Performance audit, Board of Homeopathic Medical Examiners

              DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
May 10, 1985
Members of the Arizona Legislature
The Honorable Bruce Babbitt, Governor
Dr. Harvey Bi gel sen, President
Board of Homeopathic Medical Examiners
Transmitted herewith is a report of the Auditor General, A Performance
Audit of the Board of Homeopathic Medical Examiners. This report is in
response t o an April 27, 1983, resolution of the J o i n t Legislative
Oversight Committee. The performance audit was conducted as a part of the
Sunset Review set forth in A. R. S. § § 41- 2351 through 41- 2379.
This performance a u d i t report is submitted t o the Arizona S t a t e
Legislature for use in determining whether to continue the Board of
Homeopathic Medical Examiners beyond its schedul ed termination date of
July 1, 1986. The report addresses the need for independent regulation o f
Arizona's homeopathic physicians and the impact of the Board on medical
regulation within t h e S t a t e . The r e p o r t recommends terminating the Board
and regulating homeopathic medical practices through the Board of Medical
Examiners and the Board of Osteopathic Examiners in Medicine and Surgery.
My s t a f f and I will be pleased to discuss or c l a r i f y items in the report.
Respectful l y submitted, 4ee-
Doug1 s R. Norton
Auditor General
S t a f f : W i 11 iam Thomson
Mark Fleming
Nancy Love11
Anthony Guarino
1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 ( 602) 255- 4385
SUMMARY
The Office of the Auditor General has conducted a performance audit of
the Arizona Board of Homeopathic Medical Examiners i n response to an
April 27, 1983, resol ution of the Joint Legislative Oversight Committee.
This performance audit was conducted as part of the Sunset Review set
forth i n Arizona Revised Statutes ( A. R. S. ) § § 41- 2351 through 41 - 2379.
Homeopathy, established i n the early 1800s, i s a branch of medicine based
on the philosophy that " like cures like." I t s premise is that a
substance which causes a particular set of symptoms in a healthy person
will cure those symptoms i n a sick person. Homeopaths view symptoms as
attempts by the body to heal i t s e l f . Homeopathic remedies given in
minute doses are used to stimulate the body's own defensive and curative
processes.
In Arizona, the Board of Homeopathic Medical Examiners was organized i n
1981. I t consists of five members and has the responsi bil i ty to protect
pub1 ic health, safety and we1 fare by 1 icensi ng and regulating homeopathic
physicians. Before the Homeopathic Board was establ i shed, homeopaths
were regulated by the Board of Medical Examiners ( BOMEX) or the Board of
Osteopathic Examiners i n Medicine and Surgery ( OBEX) , depending on their
medical training. To become a licensed homeopathic physician i n Arizona,
one must be licensed i n any state as a medical doctor or an osteopathic
physician, and exhibit knowledge of homeopathy by passing a written
examination. The statutory definition of homeopathy a1 1 ows homeopathic
physicians a broad scope of practice. In addition to using homeopathic
treatments, they may prescribe a1 1 opathic drugs and perform surgery.
Such procedures exceed the commonly accepted scope of homeopathy.
The Legislature should consider terminating the Homeopathic Board because
i t weakens medical regulation and i s not needed. Legislation creating
the Board gives homeopathic physicians a broad scope o f practice.
Because homeopathic physicians may engage i n medical a c t i v i t i e s t h a t were
previously regulated only by BOMEX and OBEX, the enforcement a b i l i t y o f
BOMEX and OBEX i s reduced, and Arizona's standards of medical practice
may be weakened. I n a t l e a s t two cases physicians have been able t o
continue practicing medicine under t h e i r homeopathic 1 icenses following
the loss or surrender of t h e i r medical licenses based on d i s c i p l i n a r y
actions by BOMEX.
Although proponents of the Homeopathic Board c i t e antagonism w i t h i n the
medical community as the reason the Homeopathic Board was created, a
review o f cases involving homeopathic physicians with BOMEX and OBEX does
not indicate t h a t an independent board i s warranted. BOMEX and OBEX
could regulate homeopathic physicians more e f f e c t i v e l y than the
Homeopathic Board i f the two boards would i n i t i a t e peer review i n cases
involving homeopaths. I n addition, both boards provide necessary
services and protection f o r the public t h a t the Homeopathic Board cannot
finance.
Should the Homeopathic Board not be terminated on July 1, 1986, changes
are needed i n the scope o f homeopathic practice and Board funding. The
Homeopathic Board should only be a1 lowed to sanction medical practices
related t o the commonly accepted scope o f homeopathic practice. I n
addition, Board fees should be raised or General Fund money appropriated,
or both, t o provide adequate resources f o r public protection.
TABLE OF CONTENTS
Page
INTRODUCTION AND BACKGROUND . . . . . . . . . . . . . . . . . . . . . . 1
SUNSET FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
FINDING I: THE HOMEOPATHIC BOARD SHOULD
BE TERMINATED . . . . . . . . . . . . . . . . . . . . . . . . . . 13
The Board Was Created Because O f Alleged
Antagonism Within The Medical Community . . . . . . . . . . . . . 13
The Scope O f Practice Allowed For
Homeopathic Physicians Weakens Arizona's
Medical Regulation. . . . . . . . . . . . . . . . . . . . . . . . 14
BOMEX And OBEX Could E f f e c t i v e l y
Regulate Homeopathic Physicians . . . . . . . . . . . . . . . . . 17
CIfha Tnhgee sH Aormee oNpeaetdheidc. B. oa. rd . I s. C. o. nti. nu. ed., . . . . . . . . . . . . . . 20
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . 2 1
AGENCY RESPONSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3
APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
LIST OF TABLES
TABLE 1 - Board O f Homeopathic Medical Examiners
Licensing A c t i v i t y Summary Fiscal Years 1 981 - 82 Through 1 983- 84. . . . . . . . . . . . . 3
TABLE 2 - Board O f Homeopathic Medical Examiners
Revenues And Expenditures Fiscal Years 1981- 82 Through 1984- 85. . . . . . . . . . . . . 4
INTRODUCTION AND BACKGROUND
The Office o f the Auditor General has conducted a performance audit o f
the Arizona Board o f Homeopathic Medical Examiners i n response t o an
April 27, 1983, resolution o f the J o i n t Legislative Oversight Committee.
This performance audit was conducted as p a r t o f the Sunset Review set
forth i n Arizona Revised Statutes ( A. R. S. ) § § 41- 2351 through 41 - 2379.
The Arizona Legislature passed l e g i s l a t i o n c r e a t i n g t h e Homeopathic Board
i n 1980. The Board was organized i n 1981. Before the Board was
establ i shed, physicians p r a c t i c i n g homeopathy were under the j u r i s d i c t i on
of the Board o f Medical Examiners ( BOMEX) or the Board o f Osteopathic
Examiners i n Medicine and Surgery ( OBEX), depending on t h e i r medical
training. However, a1 leged antagonism between the t r a d i t i o n a l ,
a1 1 opathic medical community and those desiring t o o f f e r a1 ternative
medical treatments such as homeopathy, resulted i n 1 egis1 a t i o n creating
the Board. Arizona i s one o f only three states t h a t regulate homeopathic
physicians through an independent board.
Homeopathy: D e f i n i t i o n and Background
Homeopathy was establ ished by a German physician, Samuel Hahnemann, i n
the early nineteenth century. It i s based on the p r i n c i p l e t h a t " 1 ike
cures l i k e " and asserts t h a t a substance which causes a p a r t i c u l a r s e t of
symptoms i n a heal thy person w i l l cure those symptoms i n a sick person.
For example, the drug Gelsemium produces i n heal thy people symptoms
simil ar t o those common t o influenza. Homeopaths maintain t h a t Gel semi um
has an excellent record for t r e a t i n g influenza i n some patients. The
concept o f " l i k e cures l i k e " can be compared t o such conventional methods
as vaccinations.
Homeopathy i s one aspect o f h o l i s t i c medicine. Homeopathic physicians
t r e a t the body as an integrated whole and view symptoms as attempts by
the body t o heal i tsel f. Therefore, homeopathic drugs administered i n
microdosages stimulate the symptoms of a disease and help t h e body t o
heal.
The homeopathic movement grew steadily i n the United States from 1826
through the end o f the century. By 1900 t h i s system o f practice
accounted f o r about 15,000 o f the 100,000 medical doctors ( M. D. ) i n the
country. During the twentieth century, however, the popularity of
homeopathy decreased i n the United States. Currently, only a few hundred
M. D. s practice homeopathy excl usively. However, there i s s t i l l a
s i g n i f i c a n t number o f a1 1 opathic and osteopathic physicians who practice
homeopathy as a portion of t h e i r practice, and it i s practiced i n other
countries such as Great B r i t a i n , Mexico, Greece and India.
Currently, there are only three states t h a t recognize homeopathy by
offering a license separate from the M. D. or osteopathic ( D. O.) license.
Arizona, Connecticut and Nevada license homeopathic physicians and
regulate them through an independent board. A l l three boards require
t h e i r licensees to be graduates o f osteopathic or medical colleges.*
Connecticut requires a degree from an accredited col 1 ege, whereas Arizona
and Nevada require an applicant t o hold a current M. D. or D. O. license
from any state i n the United States. I n addition, a l l three states t e s t
applicants through a w r i t t e n exam on the practice o f homeopathy.
Arizona Homeopathic Board A c t i v i t i e s
A. R. S. § § 32- 2902 and 32- 2904 specify the Eoard's composition, powers and
duties. The Board consists o f f i v e members, including one lay member,
appointed f o r 3- year terms. The duties o f the Board include evaluating
applications f o r examinations and licensure, administering examinations,
issuing 1 icenses, and resolving complaints against 1 icensed homeopaths.
The Board may also enact rules and regulations. Table 1 summarizes Board
1 icensing a c t i v i t i e s f o r f i s c a l years 1981 - 82 through 1983- 84.
* There are currently no homeopathic colleges i n t h i s country.
TABLE 1
Appl ications
Licenses Granted
New 1 icenses
Renewal s
BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
LICENSING ACTIVITY SUMMARY
FISCAL YEARS 1981 - 82 THROUGH 1983- 84
Actual
Source: Board of Homeopathic Medical Examiners' budget requests f o r
f i s c a l years 1985- 86, and Board 1 icensing f i l e s and accounting
records.
The Board also hears and resolves complaints. Board f i l e s indicate t h a t
the Board has received only f i v e formal complaints since 1982. The Board
determined t h a t none o f the cases required i n v e s t i g a t i v e or d i sci pl i nary
action.
Budget and Personnel
The Board o f Homeopathic Medical Examiners i s a 90/ 10 board funded by
fees f o r 1 icense appl i c a t i o n s ($ loo), 1 icenses ($ 75) and annual renewal s
($ 50 per year). The current funding method i s i n s u f f i c i e n t t o pay f o r
a1 1 the Board's operating expenses. Board members have vol u n t a r i ly
contributed t o pay those additional costs. Tab1 e 2 summarizes revenues
and expenditures f o r f i s c a l years 1981 - 82 through 1984- 85.
TABLE 2
BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
REVENUES AND EXPENDITURES
FISCAL YEARS 1981 - 82 THROUGH 1984- 85
Actual Estimated ( I
1981 - 82 1982- 83 1983- 84 1984- 85
Revenues :
Revenue Col 1e cted $ 1,325( 1) $ ~ , 3 2 5)( ~ $ 925 $ 3,000
Less 10% To General Fund 132 232 92 300
Carry- Forward From Previous Year 0 1 , I 93 3,186 3,069 d
Total In Board ~ u n d ( ~ ) $ 1.193 $ 3.286 $ 4.019 $ 5.769
Expenditures:
Professional Services $ 0 $ 0 $ 150 $ 200
Other Operating Expenditures 0 1 00 800 800
\( I
Total ( 3) 0 100 950 1,000
End Of Year Fund Balance $ 1.193 $ 3.186 $ 3.069 $ 4.769
( 1 ) The Board's budget documents contain an internal discrepancy; the
number of applications, 1 icenses and renewals shown i n the activity
summary do not produce the revenue figures shown i n Table 2. The
discprepancy equals $ 50 i n fiscal year 1981- 82 and $ 200 i n fiscal
year 1 982- 83.
