1.1                          A bill for an act
  1.2             relating to health; allowing complementary and 
  1.3             alternative health care practitioners to practice in 
  1.4             certain circumstances; creating informed consent and 
  1.5             notice requirements; establishing civil penalties; 
  1.6             amending Minnesota Statutes 1998, section 147.09; 
  1.7             proposing coding for new law as Minnesota Statutes, 
  1.8             chapter 146A. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [146A.01] [CITATION.] 
  1.11     This chapter may be cited as the Complementary and 
  1.12  Alternative Health Care Freedom of Access Act. 
  1.13     Sec. 2.  [146A.02] [DEFINITIONS.] 
  1.14     Subdivision 1.  [APPLICABILITY.] For purposes of this 
  1.15  chapter, the following terms have the meanings given to them. 
  1.16     Subd. 2.  [COMPLEMENTARY AND ALTERNATIVE HEALTH CARE CLIENT 
  1.17  OR CLIENT.] "Complementary and alternative health care client" 
  1.18  or "client" means an individual who receives services from an 
  1.19  unlicensed complementary and alternative health care 
  1.20  practitioner. 
  1.21     Subd. 3.  [COMPLEMENTARY AND ALTERNATIVE HEALTH CARE 
  1.22  PRACTICES.] (a) "Complementary and alternative health care 
  1.23  practices" means the broad domain of complementary and 
  1.24  alternative healing methods, treatments, and resources, 
  1.25  including, but not limited to:  (1) acupressure; (2) 
  1.26  anthroposophy; (3) aroma therapy; (4) ayurvedic medicine; (5) 
  1.27  cranial sacral therapy; (6) culturally traditional healing 
  2.1   practices; (7) detoxification practices and therapies; (8) 
  2.2   energetic healing; (9) environmental medicine; (10) folk 
  2.3   medicine; (11) healing practices utilizing food, food 
  2.4   supplements, nutrients, and the physical forces of heat, cold, 
  2.5   water, touch, and light; (12) Gerson therapy and colostrum 
  2.6   therapy; (13) healing touch; (14) herbal medicine; (15) 
  2.7   homeopathy; (16) iridology; (17) body work, massage, and massage 
  2.8   therapy; (18) meditation; (19) mind-body healing practices; (20) 
  2.9   naturopathy; (21) noninvasive instrumentalities; (22) 
  2.10  traditional Oriental practices, such as Qi Gong energy healing; 
  2.11  and (23) other health care and healing practices and resources 
  2.12  pursued by clients for the purpose of preventing or treating 
  2.13  illness or promoting health and well-being. 
  2.14     (b) Complementary and alternative health care practices, in 
  2.15  and of themselves, do not include surgery, x-ray radiation, 
  2.16  administering or dispensing legend drugs and controlled 
  2.17  substances, practices that invade the human body by puncture of 
  2.18  the skin, or the manipulation or adjustment of articulations of 
  2.19  joints or the spine as described in section 146.23 or 148.01. 
  2.20     (c) Complementary and alternative health care practices do 
  2.21  not include practices that are permitted under section 147.09, 
  2.22  clause (11), or 148.271, clause (5).  
  2.23     Subd. 4.  [UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH 
  2.24  CARE PRACTITIONER.] "Unlicensed complementary and alternative 
  2.25  health care practitioner" means a person who is: 
  2.26     (1) not licensed or registered by a health-related 
  2.27  licensing board, as defined in section 214.01, or by the 
  2.28  commissioner of health; 
  2.29     (2) engaging in complementary and alternative health care 
  2.30  practices; and 
  2.31     (3) engaging in complementary and alternative health care 
  2.32  practices for remuneration, or holding out to the public as a 
  2.33  practitioner of complementary and alternative health care 
  2.34  practices. 
  2.35     Sec. 3.  [146A.03] [PRACTITIONER RIGHTS AND 
  2.36  RESPONSIBILITIES.] 
  3.1      An unlicensed complementary and alternative health care 
  3.2   practitioner has the right to engage in complementary and 
  3.3   alternative health care practices if: 
  3.4      (1) the practitioner provides the appropriate disclosures, 
  3.5   notices, and informed consent required under section 146A.04 to 
  3.6   the client before treatment commences; and 
  3.7      (2) the practitioner receives the informed consent form 
  3.8   back from the client, signed and dated by the client, before 
  3.9   treatment commences. 
