SF 561

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; providing for licensing for 
  1.3             naturopathic physicians; providing criminal penalties; 
  1.4             amending Minnesota Statutes 1996, sections 62J.54, 
  1.5             subdivision 2; 116J.70, subdivision 2a; 144.335, 
  1.6             subdivision 1; 145.61, subdivision 2; 146.23, 
  1.7             subdivision 7; 148B.60, subdivision 3; 151.01, 
  1.8             subdivision 23; 214.23, subdivision 1; 604A.01, 
  1.9             subdivision 2; and 604A.015; proposing coding for new 
  1.10            law as Minnesota Statutes, chapter 147C. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12                             ARTICLE 1
  1.13                      NATUROPATHIC PHYSICIANS
  1.14     Section 1.  [147C.01] [DEFINITIONS.] 
  1.15     Subdivision 1.  [APPLICABILITY.] The definitions in this 
  1.16  section apply to this chapter. 
  1.17     Subd. 2.  [ACUPUNCTURE.] "Acupuncture" means the insertion 
  1.18  of acupuncture needles into specific points on the skin to treat 
  1.19  human disease and impairment and to relieve pain. 
  1.20     Subd. 3.  [ADVISORY COUNCIL.] "Advisory council" means the 
  1.21  naturopathic physicians advisory council established under 
  1.22  section 147C.05. 
  1.23     Subd. 4.  [APPROVED NATUROPATHIC MEDICAL 
  1.24  COLLEGE.] "Approved naturopathic medical college" means a 
  1.25  college or program granting the degree of doctor of naturopathic 
  1.26  medicine or doctor of naturopathy which: 
  1.27     (1) is accredited by the Council of Naturopathic Medical 
  1.28  Education or its successor; or 
  2.1      (2) is a candidate for accreditation by the Council of 
  2.2   Naturopathic Medical Education. 
  2.3      Subd. 5.  [BOARD.] "Board" means the board of medical 
  2.4   practice or its designee. 
  2.5      Subd. 6.  [HOMEOPATHIC PREPARATIONS.] "Homeopathic 
  2.6   preparations" means medicines prepared according to the 
  2.7   Homeopathic Pharmacopoeia of the United States. 
  2.8      Subd. 7.  [MINOR OFFICE PROCEDURES.] "Minor office 
  2.9   procedures" means the use of operative, electrical, or other 
  2.10  methods for the surgical repair and care incidental to 
  2.11  superficial lacerations and abrasions, superficial lesions, and 
  2.12  the removal of foreign bodies located in the superficial tissues 
  2.13  and the use of antiseptics and local anesthetics in connection 
  2.14  with such methods, except that it shall not include general or 
  2.15  spinal anesthetics, major surgery, surgery of the body cavities, 
  2.16  or specialized surgeries such as plastic surgery, surgery 
  2.17  involving the eye, or surgery when tendons are involved. 
  2.18     Subd. 8.  [NATURAL ANTIBIOTICS.] "Natural antibiotics" 
  2.19  means antimicrobial, antifungal, and antiprotozoal agents that 
  2.20  are naturally occurring substances or manufactured substances 
  2.21  that are substantially identical to such naturally occurring 
  2.22  substances. 
  2.23     Subd. 9.  [NATUROPATHIC CHILDBIRTH.] "Naturopathic 
  2.24  childbirth" means natural childbirth which includes the use of 
  2.25  natural obstetrical medicines, ophthalmic antibiotics, 
  2.26  obstetrical emergency medicines, and minor office procedures 
  2.27  including episiotomies, but which does not include the use of 
  2.28  forceps delivery, general or spinal anesthesia, caesarean 
  2.29  section, or induced abortions. 
  2.30     Subd. 10.  [NATUROPATHIC MANIPULATIVE 
  2.31  THERAPY.] "Naturopathic manipulative therapy" means the manually 
  2.32  administered, mechanical treatment of body structures or 
  2.33  tissues, in accordance with naturopathic principles, for the 
  2.34  purpose of restoring normal physiological function to the body 
  2.35  by normalizing and balancing the musculoskeletal system of the 
  2.36  body. 
  3.1      Subd. 11.  [NATUROPATHIC MEDICINE.] "Naturopathic medicine" 
  3.2   means a system of primary health care practiced by naturopathic 
  3.3   physicians for the prevention, diagnosis, and treatment of human 
  3.4   health conditions, injuries, and diseases that uses education, 
  3.5   natural medicines, and therapies to support and stimulate the 
  3.6   individual's intrinsic self-healing processes; and naturopathic 
  3.7   childbirth. 
