Second Regular Session Sixty-sixth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 08-0055.02 Thomas Morris HOUSE BILL 08-1064 HOUSE SPONSORSHIP Labuda, Curry, and McGihon SENATE SPONSORSHIP Williams, Gordon, and Romer House Committees Senate Committees Health and Human Services A BILL FOR AN ACT Concerning the regulation of naturopathic doctors. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Requires licensure of naturopathic doctors. Specifies the scope of practice, prohibited practices, and exemptions. Gives the director of the division of registrations within the department of regulatory agencies (director) rule-making authority. Creates a naturopathic formulary council (council) to recommend to the director a formulary for use by naturopathic doctors. Creates an advisory committee (committee). Specifies the composition and appointing authorities for the committee and the council. Establishes licensing standards, including licensure by endorsement. Requires record-keeping and specific disclosures to the public. Specifies complaint, investigation, and disciplinary procedures. Repeals the naturopath law in 2012, subject to sunset review. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Title 12, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW ARTICLE to read: ARTICLE 37.3 Naturopathic Medicine 12-37.3-101. Definitions. As used in this article, unless the context otherwise requires: (1) "Approved naturopathic medical program" means: (a) A naturopathic medical education program in the United States providing the degree of doctor of naturopathy or doctor of naturopathic medicine. Such program shall offer graduate-level, full-time, didactic, and supervised clinical training and shall be accredited, or have achieved candidacy status for accreditation, by the council on naturopathic medical education, its successor, or an equivalent federally recognized accrediting body for naturopathic medical programs. Additionally, the program shall be an institution, or part of an institution, of higher education that is either accredited or is a candidate for accreditation by a regional or national institutional accrediting agency recognized by the United States secretary of education. (b) A degree-granting college or university that, prior to the existence of the council on naturopathic medical education, offered a full-time, structured curriculum in basic sciences and supervised patient care comprising a doctoral naturopathic medical education. Such course, as a prerequisite to graduation, shall have been not less than one hundred thirty-two weeks in duration and shall have required completion within a period of not less than thirty-five months. (c) A diploma-granting, degree-equivalent college or university that, if in Canada and prior to accreditation by the council on naturopathic medical education, had provincial approval for participation in government-funded student aid programs and offered a full-time, structured curriculum in basic sciences and supervised patient care comprising a doctoral naturopathic medical education. Such course, as a prerequisite to graduation, shall have been not less than one hundred thirty-two weeks in duration and shall have required completion within a period of not less than thirty-five months. (d) A diploma-granting, degree-equivalent college or university in Canada that offers graduate-level, full-time, didactic, and supervised clinical training and that is accredited, or has achieved candidacy status for accreditation, by the council on naturopathic medical education, a successor, or an equivalent federally recognized accrediting body for naturopathic medical programs. Additionally, this college or university shall have provincial approval for participation in government-funded student aid programs. (2) "Committee" means the advisory committee of naturopathic medicine created in section 12-37.3-107. (3) "Common diagnostic procedures" means commonly used diagnostic modalities consistent with naturopathic practice; health history-taking; physical examination; radiography; laboratory medicine; and obtaining samples of human tissues, but excluding incision or excision beyond that which is authorized as a minor office procedure. (4) "Department" means the department of regulatory agencies. (5) "Director" means the director of the division. (6) "Division" means the division of registrations in the department. (7) "Laboratory medicine" means, as specified in 42 CFR part 493: (a) Ordering, but not performing or interpreting, any moderate- or high-complexity tests; and (b) Performing or interpreting waived testing after first obtaining a certificate of waiver. (8) "Minor office procedures" means: (a) Care and procedures incident thereto of superficial lacerations, lesions, and abrasions and the removal of foreign bodies located in superficial structures, not including the eye; (b) The use of antiseptics and topical or local anesthetics in connection therewith; and (c) Intramuscular, intravenous, subcutaneous, and intradermal injections of substances consistent with the practice of naturopathic medicine and in accordance with rules established by the director. (9) "Naturopathic doctor", and all designations listed in section 12-37.3-102, means a person who is required to be licensed pursuant to this article as a practitioner of naturopathic medicine. (10) "Naturopathic formulary" means the list of medicines, both nonprescription and prescription, that naturopathic doctors use in the practice of their profession, as recommended by the naturopathic formulary council and promulgated by the director. (11) "Naturopathic formulary council" means the council created in section 12-37.3-109. (12) "Naturopathic