( 2 ) Although monies were available i n the Board's fund, the Legislature
has appropriated only $ 2,100 since fiscal year 1981- 82 for Board
expendi tures : for f i scal year 1 981 - 82, $ 0; fiscal year 1 982- 83,
$ 100; fiscal year 1983- 84, $ 1,000; and fiscal year 1984- 85, $ 1,000.
( 3) Funds appropriated are insufficient to cover Board expenses. Board
members have paid approximately $ 16,000 of Board expenses i n fiscal
years 1981 - 82 through 1984- 85. They have received no reimbursement
for these expendi tures.
Source: Board of Homeopathic Medical Examiners' budget requests for
fiscal years 1 983- 84 through 1 985- 86
The Board has no f u l l - t i m e s t a f f , and operates from the Board president's
p r i v a t e medical offices. The president's personal secretary provides
secretarial services p r i m a r i l y a t the Board president's expense.
Audit Scope and Purpose
This audit was conducted t o evaluate the need f o r and the adequacy o f
regulation by the Board o f Homeopathic Medical Examiners. S p e c i f i c a l l y
we examined:
0 The need f o r an independent board regulating homeopathy,
The Board's effectiveness and efficiency, and
0 The appropriateness o f the current scope o f practice.
The Auditor General and s t a f f express appreciation t o the members o f the
Board o f Homeopathic Medical Examiners and t o the Board president's
o f f i c e s t a f f f o r t h e i r cooperation and assistance during the course of
our audit.
SUNSET FACTORS
I n accordance with Arizona Revised Statues ( A. R. S. ) 541 - 2354, the
Legislature shoul d consider the fol1 owing 12 factors i n determining
whether the Arizona Board of Homeopathic Medical Examiners should be
continued or terminated.
1. The objective and purpose i n e s t a b l i s h i n g t h e Board
The enabling s t a t u t e s f o r the Board o f Homeopathic Medical Examiners
state t h a t the purpose o f the l e g i s l a t i o n i s ". . . t o promote the
health, safety and welfare o f the people o f t h i s state by providing
f o r the licensing and regulation o f homeopathic physicians." The
s t a t u t e s e s t a b l i s h the means t o ensure competence and q u a l i t y i n the
homeopathic profession by authorizing the Board t o examine, license
and d i s c i p l i n e homeopathic physicians.
2. The effectiveness with which the Board has met i t s objective and
purpose and the efficiency with which it has operated
The Board lacks the necessary resources t o e f f e c t i v e l y p r o t e c t p u b l i c
health and safety. Current funding l e v e l s do not allow the Board t o
h i r e professional s t a f f , rent a f a c i l i t y accessible t o t h e p u b l i c or
contract f o r investigative services. I n addition, the Board may not
be able t o ensure competency based upon i t s 1 icensing examination
( see page 17). A1 though prepared by experts i n homeopathy, the exam
was not prepared according t o standards ensuring v a l i d i t y and
re1 i a b i l i t y .
I n addition, l i m i t e d funding may hamper the Board's a b i l i t y t o
s u f f i c i e n t l y enforce i t s statutes i n cases t h a t require considerable
investigation and legal action. During i t s 4 years, Board records
show t h a t only f i v e formal complaints have been f i l e d . According t o
the Board president, none of the f i v e warranted investigative or
d i s c i p l i n a r y action. To date the Board has not heard or investigated
a complaint posing serious harm t o the public. However, the Board
lacks the resources t o c o n t r a c t f o r extensive investigative services
should a major complaint come before the Board ( see page 19).
A1 though the current finding level i s 1 imited, the Board has made
e f f o r t s t o promote public health and safety. According t o the Board
president, the Board has investigated and assisted i n investigations
of two " diploma m i l l s " operating i n Arizona. I n addition, the Board
performs background checks on applicants f o r licensure i n an attempt
t o ensure t h a t only q u a l i f i e d and reputable physicians receive
homeopathic licenses.
3. The extent to which the Board has operated w i t h i n t h e p u b l i c i n t e r e s t
A1 though regulating homeopathic physicians i s i n the publ i c i n t e r e s t ,
because the Board's statutes allow homeopaths a broad scope of
practice i t s funding level may not provide adequate protection t o the
publ i c . A. R. S. § 32- 2901 allows a scope o f practice which equals t h a t
o f doctors 1 icensed by the Board o f Medical Examiners ( BOMEX) and the
Board o f Osteopathic Examiners i n Medicine and Surgery ( OBEX).
Therefore, the 1 eve1 o f regulation f o r homeopathic physicians should
be comparable t o t h a t o f medical doctors ( M. D.) and osteopathic
doctors ( D. O. ). However, as described i n Sunset Factor 2, - he
Board's funding capacity does not provide f o r adequate or cornparaole
regul a t i on ( see page 1 9).
4. The extent to which rules and regulations promulgated by the Board
are consistent with the 1 egi s l a t i v e mandate
The Homeopathic Board has not promulgated any rules and regulations
t o date. Board minutes indicate t h a t the Board began work on rules
and regulations i n 1981. Informal d r a f t s have been submitted t o the
Board ' s Attorney General representative; however, none have been
submitted t o the Attorney General's Office for o f f i c i a l review t o
determine consistency with the statutes.
5. The extent to which the Board has encouraged i n p u t from the public
before promulgating i t s rules and regulations and the extent to which
i t has informed the public as t o i t s actions and their expected
im~ act on the ~ u b l i c
Because the rules and regulations are s t i l l being drafted, public
hearings have not been held. The Board has complied w i t h the open
meeting law on public meetings. The Board has submitted a listing of
the locations of published or posted notices to the Secretary of
State.
6. The extent to which the Board has been able to investigate and
resolve complaints w i t h i n i t s jurisdiction
The Board has received few complaints and appears to have resolved
them i n a timely manner. However, the Board has conducted no major
investigations on any compl aints. According to the Board's
president, the nature of the complaints and queries submitted d i d not
merit investigative activity.
The Board has limited investigative resources because it lacks
adequate funds. According to the Board's Attorney General
representative, if a case comes before the Board that poses
significant public harm, the Board may receive investigative
assistance from the Attorney General's Office. However, she added
that the Attorney General ' s Office cannot assume full responsi bil i ty
for investigations. Because i t s staff is limited, i t could not be
the Board' s sol e investigative resource.
7. The extent to which the Attorney General or any other applicable
agency of State government has the authority t o prosecute actions
under enabl ina 1 eai sl ation
The Board's statutes appear to be adequate. According to the Board's
former Attorney General representative, the statutes are simi 1 ar to
those o f other health professions, which are considered adequate.
However, as the Board has not prosecuted or taken any d i s c i p l i n a r y
action, the adequacy o f the homeopathic statutes has not been tested.
8. The extent t o which the Board has addressed deficiencies i n the
enabling statutes which prevent it from f u l f i l l i n g i t s statutory
mandate
According t o Legislative Council s t a f f , the Board submitted a
proposal f o r statutory changes i n 1983. The proposal c a l l e d for
changes i n 1 icensing qua1 i f i c a t i o n s and exemptions f o r those
assisting homeopathic physicians i n t h e i r practices. The proposal
did not pass. The Board has no proposals f o r the 1985 l e g i s l a t i v e
session according t o the Board president.
9. The extent t o which changes are necessary i n the laws o f the Board t o
adequately comply with the factors l i s t e d i n the Sunset Laws
Based on our audit work, we recommend t h a t the Legislature consider
del e t i n g A. R. S. $ 32- 2901 et. seq. , thereby terminating the Arizona
Board o f Homeopathic Medical Examiners. This action woul d return
regulation of homeopathic physicians t o BOMEX and OBEX. I f the Board
i s not terminated, the Legislature should consider amending the
d e f i n i t i o n o f homeopathy set f o r t h i n A. R. S. $ 32- 2901. It should
1 i m i t the scope of practice to allow only homeopathic diagnoses and
treatments ( see page 20).
10. The extent to which the termination o f the Board would s i g n i f i c a n t l y
harm the public heal t h y safety or we1 fare
No harm would . occur t o the pub1 i c health, safety or we1 fare i f
regulation o f homeopathy were returned to BOMEX or OBEX. As medical
p r a c t i t i o n e r s with a scope o f practice equivalent t o t h a t o f M. D. s
and D. O. s, homeopathic physicians should be regulated. However,
BOMEX and OBEX could better regulate homeopathic physicians due to
the Homeopathic Board ' s 1 imi ted funding. If homeopathic physicians
were placed under the j u r i s d i c t i o n o f BOMEX or OBEX, public health
and safety would be adequately protected because o f these boards'
greater enforcement c a p a b i l i t i e s and resources.
11. The extent t o which the 1 evel o f regulation exercised by the Board i s
appropriate and whether 1 ess or more stringent 1 evel s o f regul ation
would be appropriate
Although the level o f regulation i s appropriate, the Homeopathic
Board's a b i l i t y t o adequately regulate i s limited. Due t o greater
investigative and s t a f f c a p a b i l i t i e s , BOMEX and OBEX could provide
more e f f e c t i v e regulation. The Homeopathic Board shoul d be
terminated and homeopathic physicians should be regulated by BOMEX or
OBEX. However, i f t h i s does not occur, the scope o f homeopathic
practice should be l i m i t e d t o allow only homeopathic diagnoses and
treatments.
12. The extent to which the Board has used ~ r i v a t e contractors i n the
performance of i t s duties and how e f f e c t i v e use o f private
contractors coul d be accompl ished
According t o the Board president, the Board has not contracted f o r
any services.
FINDING I
THE HOMEOPATHIC BOARD SHOULD BE TERMINATED
The Homeopathic Board shoul d be terminated. A1 though the Homeopathic
Board was created as a r e s u l t o f alleged antagonism w i t h i n the medical
community , the 1 egal ly a1 1 owed scope o f practice f o r homeopathic
physicians weakens medical regulation i n Arizona. Moreover, homeopathic
physicians could be more e f f e c t i v e l y regulated by the Board o f Medical
Examiners ( BOMEX) and the Board o f Osteopathic Examiners i n Medicine and
Surgery ( OBEX) if the two boards would i n i t i a t e peer review i n cases
involving homeopaths. Should t h e Legislature not a1 1 ow the Homeopathic
Board t o terminate on July 1, 1986, Arizona's medical regulation would be
improved i f 1 icensed homeopaths' medical a c t i v i t i e s conformed t o the
accepted scope o f practice and the Board had more revenue.
The Board Was Created Because o f Alleged
Antaaonism Within The Medical Communitv
Antagonism as perceived by homeopathic p r a c t i t i o n e r s , r e s u l t e d i n lobbying
e f f o r t s f o r an independent board. P r i o r t o the Homeopathic Board's
creation i n 1981, physicians who practiced homeopathy were licensed by
either BOMEX or OBEX. The l o b b y i s t working f o r the Board's enabling
1 egi sl ation stated t h a t BOMEX' s into1 erance o f homeopathic practices
necessitated an independent board. Three Homeopathic Board members
reported t h a t differences i n medical philosophy tend t o polarize
homeopathic physicians and other medical doctors. The Board's president
stated t h a t i d e a l l y , homeopathy should be treated as a medical specialty,
and regulated through e i t h e r BOMEX or OBEX. He stated, however, t h a t
while homeopathic physicians had not experienced probl ems with the
osteopathic community, he did not believe t h a t homeopathic physicians
would be f a i r l y regulated by BOFIEX. The Board's president and the l o b b y i s t
both concluded t h a t the Board was necessary t o ensure t h a t medical doctors
could practice a f u l l range of medicine, including homeopathy, without
fear o f losing t h e i r medical licenses.
The Scope Of Practice Allowed For Homeopathic
Physicians Weakens Arizona ' s Medical Regul ation
Although the Board's statutes allow licensed homeopaths to practice a wide
range of medical activities, the authorized scope of practice i s too broad
and reduces the effectiveness of medical regulation i n Arizona. The
Homeopathic Board may sanction medical a c t i v i t i e s t h a t exceed the accepted
scope of homeopathy. As a result, the ability of BOMEX and OBEX to
regulate physicians i s reduced and Arizona's standards of medical practice
are weakened.
Current Scope Of Practice Exceeds Homeopathy - Licensed homeopathic
physicians i n Arizona are authorized to engage i n medical a c t i v i t i e s t h a t
exceed the accepted scope of homeopathic practice. The Board's enabl i ng
1 egislation a1 1 ows i t to sanction medical practices previously regulated
only through B014EX or OBEX. The statute, however, incorrectly defines
homeopathy by including a wide range of medical treatments within i t s
scope of practice.
