Performance audit, Naturopathic Physicians Board

              f
PERFORMANCE AUDIT
NATUROPATHIC PHYSICIANS BOARD
\\
Report to the Arizona Legislature
By the Auditor General
April 1991
91- 3
DOLJGL. AS R. NORTON, CPA
b. UUiTOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
April 29, 1991
Members of the Arizona Legislature
The Honorable Fife Symington, Governor
Dr. Glenn T. Ozalan, Chairman
Naturopathic Physicians Board
of Medical Examiners
Transmitted herewith is a report of the Auditor General, A Performance
Audit of the Naturopathic Physicians Board of Medical Examiners. This
report is in response to a June 14, 1989, resolution of the Joint
Legislative Oversight Committee and was conducted as part of the Sunset
Review set forth in Arizona Revised Statutes $ 541- 2351 through 41- 2379.
We found that the Board licenses few practitioners and i t s a c t i v i t i e s are
comparatively limited. In reviewing the Board's a c t i v i t i e s , we found no
major deficiencies in i t s operations. Because of the limited nature of
the Board's a c t i v i t i e s , instead of developing audit findings, areas of
concerns were addressed in the statutorily mandated Sunset factors.
My staff and I w i l l be pleased to discuss or c l a r i f y items in this report.
The report w i l l be released to the public on April 30, 1991.
Sincerely,
0 0 4 R. Norton
Auditor General
DRN : l mn
Staff: William Thomson
Peter N. Francis
Lucinda A. Trimble
Leonard B. Wojciechowicz
2700 NORTH CENTRAL AVENUE SUITE 700 . PHOENIX, ARIZONA 85004 ( 602) 255- 4385 ' FAX ( 602) 255- 1251
The Office of the Auditor General has conducted a performance audit of
the Naturopathic Physicians Board of Medical Examiners pursuant to a
June 14, 1989, resolution of the Joint Legislative Oversight Committee.
This performance audit was conducted as part of the Sunset Review set
forth in Arizona Revised Statutes ( A. R. S.) 5541- 2351 through 41- 2379.
The Naturopathic Physicians Board of Medical Examiners was established in
1935. A. R. S. 532- 1501 defines the practice of naturopathic medicine as
' la medical system of treating the human mind and body by natural means,
drugless methods, nonsurgical methods, physical, electrical, hygienic and
sanitary measures or a l l forms of physiotherapy."
Personnel and Budaet
The Board consists of five members: three naturopathic physicians and two
public members appointed by the Governor for five- year terms. The Board
is primarily responsible for examining and licensing naturopathic
physicians and enforcing standards of practice.
The Board does not have full- time support s t a f f , however, i t does employ
a part- time administrative assistant to help in carrying out i t s
responsibi l it ies.
Monies for Board operat ions are appropriated from the Naturopathic
Physicians Board of Medical Examiners Fund. The fund comprises fees
collected for applications for examinations, licenses, and
registrations. The Board retains 90 percent of the fees it collects,
while the remaining 10 percent is deposited in the State General Fund.
Table 1 ( see page 2) i l lustrates the Board's revenues and expenditures
for fiscal years 1988- 89 through 1990- 91.
TABLE 1
NATUROPATHIC PHYSICIANS BOARD OF MEDICAL EXAMINERS
STATEMENT OF REVENUES, EXPENDITURES,
AND CHANGES IN FUND BALANCE
FISCAL YEARS 1988- 89 AND 1989- 90 ACTUAL,
AND 1990- 91 BUDGETED
( unaudited)
1988- 89 1989- 90 1990- 91
Actual Actual Budae t ed
Revenues $ 27.379 $ 26.539 $ 31.000
Expend i t u res
Personal services 1,410 1,410 2,400
Employee- related expenses 26 32 0
Professional and outside
se rv i ces 18,905 19,997 20,400
Travel, in- state 813 514 1,900
Travel, out- of- state 0 198 0
Equ i pmen t 0 0 0
Other operating expenses 1.831 2.467 2,300
Total Expenditures 22.985 24.618 27,000
Excess of revenues over
expenditures
Beginning fund balance 3,856 8.250 8,400( a)
Ending fund balance
( a) The beginning balance f o r the f i s c a l year 1990- 91 budget was estimated p r i o r t o the
end of f i s c a l year 1989- 90. Therefore, the actual ending balance f o r f i s c a l year
1989- 90 does not agree with the beginning balance budgeted f o r f i s c a l year 1990- 91.
Source: Arizona Financial Information Systems Fiscal Years 1988- 89 and
1989- 90 Financial Reports and the State of Arizona,
Appropriations Report for the Fiscal Year Ending June 30, 1991.