medicine" means a system of primary health care for the prevention, diagnosis, and treatment of human health conditions, injury, and disease; the promotion or restoration of health; and the support and stimulation of a patient's inherent self-healing processes through patient education and the use of naturopathic therapies and therapeutic substances. (13) "Naturopathic physical modalities" means lifestyle counseling and the use of ultrasound, electrical stimulation, and the physical forces of heat, cold water, touch, and light. (14) "Prescription drug" means any drug defined by the "Federal Food, Drug, and Cosmetic Act", 21 U.S.C. sec. 353 (b), as amended, if its label is required to bear the statement "RX only". (15) "Radiography" means the ordering, but not the interpretation, of radiographic diagnostic and other imaging studies and the taking and interpretation of standard radiographs. 12-37.3-102. Title and designation. (1) A person represents himself or herself as a practitioner of naturopathic medicine when he or she uses or adopts any of the following designations: "Doctor of naturopathic medicine", "naturopathic doctor", or "doctor of naturopathy". Naturopathic doctors shall use the title "naturopathic doctor" and the recognized abbreviation "N.D." Naturopathic doctors shall have the exclusive right to use the titles "naturopathic doctor", "naturopath", "doctor of naturopathic medicine", and "doctor of naturopathy". The abbreviations "ND" and "N.D." designate a person licensed under this article as a naturopathic doctor; except that nothing in this article shall preclude a person holding a nursing doctorate degree from using the initials "ND" or "N.D." to designate such nursing doctorate degree. Persons licensed under this article shall not use the abbreviations "NMD" or "N.M.D." or the term "naturopathic medical doctor". (2) On and after July 1, 2008, no person shall represent himself or herself to the public as a naturopathic doctor, a doctor of naturopathic medicine, or a doctor of naturopathy, or as being otherwise authorized to practice naturopathic medicine in Colorado, without first obtaining from the director a license to practice naturopathic medicine pursuant to this article. (3) The titles and abbreviations in this section identify naturopathic doctors and are restricted to describing and identifying licensed practitioners. 12-37.3-103. Requirements for licensure - reciprocity - renewal - reinstatement - fee. (1) Every applicant for a license to practice naturopathic medicine shall have: (a) Successfully completed an approved naturopathic medical program; (b) (I) Passed a competency examination administered by a national certifying agency that has been approved by the director after consultation with the committee and provided evidence of current certification by the agency; or (II) Passed a competency examination developed and administered by the director after consultation with the committee; (c) Submitted an application in the form and manner designated by the director; and (d) Paid a fee in an amount determined by the director. (2) When an applicant has fulfilled the requirements of subsection (1) of this section, the director shall issue a license to the applicant unless the director determines that the applicant has committed any act that would be grounds for disciplinary action under section 12-37.3-110. (3) (a) The director shall issue a license to practice naturopathic medicine to an applicant who otherwise meets the qualifications of this article and who submits satisfactory proof and certifies under penalty of perjury that the applicant currently possesses an unrestricted certificate or license in good standing to practice naturopathic medicine under the laws of another state or territory of the United States or a foreign country if: (I) The director determines that the qualifications for licensure or certification in the other state, territory, or foreign country are substantially equivalent to the licensure requirements in this article; and (II) The applicant has not been subject to a disciplinary action with regard to the applicant's naturopathic medicine certificate or license issued by the other state, territory, or foreign country. (b) The director may deny a license if the applicant has committed any act that would be grounds for disciplinary action under section 12-37.3-110. (4) (a) A naturopathic doctor shall be required to renew a license issued under this article according to a schedule of renewal dates established by the director. The applicant for renewal shall submit an application in the form and manner designated by the director and shall pay a renewal fee in an amount determined by the director. (b) Licenses shall be renewed or reinstated in accordance with the schedule established by the director, and such renewal or reinstatement shall be granted pursuant to section 24-34-102 (8), C.R.S. The director may establish renewal fees and delinquency fees for reinstatement pursuant to section 24-34-105, C.R.S. If a person fails to renew his or her license pursuant to the schedule established by the director, the license shall expire. Any person whose license has expired and who continues to practice naturopathic medicine shall be subject to the penalties provided in this article or section 24-34-102 (8), C.R.S. (5) All fees collected under this article shall be determined, collected, and appropriated in the same manner as set forth in section 24-34-105, C.R.S., and periodically adjusted in accordance with section 24-75-402, C.R.S. (6) A person who practices or offers or attempts to practice naturopathic medicine without an active license issued under this article commits a class 2 