Second Regular Session Sixty-eighth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 12-0218.01 Thomas Morris x4218 HOUSE BILL 12-1060 HOUSE SPONSORSHIP Massey, Ferrandino, Gardner D., Kefalas, Liston, McCann, Swerdfeger SENATE SPONSORSHIP Boyd, Steadman, Tochtrop House Committees Senate Committees Agriculture, Livestock, & Natural Resources A BILL FOR AN ACT Concerning the regulation of dietitians. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill creates the state board of dietitians, consisting of 3 licensed dietitians and 2 members of the public, to oversee the regulation of dietitians. Dietitians must be licensed. To get a license, an applicant must have a baccalaureate or post-baccalaureate degree with a major course of study in human nutrition, nutrition education, public health nutrition, food and nutrition, dietetics, or food systems management or an equivalent major course of study as approved by the board, including a practice experience component in dietetics of not less than 1,200 hours, and have successfully completed the examination for dietitians administered by the commission on dietetic registration. A dietitian from a state that has analogous requirements can be licensed by endorsement, and provisional permits, valid for one year and renewable a single time for 6 months, are also available for dietitians from such states. Standard disciplinary and procedural provisions are included. The regulation of dietitians sunsets in 2019. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, add article 35.3 to title 12 as follows: ARTICLE 35.3 Dietitians 12-35.3-101. Short title. This article shall be known and may be cited as the "Dietitian Licensing Act". 12-35.3-102. Legislative declaration. The purpose of this article is to protect the health, safety, and welfare of the public by providing for the licensing and regulation of persons engaged in the practice of dietetics. 12-35.3-103. Definitions. As used in this article, unless the context otherwise requires: (1) "Academy" means the academy of nutrition and dietetics or its successor entity. (2) "Board" means the state board of dietitians created in section 12-35.3-106 (1). (3) "Commission" means the commission on dietetic registration that is accredited by the national commission for certifying agencies and serves as the credentialing body for the academy, or its successor entity. (4) "Degree" means a degree received from a college or university that was a United States regionally accredited body recognized by the council for higher education accreditation, or its successor entity, and the United States department of education at the time the degree was received. (5) "Dietetics" means the integration, application, and communication of principles derived from food, nutrition, social, business, and basic sciences, to achieve and maintain optimal nutrition status of individuals through the development, provision, and management of effective food and nutrition services in a variety of settings. (6) "Director" means the director of the division of registrations within the department of regulatory agencies. (7) "General nonmedical nutrition information" means information on the following: (a) Principles of good nutrition and food preparation; (b) Food to be included in the normal daily diet; (c) The essential nutrients needed by the body; (d) Recommended amounts of the essential nutrients, based on standards established by the national academy of sciences; (e) The actions of nutrients on the body; (f) The effects of deficiencies or excesses of nutrients; or (g) Food and supplements that are good sources of essential nutrients. (8) "Licensed dietitian" means a person licensed under this article to practice dietetics. (9) "Medically prescribed diet" means a diet, prescribed by either a physician licensed pursuant to article 36 of this title to practice medicine or an individual authorized by his or her state-issued license to prescribe, when specific food or nutrient levels need to be monitored, altered, or both as a component of a treatment program for an individual whose health status is impaired or at risk due to disease, injury, or surgery. (10) "Medical nutrition therapy" means the use of specific nutrition services for disease management and to treat or rehabilitate an illness, injury, or condition. "Medical nutrition therapy" includes: (a) Interpreting dietary data and recommending nutrient needs relative to medically prescribed diets, including tube feedings, specialized intravenous solutions, and specialized oral feedings; (b) Analysis of food and prescription drug interactions; and (c) Developing and managing food service operations, the chief function of which is nutrition care and the provision of medically prescribed diets. (11) "Nutrition assessment" means the systematic process of obtaining, verifying, and interpreting biochemical, anthropometric, physical, and dietary data in order to make decisions about the nature and cause of nutrition-related problems. Nutrition assessment is an ongoing, dynamic process that involves not only initial data collection, but also reassessment and analysis of client or community needs and provides the foundation for nutrition diagnosis and nutritional recommendations, including enteral and parenteral nutrition. (12) "Nutrition