Trends in Licensing
Currently, only six states l icense naturopathic physicians: Arizona,
Connecticut, Washington, Oregon, Hawaii, and ~ l a s k a . ( l ) However,
Montana's Senate Public Health Cornittee is currently considering a
( 1) There are approximate1 y 500 1 icensed naturopathic physicians nationwide. I t i s
d i f f i c u l t t o determine the exact number as some hold licenses i n more than one state.
Sunrise b i l l that would allow licensure in that state. A licensure
i n i t i a t i v e has also been attempted in Nebraska. According to the
Executive Director of the American Association of Naturopathic Physicians
( AANP) , Nevada ceased l i cens i ng natu ropath i c phys i c i ans i n 1987 ( in
Nevada naturopathic physicians were required to be supervised by medical
doctors.) Utah discontinued licensing new naturopathic practitioners in
1981 and Florida in the late 1950s; however, both states allow
naturopathic physicians licensed prior to these dates to continue to
practice. ( In addition, Utah allows those who were working towards
licensure prior to 1981 to become licensed once requirements are met.)
Although Arizona remains the state with the third highest number of
licensed naturopathic physicians, the number of licensed naturopathic
physicians in the State has declined significantly during the last ten
years. In 1980, there were 140 physicians licensed by the Board. At the
present time there are 86 ( a 38 percent decrease), and only 57 of these
have in- State addresses. Reasons for the declining number of
naturopathic physicians in Arizona may include s t r i c t e r licensing
requirements, increased licensing fees, and a t t r i t i o n .
Licensina Requirements
A l l states licensing naturopathic physicians require that applicants pass
the Naturopathic Physicians Licensing Examinations' ( NPLEX) seven- part
c l i n i c a l examination. Some states also require that applicants pass the
NPLEX Bas i c Sc i ence Exam i na t i on or " add- on" NPLEX exam i na t i ons i n m i no r
surgery and homeopathy. In addition to the c l i n i c a l examination, Arizona
requires examinations in minor surgery and homeopathy. Arizona also
requires that applicants pass Board- developed examinations in
jurisprudence and acupuncture. Endorsement candidates ( those currently
licensed in another state) must also pass a Board- developed oral
examination. Statutes require that applicants attain a grade of at least
75 in each subject to pass an examination. The John Bastyr College of
Naturopathic Medicine and the National College of Naturopathic Medicine
are the only two schools from which the Board w i l l accept graduates for
l icensure at the present time.(')
( 1) The Council on Naturopathic Medical Education, which i s recognized by the U. S.
Department of Education as a speci a1 i zed accrediting agency, has given accrediting
status t o John Bastyr College of Naturopathic Medicine and the National College of
Naturopathic Medicine.
3
This audi t was conducted as a Sunset Review as defined by
A. R. S. 541- 2352, The purpose of the audit was to determine whether the
Naturopathic Physicians Board of Medical Examiners is needed and the
extent to which it has accomplished i t s statutory goals. Our work
included a review of the Board's examination, licensing, and enforcement
a c t i v i t i e s . In addition, the General Counsel of the Office of the
Auditor General reviewed legal matters concerning the Board. We found
that the Board licenses few practitioners and i t s a c t i v i t i e s are
comparatively limited. In reviewing the Board's a c t i v i t i e s , we found no
major deficiencies in i t s operations. Because of the limited nature of
the Board's a c t i v i t i e s , instead of developing audit findings, areas of
concern are addressed in the statutorily mandated Sunset Factors ( see
pages 5 through 10).
During the audit we discovered complaints questioning the credentials of
the three physician Board members. According to the Board's chairman,
the complainant has also questioned the credentials of naturopathic
physician board members in other states. However, we did not pursue this
matter because i t has been referred to the Office of the Attorney General
for investigation.
The audit was conducted in accordance with government auditing standards.
The Auditor General and staff express appreciation to the members and the
administrative assistant of the Naturopathic Board of Medical Examiners
for their cooperation and assistance during the audit.
SUNSET FACTORS
In accordance with A. R. S. 541- 2354, the Legislature should consider the
following 12 factors in determining whether the Naturopathic Physicians
Board of Medical Examiners should be continued or terminated.
1. The obiective and Durpose in establishina the Board
Legislation passed in 1982 contained a statement of Legislative
Intent that the practice of naturopathic medicine has a direct
relationship with public health, and that the profession should be
regulated to safeguard public health, safety, and welfare. The
legislation further stated that only qualified persons should be
al lowed to practice naturopathic medicine. Board members said that
the purpose of the Board is to protect the public from incompetent,
unscrupulous, and unlicensed doctors of naturopathic medicine. The
Board accomplishes i t s purpose by examining and licensing qualified
candidates, and enforcing relevant statutes and rules.
