capabilities of naturopathic physicians over the decades of our efforts to expand scope since licensure in 1986. The state insurers figured out years ago that naturopaths are a "good bet" in terms of cost and quality. NDs have insurance reimbursement parity with MDs in Alaska. However, we have our hands tied when it comes to full scope practice. Legislatively, NDs just don't have clout or money equal to our opponents.
We are hugely rich in another resource however: the genuine gratitude and love of our patients. This force will ultimately stop the ruination of our collective health by the disease-management proponents. Patients will simply not tolerate a medical monopoly indefinitely.
Stand up with me now to protect your health and your freedom.
Dr. Emily Kane