The Board's enabling legislation allows i t to regulate a wide range of
medical practices. Arizona Revised Statutes ( A. R. S. ) $ 32- 2901.2 defines
homeopathy as :
". . . a system of medicine employing substances of
animal, vegetable or mineral - origin which are given i n
microdosage, prepared according to homeopathic
pharmacology, i n accordance w i t h the principle that a
substance which produces symptoms i n a healthy person
can cure those symptoms i n an i l l person, and mana i n
the cure and prevention of illness ho istica y.
( emphasis added)
T- l- W
The reference to hol i s t i c medicine gives the Board extensive regulatory
powers. In a memorandum dated December 19, 1984, the Legislative Council
stated that:
" Holistic health focuses on the whole person and the
development of general we1 1 - being. A1 1 opathic and
osteopathic identification and treatment of disease are
part of curing the whole person and developing general
we1 1 - being. "
Using t h i s d e f i n i t i o n o f hol i s t i c medicine, the Legislative Council
concluded t h a t A. R. S. $ 32- 2901 .2 gives licensed homeopaths the authority
to practice a1 1 opathic or osteopathic medicine i r r e s p e c t i v e o f other
1 icenses he1 d.*
The Homeopathic Board, therefore, may sanction the kinds o f broad medical
a c t i v i t i e s previously regulated only through BOMEX and OBEX, because
h o l i s t i c medicine i s not l i m i t e d t o any p a r t i c u l a r type o f medical
specialty. It i s a philosopy o f treatment t h a t emphasizes the whole
person instead o f j u s t the disease, and encompasses a l l allopathic and
osteoparhic treatments including the use o f medication and surgery.
Consequently, Arizona now has three medical boards t h a t may regulate a
wide range of medical practices.
The s t a t u t e i n c o r r e c t l y defines homeopathy as i n c l uding a1 1 hol i s t i c
treatments, and therefore, a l l allopathic and osteopathic treatments
w i t h i n i t s scope of practice. Homeopathy, however, i s a 1 imited medical
practice. While h o l i s t i c i n nature, experts i n the f i e l d agree t h a t
homeopathy does not include the use o f allopathic or osteopathic
treatments such as surgery. The Homeopathic Pharmacopoeia o f the United
States ( HPUS)** sets up parameters f o r the practice o f homeopathy. The
publication describes two basic features o f homeopathic treatment: 1) a
comprehensive examination t o uncover the complete symptom p i c t u r e f o r a
p a r t i c u l a r individual; and 2) the administration o f a homeopathic drug or
drugs, as delineated i n the HPUS, t o stimulate the healing process.
Negative Effect On Arizona Regulation - The broad scope o f practice
a1 1 owed 1 icensed homeopaths 1 i m i t s the regul atory a b i l i ty o f other medical
boards and lowers Arizona's standards f o r medical practice. The scope o f
practice allowed licensed homeopaths weakens BOMEX and OBEX because it
* See Appendix f o r complete t e x t o f Legislative Council Opinion.
** The HPUS i s a l i s t i n g o f homeopathic drugs and procedural guidelines
f o r homeopathic drug preparation. It i s published by the Homoeopathic
Pharmacopoeia Convention o f the United States. The most recent
e d i t i o n was revised and pub1 ished i n 1981 with a suppl ement printed i n
1982.
a1 1 ows the Homeopathic Board to nu1 1 i fy d i scipl inary actions taken by
those boards. Further, the Board's standards f o r evaluating medical
competency are less stringent than those o f BOMEX and OBEX.
Homeopathic physicians' current scope o f practice reduces the
effectiveness o f BOMEX and OBEX. The following cases i l l u s t r a t e how t h i s
can occur.
Case 1
a A 1 icensed medical doctor ( M. D. 1 had a h i s t o r y o f problems with BOMEX,
unrelated t o homeopathy. Between 1969 and 1979 the physician was
placed on probation by BOMEX three times. During each probationary
period BOMEX placed r e s t r i c t i o n s on the doctor's r i g h t t o prescibe and
dispense drugs. F i n a l l y , i n September 1982 BOMEX revoked the
physician's license f o r unprofessional conduct and medical
incompetency. The physician appealed t h e r u l i n g , but a county
superior court upheld the decision. This physician retained a current
out- of- State medical license, which allowed him t o receive a
homeopathic 1 icense i n November 1983. .
Commen t
Despite BOMEX's r u l i n g , t h i s physician was licensed as a homeopath.
The 1 icensee agreed not t o prescribe controlled substances or class I1
drugs, I n addition he was asked t o submit a record o f his
prescriptions. A Board review of the record indicated t h a t the doctor
had not prescribed controlled substances or class I 1 drugs; however,
Board members expressed concern over the quantity o f other a1 1 opathic
drugs he had prescribed. One Board member questioned i f the doctor
was using h i s homeopathic license t o p r a c t i c e a l l o p a t h i c medicine.
The doctor's extensive use o f a1 1 opathic medicines under a homeopathic
license has, i n e f f e c t , n u l l i f i e d the BOMEX ruling.
Case 2
r A second physician used h i s current Arizona M. D. license t o obtain h i s
homeopathic license i n February 1982. At t h a t time he was being
investigated by BOMEX. Although the president o f the Homeopathic
Board maintains the doctor was t r e a t i n g the patient homeopathically,
BOMEX claimed it was a case involving misdiagnosis and the unnecessary
prescription of medication. BOMEX records do not indicate homeopathic
methods were discussed. I n June 1982, t h i s physician surrendered h i s
M. D. license and signed a s t i p u l a t i o n s t a t i n g t h a t h i s conduct may
have constituted a danger t o the p a t i e n t ' s health.
Comment
This physician surrendered h i s M. D. 1 icense rather than face possible
d i s c i p l i n a r y action by BOMEX. However, because he retained a
homeopathic license, he could do t h i s and s t i l l r e t a i n a l l medical
Further, a1 though the Homeopathic Board may allow i t s 1 icensees t o
practice allopathic and osteopathic medicine, the Board's standards for
evaluating competency i n these areas are not equal t o the requirements o f
BOMEX and OBEX. Licensed homeopaths are considered competent t o practice
these medicines because A. R. S. $ 32- 291 2 C. l . B. requires t h a t 1 icense
appl icants hol d:
". . . a current unsuspended and unrevoked 1 icense t o
practice homeopathic medicine . . . [ from] another
state o f the United States or the D i s t r i c t o f
Columbia. . . ."
The Homeopathic Board, however, i s not required t o determine i f the states
t h a t licensed the applicants have licensing standards comparable t o
Arizona's. The Board generally assumes t h a t an applicant with an
out- of- State license i s q u a l i f i e d t o p r a c t i c e a l l o p a t h i c and osteopathic
medicine regardless o f comparability. BOMEX and OBEX may a l s o l i c e n s e
applicants by endorsement. However, these boards grant licenses only if
applicants have an M. D. or osteopathic ( D. O.) 1 icense from another state
with standards comparable t o Arizona's. OBEX has determined t h a t a l l
other states meet i t s standards. However, i n the case o f M. D. sY i f
standards are not comparable, BOMEX may r e q u i r e l i c e n s e applicants t o take
a nationally approved w r i t t e n exam covering a wide range o f medical
knowledge. While the Homeopathic Board may a l s o r e q u i r e applicants t o
take a w r i t t e n exam, i t s exam t e s t s only f o r an applicant's competency i n
homeopathy. The Board's 1 icensing standards, designed t o determine a
physician's a b i l i t y t o practice homeopathy, are i n s u f f i c i e n t t o evaluate
competency i n a1 1 opathic and osteopathic medicine.
BOMEX And OBEX Could Regulate
Homeopathic Physicians E f f e c t i v e l y
BOMEX and OBEX could regulate homeopathic physicians more e f f e c t i v e l y than
the Homeopathic Board. Although proponents o f an independent board c i t e d
antagonism w i t h i n the medical community as the reason f o r creating the
Homeopathic Board, a review of cases involving homeopathic physicians with
BOMEX and OBEX show t h a t the retention of an independent board i s
unwarranted. Both of these boards provide necessary services and
protection f o r the pub1 i c t h a t the Homeopathic Board cannot finance.
An Independent Board I s Unwarranted - A review o f cases involving BOMEX
and homeopathic physicians indicates t h a t peer review woul d be s u f f i c i e n t
t o ensure t h a t BOMEX regulates the practice o f homeopathy f a i r l y . * There
are seven licensed homeopaths who were or are licensed Arizona M. D. s. A
review o f the BOMEX f i l e s on each of these physicians did not reveal
problems severe enough t o warrant an independent board. One BOMEX
i n v e s t i g a t i o n i n v o l v i n g a homeopathic physician, however, does ill ustrate
the need f o r peer review. During t h i s investigation some members o f BOMEX
and i t s s t a f f were skeptical of the doctor's method o f diagnosis and
treatments t h a t included homeopathic preparations. I n t h i s case, during
an i n v e s t i g a t i v e interview a BOMEX investigator called i n t o question
homeopathic examination procedures and the s c i e n t i f i c basi s of treatments.
Although BOMEX members expressed skepticism o f the doctor's methods, such
a p o s i t i o n does not appear t o warrant a separate medical board. BOMEX
a1 so had questions about homeopathic practice i n a case involving another
physician. Rather than a separate board, however, what BOMEX seems to
need i s greater input regarding homeopathic practices. I n the past BOMEX
has used peer review t o resolve cases f o r which board members needed
a u t h o r i t a t i v e advice regarding medical special ties. I n cases invol ving
acupuncture f o r example, BOMEX has retained physicians t o provide expert
review and advice according t o BOMEX s t a f f . These cases indicate that
peer review would be appropriate i n cases involving homeopathic physicians.
Moreover, BOMEX's statute contains a provision that would help resolve a
second area o f c o n f l i c t between BOMEX and homeopathic physicians. The
dispute i nvol ves the u t i 1 i ty o f experimental el ectrodiagnostic machines.
Nevada ' s Homeopathic Board recognizes el ectrodiagnosis as a 1 egi timate
homeopathic modality. BOMEX has resisted sanctioning the use of the
machines, and has c l osely scrutinized two homeopathic physicians regarding
the effectiveness o f the device. I n informal hearings BOMEX has
questioned both physicians concerning the machine. However, t h i s dispute
can be resolved without an independent regulatory board. BOMEX statutes
* OBEX f i l e s on the one homeopathic physician licensed by OBEX showed no
antagonism related t o homeopathic practices.
include provisions f o r the use o f experimental devices. These statutory
guidelines require the user t o obtain p a t i e n t consent, and conform t o
accepted experimental c r i t e r i a such as a periodic analysis and review by a
peer review committee.
BOMEX And OBEX Have Adequate Resources - Regulating homeopathic physicians
through BOMEX and OBEX would also ensure t h a t adequate resources are
available f o r needed a c t i v i t i e s . BOMEX and OBEX each have adequate
resources t o provide service and protection t o the public. The
Homeopathic Board, however, cannot adequately serve or protect the public
on i t s present budget.
Both BOMEX and OBEX have s u f f i c i e n t resources and can provide far greater
service and protection t o t h e p u b l i c than the Homeopathic Board. Like
other Arizona medical boards including the Homeopathic Board, BOMEX and
OBEX are funded through the State's 90/ 10 funding formula. Under t h i s
method, a board funds i t s own operations by assessing application and
licensing fees. Both BOMEX and OBEX have s u f f i c i e n t licensees t o support
needed functions including enforcement a c t i v i t i e s . BOMEX retains a s t a f f
of 25 f u l l - time equivalent employees, including f i v e f u l l - time
investigators. OBEX, a small er agency than BOMEX, retains three f u l l - time
employees, including one f u l l - time investigator.
The Homeopathic Board, however, cannot independently finance operations
needed t o serve or protect the public. I n i t s f i r s t 3 years, the Board
licensed a t o t a l o f 15 physicians and collected a t o t a l of $ 4,575.