care process" means the systematic problem-solving method that dietitians use to critically think and make decisions when providing medical nutrition therapy or to address nutrition-related problems and provide safe, effective, high-quality care. The nutrition care process consists of four distinct, but interrelated steps: Nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation. (13) "Nutrition diagnosis" means identifying and labeling nutritional problems that a licensed dietitian is responsible for treating independently. (14) "Nutrition monitoring and evaluation" means identifying patient or client outcomes relevant to the nutrition diagnosis and intervention plans and goals and comparing those outcomes with previous status, intervention goals, or a reference standard to determine the process made in achieving desired outcomes of nutrition care and whether planned interventions should be continued or revised. (15) "Registered dietitian" means an individual registered with the commission. 12-35.3-104. Scope of practice. A licensed dietitian may engage in the practice of dietetics, medical nutrition therapy, and the nutrition care process. 12-35.3-105. Title protection. Only a person licensed or otherwise authorized to practice under this article may practice dietetics or medical nutrition therapy or use the title "dietitian" or "licensed dietitian" or the letters "LD". 12-35.3-106. Board - powers - rules. (1) The state board of dietitians is hereby created within the division of registrations. (2) The board consists of five members appointed by the governor as follows: (a) (I) Three licensed dietitians who are Colorado residents and who have been actively practicing in the field of dietetics for at least five years. (II) The dietitians initially appointed to the board must be eligible for licensure pursuant to this article; thereafter, dietitians appointed to the board must be licensed pursuant to this article. (b) Two members of the public who are not licensed dietitians. (3) The governor may remove a member of the board for misconduct, incompetence, or neglect of duty. (4) The board is authorized to: (a) License dietitians in a manner consistent with this article; (b) Keep a record of its proceedings, a register of all applicants for licensure, and a register of all licensed dietitians; (c) Promulgate rules to govern its actions and provide for the administration and enforcement of this article; (d) Promulgate the licensure standards prescribed in this article, any amendments to the standards, and rules relevant to licensure as the board deems necessary; (e) Adopt a code of ethics and standards of practice and professional responsibility for licensed dietitians; (f) Establish, collect, and disburse fees as required by this article; (g) Establish application forms, determine the qualifications and fitness of applicants, and issue, renew, and reinstate licenses; (h) Enforce continuing professional competency requirements established by the commission for renewal of a license; (i) Receive and process complaints and investigate alleged violations of this article. In making its investigations the board may issue subpoenas, examine witnesses, and administer oaths. (j) Seek injunctive relief to prohibit any person from providing professional dietetic or nutrition care process without being licensed pursuant to this article; and (k) Provide for examination or waiver of examination for applicants. 12-35.3-107. Board operations. (1) The board shall meet at least quarterly and at other times as determined by the board, upon the call of the chairperson, or upon written request to the director or the board by two or more members of the board. The chairperson shall preside at all board meetings and perform all duties prescribed by law or board rules. The vice-chairperson shall preside if the chairperson is absent or disabled or the position of chairperson becomes vacant. The chairperson may appoint such advisory committees of board members and others as may assist the board in carrying out its responsibilities. (2) At the first meeting of each year, the board shall elect a chairperson and vice-chairperson from among its members. (3) A majority of the board constitutes a quorum to conduct business, and the board shall take no formal action without the concurrence of at least a majority of a quorum. (4) The board members and its staff shall not discriminate in any manner in the employment of staff or in the licensure of applicants. (5) Board members shall remain impartial in all matters that come before the board. 