misdemeanor and shall be punished as provided in section 18-1.3-501, C.R.S., for the first offense, and for the second or any subsequent offense, the person commits a class 6 felony and shall be punished as provided in section 18-1.3-401, C.R.S. 12-37.3-104. Scope of practice. (1) A naturopathic doctor may order or perform common diagnostic procedures, minor office procedures, and radiography. A naturopathic doctor may also perform physical examinations. (2) A naturopathic doctor shall refer all diagnostic tests, other than those specified in subsection (1) of this section, for performance and interpretation to a laboratory certified to perform moderate- and high-complexity testing as specified in 42 CFR part 493. (3) A naturopathic doctor may dispense, administer, order, and prescribe or perform the following: (a) Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, homeopathic medicines, all dietary supplements, and drugs that are not prescription drugs as defined by the "Federal Food, Drug, and Cosmetic Act", 21 U.S.C. sec. 353 (b), as amended; (b) Prescription substances as determined by the director; (c) Devices, including, but not limited to, therapeutic devices, barrier contraception, and durable medical equipment; (d) Health education and health counseling; (e) Repair and care incidental to superficial lacerations and abrasions; (f) Removal of foreign bodies located in the superficial structures, not including the eye; and (g) Naturopathic physical modalities. (4) A naturopathic doctor may utilize routes of administration, including oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular, consistent with the education and training of a naturopathic doctor. 12-37.3-105. Prohibitions. (1) A naturopathic doctor shall not: (a) Prescribe, dispense, or administer any controlled substance or device identified in the federal "Controlled Substances Act", 21 U.S.C. sec. 801 et seq., as amended, except as authorized by this article; (b) Perform surgical procedures, including procedures using a laser device or procedures involving the eye, ear, tendons, nerves, veins, or arteries extending beyond superficial tissue, except those minor office procedures authorized by this article; (c) Practice or claim to practice as a physician, medical doctor, osteopath, dentist, podiatrist, optometrist, psychologist, advanced practice nurse, physician assistant, chiropractor, physical therapist, acupuncturist, or any other health care professional not authorized in this title unless licensed by the state as such; (d) Use anesthesia other than topical or local anesthetics; (e) Administer ionizing radioactive substances for therapeutic purposes; (f) Perform chiropractic adjustments as defined in section 12-33-102, manipulation as referenced in section 12-33-102, or physical therapy as defined in section 12-41-103, including joint mobilization; (g) Practice obstetrics; or (h) Recommend the discontinuation of a course of care, including discontinuation of a prescription drug, that was recommended by another health care practitioner required to be licensed pursuant to this title without notifying such other practitioner. 12-37.3-106. Exemptions. (1) Nothing in this article shall be construed to prohibit or restrict: (a) The practice of a profession by individuals who are licensed, certified, or registered under other laws of this state and who are performing services within their authorized scope of practice; (b) The practice of naturopathic medicine by an individual employed by the United States government while the individual is engaged in the performance of duties prescribed by the laws and regulations of the United States; (c) The practice of naturopathic medicine by students enrolled in an approved naturopathic medical program. The performance of services shall be pursuant to a course of instruction or assignments from an instructor and under the supervision of the instructor. The instructor shall be a naturopathic doctor licensed pursuant to this article or a duly licensed or certified professional in the instructed field. (d) Anyone from treating himself or herself or the person's family based on religious or health beliefs; (e) Anyone who sells vitamins and herbs from providing information about such products; (f) Any person or practitioner from recommending any therapy that is within the scope of practice of naturopathic doctors as specified in this article if such therapy does not otherwise require a license, certificate, or registration or, if a licensed health care provider, within that provider's legally defined scope of practice, including, but not limited to, herbal medicine, homeopathy, nutrition, or other therapy; (g) A person or practitioner from using, giving, providing, selling, or advising in the use of a product that is within the scope of the practice of naturopathy as specified in this article if such person is not using a title protected pursuant to this article or holding himself or herself out to be a naturopathic doctor, including, but not limited to, general nutritional information or other nonmedical therapeutics, dietary supplements, or homeopathic remedies; or (h) The practice of naturopathic medicine by a person who is licensed or certified to practice in any other state or district in the United States as a naturopathic doctor and who enters this state on an occasional basis to consult with a naturopathic doctor of this state; except that the consultation shall be limited to examination, recommendation, or testimony in litigation. 