Appropriations during t h i s period, f i s c a l years 1981 - 82 through 1983- 84,
totaled $ 1,100. Because o f i t s inadequate funding, the Board cannot
afford t o rent o f f i c e space, h i r e s t a f f or pay Board members' expenses.*
* I n the absence o f adequate funding, a c t i v i t i e s conducted by the Board
are largely financed by Board members themselves. Since f i s c a l year
1982, Board members have incurred approximately $ 16,000 i n
uncompensated expenses. These personal contributions - psi d for Board
members' travel expenses t o and from Board meetings, the occasional
services of the Board president's private secretary, and off ice
supplies. The Board's f i l e s are kept a t the private office of the
Board president. The Board paid the president's private secretary a
t o t a l o f $ 220 i n f i s c a l years 1982- 83 and 1983- 84 f o r secretarial
services.
19
As a r e s u l t , the Board lacks v i s i b i l i t y , and i t s a c c e s s i b i l i t y t o the
pub1 i c i s 1 imited. Most s i g n i f i c a n t l y , w i t h i t s present resources the
Board has very l i m i t e d i n v e s t i g a t i v e c a p a b i l i t y , and may therefore be
unable t o adequately hand1 e major compl aints.
According to the executive director o f the Arizona State Boards
Administrative Office, which maintains f i l e s and provides secretarial and
administrative support f o r Arizona boards with small budgets, the cost o f
such services f o r the Homeopathic Board would be approximately $ 11,000
annually. Investigating complaints would r e q u i r e a d d i t i o n a l expense
beyond the basic and administrative services. The cost o f part- time
investigators f o r other small boards ranges from $ 1 5 t o $ 35 an hour.
If The Homeopathic Board I s
Continued, Changes Are Needed
If the Legislature does not allow the Homeopathic Board t o terminate on
July 1, 1986, changes are needed i n the scope o f homeopathic practice and
Board fundi ng.
Arizona's medical regulation would be more e f f e c t i v e i f the medical
a c t i v i t i e s o f licensed homeopaths conformed to the accepted scope of
homeopathic practice as outlined i n the HPUS. The current scope i s the
r e s u l t o f the statutory d e f i n i t i o n o f homeopathy t h a t includes a l l
hol i s t i c practices. Reducing the scope o f practice woul d el iminate the
problems o f j u r i s d i c t i o n and licensing described above by returning the
responsibil i ty f o r regulating a1 1 opathic and osteopathic medical practices
t o BOMEX and OBEX. If the scope of homeopathic practice i s reduced,
however, 1 icensed homeopaths should not be precluded from holding M. D. or
D. O. licenses as currently provided f o r by A. R. S. $ 32- 2933.20. I f the
scope of p r a c t i c e f o r licensed homeopaths i s 1 imited, t h i s provision would
u n f a i r l y r e s t r i c t the practice o f physicians q u a l i f i e d f o r licensure as a
homeopath, and as an M. D. or D. O.* While the Homeopathic Board should
* Iiloreover, i n a memorandum to the Auditor General , the Legislative
Council concluded t h a t a c o u r t could f i n d t h a t A. R. S. $ 32- 2933.20 i s
unconstitutional .
not be the body t h a t determines competency i n a l l o p a t h i c and osteopathic
medicine, licensed homeopaths should have the option t o be licensed i n
whatever f i e l d o f medicine f o r which they are qualified.
I n addition, the Homeopathic Board w i l l need additional funds i f it i s
continued beyond i t s termination date. To fund necessary services, the
Legislature coul d substantial ly r a i s e the Board's fees, appropriate State
General Fund monies, or implement a combination o f both. Under the 90/ 10
funding formula, the 15 presently 1 icensed homeopathic physicians woul d
each need t o pay almost $ 750 a year i n renewal fees t o finance minimal
Board operations without an additional General Fund appropriation. * A
General Fund appropriation i s another alternative. The Board collected
less than $ 1,000 i n fees during f i s c a l year 1983- 84. Without r a i s i n g
fees, the Board would need t o keep t h a t revenue and receive a General Fund
appropriation o f approximately $ 1 1,000 t o minimal l y finance operations. A
t h i r d a l t e r n a t i v e would be t o increase fees - and appropriate additional
General Fund monies.
CONCLUSI ON
Retaining the Board o f Homeopathic Medical Examiners i s unnecessary.
A1 though homeopathic physicians claim c o n f l i c t w i t h i n the medical
community resulted i n an independent board, the l e g a l l y allowed scope o f
practice weakens medical regul a t i o n i n Arizona. Homeopathi c physicians
could be regulated e f f e c t i v e l y by BOMEX and OBEX i f the two boards would
i n i t i a t e peer review i n cases involving homeopaths.
RECOIrlMENDATI ONS
1 . The Legislature shoul d consider terminating the Homeopathic Board.
Physicians p r a c t i c i n g homeopathy would then be regulated by BOMEX or
OBEX, according t o the boards ' 1 icensi ng standards.
2. The Legislature should also consider d i r e c t i n g BOMEX and OBEX t o
i n i t i a t e peer review i n cases involving disputes between the boards
and homeopathic physicians.
* BOMEX and OBEX each charge an annual renewal fee o f $ 100 a year.
3. If the Legislature does not allow the Homeopathic Board to terminate
on July 1 , 1986, consideration shoul d be given to the following.
0 Amend the Homeopathic Board's statute so the Board may sanction
only medical practices re1 ating to homeopathy.
Remove A. R. S. $ 32- 2933.20 from the Board's enabl ing 1 egis1 ation 1
so 1 icensed homeopaths may obtain 1 icenses in whatever fie1 d of
medicine they are qualified for. Removing t h i s statute would
a1 1 ow a 1 icensed homeopath to a1 so practice as a 1 icensed M. D. or
D. O. However, any medical practices falling outside the scope of
homeopathy would then be regulated by BOMEX or OBEX.
Raise the Board's fees, appropriate State General Fund monies to
the Board, or some combination of both to ensure that the Board
has resources needed to provide the public a t least a minimal
level of protection.
The o f f i c e of the Auditor General has
recently conducted a Performance Audit
of the Arizona Board of Homeopathic
Medical Examiners as part of the Sunset
Review s e t forth i n ARS 41- 2351 through
41- 2379. This draft was written in
response to the Auditor General's Report.
BACKGROUND AND SUMMARY
To understand homeopathy and why t h e Homeopathic Board was
c r e a t e d , it is necessary t o analyze t h e h i s t o r y of medical philoso-phy
and thought. The f i r s t recorded h i s t o r y of medical philosophy
is documented i n Greece by Hippocrates, t h e Father of Medicine.
A t t h a t time, and up t o t h e p r e s e n t , t h e r e have e x i s t e d two oppos-ing
schools of medical philosophy. One school of thought s t a t e d
t h a t a p a t i e n t ' s symptoms must be suppressed. For example, i f a
p a t i e n t has a f e v e r , lower it ; i f a p a t i e n t has d i a r r h e a , s t o p it.
The o t h e r school of thought s t a t e d t h a t t h e symptoms w e r e c r e a t e d
f o r a reason, and t h e body was attempting t o normalize i t s e l f by
c r e a t i n g t h e s e symptoms. For example, a fever r a i s e s t h e body's
temperature and metabolic r a t e , which enables t h e body t o f i g h t
i n f e c t i o n .
These two philosophies have feuded f o r 5,000 y e a r s . In twen-t
i e t h century h e a l t h c a r e , t h e r e is one system of medicine t h a t
t r e a t s t h e p a t i e n t by using t h e method of symptom suppression.
That system is termed " a l l o p a t h y . I ' ( Allos is Greek f o r " other,
and pathos is Greek f o r " s u f f e r i n g . " ) Allopathy is synonymous
with t r a d i t i o n a l medicine today. A l l o t h e r h e a l t h c a r e systems,
concepts, and t h e o r i e s of medicine a r e designed t o help t h e body
heal i t s e l f . Homeopathy is an example of such a system. ( Homeos
is Greek f o r " s i m i l a r " , and pathos is Greek f o r " s u f f e r i n g . " )
Homeopathy is a s c i e n t i f i c medical p r a c t i c e which t r e a t s persons
r a t h e r than d i s e a s e s . Homeopathy t r e a t s t h e whole person. I t
is t h i s t o t a l i t y of t h e i n d i v i d u a l t h a t homeopathy seeks t o cure,
r a t h e r than t o f o c u s o n l y on t h e sickness o r on a diseased p a r t .
It is homeopathy's treatment of t h e whole person, t h e t o t a l i t y ,
t h a t makes it a h o l i s t i c medical therapy. ( The word " h o l i s t i c "
comes from t h e Greek word holos meaning " whole" o r " complete.") 4
The o r i g i n a t o r of homeopathy was a German medical doctor of
g r e a t genius, D r . Samuel Hahnemann ( 1755- 1843). A s a r e s u l t of
h i s own d i s s a t i s f a c t i o n with a l l o p a t h i c medicine, during t h e 18th
4
century, D r . Hahnemann formalized t h e concept of homeopathy i n t o a
s c i e n t i f i c system of medicine which survives today.
The physicians who p r a c t i c e homeopathy have completed t h e i r
y e a r s o f p r o f e s s i o n a l medical t r a i n i n g and received t h e i r profes-s
i o n a l degrees. They a r e medical doctors, M . D . ' s o r D . O . ' s . They
t h e n s t u d y homeopathy a s a postgraduate medical s p e c i a l t y .
4
Homeopathy is a n a t u r a l medicine. A homeopathic medicine o r
remedy is used t o s t i m u l a t e t h e i n d i v i d u a l t o heal himself. Home-opathic
remedies a r e made from n a t u r a l sources, be they animal,
I
vegetable o r inineral. However, homeopathy is not herbal medicine.
Those homeopathic medicines which a r e made from herbs are p r e c i s e l y
manufactured t o p o t e n t i z e d substances f a r beyond t h e i r herbal o r i g i n s
4
according t o standards and procedures set f o r t h i n t h e Homeopathic
Pharmacopia of t h e United S t a t e s .
Many of our modern pharmaceuticals have t h e i r o r i g i n s i n home-
I
opathy. Two of many examples i n c l u d e v a c c i n a t i o n and n i t r o -
g l y c e r i n . Modern vaccination techniques u t i l i z e homeopathic
p r i n c i p l e s in t h a t small doses of the disease- causing v i r u s a r e
used t o b u i l d immunity a g a i n s t t h a t same v i r u s . Nitroglycerin
is a commonly prescribed medication f o r angina p e c t o r i s . Nitro-g
l y c e r i n was f i r s t introduced i n t h e 1850' s by homeopathic phy-s
i c i a n , Constantine Hering ( 1800- 1880), who is known a s t h e Father
of American Homeopathy.
The Growth of Homeopathy i n t h e United S t a t e s .
" The homeopathic method made its f i r s t pro-nounced
impact on American and European
thought during t h e cholera epidemic of 1832,
when, by t h e accounts of a l l observers, t h e
homeopaths had a f a r higher recovery r a t e
than r e g u l a r physicians. ( I n P a r i s , f o r
example, during t h e epidemic, t h e p r i c e of
homeopathic medicine f o r cholera increased
100 f o l d . ) Other epidemic disea- es in which
homeopathic p r a c t i t i o n e r s d i ~ t i n ~ z i s h e d
themselves w e r e s c a r l e t f e v e r , dysentary,
meningitis, and yellow f e v e r . The 19th
century homeopathic records a r e f u l l of
cases of s u c c e s s f u l treatment of t h e s e
d i s e a s e s . l f l
" Homeopathy en joyed its g r e a t e s t influence
and success i n the two decades following t h e
C i v i l War. Its power was s u f f i c i e n t t o sway
not only l o c a l boards of h e a l t h and c i t y
c o u n c i l s , but s t a t e l e g i s l a t u r e s and even, a t
times, t h e f e d e r a l government. During
t h e s e decades, t h e homeopaths and t h e i r sys-t
e m scored many successes, both medical and
p o l i t i c a l , which served t o depress s t i l l fur-t
h e r t h e already low stock of t h e orthodox
majority. While t h e overwhelming majority of
physicians remained a l l o p a t h s , t h e New School
had much of t h e c o u n t r y ' s p r o f e s s i o n a l , cul-t
u r a l and business e l i t e among its patrons
and f e l t t h a t homeopathy's complete triumph
was only a matter of t i m e . " 2
A t t h e turn of t h e century, a majority of a f f l u e n t members
of s o c i e t y were under t h e care of homeopathic physicians in t h e
l c o u l t e r , H a r r i s L. , Ph. D., Homeopathic Science and Modern
Medicine, American I n s t i t u t e of Homeopathy, 1980, Pg. 5.