  3.10     Sec. 4.  [146A.04] [DISCLOSURES, NOTICES, AND INFORMED 
  3.11  CONSENT.] 
  3.12     (a) Before providing treatment to a client, an unlicensed 
  3.13  complementary and alternative health care practitioner must 
  3.14  provide the following information in writing to the client: 
  3.15     (1) the practitioner's professional title and health care 
  3.16  services available from the practitioner; 
  3.17     (2) the practitioner's education, experience, and training, 
  3.18  and any credentials, continuing education, and professional 
  3.19  affiliations related to the complementary and alternative health 
  3.20  care practices in which the practitioner engages; and 
  3.21     (3) information regarding the fee schedule, billing 
  3.22  practices, and insurance reimbursement. 
  3.23     (b) Before providing treatment to a client, an unlicensed 
  3.24  complementary and alternative health care practitioner must 
  3.25  inform the client of the following: 
  3.26     (1) the nature and purpose of the proposed treatment or 
  3.27  procedure; 
  3.28     (2) the benefits that may most likely be expected from the 
  3.29  proposed treatment or procedure; and 
  3.30     (3) the significant risks and side effects associated with 
  3.31  the proposed treatment or procedure. 
  3.32     (c) Before providing treatment to a client, an unlicensed 
  3.33  complementary and alternative health care practitioner must 
  3.34  provide the following informed consent form to the client and 
  3.35  must receive the signed, dated form back from the client: 
  3.36     "I ...................., Client (or client's legal 
  4.1   guardian), hereby authorize .........................., 
  4.2   Practitioner, to provide complementary and alternative health 
  4.3   care to me. 
  4.4      The complementary and alternative health care practitioner 
  4.5   has provided information to me in writing about the 
  4.6   practitioner's education, experience, and training; the services 
  4.7   the practitioner provides; and information regarding fees, 
  4.8   billings, and insurance practices.  The practitioner has 
  4.9   discussed with me the nature and purpose of the proposed 
  4.10  treatment; the benefits that may most likely be expected; and 
  4.11  the common risks and side effects associated with the 
  4.12  treatment.  I have had sufficient opportunity to discuss my 
  4.13  condition and treatment with the health care practitioner, and 
  4.14  all of my questions have been answered to my satisfaction.  I 
  4.15  believe that I have adequate information about the proposed 
  4.16  course of treatment and that I understand this information. 
  4.17     I understand that THE STATE OF MINNESOTA HAS NOT ADOPTED 
  4.18  UNIFORM EDUCATIONAL AND QUALIFICATION STANDARDS FOR 
  4.19  COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS.  THE 
  4.20  PRACTITIONER'S STATEMENT OF CREDENTIALS IS FOR INFORMATIONAL 
  4.21  PURPOSES ONLY.  I understand that I can direct my complaints 
  4.22  regarding complementary and alternative health care 
  4.23  practitioners to the office of health care consumer assistance, 
  4.24  advocacy, and information at the Minnesota department of health. 
  4.25     I understand that (1) the practitioner is not credentialed 
  4.26  in the state of Minnesota to practice medicine, chiropractic, 
  4.27  osteopathy, nursing, physical therapy, dietetics or nutrition 
  4.28  practice, or acupuncture practice; (2) the practitioner may 
  4.29  provide me with personal consultations, screenings, assessments, 
  4.30  an explanation of the practitioner's method of detection and 
  4.31  assessment of my health problems and concerns, educational 
  4.32  services, and recommendations regarding the complementary and 
  4.33  alternative health care practice to be used; and (3) these 
  4.34  actions do not constitute a diagnosis from a licensed physician, 
  4.35  chiropractor, or acupuncture practitioner. 
  4.36     I understand that if I desire a diagnosis from a licensed 
  5.1   physician, chiropractor, or acupuncture practitioner, or 
  5.2   services from a physician, chiropractor, nurse, osteopath, 
  5.3   physical therapist, dietitian, nutritionist, acupuncture 
  5.4   practitioner, or any other type of health care provider, I may 
  5.5   seek such services at any time. 
  5.6      I understand that my health care records and communications 
  5.7   and transactions with the practitioner shall be kept 
  5.8   confidential, unless I authorize the release of records in 
  5.9   writing or as otherwise provided by law. 
  5.10     I understand that if I decide to act on the proposed 
  5.11  assessment, treatment, or recommendations of this health care 
  5.12  practitioner, I do so at my own risk.  I hereby accept these 
  5.13  possible risks and limitations. 
  5.14  ....................................     ..........  
  5.15  Client or Legal Guardian's Signature     Date"
  5.16     Sec. 5.  [146A.05] [SANCTIONS AGAINST PRACTITIONERS 
  5.17  LIMITED.] 
  5.18     (a) No civil remedy or disciplinary action may be sought or 
  5.19  imposed against an unlicensed complementary and alternative 
  5.20  health care practitioner by the state, a political subdivision 
  5.21  of the state, or a health-related licensing board based on 
  5.22  section 214.11 or 214.131 or other civil action unless the 
  5.23  state, political subdivision, or licensing board can demonstrate 
  5.24  by a preponderance of the evidence that: 
  5.25     (1) there was no informed consent as required under section 
  5.26  146A.04; or 
  5.27     (2) the treatment method, when used as directed by the 
  5.28  complaining client, caused serious, direct, physical or mental 
  5.29  harm; the harm occurred as a result of the complementary and 
  5.30  alternative health care practice in and of itself; and the 
  5.31  client would not have otherwise suffered the harm. 