2. The effectiveness with which the Board has met its obiective and
purpose and the efficiencv with which it has operated
The Board has been generally effective in regulating the practice of
naturopathic medicine by administering exams to ensure that only
qualified applicants become licensed, renewing licenses of qualified
practitioners, collecting fees, taking action against practitioners
that f a i l to comply with statutes or rules when complaints have been
f i l e d against them, and promulgating rules consistent with statutes.
However, we found that the Board could improve i t s efficiency and
effectiveness in five ways.
F i r s t , the Board does not f u l l y document i t s relicensure decisions.
For example, the Board does not maintain adequate documentation of
completed Continuing Medical Education ( CME) requirements for i t s
l icensed practitioners. A t the present time, the Board reviews
licenses at the end of every year to determine whether practitioners
have completed the sufficient number of CME requirements and met
other licensing requirements. However, in six of the ten f i l e s we
reviewed, we were unable to determine i f the necessary number of CME
requi rements had been met during a recent three- year period. Three
were missing documentation during one of the three years. Three
others contained documentation of seminar attendance but did not
indicate CME credits achieved. In addition, minutes of Board
meetings also failed to indicate which licensees had been approved or
disapproved for relicensure.
Second, although the Board has apparently managed complaints in an
appropriate manner, i t has no policies and procedures for handling
complaints or for any other function i t performs. The Board and the
public would be better served i f the Board established policies and
procedures, to help ensure consistency of action between present and
future Boards.
Third, public representation on the Board may currently be
inadequate. Board statutes provide that the Board shall consist of
three physician members and two public members. Although the Board
usually meets monthly, one public member has attended only five
regular session Board meetings in the last 25 months, in effect
creating a vacancy on the Board. A. R. S. 938- 291 provides: " An
office shall be deemed vacant [ when] .... [ tlhe person holding the
office ceas[ esl to discharge the duties of office for the period of
three consecutive months." According to the Board's chairman, the
Board informed the Governor of the situation.
Fourth, 1990 statutes require the Board to pub1 ish a directory that
includes the names of Board members and licensees, the Board rules
and statutes, and a l i s t of approved naturopathic medical schools.
To date, the Board has not published a directory.
Finally, the Board has not taken adequate action against licensees
who have failed to renew their licenses. The Board has not acted on
three licenses that have not been renewed, even though statutes
provide that the Board shall revoke licenses not renewed by July 1 of
each year. One of these licenses has been inactive for over ten
years. A t i t s regular session meeting in December 1990, the Board
agreed to begin the revocation process for these licenses.
3. The extent to which the Board has operated within the public interest
The Board protects the public by ensuring that only qualified
applicants are licensed, that unlicensed practitioners are not
allowed to advertise their services under a t i t l e of or similar to
" naturopathic physiciantt and that the appropriate disciplinary action
is taken against licensees that have failed to comply with statutes
and rules.
4. The extent to which rules and reaulations promulsated bv the Board are
consistent with the lesislative mandate
The Office of the Attorney General reviews and c e r t i f i e s a l l proposed
rules. According to the Board's Attorney General representative, i t
has promulgated rules and regulations that are consistent with i t s
legislative mandate.
Although at the present time the rules promulgated by the Board are
consistent with statutes, both the statutes and Board rules f a i l to
provide some important guidelines for the Board. For example,
statutes added in 1989 allow naturopathic physicians to dispense
" natural substance^'^ i f they f i r s t register with the Board. However,
the Legislature provided no definition of what constitutes a Itnatural
substance." Therefore, the Board is in the process of drafting a
considerable number of new rules. The new rules w i l l provide
guidelines for administering and dispensing of natural substances.
The new rules w i l l also provide more thorough and complete
definitions of terms and guidelines for the use of medical assistants.
5. The extent to which the Board has ertcourased input from the ~ u b l i c
before ~ romulaatins its rules and rewlations and the extent to which it
has informed the public as to its actiom and their expected impact on
the publiq
According to the Board's Attorney General representative, the Board
has encouraged input from the public before promulgating i t s rules
and regulations.
However, the Board has failed to comply with Open Meeting Law
requirements regarding proper notification of Board meetings. It has
failed to inform the Secretary of State of the locations where
meeting notices w i l I be posted as required by A. R. S. 538- 431.02( A)( I).
6. The extent to which the Board has been able to investicrate and resolve
complaints that are within its iurisdiction
The Board appears to have handled complaints in an appropriate
manner. Over the last three years the Board has received 15
complaints including practicing without a license, misdiagnosis,
patient abandonment, and wrongful death. A l l seven of the cases
received in 1988 and 1989 have been resolved. Five of the eight
cases received in 1990 are currently pending. Over the last three
years, the Board has placed one naturopathic physician on probation,
suspended one l i cense , and revoked another .