2 ~ o u l t e r , H a r r i s L. , Ph. D. , Divided Legacy : The C o n f l i c t
Between Homeopathy and t h e American Medical Association, North
A t l a n t i c Books, 1973, Pg. 285.
United S t a t e s . The Royal Family of England has h i s t o r i c a l l y been
cared f o r by homeopaths. Queen Elizabeth always t r a v e l s with a
homeopathic f i r s t aid k i t .
" In 1890, t h e r e were about 14,000 homeopaths
i n t h e country, as a g a i n s t about 85,000
" r e g u l a r " p h y s i c i a n s . In t h e a r e a s of
homeopathy's g r e a t e s t p o p u l a r i t y , however,
t h e proportion of homeopathic physicians
was h i g h e r , perhaps one t o four o r one t o
f i v e . Furthermore, it w a s admitted on a l l
s i d e s t h a t t h e s o c i a l , i n t e l l e c t u a l , p o l i t i -
cal and business e l i t e of every community
patronized t h e homeopaths. Hence, t h e
power of t h e school was g r e a t e r than its
r e l a t i v e l y small. numbers of p r a c t i t i o n e r s
would i n d i c a t e . " 3
" Some of t h e s e ' e l i t e ' of Americian s o c i e t y
included Daniel Webster, William Seward,
James G a r f i e l d , John D. Rockefeller, Edwin
Booth, Chester A. Arthur, William Cullen
Bryant, H a r r i e t Beecher Stowe, Horace Greeley,
Samuel F. B. Morse, Henry Ward Beecher,
William Lloyd Garrison, Henry Wadsworth
Longfellow, Nathaniel Hawthorne, Bronson
and Louisa May A l c o t t , P h i l l i p s Brooks and
many o t h e r s . 114
In t h e f i r s t decade of t h e 20th century, t h e r e were twenty-two
c o l l e g e s of Homeopathic Medicine in t h e United S t a t e s . Homeo- 1
p a t h i c c a r e was p r a c t i c e d i n over 100 h o s p i t a l s .
What happened t o homeopathy s i n c e its f l o u r i s h i n g in t h e
1800' s and e a r l y 1900ts? In Europe, and i n many c o u n t r i e s a l l
over t h e world, it s t i l l f l o u r i s h e s . In t h e United S t a t e s , however,
it is a matter of h i s t o r i c record t h a t t h e formation of t h e Amer-ican
Medical Association was i n d i r e c t response t o t h e formation ( I
of t h e American I n s t i t u t e of Homeopathy in 1844 and had much t o do
with t h e decline of homeopathy.
3 ~ o u l t e r , H a r r i s L. , Ph. D. , Homeopathic Science and Modern
Medicine, American I n s t i t u t e of Homeopathy, 1980, Pgs. 2- 3.
4 ~ o u l t e r , Harris L . , Ph. D., Divided Legacy: The C o n f l i c t
Between homeopath^ and t h e American Medical Association, North
A t l a n t i c Books, 1973, Pg. 317.
" For s i x t y y e a r s , t h e A . M . A . was vehemently
h o s t i l e t o t h e homeopaths. Regardless of t h e
f a c t t h a t many of t h e l a t t e r had graduated
from Harvard, Dartmouth, Pennsylvania and
o t h e r leading medical s c h o o l s , t h e y were re-fused
admittance t o t h e orthodox medical
s o c i e t i e s . P r o f e s s i o n a l c o n s u l t a t i o n with
a homeopath was punished by ostracism and
expulsion from t h e same medical s o c i e t i e s . 1 1 5
During t h e 1960' s and 1 9 7 0 ' s ) many physicians and p a t i e n t s
became d i s i l l u s i o n e d with t h e a l l o p a t h i c approach of only using
drugs and surgery. T r a d i t i o n a l medicine has t y p i c a l l y t r e a t e d
symptoms and not t r e a t e d fundamental causes of d i s e a s e . On t h e
o t h e r hand, homeopathy works a t t h e most fundamental l e v e l s t o
s t i m u l a t e t h e body's own healing c a p a b i l i t y . Since t h e 1 9 6 0 t s ,
homeopathy has experienced a r e n a i s s a n c e . A l l o p a t h i c and home-opathy
medicine have moved i n t o t h e 20th c e n t u r y w i t h i n c r e a s e d
knowledge.
The expansion of t h e homeopathic profession in t h e 20th
century has included aspects of n u t r i t i o n , preventive medicine,
e x e r c i s e , s t r u c t u r a l imbalances and electromagnetic imbalances.
Having provided some b r i e f h i s t o r i c a l background and update
on homeopathy i n t h e 20th century, we w i l l now d e a l , in g e n e r a l ,
with some of t h e conclusions mentioned in t h e Auditor General's
Draft Report.
The Auditor General's Report c o n s t a n t l y r e f e r s t o homeopathy
a s it was p r a c t i c e d i n t h e 18th century and not as it is prac-t
i c e d today i n t h e 20th century. S t a t i n g t h a t homeopaths should
only t r e a t according t o 18th century medicine would be t h e same
5
Coulter, Harris L . , Ph. D., Homeopathic Science and Modern
Medicine, American I n s t i t u t e of Homeopathy, 1980, Pg. 2.
a s not allowing a l l o p a t h s o r osteopaths t o choose any of t h e
many pharmaceutical t h e r a p i e s a v a i l a b l e i n t h e 20th century.
The Auditor General's Report s t a t e d t h a t only a few hundred
M . D . ' s p r a c t i c e homeopathy e x c l u s i v e l y . This is t r u e i f only
1 8 t h c e n t u r y homeopathy w e r e t h e standard. The estimates by
s p e c i f i c h o l i s t i c o r g a n i z a t i o n s s t a t e d t h a t approximately 10,000
physicians i n t h e United S t a t e s a r e working with some type of
homeopathic o r h o l i s t i c philosophy.
The A. M. A. s e e s p r a c t i t i o n e r s of homeopathy, acupuncture
and h o l i s t i c m o d a l i t i e s a s n o n - s c i e n t i f i c approaches, not approved
by t h e a l l o p a t h i c medical community. This A. M. A. p o s i t i o n has 4
c r e a t e d ' c o n f u s i o n and misunderstanding by medical boards around
t h e country. These occurrences eventually created t h e Arizona
Board of Homeopathic Medical Examiners.
I t is c l e a r , through t h e use of d i f f e r e n t terminologies and
concepts u t i l i z e d i n t h e Auditor G e n e r a l ' s Report, t h a t homeopathy
is not understood by those who prepared t h e Report. This problem
permeates n o t o n l y t h e Auditor G e n e r a l ' s Report, but a l l h i s t o r i c a l
dealings with t h e a l l o p a t h i c medical establishment. Homeopathy is
an extremely complex a r t and science t h a t in order t o be d e a l t ( I
with f a i r l y and j u d i c i o u s l y , must be understood, i f even on an
elementary l e v e l . To begin t o understand t h e science of homeopathy,
however, begins t h e i n e v i t a b l e process of v a l i d a t i o n of t h i s 4
remarkable a p p l i c a t i o n of medicine by t h e a l l o p a t h i c medical
establishment. There is nothing t o be gained in t h e eyes of the
a l l o p a t h i c medical establishment by v a l i d a t i n g t h e s c i e n c e of
homeopathy, t h e r e f o r e , it is u n l i k e l y t h a t an understanding of
homeopathy w i l l be sought.
I t is by no f a u l t of t h e Auditing Team t h a t t h i s lack of
understanding e x i s t s . It is simply t h e complex nature of homeopathy.
I t is t h i s b a s i c misunderstanding of homeopathy t h a t created t h e
need f o r a s e p a r a t e , autonomous homeopathic medical board. I f an
understanding is d e s i r e d , it is a simple matter t o begin t o a t t a i n it.
Past experience and h i s t o r y demonstrate an unwillingness or l a c k
of d e s i r e on t h e p a r t of t h e a l l o p a t h i c medical establishment t o
understand homeopathy. There is no reason t o t h i n k t h i s w i l l
change and makes co- existence under t h e same regulatory board
impossible.
In t h e Auditor G e n e r a l ' s Report, it is s t a t e d t h a t t h e home-opathic
physician could be more e f f e c t i v e l y regulated i f BOMEX
o r OBEX would i n i t i a t e peer review involving homeopaths. With
t h e past antagonism by BOMEX, it would be very questionable i f
they would i n i t i a t e peer review.
The Auditor General's Report c i t e s two cases involving phy-s
i c i a n s who had d i s p u t e s with BOMEX and eventually obtained
homeopathic l i c e n s e s . Four cases were a c t u a l l y involved. Care-f
u l a n a l y s i s of t h e s e cases w i l l show t h e h o s t i l i t y between t h e
p r o f e s s i o n s .
The c r i t i c i s m i n t h e Auditor General's Report a s t o t h e
e f f e c t i v e n e s s of t h e Homeopathic Board, r e l a t e s t o i n s u f f i c i e n t
funding of the Board. The Homeopathic Board performed a l l of
its d u t i e s without t h i s funding through t h e dedication of t h e
Board members and t h e s t a f f . The Auditor General's Report only
s p e c u l a t e s about f u t u r e funding f o r major i n v e s t i g a t i o n s . A t
p r e s e n t , t h e Homeopathic Board has conducted s e v e r a l i n v e s t i g a -
t i o n s and h a s r e s o l v e d them s a t i s f a c t o r i l y with minimal funding.
Therefore, t h e Auditor General's Report is only s p e c u l a t i v e .
The Homeopathic Board has p r o t e c t e d t h e public by helping t o
c l o s e down i l l e g a l p r a c t i t i o n e r s and diploma m i l l s . I t has a l s o
b e n e f i t e d t h e public by giving them freedom of choice i n h e a l t h
c a r e : t h i s is t h e r i g h t o f every i n d i v i d u a l .
SUNSET FACTORS
In accordance with ARS 41- 2354, t h e l e g i s l a t u r e should con-s
i d e r 12 f a c t o r s i n determining whether t h e Arizona Board of Homeo-p
a t h i c Medical Examiners should be continued o r terminated.
1. The o b j e c t i v e and purpose in e s t a b l i s h i n g t h e Board.
The purpose f o r e s t a b l i s h i n g t h e Board of Homeopathic Medical
Examiners was t o ensure t h a t t h e people of t h i s S t a t e would have
the r i g h t of freedom of choice i n medical c a r e . The Board was es- 4
t a b l i s h e d t o promote t h e h e a l t h , s a f e t y and welfare of t h e people
by providing f o r t h e l i c e n s i n g and r e g u l a t i n g of homeopathic
physicians.
2. The Homeopathic Board has met its o b j e c t i v e and purpose and
h a s operated e f f i c i e n t l y .
The Auditor G e n e r a l ' s Report s t a t e s t h a t t h e Board l a c k s
t h e necessary resources t o e f f e c t i v e l y p r o t e c t p u b l i c h e a l t h and
s a f e t y . The Auditor General's Report s t a t e s t h a t the Board has
not heard any complaints t h a t have posed s e r i o u s harm t o t h e public. 4
They s t a t e t h a t t h e r e have been only f i v e formal complaints f i l e d
and t h e s e were minor. These statements a r e decidedly f a l s e . The
Board has i n v e s t i g a t e d two diploma m i l l s and has worked i n coopera- I
t i o n with t h e F. B. I. and t h e Arizona Republic, as well as an in-v
e s t i g a t i v e s t a f f from Ontario, Canada. ( Enclosed is a copy of
a letter from t h e chief i n v e s t i g a t o r from Canada thanking t h e
Homeopathic Board f o r t h e i r cooperation in closing down diploma
m i l l s and i l l e g a l d e g r e e s . ) I n a d d i t i o n , t h e r e were two physicians
with good c r e d e n t i a l s who applied f o r l i c e n s u r e with t h e Homeo-p
a t h i c Board. Upon i n v e s t i g a t i n g t h e s e i n d i v i d u a l s , t h e Board
discovered t h a t t h e s e physicians w e r e using a l i a s and phony docu-ments.
These two physicians have s i n c e f l e d t h e S t a t e of Arizona.
There w a s a l s o a physician w i t h a very c o n t r o v e r s i a l and w e l l
known background who attempted t o obtain l i c e n s u r e with t h e
Board. Even though t h i s physician passed a l l t h e examinations
with very high grades, he was denied l i c e n s u r e on moral grounds.
