HAR Chapter 88 – Naturopaths

HAWAII ADMINISTRATIVE RULES
TITLE 16
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
CHAPTER 88
NATUROPATHS
Subchapter 1 General Provisions
§16-88-1 	Objective
§16-88-2 	Definitions
§16-88-3 	Notification and filing of names, addresses, and changes
§16-88-4 	Payment of renewal fees
§16-88-5 	Automatic forfeiture of license
§16-88-6 	Restoration of forfeited license
§16-88-7 	Display of wall certificate
§16-88-7.5 	Use of titles
Subchapter 2 Applications
§16-88-8 	Repealed
§16-88-9 	Application for licensure
§16-88-10 	Application for examination and reexamination
Subchapter 3 Examination
§16-88-12 	Repealed
§16-88-12.1 	Examination requirements for licensure
§16-88-12.2 	Educational requirements for licensure
§16-88-13 	Repealed
§16-88-14 	Repealed
§16-88-14.1 	Passing score
§16-88-14.2 	Reexamination
88-1

Subchapter 4 Hearings
§16-88-15 	Denial
§16-88-16 	Demand for a hearing
§16-88-17 	Proceedings upon demand for a hearing
§16-88-18 	Administrative practice and procedure
Subchapter 5 Oral Testimony
§16-88-20 	Oral testimony
Subchapter 6 Repealed
§16-88-21 	Repealed
§16-88-22 	Repealed
§16-88-23 	Repealed
§16-88-24 	Repealed
§16-88-25 	Repealed
§16-88-26 	Repealed
§16-88-27 	Repealed
Subchapter 7 Fees
§16-88-31 	Fees
Subchapter 8 Repealed
§16-88-35 	Repealed
§16-88-36 	Repealed
§16-88-37 	Repealed
§16-88-38 	Repealed
§16-88-39 	Repealed
§16-88-40 	Repealed
§16-88-41 	Repealed
Subchapter 9 Parenteral therapy
§16-88-56 	Authorization to use parenteral therapy required
§16-88-57 	Education and training requirements for parenteral therapy
§16-88-58 	Disapproval of course providers, courses, or instructors
88-2

§16-88-59 	Standards to administer parenteral therapy
Subchapter 10 Minor office procedures
§16-88-70 	Authorization to perform minor office procedures required
Subchapter 11 Standards of practice, care, and ethics
§16-88-80 	Code of ethics
§16-88-81 	Standards of practice and care
SUBCHAPTER 1
GENERAL PROVISIONS
§16-88-1 	Objective. 	This chapter is intended to clarify and implement
chapter 455, HRS, to the end that the provisions thereunder may be best effectuated
and the public interest most effectively protected. 	[Eff 6/11/79; am and ren
§16-88-1, 6/22/81; am and comp 4/28/88; comp 7/10/91; comp 10/13/94; comp
1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: 	HRS §455-6) (Imp: HRS
§455-6)
§16-88-2 Definitions. As used in this chapter:
"Board" means the board of naturopathic medicine. 	[Eff 6/11/79; am and
ren §16-88-2, 6/22/81; am and comp 4/28/88; comp 7/10/91; am and comp
10/13/94; comp 1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: 	HRS
§455-6) (Imp: HRS §§455-4, 455-6)
§16-88-3 	Notification and filing of names, addresses, and changes. Every
licensee shall file the licensee's mailing address with the board and shall notify the
board in writing of any and all changes within thirty calendar days of the change.
[Eff 6/11/79; am and ren §16-88-3, 6/22/81; am and comp 4/28/88; comp 7/10/91;
comp 10/13/94; comp 1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: HRS
§455-6) (Imp: HRS §455-6)
88-3

§16-88-4
§16-88-4 	Payment of renewal fees. 	Renewal fees paid by mail shall be
considered as paid when due if the envelope bears the postmark of December 31 or
earlier of each odd-numbered year. 	[Eff 6/11/79; am and ren §16-88-4, 6/22/81;
am and comp 4/28/88; am and comp 7/10/91; comp 10/13/94; comp 1/21/10; am
and comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §455-8)
§16-88-5 	Automatic forfeiture of license. 	A licensee's license shall be
automatically forfeited if:
(1) 	The licensee fails to pay the renewal fee on or before December 31
of each odd-numbered year;
(2) 	The licensee pays the renewal fee by check which is not honored
due to insufficient funds; or
(3) 	For any other reason, the renewal fee shall be considered not paid.
[Eff and comp 4/28/88; am and comp 7/10/91; comp 10/13/94;
comp 1/21/10; comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6)
(Imp: HRS §455-8)
§16-88-6 	Restoration of forfeited license. 	A license which is forfeited
pursuant to section 16-88-5 may be restored upon:
(1) 	Submitting an application for renewal on a form approved by the
board and payment of a renewal fee;
(2) 	Payment of all delinquent fees; and
(3) 	Payment of a penalty fee. 	[Eff and comp 4/28/88; comp 7/10/91;
am and comp 10/13/94; comp 1/21/10; am and comp 2/14/11;
comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §455-8)
§16-88-7 Display of wall certificate. A wall certificate issued by the board
shall be conspicuously displayed in the licensee's place of business. [Eff and comp
4/28/88; comp 7/10/91; comp 10/13/94; am and comp 1/21/10; am and comp
2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §455-8)
§16-88-7.5 	Use of titles. 	A person licensed under chapter 455, HRS, and
this chapter:
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§16-88-9
(1) 	Shall 	clearly 	identify 	him 	or 	herself 	as 	being 	a 	naturopathic
physician;
(2) 	May 	use 	the 	titles 	"natureopath", 	"naturopath", 	"doctor 	of
naturopathy", 	"doctor 	of 	naturopathic 	medicine", 	"naturopathic
healthcare", 	"naturopathic 	physician", 	"naturopathic 	medicine",
"naturopathy", "naturopathic doctor", and "N.D.";
(3) 	Shall not use any title to induce the belief that the person is licensed
as a physician or an osteopathic physician in this State; and
(4) 	Shall not use the title "naturopathic medical doctor" or the acronym
"N.M.D."; provided that this prohibition shall not apply to a
naturopathic 	physician 	who 	is 	licensed 	as 	a 	physician 	or 	an
osteopathic physician in this State. [Eff and comp 1/21/10; am and
comp 2/14/11; comp 4/13/12] (Auth: 	HRS §455-6) (Imp: 	HRS
§§455-9, 455-11)
SUBCHAPTER 2
APPLICATIONS
§16-88-8 Repealed. [R 4/28/88]
§16-88-9 	Application for licensure. 	(a) An application for licensure filed
with the board shall be prepared in accordance with the application forms and
instructions provided by the board and shall be accompanied by:
(1) 	The required application fees, which shall not be refunded;
(2) 	A certified copy of an official transcript;
(3) 	Passing 	scores 	of 	the 	examinations 	as 	required 	in 	section
16-88-14.1. 	The applicant shall be responsible for having the
professional testing agency verify, directly to the board, the passing
scores of the examinations as required in section 16-88-14.1; and
(4) 	Any other documents deemed necessary by the board.
