Haw. Code R. § 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

(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 andassist 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 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;

(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 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 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 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.

Notes

Haw. Code R. § 16-88-81

[Eff and comp 4/13/12] (Auth: HRS § 455-6) (Imp: HRS §§ 455-6, 455-11)