A performance audit of the Naturopathic Board of Examiners

              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
OF THE
NATUROPATHIC BOARD OF EXAMINERS
SEPTEMBER 1981
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 81 - 8
DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
September 16, 1981
Members of the Arizona L e g i s l a t u r e
The Honorable Bruce Babbitt, Governor
D r . Milburn C. Shelton, President
Naturopathic Board of Examiners
Transmitted herewith is a report of t h e Auditor General, A Performance
Audit of the Naturopathic Board of Examiners. This r e p o r t is i n response
t o a January 30, 1980, r e s o l u t i o n of t h e J o i n t L e g i s l a t i v e Oversight
Committee. The performance a u d i t was conducted a s a p a r t of the Sunset
review s e t f o r t h i n A. R. S. $ 541- 2751 through 41- 2379.
The blue pages present a summary of the r e p o r t ; a response from the
Naturopathic Board of Examiners is found on the yellow pages preceding the
appendices.
My s t a f f and I w i l l be pleased t o d i s c u s s or c l a r i f y items i n the r e p o r t .
Respectfully submitted,
~ b u ~ lR&. Norton
Auditor General
S t a f f : Gerald A. Silva
W i l l i a m Thomson
Robert T. Back
J e r r y M i l l s
Enclosure
LEGISLATIVE SERVICES WING SUITE 200 STATE CAPITOL PHOENIX. ARIZONA 85007 a 255- 4385
OFFICE OF THE AUDITOR GENERAL
A PERFORMANCE AUDIT OF THE
NATUROPATHIC BOARD OF EXAMINERS
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 81- 8
TABLE OF CONTENTS
Page
INTRODUCTION AND BACKGROUND
SUNSET FACTORS
FINDINGS
FINDING I
Past and present members of the Naturopathic
Board of Examiners have reviewed t h e q u a l i f i c a t i o n s
of license applicants under an i n t e r p r e t a t i o n of
statutory requirements that apparently d i f f e r s
from actual requirements for licensure. A s a
r e s u l t , 136 of the 139 currently licensed naturopathic
physicians may not be properly licensed.
CONCLUSION
RECOl@ IENDAT I ONS
FINDING I1
While the scope of naturopathic practice i n
Arizona approximates that i n the five other
s t a t e s which license and regulate the
practice of naturopathy, its definition is
inconsistent and unclear.
CONCLUSION
RECO~ IrnNDATIO NS
FINDING I11
The Naturopathic Board of Examiners is not
resolving complaints i n a timely manner. A s a
r e s u l t , the Board may not be f u l f i l l i n g its
responsibility to protect the public.
CONCLUSION
RECOMMENDATIONS
OTHER PERTINENT INFORMAT I ON
WRITTEX RESPOIiSE TO THE AUDITOR GENERAL'S REPORT
APPEND1 CES
APPENDIX I - Legislative Council Opinion 0- 81- 59, June 29,
1981
APPENDIX I1 - Legislative Council Opinion 0- 81- 57, June 29,
1981
APPENDIX I11 - Legislative Council Opinion 0- 81- 58, July 1, 1981
SUMMARY
The Office of the Auditor General has conducted a performance audit of the
Naturopathic Board of Examiners i n response to a January 30, 1980,
resolution of the Joint Legislative Oversight Committee. This performance
audit was conducted as a part of the Sunset review s e t forth i n Arizona
Revised Statutes ( A. R. s. ) § $ 41- 2351 through 41- 2379.
The Naturopathic Board of Examiners was created i n 1935. The four members
of the Board are appointed by the Governor to three- year terms. Three of
the Board members must be licensed naturopathic physicians and the
remaining member must be a lay member.
The a c t i v i t i e s of the Board and its administrative office are funded
through fees charged for application, examination and license renewal, ten
percent of which is deposited i n the State General Fund.
Past and present members of the Naturopathic Board of Examiners have
reviewed the q u a l i f i c a t i o n s of l i c e n s e a p p l i c a n t s under an i n t e r p r e t a t i o n
of statutory requirements t h a t apparently d i f f e r s from actual requirements
for licensure. Our review of the Board's handling of t h e l i c e n s u r e
process revealed that the Board granted licenses to individuals who may
not qualify under the s t a t u t e s to practice naturopathy i n Arizona. Our
review revealed that these individuals apparently did not comply with one
or more of the following statutory requirements:
1. A. R. S. $ 32- 1523, which requires that applicants for licensure
achieve a score of 75 percent or more i n s p e c i f i e d s u b j e c t s on a
licensure examination,
2. A. R. S. $ 32- 1522, which requires t h a t applicants submit evidence
to show that they have successfully completed required hours of
course work i n s p e c i f i e d s u b j e c t s , and
3. A. R. S. $ 32- 1521. C, which requires that applicants submit
affidavits signed by residents of the State of Arizona a t t e s t i n g
to t h e i r good moral character.
A s a r e s u l t , 136 of the 139 currently licensed naturopathic physicians may
not be properly licensed. We were unable to determine whether the Board's
actions could cause a l i a b i l i t y to the State i f an improperly licensed
individual were to become involved in a malpractice case. We recommend
that the Legislature allow the Naturopathic Board of Examiners to
terminate under the provisions or A. R. S. $$ 41- 2351 through 41- 2379 and, i f
it deems the continued licensing of naturopathic physicians desirable,
i n s t i t u t e a new Board effective July 1, 1982. Such an action could
mitigate legal l i a b i l i t y of the State as a result of the Board's actions.
( page 7)
Our review also found that while the scope of naturopathic practice i n
Arizona approximates that i n the five other s t a t e s which license and
regulate the practice of naturopathy, its definition is inconsistent and
unclear. We recommend that the Legislature review the scope of
naturopathic practice as currently defined, review the prohibitions on the
use of drugs and surgery and consider adding s p e c i f i c s t a t u t o r y language
t o c l a r i f y definitions and/ or remove inconsistencies with respect to
specific areas of practice. ( page 25)
Finally, our review found that the Naturopathic Board of Examiners is not
resolving complaints in a timely manner. A s a r e s u l t , the Board may not
be f u l f i l l i n g its responsibility to protect the public. We recommend that
the Board resolve complaints i n a timely manner. I f the Board deems that
additional funds are required to respond to complaints i n a timely manner,
it should appeal to the Legislature for these resources. ( page 33)
INTRODUCTION AND BACKGROUND
The Office of the Auditor General has conducted a performance audit of the
Naturopathic Board of Examiners in response to a January 30, 1980,
resolution of the Joint Legislative Oversight Committee. This performance
audit was conducted as a part of the Sunset review set forth in Arizona
Revised Statutes ( A. R. S. ) 5541- 2351 through 41- 2379.
Naturopathy has been defined as " the science and art of diagnosing and
treating and preventing disease and the promotion and preservation of
health, as taught in naturopathic medical schools." Naturopathic
procedures include: heat, cold, light, water, ultrasound, electricity,
manipulation, massage, hypnotherapy, biofeedback, vitamins, minerals,
enzyres, glandular extracts and hormones, botanical medicines,
acupuncture, reflexology* and homeopathy.** In addition, in three states
naturopathic physicians are permitted to use pharmaceuticals and perform
minor surgery.
The Naturopathic Board of Examiners was created in 1935. The. stated goals
and objectives of the Board are to:
" Regulate the practice of Naturopathy by:
administering examinations to individuals requesting a
certificate of licensure, issuing licenses to
applicants meeting the qualifications standard,
renewing licenses of present practitioners and revoking
or suspending licenses previously issued when the
licensee fails to comply with such standards; and
promulgating rules and regulations consistent with
their statutes."
* The study and interpretation of behavior in terms of simple and
complex reflexes. ** A system of medical practice that treats a disease by the
administration of minute doses of a remedy that would in healthy
persons produce symptoms of the disease treated.
The four members of the Board a r e appointed by the Governor to three- year
terms. Three of the Board members must be licensed naturopathic
physicians, and the remaining member must be a l a y member.
The Board has no f u l l - t i m e support s t a f f . Support functions a r e handled
by the Arizona S t a t e Boards Administrative Office ( AsBAO) , which was
created i n 1976. ASBAO serves a s the support s t a f f f o r the Board and ten
other s t a t e boards or commissions, providing s e c r e t a r i a l and c l e r i c a l
s e r v i c e s f o r each tenant board or commission.
The Board is funded through f e e s charged f o r examination and l i c e n s u r e .
Ninety percent of the f e e s c o l l e c t e d a r e deposited i n the Naturopathic
Board fund. The remaining ten percent is deposited i n the S t a t e General
Fund. Table 1 i l l u s t r a t e s the expenditures of the Board f o r f i s c a l years
1977- 78 through 1980- 81 and the a p p r o p r i a t i o n f o r f i s c a l year 1981- 82.
TABLE 1
SUMMARY OF BOARD EXPENDITURES FOR FISCAL
YEARS 1977- 78 THROUGH 1980- 81 AND THE
APPROPRIATION FOR FISCAL YEAR 1981- 82
Appropriation
1977- 78 1978- 79 1979- 80 1980- 81 1981- 82
Personal s e r v i c e s $ 2,340 $ 1,600 $ 3,000 $ 3,100
Employee- related 6
P r o f e s s i o n a l and
outside s e r v i c e s 1,800 2,100 3,100 5,200
Travel - i n - S t a t e 400
0 ther operating
expenses 445 300 500 800
Totals
The Auditor General expresses g r a t i t u d e t o the members of the Naturopathic
Board of Examiners and to the s t a f f of ASBAO f o r t h e i r cooperation,
a s s i s t a n c e and consideration during the course of t h i s a u d i t .
* For f i s c a l year 1981- 82, the Board received a lump sum a p p r o p r i a t i o n
of $ 12,600.
SUNSET FACTORS
SUNSET FACTOR: OBJECTIVE AND
PURPOSE I N ESTABLISHING THE BOARD
The Naturopathic Board of Examiners was created i n 1935. Its purpose is
t o p r o t e c t the h e a l t h and well being of the public by r e g u l a t i n g t h e
p r a c t i c e of naturopathic physicians.
The Board views the reason f o r its c r e a t i o n a s follows:
" The object and purpose of e s t a b l i s h i n g the Board is
f i r s t and foremost the p r o t e c t i o n of the p u b l i c w e l f a r e
i n matters r e l a t i n g t o h e a l t h and disease and the
establishment of the board arose due t o the need t o
provide the public with q u a l i t y naturopathic medical
care by e s t a b l i s h i n g p r o f e s s i o n a l standards and
requirements t o ensure an e f f e c t i v e , i n t e l l i g e n t
d e l i v e r y of t h i s medical care system."
SUNSET FACTOR: THE DEGREE TO WHICH THE
BOARD HAS BEEB ABLE TO RESPOND TO THE
NEEDS OF THE PUBLIC AND THE EFFICIENCY
WITH WHICH IT HAS OPERATED
Past and present Board members have reviewed t h e q u a l i f i c a t i o n s of
a p p l i c a n t s under an i n t e r p r e t a t i o n of s t a t u t o r y requirements t h a t
apparently d i f f e r s from a c t u a l requirements f o r l i c e n s u r e . A s a r e s u l t ,
136 of the 139 c u r r e n t l y licensed n a t u r o p a t h i c p h y s i c i a n s may not be
p r o p e r l y l i c e n s e d . ( page 7)
SUNSET FACTOR: THE EXTENT TO WHICH THE BOARD HAS
ENCOURAGED INPUT FROM THE PUBLIC BEFORE PROWLGATING
ITS RULES AND REGULATIONS AND THE EXTENT TO WHICH
IT HAS INFORTIED THE PUBLIC AS TO ITS ACTIONS AND
THEIR EXPECTED INPACT ON THE PUBLIC
Meetings of the Board a r e open t o the p u b l i c . Notices of meetings a r e
posted i n the Occupational Licensing Building and a r e c i r c u l a t e d to
i n t e r e s t e d p a r t i e s through d i r e c t mailings. The Board has heard
statements from public organizations and i n d i v i d u a l s and has made an
e f f o r t to incorporate such p u b l i c i n p u t i n t o its procedures.
The Board has h e l d p u b l i c h e a r i n g s on proposed r u l e changes. The general
p u b l i c h a s had the opportunity t o speak a t these hearings, and the records
i n d i c a t e t h a t i n d i v i d u a l s and groups have done so.
~ SUNSET FACTOR: THE EXTENT TO WHICH THE BOARD
HAS BEEN ABLE TO INVESTIGATE AND RESOLVE
COMPLAINTS THAT ARE WITHIN ITS JURISDICTION
The Board receives a limited number of complaints. During the period
January 1, 1980, to June 30, 1981, the Board received s i x complaints. A s
of June 30, 1981, t h r e e had been resolved and closed and t h r e e still were
under i n v e s t i g a t i o n .
During 1978 through June 30, 1981, the Board dismissed or delayed a c t i o n
on two complaints, c i t i n g a lack of funding. Our review, however,
i n d i c a t e s the Board - did have s u f f i c i e n t funds t o i n v e s t i g a t e these
complaints. ( page 33)
SUNSET FACTOR: THE EXTENT TO WHICH THE BOARD
HAS OPERATED WITHIN THE PUBLIC INTEREST
The Board may not have operated within the public i n t e r e s t i n t h a t it has
reviewed a p p l i c a n t s f o r l i c e n s u r e under an i n t e r p r e t a t i o n of s t a t u t o r y
requirements t h a t apparently d i f f e r s from a c t u a l requirements. ( page 7)
SUNSET FACTOR: THE EXTENT TO WHICH RULES AND
REGULATIONS PROWJLGATED BY THE BOARD ARE
C9NSISTENT WITH LEGISLATIVE MANDATE
- --
Administrative r u l e s and r e g u l a t i o n s promulgated by the Board must be
reviewed f o r consistency and l e g a l i t y and approved by the Attorney General
p r i o r t o t h e i r implementation.