(b) 	The 	board 	may 	delegate 	to 	the 	board's 	executive 	officer 	the
authority to issue a license upon verification that an applicant has met the education
and examination requirements of this chapter and chapter 455, HRS. [Eff and comp
4/28/88; am and comp 7/10/91; am and comp 10/13/94; am and comp 1/21/10;
comp 2/14/11; comp 4/13/12] (Auth: 	HRS §455-6) (Imp: 	HRS §§455-2, 455-3,
455-7)
88-5

§16-88-10
§16-88-10 Application for examination and reexamination. An application
for examination and reexamination shall be filed directly with the professional
testing agency contracted with the board. 	[Eff and comp 4/28/88; am and comp
7/10/91; comp 10/13/94; am and comp 1/21/10; am and comp 2/14/11; comp
4/13/12] (Auth: HRS §455-6) (Imp: HRS §§455-2, 455-7)
SUBCHAPTER 3
EXAMINATION
§16-88-12 	Repealed. [R 4/28/88]
§16-88-12.1 	Examination requirements for licensure. 	Each applicant shall
be required to take and pass the following Naturopathic Physicians Licensing
Examinations (NPLEX):
(1) 	Part I of the NPLEX;
(2) 	Part II of the NPLEX; and
(3) 	Examination on homeopathy; provided that after February 2007, the
examination 	on 	homeopathy 	will 	no 	longer 	be 	a 	separate
examination as it will be incorporated into the Part II of the
NPLEX. 	[Eff and comp 4/28/88; comp 7/10/91; am and comp
10/13/94; am and comp 1/21/10; am and comp 2/14/11; comp
4/13/12] (Auth: HRS §455-6) (Imp: HRS §455-7)
§16-88-12.2 	Educational requirements for licensure. 	The naturopathic
medical education program shall be a minimum of four academic years, with
in-residence curriculum in basic science and clinical didactic studies, as well as
clinical training. 	[Eff and comp 1/21/10; comp 2/14/11; comp 4/13/12] (Auth:
HRS §455-6) (Imp: HRS §455-3)
§16-88-13 Repealed. [R 4/28/88]
§16-88-14 Repealed. [R 4/28/88]
88-6

§16-88-15
§16-88-14.1 	Passing score. 	(a) The passing score, which shall be verified
directly to the board by the professional testing agency, for each examination or
each part of the examinations specified in section 16-88-12.1 shall be a converted
score of at least seventy-five or a result of "P" or "pass"; provided that the score
report of "P" or "pass" is equivalent to a converted score of at least seventy-five.
(b) 	The 	professional 	testing 	agency 	shall 	grade 	and 	score 	the
examinations. 	[Eff and comp 4/28/88; am and comp 7/10/91; am and comp
10/13/94; am and comp 1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth:
HRS §455-6) (Imp: HRS §455-7)
§16-88-14.2 	Reexamination. 	(a) An applicant who fails any part of Part I
of the NPLEX shall be required to retake all failed parts during the same
administration of the NPLEX examination and shall attain a converted score of at
least seventy-five on all parts of the examination that the applicant had failed and
had retaken; provided that:
(1) 	An applicant who fails more than two parts of Part I of the NPLEX
shall retake the entire Part I of the NPLEX; and
(2) 	An applicant who fails to pass all parts of Part I of the NPLEX
within four attempts shall retake the entire Part I of the NPLEX. An
applicant who has not passed all five parts of Part I of the NPLEX
prior to August 2009, shall retake the entire Part I of the NPLEX.
After February 2009, an applicant who fails any part of the Part I of
the NPLEX shall retake the entire examination.