  5.32     (b) No criminal sanction may be sought or imposed against 
  5.33  an unlicensed complementary and alternative health care 
  5.34  practitioner by the state, a political subdivision of the state, 
  5.35  or a health-related licensing board for practicing medicine 
  5.36  without a license under section 147.081, subdivision 3, clause 
  6.1   (3). 
  6.2      (c) A client's choice to delay the use of conventional 
  6.3   medical care and receive complementary and alternative health 
  6.4   care practices is not, in and of itself, evidence of harm. 
  6.5      Sec. 6.  [146A.06] [PROFESSIONAL CONDUCT; UNLICENSED 
  6.6   COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS.] 
  6.7      Subdivision 1.  [PROHIBITED CONDUCT.] The following conduct 
  6.8   by an unlicensed complementary and alternative health care 
  6.9   practitioner is prohibited: 
  6.10     (1) engaging in sexual conduct with a client unless the 
  6.11  client is the practitioner's spouse or current or former sexual 
  6.12  partner, engaging in any verbal behavior that is seductive or 
  6.13  sexually demeaning to a client, or engaging in sexual 
  6.14  exploitation of a client; 
  6.15     (2) improper or unauthorized personal or other use of any 
  6.16  legend drugs as defined in section 151.01 or any controlled 
  6.17  substances as defined in section 152.01; 
  6.18     (3) revealing a communication from or relating to a client 
  6.19  without the client's express written authorization; or 
  6.20     (4) splitting fees or promising to pay a portion of a fee 
  6.21  to anyone other than for services rendered to a client by 
  6.22  another health care practitioner. 
  6.23     Subd. 2.  [PROHIBITED PRACTICE.] An unlicensed 
  6.24  complementary and alternative health care practitioner is 
  6.25  prohibited from engaging in complementary and alternative health 
  6.26  care practices if the practitioner: 
  6.27     (1) was convicted of a crime within the past five years, 
  6.28  including a finding or verdict of guilt, an admission of guilt, 
  6.29  or a no contest plea, in any court in Minnesota or any other 
  6.30  jurisdiction in the United States, reasonably related to 
  6.31  engaging in complementary and alternative health care 
  6.32  practices.  Conviction, as used in this clause, includes a 
  6.33  conviction of an offense which, if committed in this state, 
  6.34  would be deemed a felony or gross misdemeanor without regard to 
  6.35  its designation elsewhere, or a criminal proceeding where a 
  6.36  finding or verdict of guilty is made or returned but the 
  7.1   adjudication of guilt is either withheld or not entered; 
  7.2      (2) was convicted of criminal acts against persons within 
  7.3   the past five years.  For purposes of this clause, a crime 
  7.4   against a person means violations of the following:  sections 
  7.5   609.185; 609.19; 609.195; 609.20; 609.205; 609.21; 609.215; 
  7.6   609.221; 609.222; 609.223; 609.224; 609.2242; 609.23; 609.231; 
  7.7   609.2325; 609.233; 609.2335; 609.235; 609.24; 609.245; 609.25; 
  7.8   609.255; 609.26, subdivision 1, clause (1) or (2); 609.265; 
  7.9   609.342; 609.343; 609.344; 609.345; 609.365; 609.498, 
  7.10  subdivision 1; 609.50, subdivision 1, clause (1); 609.561; 
  7.11  609.562; 609.595; and 609.72, subdivision 3; or 
  7.12     (3) is currently adjudicated as mentally incompetent or as 
  7.13  a person who is dangerous to self, or adjudication pursuant to 
  7.14  chapter 253B as chemically dependent, mentally retarded, 
  7.15  mentally ill and dangerous to the public, or a sexual 
  7.16  psychopathic personality or sexually dangerous person. 
  7.17     Subd. 3.  [ENFORCEMENT.] A city attorney or county attorney 
  7.18  shall enforce the provisions of subdivisions 1 and 2 by seeking 
  7.19  civil penalties against, or by seeking injunctive relief to 
  7.20  enjoin, limit, or condition the practice of, any unlicensed 
  7.21  complementary and alternative health care practitioner who 
  7.22  violates any provision of subdivision 1 or 2.  A client with a 
  7.23  complaint about the care received from an unlicensed 
  7.24  complementary and alternative health care practitioner may 
  7.25  contact the office of health care consumer assistance, advocacy, 
  7.26  and information established under sections 62J.77 to 62J.79 
  7.27  regarding the complaint. 