The Board's handling and disposition of complaint cases appears to
have been appropriate, especially given i t s limited resources. The
Board has no full- time support staff. It employs only one
administrative assistant on a part- time basis, and hires an
investigator to pursue complaint investigations as needed. In
handling complaints, the Board has also sought the assistance of i t s
Attorney General representative('), a hearing officer, and specialty
organizations like the American College of Naturopathic Obstetricians.
7. The extent to which the Attorney General or anv other a ~ ~ l i c a b l e
aaencv of State government has the authoritv to prosecute actions under
the enablina legislation
According to the Board's Attorney General representative, the Board's
statutes provide sufficient authority to prosecute.
( 1) I n addition t o assisting the Board with complaints, the Office of the Attorney General
i s also current1 y determining how best to proceed with investigations regarding recent
complaints about the credentials of the three physician Board members.
8. The extent to which the Board has addressed deficiencies in its enabling
statutes which prevent it from fulfillina its statutory mandate
For the last few years, the Board has been actively pursuing changes
in both i t s statutes and rules. The statutes under which the Board
currently operates have changed considerably during the last two
years. For examp l e, two new sect ions have been added. One a I lows
medical assistants to help naturopathic physicians in their
practice. The other al lows registered naturopathic physicians to
dispense natural substances under certain conditions. These new
statutes also require the Board to adopt rules regulating natural
substances, a process which the Board has recently undertaken ( see
# 4, page 7). Some definitions were also added.
9. The extent to which chanaes are necessary in the laws of the Board
to adeauatelv com~ lv with the factors listed in the subsection
We question the need for the Board to conduct oral examinations of
applicants seeking Iicensure. No other state that licenses
naturopathic physicians requires oral examinations. As the purpose
of the national examination ( NPLEX) is to sample a l l of the ski I Is
and knowledge needed by an entry- level naturopathic physician to
practice safely, we see no reason for the Board to require an oral
examination. According to the Board's Attorney General
representative, i t would be unlikely the oral examination would
survive scrutiny i f challenged by a person taking the examination.
We recommend that the Legislature amend A. R. S. 932- 1525 to delete
oral examinations as a test that may be administered. We also
recommend that A. R. S. 932- 1523.4 be deleted so that applicants for
licensure by endorsement need not pass an oral examination to become
l i censed .
10. The extent to which the termination of the Board would sianificantlv
harm the public health, safety or welfare
Termination of the Board could pose a threat to public health,
safety, or welfare because current naturopathic modalities or
misdiagnosis can cause significant risks to patients. For example,
naturopathic physicians are allowed to attend live births.
Misdiagnosis can be of equal concern. In a recent complaint case, a
naturopathic physician misdiagnosed skin cancer as poor circulation.
Eliminating licensure could therefore be detrimental because
practitioners would be l e f t unregulated.
Continued licensure in Arizona is consistent with licensing decisions
in other states. After Sunset reviews, both the Washington
Legislative Budget Committee and the Hawaii Legislative Auditor
recommended continued licensure of naturopathic practitioners to
protect the pub1 ic from harm.
In addition to protecting public safety, licensure may benefit the
public welfare by providing for another healthcare alternative.
Licensure helps the profession compete with other healthcare
providers by making i t eligible to receive third- party ( i . em,
insurance) payments. According to the Board's vice chai rman, about
30 to 40 percent of naturopathic patients are assisted by third party
paymen t s .
11. The extent to which the level of reaulation exercised bv the Board is
appromiate and whether less or more s t r i n ~ n tle vels of resulation
would be awrwriate
Based on our review, in general, the present level of regulation
exercised by the Board is appropriate.
12. The extent to which the Board has used ~ r i v a t e contractors in the
performance of its duties and how effective use of ~ r i v a t e contractors
could be accom~ lished.
Current use of private contractors appears appropriate. The Board
contracts with an investigator and hearing officer as needed.
However, because of the Board ' s sma l l budget and the low number of
complaints that come before i t , opportunities for further use appear
l i m i ted.
-
STATE OF ARIZONA
NATUROPATHIC PHYSICANS BOARD OF MEDICAL EXAMINERS
1645 W. Jefferson, Room 410 Phoenix, Arizona 85007
( 602) 542- 3095
April 26, 1991
Douglas R. Norton
Auditor General
2700 North Central Avenue Suite 700
Phoenix, Arizona 85004
Dear Mr. Norton:
I have completed my review of your revised preliminary draft, aside from the
specific comments noted below, I feel that you and your staff have been very
fair in your evaluation and for the most part accurate in your assessment.