(b) 	An applicant who fails any part of Part II of the NPLEX shall retake
the entire examination. 	[Eff and comp 4/28/88; comp 7/10/91; comp 10/13/94;
am and comp 1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6)
(Imp: HRS §455-7)
SUBCHAPTER 4
HEARINGS
§16-88-15 	Denial. 	If an application for a license, renewal of a license, or
restoration of a license is denied by the board, the applicant or licensee, as the case
may be, shall be notified by letter of the board's action which shall include a
concise statement of the reasons for denial and a statement informing the applicant
or licensee of the right to a hearing. [Eff 6/11/79; am and ren §16-88-15, 6/22/81;
am and comp 4/28/88; comp 7/10/91; comp 10/13/94; comp 1/21/10;
88-7

§16-88-15
am and comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §§455-6,
455-11)
§16-88-16 	Demand for a hearing. 	Any person whose application for a
license, renewal of a license, or restoration of a license has been denied by the
board may petition for hearing relief pursuant to chapter 16-201; provided that the
petition for hearing relief is filed with the board within sixty calendar days of the
date of the denial of the application. [Eff 6/11/79; am and ren §16-88-16, 6/22/81;
am and comp 4/28/88; comp 7/10/91; comp 10/13/94; am and comp 1/21/10; am
and comp 2/14/11; comp 4/13/12] (Auth: 	HRS §455-6) (Imp: 	HRS §§91-13.1,
455-6, 455-11)
§16-88-17 	Proceedings upon demand for a hearing. 	If a demand for a
hearing is filed pursuant to section 16-88-16, the board shall order a hearing
pursuant to chapter 16-201. [Eff 6/11/79; am and ren §16-88-17, 6/22/81; am and
comp 4/28/88; comp 7/10/91; comp 10/13/94; am and comp 1/21/10; am and
comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §§455-6, 455-11)
§16-88-18 	Administrative practice and procedure. 	The rules of practice
and procedure provided in chapter 16-201, as amended, shall be followed for
administrative hearings, and are hereby incorporated into and made a part of this
chapter. 	[Eff and comp 4/28/88; comp 7/10/91; am and comp 10/13/94; comp
1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: HRS §§91-2, 455-6) (Imp:
§§91-2, 455-6)
SUBCHAPTER 5
ORAL TESTIMONY
§16-88-20 	Oral testimony. 	(a) The board shall accept oral testimony on
any item which is on the board's agenda, provided that the testimony shall be
subject to the following conditions:
(1) 	Each person seeking to present oral testimony is requested to notify
the board not later than forty-eight hours prior to the meeting, and
at that time shall state the item on which testimony is to be
presented;
88-8

§16-88-23
(2) 	The board may request that any person providing oral testimony
submit the remarks, or a summary of the remarks, in writing to the
board;
(3) 	The board may rearrange the items on the agenda for the purpose of
providing for the most efficient and convenient presentation of oral
testimony;
(4) 	Persons presenting oral testimony shall, at the beginning of the
testimony, identify themselves and the organization, if any, that they
represent;
(5) 	The board may limit oral testimony to a specified time period but in
no case shall the period be less than five minutes, and the person
testifying shall be informed prior to the commencement of the
testimony of the time constraints to be imposed; and
(6) 	The board may refuse to hear any testimony which is irrelevant,
immaterial, or unduly repetitious to the agenda item on which it is
presented.
(b) 	Nothing in this section shall require the board to hear or receive any
oral or documentary evidence from a person on any matter which is the subject of
another proceeding pending subject to the hearings relief, declaratory relief, or rule
relief provisions of chapter 16-201.
(c) 	Nothing in this section shall prevent the board from soliciting oral
remarks from persons present at the meeting or from inviting persons to make
presentations to the board on any particular matter on the board's agenda. [Eff and
comp 4/28/88; comp 7/10/91; am and comp 10/13/94; comp 1/21/10; comp
2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §§92-3, 455-6)
SUBCHAPTER 6
§16-88-21 Repealed. [R 7/10/91]
§16-88-22 Repealed. [R 7/10/91]
§16-88-23 Repealed. [R 7/10/91]
88-9

§16-88-24
§16-88-24 Repealed. [R 7/10/91]
§16-88-25 Repealed. [R 4/28/88]
§16-88-26 Repealed. [R 7/10/91]
§16-88-27 Repealed. [R 7/10/91]
SUBCHAPTER 7
FEES
§16-88-31 	Fees. 	All fees under chapter 455, HRS, and this chapter shall
be specified in chapter 16-53, relating to boards and commissions. 	[Eff 11/7/64;
am and ren §16-88-31, 6/22/81; am and comp 4/28/88; comp 7/10/91; comp
10/13/94; comp 1/21/10; am and comp 2/14/11; comp 4/13/12] (Auth: 	HRS
§92-28) (Imp: HRS §§26-9, 92-28)
SUBCHAPTER 8
§16-88-35 Repealed. [R 7/10/91]
§16-88-36 Repealed. [R 7/10/91]
§16-88-37 Repealed. [R 7/10/91]
§16-88-38 Repealed. [R 7/10/91]
§16-88-39 Repealed. [R 7/10/91]
88-10

§16-88-57
§16-88-40 Repealed. [R 7/10/91]
§16-88-41 Repealed. [R 7/10/91]
SUBCHAPTER 9
PARENTERAL THERAPY
§16-88-56 	Authorization to use parenteral therapy required. 	(a) For the
purposes 	of 	this 	chapter, 	parenteral 	therapy 	is 	limited 	to 	subcutaneous,
intramuscular, and intravenous injection.
(b) 	Only a naturopathic physician licensed under chapter 455, HRS,
who meets the education and training requirements of this subchapter shall be
authorized 	to 	administer 	parenteral 	therapy 	in 	the 	naturopathic 	physician's
practice. 	[Eff and comp 2/14/11; comp 	4/13/12] (Auth: 	HRS §455-6) (Imp:
HRS §§455-1, 455-6, 455-11)
§16-88-57 Education and training requirements for parenteral therapy.
(a) 	To qualify to administer parenteral therapy in the naturopathic
physician's practice, a naturopathic physician shall submit an application and
applicable fees to the board and demonstrate that the naturopathic physician has:
(1) 	A current naturopathic physician's license in this State; and
(2) 	Completed a qualifying course on parenteral therapy from an
approved course provider as provided in this section.
(b) 	The 	qualifying 	course 	shall 	consist 	of 	a 	minimum 	of 	thirty
classroom hours on parenteral administration through injection of applicable
naturopathic formulary substances.