SUNSET FACTOR: THE EXTENT TO WHICH THE ATTORNEY
GENERAL OR ANY OTHER APPLICABLE AGENCY OF STATE
GOVERNIvIENT HAS THE AUTHORITY TO PROSECUTE
ACTIONS UNDER THE ENABLING LEGISLATION
A. R. S. $ 32- 1556 s t a t e s , i n part:
" The county attorney of each county o r t h e attorney
general s h a l l prosecute a l l persons charged with
violating t h i s chapter, but the board may r e t a i n its
own attorney or i n v e s t i g a t o r s o r request legal
assistance from t h e a t t o r n e y general to aid i n
prosecuting such a violator."
SUBSET FACTOR: THE EXTENT TO WHICH THE
BOARD HAS ADDRESSED D E F I C I E N C I E S I N I T S
ENABLING STATUTES WHICH PREVENT I T FROM
F U L F I L L I N G I T S STATUTORY MANDATE
The Board proposed new l e g i s l a t i o n during the 1979, 1980 and 1981
l e g i s l a t i v e sessions. Most recently, the Board proposed l e g i s l a t i o n which
would have removed statutory provisions specifying the number of study
hours applicants must complete i n specific subjects t o qualify for
licensure.
SUNSET FACTOR: THE EXTENT TO WHICH CHANGES ARE
NECESSARY I N THE LAWS OF THE BOARD TO ADEQUATELY
COIPLY WITH THE FACTORS L I S T E D I N T H I S SUBSECTION
Statutory changes are needed for c l a r i f i c a t i o n and consistency regarding
the scope of practice for naturopathy. ( page 25)
FINDING I
PAST AND PIBSENT ! EMBERS OF THE NATUROPATHIC BOARD OF EXAI4INERS HAVE
REVIEWED THE QUALIFICATIONS OF LICENSE APPLICANTS UNDER AN INTERPRETATION
OF STATUTORY REQUIREMENTS THAT APPARENTLY DIFFERS FROM ACTUAL REQUIREMENTS
FOR LICENSUIIE. AS A RESULT, 136 OF THE 139 CURRENTLY LICENSED
NATUROPATHIC PHYSICIANS MAY NOT BE PROPERLY LICENSED.
A. R. S. $ 32- 1505 gives the Naturopathic Board of Examiners a u t h o r i t y t o
i s s u e l i c e n s e s t o p r a c t i c e naturopathy i n t h e S t a t e of Arizona. A. R. S.
$$ 32- 1521 through 32- 1525 s p e c i f y the requirements f o r l i c e n s u r e . In
order to q u a l i f y f o r a l i c e n s e t o p r a c t i c e naturopathy i n Arizona, an
applicant must :
1. F i l e an a p p l i c a t i o n ,
2. Submit an a p p l i c a t i o n f e e of $ 50,
3. Submit documentation which proves t h a t the applicant meets the
educational requirements s p e c i f i e d i n A. R. S. $ 32- 1522,
4. Submit two a f f i d a v i t s signed by S t a t e r e s i d e n t s a t t e s t i n g t o the
a p p l i c a n t ' s moral c h a r a c t e r , and
5. Successfully complete an examination with a score of 75 percent
or b e t t e r .
If a n i n d i v i d u a l is licensed t o p r a c t i c e naturopathy i n another s t a t e , he
may apply f o r l i c e n s u r e through r e c i p r o c i t y , provided the other s t a t e ' s
requirements f o r l i c e n s u r e a r e not l e s s than those i n t h i s S t a t e .
Our review of the Board's handling of t h e l i c e n s u r e process revealed t h a t
the Board may have granted l i c e n s e s t o as many a s 136 i n d i v i d u a l s who may
not q u a l i f y under the s t a t u t e s t o p r a c t i c e naturopathy i n Arizona. Our
review revealed t h a t t h e s e i n d i v i d u a l s a p p a r e n t l y d i d not comply with one
or more of the following s t a t u t o r y requirements:
1. Examination ( A. R. s. $ 32- 1523) ,
2. Educational q u a l i f i c a t i o n s ( A. R. S. $ 32- 1522), and
3. F i l i n g of a f f i d a v i t s ( A. R. s. $ 32- 1521.~).
Additionally, the Board's granting of r e c i p r o c i t y t o l i c e n s e e s of Oregon's
naturopathic board of examiners may v i o l a t e t h e provisions of A. R. S.
$ 32- 15 24.
F i n a l l y , because a s many as 136 of the 139 c u r r e n t l y licensed naturopathic
physicians may not be q u a l i f i e d t o p r a c t i c e naturopathy i n Arizona, the
S t a t e could be l i a b l e f o r substandard care provided by an improperly
licensed p r a c t i t i o n e r .
Examination
A0R. S. $ 32- 1523 s t a t e s :
" A. For the purpose of determining the q u a l i f i c a t i o n s
of a p p l i c a n t s f o r l i c e n s e under the provisions of t h i s
chapter, the board s h a l l hold meetings and conduct
examinations of a p p l i c a n t s f o r l i c e n s e s a t times and
places and under r u l e s and r e g u l a t i o n s the board
determines. The time and p l a c e o f holding the
examination s h a l l be published a t l e a s t t h i r t y days
p r i o r t o the date of the examination.
" B. The examination s h a l l be i n w r i t i n g and s h a l l
embrace the s u b j e c t s s e t f o r t h i n 532- 1522 and other
s u b j e c t s required by the board. I f the applicant
answers seventy- five ~ e r c e n t of the auestions asked on
each of the s u b j e c t s of the examination c o r r e c t l y , a
l i c e n s e t o p r a c t i c e naturopathy s h a l l be issued t o the
" C. I f an applicant f a i l s to pass the examination he
s h a l l , within one year a f t e r h i s f a i l u r e t o pass,
without losing c r e d i t f o r s u b j e c t s passed and without
paying another f e e , be permitted t o t a k e a n o t h e r
examination a t the convenience of the board. An
applicant f o r reexamination s h a l l , not l e s s than
f i f t e e n days before the date of the examination, n o t i f y
the board of h i s i n t e n t i o n t o take the examination."
( ~ m p h a s i sa dded)
Our review of the l i c e n s u r e f i l e s of the 139 c u r r e n t l y licensed
naturopathic physicians revealed t h a t 16 of them were licensed through
r e c i p r o c i t y with other s t a t e s and 123 were licensed through the
examination process. In attempting t o review the examinations
administered by the Board t o the 123 persons licensed through examination,
we discovered t h a t the Board: 1) had n o t r e t a i n e d the examinations
administered t o 98 c u r r e n t l y licensed n a t u r o p a t h i c p h y s i c i a n s b e f o r e 1976,
and 2) had not retained or misplaced s e v e r a l examination s e c t i o n s
administered t o one c u r r e n t l y l i c e n s e d n a t u r o p a t h i c p h y s i c i a n a f t e r 1975.
A s a r e s u l t , our review of examinations was r e s t r i c t e d t o those
administered between December 1975 and June 30, 1981, t o 24 c u r r e n t l y
licensed naturopathic physicians. This review revealed t h a t : 1) the
Board's w r i t t e n examination may not comply with the provisions of A. R. S.
$ 32- 1523. B, and 2) the Board has granted l i c e n s e s t o 22 of the 24
a p p l i c a n t s d e s p i t e t h e f a c t t h a t they d i d n o t pass the examination as
required by A. R. S. $ 32- 1523. B.
The Board's Examination Mav Not
Comply with A. R. S. $ 32- 1523.~
A. R. S. $ 32- 1523.~ s t a t e s , i n p a r t :
" The examination s h a l l be i n w r i t i n g and s h a l l embrace
the s u b j e c t s s e t f o r t h i n $ 32- 1522 and other s u b j e c t s
required by the board."
A. R. S. $ 32- 1522 lists 19 s p e c i f i c subject a r e a s and p e r m i t s t h e Board t o
include such o t h e r s u b j e c t s a s it deems appropriate.
In an opinion dated June 29, 1981, the L e g i s l a t i v e Council stated:*
" The Board is required t o cover t h e s u b j e c t s l i s t e d i n
A. R. S. 32- 1522 on t h e l i c e n s i n g examination. The
Board may a l s o require s u b j e c t s o t h e r t h a n those l i s t e d
t o be on the exam. I f the L e g i s l a t u r e had intended the
Board to have d i s c r e t i o n a r y a u t h o r i t y t o exclude some
of the subject areas l i s t e d i n A. R. S. $ 32- 1522 it would
have so provided r a t h e r than mandating t h a t the Board
include the s u b j e c t s l i s t e d and any other s u b j e c t s the
Board may r e q u i r e on the l i c e n s i n g exam."
Appendix I contains the memorandum t e x t .
9
Our review of the Board's l i c e n s u r e examination revealed t h a t it h a s n o t
t e s t e d a p p l i c a n t s i n a l l s u b j e c t s l i s t e d i n A. R. S. 532- 1522. Table 2
lists the s u b j e c t a r e a s s p e c i f i e d i n A. R. S. $ 32- 1522 and i l l u s t r a t e s which
s u b j e c t s were offered a s p a r t s of the l i c e n s u r e examination.
TABLE 2
SUBJECT AREAS OFFERED AS PARTS OF
THE LICENSURE EXAMINATION
DECEMBER 1976 TO JUNE 30, 1981
Subject Area Specified
In A. R. S. $ 32- 1522
April May
- 1979 - 1980*
Dee. May Nov. April
- 1976 - 1977 - 1977 - 1978
Nov.
1978
Anatomy
Histology and embryology
Physiology
Chemistry
Bacteriology
Pa thology X
Diagnosis X
Orthopedics X
Manipulative and ad j u s t i v e technic X
D i e t e t i c s
Drugless gynecology** X
Nonsurgical obstetrics*" X
Toxicology X
F i r s t a i d X
Ear, nose and t h r o a t
Hygiene and s a n i t a t i o n
Jurisprudence
Drugless t h e r a p e u t i c s
C l i n i c a l p r a c t i c e
* No complete examination was offered i n November 1979. Therefore, i t
was eliminated from t h i s summary.
** O b s t e t r i c s and gynecology were offered a s one s u b j e c t of
examination. This may v i o l a t e the p r o v i s i o n s o f A. R. S. $ 32- 1523. B.
A s shown i n Table 2, the Board did not o f f e r an examination from December
1976 through May 1980 t h a t s p e c i f i c a l l y covered every subject s t i p u l a t e d
i n A. R. S. $ 32- 1522.
According to Board members, questions from s e v e r a l subject a r e a s may be
incorporated i n t o one examination p a r t . For example, the 19 s u b j e c t s
s p e c i f i e d i n A. R. S. 532- 1522 could be incorporated i n t o e i g h t examination
p a r t s . However, such a p r a c t i c e may r e s u l t i n the only coverage of a
s p e c i f i c subject being two or t h r e e questions i n an examination p a r t
containing 50 questions or more. Not only is it questionable as t o
whether two or t h r e e questions on a subject c o n s t i t u t e s adequate
examination, but A. R. S. $ 32- 1523.~ s t a t e s t h a t an applicant must answer - 75
percent of the questions on each s u b j e c t c o r r e c t l y . In order f o r the
Board to determine t h a t an applicant has answered 75 percent of the
questions on each s u b j e c t c o r r e c t l y , it would be necessary t o analyze
every q u e s t i o n o f every p a r t ; t h a t apparently has not been done.
Table 2 i l l u s t r a t e s the problem i n t h a t o b s t e t r i c s and gynecology were
offered as one s e c t i o n . T h e o r e t i c a l l y , an applicant could score 100
percent i n o b s t e t r i c s but only 50 percent i n gynecology and still pass the
examination p a r t with a combined score of 75 percent, d e s p i t e t h e f a c t
t h a t the gynecology score was lower than the s t a t u t o r i l y required score of
75 percent f o r each s u b j e c t .
I n d i v i d u a l s Have Been Licensed bv the Board
Who Have Not Passed the Licensure Examination
During the period December 1976 t o June 30, 1981, the Board licensed 24
i n d i v i d u a l s through the examination process. Our review of the
examination papers of these i n d i v i d u a l s revealed t h a t 22 of the 24 did not
achieve scores of 75 percent i n a l l p a r t s as required by law. The Board
had: 1) deleted some questions and adjusted some scores and 2) licensed
a p p l i c a n t s who apparently d i d n o t achieve a passing score of 75 percent on
a l l examination p a r t s .
Deleted Questions
During our review of examination papers we noticed s e v e r a l t h a t had two
scores w r i t t e n on the f r o n t of an examination section. On i n q u i r y , Board
members responded t h a t a question may have been deleted because it was
deemed by the Board to be improper or u n f a i r , and applicant scores were
adjusted accordingly. This p r a c t i c e does not appear to be i n compliance
with A. R. S. $ 32- 1523.~, which s t a t e s i n p a r t :
" . . . I f the applicant answers seventy- five percent of
the questions asked on each of the subjects of the
examination c o r r e c t l y , a l i c e n s e to p r a c t i c e
naturopathy s h a l l be issued t o the applicant."