12-35.3-108. Licensure - application - qualifications - licensure by endorsement - renewals - fees. (1) Application. (a) A person who wishes to practice dietetics in this state shall apply to the board, by a date and in a form and manner determined by the board by rule, for a license and shall pay the fee determined by the board. The applicant shall certify and furnish evidence satisfactory to the board that the applicant meets all of the following conditions: (I) Is at least twenty-one years of age; (II) Is of good moral character; (III) Has received a baccalaureate or post-baccalaureate degree with a major course of study in human nutrition, nutrition education, public health nutrition, food and nutrition, dietetics, or food systems management or an equivalent major course of study as approved by the board. An applicant who obtained his or her education outside the United States and its territories must have the applicant's academic degree validated by the commission as equivalent to the baccalaureate or post-baccalaureate degree conferred by a regionally accredited college or university in the United States. (IV) Has completed a documented, supervised, pre-professional practice experience component in dietetics of not less than one thousand two hundred hours under the supervision of a registered dietitian, a licensed dietitian, or an individual with a doctoral degree with a major course of study in human nutrition, nutrition education, food and nutrition, dietetics, or food systems management. Supervised practice experience must be completed in the United States or its territories. A supervisor who obtained a doctoral degree outside the United States and its territories must have the degree validated by the commission as equivalent to the doctoral degree conferred by a United States regionally accredited college or university. (V) Has successfully completed the examination for dietitians administered by the commission. (b) The board may waive the requirements of paragraph (a) of this subsection (1) for grounds specified by the commission by rule. (c) (I) For one year beginning on the effective date of this article, the board shall waive the examination requirement and may grant a license to any applicant who makes satisfactory application to the board and: (A) Is registered with the commission; or (B) Has received a baccalaureate or post-baccalaureate degree in a program in dietetics or an equivalent major course of study as approved by the board, completed an experience component as approved by the board, and met the educational requirements of the commission. (II) The board shall waive any additional educational requirements the board considers necessary if the applicant presents satisfactory evidence of current registration as a registered dietitian. (III) The board shall waive the examination requirements if an application for renewal is made within two years after the date of license expiration. (2) License. When an applicant has fulfilled the requirements of subsection (1) of this section, the board shall issue a license to the applicant; except that the board may deny a license if the applicant has committed any act that would be grounds for disciplinary action under section 12-35.3-111. (3) Licensure by endorsement. (a) An applicant for licensure by endorsement shall file an application and pay a fee as prescribed by the board and must hold a current, valid license or registration in a jurisdiction that requires qualifications substantially equivalent to those required for licensure by subsection (1) of this section. (b) An applicant for licensure by endorsement shall submit with the application verification that the applicant has actively practiced for a period of time determined by board rules or otherwise maintained continued professional competency as determined by the board. (c) Upon receipt of all documents required by paragraphs (a) and (b) of this subsection (3), the board shall review the application and make a determination of the applicant's qualification to be licensed by endorsement. (d) The board may deny the license if the applicant has committed an act that would be grounds for disciplinary action under section 12-35.3-111. (4) License renewal. (a) A licensed dietitian shall renew the license issued under this article according to a schedule of renewal dates established by the director. The licensed dietitian 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 are renewed or reinstated in accordance with the schedule established by the director, and the director renews or reinstates licenses 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 licensed dietitian fails to renew his or her license pursuant to the schedule established by the director, the license expires. A person whose license has expired and who continues to practice as a dietitian is subject to the penalties provided in this article or section 24-34-102 (8), C.R.S., for reinstatement. (c) Licenses may be renewed upon satisfactory completion of the renewal application, payment of the renewal fee, and the successful completion of continuing professional competency requirements as determined by the commission pursuant to section 12-35.3-106 (3) (h). (5) Fees. All fees collected under this article are determined, collected, and appropriated in the manner set forth in section 24-34-105, C.R.S., and periodically adjusted in accordance with section 24-75-402, C.R.S. 12-35.3-109. Provisional permits - fees. (1) The board may issue a provisional permit to practice as a dietitian upon the filing of an application and submission of evidence of successful completion of the education requirements of section 12-35.3-108 (1) (a) (III). (2) A provisional permit expires one year after the date of issuance. The board may renew a permit one time for a period not to exceed six months upon submission to the board of a satisfactory explanation for the applicant's failure to become licensed within the original one-year period. (3) A provisional permit allows the holder to practice only under the supervision of a licensed dietitian. (4) The board shall determine the fee by rule for a provisional permit and for each renewal. (5) A dietitian licensed or registered in another state may practice dietetics in this state without a license issued pursuant to this article for up to ninety days if the requirements for licensure in the other state are substantially equal to the requirements for licensure contained in this article. 