(1) 	At a minimum, the qualifying course shall have covered all of the
following topics:
(A) 	Current and historical research on parenteral therapy;
(B) 	Indications and contraindications of parenteral therapy;
(C) 	Parenteral therapy side effects and toxicity, nutrient/drug
interactions;
(D) 	Parenteral 	therapy 	and 	practical 	application, 	vein
selection, and insertion techniques;
(E) 	Intravenous solutions, equipment, supplies, catheters, and
pic lines;
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§16-88-57
(F) 	Initial evaluation and treatment monitoring requirements;
(G) 	Frequency of parenteral treatments;
(H) 	Charting 	requirements, 	standards 	of 	care, 	office
procedures, 	consent 	to 	treat, 	nutrition 	and 	lifestyle
recommendations during treatment, errors and adverse
reactions; and
(I) 	Practicum 	on 	mixing 	and 	administering 	parenteral
solutions, including observation of intravenous set up and
administration (the licensee shall have observed at least
ten of these); and successful completion of intravenous set
up (the licensee shall have completed at least ten of these).
(2) 	The 	licensee 	shall 	have 	successfully 	completed 	a 	written
examination developed and administered by the course provider,
and the practicum described in subparagraph (b)(1)(I). 	The
written examination shall consist of at least fifty questions that are
relevant to the topics set forth in this subsection. 	Successful
completion of the written examination shall be a passing score of
at least seventy-five percent or its equivalent.
(3) 	One classroom hour is defined as fifty minutes out of each sixty
minute segment and may include time devoted to examinations.
(4) 	No credit shall be granted for distance education, including but
not limited to correspondence courses, internet courses, or video
or remote television offerings.
(c) 	Schools, universities, or colleges that meet the requirements of
section 455-3, HRS, and schools, universities, or colleges that are accredited by
a 	regional 	or 	national 	accrediting 	body 	recognized 	by 	the 	United 	States
Department of Education, shall automatically be approved course providers.
The dean of these approved course providers shall certify to the board that the
qualifying course and licensee met the requirements of subsection (b).
(d) 	Course providers that are not automatically approved pursuant to
subsection (c) shall submit an application and applicable fees, course description
and outline, and course instructor qualifications to the board for approval.
(1) 	Course instructors shall have had at least one year of experience
teaching parenteral therapy at a school, university or college as
described in 16-88-57(c), and at least five years' experience and
training combined in parenteral therapy.
(2) 	These course providers shall:
(A) 	Provide attendees within sixty days of completion of the
course or the examination, completion certificates which
shall include information regarding the number of
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§16-88-59
classroom hours and, whether there was successful passage
of the course examination; and
(B) 	Keep attendance records for a minimum of seven years.
(3) 	Completion certificates shall be issued only if the attendee physically
attended the course.
(4) 	Attendees 	may 	take 	no 	more 	than 	one 	make-up 	examination;
provided that the examination is taken within ninety days after the
end date of the course. 	[Eff and comp 2/14/11; comp 4/13/12]
(Auth: HRS §455-6) (Imp: HRS §§455-3, 455-6, 455-11)
§16-88-58 	Disapproval of course providers, courses, and instructors. 	(a)
Course providers, courses, and instructors may be disapproved when:
(1) 	The instructor or administrators of the course provider have had any
disciplinary action imposed against them in any jurisdiction; or
(2) 	The 	course 	provider, 	course, 	or 	instructor 	fails 	to 	meet 	the
requirements in section 16-88-57.
(b) 	Course approval may be withdrawn for cause after notification to
the course provider by the board or the board's authorized designee. 	[Eff and
comp 2/14/11; comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §455-6)
§16-88-59 	Standards to administer parenteral therapy. 	(a) To protect
the general public, every licensee authorized to administer parenteral therapy in
the licensee's practice shall make a good faith effort to comply with the
standards set forth in this section. 	These standards are designed to be a
systematic process to improve professional performance, a measurable tool for
implementation and disciplinary action, and a statement of level of practice for
the best outcome in patient care. 	Standard of practice guidelines for parenteral
therapy are not intended to replace professional clinical judgment in individual
cases, but rather to establish patient care parameters for safe and effective
patient care.
(b) 	Standards of care summary:
(1) 	General 	and 	intravenous 	specific 	history 	and 	physical
examination;
(2) 	Appropriate laboratory evaluations;
(3) 	Referrals: 	assessment 	of 	referral 	from 	other 	provider 	and
necessity for potential referral from your facility;
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§16-88-59
(4) 	Prevention and intervention: 	assessment of need for prevention
of adverse events specific to the patient's history and condition
and intervention in the plan to address these assessments;
(5) 	Follow up evaluation: evaluate the patient at the end of treatment
and on discharge;
(6) 	Stated assessment on weekly, monthly, quarterly, or yearly basis:
the original plan should have treatment goals and intervals for
follow up assessment;
(7) 	Therapeutic options: 	address other options (additional to the
original plan) as the need arises;
(8) 	Self 	management 	education: 	assure 	that 	patient 	follow-up
instruction is given and patient care at home is addressed; and
(9) 	Note appropriate details of treatment in a patient's record.
(c) 	A 	written 	intravenous 	order 	shall 	include 	the 	following
information:
(1) 	Patient: name and date;
(2) 	Type of carrier solution and amount;
(3) 	Type and amount of medication added to the carrier solution;
(4) 	Rate of infusion;
(5) 	Route solution is given (e.g., intravenous, intramuscular, etc.);
and
(6) 	Type of access device used: catheter, butterfly, or central venous
access device.