  3.8      Subd. 12.  [NATUROPATHIC PHYSICAL MEDICINE.] "Naturopathic 
  3.9   physical medicine" means the therapeutic use of the physical 
  3.10  agents of air, water, heat, cold, sound, light, and 
  3.11  electromagnetic nonionizing radiation and the physical 
  3.12  modalities of electrotherapy, acupuncture, diathermy, 
  3.13  ultraviolet light, ultrasound, hydrotherapy, naturopathic 
  3.14  manipulative therapy, and therapeutic exercise. 
  3.15     Subd. 13.  [NATUROPATHIC PHYSICIAN.] "Naturopathic 
  3.16  physician" means a person authorized and licensed to practice 
  3.17  naturopathic medicine under this chapter. 
  3.18     Subd. 14.  [TOPICAL MEDICINES.] "Topical medicines" means 
  3.19  topical analgesics, anesthetics, antiseptics, scabicides, 
  3.20  antifungals, and antibacterials. 
  3.21     Sec. 2.  [147C.02] [LICENSURE.] 
  3.22     Subdivision 1.  [LICENSURE REQUIRED.] Except as provided in 
  3.23  subdivision 4, after July 1, 1998, persons who practice 
  3.24  naturopathic medicine, or represent themselves as practicing 
  3.25  naturopathic medicine by use of a term in subdivision 2, shall 
  3.26  apply to the board for a license to practice naturopathic 
  3.27  medicine.  Each licensee shall conspicuously display the license 
  3.28  in the place of practice. 
  3.29     Subd. 2.  [DESIGNATION.] Licensees shall use the title 
  3.30  "naturopathic physician" and the abbreviation "N.D." in a 
  3.31  professional setting.  Licensees have the exclusive right to use 
  3.32  of the terms "naturopathic physician," "naturopathic doctor," 
  3.33  "naturopath," "doctor of naturopathic medicine," "doctor of 
  3.34  naturopathy," "naturopathic medicine," "naturopathic health 
  3.35  care," "naturopathy," and "N.D."  No person may use the terms 
  3.36  "naturopathic medical doctor" and "N.M.D." 
  4.1      Subd. 3.  [PENALTY.] A person who violates this section is 
  4.2   guilty of a misdemeanor and subject to discipline under section 
  4.3   147.091. 
  4.4      Subd. 4.  [EXCEPTIONS.] (a) Nothing in this chapter shall 
  4.5   be construed to prohibit or to restrict: 
  4.6      (1) the practice of a profession by individuals who are 
  4.7   licensed, certified, or registered under other laws of this 
  4.8   state and are performing services within their authorized scope 
  4.9   of practice; 
  4.10     (2) the practice of naturopathic medicine by an individual 
  4.11  licensed in another state and employed by the government of the 
  4.12  United States while the individual is engaged in the performance 
  4.13  of duties prescribed by the laws and regulations of the United 
  4.14  States; 
  4.15     (3) the practice by a naturopathic physician duly licensed 
  4.16  in another state, territory, or the District of Columbia when 
  4.17  incidentally called into this state for consultation with a 
  4.18  Minnesota licensed physician or Minnesota licensed naturopathic 
  4.19  physician; 
  4.20     (4) the practice of naturopathic medicine by students 
  4.21  enrolled in an approved naturopathic medical college if the 
  4.22  performance of services is pursuant to a course of instruction 
  4.23  or assignments from, and under the supervision of an instructor 
  4.24  who is a licensed physician, osteopath, or naturopathic 
  4.25  physician; 
  4.26     (5) an individual rendering aid in an emergency, when no 
  4.27  fee or other consideration for the service is charged, received, 
  4.28  expected, or contemplated; 
  4.29     (6) an individual administering a remedy to a family 
  4.30  member; 
  4.31     (7) a person engaged in the sale of vitamins, health foods, 
  4.32  dietary supplements, and other products of nature, the sale of 
  4.33  which is not otherwise prohibited under state or federal law 
  4.34  except that this clause does not: 
  4.35     (i) allow that person to diagnose any human disease, 
  4.36  ailment, injury, infirmity, deformity, or other condition; or 
  5.1      (ii) prohibit providing truthful and nonmisleading 
  5.2   information regarding anything in this clause; 
  5.3      (8) a person engaged in good faith in the practice of the 
  5.4   religious tenets of any church or religious belief, without the 
  5.5   use of prescription drugs; 
  5.6      (9) a person acting in good faith for religious reasons as 
  5.7   a matter of conscience or as a personal belief when obtaining or 
  5.8   providing information regarding health care and the use of any 
  5.9   product under clause (7); and 
  5.10     (10) persons not licensed by this chapter from the use of 
  5.11  individual modalities which comprise the practice of 
  5.12  naturopathic medicine, such as the use of nutritional 
  5.13  supplements, herbs, foods, homeopathic preparations, and such 
  5.14  physical forces as heat, cold, water, touch, and light so long 
  5.15  as these modalities are not performed in a manner that 
  5.16  constitutes the practice of naturopathic medicine. 