I n an opinion dated June 29, 1981, the L e g i s l a t i v e Council stated:*
" . . . If an applicant does not answer seventy- f ive
percent of the questions asked on each of the s u b j e c t s
of the examination c o r r e c t l y , he is n o t q u a l i f i e d and
the Board should not i s s u e a l i c e n s e t o t h a t applicant."
Failure to Achieve Passing Scores
During our review we noted s e v e r a l instances i n which the Board granted
l i c e n s e s t o a p p l i c a n t s who apparently did not pass every required
examination s e c t i o n s u c c e s s f u l l y .
CASE I
The applicant achieved the following scores during three examinations:
Examination Section December 1976 May 1977 November 1977
~ b s t e r i c s / ~ ~ n e c o l o ~ ~
F i r s t a i d
Pathology
X- ray
P h y s i c a l t h e r a p y
Orthopedics
Naturopathic p r a c t i c e
Diagnosis
Toxicology
* Appendix I contains the memorandum t e x t .
The November 1977 score on the diagnosis s e c t i o n was adjusted from 44
percent t o 75 percent without explanation. When the Board deleted
questions or regraded answers, there was no evidence of which questions
were affected or why. Further, t h e a p p l i c a n t did n o t r e t a k e
obstetrics/ gynecology, X- ray, naturopathic p r a c t i c e o r toxicology and,
t h e r e f o r e , never achieved a s c o r e o f 75 percent on those examination
sections .
CASE I1
The applicant s a t f o r the November 1977, April 1978, November 1978 and
April 1979 examinations, achieving t h e scores indicated:
November Apri 1 November Apr i 1
Examination Section 1977 1978 1978 1979
Obstetrics/ gynecology
F i r s t aid
Pathology
X- ray
Physical therapy
Orthopedics
Public ~ e a l t h / ~ o x i c o l o g y
Diagnosis
Na turopa t h i c p r a c t i c e
Anatomy
Bacteriology
Chemistry
Physiology
As shown, the applicant did not achieve a score of 75 percent i n every
subject as required by A. R. S. $ 32- 1523.
* Diagnosis and pathology were combined i n t o one examination p a r t i n
April 1978 and November 1978.
*" Applicants' f i l e contained an answer sheet f o r a p r a c t i c a l examination
i n X- ray. Score on the answer sheet was 90 percent.
CASE I11
The applicant sat for the December 1976 and May 1977 examinations and
achieved the scores indicated:
Examination Section
Obstetrics/ gynecology
First aid
Pathology
X- ray
Physical therapy
Orthopedics
Naturopathic practice
Diagnosis
Toxicology
December 1976 May 1977
As shown, the applicant did not achieve a passing score of 75 percent on
obstetri~ s/~~ necolnoa~ t~ ur, o pathic practice or toxicology.
CASE IV
The applicant sat for the April 1978 and April 1979 examinations and
achieved the scores indicated:
Examination Section
Obstetrics/ gynecology
X- ray
Physical therapy
Orthopedics
Naturopathic practice
~ ia~ nosis/~ atholo~~
Physiology
Chemistry
Bacteriology
Anatomy
Toxicology
April 1978 April 1979
The applicant did not achieve a score of 75 percent in X- ray, orthopedics,
diagnosis/ pathology, physiology, chemistry or toxicology.
A t the conclusion of our review we met with present and past Board members
t o d i s c u s s t h e s e discrepancies. According t o Board members, i n order t o
compensate f o r the d i f f i c u l t y of some examination p a r t s , adjustments were
made t o the scores of the 22 a p p l i c a n t s whose raw scores were below the
required score of 75 percent. However, the Board did not document the
reasons f o r grading changes, or change the scores on the examination
papers. Thus, the Board cannot document t h a t these a p p l i c a n t s passed the
examination.
It should be noted t h a t t h e Board would have had t o a d j u s t some applicant
scores by a s much as 40 p o i n t s i n order f o r them t o achieve passing
scores. Further, i n December 1976, every applicant f a i l e d the toxicology
examination s e c t i o n and a l l but three of the 15 a p p l i c a n t s f a i l e d the
obstetrics/ gynecology s e c t i o n . None of t h e s e a p p l i c a n t s retook the
sections but the Board granted l i c e n s e s t o each.
Educational Q u a l i f i c a t i o n s
A. R. S. $ 32- 1522" s t a t e s :
" Except a s provided i n t h i s s e c t i o n , the minimum
educational requirements f o r l i c e n s e under the
provisions of t h i s chapter s h a l l be a high school
diploma, o r t h e equivalent t h e r e o f , c e r t i f i e d t o by the
superintendent of public i n s t r u c t i o n or a county school
superintendent, and subsequent graduation from a school
or schools of drugless t h e r a p e u t i c s , approved by the
board, embracing r e s i d e n t i a l s t u d i e s of not l e s s than
f o u r y e a r s of e i g h t months each devoted t o a s t u d y o f
the following s u b j e c t s i n the approximate number of
hours assigned t o each a s follows:
1. Anatomy, including d i s s e c t i o n , s i x hundred f i f t y
hours.
2. Histology and embryology, one hundred f i f t y
hours .
3. Physiology, two hundred f i f t y hours.
4. Chemistry, two hundred hours.
5. Bacteriology, one hundred hours.
6. Pathology, t h r e e hundred f i f t y hours.
* It should be noted t h a t education requirements f o r l i c e n s u r e have not
been amended since the Board was created i n 1935 and t h a t a l l l i c e n s e s
have been granted under the same educational requirements.
II 7. Diagnosis, including p h y s i c a l , c l i n i c a l , X- ray,
symptomatology, dermatology and mental d i s e a s e s , f i v e
hundred hours.
8. Orthopedics, one hundred hours.
9. Manipulative and a d j u s t i v e t e c h n i c , two hundred
hours.
10. D i e t e t i c s , two hundred hours.
11. Drugless gynecology, one hundred f i f t y hours.
12. Nonsurgical o b s t e t r i c s , one hundred f i f t y hours.
13. Toxicology, f i f t y hours.
14. F i r s t a i d , f i f t y hours.
15. Ear, nose and t h r o a t , f i f t y hours.
16. Hygiene and s a n i t a t i o n , one hundred hours.
17. Jurisprudence, f o r t y - f i v e hours.
18. Drugless t h e r a p e u t i c s , including e l e c t r o t h e r a p y ,
physiotherapy, hydrotherapy, massage and p r a c t i c e of
naturopathy, seven hundred f i f t y hours.
19. C l i n c i a l p r a c t i c e , t h r e e hundred hours.
20. Such o t h e r s u b j e c t s a s the board r e q u i r e s ,
excepting materia medica and major surgery, t o t a l i n g
not l e s s t h a n f o r t y - f i v e hundred hours." ( ~ m p h a s i s
added)
Our review of the l i c e n s u r e f i l e s of the 139 c u r r e n t l y licensed
n a t u r o p a t h i c p h y s i c i a n s revealed t h a t 127 of them presented evidence t h a t
they had completed 4,500 hours a s required by law. However, 1) a
s i g n i f i c a n t number of t h e l i c e n s e e s may not have completed any hours a t
a l l i n one or more of the s p e c i f i e d s u b j e c t s ; and/ or 2) a p p l i c a n t s may
have completed fewer than the minimum number of hours i n s p e c i f i c subjects
a s required by law.
Applicants f o r l i c e n s u r e a s naturopathic physicians a r e required to
present evidence t h a t they have s a t i s f i e d educational requirements. The
Board allows them e i t h e r t o submit o f f i c i a l t r a n s c r i p t s from schools of
drugless t h e r a p u t i c s o r have the school t h e y a t t e n d e d a t t e s t t o t h e i r
s c h o l a s t i c c r e d e n t i a l s on t h e a p p l i c a t i o n form. E i t h e r kind of
documentation must show the number of hours completed i n each s u b j e c t .
Applicants Not Completing A l l Course Work
I n an opinion dated June 29, 1981, t h e L e g i s l a t i v e Council stated:"
" The L e g i s l a t u r e intended t h a t a p p l i c a n t s f o r l i c e n s e s
to p r a c t i c e naturopathy complete course work i n the
subjects l i s t e d and i n the approximate number of hours
s t a t e d or they would not have s e t out the educational
requirements with such s p e c i f i c i t y .
" In order t o s a t i s f y the educational requirement i n
A. R. S. s e c t i o n 32- 1522, an applicant is required t o
complete course work i n each of the s u b j e c t s l i s t e d i n
the approximate number of hours assigned t o each
subj ectT " ( ~ m ~ h a saidsd ed)
Our review revealed t h a t 85 of the 139 c u r r e n t l y licensed naturopathic
physicians did not submit evidence t h a t they had completed course work i n
one or more of the s u b j e c t a r e a s s p e c i f i e d i n A. R. S. 332- 1522. Further,
the Board's a p p l i c a t i o n form does not request a p p l i c a n t s t o i n d i c a t e
whether they have completed course work i n d i e t e t i c s , a subject s p e c i f i e d
i n A. R. S. 332- 1522. Thus, i f the applicant provided only the information
requested, the Board would be unable to determine whether t h e i n d i v i d u a l
had completed course work a s required by t h e s t a t u t e .
In reviewing the l i c e n s u r e f i l e s of each of the 139 c u r r e n t l y licensed
n a t u r o p a t h i c p h y s i c i a n s , we found t h a t : 1) eleven f i l e s contained no
t r a n s c r i p t s or other documents p e r t a i n i n g t o the l i c e n s e e ' s educational
background, and 2) 85 f i l e s contained no evidence t h a t t h e applicant had
completed any course work i n one or more of the following s p e c i f i e d
subject areas.""
" Appendix I1 contains the memorandum t e x t .
** Because the Board excluded d i e t e t i c s from its a p p l i c a t i o n form, we
have not included it i n our s t a t i s t i c s . We did note t h a t 108 licensee
f i l e s contained no information r e l a t i n g t o course work i n d i e t e t i c s .
Required Subject per A. R. S. $ 32- 1522
Anatomy
is tology/ embryology
Physiology
Chemistry
Bacteriology
Pathology
Diagnosis
Orthopedics
Manipulative and a d j u s t i v e technic
Drugless gynecology
Nonsurgical o b s t e t r i c s
Toxicology
F i r s t a i d
Ear, nose and t h r o a t
Hygiene and s a n i t a t i o n
Jurisprudent e
Drugless t h e r a p e u t i c s
C l i n i c a l p r a c t i c e
Number of Licensure F i l e s
which Contained No Evidence
t h a t the Applicant Had
Completed Any Hours i n the
I n d i c a t e d S u b j e c t
Based on the above, the Board granted l i c e n s e s t o 85 i n d i v i d u a l s who did
not present adequate evidence t h a t they had completed course work i n a l l
s p e c i f i e d s u b j e c t s a s required by A. R. S. $ 32- 1522.
Applicants Completing Fewer than
the Minimum Hours i n S p e c i f i c Subjects
During our review, we a l s o noticed t h a t numerous l i c e n s e d n a t u r o p a t h i c
physicians were s i g n i f i c a n t l y d e f i c i e n t i n the number of hours of course
work. A. R. S. $ 32- 1522 s t a t e s i n p a r t :
". . . A study of the following s u b j e c t s i n the
approximate number of hours assigned to each ...."
* A l l l i c e n s e e s ' f i l e s contained evidence of some hours completed i n the
indicated s u b j e c t area.
In an opinion dated July 29, 1981, the L e g i s l a t i v e Council stated:"
" The phrase ' i n the approximate number of hours
assigned t o each' means a number of hours merely
resembling t h a t assigned t o each subject ....
" The applicant is required t o have completed almost but
not q u i t e the exact number of hours s t a t e d i n A. R. S.
932- 1522. The u s e o f the word approximate was probably
meant t o allow the Board some f l e x i b i l i t y when
considering a p p l i c a n t s ' educational backgrounds since
it is unlikely t h a t a l l the schools of drugless
t h e r a p e u t i c s approved by the Board would o f f e r the
i d e n t i c a l number of hours as required i n the s t a t u t e
f o r each subject."
Given the lack of c l a r i t y regarding a d e f i n i t i o n of approximate hours, we
assumed f o r the purpose of our review t h a t 50 percent or l e s s d i d n o t
approximate the s t a t u t o r i l y prescribed course hours. Based on t h a t
c r i t e r i a , we i d e n t i f i e d 34 l i c e n s e e s whose classroom hours, a s indicated
on t h e i r a p p l i c a t i o n forms or t r a n s c r i p t s , were 50 percent or l e s s than
the s p e c i f i e d hours i n one or more o f t h e required s u b j e c t s .
According t o Board members, e v e r y n a t u r o p a t h i c l i c e n s e e has completed a t
l e a s t 4,500 hours of course work a t a school o r schools of drugless
t h e r a p e u t i c s , and most l i c e n s e e s present evidence of completed hours i n
c l i n i c a l p r a c t i c e t h a t 1) far exceed the 300 hours required by A. R. S.
532- 1522, 2) cover every phase of naturopathic medicine, and 3) make up
f o r d e f i c i e n c i e s i n o t h e r s u b j e c t areas.
We were not able t o v e r i f y the Board's a s s e r t i o n t h a t c l i n i c a l p r a c t i c e
hours compensate f o r shortages i n s p e c i f i c s u b j e c t hours. When we
contacted the two schools t h a t were attended by most of the l i c e n s e e s i n
question, we were t o l d t h a t formal research would have t o be conducted t o
determine if c l i n i c a l p r a c t i c e included enough hours i n such a r e a s as
o b s t e t r i c s to make up f o r shortages ranging up to 150 hours. Further, we
noted 17 cases i n which the t o t a l number of c l i n i c a l p r a c t i c e hours could
n o t p o s s i b l y include s u f f i c i e n t hours to cover observed shortages i n some
subjects.