  7.28     Sec. 7.  Minnesota Statutes 1998, section 147.09, is 
  7.29  amended to read: 
  7.30     147.09 [EXEMPTIONS.] 
  7.31     Section 147.081 does not apply to, control, prevent or 
  7.32  restrict the practice, service, or activities of:  
  7.33     (1) A person who is a commissioned medical officer of, a 
  7.34  member of, or employed by, the armed forces of the United 
  7.35  States, the United States Public Health Service, the Veterans 
  7.36  Administration, any federal institution or any federal agency 
  8.1   while engaged in the performance of official duties within this 
  8.2   state, if the person is licensed elsewhere.  
  8.3      (2) A licensed physician from a state or country who is in 
  8.4   actual consultation here.  
  8.5      (3) A licensed or registered physician who treats the 
  8.6   physician's home state patients or other participating patients 
  8.7   while the physicians and those patients are participating 
  8.8   together in outdoor recreation in this state as defined by 
  8.9   section 86A.03, subdivision 3.  A physician shall first register 
  8.10  with the board on a form developed by the board for that 
  8.11  purpose.  The board shall not be required to promulgate the 
  8.12  contents of that form by rule.  No fee shall be charged for this 
  8.13  registration.  
  8.14     (4) A student practicing under the direct supervision of a 
  8.15  preceptor while the student is enrolled in and regularly 
  8.16  attending a recognized medical school.  
  8.17     (5) A student who is in continuing training and performing 
  8.18  the duties of an intern or resident or engaged in postgraduate 
  8.19  work considered by the board to be the equivalent of an 
  8.20  internship or residency in any hospital or institution approved 
  8.21  for training by the board, provided the student has a residency 
  8.22  permit issued by the board under section 147.0391. 
  8.23     (6) A person employed in a scientific, sanitary, or 
  8.24  teaching capacity by the state university, the department of 
  8.25  children, families, and learning, or by any public or private 
  8.26  school, college, or other bona fide educational institution, or 
  8.27  the state department of health, whose duties are entirely of a 
  8.28  public health or educational character, while engaged in such 
  8.29  duties. 
  8.30     (7) Physician's assistants registered in this state.  
  8.31     (8) A doctor of osteopathy duly licensed by the state board 
  8.32  of osteopathy under Minnesota Statutes 1961, sections 148.11 to 
  8.33  148.16, prior to May 1, 1963, who has not been granted a license 
  8.34  to practice medicine in accordance with this chapter provided 
  8.35  that the doctor confines activities within the scope of the 
  8.36  license. 
  9.1      (9) Any person licensed by a health related licensing 
  9.2   board, as defined in section 214.01, subdivision 2, or 
  9.3   registered by the commissioner of health pursuant to section 
  9.4   214.13, including psychological practitioners with respect to 
  9.5   the use of hypnosis; provided that the person confines 
  9.6   activities within the scope of the license.  
  9.7      (10) A person who practices ritual circumcision pursuant to 
  9.8   the requirements or tenets of any established religion. 
  9.9      (11) A Christian Scientist or other person who endeavors to 
  9.10  prevent or cure disease or suffering exclusively by mental or 
  9.11  spiritual means or by prayer. 
  9.12     (12) A physician licensed to practice medicine in another 
  9.13  state who is in this state for the sole purpose of providing 
  9.14  medical services at a competitive athletic event.  The physician 
  9.15  may practice medicine only on participants in the athletic 
  9.16  event.  A physician shall first register with the board on a 
  9.17  form developed by the board for that purpose.  The board shall 
  9.18  not be required to adopt the contents of the form by rule.  The 
  9.19  physician shall provide evidence satisfactory to the board of a 
  9.20  current unrestricted license in another state.  The board shall 
  9.21  charge a fee of $50 for the registration.  
  9.22     (13) A psychologist licensed under section 148.907 or a 
  9.23  social worker licensed under section 148B.21 who uses or 
  9.24  supervises the use of a penile or vaginal plethysmograph in 
  9.25  assessing and treating individuals suspected of engaging in 
  9.26  aberrant sexual behavior and sex offenders. 
  9.27     (14) Any person issued a training course certificate or 
  9.28  credentialed by the emergency medical services regulatory board 
  9.29  established in chapter 144E, provided the person confines 
  9.30  activities within the scope of training at the certified or 
  9.31  credentialed level. 
  9.32     (15) An unlicensed complementary and alternative health 
  9.33  care practitioner practicing according to chapter 146A.