  5.17     Subd. 5.  [LICENSURE BY EQUIVALENCY DURING TRANSITIONAL 
  5.18  PERIOD.] (a) Residents of the state who are of legal majority 
  5.19  and who have held themselves out as naturopaths or doctors of 
  5.20  naturopathic medicine in the state prior to July 1, 1993, may be 
  5.21  issued a transitional license renewable annually until June 30, 
  5.22  2002, under this subdivision if they: 
  5.23     (1) are not licensed, certified, or registered as health 
  5.24  care providers under any other law of this state; 
  5.25     (2) derive the majority of their earned income from the 
  5.26  practice of naturopathic medicine in Minnesota as documented by 
  5.27  federal income tax returns prior to 1993; and 
  5.28     (3) submit transitional license applications on or before 
  5.29  July 1, 1998. 
  5.30     (b) Persons licensed pursuant to paragraph (a) shall: 
  5.31     (1) be subject to all eligibility requirements to practice 
  5.32  naturopathic medicine in subdivision 7, except that they are 
  5.33  exempt from subdivision 7, paragraph (b), clauses (1) to (3); 
  5.34     (2) have their patients sign informed consents disclosing 
  5.35  their individual training backgrounds and qualifications, and 
  5.36  that they are practicing with transitional licenses; 
  6.1      (3) pass the Naturopathic Physicians Licensing Examination 
  6.2   or its successor examination for licensure on or before June 30, 
  6.3   2003; and 
  6.4      (4) pay a fee of $150 for each renewal period. 
  6.5      Subd. 6.  [LICENSE BY ENDORSEMENT.] The board shall issue a 
  6.6   license to practice naturopathic medicine to a person who holds 
  6.7   a current license from another jurisdiction if the board 
  6.8   determines that the standards for licensure in the other 
  6.9   jurisdiction meet the requirements for licensure in Minnesota 
  6.10  and a letter is received from the licensing body in that 
  6.11  jurisdiction that the naturopathic physician is in good standing 
  6.12  in that jurisdiction.  Applicants must have passed the 
  6.13  Naturopathic Physicians Licensing Examination or a comprehensive 
  6.14  examination prepared and graded by that state and pay a $150 fee.
  6.15     Subd. 7.  [LICENSURE REQUIREMENTS.] (a) An applicant for 
  6.16  licensure must submit a completed application for licensure on 
  6.17  forms provided by the board, which must include the applicant's 
  6.18  name and address of record.  The name and address are public 
  6.19  data on individuals under section 13.02. 
  6.20     (b) Unless licensed under subdivision 5 or 6, an applicant 
  6.21  must: 
  6.22     (1) be a graduate of an approved naturopathic medical 
  6.23  college and pass the Naturopathic Physicians Licensing 
  6.24  Examination or its successor examination covering the 
  6.25  appropriate naturopathic subjects; 
  6.26     (2) be a graduate of a naturopathic medical college having 
  6.27  appropriate education standards for naturopathic medical 
  6.28  programs which granted degrees prior to 1988 and pass the 
  6.29  Naturopathic Physicians Licensing Examination or its successor 
  6.30  examination covering the appropriate naturopathic subjects; or 
  6.31     (3) be a graduate of a naturopathic college outside of 
  6.32  North America, and pass the Naturopathic Physicians Licensing 
  6.33  Examination or its successor examination covering the 
  6.34  appropriate naturopathic subjects, and 
  6.35     (i) successfully practice as a naturopathic physician under 
  6.36  the direct supervision of a board-approved licensed physician, 
  7.1   osteopath, or naturopathic physician in Minnesota for a minimum 
  7.2   of two years following initial licensure.  Successful completion 
  7.3   shall be determined by the board-approved supervising 
  7.4   practitioner.  Failure to successfully complete the supervised 
  7.5   practice period shall result in nonrenewal of the license; and 
  7.6      (ii) demonstrate competent written and verbal skills in the 
  7.7   English language by achieving a minimum score of 560 on the 
  7.8   TOEFL (Test of English as a Foreign Language) examination 
  7.9   administered by the Educational Testing Service, Inc., 
  7.10  Princeton, New Jersey or a comparable nationally recognized 
  7.11  examination approved by the board; 
  7.12     (4) be capable of practicing naturopathic medicine with 
  7.13  reasonable skill for the safety of the public; 
  7.14     (5) have had no license to practice naturopathic medicine 
  7.15  refused, revoked, or suspended by any other jurisdiction which 
  7.16  has not been reinstated; and 
  7.17     (6) file an application and pay the $150 licensing fee. 