* Appendix I1 contains the memorandum t e x t .
It should be noted t h a t Board members contend t h a t : 1) the s t a t u t o r y
course- hours requirements a r e outdated i n t h a t they have not been amended
since t h e i r adoption i n 1935 and do not correspond t o the c u r r i c u l a of
modern schools and the educational requirements f o r l i c e n s u r e , and
2) other h e a l t h regulatory agencies require o n l y g r a d u a t i o n from a
recognized u n i v e r s i t y or medical school which o f f e r s a p a r t i c u l a r course
of study. During 1981, the Board suggested l e g i s l a t i o n which would have
changed A. R. S. $ 32- 1522 to require t h a t an applicant be a graduate of " an
approved naturopathic school" and would have deleted s p e c i f i c subjects
from t h e s t a t u t e . The b i l l did not pass.
F i l i n g of A f f i d a v i t s
A. R. S. $ 32- 1521.~ s t a t e s :
" The applicant s h a l l be of good moral c h a r a c t e r and
s h a l l f i l e with the a p p l i c a t i o n a f f i d a v i t s of two
reputable r e s i d e n t s of the s t a t e a t t e s t i n g- the g- ood
moEal character of the applicant and two photographs of
the applicant taken within s i x t y days of the
a p p l i c a t i o n . Other data and information a s the board
r e q u i r e s s h a l l be f i l e d with the a p p l i c a t i o n . A t the
time and place the board has p r e v i o u s l y d e s i g n a t e d , the
applicant s h a l l appear before the board f o r examination
a s t o h i s f i t n e s s t o p r a c t i c e naturopathy." ( ~ m ~ h a s i s
added)
Our review of the 139 current l i c e n s e e s of the Board revealed t h a t 95 of
them did not comply with the requirements of A. R. S. $ 32- 1521. C.
Noncornpliances included: f a i l u r e t o submit any a f f i d a v i t s , submitting
only one a f f i d a v i t , and submitting a f f i d a v i t s signed by r e s i d e n t s of other
s t a t e s .
I n an opinion dated July 1, 1981, the L e g i s l a t i v e Council stated:"
" The a f f i d a v i t s required under A. R. S. $ 32- 1521,
subsection D must be signed by reputable r e s i d e n t s of
the S t a t e of Arizona.
" . . . Since A. R. S. $ 32- 1521, subsection C c l e a r l y s t a t e s
t h a t the applicant is required to f i l e a f f i d a v i t s of
two reputable r e s i d e n t s of the S t a t e with h i s
a p p l i c a t i o n , t h e a f f i d a v i t s must be signed by r e s i d e n t s
of the S t a t e of Arizona. No other meaning can be given
t o t h i s language. I f the L e g i s l a t u r e had intended t h a t
the a f f i d a v i t s could be signed by r e s i d e n t s of any
s t a t e it would have used d i f f e r e n t language.
" I f the a f f i d a v i t s a r e not signed by r e s i d e n t s of the
S t a t e of Arizona the applicant is not q u a l i f i e d t o take
t h e l i c e n s i n g examination or t o become licensed t o
p r a c t i c e naturopathy."
Board members s t a t e d t h a t they had i n t e r p r e t e d A. R. S. $ 32- 1521. C t o mean
t h a t the a f f i d a v i t s merely had t o be signed by r e s i d e n t s of any s t a t e and
f i l e d with the Board p r i o r t o l i c e n s u r e . Board members a l s o questioned
t h e u s e f u l l n e s s and purpose of the a f f i d a v i t s . The Board does not
consider its noncompliance with A. R. S. $ 32- 1521. C. t o be c r i t i c a l .
The Board's Granting of R e c i ~ r o c i t v
May Violate A. R. S. $ 32- 1524
A. R. S. $ 32- 1524 s t a t e s :
" The board may, upon payment of a f e e of one hundred
d o l l a r s , grant a l i c e n s e t o p r a c t i c e naturopathy
without examination t o a n a t u r o p a t h i c p h y s i c i a n
licensed t o p r a c t i c e i n another s t a t e i f the
requirements i n such s t a t e are not l e s s than those
required of a p p l i c a n t s f o r l i c e n s e i n t h i s s t a t e and i f
such other s t a t e g r a n t s s i m i l a r r e c i p r o c a l p r i v i l e g e s
t o n a t u r o p a t h i c p h y s i c i a n s l i c e n s e d i n t h i s s t a t e . "
( ~ m ~ h a saidsd ed)
- -- * Appendix I11 c o n t a i n s t h e memorandum t e x t .
A s of June 30, 1981, the Board has granted l i c e n s e s t o 16 persons by
v i r t u e of t h e i r l i c e n s u r e i n Oregon. However, a comparison of Arizona's
naturopathic s t a t u t e s with those of Oregon i n d i c a t e s t h a t Arizona's
l i c e n s u r e requirements regarding educational requirements a r e more
extensive than Oregon's.
Oregon Revised S t a t u t e s $ 685.060.2 s t a t e s :
" The s t u d i e s required of the applicant f o r a l i c e n s e t o
p r a c t i c e naturopathy i n t h i s s t a t e s h a l l include
anatomy, h i s t o l o g y , embryology, physiology, chemistry,
pathology, bacteriology, public h e a l t h and hygiene,
toxicology, o b s t e t r i c s and gynecology, diagnosis,
theory, p r a c t i c e and philosophy of naturopathy ,
e l e c t r o t h e r a p y , hydrotherapy, physiotherapy, c l i n i c s ,
eye- ear- nose- throat, minor surgery, f i r s t a i d ,
herbology, proctology, d i e t e t i c s , jurisprudence, and
such o t h e r naturopathic s u b j e c t s as the board may
r e q u i r e , except m a t e r i a l medica, pharmacology and major
surgery, with a t o t a l of not l e s s than 4,000 l e c t u r e o r
r e c i t a t i o n hours."
Applicants i n Oregon a r e not required t o complete course work i n
orthopedics or manipulative and ad j u s t i v e t e c h n i c , as a r e a p p l i c a n t s f o r
l i c e n s u r e i n Arizona. Additionally, Oregon Revised S t a t u t e s $ 685.060.2
requires a p p l i c a n t s t o complete a t l e a s t 4,000 hours, while A. R. S.
532- 1522 s t a t e s t h a t a p p l i c a n t s must complete not l e s s than 4,500 hours of
study. Thus, it appears t h a t r e c i p r o c i t y with Oregon does not meet the
requirements of A. R. S. $ 32- 1524.
Possible L i a b i l i t y t o the S t a t e
a s a Result of the Board's Actions
A. R. S. $ 32- 1504. A s t a t e s , i n p a r t :
" The board s h a l l carry the provisions of t h i s chapter
i n t o e f f e c t ...."
Our review has shown t h a t the Board may have granted only t h r e e l i c e n s e s
properly, and may have granted l i c e n s e s improperly t o a s many a s 136
i n d i v i d u a l s who have not met the q u a l i f i c a t i o n s f o r l i c e n s u r e s e t f o r t h i n
A. R. S. $$ 32- 1521 through 32- 1524.
We were unable t o determine whether the Board's a c t i o n s could cause a
l i a b i l i t y t o the S t a t e i f an improperly licensed i n d i v i d u a l s were to
become involved i n a malpractice case.
COXCLUSION
Past and present members of the Naturopathic Board of Examiners have
reviewed the q u a l i f i c a t i o n s of l i c e n s u r e under an i n t e r p r e t a t i o n of
s t a t u t o r y requirements t h a t apparently d i f f e r s from a c t u a l requirements
f o r licensure. A s a r e s u l t , as many as 136 of the 139 i n d i v i d u a l s
licensed a s n a t u r o p a t h i c p h y s i c i a n s may not meet the s t a t u t o r y
requirements t o p r a c t i c e naturopathy i n Arizona.
rnCOMMENDATIONS
Consideration should be given t o the following recommendations:
1. The Board c a r e f u l l y review each a p p l i c a t i o n f o r l i c e n s u r e t o
ensure t h a t the applicant meets a l l requirements f o r l i c e n s u r e .
2. The Board c a r e f u l l y prepare the l i c e n s u r e examination t o ensure
its compliance with the requirements of A. R. S. $ 32- 1523.
3. The Board r e f r a i n from granting licenses to individuals u n t i l
they successfully complete the examination as required by A. R. S.
$ 32- 1523
4. The Board request that the Attorney General review its reciprocal
agreement with Oregon to ensure that it meets the requirements of
A. R. S. $ 32- 1524.
5. The Attorney General review the Board's actions and determine i f
the State is l i a b l e for damages which could r e s u l t from improper
Board actions.
6. The Legislature review A. R. S. $ 32- 1522 and decide whether to
r e t a i n specific course- hour requirements i n the s t a t u t e or to
accept the recommendations of the Board to change the educational
requirements.
7. The Legislature allow the Naturopathic Board of Examiners to
terminate under the provisions of A. R. S. § § 41- 2351 through
41- 2379 and, i f it deems the continued licensing of naturopathic
physicians desirable, i n s t i t u t e a new Board effective July 1,
1982, for the purpose of issuing new Licenses to the licensees of
the former Board. Such an action could mitigate legal l i a b i l i t y
of the State as a result of the current Board's improper
naturopathic license- granting.
FINDING I1
WHILE THE SCOPE OF NATUROPATHIC PRACTICE I N ARIZONA APPROXINATES THAT I N
THE FIVE OTHER STATES WHICH LICENSE AND REGULATE THE PRACTICE OF
NATUROPATHY. ITS DEFINITION IS INCONSISTENT AND UNCLEAR.
The Naturopathic Board of Examiners has s t a t e d t h a t :
" A change i n d e f i n i t i o n of t h e p r a c t i c e of naturopathic
medicine is necessary because the present d e f i n i t i o n is
antiquated and h a s r e s u l t e d i n narrowing of the scope
of the authorized p r a c t i c e of naturopathic medicine i n
the s t a t e of Arizona."
Our review of the scope of naturopathic p r a c t i c e i n the s i x s t a t e s which
c u r r e n t l y l i c e n s e n a t u r o p a t h i c p h y s i c i a n s revealed t h a t Arizona's scope of
p r a c t i c e approximates the scope of p r a c t i c e i n the f i v e other s t a t e s .
However, there a r e i n c o n s i s t e n c i e s i n the i n t e r p r e t a t i o n of t h e scope of
p r a c t i c e t h a t need review and possible c l a r i f i c a t i o n .
Scope of Naturopathic P r a c t i c e
A. R. S. $ 32- 1501.2 reads:
It I Naturopathy' includes a l l forms of physiotherapy and
means a system of t r e a t i n g the abnormalities of the
human mind and body by the use of drugless and
non- surgical methods, including the use of physical,
e l e c t r i c a l , hygenic and s a n i t a r y measures incident
t h e r e t o . "
The Naturopathic Board has claimed:
" The p r o f e s s i o n h a s been unnecessarily limited by the
antiquated terms ' d r u g l e s s ' and ' nonsurgical' a s these
two terms a r e t o t a l l y inadequately defined and not
appropriate nor c o n s i s t e n t with t h e e v o l u t i o n and
teachings of naturopathic medicine. P o l i t i c a l lobbying
from other groups i n t e r e s t e d i n the general medical
f i e l d has c o n s i s t e n t l y served t o prejudice many of the
l e g i s l a t o r s against t h e o r i g i n a l purposes, evolution
and teachings of naturopathic medicine which was not
meant to be a drugless and nonsurgical medical p r a c t i c e
from its inception."
Board members a l s o contend t h a t 1) a t the time the Board's l i c e n s i n g a c t
was adopted i n 1935, the term " drug" did n o t i n c l u d e many substances t h a t
a r e a v a i l a b l e today and 2) many substances t h a t could be obtained
over- the- counter i n p r i o r years now a r e p r e s c r i p t i o n items only. They
contend t h i s h a s r e s u l t e d i n a l i m i t i n g of t h e i r scope of p r a c t i c e beyond
t h a t which was o r i g i n a l l y intended by the Legislature.
We learned t h a t t h i s argument was reviewed and r e j e c t e d by the Arizona
Supreme Court more than 30 years ago. I n the case of Kuts- Cheraux e t a1
v. Wilson ( 71 Ariz. 461, 229 p. 2d ( 713)) the Court s t a t e d :
" Had the l e g i s l a t u r e not intended t o q u a l i f y and l i m i t
naturopathic p r a c t i c e , it could e a s i l y have s p e l l e d out
i n c l e a r and unequivocal language its recognition of
naturopathy a s i t was taught and practiced at the time
the a c t was adopted."
The Court added:
"... it is evident t h a t t h e l e g i s l a t u r e desired t o
prevent naturopaths from doing two things f o r which, by
t r a i n i n g , they are not q u a l i f i e d , viz: p r e s c r i b i n g
drugs and performing s u r g i c a l operations."
Thus, the Board's contention t h a t naturopathic medicine was not meant to
be drugless and nonsurgical apparently does n o t a g r e e w i t h the Court's
i n t e r p r e t a t i o n of l e g i s l a t i v e i n t e n t .
Naturopathic Practice i n other States
A s of July 1, 1981, there were s i x s t a t e s which license individuals to
practice naturopathy. They are: Arizona, Connecticut, Hawaii, Nevada,
Oregon and Washington. Two other s t a t e s , Florida and Utah, continue to
regulate practitioners as a " dying c l a s s " ; t h a t is, allowing existing
licensees to practice, but not granting new licenses.