12-35.3-110. Exemptions. (1) This article does not affect or prevent the following: (a) Any person licensed, certified, or registered in this state under any other article of this title from engaging in the practice of dietetics when it is within his or her scope of practice and is incidental to the practice for which he or she is licensed, certified, or registered; (b) Any person licensed, certified, or registered in this state under any other article of this title from engaging in the practice for which he or she is licensed, certified, or registered; (c) A student enrolled in a program in dietetics or nutrition that has been accredited by the accreditation council for education in nutrition and dietetics, or its successor entity, from engaging in the practice of dietetics under the supervision of a licensed dietitian as part of the program; (d) A dietitian who is serving in the armed forces or the public health service of the United States or is employed by the veterans administration from engaging in the practice of dietetics if the practice is related to his or her service or employment; (e) A person or retailer that does not purport to be a licensed dietitian from furnishing oral or written general nonmedical nutrition information related to food, food materials, or dietary supplements or the marketing of food, food materials, or dietary supplements, if the person is not engaged in the practice of dietetics, including medical nutrition therapy and the nutrition care process; (f) A person employed by a school district who is responsible for menu planning, purchasing food, meal preparation, or food safety from using general nonmedical nutrition information in the performance of the person's duties as long as the person does not purport to be practicing dietetics and does not claim to be a licensed dietitian; (g) A person who is employed as an instructor at a United States regionally accredited college or university with a major course of study in human nutrition, nutrition education, public health nutrition, food and nutrition, dietetics, or food systems management or the equivalent major courses of study approved by the board from providing instruction in those fields; or (h) A person from providing weight control services through a program that has been reviewed by a licensed dietitian, if consultation is available from a licensed dietitian, or by a dietitian licensed in another state that has licensure requirements at least as stringent as the requirements for licensure under this article, a registered dietitian, or a physician licensed in this state. A person shall not initiate program changes without prior approval by the person who reviewed the program. (2) A person who has satisfied the requirements of section 12-35.3-108 (1) (a) (I) to (1) (a) (IV) but has not yet passed the examination component required by section 12-35.3-108 (1) (a) (V) may practice under the supervision of a licensed dietitian for one year after completion of his or her educational and experiential practice. 12-35.3-111. Grounds for discipline - disciplinary proceedings - judicial review. (1) The board may take disciplinary action against a licensed dietitian if the board finds that the licensed dietitian has represented himself or herself as a licensed dietitian after the expiration, suspension, or revocation of his or her license. (2) The board may revoke, suspend, deny, or refuse to renew a license or issue a cease-and-desist order to a licensed dietitian in accordance with this section upon proof that the licensed dietitian: (a) Has engaged in a sexual act with a person receiving services while a therapeutic relationship existed or within six months immediately following termination of the therapeutic relationship. For the purposes of this paragraph (a): (I) "Sexual act" means sexual contact, sexual intrusion, or sexual penetration, as 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. (b) Has falsified information in an application or has attempted to obtain or has obtained a license by fraud, deception, or misrepresentation; (c) Excessively or habitually uses or abuses alcohol or habit-forming drugs or habitually uses a controlled substance, as defined in section 18-18-102, C.R.S., or other drugs having similar effects; except that the board has the discretion not to discipline the licensed dietitian if he or she is participating in good faith in a board-approved program to end the use or abuse; (d) Fails to: (I) Notify the board of a physical or mental illness or condition that affects the licensed dietitian's ability to treat clients with reasonable skill and safety or that may endanger the health or safety of persons under his or her care; (II) Act within the limitations created by a physical or mental illness or condition that renders the person unable to practice with reasonable skill and safety or that