12-37.3-107. Advisory committee of naturopathic medicine. The director shall appoint an advisory committee of naturopathic medicine to make recommendations concerning naturopathic medicine, which committee shall serve at the request and pleasure of the director. The majority of the members of the advisory committee shall be naturopathic doctors. The director may appoint to the committee representatives of the public who have no pecuniary interest in the practice of naturopathic medicine. Members of the committee shall receive no compensation but shall be reimbursed for actual and necessary expenses incurred in the performance of their duties under this article. 12-37.3-108. Powers and duties of the director - rules. (1) The director shall: (a) Promulgate all rules and conduct all hearings required by this article; (b) Designate the application form to be used by applicants and process all applications; (c) Issue licenses, and renewals thereof, to all persons who meet the qualifications for licensure as described in section 12-37.3-103; (d) Investigate complaints; (e) Determine whether a naturopathic doctor should be the subject of a disciplinary hearing; (f) Designate and impose sanctions and penalties for violation of this article or the rules promulgated pursuant to this article; and (g) Perform any administrative, nondisciplinary, and nonrule-making functions as provided by this article. 12-37.3-109. Naturopathic formulary council - creation - director - rules. (1) (a) There is hereby established a naturopathic formulary council, which shall consist of the director and six members appointed by the director as follows: (I) Two members shall be naturopathic doctors. (II) Two members shall be pharmacists licensed under part 1 of article 22 of this title. (III) Two members shall be physicians licensed under part 1 of article 36 of this title. (b) Members of the council shall serve three-year terms; except that, of the initial appointments, one naturopathic doctor, one physician, and one pharmacist shall serve two-year terms. If a vacancy occurs, the director shall appoint a qualified replacement to serve the remainder of the term. (2) The naturopathic formulary council shall recommend to the director a naturopathic formulary for use by naturopathic doctors. The director shall adopt or revise the naturopathic formulary by rule. (3) The naturopathic formulary council shall review the naturopathic formulary annually or upon request of the director. (4) The naturopathic formulary may not go beyond the scope of naturopathic medicine set forth in section 12-37.3-104. (5) The naturopathic formulary shall not include medicines or devices that are inconsistent with the training provided by approved naturopathic medical programs. (6) Nothing in this article shall be construed to allow a naturopathic doctor to dispense, administer, or prescribe any drug or device unless such drug or device is specifically included in the naturopathic formulary. 12-37.3-110. Disciplinary actions - definitions. (1) The director may revoke, suspend, deny, or refuse to renew a license, place a naturopathic doctor on probation, or issue a cease-and-desist order or letter of admonition to a naturopathic doctor or applicant in accordance with this section upon proof that the naturopathic doctor or applicant: (a) Has committed an act that does not meet generally accepted standards of naturopathic medical practice or has failed to perform an act necessary to meet generally accepted standards of naturopathic medical practice; (b) Has engaged in a sexual act with a person receiving services while a therapeutic relationship existed or during the six-month period immediately following the termination of the therapeutic relationship. For the purposes of this paragraph (b): (I) "Sexual act" means sexual contact, sexual intrusion, or sexual penetration, as such terms are defined in section 18-3-401, C.R.S. (II) "Therapeutic relationship" means the period beginning with the initial evaluation and ending upon the written termination of treatment. (c) Has failed to provide a referral to another naturopathic doctor or to other appropriate health care practitioners when providing the referral is necessary to meet generally accepted standards of naturopathic medical practice; (d) Has failed to refer a person to an appropriate licensed health care provider when the services required are beyond the scope of practice or level of competence of the naturopathic doctor; (e) Has failed to provide adequate or proper supervision to student naturopathic doctors acting under the direction of the naturopathic doctor; (f) Has failed to keep appropriate records or has falsified or made incorrect entries of an essential nature on such records; (g) Has falsified information in an application or has attempted to obtain or has obtained a license by fraud, deception, or misrepresentation; (h) Is an excessive or habitual user or abuser of alcohol or habit-forming drugs or is a habitual user of a controlled substance, as defined in section 18-18-102, C.R.S., or other drugs having similar effects; except that the director has the discretion not to discipline the naturopathic doctor if he or she is participating in good faith in a program that the director has approved to end such use or abuse; (i) Has a physical or mental condition or disability that renders the naturopathic doctor unable to provide naturopathic medical services with reasonable skill and safety or that may endanger the health or safety of individuals receiving services; (j) Has failed to notify the director, in writing, of the entry of a final judgment by a court of competent jurisdiction in favor of any party and against the naturopathic doctor for malpractice of naturopathic medicine or any settlement by the naturopathic doctor in response to charges or allegations of malpractice of naturopathic medicine. The notice shall be