It is enco*~ ragingt o see that two agencies can have a constructive rather
than adversarial relationship in accomplishing their purposes.
Under Trends in Licensinz, last week the Montana Legislature passed a sunrise
bill, which was signed into law creating licensure and a regulatory board for
naturopathic physicians.
Part of the reason for the decling number of naturopathic physicians in
Arizona is also due to the fact that some of the other licen~ ed states have
better laws which allow recent graduates to practice with less restriction
in regard to the use of natural substances than is presently the case in
Arizona. Although recent Legislative changes have brought Arizona up to date,
there may be need for further clarification by the Legislature.
Under the heading Scope and Methodology mention is made to the request by
Mr. Hayhurst for the Attorney General's office is investigate the credentials
of the board members. My concern is that this paragraph suggests to the
Legislature and to the public that there is a possibility that the cu7: rent
board members have been involved in some wrong doing. The fact of the matter
is these are not complaints in the usual sense, but an attempt by oce individual
to question the credibility of - all the recently licensed individuals in
Arizona, as well as, board members and individuals in other licensed States
as well. The requests for ir~ vestigation by Mr. Hayhurst are made in an
attempt to undermind, if at all possible, the credibility of those individuals
that are participants in a national effort of the bzards irr the iicerised
States to regulate the Naturopathic profession. In states which do not have
a licensing law, an individual can use the title Naturopathic Physician ( N. D.)
whithout having any credentials whatsoever. The Arizona Naruropathic
Physicians Board has had to take action against one individual licensed by
Mr. Hayherst's organization who had attempted to pass himself off as a
Naturopathic Physician in Arizona . For further clarification I am enclosing
a copy of an investigative report from the Townsend Letter for Doctors, April
1990 which gives a fairly znbiased view of the events taking place on a
national level.
On page five a comment is made that the board does not maintain adequate
documentation of the CME requirements. At the present time the board
is in a process of reorganizing and training a new administrative assistant.
Our previous administrative assistant, of many years, had to retire due to
health reasons. We have found in the process of cleaning out old files that
records were misplaced and because the individuals responsible for reviewing
the CME credits knew that the number of hours given by a particular
relicensing semixar were adequate and verifiable, they did not make specific
corrective notations in thefiles. We recognize that this would be questionable
to an outside individual attempting to audit the file. In the new rules and
p~ o? edures presently being developed by the board this particular problem
will be eliminated and the approval of these credits be mads a part of the
minutes.
Under the second comment of this section, we are acutely aware of the need
for policies and procedures and wholeheartedly agree with your comments. Our
plan was to first make the necessary changes to the statutes which was
accomplished in the ' 89 and ' 90 sessions. Our next step is the Rules and
finally policy and proc~ dure, which has to be the logical extension of the
Rules. We are in the process of ccnstructing a computerized procedural
database which when finished will automatically link specific tasks with the
necessary forms and reports for verification. This will concurrently be
developed with the 30- 40 pages of new Rules which will be ready for submission
to the Attorney General's Office after a public hearing. We expect this to
occur withing the next 60 to 90 days. 8
Under your third comment of this section, the Board had specifically disgssed
this particular issue wi~ hN el Evans of Govt? rnor Moffords' staff, advising
her of all aspects oE the issue. Since the board serves at the pleasure of
of the Governor, it would have been up to the Governor's Office to make any
changes if they had decided it was necessary. The board did not feel it was
it's place to persue the item further.
Under your fourth comment of this section, we have, as mentioned above,
rc+ ccntly constructed that part of the relational database which contains
information on the cu7: renc licensiates and are now in the process 01 preparing
thc directory for publication which will be forthcomi: lg within the month. ( I
Under your iant comment of this section, the board had chosed not to persue
action against the individuals who had not rerlewed their license due to the
expensed involved. To rev9ke a license requires a formal hearicg, a formal
hearing is expensive for the board who has a limited budget, since thc~ s:?
individuals are no longer practicing, the board felt that it's duty to
ptotect the public would not be compromised and that the funds would be
better spent on actions which do protect the public, until Legislative
changes could be made to make the process automatic. Thz board had made
wording changes in ARS 32- 1526 in the ' 89 Legislative Session, which it
had hoped would allow for automatic revocation, only to find out afterward
from it's Assistant Attorney General that revocation requires a formal
hearing regardless of what the Statute implies. A plan of acrion ha,;
recently been formulated by the board with the assistance of it's Assistant
Attorney Gener: il. After a thorough review of a l l past f i l e s the board
w i l l begin a " g~ o: lp!' l i c e n s e revocation hearing as required by the S t a t u t e .