Our review of the scope of naturopathic practice i n other s t a t e s revealed
a broad range - from very r e s t r i c t i v e i n Nevada to extremely permissive i n
Oregon. A comparison of these scopes is shown in Table 3.
TABLE 3
THE SCOPE OF NATUROPATHIC PRACTICE I N THE STATES WHICH LICENSE NATUROPATHS
Arizona
P r a c t i c e under
supervision of
licensed MD only No
Prescribe drugs No
Perform acupuncture Yes0
Perform minor
surgery No
Hydro therapy Yes
Colonic i r r i g a t i o n Yes
Physiotherapy Yes
Manipulation Yes
Electrotherapy Yes
X- ray Yes
Venapuncture** N o
Obstetrics/ gynecology Yes
May clamp and sever
umbilical cords N o
Connecticut
N 0
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Hawaii
No
N 0
N 0
No
Yes
Yes
Yes
Yes
Yes
N/ R
Yes
Yes
N/ R
Nevada
Yes
N 0
N 0
N 0
Yes
Yes
Yes
Yes
Yes
No
Yes
No
No
Oregon
No
Yes***
Yes""
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Washington
N 0
Yes
Yes
Yes
Yes
Yes
Yes
N 0
No0""
* Naturopaths a r e permitted t o p r a c t i c e as a " dying c l a s s . "
JC Q Venapuncture is the drawing of blood by needle syringe f o r
diagnostic purposes.
+ Y+ Naturopaths i n Oregon may p r e s c r i b e n a t u r a l drugs only; s y n t h e t i c
drugs a r e n o t w i t h i n the scope of p r a c t i c e ; may p r e s c r i b e
n a r c o t i c s which a r e d e r i v a t i o n s of the o p i a t e c l a s s .
0 The Board i s s u e s a s p e c i a l t y c e r t i f i c a t e i n acupuncture. It
should be noted t h a t the p r a c t i c e of acupuncture may be outside
the scope of p r a c t i c e i n Arizona. ( see page 39)
0 0 Electro- acupuncture is permitted; needle acupuncture is not.
0 0 0 Naturopaths may perform some gynecological procedures; o b s t e t r i c s
n o t w i t h i n the scope of p r a c t i c e .
N/ R - No Response
Florida*
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
N/ R
Yes
Yes
N/ R
Utah*
N 0
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
A s shown i n Table 3, the scope of naturopathic practice i n Arizona is
roughly equivalent t o t h a t i n the f i v e other s t a t e s which continue to
license naturopathy. It should be noted that there is no national trend
regarding the scope of naturopathic practice. While two of the most
permissive s t a t e s ' s t a t u t e s ( ~ t a h ' s and ~ l o r i d a ' s ) have been amended to
establish naturopathic physicians as a " dying c l a s s , " Oregon recently
widened its scope of practice to include the r i g h t to prescribe and
dispense drugs. On the other hand, the s t a t e which most recently adopted
l e g i s l a t i o n regulating the practice of naturopathy, Nevada, also is the
s t a t e with the most r e s t r i c t i v e scope of practice. For example, i n
Nevada, naturopathic physicians must practice under the supervision of a
licensed medical doctor and are not permitted to take X- rays or perform
o b s t e t r i c a l or gynecological procedures.
Inconsistencies within Scope of Practice
A. R. S. 532- 1501.2 excludes drugs and surgery from the practice of
naturopathy i n Arizona. Attorney General opinions and court decisions
have upheld those exclusions and have provided f u r t h e r d e f i n i t i o n s of
drugs and surgery. Attorney General Opinion No. 72- 8 defined " drugs" to
be a r t i c l e s for which standards are recognized i n the o f f i c i a l compendium
and which are intended f o r use i n the diagnosis, c a r e , m i t i g a t i o n ,
prevention or treatment of disease. Attorney General Opinion No. 63- 85- L
found that surgery was related t o severing or penetrating the skin.
We found these d e f i n i t i o n s r e s u l t i n inconsistencies i n a p p l i c a t i o n a c r o s s
the whole of the naturopathic scope of practices. The inconsistencies
a r i s e because the d e f i n i t i o n s prohibit the use of some procedures or
materials that ( a) may be i n t e g r a l parts of other procedures allowed by
law, and ( b) pose l i t t l e or no r i s k of harm to the patient i n comparison
to the procedures that are allowed.
Examples of some i n c o n s i s t e n c i e s i n the scope of p r a c t i c e are:
( a) X- rays and Radiopaque Contrast Media
Naturopathic physicians a r e permitted t o take and use X- rays a s a p a r t
of t h e i r scope of p r a c t i c e . However, i n Attorney General Opinion
No. 72- 8, the Attorney General ruled t h a t barium s u l f a t e ( a radiopaque
c o n t r a s t media) was a drug and could not be used by naturopaths.
According t o an expert from the radiology s e c t i o n of the University of
Arizona Medical School, barium s u l f a t e has no t h e r e p e u t i c value and
poses no r i s k of harm t o p a t i e n t s when used f o r diagnostic purposes.
However, its u s e a l l o w s a r a d i o l o g i s t to view the esophagus and upper
g a s t r o i n t e s t i n a l t r a c t or t o properly diagnose u l c e r s o r other
g a s t r o i n t e s t i n a l ailments.
Thus, under current s t a t u t o r y provisions and d e f i n i t i o n s naturopaths
may take and use X- rays, but may not use m a t e r i a l s sometimes needed t o
make s p e c i f i c diagnoses from the X- rays. To achieve consistency,
e i t h e r the n a t u r o p a t h i c u s e o f X- rays should be r e s t r i c t e d i n cases
requiring radiopaque m a t e r i a l s , o r t h e use of radiopaque materials
should be allowed.
( b) Laboratory Analysis and Venapunc t u r e
Naturopathic physicians may not draw blood samples with needle
syringes f o r laboratory a n a l y s i s . Attorney General Opinion
No. 63- 85- L found t h a t such a p r a c t i c e c o n s t i t u t e s minor surgery.
However, n a t u r o p a t h i c p h y s i c i a n s may send the p a t i e n t t o a laboratory
where the blood may be drawn by a technician who holds no h e a l t h
l i c e n s e . Then the naturopathic physician may diagnose from the
laboratory r e s u l t s .
( c) O b s t e t r i c s
The naturopathic scope of p r a c t i c e has been defined by the Board t o
include o b s t e t r i c s . The Board once considered e s t a b l i s h i n g
obstetrics- gynecology as a s p e c i a l t y area. While naturopathic
physicians may d e l i v e r b a b i e s , t h e y may not use general or l o c a l
a n e s t h e t i c s o r perform s u r g i c a l procedures.
Comparing p r a c t i c e s i n the area of o b s t e t r i c s we found t h a t , unlike
midwives, naturopathic physicians a r e not r e s t r i c t e d as to the types
of pregnancy conditions they may accept. For example, midwives may
not a t t e n d b i r t h s if t h e r e a r e such conditions as: m u l t i p l e
g e s t a t i o n s , previous cesarean s e c t i o n s , suspected prematurity,
abnormal p r e s e n t a t i o n s or a c t i v e i n f e c t i o u s d i s e a s e s ; naturopathic
physicians may. Midwives must c a l l a physician or t r a n s p o r t t h e
expectant mother to a h o s p i t a l i f s p e c i f i e d conditions a r i s e during
l a b o r ; n a t u r o p a t h i c p h y s i c i a n s need not. However, midwives may clamp
and sever u m b i l i c a l c o r d s ; n a t u r o p a t h i c p h y s i c i a n s may not.
Again, t o achieve consistency, e i t h e r n a t u r o p a t h i c p h y s i c i a n s should
be r e s t r i c t e d to a scope of o b s t e t r i c a l p r a c t i c e more nearly
resembling t h a t r e s t r i c t i n g midwives, o r n a t u r o p a t h i c p h y s i c i a n s
should be allowed t o add t o t h e i r scope such midwivery procedures a s
clamping and s e v e r i n g u m b i l i c a l cords.
CONCLUSION
The Naturopathic Board of Examiners has advocated an expansion i n the
scope of naturopathic p r a c t i c e . Our review has shown t h a t the L e g i s l a t u r e
intended to r e s t r i c t the p r a c t i c e of naturopathy to drugless and
nonsurgical t h e r a p e u t i c s when the scope of p r a c t i c e was defined i n 1935.
F u r t h e r , o u r review revealed t h a t the scope of p r a c t i c e of naturopathy i n
Arizona approximates t h a t i n the f i v e other s t a t e s which continue t o
regulate t h e p r a c t i c e of naturopathy. However, t h e scope of p r a c t i c e as
c u r r e n t l y defined does produce i n c o n s i s t e n c i e s and needs review and
possible c l a r i f i c a t i o n .
Consideration should be given t o the following recommendations:
The L e g i s l a t u r e - 1) review the naturopathic scope of p r a c t i c e a s
c u r r e n t l y defined by s t a t u t e , c o u r t d e c i s i o n s and Attorney General
opinions, 2) review the p r o h i b i t i o n s on the u s e o f drugs and surgery and
3) consider adding s p e c i f i c s t a t u t o r y language t o c l a r i f y d e f i n i t i o n s
and/ or remove i n c o n s i s t e n c i e s with respect t o s p e c i f i c a r e a s of p r a c t i c e
such as X- ray and o b s t e t r i c s .
3 1
FINDING I11
THE NATUROPATHIC BOARD OF EXAMINERS IS NOT RESOLVING COMPLAINTS I N A
TIMELY MANNER. AS A RESULT, THE BOARD NAY NOT BE FULFILLING ITS
RESPONSIBILITY TO PROTECT THE PUBLIC.
The Naturopathic Board of Examiners receives few complaints against
naturopathic physicians. During the 18- month period January 1, 1980, to
June 30, 1981, the Board received s i x complaints a g a i n s t naturopathic
physicians i n Arizona. A s of June 30, 1981, the Board had resolved t h r e e
of these complaints,* but was unable t o close the o t h e r t h r e e because the
i n v e s t i g a t i o n s i n t o these complaints had not been completed. According t o
the Board, i t was advised by a previous Attorney General r e p r e s e n t a t i v e
t h a t it lacked adequate funds t o i n v e s t i g a t e complaints e f f i c i e n t l y and
bring l e g i t i m a t e complaints t o formal hearings. However, our review
revealed t h a t the Attorney General r e p r e s e n t a t i v e i n question does not
r e c a l l ever advising the Board t h a t it lacked the funds t o pursue a
complaint, t h a t the Board had s u f f i c i e n t funds t o bring a t l e a s t one of
the t h r e e open complaints to a hearing and t h a t its f a i l u r e t o do so may
pose a t h r e a t t o t h e h e a l t h and s a f e t y of the public.
Complaint Review Process
When a complaint is received, it is placed on the agenda f o r discussion a t
the next Board meeting. A t t h a t time, the Board reviews the complaint t o
determine i f the complaint is within its j u r i s d i c t i o n . I f it is, the
Board n o t i f i e s the naturopathic physician a g a i n s t whom the complaint was
made and requests him t o respond, i n w r i t i n g , t o the charges made i n the
complaint.
* Two of t h e t h r e e complaints which the Board has closed during t h i s
period deal with a d v e r t i s i n g p r a c t i c e s . The Board d i r e c t e d the
n a t u r o p a t h i c p h y s i c i a n s involved to comply with s p e c i f i c a d v e r t i s i n g
requirements. The other complaint involved a business dispute between
two l i c e n s e e s . The Board decided t h a t the complaint was a c i v i l
matter and closed the case.
Once the response is received, the Board agains reviews the matter to
determine i f further information is needed. I f not, the Board rules on
the complaint and closes the case. I f further information is required,
the Board requests assistance from other agencies to complete the
investigation. For example, the Board has received assistance from the
Attorney General through the loan of an investigator to collect
information regarding a complaint. The Attorney General has been
responsive to the Board's needs.
The Board must bear the cost of an administrative hearing. Fees for
investigators, attorneys, processing, court reporters and other related
expenses included i n a formal administrative hearing can exceed $ 1,000.
I f the Board's decision is appealed to the Supreme Court, costs can be
significantly higher.
In a t l e a s t two cases, the Board has cited the cost of bringing complaints
to an administrative hearing as the reason the Board dropped the complaint
or delayed disposing of it. However, i n both cases, it appears the Board
may have had s u f f i c i e n t funds:
CASE I
The Board granted a license through reciprocity in March 1976. After the
individual was licensed, it was learned that he 1) had f a l s i f i e d
information on his license application form, 2) and been convicted on two
counts of Social Security fraud and 3) had been arrested f o r violations
of the narcotics a c t , criminal conspiracy and sale of medical degrees.
The Board met and voted to hold a formal hearing to determine i f the
naturopath's license should be revoked. In a l e t t e r dated December 29,
1977, the Board requested the licensee's presence a t a hearing.
In a January 5, 1978, l e t t e r to the Board, the naturopathic physician
threatened s u i t i f legal action were taken against h i s license.
". . . any i l l e g a l revocation of my license w i l l result i n
a c i v i l rights action and massive law s u i t f o r damages
against your Board."
The Attorney General proceeded with a review and prepared a formal notice
of hearing, d e t a i l i n g the s t a t u t o r y violations a t t r i b u t e d to the
naturopathic physician. The Attorney General requested that the Board
review the notice, approve or amend it and schedule the formal hearing.