(d) 	The following procedure is required prior to providing initial or
new intravenous therapy to patients:
(1) 	The written order for intravenous therapy shall be issued by a
licensed naturopathic physician who is authorized to administer
parenteral therapy;
(2) 	Each patient shall read and sign an informed consent form for
intravenous therapy;
(3) 	For patients that have been referred to the clinic by another
physician 	for 	intravenous 	therapy, 	ensure 	that 	the 	desired
intravenous treatment is clearly described and that any questions
or concerns are addressed with the referring physician prior to
the patient visit;
(4) 	Review patient history;
(5) 	Perform the required physical examination and vital signs;
(6) 	Evaluate other considerations relative to intravenous therapy from
the intake form;
(7) 	Perform appropriate laboratory tests;
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§16-88-70
(8) 	Compliance with the professional standards of the Centers for
Disease Control and Prevention and Occupational Safety and
Health Administration for the prevention of contamination and
infection control;
(9) 	Utilize sterile and hygienic techniques at all times during the
procedure, 	from 	preparation 	of 	the 	intravenous 	solution 	to
cleansing the injection site and attention to maintaining the sterile
field throughout the procedure; and
(10) 	Document 	a 	Procedure/Alternatives/Risks/Questions 	(PARQ)
communication 	with 	the 	patient 	during 	the 	first 	consultation
regarding intravenous therapy:
(A) 	Procedure: explain the procedure;
(B) 	Alternatives: inform the patient about alternatives to the
procedure;
(C) 	Risks: assess and address the risks involved; and
(D) 	Questions: answer the patient's questions and concerns.
[Eff 	and 	comp 	2/14/11; 	comp 	4/13/12] 	(Auth: 	HRS
§455-6) (Imp: HRS §§455-6, 455-11)
SUBCHAPTER 10
MINOR OFFICE PROCEDURES
§16-88-70 Authorization to perform minor office procedures required.
(a) 	Only a naturopathic physician licensed under chapter 455, HRS,
who meets the examination requirements of this section shall be authorized to
perform minor office procedures in the naturopathic physician's practice.
(b) 	To qualify to perform minor office procedures in the naturopathic
physician's practice, a naturopathic physician shall submit an application and
applicable fees to the board and demonstrate that the naturopathic physician has
a current naturopathic physician's license in this State, and:
(1) 	Successfully passed the NPLEX Clinical Elective Minor Surgery
Examination; or
(2) 	Licensees who were licensed prior to the establishment of the
NPLEX may provide evidence of successful passage of a minor
surgery examination that was administered by another licensing
jurisdiction and required to allow the licensee to practice minor
surgery in that licensing jurisdiction. 	The licensee shall be
responsible for having the other licensing jurisdiction verify,
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directly to the board, the successful passage of the minor surgery
examination and that passage of that examination was required to
allow the licensee to practice minor surgery in that licensing
jurisdiction. 	[Eff and comp 2/14/11; comp 4/13/12] (Auth: 	HRS
§455-6) (Imp: HRS §§455-1, 455-6, 455-11)
SUBCHAPTER 11
STANDARDS OF PRACTICE, CARE, AND ETHICS
§16-88-80 	Code of ethics. 	(a) To provide protection to the general
public, a naturopathic physician shall abide by the following code of ethics:
(1) 	Honesty: 	A naturopathic physician shall conduct himself or
herself in an honest manner; shall not represent himself or herself
to patients or the public in an untruthful, misleading, or deceptive
manner; and shall not engage in advertising that is false or
deceptive.
(2) 	Improper relationship: 	A naturopathic physician shall not engage
in sexual relations with a patient unless that patient has been
released from the naturopathic physician's care for at least one
year. 	The termination of the physician-patient relationship shall
be 	in 	writing, 	and 	the 	patient 	shall 	understand 	that 	the
physician-patient relationship has ended.
(3) 	Privacy: 	A naturopathic physician shall maintain patient privacy
and confidentiality; provided that if the naturopathic physician
becomes aware that a patient is a danger to the public, the
naturopathic 	physician 	shall 	take 	reasonable 	steps 	to 	advise
appropriate public officials or agencies of the potential danger,
within the guidelines of applicable laws.
(4) 	Performance: 	A 	naturopathic 	physician 	shall 	perform
professional 	tasks 	and 	responsibilities 	to 	the 	best 	of 	the
naturopathic physician's ability, and refrain from engaging in any
behavior that will detract from his or her ability to engage in the
practice of naturopathic medicine.
(5) 	Obligation: 	The 	fundamental 	and 	primary 	obligation 	of 	a
naturopathic physician is to the patient, and the maintenance and
improvement of the patient's health and well-being.
(A) 	A naturopathic physician shall at all times seek to employ
methods of therapy that are consistent with naturopathic
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medical 	philosophy, 	scientific 	principles 	and 	evidence,
and the naturopathic physician's training and experience,
and shall provide patients with information about these
therapies and potential alternative therapies so that the
patient 	may 	give 	fully 	informed 	consent 	to 	the
recommended treatments.
(B) 	As part of the obligation to provide care, a naturopathic
physician shall use his or her best efforts to facilitate a
patient's 	access 	to 	high 	quality, 	safe 	and 	reliable
medicines, medical devices, and supplements.
(C) 	A naturopathic physician shall offer alternative sources for
obtaining the items in subparagraph (5)(B) as long as those
alternative sources do not compromise patient safety or
clinical effectiveness.
(D) 	The naturopathic physician shall adequately disclose the
contents of medicines or the nature and description of
treatments recommended to a patient.
(E) 	Furthermore, 	all 	therapies 	shall 	be 	monitored 	by 	the
naturopathic 	physician 	in 	a 	timely 	manner 	utilizing
reliable means in order to accurately assess the patient's
response to employed treatments.
(F) 	A naturopathic physician shall only provide or recommend
services that are medically necessary or deemed to be
beneficial for an individual patient.
(6) 	Competence: A naturopathic physician shall maintain proficiency
and 	competence, 	and 	be 	diligent 	in 	the 	provision 	and
administration of patient care.