We a n t i c i p a t e the process w i l l be f i n a l i z e d within the next s i x months.
Page seven comment f i v e , the board was not aware t h a t t h e S e c r e t a r y of
S t a t e was not informed as to where n o t i c e s were to be posted. The b u l l e t i n
board i n f r o n t of the Boards' Oftice seemed the l.> gica? place < or notices
to be posted. We have researched tile :-: tatutory reference and w i l l be in
compliance for the next scheduled meeting.
Page nine comment nine, the board understa~ ids and has considered previously
; he asgJmt! nCs against an o r a l exam. We had considered elimating it as p a r t
of the s t a t u t o r y changes i n ' 89 and ' 90. We f e e l however t h a t there i s no
s u b s t i t u e f o r personal interview.
,/ ---
,&@&) <
Glenn T. Ota an, N. D.
w Chairman
enclosure
Dr. Donald Hayhurst
Organizer of ccOld- Timer" Naturopaths and Critic of A. A. N. P.
reported by Emily Kane
edited by Jonathan Collin, M. D.
The American Naturopathic Medical
Association ( ANMA)
The oldest naturopathic professional
organization, called the National
Association of Naturopathic Physicians
( NANP) was organized around the turn of
the century. According to Irv Wller, ND,
the last NANP president, the organization
had been moribund since the ' 308, except
for a spurt of activity under the leadership
of Dr. Ron Hoye, 1977- 1981. The NANP
finally " died" in 1982.
Later that same year, Jim Sensenig,
ND, then Academic Dean at National
College of Naturopathic Medicine ( NCNM)
called ameeting of physicians from around
the U. S. in Portland to discuss the re-organization
of a national professional
organization. It was decided at that
meeting tolet theNANPrestin peace, and
tobegin anew organization tobe called the
American Naturopathic Medical
Association ( ANMA). Bylaws agreed upon
at thatmeeting stated that the organization
would represent and support licensed
naturowthic physicians in good standing,
in any state. At that meeting, Dr. Bernard
Steuber was elected President, Dr. Richard
Thurmer Vice- President and Donald
Hayhurst Secretaryrneasurer. However,
this group was never able to garner the
support of the profession. So the first
meeting ofthe ANMA, which transpired at
the MGM Grand in Las Vegas, January
1983, was also the last meeting. The by-laws
and corporation papers were never
filed.
Later that same year, Dr. Donald
Hayhurst from Nevada quietly formed
another association, also called the ANMA,
whose articles declared that general
( voting) members must be " currently
licensed to practice in any state, or temtory
of the United States or Canada; or
recognized as lawfully practicing in any
state, etc." This second ANMA was
unknown to the bulk of politically active
members of the profession.
The American Aseociation of
Naturopathic Physicians ( AANP)
m e following year Dr. Jim Sensenig,
graduate and former Dean of NCNM, felt
it was time to get a national organization
going again, whose explicit purposes
included both standardizing ahigh quality
of naturopathic medical education and
protecting the American public from falling
prey to quacks. He decided, with a group of
others, based on past experience, to first
put together a forum and then invite
members. Dr. Sensenig sought the advice
of both Dr. Miller and Dr. Steuber
( presidents of the dormant NANP and
original ANMA, respectively), who were
invited to be on the board of the forming
AANP. Physicians from many states
convened and agonized over credentials;
how to protect the public while also
endorsing legitimate naturopathic
physicians whohad been formafiy educated
in now- defunct schools. Dr. Allen Gamble
hit upon the ingenious idea of members
needing to meet 2 out of the following 3
criteria: 1) Graduation from a college of
naturopathic medicine recognized by the
AANP ( which includes the naturopathic
colleges from the past which have been
recognized by astate as abasisforlicensure,
and the two existing colleges, Bastyr
College in Seattle and National College in
Portland), 2) licensure in a state which
offers board exams for the profession, and
3) active membership in a state association
which is recognized by the AANP.
Physicians from nearly all licensed states
( which are Washington, Oregon, Arizona,
Alaska, Hawaii, Connecticut, Utah and
Florida - although these last two are
accepting no new members) were involved
in the formation of the AANP which
officially became incorporated on December
30,1985 in Portland. The first convention
was held in the fall of 1986 in Scottsdale,
Arizona.
During the following year, 1987, the
Townsend Letter for Dodors April 1990
AANPs national licensing exam task force
succeeded in creating the new
Naturopathic Physicians7 Licensing
Examination ( NPLEX), a national
standard exam for use by licensing states.
In September 1987 the CNME was
recognized by the U. S. Department of
Education as the accrediting agency for
naturopathic medicine; this milestone for
the profession was celebratedat the second
AANP convention, which was held in
Washington state in October. About this
time, Dr. Hayhurst wrote a letter to the
naturopathic physicians complaining that
the AANP was pretending to be judge and
jury of naturopathic education and that
many naturopathic physicians were
unrepresented by the association. Dr.
