Dr. Ellen Lewis of the Shalva Clinic in Westport has many patients—some with children, who want her as their primary care doctor. But at least for now, she can’t fulfill that role for them in the state of Connecticut. As a naturopathic doctor (ND), Lewis focuses on holistic, proactive prevention and comprehensive diagnosis and treatment, using natural healing agents such as herbs, vitamins, nutrient supplements and other techniques. The most common ailments NDs treat include allergies, chronic pain, digestive issues, hormonal imbalances, obesity, heart disease, fibromyalgia and menopause. NDs have full diagnostic capabilities. They can diagnose and treat patients, refer patients to get X-rays or cat scans, and order medical devices such as an e-glucose monitor or an insulin pump for diabetes. However, at this time Lewis and other NDs in Connecticut cannot prescribe medications—including B12 nutrient therapy, which is easily administered in an office—because they have no prescriptive authority.
That might change this year as the Connecticut Naturopathic Physicians Association (CNPA) and the University of Bridgeport’s College of Naturopathic Medicine (UBCNM) are urging the state legislature to update a nearly century-old law. On March 16, the state legislature’s public health committee held a public hearing to hear HB 6797. The CNPA and UBCNM are urging supporters to contact their legislators and push this bill along.
The bill appears to have significant support in the public. As of 2012, the National Institutes of Health stated that 33 percent of American adults use some complementary or integrative approaches to health. “It’s a good chunk of the public that uses integrative medicine,” says Michael Jawer, director of government and public affairs for the American Association of Naturopathic Physicians. Approximately 4,400 naturopathic doctors are now licensed nationwide. Twenty states and territories license NDs, and 11 of those currently allow NDs to have prescriptive authority.
The History
Connecticut’s law giving NDs licenses to practice in the state dates back to the early 1920s. Until the 1980s, NDs could only prescribe foods. In 1985, Dr. Rick Liva, president and chairman of the legislative committee for the state association, and a colleague from Guilford pushed to have the law allow NDs to prescribe anything delivered orally, including herbals and vitamins. Prescriptions were excluded. Recently, in 2014, the state law was updated to include more modern language about how NDs can diagnose illness, prevent it with natural remedies and
treat patients.
However, without prescriptive authority, the law still does not accurately reflect the dramatic advances in the education, training, experience and competence of NDsin the past few decades.
Pharmacology and anatomy are among the subjects NDs study in naturopathic medical school; in fact, the first two years of their education is similar to a medical doctor’s curriculum. The second two years diverge when NDs learn more about botanical and nutritional medicine, Jawer says.
UBCNM requires more hours of basic and clinical science than many top medical schools, adds Liva, who is also chief medical director of Middletown-based Vital Nutrients. UBCNM is only one of five accredited naturopathic four-year graduate programs in the U.S. and the only one in the eastern region of the U.S.
The Push for Prescriptions
The movement to shift the law has been ramping up for the past several years. For the past two years, changes have been proposed to the Connecticut Department of Public Health, which is the first step in the lengthy process to get approval. The department reviews any proposed written changes of the law before it can be sent to the legislature’s Public Health Committee.
Connecticut is not alone in this effort; naturopathic doctors in several states are seeking expanded prescriptive authority. In California, naturopathic doctors can prescribe medications, but they must be overseen by a medical doctor, explains Jawer. The current law in Connecticut means UBCNM’s program cannot efficiently meet its educational mission in training doctors for preparation to work in all states, including those with more expansive scopes of practice and prescriptive authority, says Dr. David M. Brady, vice provost of the Health Science division and
director of Human Nutrition Institute at the university.
It is often necessary to bring in medical doctors to supervise procedures and oversee treatment within the competency and practice authority of the ND in other states, Brady expands. The UBCNM program occasionally has to send their students and interns out of state to receive certain types of advanced clinical training that the students wish to pursue, he says. Liva adds that students sometimes “beeline out of the state because they don’t want to practice in a state that has a 90-year-old law. Connecticut loses a sort of brain drain.”
“We need to have the ability to deliver more comprehensive types of care and services in the UB clinics, where we now see over 20,000 patients—mainly those from the greater Bridgeport area who often have little or no insurance and who are unable to obtain such proactive care on the private market,” says Dr. Brady, who is also a naturopathic physicianat Whole Body Medicine in Trumbull and Fairfield. A new law is needed to reflect modern life,
he continues.
“Under the current situation, many patients go to two doctors, their MD and ND, which means they spend more time and money going to redundant appointments. The patientsoften give up when they can’t get an appointment for weeks and do not get follow-up care,”Dr. Brady states. An ND can examine and diagnose a client with a urinary tract infection now, for example, but can’t treat her with antibiotics. “It’s really silly at this point,” Brady declares. “And the state has primary care work shortage issues and here are the other primary care workers who are ready and willing.”
In the latest round to get the bill considered in the state legislature, Liva says he submitted documents that included NDs’ adequate education requirements and the adequate knowledge to prescribe medication. His documents include the safety record of NDs in other states such as Oregon, Washington, Arizona, Montana, New Hampshire and Vermont. “Their safety record is extremely good,” pronounces Liva. He adds that no evidence has been found of an ND being disciplined for inadvertently hurting someone or worse when they prescribed medication.
What the New Law Would Encompass
The new law would include a five-month long refresher pharmacology online training course and a post-course exam to ensure NDs have the proper knowledge of pharmaceuticals. If NDs do not pass the test, they won’t receive prescriptive authority. Right now, NDs do learn about biochemistry, medicinal chemistry, pharmacology and pathology, among many other courses. “This provides the background knowledge to properly prescribe pharmaceuticals,” Liva says. “Our training is just as robust as MDs in regard to all of that background education. NDs only want to use prescriptions conservatively and appropriately where people need them,” Liva continues. NDs would be able to help clients, if they so chose, to reduce medication whenever and wherever possible in a safe, slow matter. Under the proposed law, NDs would not be able to prescribe any cancer drugs, general anesthetics, some narcotics (such as ketamine), certain injections, abortion drugs or anti-psychotic drugs.
“I am an expert in natural medicine, drugs and conventional medicine,” says Liva, whohas been practicing for 30 years. “My most passionate goal is to teach people about effective natural medicine therapies and how to incorporate them into their lives to increase health and well-being, and to alleviate disease.”
Brady says the issue won’t just disappear. “They (state legislators) know we’re serious and that we’re not going away,” he adds. “And we’ll keep banging on the door until it opens and we are given the ability to serve our patients to the level of our training and competency. And every year that it’s delayed, more doctors are leaving Connecticut and fewer patients are served.”
“It’s not about one profession versus the other,” Shalva Clinic’s Lewis sums up. “We work well in preventive medicine and we reduce the overall health care costs and burdens for people.”