In an August 23, 1978, l e t t e r t o the Attorney General, the Board secretary
wrote:
" I t is my opinion t h a t any action regarding [ the
naturopathic physician] should be postponed a t t h i s
time for the following reasons. F i r s t , a t t h i s time,
the Board is q u i t e s h o r t of funds and they cannot
afford financing a big court procedure. May I note,
had the l e g i s l a t u r e seen f i t to increase our income, we
would not be i n financial d i s t r e s s .
" Second. It is my understanding that [ t h e naturopathic
physician] is i n ill health and is only ambulatory with
the aid of crutches. Since he is outside the s t a t e , as
commented once before, he presents no great menace a t
t h i s time."
The Board informed our s t a f f t h a t it had reached an informal agreement
with the naturopathic physician: he would not renew his license and the
Board would postpone the revocation hearing i n d e f i n i t e l y . We found,
however, the naturopathic physician - did renew h i s license and presently
holds a valid Arizona license.
This case would have been heard during f i s c a l year 1978- 79, a t the end of
which the Board had a fund balance of $ 1,300.
CASE I1
On October 22, 1980, a licensed naturopathic physician was arrested and
charged with practicing medicine without a license. A search warrant was
obtained, and Department of Public Safety agents found the following drugs
i n his possession:
1. RIMSO- 50,
2. DMSO,
3. Reagent DMSO,
4. Testostrone ( a male hormone),
5. Estrogen ( a female hormone),
6. B i r t h c o n t r o l p i l l s ,
7. Potassium chloride ( i n i n j e c t i b l e form),
8. Bethamphetamines, and
9. Amy1 n i t r a t e .
The agents also found many syringes and needles.
On October 30, 1980, the naturopathis physician was brought before a joint
meeting of the Naturopathic and Chiropractic Boards." During the meeting,
the Chiropractic Board members voted to suspend immediately the
p r a c t i t i o n e r ' s chiropractic license as a threat to the health and safety
of the public and to proceed with a formal disciplinary hearing. The
Naturopathic Board voted - not to suspend the p r a c t i t i o n e r ' s license, but to
proceed with a formal hearing.
The Chiropractic Board has held its formal heering, and the p r a c t i t i o n e r ' s
chiropractic license was suspended f o r s i x months. A s of September 1,
1981, the Naturopathic Board had not held its hearing, and the individual
continues to practice, using his naturopathic license. However, Board
members have informed audit s t a f f that a formal hearing has been scheduled
for September 29, 1981.
Board members said the hearing was delayed i n the hope that the county
attorney would f i l e criminal charges against the individual for unlawful
practice of medicine, a felony. Conviction of a felony is grounds for
revocation of a license. The Board viewed t h i s option as a means to take
d i s c i p l i n a r y action without bearing the costs of a lengthy hearing. It
should be noted that since June 1980, the Naturopathic Board has
maintained a fund balance of $ 4,900 to $ 6,600.
* The p r a c t i t i o n e r a l s o held a chiropractic license.
CONCLUSION
The Board is not resolving complaints i n a timely manner. A s a r e s u l t ,
the Board may not be f u l f i l l i n g its r e s p o n s i b i l i t y t o p r o t e c t t h e public.
RECOTG4ENDATIONS
Consideration should be given t o the following recommendations:
1. The Board dedicate i t s resources t o p r o t e c t i n g t h e h e a l t h and
s a f e t y of the public.
2. The Board appeal t o the L e g i s l a t u r e f o r a d d i t i o n a l resources if
a d d i t i o n a l funds a r e required.
OTHER PERTINENT INFORPIATION
ACUPUNCTURE
The Board allows n a t u r o p a t h i c p h y s i c i a n s t o p r a c t i c e acupuncture* d e s p i t e
the f a c t t h a t t h i s may be construed t o be minor surgery.
A s defined i n previous Attorney General o p i n i o n s , s u r g e r y i n v o l v e s
severing or p e n e t r a t i n g the skin. Board members have t o l d u s they do not
believe the i n s e r t i o n of very t h i n needles c o n s t i t u t e s surgery. When
questioned about the d i f f e r e n c e between the i n s e r t i o n of needles f o r
venapuncture** and t h e i n s e r t i o n of needles f o r acupuncture, the Board
president t o l d u s he believed surgery involves the removal of something.
He said venapuncture may c o n s t i t u t e surgery because the needle is hollow
and a minute plug of skin is removed. He said acupuncture is not surgery
because the needles a r e not hollow and no plug of s k i n is removed.
A s shown previously on page 28, we found acupuncture is not within the
scope of p r a c t i c e of the other s t a t e s which l i c e n s e naturopathy. We a l s o
found the Board has not sought an Attorney General opinion as t o whether
acupuncture is within the scope o f n a t u r o p a t h i c p r a c t i c e i n Arizona.
The matter may be resolved by t h e c o u r t s soon. A t t h e present time
Arizona's Board of Medical Examiners ( BOMEX) is pursuing court a c t i o n t o
prevent c h i r o p r a c t o r s from performing acupuncture because c h i r o p r a c t o r s
are r e s t r i c t e d t o drugless and nonsurgical methods. The court decision on
c h i r o p r a c t o r s ' use of acupuncture may apply equally t o naturopathic
physicians.
* Acupuncture is an ancient o r i e n t a l system of therapy involving
puncture of the skin with long, f i n e needles. ** Venapuncture is the puncture of a vein f o r diagnostic purposes.
ARIZONA NATUROPATHIC PHYSICIANS
BOARD OF EXAMINERS
1645 W. Jefferson, Room 418 Phoenix, AZ 85007
( 602) 255- 3095
September 10, 1981
Mr. Douglas Norton
Office of the Auditor General
Legislative Services Wing
Room 200
State Capi to1
Phoenix, Arizona 85007
Dear Mr. Norton:
The Board wishes to take this opportunity to thank the Arizona Legislature
for instituting the Sunset Review Program and implementing a performance
audit of a non- fiscal nature. All previous audits have been of a fiscal
nature and therefore, did not address any irregularities in the Board's
interpretation of the law.
The Board wishes to express its gratitude to the staff of the Auditor
General's office for their cooperation, assistance and consideration during
the course of this audit.
The Board has reviewed the revised draft report of the Auditor General's
office and submits the attached responses.
Sincerely,
M. C. Shelton, N. D.
President
Attachments
FINDING I
In reviewing the qualifications of current licenses under the Board's
interpretation of statutory requirements relating to Examinations
( A. R. S. 32- 1523), Educational Qualifications ( A. R. S. 32- 1522), Filing
of Affidavits ( A. R. S. 32- 1521. C) and Reciprocity ( A. R. S. 32- 1524),
the Board does not agree that 136 of 139 currently licensed Naturopathic
Physicians are improperly licensed; therefore, the Board has responded
to the needs of the public and has operated with efficiency.
However, the Board recognizes the possibility of differences of technical
interpretations of the statutes and will immediately implement the more
technical aspect of the statutes as outlined in the report.
FINDING I1
The Board appreciates the statements in the Sunset Review report of
Finding I1 as it has tried for years to bring these inconsistencies
and unclear statutory requirements before the legislative process, but
the Board's needs have not been met.
FINDING I11
The Board has investigated and resolved complaints in a timely manner during
the course of its operation, always keeping uppermost in mind, the
protection, health and welfare of the public.
During the period of January 1, 1980 thru June 30, 1981, as stated in the
draft, only 6 complaints have been lodged against licensees which is a
very insignificant number and represents the quality of Naturopathic
Medical practitioners. According to the Board's records from 1970 thru
1980 there were only 6 complaints. All were satisfactorily processed in
a timely manner.
The Board wishes to review the report in detail.
Page 1, paragraph 2.
Naturopathy has been defined as " the science and art of diagnosing
and treating and preventing diseases and the promotion and
preservation of health, as taught in naturopathic medical schools."
Naturopathic procedures include, but not limited to: heat, cold,
light, water . . .
Page 5, paragraph 1.
The Attorney General's Office has been cooperative in the great
majority of cases. However, the Board has been advised on
occasion that the prosecution of a misdemeanor was low on the
list of investigations because of the multitude of a more severe
type of infraction. This situation will be properly dealt with
in view of the fact that the infraction in this statute is now deemed
a class 5 ( five) felony.
Page 5, paragraph 3.
The Board is in unanimous agreement with the Auditor General's
office of the need to update the scope of practice and the statutes.
Page 9, paragraph 1.
The Board did not retain examinations until the Attorney General's
office advised the Board to do so in 1975. Prior to this time
grades were kept on a master sheet. This sheet was retained at
the office of the Board Secretary and when the Board moved to the
Occupational Licensing Building, 1645 W. Jefferson, this list was
moved with all the files. The master list was kept up to date
thru 1977 and since then there have been many people examining the
Board's files and attempts to locate this list and other materials,
have all been futile.
Page 9, paragraph 1, line 12.
The Board feels it has complied with the statutes and refers to
32- 1523. A. which a1 lows "*" and under rules and regulations the
Board determines.". We contend the combining of subjects is a
standard procedure practiced by other state boards of naturopathic
medicine, also used in the colleges by conjoining subject teaching.
In an opinion dated June 29, 1981, the Legislative Council stated:
" The Board is required to cover the subjects listed in A. R. S. 32- 1522
on the licensing examination. The Board may also require subjects
other than those listed to be on the exam." If the legislature had
intended the Board to have discretionary authority to exclude some
of the subject areas listed in A. R. S. 32- 1522 it would have so
provided rather than mandating that the Board include the subjects
listed and any other subjects the Board may require on the licensing
exam. The above does not specify each subject to be examined
separately; it does say, " the Board is required to cover the
subjects listed in A. R. S. 32- 1522***". It does not prescribe the
manner in which the examination is to be executed other than it is
to be in writing. Subjects listed under 32- 1522 we refer to item
818. " Drugless therapeutics, including electrotherapy, physio-therapy,
hydrotherapy, massage and practice of naturopathy, seven
hundred fifty hours." This is a prime example and precedent for
the combining of subjects on the examinations.
The Board is interested in the applicant% overall knowledge and
ability to practice naturopathic medicine in its entirety and has
found by combined examinations that this has proven to be a
superior process.
The Board feels if it has operated improperly, then it recommends a
change in the statute to allow the Board the latitude as do the
other medical boards to determine the knowledge of the applicants
in the practice of naturopathic medicine.
Page 9, paragraph 1, line 14.
In the first portion of the 70' s the Board determined, for increased
protection of the public health and welfare, to elevate the level
of difficulty of the examinations. This was perhaps carried out to
extreme as some questions were niissed by all applicants and some
questions by a large majority of the applicants. On the basis of
accepting applicants from only one college, in recent years, whose
students are required to have considerably more class hours than our
chapter requires, it is reasonable to presume that some examination
questions could be inappropriate. The Board has taken this into
consideration and adjusted accordingly as it is not the Board's
intent to prevent a qualified doctor of naturopathic medicine the
privilege to practice in the State of Arizona. Also at this time the
Board commenced the practice of grading papers as a group ( members)
where questions were evaluated as to their inappropriateness, and
validity.
Based upon A. R. S. 32- 1523. A. " For the purpose of determining the
qualifications of applicants for license under the provisions of
this chapter, the board shall hold meetings and conduct examinations
of applicants for licenses at times and places and under rules and
regulations the Board determines." the Board felt that it had the
prerogative to deteriiiine grading procedures.
Page 10, table 2.
The following subjects have been combined for as many years as this
Board can remember.
Anatomy, histology and embryology
Obstetrics and gynecology
First aid and hygiene and sanitation
Diagnosis and ear, nose and throat
Dietetics, drugless therapeutics, jurisprudence and clinical practice
The Board has also always given an oral examination covering the
clinical aspect of practice.
Page 11, paragraph 1.
The Board did, through combined exams, cover all subjects as outlined
in A. R. S. 32- 1522.
Page 11, paragraph 2.
The Board's purpose is to completely evaluate the total comprehension
of the applicant and determine his practice capabilities.
Page 11, paragraph 3.
The Board feels, in the combined subjects, that if an applicant isn't
knowledgeable in one subject he can't be in the other, since the
subjects are so interlocking.
Page 11, paragraph 4.
1. The Board deleted questions that were deemed to be inappropriate
and/ or if difficulty level was too high.
2. At the Board meeting on November 30, 1978, it was determined that
" doctors who have been in practice for a considerable length of time
might be given some consideration in the future".
Page 12, case I.
Questioning past Board members concerning these exams, obstetrics,
gynecology, naturopathic practice, toxicology and diagnosis, it was
determined that there was an extrenie difficulty factor in the exam-ination
of December 1976.
Page 13, case 11.
The subjects of pathology, x- ray and oral, public health/ toxicology
and diagnosis were all re- evaluated to the number of years the
applicant had been in practice ( 18 years), using 4 point per year
for the first 10 years and 1 point per year thereafter, for a
maximum of 15 points.
Page 14, case 111.
The subjects of obstetrics/ gynecology, naturopathic practice and
toxicology were all re- evaluated because of the extreme difficulty
factor of the December, 1976 examination.
Page 14, case IV.
The subjects of x- ray, orthopedics, diagnosis/ pathology, physiology,
chemistry and toxicology wefe all re- evaluated because of the
number of years the applicant has been in the field ( 36 years),
using % point per year for the first 10 years and 1 point per year
thereafter for a maximum of 15 points.
4 5
Page 15, asterisk.
The Board wishes to compliment the fact that the review recognized
the fact the educational requirements have not been upgraded since
the enactment of this chapter. The Board has, and shall continue
t o administer the best possible from an antiquated law.
The Board has addressed the legislature on many occasions regarding
this matter. Again, regarding qua1 if ications, we refer to 32- 1523
and previous discussion in this paper.