  7.18     (c) Applicants must also: 
  7.19     (1) sign a statement that the information in the 
  7.20  application is true and correct to the best of the applicant's 
  7.21  knowledge and belief; 
  7.22     (2) submit with the application all fees required; and 
  7.23     (3) sign a waiver authorizing the board to obtain access to 
  7.24  the applicant's records in this state or any state in which the 
  7.25  applicant has engaged in the practice of naturopathic medicine. 
  7.26     (d) The board may ask the applicant to provide any 
  7.27  additional information necessary to ensure that the applicant is 
  7.28  able to practice with reasonable skill and safety to the public. 
  7.29     (e) The board may investigate information provided by an 
  7.30  applicant to whether the information is accurate and complete.  
  7.31  The board shall notify an applicant of action taken on the 
  7.32  application and the reasons for denying licensure if licensure 
  7.33  is denied. 
  7.34     (f) The board has the authority to restrict, limit, 
  7.35  condition, or deny licenses pursuant to section 147.091, 
  7.36  subdivision 1. 
  8.1      Subd. 8.  [LICENSURE EXPIRATION.] Licenses issued under 
  8.2   this section expire annually. 
  8.3      Subd. 9.  [RENEWAL.] To renew a license an applicant must: 
  8.4      (1) annually complete a renewal application on a form 
  8.5   provided by the board; 
  8.6      (2) submit the renewal fee; 
  8.7      (3) provide evidence of the completion of 15 hours of 
  8.8   continuing education including one hour of education in the 
  8.9   subject of infection control, including blood borne pathogen 
  8.10  diseases; 
  8.11     (4) submit any additional information requested by the 
  8.12  board to clarify information presented in the renewal 
  8.13  application; if the information is not submitted within 30 days 
  8.14  after the board's request, the renewal request is nullified; and 
  8.15     (5) provide other information consistent with renewal 
  8.16  criteria for other health professions regulated by the board. 
  8.17     Subd. 10.  [LICENSURE RENEWAL NOTICE.] At least 30 days 
  8.18  before the license renewal date, the board shall send out a 
  8.19  renewal notice to the last known address of the licensee.  The 
  8.20  notice must include a renewal application and a notice of fees 
  8.21  required for renewal.  If the licensee does not receive a 
  8.22  renewal notice, the licensee must still meet the requirements 
  8.23  for registration renewal under this section. 
  8.24     Subd. 11.  [RENEWAL DEADLINE.] The renewal application and 
  8.25  fee must be postmarked on or before June 30 of the year of 
  8.26  renewal. 
  8.27     Subd. 12.  [CANCELLATION OF LICENSE.] (a) A person holding 
  8.28  an active license to practice naturopathic medicine in the state 
  8.29  may, upon approval of the board, be granted license cancellation 
  8.30  if the board is not investigating the person as a result of a 
  8.31  complaint or information received or if the board has not begun 
  8.32  disciplinary proceedings against the person.  Such action by the 
  8.33  board shall be reported as a cancellation of a license in good 
  8.34  standing. 
  8.35     (b) A person who receives board approval for license 
  8.36  cancellation is not entitled to a refund of any license fees 
  9.1   paid for the licensure year in which cancellation of the license 
  9.2   occurred. 
  9.3      (c) The board shall not renew, reissue, reinstate, or 
  9.4   restore a license that has lapsed and has not been renewed 
  9.5   within two annual license renewal cycles. 
  9.6      (d) If a person whose license has been canceled under this 
  9.7   section desires to resume the practice of naturopathic medicine 
  9.8   in Minnesota, that person must obtain a new license by applying 
  9.9   for licensure and fulfilling the requirements then in existence 
  9.10  for obtaining an initial license to practice naturopathic 
  9.11  medicine in Minnesota. 
  9.12     Subd. 13.  [TEMPORARY PERMIT.] The board may issue a 
  9.13  temporary permit to practice naturopathic medicine to an 
  9.14  applicant eligible for licensure under this section only if the 
  9.15  application for licensure is complete, all applicable 
  9.16  requirements in this section have been met, and a $60 
  9.17  nonrefundable fee has been paid.  The permit remains valid only 
  9.18  until the meeting of the board at which a decision is made on 
  9.19  the naturopathic physician's application for licensure. 
  9.20     Subd. 14.  [NATUROPATHIC CHILDBIRTH OR ACUPUNCTURE 
  9.21  SPECIALTY CERTIFICATION.] (a) A doctor of naturopathic medicine 
  9.22  may not practice naturopathic childbirth or acupuncture without 
  9.23  first obtaining a certificate of specialty practice. 