(A) 	A 	naturopathic 	physician 	shall 	recognize 	and 	exercise
professional 	judgment 	within 	the 	limits 	of 	his 	or 	her
qualifications, and collaborate with others, seek counsel,
or make referrals as appropriate.
(B) 	When expanding the naturopathic treatments or services
provided to patients, a naturopathic physician shall pursue
the appropriate advanced education and training.
(C) 	A naturopathic physician shall dedicate sufficient time to
each 	patient 	in 	order 	to 	provide 	(to 	the 	best 	of 	the
naturopathic physician's ability) accurate, comprehensive,
and individualized patient assessment and treatment.
(7) 	Discrimination: 	A 	naturopathic 	physician 	is 	free 	to 	decide
whether 	or 	not 	to 	provide 	naturopathic 	medical 	care 	of 	a
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particular person, unless confronted with a medical emergency;
provided that the naturopathic physician shall not refuse his or
her best care if other reasonable options are not available.
(A) 	A naturopathic physician shall not decline to provide care
for a person or discriminate against others on the basis of
race, ethnicity, creed, religion, disability, sex, age, sexual
orientation, or national origin.
(B) 	Once the naturopathic physician-patient relationship has
begun, the naturopathic physician shall provide care until
care is complete, the patient ends the relationship, or the
naturopathic physician has discharged the patient from
care.
(C) 	If a naturopathic physician justifiably desires to end the
naturopathic 	physician-patient 	relationship, 	and 	if
continued medical care is appropriate, the naturopathic
physician 	shall 	document 	a 	formal 	referral 	to 	an
appropriate health care provider.
(8) 	Communication: 	A naturopathic physician has a duty to not only
communicate effectively with a patient, but also to educate the
patient and convey relevant information in terms the patient can
understand, providing adequate opportunity for the patient to ask
questions and discuss matters related to the patient's care.
(A) 	A naturopathic physician shall transfer a patient's records
to 	another 	health 	care 	provider at the request of the
patient, in accordance with appropriate and applicable
legal guidelines, in a reasonable and timely fashion, and at
reasonable cost.
(B) 	A naturopathic physician shall maintain confidentially of
all 	patient 	records 	unless 	otherwise 	instructed 	by 	the
patient or required by law.
(9) 	Conflicts of interest: 	If a naturopathic physician is faced with a
conflict of interest, the conflict shall be resolved in the best
interest of the patient.
(A) 	If a naturopathic physician has any financial interests that
may 	conflict 	with 	appropriate 	medical 	care, 	the
naturopathic physician shall disclose those interests to the
patient.
(B) 	A naturopathic physician who makes written or oral public
statements 	concerning 	specific 	products 	sold 	by 	a
company from which the naturopathic physician receives
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compensation, 	or 	in 	which 	the 	naturopathic 	physician
holds an ownership interest, shall disclose this financial
relationship in those public statements.
(10) 	Improper conduct: 	A naturopathic physician shall not prescribe,
provide, or seek compensation for medical services that are not
specifically indicated for an individual patient.
(11) 	Influence: A naturopathic physician shall not exert influence over
a patient to undertake any action that is contrary to the patient's
best interest.
(12) 	Accepting gifts: 	A naturopathic physician shall not accept gifts
from any individual or entity that are deemed to influence the
naturopathic physician's professional clinical judgment.
(b) 	The failure to comply with any of the provisions of this section
shall subject a licensee to discipline under chapters 436B and 455, HRS, and this
chapter. 	[Eff and comp 4/13/12] (Auth: 	HRS §455-6) (Imp: HRS §§436B-18 to
436B-19, 436B-20 to 436B-28, 455-6, 455-11)
§16-88-81 Standards of practice and care. (a) Basic standards. To protect
the general public, a naturopathic physician shall make a good faith effort to abide
by the standards of practice and patient care provided in this section.
(b) 	Ongoing education. 	A naturopathic physician shall use his or her
best efforts to keep up with the changes and advancements in naturopathic
medicine.
(1) 	A naturopathic physician shall critically and without bias evaluate
new therapeutic agents and methods that may be of benefit to the
naturopathic physician's patients; and
(2) 	A naturopathic physician shall use his or her best efforts to
continually 	evolve 	the 	naturopathic 	physician's 	practice 	of
medical care to provide increased benefit to patients.
(c) 	Primary care. A naturopathic physician is trained to be a primary
care family practice physician, and may choose to emphasize or specialize in
certain methods, modalities, or areas of practice, either singly or within the
scope of a general practice.
(d) 	Specialization. 	If a naturopathic physician decides to emphasize
or specialize in certain methods, modalities, or areas of practice within the scope
of a general practice, the naturopathic physician shall:
(1) 	Disclose 	the 	nature 	of 	the 	naturopathic 	physician's 	limited
practice to the public, patients, and colleagues; and
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§16-88-81
(2) 	Make appropriate referrals if requested by a patient, or if a
patient requires treatment that is not within the limited practice.
(e) 	Naturopathic 	physician's 	role 	in 	health 	promotion. A
naturopathic physician's role in health promotion includes:
(1) 	The prevention of disease through education and the promotion of
healthy ways of living. A naturopathic physician shall:
(A) 	Assess risk factors and hereditary susceptibility to disease;
(B) 	Make 	appropriate 	interventions 	to 	prevent 	illness 	and
assist patients to achieve their optimum health;
(C) 	Encourage 	a 	patient 	towards 	independence 	and
self-direction;
(D) 	View health optimization as the ultimate goal rather than
crisis intervention;
(E) 	Assist 	a 	patient 	to 	identify, 	test 	out, 	and 	evaluate
constructive patterns of living; and
(F) 	Reinforce positive behavior patterns.