Page 16, paragraph 2, ( 1 and 2).
The alleged discrepancies regarding completion of course work has
been repeatedly described and explained. In this regard the Board
wishes to submit the following: The Arizona law stating the
subjects and hours that an applicant shall have in a school has
been a problem since 1935 because the schools do not necessarily
follow our subject and hourly outlines. Also, this Board is not
empowered to tell the schools how or what subjects they must teach.
Therefore, it strikes this Board as being most unreasonable for any
agency to insist upon absolute adherence to the number of hours
required in each subject and the disallowance of conjoined subjects
in the classroom and on examination. The chapter clearly states
approximate hours in a subject and demonstrates the combining of
subjects in item # 18 of the list of subjects outlined in A. R. S.
32- 1522. Further, all applicants have been considered on an
individual basis so that the applicant's educational background
was proper for him to be licensed as a naturopathic physician as a
graduate from an approved college of drugless therapeutics, if he
passed the exams.
The Board realizes the above is a legislative problem and we have
approached that body for more than the last thirty years for relief
and have been denied consistently.
Page 17, paragraph 2.
85 of 139 currently licensed naturopathic physicians show no evidence
of having completed course work and is again demonstrative in the
above answer.
Page 17, paragraph 3.
Eleven files contain no transcripts. In response to this, the
Boards observation of this fact contends that these early
licensees may have been reciprocal applicants or grandfathered in.
Page 17, double asterisk.
The Board appreciates the Auditor General's finding of dietetics
( subject of) not being listed on the application form. We wish to
submit that dietetics is involved in many subjects, such as,
physiology, chemistry, pathology, orthopedics, hygiene, cl inical
practice, etc., and applicants have always been examined in this.
Page 18, paragraph 2.
The Arizona law in mandating the subjects and hours that an applicant
shall have in a school has been a problem since 1935 because the
schools do not necessarily follow our subject and hourly outline
and we do not have the authority to tell the schools out of state
to teach these subjects. The Board, in carrying out its duties and
administering the chapteq has made such policies that an applicant
taking combined courses such as patho- physiology has been accepted
as meeting the requirements for the Arizona law. All applicants have
been considered on an individual basis so that the applicant's
educational background was adequate for him to be licensed as a
naturopathic physician and graduate from a college of drugless
therapeutics.
The colleges have difficulty issuing transcripts to satisfy the
Arizona Board. We realize this is a legislative problem and we have
asked for relief for the past 30 years and have been denied.
The Board feels that in 1935 the 32- 1522 was the way the legislature
had of making sure that a person would have at least those minimal
qualifications.
The Board, in 1976, realizing the problems of subject hours made a
policy to accept only graduates from approved naturopathic medical
colleges with N. D. degrees. The Board was trying to improve on its
response to the statute, the graduates of these schools now have
5000+ hours.
The Board has determined that the clinical subjects in questions are
of such a nature that practical application must be made. The
clinic11 practice is the follow up to all classroom didactic hours
as exemplified by obstetrics and gynecology in which the applicant
must complete his training in the clinic.
Page 19, paragraph 1.
See the legislative council statement on page 19 of the draft,
as follows: "*** The use of the word approximate was probably meant
to allow the Board some flexibility when considering applicants'
educational backgrounds***." The Board does need reasonable latitude
and flexibility to administer the statute.
Page 20, paragraph 3.
A. R. S. 32- 1521 states: " Affidavits of two reputable residents of the
state attesting the good moral character of the applicant." Please
note " of the state" which does not designate any particular state.
It should be noted the Board feels it should be allowed to make
' presumptive conclusions the same as any other agency.
Page 22, paragraph 3.
Oregon does examine in orthopedics or manipulative and adjustive
technique ( see attached document). Please note that the Oregon
Board accepts only graduates from colleges which this Board accepts
and said college requires five thousand plus hours to graduate;
this complies with our 4500 requisite. Additionally, the college
requires 1500 hours in clinical practice as compared with the 300
hour requirement of our statute.
Page 23, paragraph 4 ( conclusion)
The Board does not feel that 136 people were improperly licensed.
The explanations have been stated previously.
Page 23, paragraph 5, Recommendations.
The Board feels that a strict adherance to the technicality of
the statute must be followed and agrees with the recommendation.
Page 25, paragraph 2. ( I
The Board feels that changes are a must in order to afford the people
of Arizona the services they wish and deserve. Many people of this
state prefer an alternative to the predominate philosophy of health
care which now exists in the State of Arizona. We feel the changes
are necessary for the progress and evolution of the profession and
more so for the betterment of the people of Arizona.
Page 26, paragraph 1.
A claim made by the Board at the top of the page should be greatly
emphasized. Contrary to a court decision of over 30 years ago, which has
the probability of also being outdated and inconsistent with
procedures and practices of today and of teachings in present
colleges of naturopathic medicine.
A 1925 Websters dictionary of the English language describes
" drug" as follows: 1. An ingredient used in medicine.
2. A narcotic.
3. An unsalable article.
Page 26, paragraph 4.
The Board feels that these manners concerning practice should not be
determined by the courts but by the legislature and the Board does
not feel that the legislature in 1935 meant drugless and nonsurgical.
Page 27, paragraph 1.
The dying class is not true in the fact that both Florida and Utah
are preparing legislation for reinstatement of that portion of their
statute which prohibits new licensing.
Page 28, table 3.
In reference to " practice under supervision of licensed M. D. only",
in Nevada, the Board understands the Attorney General's office of
Nevada had determined this to mean that a medical doctor is on the
Board but has nothing to do with practicing under a medical
physician's prescription.
X- Ray - Hawaii and Florida have x- ray privileges.
Page 28, table 3, continued.
This Board does give an examination in acupuncture and issues
to those who are successful a letter stating they have passed the
examination. This is not a license to practice acupuncture. It is
a method of showing proficiency in the subject.
Page 29, paragraph 1.
The statement: " It should be noted that there is no national trend
regarding the scope of naturopathic practice". Since 1978 the
President of this Board is also the President of the Federation of
Licensing Boards which is dedicated to the betterment of the profession.
This Federation is making provisions for the standardization of
practice and procedures for formation of a committee to standardize
the examination and procedures that may be used by any and all
naturopathic examining boards.
In May, 1981, the President of this State Board of Naturopathic
Examiners was elected to the Presidency of the Council on Naturopathic
Medical Education. This council was formed in 1978 and incorporated
in Washington, D. C. The purpose of this body is to become the
accrediting agency of the naturopathic medical profession. The council
has made great strides in this direction in its workings with the
Department of Education in Washington, D. C. The council has made
voluminous compilations setting forth procedures for accrediting
colleges and the methods necessary to carry out their implementation.
Page 29, paragraph 2.
The term " drugs" in 1935 when our law was enacted meant:
1. An ingredient used in medicine.
2. A narcotic.
3. An unsalable article.
Page 31, Conclusion.
As stated before, " drugs" as defined in 1935 is not the same as
defined today. Minor surgery has always been a part of naturopathic
practice since the founders of naturopathic medicine were doctors of
medicine and surgery and so carried it over into naturopathic practice.
Under RECOFIMENDATIONS on page 31, this Board agrees.
Page 33, paragraph 2.
The estimated cost of a formal hearing as presented to this Board was
considerably more than $ 1000. As to case # I, the Attorney General's
representative did make preparation for a formal hearing. At a meeting
in his office he stated that such a hearing would probably cost several
thousand dollars. He also remarked that since the doctor was in ill
health and resided and practiced in Florida he was not considered to be
a present danger to the health and welfare of the people of Arizona.
The doctor did write " any illegal revocation of my license will result
in a civil rights action and massive law suit for damages against your
Board". To our knowledge there was no informal agreement and this
Board finds no documentation of such agreement.
Page 35, paragraph 5, case 11.
( I
Case I1 is pending and a formal hearing date has been set for September 29,
1981. In the third paragraph of page 34 the statement appears to be in
error regarding the " dropped" complaint.
The Board was anxious for the Chiropractic Board to institute its hearing
in order to utilize its findings and thus use this position to reach a
possible consent agreement.
Page 36.
The statement " the naturopathic board has maintained a fund balance of
$ 4,900 to $ 6,600." This appears to be enough funds to institute legal
proceedings. However, it is this Board's opinion the question involves
mitigating circumstances such as: The Board, even since its inclusion
in the administrative offices has not been aware of an accumulating
reserve. At a board meeting in July, 1981, the Board was informed by
Don Reville of the Executive Budget Office of such a reserve fund.
Page 37, Conclusion.
The Board has investigated and resolved complaints in a timely manner
during the course of its operation, always keeping uppermost in mind,
the protection, health and welfare of the public.
Page 37, Recommendations.
This Board agrees with the recommendations.
Page 39, paragraph 2.
The Board President says " acupuncture needles are not hollow as are
needles for injection or aspiration. The acupuncture needle neither
implants nor withdraws any substance whatsoever. The hollow needle
will collect a plug of tissue as it penetrates and this plug may be
deposited or extracted. The use of the hollow needle in some circles
may be considered surgery. I do not consider either to be a surgical
procedure. If these modalities are of a surgical nature, why is ear
piercing permitted by one other than a surgeon? Also, technicians in
laboratories hospitals, clinics and other facilities, who routinely
Page 39, paragraph 2, continued.
do needle puncturing without benefit of being licensed to do surgery.
Recently two chiropractors won a court case permitting them to do
needle acupuncture as it is not considered to be surgery in the
State of Arizona. So far, that decision has not been overturned.
There are records of court decisions in recent years in other states
showing acupuncture ( needle) not to be surgery. In 1975, the
Board made provisions for examining in acupuncture, as provided for in
the statute, for those licensed naturopathic physicians in Arizona
who presented proper credentials to take an examination in the subject
of acupuncture. The Board offered a letter of proficiency to those
who were successful in both the written and oral examination.
The Board does feel that acupuncture is a natural healing modality and
fits into our realm of practice.
SUMMARY
The Board feels it has done an efficient job based upon a 1935 unchanged
statute and is amenable to recommendations by the report. This Board
shall adhere to a more strict technical interpretation of the statutes.
a 33619 S. E. DIVISION, PORTLAND, OREGON 97202 PHONE 2344044
August 18, 1981
Dr. Milburn C. Shelton
4814 W. Gendale Avenue
Glendale, Az 85301
' 0 6
LG - 2 2- , a# : --: i: :
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\ \, - p,", 1 .,;
VICTOR AT, YEM
OCM m. 0
Dear. Ds- Shelton:
Deparfmenf of Human Resources '
HEALTH DIVISION
Board of Naturopathic Exam~ ners .. llUG 2 l 198,
In answer to vour question concerning the exainination i n
orthopedics and manipulation. Orthopedic questions are
covered i n physical diagnosis examination, Planipulation
and xdray positioning i s handeled by o r a l examination but
no spearate grade i s given. This grade would be r e f l e c t e d
in the physical therapy subject-
Respectfully yours,
Don C. Walker, N. D.
Executive Secretary
AN EQUAL OPPORTUNlN E~~ IPLOYER
5 3
APPENDIX I
LEGISLATIVE COUNCIL OPINION 0- 81- 59
JUNE 29, 1981
APPENDIX I
TO: Douglas R. Norton
Attorney General
June 29, 1981
FROM: Arizona Legislative Council
RE: Request for Research and Statutory Interpretation ( 0- 8 1- 59)
This is in response to a request submitted on your behalf by Gerald A. Silva in a
memo dated June 12, 1981. No input was received from the Attorney General concerning
this request.
FACT SITUATION:
Arizona Revised Statutes ( A. R. S.) section 32- 1523, subsection B states:
B. The examination shall be in writing and shall embrace the subjects
set forth in section 32- 1522 and other subjects required by the board. If the
applicant answers seventy- five per cent of the questions asked on each of
the subjects of the examination correctly, a license to practice naturopathy
shall be issued to the applicant.
QUESTIONS:
I. Is the Naturopathic Board of Examiners ( Board) required to test applicants on
all subject areas listed in A. R. S. section 32- 1522 or does the Board have the discretionary
authority to exclude some of the subject areas listed in section 32- 1522?
2. If an applicant fails to achieve a seventy- five percent score in one or more of
the subject areas of the examination, does the Board have the authority to issue a license
to the individual?
3. If it is determined that a currently licensed naturopath had failed to achieve a
score of seventy- five percent on one or more parts of the licensure examination, what is
the impact on the individual's license?
ANSWERS:
1. The Board is required to test applicants on all of the subject areas listed in
A. R. S. section 32- 1522.
A. R. S. section 32- 1523, subsection B provides that the examination "/ qhall
embrace the subjects set forth in section 32- 1522 and other subjects required by the
board." ( Emphasis added.) " It is a fundamental rule of statutory construction that plain,
clear and unambiguous language of a statute is to be given that meaning unless impossible
or absurd consequences may result." Balestrieri v. Hartford Accident and Indemnity
Insurance Co., 112 Ariz. 160, 163, 540 P. 2d 126 ( 1975). I1Embrace" means " to take in:
enfold, include, cover . . . . I1 Websterls Third New International Dictionary 740 ( 1 976).
The Board is required to cover the subjects listed in A. R. S. section 32- 1522 on the
licensing examination. The Board may also require subjects other than those listed to be
on the exam. If the Legislature had intended the Board to have discretionary authority to
exclude some of the subject areas listed in A. R. S. section 32- 1522 it would have so
provided rather than mandating that the Board include the subjects listed and any other
subjects the Board may require on the licensing exam.