H i s denial w a s a r e s u l t of extensive i n v e s t i g a t i o n by t h e Board.
This physician t h e n brought s u i t a g a i n s t t h e Board which was sum-marily
dismissed i n t h e Arizona c o u r t s . The Auditor General's
Report makes a statement t h a t t h e Board may not be a b l e t o ensure
competency, based upon its l i c e n s i n g examination. The question
r a i s e d is where does t h e Auditor General's Report r e c e i v e its in-formation
in order t o make such statements? These statements a r e
i n v a l i d . In a d d i t i o n , Brigham Young University volunteered t o
prepare, grade and s t a n d a r d i z e our t e s t i n g . They set up a s i m i l a r
program i n t h e S t a t e of Nevada.
3. The Homeopathic Board h a s operated within t h e p u b l i c i n t e r e s t .
The Auditor G e n e r a l ' s Report s t a t e s t h a t t h e Homeopathic Board
may not provide adequate p r o t e c t i o n to t h e public because of its
low funding l e v e l . This is highly s p e c u l a t i v e s i n c e t h e Board has
handled everything, including i n v e s t i g a t i o n s , with t h i s low funding.
It would appear t h a t t h e Homeopathic Board is being placed in a
" Catch- 22" s i t u a t i o n .
4. The extent t o which r u l e s and r e g u l a t i o n s promulgated by t h e
Board a r e c o n s i s t e n t with t h e l e g i s l a t i v e mandate. a
A t p r e s e n t , t h e Board has s e v e r a l r u l e s and r e g u l a t i o n s which
w i l l be offered i n p u b l i c hearing over t h e next s e v e r a l months.
5. The extent t o which t h e Board has encouraged input from t h e
p u b l i c b e f o r e promulgating its r u l e s and r e g u l a t i o n s and t h e
extent t o which it has informed t h e ~ u b l i ca s t o its a c t i o n s
and t h e i r expected impact on the p u b l i c .
Not a p p l i c a b l e a t p r e s e n t .
6. The Homeopathic Board has been able t o i n v e s t i g a t e and resolve
complaints w i t h i n its j u r i s d i c t i o n .
The Auditor G e n e r a l ' s Report s t a t e s t h a t t h e Board h a s o n l y r e -
ceived a few complaints, and t h e s e had been resolved i n a timely 4
manner. The Auditor G e n e r a l ' s Report a l s o s t a t e s t h a t no major in-v
e s t i g a t i o n s w e r e done. These statements have been examined pre-v
i o u s l y . I n a d d i t i o n , s i n c e t h e r e have been only a few minor
complaints, perhaps it is an indication- of t h e s a t i s f a c t i o n t h a t
t h e p a t i e n t s have received from these physicians. In f a c t , t h e r e
w e r e no complaints on t h e physicians, themselves, o n l y q u e s t i o n s
r a i s e d by insurance companies and i n q u i r i e s about what homeopathic
therapy is.
7. The extent t o which t h e Attorney General or any o t h e r a p p l i c a b l e 4
agency of S t a t e government has the a u t h o r i t y t o prosecute a c t i o n s
under enabling l e g i s l a t i o n .
The s t a t u t e s a r e adequate as f a r as t h e Board's a u t h o r i t y is
concerned. Again, t h e Auditor General's Report only brings up
s p e c u l a t i o n s . Thus f a r , t h e Board, with its l i m i t e d resources, has
handled everything e f f i c i e n t l y .
8. The extent t o which t h e Board has addressed d e f i c i e n c i e s in
t h e enabling s t a t u t e s which prevent it from f u l f i l l i n g its
s t a t u t o r y mandate.
The Board has no proposals f o r the 1985 l e g i s l a t i v e s e s s i o n ,
but w i l l make d e f i n i t e proposals during t h e course of t h e Sunset
Review.
9. The laws of t h e Board are adequate in compliance with t h e
f a c t o r s l i s t e d i n t h e Sunset laws.
The Auditor General's Report s t a t e s t h a t t h e Board should be
terminated o r t h e s t a t u t e should l i m i t " the scope of p r a c t i c e t o
allow only homeopathic diagnoses and t r e a t m e n t s . " T h i s statement
c l e a r l y shows t h e lack of understanding of t w e n t i e t h century homeo-pathy.
There a r e no homeopathic diagnoses. Diagnoses a r e a l l o -
p a t h i c t e r m s used t o c a t e g o r i z e d i s e a s e s . Homeopathy does not
t r e a t c o l i t i s . Instead, it t r e a t s t h e person who has an inflamed
colon. I f t h e l e g i s l a t u r e were t o l i m i t homeopathic physicians t o
p r a c t i c e only 18th century medicine, it would follow t h a t t h e l e g i s -
l a t u r e should l i m i t osteopaths t o manipulation only without t h e
use of such treatments a s surgery o r drugs. I t would a l s o follow
t h a t a l l o p a t h s should be then l i m i t e d t o blood l e t t i n g and leaching,
and not t h e use of 20th century pharmaceuticals or surgery. I t is
obvious t h a t t h i s would be a g i a n t s t e p backwards f o r a l l o p a t h s and
osteopaths. I t would be t h e same f o r homeopaths. Homeopathic
physicians, according t o s t a t u t e , must be l i c e n s e d a s 1 4 . D . ' ~ o r
D . O . ' s p r i o r t o o b t a i n i n g a homeopathic l i c e n s e . A l l homeopathic
physicians must pass t h e a l l o p a t h i c proficiency t e s t i n g , and t h e i r
schooling and t r a i n i n g cover pharmaceutical and s u r g i c a l medicine;
t o l i m i t t h e homeopath would e f f e c t i v e l y make them i n e f f e c t i v e
physicians.
10. The termination of t h e Board would s i g n i f i c a n t l y harm t h e
public h e a l t h , s a f e t y and welfare.
The Auditor General's Report s t a t e s t h a t t h e public h e a l t h ,
s a f e t y and welfare would be b e t t e r served i f homeopathic physicians
were placed under t h e supervision of BOMEX o r OBEX. The Auditor
General's Report seems t o have completely ignored t h e h i s t o r y of
t h e feuding of t h e p r o f e s s i o n s and t h e previous a c t i o n s of BOMEX
a g a i n s t homeopathic physicians. I f t h e homeopathic physicians w e r e
placed under t h e j u r i s d i c t i o n of BOMEX, t h i s would i n e v i t a b l y re-s
u l t i n a d e a t h s e n t e n c e of t h e homeopathic profession. There is
no reason t o believe now t h a t BOMEX would change its views. Fur-thermore,
by placing homeopathic physicians under BOMEX, it would
s i g n i f i c a n t l y hamper t h e freedom of choice t h a t t h e people i n t h e
S t a t e of Arizona have i n choosing t h e i r h e a l t h c a r e . A s a matter
of r e c o r d , s e v e r a l very prominent and wealthy c i t i z e n s of t h i s
S t a t e have had t o go t o Europe and o t h e r c o u n t r i e s in order t o
r e c e i v e treatment by p h y s i c i a n s u s i n g homeopathic philosophy.
Since t h e enactment of t h i s law, these c i t i z e n s can now receive
t h e i r treatments i n t h e S t a t e of Arizona. If t h e law were t o be
" s u n s e t t e d , " t h e s e c i t i z e n s would again be forced outside of
Arizona.
11. The l e v e l of r e g u l a t i o n exercised by t h e Board is a p p r o p r i a t e .
4
Again, t h e Auditor G e n e r a l ' s Report shows its lack of homeo-p
a t h i c o r i e n t a t i o n a s it brings up only s p e c u l a t i v e answers as t o
what would happen i f t h e Board needed more i n v e s t i g a t i v e power.
The Auditor General's Report s t a t e s t h a t t h e Board should be ter-minated
because it could be b e t t e r regulated by BOMEX or OBEX.
12. The extent t o which t h e Board has used p r i v a t e c o n t r a c t o r s i n
t h e performance of its d u t i e s and how e f f e c t i v e use of p r i v a t e
contracors could be accomplished.
P r i v a t e c o n t r a c t o r s have not been used; however, a s was pre-viously
s t a t e d , Brigham Young U n i v e r s i t y h a s volunteered its ser-v
i c e s .
FINDING 1
THE HOMEOPATHIC BOARD SHOULD NOT BE TERMINATED
The Auditor G e n e r a l ' s Report s t a t e s t h a t homeopathic physicians
could be more e f f e c t i v e l y r e g u l a t e d by BOMEX or OBEX " i f t h e two
Boards would i n i t i a t e peer review in cases involving homeopaths."
There have been two cases of homeopathic physicians brought i n f o r
informal hearings with BOMEX. BOMEX has r u l e s and r e g u l a t i o n s and
a peer review department r e g u l a t i n g acupuncture. Y e t i n t h e s e two
c a s e s , BOhIEX ignored t h e peer review process and r e f e r r e d t o acupunc-t
u r e a s " gobbledegook." I f BOMEX b e l i e v e s acupuncture is " gobbledegook,
and not one member even understands b a s i c terminology i n acupunc-t
u r e , how could they e f f e c t i v e l y r e g u l a t e such a system? There
is no reason t o b e l i e v e t h a t BOMEX would change its philosophy
i n mid- stream. Also, t h e Auditor G e n e r a l ' s Report s t a t e d t h a t
l i c e n s e d homeopaths should conform t o t h e accepted scope of p r a c t i c e
of homeopathy. Again, t h e Auditor G e n e r a l ' s Report erroneously
suggests t h e l i m i t a t i o n of homeopathic p r a c t i c e t o 1 8 t h c e n t u r y
medicine.
THE BOARD WAS CREATED BECAUSE OF ANTAGONISM WITHIN THE MEDICAL
COMMUNITY
The Auditor G e n e r a l ' s Report s t a t e s t h a t the antagonism be-tween
t h e professions is alleged. If t h e t r a n s c r i p t i o n s of BOMEX
were s t u d i e d , it would be shown t h a t i n p u b l i c h e a r i n g , BOhiEX has
c o n s i s t e n t l y and a r r o g a n t l y attempted t o demean and h u m i l i a t e homeo-
4
p a t h s . In t h e p a s t , BOMEX has c o n s i s t e n t l y taken homeopaths through
a d m i n i s t r a t i v e proceedings t h a t have been f i n a n c i a l l y as w e l l as emo-t
i o n a l l y d r a i n i n g . There is no reason to assume t h a t t h i s would not
a
continue. The A s s i s t a n t Executive D i r e c t o r of BOMEX has s t a t e d :
" The Board r e p r e s e n t s orthodox medicine. They are not going t o sit
i d l y by and let another M. D., who they f e e l should know b e t t e r , m i s -
4
treat p a t i e n t s by p r a c t i c i n g some type of crazy medicine.'' Homeo-pathy
cannot and should not be judged by a l l o p a t h i c o r orthodox
s t a n d a r d s . The l i m i t e d understanding of homeopathy on t h e p a r t of
a
t h e t r a d i t i o n a l medical e s t a b l i s h m e n t does tremendous i n j u s t i c e t o
homeopathic p h y s i c i a n s .
THE SCOPE OF PRACTICE ALLOWED FOR HOMEOPATHIC PHYSICIANS STRENGTHENS
ARIZONA'S MEDICAL REGULATIOX 1
The l e g i s l a t u r e o r i g i n a l l y p e r m i t t e d homeopaths t h e use of
h o l i s t i c m o d a l i t i e s . The l e g i s l a t u r e w a s a l s o very clear, a s was
t h e Arizona L e g i s l a t i v e Council, concerning t h e u s e o f h o l i s t i c
concepts and t h e a b i l i t y t o use pharmaceutical p r e s c r i p t i o n s being
w i t h i n t h e scope of t h e homeopathic p h y s i c i a n ' s l i c e n s e . For
example, i n London, t h e r e is a Royal Homeopathic H o s p i t a l which
does major s u r g e r y and u t i l i z e s a l l of t h e m o d a l i t i e s of 20th cen-t
u r y medicine. There are four o t h e r prominent h o s p i t a l s i n Great
B r i t a i n t h a t employ homeopathic p h y s i c i a n s , t h e r a p i e s and o t h e r
m o d a l i t i e s . The Auditor G e n e r a l ' s Report s t a t e s t h a t homeopathy
is a l i m i t e d medical p r a c t i c e and does n o t i n c l u d e t h e use of a l l o -
p a t h i c and o s t e o p a t h i c t r e a t m e n t s such as s u r g e r y . The Auditor
G e n e r a l ' s Report is, a g a i n , not clear with its i n f o r m a t i o n .