Hayhurst andhis organization ( the ANMA)
were invited to work with the AANP;
however, he did not document his or other
members'capacity tomeet themembership
criteria. Dr. Hayhurst stated that the
ANMA represents " over 2,000
naturopaths," althoughonly 75individuals
attended the September 1989 ANMA
conference.
Hayhurst's Education and Practice
It is uncertain if Hayhurst graduated
from a school offering naturopathic medical
training with examinations. Dr. Hayhurst
reported in our interview with him that he
received degrees in Naturopathy and
Homeopathy from Clayton University in
St. Louis. When we called the school, the
registrar explained that it is an
" independent study program by
correspondence, which uses local adjunct
faculty selected by the students" whose
course of study generally lasts on average
one year. She stated further that the school
does not confer accredited degrees per se,
but " a transcript diploma that says
whatever you need it to say." Donald
Hayhurst also stated that he acquired a
degree in psychology from UCLA. A call to
the registrarrevealed that he was involved
in the UCLAExtension program for aclass
in hypnosis from 1016/ 88 to 1018188.
Hayhurst has told other people, for example
his district assemblyman, Dr. Marvin
Sedway, that he received his ND from the
Utah College of Naturopathic Medicine.
This school seems to never have existed,
although a prospectus was circulated which
had some blank diplomas in the appendices.
Hayhurst currently offers smoking
cessation and counselling to his clients in
Las Vegas, where he has lived for the past
12 years. He lists himself ( on page 868 of
the current LasVegas Yellow Pages) under
Physicians & Surgeons as a " Naturopathic
Psychiatrist." He is also listed ( on page
823) under " General Physicians." Dr.
Sedway, anoptometrist and not aHayhurst
fan, directedme toDetective Sandy Durgin
of the LasVegas Metropolitan Police force
and to George Knapp, of Channel 8 in
Nevada for further investigative
information. Dr. Sedway told me that
Hayhurst periodically ran advertisements
claiming to " enlarge breasts by hypnosis."
A TV journalist called Hayhurst up, in
1987, to see if he wanted to show his
prowess with themammaryglandin living,
prime- time color. Hayhurst agreed to go
on the air and was viewed cupping his
hands over the chest of a supine, bare-breasted
female model intoning ' Your
breasts will get larger, your breasts will
get larger ....*
Dr. Hayhurst's Supporters
A fellow Nevadan, Vera Allison, NMD,
who graduated from a recognized school of
NaturopathicMedicine, and has conducted
research with Linus Pauling, supports
Hayhurst and the ANMA. What Allison
sees in Hayhurst, evidently, is some kind
of leader for the profession who has
connections with the allopathic medical
community and to national politics. Dr.
Allison believes that the two " campsn ( MDs
and NDs) need to come together, and
professes that to be a major goal of
Hayhurst's ANMA. She spoke of having
James Forsyth, MD, oncologst, researcher
in interferon and the Surgeon General of
Nevada, asa keynote speaker at the recent
ANMAconvention. She commented about
her work with the Rife microscope and the
properties of color for heailng. Allison
thought the " Naturopath~ c Act" ( HR
12169), passed into law on February 7,
1931, wasafederal mandate for the legality
of the naturopathic profession ! n every
state. She said, " Why nrr the AANP
representatives ( Labnolit i t nd Gamble)
running around state tr) - t. ltr when it's
[ naturopathy] already i e ~ ; iiir: tavrrys tate?
These guys should do th6. i~ homework."
However, Townsenrl Lt. trt, r research
indicated that HR 121 6!+ iicijildt~; ttesfo r
the District of Columbia i+ nl> Ik Allison
told us that " Don Hayhurst 1s w accepted
in D. C .... in fact, Congrrs.. i rcacognlzes the
profession now because of h I rn .'
According toa summer 1989, ~ nterview
in The Choice ( the newsletter of American
Biologics- Mexico S. A.), ' Dr." f- iayhurst
serves on the advisory h r d oft he National
Security Council. Who are hl sconsti tuents?
Does he really represent the naturopathic
profession by way of the ANMA'..
Hayhurst & AANP
AANP: " Nothing But A Private Club
for JBC and NCNM Graduates"
In the fall of 1988, Hayhurst was
informed, at the third annual AANP
convention in Missoula, that the
Association had changed its by- laws in
order to accommodate state associations -
like Hayhurst's Nevada group - that had
some members that didn't meet AANP
requirements, if these state associations
would provide a list of members and their
credentials. The Nevada list never
materialized. Earlier, in March of 1988,
the ANMA had made application for
national representation on the CNME. The
CNME accepted the application for
consideration, and requested additional
information; for example, it asked that Dr.