may endanger the health or safety of persons under his or her care; or (III) Comply with the limitations agreed to under a confidential agreement entered pursuant to section 12-35.3-113; (e) 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 board; (f) Has had a license, certificate, or registration suspended or revoked for actions that are a violation of this article; (g) Has been convicted of or pled guilty or nolo contendere to a felony or committed an act specified in section 12-35.3-113. A certified copy of the judgment of a court of competent jurisdiction of the conviction or plea is conclusive evidence of the conviction or plea. In considering the disciplinary action, the board is governed by section 24-5-101, C.R.S. (h) Has fraudulently obtained, furnished, or sold any dietitian diploma, certificate, registration, license, renewal of license, or record or aided or abetted such act; (i) Has failed to notify the board of the suspension or revocation of the person's past or currently held license, certificate, or registration required to practice dietetics in this or any other jurisdiction; or (j) Has refused to submit to a physical or mental examination when ordered by the board pursuant to section 12-35.3-112. (3) Except as otherwise provided in subsection (2) of this section, the board need not find that the actions that are grounds for discipline were willful but may consider whether the actions were willful when determining the nature of disciplinary sanctions it may impose. (4) (a) The board may commence a proceeding to discipline a licensed dietitian when the board has reasonable grounds to believe that the licensed dietitian has committed an act enumerated in this section or has violated a lawful order or rule of the board. (b) In any proceeding under this section, the board may accept as evidence of grounds for disciplinary action any disciplinary action taken against a licensed dietitian in another jurisdiction if the violation that prompted the disciplinary action in the other jurisdiction would be grounds for disciplinary action under this article. (5) The board shall conduct disciplinary proceedings in accordance with article 4 of title 24, C.R.S., and the board or an administrative law judge appointed at the board's discretion shall conduct the hearing and opportunity for review pursuant to that article. The board may exercise all powers and duties conferred by this article during the disciplinary proceedings. (6) (a) No later than thirty days following the date of the board's action, the board shall notify a licensed dietitian disciplined under this section, by a certified letter to the most recent address provided to the board by the licensed dietitian, of the action taken, the specific charges giving rise to the action, and the licensed dietitian's right to request a hearing on the action taken. (b) Within thirty days after the board sends the notification, the licensed dietitian may file a written request with the board for a hearing on the action taken. Upon receipt of the request the board shall grant a hearing to the licensed dietitian. If the licensed dietitian fails to file a written request for a hearing within thirty days, the action of the board becomes final on that date. (c) If the licensed dietitian fails to appear at the hearing without good cause, the request for a hearing is withdrawn, and the board's action becomes final on that date. If the board fails, without good cause, to appear at the hearing, the proceeding is dismissed. (7) (a) The board 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 is not 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 board may investigate, hold hearings, and gather evidence in all matters related to the exercise and performance of the board's powers and duties. (II) In order to aid the board in any hearing or investigation instituted pursuant to this section, the board or an administrative law judge appointed pursuant to paragraph (c) of this subsection (7) may administer oaths, take affirmations of witnesses, and issue subpoenas compelling the attendance of witnesses and the production of all relevant records, papers, books, documentary evidence, and materials in any hearing, investigation, accusation, or other matter before the board or an administrative law judge. (III) Upon failure of any witness or licensed dietitian to comply with a subpoena or process, the district court of the county in which the subpoenaed person or licensed dietitian resides or conducts business, upon application by the board with notice to the subpoenaed person or licensed dietitian, may issue to the person or licensed dietitian an order requiring the person or licensed dietitian to appear before the board; 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 licensed dietitian fails to obey the order of the court, the court may hold the person or licensed dietitian in contempt of court. (c) The board 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 board. (8) (a) The board, the board's staff, any person acting as a witness or consultant to the board, any witness testifying in a proceeding authorized under this article, and any person who lodges a complaint pursuant to this article is immune from liability in any civil action brought against him or her for acts occurring