  9.24     (b) To be certified in naturopathic childbirth, a doctor of 
  9.25  naturopathic medicine shall: 
  9.26     (1) pass the American College of Naturopathic Obstetricians 
  9.27  (ACNO) examination in obstetrics for natural childbirth; 
  9.28     (2) have at least 200 hours of course work, internship, or 
  9.29  preceptorship in obstetrics or natural childbirth; 
  9.30     (3) have participated in 50 supervised births, including 
  9.31  prenatal and postnatal care, under the direct supervision of a 
  9.32  licensed physician, osteopath, or naturopathic physician or a 
  9.33  licensed practitioner with specialty training in obstetrics or 
  9.34  natural childbirth; 
  9.35     (4) be a member of the American College of Naturopathic 
  9.36  Obstetricians or its successor; and 
 10.1      (5) follow a written plan for naturopathic physicians 
 10.2   practicing naturopathic childbirth, that includes entering into 
 10.3   an agreement with a consulting physician or osteopath, in cases 
 10.4   where the scope of naturopathic childbirth may be exceeded and 
 10.5   specialty care and delivery is indicated.  The plan must state 
 10.6   guidelines by which the naturopathic physician will refer 
 10.7   patients to the consulting physician and will consult with the 
 10.8   consulting physician.  The licensee shall supply a copy of the 
 10.9   written plan upon request of the board.  The plan shall be 
 10.10  reviewed on an annual basis by the licensee. 
 10.11     (c) To be certified in acupuncture, a licensee shall 
 10.12  complete a program in acupuncture that includes at least 500 
 10.13  hours of training in acupuncture, including both didactic and 
 10.14  clinical training, and pass the Naturopathic Physicians 
 10.15  Licensing Examination in acupuncture. 
 10.16     (d) Licensees obtaining specialty certification under this 
 10.17  subdivision shall submit a fee of $25 for each specialty at each 
 10.18  renewal period. 
 10.19     Sec. 3.  [147C.03] [NATUROPATHIC PHYSICIAN PROFESSIONAL 
 10.20  DEVELOPMENT ACTIVITY REQUIREMENTS.] 
 10.21     Subdivision 1.  [CONTINUING EDUCATION 
 10.22  REQUIREMENTS.] Continuing education requirements may be met 
 10.23  through a board-approved continuing education program. 
 10.24     Subd. 2.  [BOARD APPROVAL.] The board shall approve a 
 10.25  continuing education program if the program meets the following 
 10.26  requirements: 
 10.27     (1) it directly relates to the practice of naturopathic 
 10.28  medicine; 
 10.29     (2) it is sponsored for continuing education by the 
 10.30  American Association of Naturopathic Physicians or any of its 
 10.31  constituent state associations, the American Chiropractic 
 10.32  Association or any of its constituent state associations, the 
 10.33  American Osteopathic Association Bureau of Professional 
 10.34  Education, or an organization approved by the Accreditation 
 10.35  Council for Continuing Medical Education; and 
 10.36     (3) it lasts at least 50 minutes per contact hour. 
 11.1      Subd. 3.  [CONTINUING EDUCATION TOPICS.] (a) Continuing 
 11.2   education program topics may include, but are not limited to, 
 11.3   naturopathic medical theory and techniques including diagnostic 
 11.4   techniques, nutrition, botanical medicine, homeopathic medicine, 
 11.5   physical medicine, lifestyle modification counseling, anatomy, 
 11.6   physiology, biochemistry, microbiology, psychology, history of 
 11.7   medicine, and medical terminology or coding. 
 11.8      (b) Practice management courses are excluded under this 
 11.9   section. 
 11.10     Subd. 4.  [VERIFICATION.] The board shall periodically 
 11.11  select a random sample of licensees and require the licensee to 
 11.12  show evidence of having completed the professional development 
 11.13  activities requirements.  Either the licensee, the state, or a 
 11.14  national organization that maintains continuing education 
 11.15  records may provide the board documentation of the continuing 
 11.16  education program. 
 11.17     Sec. 4.  [147C.04] [BOARD ACTION ON APPLICATIONS.] 
 11.18     Subdivision 1.  [VERIFICATION OF APPLICATION 
 11.19  INFORMATION.] The board, or advisory council with the approval 
 11.20  of the board, may verify information provided by an application 
 11.21  for licensure under section 147C.02 to determine if the 
 11.22  information is accurate and complete. 
 11.23     Subd. 2.  [NOTIFICATION OF BOARD ACTION.] Within 120 days 
 11.24  of receipt of the application, the board shall notify each 
 11.25  applicant in writing of the action taken on the application. 
 11.26     Subd. 3.  [REQUEST FOR HEARING BY APPLICANT DENIED.] An 
 11.27  applicant denied licensure must be notified of the 
 11.28  determination, and the grounds for it, and may request a hearing 
 11.29  on the determination by filing a written statement of issues 
 11.30  with the board within 20 days after receipt of the notice from 
 11.31  the board.  After the hearing, the board shall notify the 
 11.32  applicant in writing of its decision. 