2. A. R. S. section 32- 1523, subsection A requires the Board to conduct
examinations for the purpose of determining the qualifications of applicants for licenses
to practice naturopathy. If an applicant answers seventy- five percent of the questions
asked on each of the subjects on the examination correctly and he meets the other
requirments for licensure, he is qualified and the Board is required to issue the applicant a
license to practice naturopathy. Conversely, if an applicant does not answer seventy- five
percent of the questions asked on each of the subjects of the examination correctly, he is
not qualified and the Board should not issue a license to that applicant.
If an applicant fails to pass the examination, that is, he does not answer
seventy- five percent of the questions asked on each of the subjects correctly, he is
allowed to take another exam at the convenience of the Board, within one year after his
failure to pass, without losing credit for subjects passed and without paying another fee.
A. R. S. section 32- 1523, subsection C. If any applicant does not answer seventy- five
percent of the questions asked on each of the subjects of the examination correctly, the
Board should not issue him a license to practice naturopathy. Rather the applicant should
take another exam as permitted under A. R. S. section 32- 1523, subsection C in order to
qualify for a license.
3. The function of this office in connection with performance audits by the
Auditor General is to provide legal research and statutory interpretation. It would be
inappropriate for this office to apply legal principles to a question which asks what the
impact of a particular administrative action would be if the result would imply the same
conclusion in all cases. A subjective application of the law can only be done on a
case- by- case basis and is properly left t o t h e administrative authority in the first
instance and to the courts in the second.
CONCLUSION:
I. The Board is required to test applicants on all of the subject areas listed in
A. R. S. section 32- 1522.
2. If an applicant fails to answer seventy- five percent of the questions asked on
each of the subjects of the examination, he is not statutorily qualified to be licensed and
the Board should not issue him a license.
3. It is not appropriate for this office to answer this question f o r the reasons set
forth above.
cc: GeraldA. Silva
Performance Audit Manager
APPENDIX I1
LEGISLATIVE COUNCIL OPINION 0 - 8 1 - 5 7
JUNE 29, 1981
APPENDIX I1
TO: Douglas R. Norton
Auditor General
June 29, 1981
FROM: Arizona Legislative Council
RE: Request for Research and Statutory Interpretation ( 0- 8 1- 57)
This is in response to a request submitted on your behalf by Gerald A. Silva in a
memo dated June 10, 1981. No input was received from the attorney general concerning
I) this request. -
FACT SITUATION:
Arizona Revised Statutes ( A. R. S.) section 32- 1522 states:
Except as provided in this section, the minimum educational requirements
for license under the provisions of this chapter shall be a high school
diploma, or the equivalent thereof, certified to by the superintendent of
public instruction or a county school superintendent, and subsequent
graduation from a school or schools of drugless therapeutics, approved by
the board, embracing residential studies of not less than four years of eight
months each devoted to a study of the following subjects in the approximate
number of hours assigned to each as follows:
1. Anatomy, including dissection, six hundred fifty hours.
2. Histology and embryology, one hundred fifty hours.
3. Physiology, two hundred fifty hours.
4. Chemistry, two hundred hours.
5. Bacteriology, one hundred hours.
6. Pathology, three hundred fifty hours.
7. Diagnosis, including physical, clinical, X- ray, symptomatology,
dermatology and mental diseases, five hundred hours.
8. Orthopedics, one hundred hours.
9. Manipulative and adjustive technic, two hundred hours.
10. Dietetics, two hundred hours.
1 1. Drugless gynecology, one hundred fifty hours.
12. Nonsurgical obstetrics, one hundred fifty hours.
13. Toxicology, fifty hours.
14. First aid, fifty hours.
15. Ear, nose and throat, fifty hours.
16. Hygiene and sanitation, one hundred hours.
17. Jurisprudence, forty- five hours.
18. Drugless therapeutics, including electrotherapy, physiotherapy,
hydrotherapy, massage and practice of naturopathy, seven hundred fifty
hours.
19. Clinical practice, three hundred hours.
20. Such other subjects as the board requires, excepting materia
medica and major surgery, totaling not less than forty- five hundred hours.
QUESTIONS PRESENTED:
1. Are applicants for licensure by the State Naturopathic Board of Examiners
( Board) required to complete course work in each of the subjects listed in A. R. S. section
32- 15221
2. What is meant by the phrase ". . . in the approximate number of hours assigned
to each. . ."? Does case law or statutory precedent exist which provides a basis for
evaluating candidates1 educational backgrounds?
3. If an individual who has been licensed by the Board is shown to have completed
less than the statutorily required course work, what is the impact on the individual's
license?
ANSWERS:
1. Yes. A. R. S. section 32- 1522 sets forth the minimum educational requirements
for an individual to be eligible for a license to practice naturopathy in the State of
Arizona. These requirements are a high school diploma or the equivalent of a high school
diploma and graduation from a school or schools of drugless therapeutics approved by the
Board. The board- approved school or schools must include a four year residential studies
program devoted to the study of the subjects listed in the statute. The number of hours of
study in each subject listed are to be in approximately the same number as stated in the
statute.
" A statute should be construed so t h a t e f f e c t is given to all its provisions, so that
no part will be inoperative or superfluous, void or insignificant . . . ." Sutherland, Statutes
and Statutory Construction section 46.06 ( 4th ed., Sands, 1972); State Board of Technical
Registration v. McDaniel, 84 Ariz. 223, 326 P. 2d 348 ( 1958). All the provisions of A. R. S.
section 32- 1522 must be given effect. The Legislature intended that applicants for
licenses to practice naturopathy complete course work in the subjects listed and in the
approximate number of hours stated or they would not have set out the educational
requirements with such specificity.
In order to satisfy the educational requirements in A. R. S. section 32- 1522, an
applicant is required to complete course work in each of the subjects listed in the
approximate number of hours assigned to each subject.
2. The phrase "/ Vn the approximate number of hours assigned to each" means a
number of hours n e a r l y r e ~ e m b l i nt~ ha t assigned to each subject. " Approximate1' means
nearly resembling; near to correctness or accuracy; nearly exact; located very close
together. See Websterls Third New International Dictionary 107 ( 1976). The applicant is
required to have completed almost but not quite the exact number of hours stated in
A. R. S. section 32- 1522. The use of the word Lapproximatel' was probably meant to allow
the Board some flexibility when considering applicants' educational backgrounds since it is
unlikely that all the schools of drugless therapeutics approved by the Board would offer
the identical number of hours as required in the s t a t u t e for each subject.
The basis for evaluating the educational backgrounds of applicants for licenses to
practice naturopathy in Arizona is fodnd in A. R. S. section 32- 1522. An applicant must
have a high school diploma or its equivalent and be a graduate of a board- approved school
of drugless therapeutics with a total of not less than forty- five hundred hours of study in
the subjects listed with the hours divided between the subjects in approximately the same
number as assigned to each in the statute.
Arizona courts have only briefly mentioned the educational requirements of
naturopaths. In Chalupa v. Industrial Commission, 17 Ariz. App. 386, 498 P. 2d 228 ( 19721,
the Court of Appeals stated that:
- N h e statutes / R S section 32- 15227delineating the educational
requirements of naturopaths indicate that as a group they are likely t o be
relatively well schooled in medical matters. 17 Ariz. App. at 390.
-
The Supreme Court in Kuts- Cheraux v. Wilson, 71 Ariz. 461, 465, 229 P. 2d 773 ( 19511,
noted that naturopaths are not qualified by their training t o prescribe drugs or perform
surgical operations.
The Board has adopted a rule regarding educational requirements. Arizona Code of
Administrative Rules and Regulations ( A. C. R. R.), R4- 18- 05 provides that:
A. No credit whatever will be allowed on the educational
requirements of this Act f o r any so- called home extension or
correspondence study.
B. The educational requirements for certification for this Board shall
be those stated in the A. R. S. section 32- 1522, which excludes major surgery
and includes diagnosis. Each licentiate is required to participate in fifteen
( 15) hours of postgraduate work during each calendar year. Said
postgraduate work shall be as prescribed by this Board or said requirement
shall be satisfied by an affidavit sworn t o by the registrar of a Naturopathic
college that is recognized by the National Association of Naturopathic
Physicians.
3. The function of this office in connection with performance audits by the
Auditor General is to provide legal research and statutory interpretation. It would be
inappropriate for this office to apply legal principles t o a question which asks what the
impact of a particular administrative action would be if the result would imply t h e s a m e
conclusion in all cases. A subjective application of the law can only be done on a
case- by- case basis and is properly left to the administrative authority in the first
0 instance and to the courts in the second.
CONCLUSION:
1. Applicants for licensure by the Board are required t o complete course work in
each of the subjects listed in A. R. S. section 32- 1522.
2. The phrase l1/ Qn the approximate number of hours assigned t o each" means a
number of hours nearly~ esemblingt hat assigned to each subject.
3. It would be inappropriate for t h i s office t o answer this question for the reasons
set forth above.
cc: Gerald A. Silva
Performance Audit Manager
APPENDIX I11
LEE ISLATIVE COUNCIL OPINION 0- 8 1- 58
JULY 1 , 1981
ARIZONAL EGISLATIVCEO UNCIL APPENDIX I11
M E M O
TO: Douglas R. Norton
Auditor General
FROM: Arizona Legislative Council
July 1, 1981
RE: Request for Research and Statutory Interpretation ( 0- 81- 58)
This is in response to a request submitted on your behalf by Gerald A. Silva in a
memo dated June 10, 198 1. No input was received from the Attorney General concerning
this request.
FACT SITUATION:
Arizona Revised Statutes ( A. R. S.) section 32- 152 1, subsection C states that:
The applicant shall be of good moral character and shall file with the
application affidavits of two reputable residents of the state attesting the
good moral character of the applicant and two photographs of the applicant
taken within sixty days of the application. Other data and information as
the board requires shall be filed with the application. At the time and place
the board has previously designated, the applicant shall appear before the
board for examination as to his fitness to practice naturopathy.
QUESTIONS PRESENTED:
1. Do the requirements of A. R. S. section 32- 1521, subsection C state that the
0 affidavits shall be signed by reputable residents of the State of Arizona, or may they be
the residents of any state?
2. If the affidavits must be signed by residents of the State of Arizona, does the
failure to comply with this requirement automatically disqualify an applicant?
3. If an individual is already licensed by the Board of Naturopathic Examiners
( Board) and i t is learned that the affidavits are signed by residents of states other than
Arizona, what impact would this have on the individual's license to practice naturopathy?
ANSWERS:
m I. The affidavits required under A. R. S. section 32- 1521, subsection C must be
signed by reputable residents of the State of Arizona.
" It is a fundamental rule of statutory construction that plain, clear and
unambiguous lang- uag- e of a statute is to be given that meaning unless impossible or absurd
consequ< nces may result." Balestrieri v. ~% tfot- d Accident and Indemnity Insurance Co.,
112 Ariz. 160, 163, 540 P. 2d 126 ( 1 975). Since A. R. S. section 32- 1521, subsection C
clearly states that the applicant is required to file affidavits of two reputable residents of
the state with his application, the affidavits must be signed by residents of the state of
Arizona. No other meaning can be given to this language. If the Legislature had intended
that the affidavits could be signed by residents of any state i t would have used different
language.
Impossible or absurd consequences do not result from giving the language its plain
meaning. Indeed, since the applicant will be practicing naturopathy in Arizona i t is more
desirable to have Arizona residents attest to the applicant's good moral character.
2. It is mandatory for an applicant to file affidavits of two reputable residents of
the state attesting to the good moral character of the applicant in order to satisfy the
application requirements for taking the quaiif ying examination and obtaining a license to
practice nat uropathy.
Where an individual's rights depend upon his compliance with the provisions
of a statute, those provisions are generally mandatory, and complianc
therewith a condition precedent to the perfection of such rights. f
Sutherland, Statutes and Statutory Construction section 57.15 ( 4th ed.,
Sands, 1972).
An applicant's qualification for the privilege of taking the naturopathic exam and
obtaining a license to practice naturopathy depends upon his compliance with A. R. S.
section 32- 1521. That compliance is a condition precedent to his qualifying to take the
exam and for a naturopathic license.
So long as the applicant files the affidavits called for with the application and
satisfies the other requirements of A. R. S. section 32- 1521 not less than thirty days before
the date of the examination he will qualify to take the examination. If those conditions
have not been met t h e applicant is not qualified to take the examination or to become
licensed to practice naturopathy.
3. The function of this office in connection with performance audits by the
Auditor General is to provide legal research and statutory interpretation. It would be
inappropriate for this office to apply legal principles to a question which asks what the
impact of a particular administrative action would be if the result would imply the same
conclusion in all cases. A subjective application of the law can only be done on a
case- by- case basis and is properly left to the administrative authority in the first
instance and t o the courts in the second.
CONCLUSION:
1. The affidavits required under A. R. S. section 32- 1521, subsection C must be
signed by reputable residents of the State of Arizona.
1. In Arizona, no right to practice medicine exists, but a privilege to practice
medicine as allowed and regulated by the Legislature does exist. Kuts- Cheraux v. Wilson,
7 1 Ariz. 46 1, 229 P. 2d 7 13, opinion supplemented 72 Ariz. 37, 230 P. 2d 51 2 ( 1 95 1).
2. If the affidavits are not signed by residents of the State of Arizona the
applicant is not qualified to take the licensing examination or to become licensed to
practice nat uropathy.
3. It would be inappropriate for this office to answer this question for the reasons
set forth above.
cc: Gerald A. Silva
Performance Audit Manager