C l a s s i c a l osteopathy was founded in the 19th century by Andrew
Taylor S t i l l , as an art using manipulation only. Osteopaths today
a r e allowed t o use surgery and/ or pharmaceutical medication which
c l e a r l y a r e not i n t h e scope of p r a c t i c e according t o t h e theory
of osteopathy. Osteopaths can use 20th century medicines. There-f
o r e , homeopaths who have s i m i l a r a l l o p a t h i c t r a i n i n g must be
able t o u t i l i z e pharmaceuticals.
POSITIVE EFFECT ON ARIZONA REGULATION BY ALLOWING FREE CHOICE
AND COMPETITION
The Auditor G e n e r a l ' s Report s t a t e s t h a t t h e Homeopathic
Board has been allowed t o n u l l i f y d i s c i p l i n a r y a c t i o n s on physi-c
i a n s previously taken by BOMEX. They site two cases in d i s p u t e
between BOMEX and homeopathic physicians. In r e a l i t y , t h e r e were
f o u r c a s e s , but t h e Auditor G e n e r a l ' s Report, i n order t o j u s t i f y
t h e i r conclusions, barely touch t h e o t h e r two cases. We w i l l now
examine a l l four of t h e s e cases from t h e viewpoint of t h e Homeo-p
a t h i c Board.
CASE # 1
The Auditor G e n e r a l ' s Report c i t e s t h e case of a ten- year
i n v e s t i g a t i o n of a physician whose l i c e n s e w a s f i n a l l y revoked i n
September of 1982, f o r medical incompetency. Following t h i s , t h e
Homeopathic Board issued t h i s physician a l i c e n s e , because he was
q u a l i f i e d according t o t h e l a w . This case was thoroughly reviewed
by t h e Homeopathic Board. The physician i n question did not l o s e
h i s l i c e n s e f o r medical incompetency, but f o r questions of sub-s
t a n c e abuse. This physician was granted a homeopathic l i c e n s e
w i t h e x t e n s i v e r e s t r i c t i o n s placed on it. He has appeared before
t h e Homeopathic Board every 3- 6 months, and h i s p r e s c r i p t i o n s and
c h a r t s a r e reviewed. He has b e e n s e v e r e l y l i m i t e d i n w r i t i n g pre-
s c r i p t i o n s f o r c o n t r o l l e d substances. He has been followed so
c l o s e l y t h a t h i s lawyer has brought up charges of harrassment by
t h e Homeopathic Board. Since t h i s physician h a s been l i c e n s e d
by t h e Homeopathic Board, he has had no complaints made a g a i n s t
him by anyone. a
CASE # 2
The Auditor G e n e r a l ' s Report again shows its poor understand-ing
by s t a t i n g t h a t t h e charges against t h i s physician were primar- 4
i l y u n r e l a t e d t o homeopathy. T h i s p h y s i c i a n was using h o l i s t i c
and homeopathic m o d a l i t i e s t o t r e a t h i s p a t i e n t s . He eventually
signed a s t i p u l a t i o n t o give up h i s medical l i c e n s e because of t h e ( I
constant harrassment over s e v e r a l years. The physician was placed
under such g r e a t emotional and f i n a n c i a l stress, t h a t a t one p o i n t ,
he was forced t o s t a r t bankruptcy a c t i o n . Several years of harrass- 4
ment completely drained t h i s physician .- of a l l h i s f i n a n c i a l , phy-s
i c a l and emotional resources.
- CASE- 8 3
The Auditor General's Report b r i e f l y addresses t h i s p h y s i c i a n ' s
case by s t a t i n g t h a t h i s examinations and procedures were ques-t
i o n a b l e . I n f a c t , t h i s physician was t o l d i n p u b l i c hearings t h a t 4
he needed psychological examinations and t h a t h i s work had no scien-t
i f i c b a s i s . These a l l e g a t i o n s w e r e never s u b s t a n t i a t e d . This
physician h a s a one year waiting list f o r new p a t i e n t s . He is one 4
of t h e b u s i e s t p r a c t i t i o n e r s i n t h e S t a t e of Arizona. In t h e
r e a l i t y of a f r e e marketplace which encourages competition, t h i s
physician is very s u c c e s s f u l , and h i s s e r v i c e s are i n g r e a t demand. I
If t h i s physician was incompetent, t h e demand f o r h i s s e r v i c e s
would not be so g r e a t .
CASE # 4
This is t h e case of another very busy and prominent homeopath-ic
physician t h a t w a s r i d i c u l e d by BOMEX in p u b l i c hearing. The
t r a n s c r i p t s w i l l show t h a t t h i s physician was c a l l e d a crank, a
quack magician and a madman i n p u b l i c h e a r i n g , and h i s work with
acupuncture was considered " gobbledegook." When t h i s physician
attempted t o present documentation of h i s work from Stanford Uni-v
e r s i t y , it was n o t a d m i s s i b l e . The only complaint ever received
on t h i s physician w a s r e l a t e d t o h i s f e e s and t h e use of e l e c t r o -
diagnosis. T h i s physician has brought s u i t in Federal Court f o r
c i v i l r i g h t s conspiracy and v i o l a t i o n of t h e Sherman A c t . A
Federal Judge has refused t o summarily dismiss t h i s case, and it
is proceeding in t h e c o u r t s .
The Phoenix Gazette i n v e s t i g a t i v e r e p o r t of March 30, 1983,
concluded t h a t , " An examination of t h e r e c o r d s o f d i s c i p l i n a r y
a c t i o n s taken by t h e Board during t h e past s i x years i n d i c a t e s
a physician has more l i k e l i h o o d of s u r v i v i n g i n t h e S t a t e p r a c t i c i n g
substandard medicine than f r i n g e medicine." " A doctor can remove
healthy appendixes, s h o o t j u n k i e s f u l l of speed, botch o p e r a t i o n s ,
pop p i l l s , k i l l p a t i e n t s through incompetence, o v e r b i l l c l i e n t s
and, i n many c a s e s , continue t o p r a c t i c e medicine", but, " The S t a t e
Board of Medical Examiners has something t o say about the claims
of so- called f r i n g e medicine: I t disapproves and even h a t e s such
p r a c t i c e . " Furthermore, it was s t a t e d in t h e Phoenix Gazette t h a t
BOMEX has allowed s e v e r a l physicians t o maintain l i c e n s e s who have:
" served t i m e in prison f o r medically r e l a t e d c o n v i c t i o n s ; "
" have been convicted of sexually molesting a 15 year old g i r l ; "
" and have staggered drunk through t h e c o r r i d o r s of a h o s p i t a l
while on duty. "
One BOMEX member s t a t e d , " A poor physician can p r a c t i c e bad medicine
f o r a long t i m e ... but f r i n g e p r a c t i t i o n e r s d o n ' t have such a good ( I
r e c o r d w i t h t h i s Board."
The l e g i s l a t u r e showed w i s e f o r e s i g h t by c r e a t i n g t h e Homeo-p
a t h i c Board s e v e r a l y e a r s ago. This has had a p o s i t i v e e f f e c t ( I
by allowing f r e e choice and competition i n t h e h e a l t h care market.
The Auditor G e n e r a l ' s Report s t a t e s t h a t t h e l i c e n s i n g s t a n -
dards of homeopathic physicians a r e not t h e same a s BOUEX or OBEX. 4
The Report a l s o s t a t e s t h a t t h e Homeopathic Board " generally assumes
t h a t an applicant with an out- of- state l i c e n s e is q u a l i f i e d t o
p r a c t i c e a l l o p a t h i c and o s t e o p a t h i c medicine r e g a r d l e s s of compara- 4
b i l i t y . " " However, t h e s e Boards grant l i c e n s e s only i f a p p l i c a n t s
have an M. D. o r D. O. l i c e n s e from another s t a t e with standards com-parable
t o Arizona's." BOMEX standards may r e q u i r e a l i c e n s e d ap- ( I
p l i c a n t t o take a n a t i o n a l l y approved w r i t t e n examination i f t h e
standards of another s t a t e a r e not the same as Arizona's. OBEX
has determined t h a t a l l o t h e r s t a t e s meet its standards. The
Homeopathic Board's s t a n d a r d s and OBEX's s t a n d a r d s are exactly
t h e same. The only r e a l d i f f e r e n c e in BOMEX's standards is re-garding
foreign graduates of medical schools.
ALLEGED ANTAGONISM
There is g r e a t concern about the continued reference in t h e
Auditor G e n e r a l ' s Report t o " alleged antagonism" between t h e pro- 4
f e s s i o n s . To deny t h e evidence presented in t h i s w r i t t e n response
and evidence t h a t is a m a t t e r of public and h i s t o r i c record is a
s e r i o u s o v e r s i g h t .
AN INDEPENDENT BOARD IS WARRANTED
The Auditor General's Report s t a t e s t h a t peer review by BOMEX
and OBEX would be s u f f i c i e n t t o solve any problems with homeopathic
physicians. Again, t h i s is obviously ignoring t h e record of BOMEX
i n t h e p a s t . Since BOMEX has s t a t e d its negative opinions regarding
homeopathic physicians, how could they e f f e c t i v e l y r e g u l a t e homeo-p
a t h i c physicians without prejudice?
THE HOMEOPATHIC BOARD HAS ADEQUATE RESOURCES
The Auditor General's Report s t a t e s t h a t t h e Homeopathic Board
does not have adequate resources t o provide s e r v i c e and p r o t e c t i o n
f o r t h e public. Also, a s a r e s u l t of t h e lack of resources, t h e
Board lacks v i s i b i l i t y and its a c c e s s i b i l i t y t o t h e public is l i m i t e d .
This is another " Catch- 22" s i t u a t i o n . For example, t h e Board was
granted $ 100 appropriation f o r its f i r s t year i n e x i s t a n c e . The
Board was also t o l d by t h e S t a t e Budget Director t h a t t h e S t a t e
would not a i d them f i n a n c i a l l y , and t h a t t h e Board would have t o
provide f o r its f u n c t i o n s independently.
I n t e r e s t i n g l y , t h e Auditor General's Report made no disparaging
comments on t h e performance of t h e Homeopathic Board. According t o
t h e Auditor General's Report, t h e Homeopathic Board has c a r r i e d out
its functions s a t i s f a c t o r i l y . It should be a c r e d i t t o t h e members
of t h e Homeopathic Board t h a t they have done such a s a t i s f a c t o r y
job, i n s p i t e of t h e f i n a n c i a l handicaps they have faced. To
penalize t h e Board and t h e c i t i z e n s who seek t h i s care f o r l a c k
of funds, seems unreasonable. We concur with t h e Auditor General
t h a t it is necessary t o i n c r e a s e t h e f e e s f o r homeopathic l i c e n s u r e .
The S t a t e should remove t h e r e s t r i c t i o n t h a t a homeopathic
physician must b e a r e s i d e n t of Arizona i n order t o get a l i c e n s e 4
i n Arizona. Neither BOMEX o r OBEX have such r e s t r i c t i o n s . If
out- of- state homeopathic physicians could be l i c e n s e d , t h e number
of l i c e n s e e s i n t h e f u t u r e would s u b s t a n t i a l l y i n c r e a s e . a
IF THE HOMEOPATHIC BOARD IS CONTINUED, CHANGES ARE NEEDED
The Auditor G e n e r a l ' s Report states t h a t i f t h e Homeopathic
Board is allowed t o continue, t h e scope of t h e i r p r a c t i c e should be a
r e s t r i c t e d i n t h e a r e a of p r e s c r i p t i o n w r i t i n g . Homeopathic phy-s
i c i a n s cannot accept any l i m i t a t i o n on t h i s scope of p r a c t i c e ,
which includes t h e use of pharmaceuticals and o t h e r h o l i s t i c modali- @
ties. A homeopathic physician is a t o t a l physician. The homeopathic
physicians l i s t e d i n t h e S t a t e of Arizona a r e a l s o l i s t e d a s General
P r a c t i t i o n e r s . They do complete o u t - p a t i e n t c a r e , using homeopathic ( I
and a l l o p a t h i c philosophy. I f t h e h o l i s t i c modalities were eliminated,
these physicians would be unable t o e f f e c t i v e l y p r a c t i c e 20th century
medicine. ( I
CONCLUSION
The Auditor General's Report lacks understanding about 20th
century homeopathic physician p r a c t i c e s , and t h e i r conclusions
a r e erroneous. Far from weakening t h e p r a c t i c e of medicine in t h e
S t a t e of Arizona, it encourages freedom of choice and open competition a
without harrassment o r monopolies. The Auditor General's Report
s t a t e s , again, i f BOMEX o r OBEX would i n i t i a t e peer review involving
homeopaths, homeopathy could be r e g u l a t e d more e f f e c t i v e l y . Accord- a
ing t o t h e past h i s t o r y of BOMEX, it appears very doubtful t h a t
t h i s would ever be administered f a i r l y . The c i t i z e n s in t h e S t a t e
of Arizona and t h e l e g i s l a t u r e responsibly i n i t i a t e d a new l a w
t o enable a r e v o l u t i o n a r y , new freedom of choice i n health care.