 11.33     Sec. 5.  [147C.05] [NATUROPATHIC PHYSICIANS ADVISORY 
 11.34  COUNCIL.] 
 11.35     Subdivision 1.  [CREATION.] The naturopathic physicians 
 11.36  advisory council consists of five members appointed by the board 
 12.1   to three-year terms.  Three members must be licensed 
 12.2   naturopathic physicians, one member must be a licensed physician 
 12.3   or osteopath who also practices natural medicine, and one member 
 12.4   must be a member of the public who has received naturopathic 
 12.5   treatment as a primary therapy from a naturopathic physician. 
 12.6      Subd. 2.  [ADMINISTRATION; COMPENSATION; REMOVAL; 
 12.7   QUORUM.] The advisory council is governed by section 15.059, 
 12.8   except that the council does not expire until June 30, 2002. 
 12.9      Subd. 3.  [DUTIES.] The advisory council shall: 
 12.10     (1) advise the board on issuance, denial, renewal, 
 12.11  suspension, revocation, conditioning, or restricting of licenses 
 12.12  to practice naturopathic medicine; 
 12.13     (2) advise the board on issues related to receiving, 
 12.14  investigating, conducting hearings, and imposing disciplinary 
 12.15  action in relation to complaints against naturopathic 
 12.16  physicians; 
 12.17     (3) maintain a register of naturopathic physicians licensed 
 12.18  under section 147C.02; 
 12.19     (4) maintain a record of all advisory council actions; 
 12.20     (5) prescribe application forms, license forms, protocol 
 12.21  forms, and other necessary forms; 
 12.22     (6) review the records submitted by applicants during the 
 12.23  transition period; 
 12.24     (7) advise the board regarding standards for naturopathic 
 12.25  medicine; 
 12.26     (8) distribute information regarding naturopathic medicine 
 12.27  practice standards; 
 12.28     (9) review complaints; 
 12.29     (10) review the investigation of reports of complaints and 
 12.30  recommend to the board whether disciplinary action should be 
 12.31  taken; and 
 12.32     (11) perform other duties authorized by advisory councils 
 12.33  under chapter 214, as directed by the board. 
 12.34     Sec. 6.  [147C.06] [PROFESSIONAL CONDUCT.] 
 12.35     Subdivision 1.  [PRACTICE STANDARDS.] The licensee shall 
 12.36  obtain informed consent from the patient after advising the 
 13.1   patient of the licensee's qualifications including:  education, 
 13.2   license information, and outline of the scope of practice of 
 13.3   naturopathic physicians in Minnesota.  This information must be 
 13.4   supplied to the patient in writing before or at the time of the 
 13.5   initial visit. 
 13.6      Subd. 2.  [STERILIZED EQUIPMENT.] A naturopathic physician 
 13.7   shall use sterilized equipment that has been sterilized under 
 13.8   standards of the National Centers for Disease Control and 
 13.9   Prevention. 
 13.10     Subd. 3.  [STATE AND MUNICIPAL PUBLIC HEALTH 
 13.11  REGULATIONS.] A naturopathic physician shall comply with all 
 13.12  applicable state and municipal requirements regarding public 
 13.13  health.  
 13.14     Subd. 4.  [SCOPE OF PRACTICE.] (a) The scope of practice of 
 13.15  naturopathic medicine includes, but is not limited to, 
 13.16  paragraphs (b) to (f). 
 13.17     (b) Licensees may use, administer, prescribe, or dispense 
 13.18  for preventive and therapeutic purposes the following medicines 
 13.19  and therapies:  food, food extracts, vitamins, minerals, amino 
 13.20  acids, enzymes, digestive aids, whole gland thyroid, glandulars, 
 13.21  protomorphogens, natural hormones, plant substances, all 
 13.22  homeopathic preparations, natural antibiotics, immunizations, 
 13.23  topical medicines, counseling, hypnotherapy, biofeedback, 
 13.24  dietary therapy, electrotherapy, ultrasound, galvanic therapy, 
 13.25  naturopathic physical medicine, oxygen, therapeutic devices, 
 13.26  barrier devices for contraception, and minor office procedures. 
 13.27     (c) Licensees may use or order for diagnostic purposes 
 13.28  physical and orificial examinations, x-rays, electrocardiograms, 
 13.29  ultrasound, phlebotomy, clinical laboratory tests and 
 13.30  examinations, and physiological function tests.  Licensees are 
 13.31  subject to section 144.121, except for subdivision 5. 
 13.32     (d) Licensees may prescribe nonprescription medications and 
 13.33  therapeutic devices or use noninvasive diagnostic procedures 
 13.34  commonly used by physicians in general practice. 