given within ninety days after the entry of the judgment or settlement and, in the case of a judgment, shall contain the name of the court, the case number, and the names of all parties to the action. (k) Has violated this article or aided or abetted or knowingly permitted any person to violate this article, a rule adopted under this article, or any lawful order of the director; (l) Has been disciplined in any way by a national certifying agency or by a regulatory agency of another jurisdiction; (m) Has been convicted of or pled guilty or nolo contendere to a felony or any crime defined in title 18, C.R.S., that relates to the naturopathic doctor's employment as a naturopathic doctor. A certified copy of the judgment of a court of competent jurisdiction of the conviction or plea shall be prima facie evidence of the conviction or plea. In considering the disciplinary action, the director shall be governed by section 24-5-101, C.R.S. (n) Has fraudulently obtained, furnished, or sold any naturopathic medical diploma, license, certificate, renewal of a license or certificate, or record or aided or abetted such act; (o) Has advertised, represented, or held himself or herself out, in any manner, as being a naturopathic doctor or being state- or Colorado-licensed or has practiced naturopathic medicine unless licensed or exempt under this article; (p) Has practiced naturopathic medicine during the time the person's license was expired, suspended, or revoked; (q) Has knowingly employed a person as a naturopathic doctor when the person was not licensed under this article; (r) Has practiced naturopathic medicine without a license; (s) Has failed to notify the director of the suspension, probation, or revocation of the person's past or currently held license, certificate, or registration required to practice naturopathic medicine in this or any other jurisdiction; (t) Has refused to submit to a physical or mental examination when so ordered by the director; (u) Has failed to confine his or her practice to the types of naturopathic medicine for which he or she was trained and educated; or (v) Has been disciplined in another state, territory, or country. This paragraph (v) shall apply only to discipline that is based upon an act or omission in such other state, territory, or country that is substantially the same as conduct specified in this subsection (1). (2) Except as otherwise provided in subsection (1) of this section, the director need not find that the actions that are grounds for discipline were willful but may consider whether such actions were willful when determining the nature of disciplinary sanctions to be imposed. (3) The director may commence a proceeding to discipline a naturopathic doctor when the director has reasonable grounds to believe that the naturopathic doctor has committed an act enumerated in this section. (4) Disciplinary proceedings shall be conducted in accordance with article 4 of title 24, C.R.S., and the hearing and opportunity for review shall be conducted pursuant to that article by the director or by an administrative law judge, at the director's discretion. The director has the authority to exercise all powers and duties conferred by this article during the disciplinary proceedings. (5) (a) The director may request the attorney general to seek an injunction, in any court of competent jurisdiction, to enjoin a person from committing an act prohibited by this article. When seeking an injunction under this paragraph (a), the attorney general shall not be required to allege or prove the inadequacy of any remedy at law or that substantial or irreparable damage is likely to result from a continued violation of this article. (b) (I) In accordance with article 4 of title 24, C.R.S., and this article, the director is authorized to investigate, hold hearings, and gather evidence in all matters related to the exercise and performance of the powers and duties of the director. (II) In order to aid the director in any hearing or investigation instituted pursuant to this section, the director or an administrative law judge appointed pursuant to paragraph (c) of this subsection (5) is authorized to administer oaths, take affirmations of witnesses, and issue subpoenas compelling the attendance of witnesses and the production of the originals or copies of all records, papers, books, documents, and materials of the naturopathic doctor or another person containing information relevant to the hearing or investigation. (III) Upon failure of any witness or naturopathic doctor to comply with a subpoena or process, the district court of the county in which the subpoenaed person or naturopathic doctor resides or conducts business, upon application by the director with notice to the subpoenaed person or naturopathic doctor, may issue to the person or naturopathic doctor an order requiring that person or naturopathic doctor to appear before the director; to produce the relevant papers, books, records, documentary evidence, or materials if so ordered; or to give evidence touching the matter under investigation or in question. If the person or naturopathic doctor fails to obey the order of the court, the person or naturopathic doctor may be held in contempt of court. (c) The director may appoint an administrative law judge pursuant to part 10 of article 30 of title 24, C.R.S., to conduct hearings, take evidence, make findings, and report such findings to the director. (6) If the director finds the charges proved and orders that discipline be imposed, the director may require, as a condition of licensure, that the naturopathic doctor take such therapy or courses of training or education as may be needed to correct any deficiency found as