1. The Homeopathic Board should be continued because it has s a t i s -
f a c t o r i l y served t h e p u b l i c , and it has provided freedom of choice
i n h e a l t h c a r e .
2. The Homeopathic Board proposed s e v e r a l changes i n the Homeopathic
S t a t u t e :
( a ) Removal of t h e r e s t r i c t i o n t h a t a homeopathic physician
must be a r e s i d e n t i n t h e S t a t e of Arizona.
( b) Removal of t h e r e s t r i c t i o n t h a t in order t o become l i c e n s e d
as a homeopath, a physician must have t h r e e a f f i d a v i t s
from physicians p r a c t i c i n g in t h e S t a t e of Arizona. This
should be changed t o t h r e e physicians l i c e n s e d i n any s t a t e .
( c ) There should be s i g n i f i c a n t i n c r e a s e s i n t h e f e e s f o r
a p p l i c a t i o n s and renewals of l i c e n s e s f o r homeopathic
physicians.
( d) Removal of ARS Section 32- 2933, paragraph 20, which s t a t e s
t h a t it is unprofessional conduct t o renew a l i c e n s e i n
another profession as a h e a l t h c a r e provider i n t h e S t a t e
of Arizona. The Arizona L e g i s l a t i v e Council b e l i e v e s t h i s
t o be u n c o n s t i t u t i o n a l .
College of
Physicians and
Surgeons of @ I Ontario
* Names deleted on advice of Attorney General to preserve confidentiality.
December 1 8 , 1984 I
Dr. Harvey Bigelsen
P r e s i d e n t
Arizona Board o f Homeopathic Medical Examiners
S u i t e 15 - 7333 E. Monterey Way
S c o t t s d a l e , Arizona 85251
Dear Dr. Bigelsen:
- Re: *
4
I wish t o thank you and acknowledge r e c e i p t o f your l e t t e r dated
December 3, 1984.
.. > .
I am assuming t h a t your i n f o r m a t i o n s u g g e s t s t h a t the captioned
u n i v e r s i t y had no a c c r e d i t a t i o n p r i o r t o t h e d a t e o f J u l y 1983.
Could you c l a r i f y t h i s f o r me, p l e a s e .
I would r e s p e c t f u l l y r e q u e s t t h a t you c o n s i d e r s h a r i n g with me
t h a t i n f o r m a t i o n you may have touching on *
p a r t i c u l a r l y your r e f e r e n c e t o " Diploma Mills" and " q u e s t i o n a b l e
c r e d e n t i a l s " . I b e l i e v e * is a p r e v i o u s r e s i d e n t o f
Toronto, Ontario and any d a t a provided would c e r t a i n l y be of
a s s i s t a n c e t o us i n t h e event he should some day choose t o
r e t u r n .
Again, I want t o thank you f o r a l l t h e a s s i s t a n c e provided by
your Board and p a r t i c u l a r l y y o u r s e l f during t h e c o u r s e of my
e n q u i r i e s . I want t o a s s u r e you t h a t t h e i n f o r m a t i o n is beinq
b e s t o f its advantage and d e f i n i t e p r o g r e s s is being
r e s p e c t of our e f f o r t s t o d e a l with i n d i v i d u a l s
t o have c r e d e n t i a l s and diplomas which obviously a r e
I
MRh: jcs
D 80 Collci: c Street, Toronto, C~~:]. kihal SG 2C? 1 110) 0 01 - 17? - 1- 011 Free ( 800' ?\ :, 70~, 0
APPENDIX
LEGISLATIVE COUNCIL OPINION ON
HOMEOPATHIC STATUTES
December 19, 1984
TO: Douglas R. Norton, Auditor General
FROM: Arizona Legislative Council
RE: Request for Research and Statutory Interpretation ( 0- 85- 1)
This memo is sent in response to a request submitted on your behalf by ' X7illiarn
Thomson In a memorandum dated December 6, 1983.
FACT SITUATION A:
In 1980 the Legislature passed Arizona Revised Statutes ( A. R. S.) section 32- 2901
et seg. establishing the Board of Homeopathic Medical Examiners ( Board) and gzve ir the
authority t o license homeopathic physicians. Homeopathy is defined as " a system of
medicine employing substances of animal, vegetable or mineral origin which a r e given in
microdosage, prepzred according to homeopathic pharmacology, in accordance with the
principie that a substance which produces symptoms in a heal; hy person can cure those
symptoms in an ill person, and managing t h e c u r e and prevention of illness hotistically."
A. R. S. section 32- 290 1, paragraph 2.
To obtain s. homeopthic license, an appiicant must Se an 1I. D. or D. O., either
licensed in Arizona or another state. Based on interviews with Boarci members otners
in the medical community, current opinion suggests that an Arizona licensed homeopath
may use and prescrije the same treatments and drugs ( allopathic) as 2hysicians iicensed
by the aoard of lledical Examiners and the Board of Osteopathic Examiners in l f e d i c i n e
and Surgery. An Attorney General's informal opinion staxes that as a licensed X1. D. or
D. O. " a homeopathic physician is a medical practitioner . . . thereiore, : here does not
appear to 5e any legal impediment to a homeopathic physician's a5ili: y to prescrl'm d r ~ g s
and devices for the treatment of the sick and injured." The present inter2retation of
homeopathic starures allows 3 homeopathic physician, whether licensed an 11. C. or
D. O. in Arizona or licensed as an ' v1. D. or D. Q. in another state, all privileges ~ f a-~
Arizona licensed C1. D. or D. O. in addition to his privileges as a licensed homeoparh.
QUESTIGNS PRESENTED:
1. !, lay a homeopathic physician licensed by the Board and a! so licerlsed In . Arizona
as an 11. D. or D. O. prescribe allopathic or osreopathic drugs and treatrnen~ s'?
2. May a homeopati~ ic physician licensed by the Board and licensed as an h1. D. or
D. O. in another state ? rescribe allopathic or osteopathic drugs and treatments?
3. Does the scope of homeopathy as defined by rl,. R. S. section 32- 2901, paragraph
2 allow a homeopathic physician to use and prescribe allopathic or osteopathic drugs and
treatments ir: espective of o ~ h e rii censes held?
ANSWERS:
I. Yes. See discussion at 3.
2. Yes. See discussion a t 3.
3. Homeopathic physicians licensed pursuant t a A. R. S. t i t l e 32, chapter 29 may use
and prescribe allopathic or osteopathic drugs and treatments irrespective of other licenses
they hold.
The s t a t u t o r y definition of homeopathy includes " managing the c u r e o r prevention
of illness holistically." A. R. S. section 32- 290 1, paragraph 2. Holistic health focuses on
the whole person and the development of general well- being. Allopathic and osteopathic
identification and treatment of disease a r e part of curing the whole person and developing
general well- being.
In order to ' be licensed as a homeopathic physician pursuant t o A. R. S. t i t l e 32,
chapter 29, an applicant is required to be a licensed X1. D. or D. O. A. R. S. section 32- 2912,
subsection A, paragraph 2. . A license to practice as an X1. D. or D. O. shows that another
licensing agency has deemed the 1I. D. or D. O. t o be qualified by training to use and
prescribe allopathic or osteopathic drugs and treatments. Licensed homeopathic
physicians are qualified by training to use and prescribe allopathic or osteopathic d r ~ g s
and treatments.
The ability of licensed homeopathic physicians t o use and prescribe drugs is made
even clearer by ' 4. EI. S. section 32- 2933? paragrzph 6. A. R. S. section 32- 2933, paragraph 6
provides that unprafessional cc~ nducti ncludes "? rescribing narcotic or hypnotic dr:~ gs., o r
both, for oiher than accepted rherapeutic purposes." " What i j necessarily implied ! n a
s t a t u t e is as much a part of it as what is expressed." C o q i n s v. Elv, 2G2 P. 391, 23 Xriz.
155, 162 ( 1921). Since it is unproiessional conducs to prescribe sucn drugs for oiher ~ h a n
therapeutic p u r p s e s , 5y implication, licensed homeopathic physicians can prescrije those
drugs as ; veil as oiher drugs f o r therapeutic purposes.
Since the s t a t u t o r y definition of homeopathy includes allopathic 2nd osteopathic
treatment of disease and licensed hommpathic physicians are qualified by t r i n i n g to ilse
and prescribe allopathic or osteopathic drugs and treannen; and speciiic starutory
reierence to prescribing drugs is present in the homeopathy statutes, ! icensed
homeopathic physicians may use and prescribe allopathic or o s t e o p t 3 i c drugs and
treatment. They are not required to hold either current 1I. D. or D. O. licenses isscled by
this s t a t e or any other state in order t a use or prescribe allopat5ic or osteopathic drugs or
treatment.
FACT ITUATION B:
X. R. S. section 32- 2912, subsection A, paragraph 2 requires an applicant lor
licensare as a homeopathic physician to be a licensed k1. D. or D. O. but not specifically in
Arizona. .4. R. S. section 32- 2933, paragraph 29 s t a t e s that it is unprofessional conduct to
obtain or renew an . qrizona license as a heaith care provider. Although some licensees
have complied with th? provisions, others have retained their 41. D. or D. a. Arizona
licenses. The Board has chosen to take no actior, against those with multiple licenses. Its
position is based in part on the Attorney General respresen: ativels advice that X. 2. S.
section 32- 2933, paragraph 23 may be clnconstilutional.
QUESTION PRESENTED:
Does the requirement to prohibit multiple licensing as stated in A. R. S. section
32- 2933, paragraph 20 pose constitutional problems?
ANSWER:
The right to practice medicine is a valuable property right. 61 Am. Jur. 2d section
13. TZs right is subject t o t h e state's police power to impose such reguiations, within the
limits of the Constitution, as may be required to protect the public health, safety and
weuare. State v. Borah, 51 k i z . 318, 322, 76 ?. 2d 757 ( 1938). The right " may be
divested only by procedure satisfying the requirements of the due process clause of the
Federal Constitution." In re Buck's License, 192 Or. 66, 232 P. 2d 791, 796 ( 1951), 200 Or.
458, 258 P. 2d 124 ( 1953), appeal dismissed 346 U. S. 919, 74 S. Ct. 3 13, 98 L. Ed. 414 ( 1954).
See also Willner v. Committee on Character and Fitness, 373 U. S. 96, 53 S. Ct. 1175, 10
L. Ed. 2d 224 ( 1963). 2evocation of licenses for good cause falls - under the valid exercise
of police power if the s t a t e complies with due process requirements. 61 Am. Jur. 2d
section 75.
A. R. S. section 32- 2933, paragraph 20 requires a licensed homeopathic physician to
give up any other h e d t h care provider license he holds in order to avoid losing his
homeopzthic 2hysician license. This s t a t u t e requires an individual to give up his license t o
practice medicine '~ lithout any due process protections. Our office was unable to ! ocate
any case law which dealt with a s t a t u t e similar to . A. R. S. section 32- 2933, paragraph 20,
but based on the above principles of law we ccnclude that a court could find thar ii. R. 5.
section 32- 2933, , aragraph 20 is inconstitutional. Not only are there no due process
considerations invcived in he loss of a health care ~ r o v i d e r! i cense, but i t is ques: ionable
wherher the provision is even a valid exercise af police power.
cc: ' Villiarn Thornson, Director
Perf orrnance ' Audit Division