while acting in his or her capacity as board member, staff, consultant, witness, or complainant, respectively, if the 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 is immune from any civil or criminal liability that otherwise might result by reason of the participation. (9) A final action of the board is subject to judicial review by the court of appeals pursuant to section 24-4-106 (11), C.R.S. (10) An employer of a licensed dietitian shall report to the board any disciplinary action taken against the licensed dietitian or the resignation of the licensed dietitian in lieu of disciplinary action for conduct that violates this article. (11) When a complaint or an investigation discloses an instance of misconduct that, in the opinion of the board, warrants formal action, the board shall not resolve the complaint by a deferred settlement, action, judgment, or prosecution. (12) (a) If it appears to the board, based upon credible evidence as presented in a written complaint by any person, that a licensed dietitian is acting in a manner that is an imminent threat to the health and safety of the public, or a person is acting or has acted without the required license, the board may issue an order to cease and desist the activity. The board shall include in the order 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 (12), the respondent may request a hearing on the question of whether acts or practices in violation of this article have occurred. The board shall conduct the hearing pursuant to sections 24-4-104 and 24-4-105, C.R.S. (13) (a) If it appears to the board, based upon credible evidence as presented in a written complaint by any person, that a person has violated any other provision of this article, in addition to any specific powers granted pursuant to this article, the board may issue to the person an order to show cause as to why the board should not issue a final order directing the person to cease and desist from the unlawful act or unlicensed practice. (b) The board shall promptly notify a person against whom the board has issued an order to show cause pursuant to paragraph (a) of this subsection (13) 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 board 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) constitutes notice of the order to the person. (c) (I) The board shall hold a hearing on an order to show cause no sooner than ten and no later than forty-five calendar days after the date the board transmits or serves the notification as provided in paragraph (b) of this subsection (13). The board may continue the hearing upon agreement of all parties based on the complexity of the matter, number of parties to the matter, and legal issues presented in the matter, but in no event may the board hold the hearing later than sixty calendar days after the date of transmission or service of the notification. (II) If a person against whom the board has issued an order to show cause pursuant to paragraph (a) of this subsection (13) does not appear at the hearing, the board may present evidence that the board properly sent or served notification on the person pursuant to paragraph (b) of this subsection (13) and may present such other evidence related to the matter as the board deems appropriate. The board shall issue the order within ten days after the board's determination related to reasonable attempts to notify the respondent, and the order becomes final as to that person by operation of law. The board shall conduct the hearing pursuant to sections 24-4-104 and 24-4-105, C.R.S. (III) If the board reasonably finds that the person against whom it issued the order to show cause is acting or has acted without the required license, or has or is about to engage in acts or practices constituting a violation of this article, the board may issue a final cease-and-desist order, directing the person to cease and desist from further unlawful acts or unlicensed practices. (IV) The board shall provide notice, in the manner set forth in paragraph (b) of this subsection (13), 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 it has issued the final order. The final order issued pursuant to subparagraph (III) of this paragraph (c) is effective when issued and is a final order for purposes of judicial review. (14) If it appears to the board, based upon credible evidence presented to the board, 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 board may enter into a stipulation with the person. (15) If any person fails to comply with a final cease-and-desist order or a stipulation, the board 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. (16) A person aggrieved by the final cease-and-desist order may seek judicial review of the board's determination or of the board's final order as provided in subsection (9) of this section. 