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Board of Homeopathic Medical Examiners (August 2007, Report No. 07-07)

 

 

SUMMARY

The Office of the Auditor General has conducted a performance audit and sunset review of the Board of Homeopathic Medical Examiners (Board) pursuant to a May 22, 2006, resolution of the Joint Legislative Audit Committee. This audit was conducted as part of the sunset review process prescribed in Arizona Revised Statutes (A.R.S.) §41-2951 et seq.

The Board was organized in 1981 after certain physicians regulated by the Arizona Medical Board (AMB) alleged that the the AMB was antagonistic toward nontraditional medicine. In order to obtain a license, applicants must have an active allopathic (MD) or osteopathic (DO) license from Arizona or another U.S. state, district, or territory. However, after obtaining a homeopathic license, the physician can allow the allopathic or osteopathic license to lapse. As of May 2007, the Board had 104 licensed homeopathic physicians; 11 of these had active Arizona DO licenses, 44 had active Arizona MD licenses, and 21 practice under their MD(H) license without an Arizona MD or DO license. The remaining 28 homeopathic physicians reside out of state.

Homeopathy is traditionally a system of medicine that seeks to stimulate the body’s own healing response when health problems develop. It was developed by Samuel Hahnemann in Germany in the late 1700s. In 1810, he published the Organon of Medicine, which describes the homeopathic philosophy and practice. Homeopathic medicine is holistic. Homeopathic physicians treat the body as an integrated whole and view symptoms as attempts by the body to heal itself. Therefore, homeopathic drugs administered in microdosages stimulate the symptoms of a disease and help the body to heal. However, in Arizona the statutory definition of homeopathy encompasses numerous other therapies, including:

  • Acupuncture—The diagnosis and treatment of ailments using needles, heat, or physical and electromagnetic impulses or currents.
     

  • Chelation therapy—The use of a synthetic solution injected into the body where it binds with metals and is excreted through the kidneys.
     

  • Homeopathy—A system of medicine that treats symptoms in accordance with the principle that a substance that produces symptoms in a healthy person will cure those symptoms in a sick person.
     

  • Minor surgery—Surgical procedures performed in an outpatient setting, including repairing injuries to the skin or mucous membranes and using topical, local, or regional anesthetics.
     

  • Neuromuscular integration—The use of manual methods, physical agents, and physical medicine procedures and devices to normalize body structure.
     

  • Nutrition—The recommendation of therapeutic or preventive dietary measures, food factor concentrates, fasting and cleansing regimens, and the rebalancing of digestive system function.
     

  • Orthomolecular therapy—The use of an optimum concentration of vitamins, minerals, and other substances normally present in the human body.
     

  • Pharmaceutical medicine—The use of prescription-only and nonprescription pharmaceuticals, as well as botanical, biological, or mineral medicines.

Legislature should consider best regulation
method (see pages 13 through 25)

The Legislature should consider whether there is a need to continue the Board. Both board members and supporters continue to support the Board’s existence. Some board members argue that the Board’s presence increases access to care and continuity of care because patients can see one physician for all of their care rather than several different practitioners. Homeopathic treatments are available from practitioners other than homeopathic physicians, such as naturopaths. However, some board members assert that homeopathic physicians have a greater depth of medical knowledge and therefore a better understanding of how to treat disease or dysfunction. Board supporters also believe that the AMB and the Osteopathic Board are still intolerant of homeopathic physicians. In fact, at the January 2007 board meeting, several patients of homeopathic physicians reported that the Board was critical to ensuring they could continue to obtain their healthcare of choice. Although allopathic and osteopathic physicians are not restricted from practicing any of the therapies that the Homeopathic Board regulates, the use of chelation therapy is more strictly limited by the AMB and is not embraced by the Osteopathic Board (although some procedures may be within its standard of care). Furthermore, the Osteopathic Board reports that it considers orthomolecular therapy to be an experimental treatment and would expect any physician using the therapy to comply with statutory requirements for experimental therapies, including informed patient consent, periodic analysis of results, and peer review. These regulations are not required for homeopathic physicians to practice orthomolecular therapy.

Although the Board was created to address perceived intolerance for nontraditional care, nontraditional medicine is more accepted than it was in the 1980s. According to the Centers for Disease Control and Prevention, National Center for Health Statistics, in 2002, 36 percent of adults reported using nontraditional medicine. In addition, during the 2002-2003 academic year, 98 out of 126 medical schools in the United States included nontraditional medicine as a topic in at least one required course. Further, allopathic and osteopathic physicians in Arizona are not statutorily restricted from practicing the therapies within the Board’s purview. In addition, naturopathic physicians can practice the same or similar therapies that homeopathic physicians practice, and other licensed providers in the State provide many of the therapies as well. For example, naturopathic physicians can practice acupuncture, chelation therapy, homeopathy, nutrition, orthomolecular therapy, pharmaceutical medicine, and minor surgery. Finally, a separate board is not a common approach nation-wide to regulating nontraditional medicine. Arizona is one of only three states with a separate board for homeopathy. Auditors identified at least 14 states that have statutes to address allopathic and osteopathic physicians’ practice of nontraditional medicine. These statutes include: specifying that using nontraditional methods is not unprofessional conduct, prohibiting boards from denying a license to an applicant because the physician practices nontraditional medicine, requiring oral or written informed patient consent when physicians provide nontraditional care, and requiring at least one of its board members to be a physician who practices nontraditional medicine. If the Legislature chooses to sunset the Board, it would need to determine how to address the issue of those homeopathic physicians left without a license to practice. For example, the Legislature could require them to obtain either an allopathic or osteopathic license to continue to practice or allow them to be grandfathered in to the respective board that previously licensed them if their licenses are or were in good standing. The Legislature would also need to address the Board’s responsibility for registering homeopathic medical assistants. Options include permitting homeopathic medical assistants to continue as such without requiring the training prescribed by rule for allopathic and osteopathic medical assistants, authorizing the AMB or the Osteopathic Board to set up a registration system for such assistants as currently exists for the Homeopathic Board, or taking no action, which would require homeopathic medical assistants to qualify under the existing AMB or Osteopathic Board Rules.