 13.35     (e) Licensees may prescribe and dispense the following 
 13.36  legend drugs classifications:  thyroid hormones, male and female 
 14.1   hormones, class III antitussives, chelating agents, local 
 14.2   anesthetics, contraceptive barrier devices, adrenal hormones, 
 14.3   legend nutritional substances, all homeopathic remedies, all 
 14.4   anti-infective agents for oral and topical use, vaccines, 
 14.5   toxoids and allergy extracts, and all legend botanical 
 14.6   substances.  The authority to dispense includes, but is not 
 14.7   limited to, the authority to request, receive, and dispense 
 14.8   sample drugs.  This authority to dispense legend drugs extends 
 14.9   only to those drugs described in this paragraph. 
 14.10     (f) Naturopathic physicians shall not: 
 14.11     (1) prescribe, dispense, or administer any controlled 
 14.12  substances or devices except those natural medicines and devices 
 14.13  authorized by this chapter; 
 14.14     (2) perform surgical procedures except those procedures 
 14.15  authorized by this chapter; 
 14.16     (3) practice emergency medicine except as a good samaritan 
 14.17  rendering gratuitous services in the case of emergency and 
 14.18  except for the care of minor injuries; or 
 14.19     (4) practice or claim to practice medicine and surgery, 
 14.20  osteopathy, dentistry, podiatry, optometry, chiropractic, 
 14.21  physical therapy, or any other system or method of treatment not 
 14.22  authorized in this chapter. 
 14.23     Subd. 5.  [PATIENT RECORDS.] A naturopathic physician shall 
 14.24  maintain a patient record for each patient treated, including: 
 14.25     (1) a copy of the informed consent; 
 14.26     (2) evidence of a patient interview concerning the 
 14.27  patient's medical history and current physical condition; 
 14.28     (3) evidence of an examination and diagnosis; 
 14.29     (4) record of the treatment; and 
 14.30     (5) evidence of evaluation and instructions given to the 
 14.31  patient. 
 14.32     Subd. 6.  [REFERRAL TO OTHER HEALTH CARE 
 14.33  PRACTITIONERS.] Referral to other health care practitioners is 
 14.34  required when a licensee sees patients with potentially serious 
 14.35  disorders including, but not limited to: 
 14.36     (1) cardiac conditions including uncontrolled hypertension; 
 15.1      (2) acute, severe abdominal pain; 
 15.2      (3) acute, undiagnosed neurological changes; 
 15.3      (4) unexplained weight loss or gain in excess of 15 percent 
 15.4   of the body weight in less than a three-month period; 
 15.5      (5) suspected fracture or dislocation; 
 15.6      (6) any serious undiagnosed hemorrhagic disorder; and 
 15.7      (7) acute respiratory distress without previous history. 
 15.8      Subd. 7.  [DATA PRACTICES.] Data maintained on a 
 15.9   naturopathic patient by a licensee is subject to section 144.336.
 15.10     Sec. 7.  [147C.07] [DISCIPLINE; REPORTING.] 
 15.11     For purposes of this chapter, licensees and applicants are 
 15.12  subject to the provisions of sections 147.091 to 147.162. 
 15.13     Sec. 8.  [147C.08] [FEES.] 
 15.14     Subdivision 1.  [ANNUAL REGISTRATION FEE.] The fee for 
 15.15  initial licensure and annual license renewal is $150 for each. 
 15.16     Subd. 2.  [PENALTY FEE FOR LATE RENEWALS.] The penalty fee 
 15.17  for late submission for renewal application is $50. 
 15.18     Subd. 3.  [DEPOSIT.] Fees collected by the board under this 
 15.19  chapter must be deposited in the state government special 
 15.20  revenue fund. 
 15.21     Sec. 9.  [INITIAL ADVISORY COUNCIL.] 
 15.22     (a) Notwithstanding section 5, the three members of the 
 15.23  advisory council required by that section to be licensed 
 15.24  naturopathic physicians need not be licensed to be appointed to 
 15.25  the initial advisory committee, but must be recommended by the 
 15.26  Minnesota Association of Naturopathic Physicians. 
 15.27     (b) Two members of the initial advisory committee appointed 
 15.28  must have an initial term of one year, two members an initial 
 15.29  term of two years, and one member an initial term of three years.
 15.30     (c) The first council must be appointed by January 1, 1998. 
 15.31     Sec. 10.  [EFFECTIVE DATE.] 
 15.32     This act is effective July 1, 1997. 
 15.33                             ARTICLE 2 
 15.34                       CONFORMING AMENDMENTS 
 15.35     Section 1.  Minnesota Statutes 1996, section 62J.54, 
 15.36  subdivision 2, is amended to read: 
 16.1      Subd. 2.  [UNIQUE IDENTIFICATION NUMBER FOR INDIVIDUAL 
 16.2   HEALTH CARE PROVIDERS.] (a) On and after January 1, 1998, all 
 16.3   group purchasers and health care providers in Minnesota shall 
 16.4   use a unique identification number to identify an individual 
 16.5   health care provider, except as provided in paragraph (e). 