a condition for continuing or reinstating licensure pursuant to this article. Upon the failure of the naturopathic doctor to comply with any conditions imposed by the director pursuant to this subsection (6), unless due to conditions beyond the naturopathic doctor's control, the director may order suspension of the naturopathic doctor's license until such time as the naturopathic doctor complies with such conditions. (7) (a) The director, the director's staff, any person acting as a witness or consultant to the director, any witness testifying in a proceeding authorized under this article, and any person who lodges a complaint pursuant to this article shall be immune from liability in any civil action brought against him or her for acts occurring while acting in his or her capacity as director, staff, consultant, or witness, respectively, if such individual was acting in good faith within the scope of his or her respective capacity, made a reasonable effort to obtain the facts of the matter as to which he or she acted, and acted in the reasonable belief that the action taken by him or her was warranted by the facts. (b) A person participating in good faith in making a complaint or report or in an investigative or administrative proceeding pursuant to this section shall be immune from any civil or criminal liability that otherwise might result by reason of the participation. (8) A final action of the director is subject to judicial review by the court of appeals pursuant to section 24-4-106 (11), C.R.S. A judicial proceeding to enforce an order of the director may be instituted in accordance with section 24-4-106, C.R.S. (9) An employer of a naturopathic doctor shall report to the director any disciplinary action taken against the naturopathic doctor or the resignation of the naturopathic doctor in lieu of disciplinary action for conduct that violates this article. (10) (a) When a complaint or investigation discloses an instance of misconduct that, in the opinion of the director, does not warrant formal action by the director but that should not be dismissed as being without merit, the director may issue a letter of admonition to the naturopathic doctor by certified mail. (b) When the director sends a letter of admonition to a naturopathic doctor, the naturopathic doctor shall be advised that he or she has the right to request that formal disciplinary proceedings be initiated to adjudicate the propriety of the conduct upon which the letter of admonition is based. The naturopathic doctor shall make the request in writing within twenty days after receipt of the letter. (c) If the request for adjudication is timely made, the letter of admonition shall be deemed vacated and the matter shall be processed by means of formal disciplinary proceedings. (11) When a complaint or investigation discloses an instance of conduct that does not warrant formal action by the director and, in the opinion of the director, the complaint should be dismissed, but the director has noticed indications of possible errant conduct by the naturopathic doctor that could lead to serious consequences if not corrected, the director may issue a confidential letter of concern to the naturopathic doctor. (12) When a complaint or an investigation discloses an instance of misconduct that, in the opinion of the director, warrants formal action, the complaint shall not be resolved by a deferred settlement, action, judgment, or prosecution. (13) (a) If it appears to the director, based upon credible evidence as presented in a written complaint by any person, that a naturopathic doctor is acting in a manner that causes or constitutes an imminent threat to the health and safety of the public, or a person is acting or has acted without the required license, the director may issue an order to cease and desist such activity. The order shall set forth the statutes and rules alleged to have been violated, the facts alleged to have constituted the violation, and the requirement that all unlawful acts or unlicensed practices immediately cease. (b) Within ten days after service of the order to cease and desist pursuant to paragraph (a) of this subsection (13), the respondent may request a hearing on the question of whether acts or practices in violation of this article have occurred. The hearing shall be conducted pursuant to sections 24-4-104 and 24-4-105, C.R.S. (14) (a) If it appears to the director, based upon credible evidence as presented in a written complaint by any person, that a person has violated any other portion of this article, in addition to any specific powers granted pursuant to this article, the director may issue to the person an order to show cause as to why the director should not issue a final order directing the person to cease and desist from the unlawful act or unlicensed practice. (b) A person against whom an order to show cause has been issued pursuant to paragraph (a) of this subsection (14) shall be notified promptly by the director of the issuance of the order, along with a copy of the order, the factual and legal basis for the order, and the date set by the director for a hearing on the order. The notice may be served on the person against whom the order has been issued by personal service, by first-class, postage prepaid United States mail, or in another manner as may be practicable. Personal service or mailing of an order or document pursuant to this paragraph (b) shall constitute notice of the order to the person. (c) (I) The hearing on an order to show cause shall be held no sooner than ten and no later than forty-five calendar days after the date of transmission or service of the notification by the director as provided in paragraph (b) of this