(2) 	Following the guidelines of applicable public health agencies
including:
(A) 	Reporting diseases; and
(B) 	Keeping up with public health data such as updates issued
by the U.S. Centers for Disease Control and Prevention
and the State Department of Health.
(3) 	Using methods to prevent illness and maintain optimum health
such as:
(A) 	Periodic 	screening 	for 	common 	risk 	factors, 	such 	as
elevated 	serum 	(blood) 	glucose, 	hypertension, 	and
obesity; and
(B) 	Periodic screening for specific diseases such as cancer,
coronary 	artery 	disease, 	diabetes, 	osteoporosis, 	and
thyroid dysfunction.
(f) 	Patient records. 	A naturopathic physician shall keep clear and
concise records documenting patient care. 	Records shall be legible, orderly,
complete, and abbreviations and symbols employed shall be commonly used and
understood. 	The 	Problem 	Oriented 	Medical 	Record, 	also 	known 	as 	the
Subjective, Objective, Assessment and Plan (SOAP) format, shall be used as the
standard form for keeping records.
(1) 	Patient data may be collected from:
(A) 	The patient affected;
(B) 	The patient's family or friends; or
(C) 	Medical records from previous physicians, or other health
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§16-88-81
care providers, for the purpose of patient evaluation.
(2) 	Patient records shall include the following:
(A) 	Identifying 	data 	(e.g., 	name, 	age, 	sex, 	occupation,
nationality, etc.);
(B) 	Description of the patient's chief complaint, preferably in
the patients' own words;
(C) 	History of the present illness including any concurrent
medical problems;
(D) 	Past medical history (e.g., previous illnesses, surgeries,
medications, 	hospitalizations, 	childhood 	illnesses,
accidents, injuries, pregnancies, etc.);
(E) 	Current health status (e.g., allergies, current medications
and supplements, immunization history, tobacco, alcohol
or recreational drug use, exercise and leisure activities,
sleep habits, diet, environmental hazards, etc.);
(F) 	Family 	history 	(e.g., 	familial 	tendencies, 	genetic
predispositions, infectious diseases, etc.);
(G) 	Psychosocial disposition (e.g., brief biography, family and
home situation, occupation, lifestyle, emotional make-up,
stressors, typical daily events, etc.);
(H) 	Review 	of 	systems 	or 	written 	positive 	findings 	and
pertinent negatives;
(I) 	Patient's general appearance, vital signs, and the results of
the 	rest 	of 	the 	examination whether it is regional or
comprehensive; and
(J) 	Results of any laboratory studies.
(g) 	Diagnostic 	criteria. 	A 	naturopathic 	physician 	shall 	use
conventional medical diagnostic criteria in the establishment of a diagnosis,
taking 	into 	account 	all 	information 	recorded 	in 	subsection 	(f)(2). 	Other
diagnostic 	criteria 	may 	be 	used, 	including 	those 	of 	non-western 	medical
traditions. 	All diagnostic criteria shall be consistent with other health care
disciplines that utilize the same criteria. 	A naturopathic physician may use a
combination of conventional and other diagnostic criteria. 	A naturopathic
physician utilizing diagnostic criteria other than conventional diagnostic criteria
shall also apply conventional forms when:
(1) 	A patient is also being evaluated by another health care provider
for 	the 	same 	or 	a 	related 	condition, 	in 	order 	to 	maintain
continuity among the different disciplines of medicine and to
assure quality patient care;
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§16-88-81
(2) 	Faced with a life threatening or degenerative illness with the
possibility that interventional therapies may be needed;
(3) 	The naturopathic physician knows that a patient will need referral
for the same or other illnesses;
(4) 	A patient requests it; or
(5) 	As required by State law.
(h) 	Assessment. 	A naturopathic physician shall begin a written
assessment 	with 	a 	summary 	of 	the 	patient's 	medical 	history 	and 	physical
examination that recaps the findings in a way that supports the differential
diagnosis or working diagnosis. 	The assessment shall include an explanation of
the analysis and reasoning for the assessment that includes:
(1) 	The type of care that is needed (e.g., immediate, acute, chronic,
long or short-term);
(2) 	A discussion of naturopathic considerations; and
(3) 	A patient's ability to respond to treatment based on past medical
history and the naturopathic physicians' subjective assessment.
(i) 	Treatment plan. A naturopathic physician shall develop a specific
written health plan for each patient that is:
(1) 	Rational and is:
(A) 	Based on identified needs;
(B) 	Realistic in its goals;
(C) 	Practical in light of the patient's condition and situation;
(D) 	In the best interest of the patient;
(E) 	Logical in sequence and internally consistent;
(F) 	Prioritized to the patient's most pressing conditions;
(G) 	Compatible 	with 	other 	therapies 	the 	patient 	may 	be
undergoing;
(H) 	Cost effective;
(I) 	Flexible to accommodate new developments, findings, and
(J) 	Experimental only with informed consent and only in
areas of a naturopathic physician's expertise.
(2) 	Based on proper assessment, including:
(A) 	Ruling 	out 	or 	identifying 	life-threatening 	or 	hidden
conditions 	with 	appropriate 	history, 	examination 	and
testing, including referral for specialized evaluation, when
appropriate; and
(B) 	Allowing for timely on-going reassessment.
(3) 	Based on naturopathic principles including:
(A) 	Stimulating a patient's vital force to promote healing or,
in special instances, supplementing or replacing the action
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§16-88-81
of the vital force when the patient is unable to respond to
curative treatment;
(B) 	Removing the cause of conditions, when known;
(C) 	Choosing treatments that pose the least risk of patient
harm;
(D) 	Individualizing treatments to the whole patient, including
referral 	to 	appropriate 	health 	care 	providers 	for
specialized therapies;
(E) 	Educating a patient to participate responsibly in his or her
own health care and to learn the principles for building of
health and preventing future disease;
(F) 	Involving, when appropriate, others significant to a patient
in the treatment plan; and
(G) 	Prevention of disease.