12-35.3-112. Mental and physical examination of licensed dietitians. (1) If the board has reasonable cause to believe that a licensed dietitian is unable to practice with reasonable skill and safety, the board may order the licensed dietitian to take a mental or physical examination administered by a physician or other licensed health care professional designated by the board. Except where due to circumstances beyond the licensed dietitian's control, if the licensed dietitian fails or refuses to undergo a mental or physical examination, the board may suspend the licensed dietitian's license until the board has made a determination of the licensed dietitian's fitness to practice. The board shall proceed with an order for examination and shall make its determination in a timely manner. (2) The board shall include in an order requiring a licensed dietitian to undergo a mental or physical examination the basis of the board's reasonable cause to believe that the licensed dietitian is unable to practice with reasonable skill and safety. For purposes of a disciplinary proceeding authorized under this article, the licensed dietitian waives all objections to the admissibility of the examining physician's or licensed health care professional's testimony or examination reports on the grounds that they are privileged communication. (3) The licensed dietitian may submit to the board testimony or examination reports from a physician chosen by the licensed dietitian and pertaining to any condition that the board has alleged may preclude the licensed dietitian from practicing with reasonable skill and safety. The board may consider the testimony and reports submitted by the licensed dietitian in conjunction with, but not in lieu of, testimony and examination reports of the physician designated by the board. (4) The results of a mental or physical examination ordered by the board cannot be used as evidence in any proceeding other than one before the board and are not a public record or shall not be made available to the public. 12-35.3-113. Confidential agreement to limit practice - violation - grounds for discipline. (1) If a licensed dietitian has a physical or mental illness or condition that renders the person unable to practice with reasonable skill and safety to clients, the licensed dietitian shall notify the board of the illness or condition in a manner and within a period determined by the board. The board may require the licensed dietitian to submit to an examination to evaluate the extent of the illness or condition and its impact on the licensed dietitian's ability to practice with reasonable skill and safety to clients. (2) (a) Upon determining that a licensed dietitian with a physical or mental illness or condition is able to render limited services with reasonable skill and safety to clients, the board may enter into a confidential agreement with the licensed dietitian in which the licensed dietitian agrees to limit his or her practice based on the restrictions imposed by the illness or condition, as determined by the board. (b) As part of the agreement, the licensed dietitian is subject to periodic reevaluations or monitoring as determined appropriate by the board. (c) The parties may modify or dissolve the agreement as necessary based on the results of a reevaluation or monitoring. (3) By entering into an agreement with the board pursuant to this section to limit his or her practice, a licensed dietitian is not engaging in activities prohibited pursuant to section 12-35.3-111. The agreement does not constitute a restriction or discipline by the board. However, if the licensed dietitian fails to comply with the terms of an agreement entered into pursuant to this section, the failure constitutes a prohibited activity pursuant to section 12-35.3-111, and the licensed dietitian is subject to discipline in accordance with that section. (4) This section does not apply to a licensed dietitian subject to discipline for prohibited activities as described in section 12-35.3-111. 12-35.3-114. Penalties. (1) A person who violates this article by practicing dietetics without complying with this article is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than five hundred dollars or imprisonment for a period not exceeding six months, or both. (2) Each day of violation constitutes a separate offense. (3) In addition to any other fine or penalty that may be imposed against any person found to have violated this article, the board may assess and collect all costs incurred in connection with disciplinary actions, including investigator fees, stenographer fees, attorney fees, and hearing costs. The board shall transmit all revenues collected pursuant to this subsection (3) to the state treasurer, who shall credit them to the division of registrations cash fund created in section 24-34-105 (2) (b) (I), C.R.S. (4) The board shall transmit all fines collected pursuant to this section to the state treasurer, who shall credit them to the general fund. 12-35.3-115. Repeal of article. This article is repealed, effective September 1, 2019. Prior to its repeal, the department of regulatory agencies shall review the functions of the board and the regulation of licensed dietitians as provided in section 24-34-104, C.R.S. SECTION 2. In Colorado Revised Statutes, 24-34-104, amend (50.5) introductory portion; and add (50.5) (e) as follows: 24-34-104. General assembly review of regulatory agencies and functions for termination, continuation, or reestablishment. (50.5) The following agencies, functions, or both, shall terminate on September 1, 2019: (e) The state board of dietitians created by article 35.3 of title 12, C.R.S., and the regulation of licensed dietitians pursuant to that article. SECTION 3. 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.