subsection (14). The hearing may be continued by agreement of all parties based upon the complexity of the matter, number of parties to the matter, and legal issues presented in the matter, but in no event shall the hearing be held later than sixty calendar days after the date of transmission or service of the notification. (II) If a person against whom an order to show cause has been issued pursuant to paragraph (a) of this subsection (14) does not appear at the hearing, the director may present evidence that notification was properly sent or served on the person pursuant to paragraph (b) of this subsection (14) and such other evidence related to the matter as the director deems appropriate. Such hearing shall be conducted pursuant to sections 24-4-104 and 24-4-105, C.R.S. The director shall issue the order within ten days after the director's determination related to reasonable attempts to notify the respondent, and the order shall become final as to that person by operation of law. (III) If the director reasonably finds that the person against whom the order to show cause was issued is acting or has acted without the required license, or has or is about to engage in acts or practices constituting violations of this article, a final cease-and-desist order may be issued, directing the person to cease and desist from further unlawful acts or unlicensed practices. (IV) The director shall provide notice, in the manner set forth in paragraph (b) of this subsection (14), of the final cease-and-desist order within ten calendar days after the hearing conducted pursuant to this paragraph (c) to each person against whom the final order has been issued. The final order issued pursuant to subparagraph (III) of this paragraph (c) shall be effective when issued and shall be a final order for purposes of judicial review. (15) If it appears to the director, based upon credible evidence presented to the director, that a person has engaged or is about to engage in an unlicensed act or practice; an act or practice constituting a violation of this article, a rule promulgated pursuant to this article, or an order issued pursuant to this article; or an act or practice constituting grounds for administrative sanction pursuant to this article, the director may enter into a stipulation with the person. (16) If any person fails to comply with a final cease-and-desist order or a stipulation, the director may request the attorney general or the district attorney for the judicial district in which the alleged violation exists to bring, and if so requested such attorney shall bring, suit for a temporary restraining order and for injunctive relief to prevent any further or continued violation of the final order. (17) A person aggrieved by the final cease-and-desist order may seek judicial review of the director's determination or of the director's final order as provided in subsection (8) of this section. (18) Naturopathic doctors shall observe and be subject to all applicable laws with regard to the control of contagious and infectious diseases, the reporting of births and deaths, and any other matters pertaining to the public health. 12-37.3-111. Mental and physical examination of naturopathic doctors. (1) If the director has reasonable cause to believe that a naturopathic doctor is unable to practice with reasonable skill and safety, the director may order the naturopathic doctor to take a mental or physical examination administered by a physician or other licensed health care professional designated by the director. If the naturopathic doctor refuses to undergo a mental or physical examination, the director may suspend the naturopathic doctor's license until the director has made a determination of the naturopathic doctor's fitness to practice. The director shall proceed with an order for examination and shall make his or her determination in a timely manner. (2) An order requiring a naturopathic doctor to undergo a mental or physical examination shall contain the basis of the director's reasonable cause to believe that the naturopathic doctor is unable to practice with reasonable skill and safety. For purposes of a disciplinary proceeding authorized under this article, the naturopathic doctor shall be deemed to have waived all objections to the admissibility of the examining physician's or other licensed health care professional's testimony or examination reports on the ground that they are privileged communications. (3) The naturopathic doctor may submit to the director testimony or examination reports from a physician or other licensed health care professional chosen by the naturopathic doctor and pertaining to any condition that the director has alleged may preclude the naturopathic doctor from practicing with reasonable skill and safety. The testimony and reports submitted by the naturopathic doctor may be considered by the director in conjunction with, but not in lieu of, testimony and examination reports of the physician or other licensed health care professional designated by the director. (4) The results of a mental or physical examination ordered by the director shall not be used as evidence in any proceeding other than one before the director and shall not be deemed a public record or made available to the public. 