Hayhurst provide a membership list,
documentation supporting ANMA
activities and meetings, and the criteria
by which the ANMA assessed the
credentials of its members. Again, the
ANMA chose not to complete their
application, but which was not formally
withdrawn until 1989.
Hayhurst also seems tobe purposefully
pushing the idea that there exists two
" factionsn in the profession - the " old-timers"
and the ' young upstarts." He told
me that he views the AANPas nothing but
a " private club for JBC and NCNM
graduates." Although he claims to
represent a constituency of older
naturopathic physicians who were in
practice Yongbefore the twoschools( Bastyr
and National) were even around," he has
attempted to block the profession
nationally. Instead of working with the
AANP to gain licensing status for
naturopathic physicians in all " States and
territories," the ANMA has objected to
naturopathic licensing in Nebraska and
Townsend Letter for Doctors April 1990
Townsend Letter for Doctars April 1990
Hayhurst & AANP
Montana. Dr. Hayhurst also attempted to accreditation. Membersofthe OCNMboard
dismantle the accredited status ( as of who support the ANMAIANMCAB take
October 2, 1989) of Bastyr College in a the position that they want to be " friendly
letter to the executive director of the with all accrediting agencies," although
Northwest Association of Schools & the CNME is the only nationally approved
Colleges. Hayhurst's organization has also agency to accredit natumpathic medical
worked extensively to get the U. S. programs and is recognized by all state
Department of Education to remove its licensing boards. An annual meeting of
recognition of the naturopathic education INER was called for by court order ( held
accrediting body, the CNME. After January 10) in which elections of new
' express[ ing] concern to the Department OCNM board members was accomplished,
of Education that the CNME [ at its and which succeeded in ousting members
inception] had not consulted with the supportive of Hayhurst.
ANMA.," Hayhurst formulated another As this article goes to press, Hayhurst
accrediting agency for naturopathic says he is mounting alegal suit against the
medical education, called the ANMCAB, CNME, and has already spent " thousands
headedup by Dr. R. M. Finley, amember of of dollars." His complaint, weak even if
the Oregon state association. F'inley was accurate, is that the ' CNME falsified their
part of the CNME start- up team until minutesn of the meeting in which they
1981, but, accordingtoHayhurst, withdrew verbally invited the ANMAto be acorporate
in 1988 to Pevive" the ANMCAB. member. They pretended they didn't say
that even though 11 of us [ ANMAmembersl
Ontario College of Naturopathic were right there in the room [ in Missoula]."
Medicine Invited to be Accredited Hayhurst's plan may be to try to dismantle
by ANMCAB the CNME, and install the ANMCAB with
Considerable concern was expressed at its '' NFLEX" exam, which both F'inley and
the recent AANP convention about the Hayhurst have claimed, in letters to all the
current political situation for natumpathic students and faculty of OCNM, will
medicine in the province of Ontario. Not guarantee the Canadians' right to sit for
only has the profession been actively U. S. licensing exams.
rallying support tomaintain the threatened
legal status of naturopathy in Ontario, but
the third " modern" school in North
America, the Ontario College of
Naturopathic Medicine ( OCNM), has been
approached by ANMCAB with claims to
guarantee the Canadians' wish that their
graduates will be able to Ypracticel egallf
in the U. S. In fact, neither the federal
government nor any state licensing board
currently recognizes the ANMCAB. At the
convention OCNM students were urged to
impress upon their Board of Trustees the
need to complete a CNME application, so
that a site visit could be arranged. Foreign
schools can gain, through application,
' communicating status,' with the CNME,
which gives them the same evaluation as
recognized for accreditation.
Nevertheless, as of January, 1990, OCNM*
had been awarded ' provisional"
accreditation by ANMCAB. Members of
the Institute of Naturopathic Education
and Research ( INER, who elect the OCNM
Board) are planning to pursue CNME
accreditation by conducting a self- study.
However, the CNME self- study has not
been started yet. The ANMA has made a
move toinfluence INER's votingregarding *
J
This investigative report
hmbeen de& ed by Hayhmt
biased, * in= the Townsend
supports accredited natUFOPawthe
GANP, and organized
naturogathy. Dr. Hayhurst
was inviwtosubmitanarticle
countering any mis-information
in this piece, but
chose not to.
We invita Dr; fZayhurst to
present his side of the story
and will publish relevant
iftformation. The facts
presented have been
researched With phone calls,
usually more than one time.
Any distortion of fact will be
gracefully c0- d and is
a p w z e d for in advance. .