(4) 	Self-critical, but is not limited to:
(1) 	A mechanism for timely evaluation of plan effectiveness;
and
(2) 	A mechanism for timely modification of failed plans,
including 	referral 	to 	other 	appropriate 	health 	care
providers.
(j) 	Consent to treatment. 	A naturopathic physician shall inform a
patient of the patient's right to informed consent and freedom of choice in health
care and present the patient with all the options for medical care in an unbiased
manner. 	A naturopathic physician may express his or her opinion as to the
quality of the different types of health care options, or if requested to by the
patient.
(k) 	Patient participation. 	A naturopathic physician shall encourage
patient participation in a patient's own health care as it is recognized that such
participation leads to better compliance and a faster recovery. 	The naturopathic
physician shall assess whether a patient has the ability to participate; provided
that this assessment shall include the:
(1) 	Ability of the patient to understand the nature of the illness;
(2) 	Ability of the patient to understand the medical options available
and their consequences;
(3) 	Patient's mental status; and
(4) 	Ability of the patient to make an informed consent.
(l) 	Goals and priorities of the naturopathic physician and patient.
The naturopathic physician, patient, or a combination of both shall set the goals
and priorities. 	If in the opinion of the naturopathic physician, a patient makes a
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§16-88-81
choice that may be harmful to the patient, the naturopathic physician shall
document this in the patient's records, and:
(1) Inform the patient of such, and offer to continue or resume treating
the patient if the patient so desires;
(2) Refuse to participate further in the health care of the patient by both
verbal and written notice to patient; or
(3) Refer the patient to another health care provider.
(m) 	Family participation. 	Family members may participate in setting
goals and priorities at the discretion of the patient or naturopathic physician. 	In
the event that a patient is unable to make choices for himself or herself or
participate in the patient's health care, the patient's spouse, parent, eldest or
designated child, or court appointed guardian or advocate shall participate on the
patient's behalf.
(n) 	Progress review. 	A naturopathic physician shall determine when
health care plans should be reviewed, and shall be reviewed in the event the
patient fails to progress.
(o) 	Patient 	progress 	assessment. 	A 	naturopathic 	physician 	shall
assess patient progress using subjective evaluation and objective measurement of
progress when appropriate. 	Subjective evaluation of assessment is solicited
from the patient, recorded by the physician, and is a gauge of progress.
Objective measurement of progress can be determined by the restoration of
function 	or 	decrease 	in 	symptoms 	using 	such 	methods 	as 	physical
measurements, function scales, or by appropriate diagnostic, laboratory, and
imaging methods.
(1) 	A naturopathic physician shall measure patient progress against
the 	naturopathic 	physician's 	prognosis 	to 	determine 	the
naturopathic physician's response to a patient's treatment.
(A) 	If 	the 	assessed 	progress 	is 	deemed 	appropriate, 	the
treatment plan should be continued. 	Treatment would be
discontinued when sufficient progress had been achieved,
or revised, based upon the patient's response;
(B) 	Lack of appropriate progress could indicate the need for
reevaluation 	of 	the 	treatment 	plan 	or 	the 	need 	for
reevaluation of the condition or underlying basis of the
condition being treated; or
(C) 	In cases where no progress is made, at some point the
determination to refer the patient for consultation with
another health care provider may be necessary. 	The
timing of such determination is based in part upon the
prognosis in the patient's case. A referral for this purpose
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shall be made in a timely manner, to preserve the health
of the patient.
(2) 	A naturopathic physician may consult with a patient's family
members in the assessment of progress. A naturopathic physician
shall encourage the patient to seek a second opinion if the patient
disagrees 	with 	the 	naturopathic 	physician's 	assessment 	of
progress. 	The naturopathic physician shall inform the patient of
the patient's progress, through family or individual conferences,
periodic or yearly evaluations, by letter or phone consultation;
refer the patient to another health care provider if no progress is
being made after a reasonable length of time; and change the
treatment protocol based upon reevaluation of the case.
(p) 	The failure to comply with any of the provisions of this section
shall subject a licensee to discipline under chapter 455, HRS, and this chapter.
[Eff and comp 4/13/12] (Auth: HRS §455-6) (Imp: HRS §§455-6, 455-11)
88-25

Amendments to and compilation of chapter 16-88, Hawaii Administrative
Rules, on the Summary page dated February 10, 2012, were adopted on February
10, 2012, following a public hearing held on February 10, 2012, after public notice
was given in the Star Advertiser, The Garden Island, The Maui News, West
Hawaii Today, and Hawaii Tribune-Herald on January 8, 2012.
They 	shall 	take 	effect 	ten 	days 	after 	filing 	with 	the 	Office 	of 	the
Lieutenant Governor.
/s/ Michael L. Traub, N.D.
MICHAEL L. TRAUB, N.D., Chairperson
Board of Naturopathic Medicine
APPROVED AS TO FORM: 	Date 3/15/12
/s/ Rodney J. Tam
Deputy Attorney General
APPROVED: 	Date 3/27/12
/s/ Kealii S. Lopez
KEALII S. LOPEZ, Director
Commerce and Consumer Affairs
APPROVED: 	Date 3/30/12
/s/ Neil Abercrombie
NEIL ABERCROMBIE, Governor
State of Hawaii
April 3, 2012
Filed
88-27

DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Amendment and Compilation of Chapter 16-88
Hawaii Administrative Rules
February 10, 2012
SUMMARY
1. 	A new §16-88-80 is added.
2. 	A new §16-88-81 is added.
3. 	Chapter 88 is compiled.
This material can be made available for individuals with special needs. Please call the Program Specialist,
Professional and Vocational Licensing Division, DCCA, at 586-2692, to submit your request.
Effective 04/13/12