12-37.3-112. Professional liability insurance required - vicarious liability. (1) It is unlawful for any person to practice naturopathic medicine in this state unless the person is covered by a professional liability insurance policy or the equivalent in an amount not less than one hundred thousand dollars per claim with an aggregate liability limit for all claims during the year of at least three hundred thousand dollars. The professional liability insurance required by this section shall cover all acts within the scope of the practice of naturopathic medicine. (2) A naturopathic doctor shall be liable for his or her acts or omissions in the performance of naturopathic medicine, and no licensed physician, nurse, prehospital emergency medical personnel, or health care institution shall be liable for any act or omission resulting from the performance of naturopathic medicine by any naturopathic doctor. This subsection (2) shall not relieve any physician, nurse, prehospital emergency personnel, or health care institution from liability for any willful and wanton act or omission or any act or omission constituting gross negligence, or if a naturopathic doctor has a business or supervised relationship with any such physician, nurse, prehospital emergency personnel, or health care institution. A physician, a nurse, prehospital emergency personnel, or a health care institution may provide consultation or education to the naturopathic doctor without establishing a business or supervisory relationship. 12-37.3-113. Complaints - investigation. (1) Any person may report to the director in writing any information the person has reason to believe indicates that a naturopathic doctor is or may be medically or legally incompetent, engaged in the unauthorized practice of naturopathic medicine, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of naturopathic medicine. (2) A naturopathic doctor shall report to the director in writing any information the naturopathic doctor has reason to believe indicates that a naturopathic doctor is or may be medically or legally incompetent, engaged in the unauthorized practice of naturopathic medicine, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of naturopathic medicine, within thirty days after becoming aware of such information. (3) A naturopathic doctor's voluntary resignation from the staff of a health care institution, voluntary limitation of staff privileges, or failure to reapply for hospital privileges at such an institution shall be promptly reported to the director by the institution and the naturopathic doctor if that action occurs while the naturopathic doctor is under formal or informal investigation by the institution or a committee thereof for any reason related to possible medical incompetence, unprofessional conduct, or mental or physical impairment. (4) Upon receiving a credible complaint or report concerning a naturopathic doctor or on his or her own motion, the director may investigate any evidence that appears to show that a naturopathic doctor is committing or has committed any act that would constitute grounds for disciplinary action pursuant to section 12-37.3-110. 12-37.3-114. Disclosures - record-keeping. (1) A naturopathic doctor shall provide the following information in writing to each patient: The naturopathic doctor's name, business address, and telephone number; the nature of the services to be provided; the scope of practice for naturopathic doctors; a statement that naturopathic doctors may not practice medicine as defined in the "Colorado Medical Practice Act", article 36 of this title; how to file a complaint against a naturopathic doctor; and any degrees, training, experience, credentials, or other qualifications of the naturopathic doctor, including whether or not such degrees were awarded by institutions accredited by a regional or professional accrediting agency recognized by the United States department of education or the council on postsecondary accreditation, or a successor agency, or recognized as a candidate for accreditation by such an agency. (2) A naturopathic doctor shall obtain a written acknowledgment from the patient stating that the patient has been provided the information described in subsection (1) of this section. The naturopathic doctor shall maintain the acknowledgment for five years after the last services provided to the patient. 12-37.3-115. Repeal of article. This article is repealed, effective July 1, 2012. Prior to such repeal, the licensure of naturopathic doctors, the advisory committee, and the functions of the advisory committee and the naturopathic formulary council shall be reviewed as provided for in sections 2-3-1203 and 24-34-104, C.R.S. SECTION 2. 13-4-102 (2), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read: 13-4-102. Jurisdiction. (2) The court of appeals shall have initial jurisdiction to: (kk) Review all final actions and orders appropriate for judicial review of the director of the division of registrations as provided in section 12-37.3-110 (8), C.R.S. SECTION 3. 24-34-104 (43), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read: 24-34-104. General assembly review of regulatory agencies and functions for termination, continuation, or reestablishment. (43) The following agencies, functions, or both, shall terminate on July 1, 2012: (n) The licensing of naturopathic doctors pursuant to article 37.3 of title 12, C.R.S. SECTION 4. 2-3-1203 (3) (y), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBPARAGRAPH to read: 2-3-1203. Sunset review of advisory committees. (3) The following dates are the dates for which the statutory authorization for the designated advisory committees is scheduled for repeal: (y) July 1, 2012: (III) The naturopathic formulary council created in section 12-37.3-109, C.R.S., and the advisory committee of naturopathic medicine created in section 12-37.3-107, C.R.S. SECTION 5. Effective date - applicability. This act shall take effect upon passage and shall apply to all persons practicing or seeking to practice naturopathic medicine on or after said date. SECTION 6. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.