If the Legislature chooses to continue the Board, the Legislature and the Board need to take steps to address three regulatory issues that potentially limit the protection provided to the public. First, the Board appears to allow conduct that the other two Arizona physician regulatory boards have determined is unsafe or unprofessional. For example, the Board has allowed two physicians to continue to practice although either the AMB or the Osteopathic Board has revoked their licenses. As a result, the Board’s actions have contradicted the other board’s actions. The Legislature should consider forming a study committee comprising, at a minimum, members of the Board, the AMB, and the Osteopathic Board to determine the best way to help ensure that one board's actions do not negate or mitigate another board's actions, including any recommended statutory changes. Second, members of the public may be confused by a physician holding both a homeopathic and an allopathic or osteopathic license. As a result, they may not know whether the treatment being provided is traditional or nontraditional. To ensure that patients know they are receiving nontraditional treatment, the Legislature should consider amending board statutes to require homeopathic physicians to obtain informed consent, and the Board should determine what information should be included in a written informed patient consent and develop a policy to require it. Finally, the Board’s name does not reflect the scope of therapies Arizona-licensed homeopathic physicians can practice. Homeopathy is only one of many therapies the Board’s statutes authorize; therefore, the Board should identify a more appropriate name and request that the Legislature change the Board’s name to more accurately reflect the therapies authorized in its statutes.

Board needs to improve its complaint-handling
practices (see pages 27 through 33)

If the Board is continued, it needs to improve its complaint-handling process. The Auditor General’s Office has found that health regulatory board complaints should be resolved in 180 days or fewer, but more than one-third of the Board’s 41 complaints received in fiscal years 2004 through 2006 were open longer than 180 days. Further, all 6 complaints open in November 2006 had been open longer than 180 days. Several factors contribute to the Board’s delay in resolving complaints, including waiting for another board to agree that the Board has jurisdiction before beginning an investigation, holding investigational interviews in board meetings rather than having a board member or a designee conduct the interview outside of the board meeting, and lacking time frames for the complaint process as well as a system to monitor complaint progress.

In addition, when the Board considers complaints, it sometimes fails to decide whether or not each allegation was substantiated as part of the adjudication. For example, in considering a complaint involving misdiagnosing a patient’s condition, the Board discussed that the therapy used was allowed under the Board’s statutes, but it did not address the allegation that the physician had inappropriately diagnosed the patient’s condition.

Licensure does not ensure competency in
authorized therapies (see pages 35 through 39)

If the Board is continued, the Legislature and the Board should take steps to ensure that its licensees are sufficiently qualified to practice all the therapies authorized by statute. A.R.S. §32-2901(22) identifies several therapies that homeopathic physicians can practice, but the Board lacks clear statutory authority to ensure that its licensees are qualified to practice those therapies. The Board does not limit a physician’s practice to only those therapies in which the applicant is educated, apparently because the Board’s statutes do not specifically allow such a limitation. To ensure that homeopathic physicians are sufficiently trained to practice, the Legislature should consider amending A.R.S. §32-2912 to limit a physician’s practice to the therapies he or she is educated in.

In addition, the Board has not developed exams that ensure its licensees have adequate knowledge to practice all therapies. First, the Board’s written exam covers only homeopathy and none of the other therapies allowed by the Board’s statutes. Second, although the Board has an oral exam, it does not require the applicant to discuss all authorized therapies during the oral exam. In addition, the oral exam is not considered a confidential record by statute and is conducted during the regular session of board meetings. The Board needs to take steps to develop and implement comprehensive written and oral exams that cover all therapies the homeopathic license authorizes. In addition, the Board should seek a statutory change to classify the oral exam as a confidential record.

Finally, unlike other Arizona health regulatory boards, the Board does not require homeopathic physicians to obtain continuing education to renew their license. During the course of the audit, the Board began to develop continuing education requirements. To ensure homeopathic licensees are educated in their field’s most recent developments, the Legislature should consider amending board statutes to require continuing education for its licensees.

Other pertinent information (see pages 41 through 42)

The Board’s statutes require that a physician be of good moral character; have a professional record that indicates that a license to practice medicine has not been refused, revoked, suspended, or restricted in any way; and have a professional record that indicates that the applicant has not engaged in any conduct that would constitute grounds for disciplinary action against the homeopathic license. However, statute also allows the Board to determine whether the conduct has been corrected, monitored, and resolved to its satisfaction. Between fiscal years 2004 and 2006, the Board considered 23 applications for homeopathic physicians. Of those, 2 were from applicants who had a felony conviction, and the Board licensed both of the applicants after discussing their cases in public board meetings. Some Arizona health regulatory boards have similar language in their statutes; auditors identified only two boards, the Board of Nursing and the Board of Massage Therapy, that bar felons from applying for a license until 5 years after conviction or after they have completed their sentences.


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