 16.6      (b) The first eight digits of the national provider 
 16.7   identifier maintained by the federal Health Care Financing 
 16.8   Administration's national provider system shall be used as the 
 16.9   unique identification number for individual health care 
 16.10  providers.  
 16.11     (c) Individual providers required to have a national 
 16.12  provider identifier are:  
 16.13     (1) physicians licensed under chapter 147; 
 16.14     (2) naturopathic physicians licensed under chapter 147C; 
 16.15     (3) dentists licensed under chapter 150A; 
 16.16     (3) (4) chiropractors licensed under chapter 148; 
 16.17     (4) (5) podiatrists licensed under chapter 153; 
 16.18     (5) (6) physician assistants as defined under section 
 16.19  147A.01; 
 16.20     (6) (7) advanced practice nurses as defined under section 
 16.21  62A.15; 
 16.22     (7) (8) doctors of optometry licensed under section 148.57; 
 16.23     (8) (9) individual providers who may bill Medicare for 
 16.24  medical and other health services as defined in United States 
 16.25  Code, title 42, section 1395x(s); and 
 16.26     (9) (10) individual providers who are providers for state 
 16.27  and federal health care programs administered by the 
 16.28  commissioner of human services. 
 16.29     Providers shall obtain a national provider identifier from 
 16.30  the federal Health Care Financing Administration using the 
 16.31  Health Care Financing Administration's prescribed process.  
 16.32     (d) Only the unique individual health care provider 
 16.33  identifier shall be used for purposes of submitting and 
 16.34  receiving claims, and in conjunction with other data collection 
 16.35  and reporting functions. 
 16.36     (e) The state and federal health care programs administered 
 17.1   by the department of human services shall use the unique 
 17.2   identification number assigned to health care providers for 
 17.3   implementation of the Medicaid Management Information System or 
 17.4   the national provider identifier maintained by the federal 
 17.5   Health Care Financing Administration. 
 17.6      (f) The commissioner of health may become a subscriber to 
 17.7   the federal Health Care Financing Administration's national 
 17.8   provider system to implement this subdivision. 
 17.9      Sec. 2.  Minnesota Statutes 1996, section 116J.70, 
 17.10  subdivision 2a, is amended to read: 
 17.11     Subd. 2a.  [LICENSE; EXCEPTIONS.] "Business license" or 
 17.12  "license" does not include the following:  
 17.13     (1) any occupational license or registration issued by a 
 17.14  licensing board listed in section 214.01 or any occupational 
 17.15  registration issued by the commissioner of health pursuant to 
 17.16  section 214.13; 
 17.17     (2) any license issued by a county, home rule charter city, 
 17.18  statutory city, township, or other political subdivision; 
 17.19     (3) any license required to practice the following 
 17.20  occupation regulated by the following sections:  
 17.21     (a) abstracters regulated pursuant to chapter 386; 
 17.22     (b) accountants regulated pursuant to chapter 326; 
 17.23     (c) adjusters regulated pursuant to chapter 72B; 
 17.24     (d) architects regulated pursuant to chapter 326; 
 17.25     (e) assessors regulated pursuant to chapter 270; 
 17.26     (f) athletic trainers regulated pursuant to chapter 148; 
 17.27     (g) attorneys regulated pursuant to chapter 481; 
 17.28     (h) auctioneers regulated pursuant to chapter 330; 
 17.29     (i) barbers regulated pursuant to chapter 154; 
 17.30     (j) beauticians regulated pursuant to chapter 155A; 
 17.31     (k) boiler operators regulated pursuant to chapter 183; 
 17.32     (l) chiropractors regulated pursuant to chapter 148; 
 17.33     (m) collection agencies regulated pursuant to chapter 332; 
 17.34     (n) cosmetologists regulated pursuant to chapter 155A; 
 17.35     (o) dentists, registered dental assistants, and dental 
 17.36  hygienists regulated pursuant to chapter 150A; 
 18.1      (p) detectives regulated pursuant to chapter 326; 
 18.2      (q) electricians regulated pursuant to chapter 326; 
 18.3      (r) embalmers regulated pursuant to chapter 149; 
 18.4      (s) engineers regulated pursuant to chapter 326; 
 18.5      (t) insurance brokers and salespersons regulated pursuant 
 18.6   to chapter 60A; 
 18.7      (u) certified interior designers regulated pursuant to 
 18.8   chapter 326; 
 18.9      (v) midwives regulated pursuant to chapter 148; 
 18.10     (w) morticians regulated pursuant to chapter 149; 
 18.11     (x) naturopathic physicians regulated pursuant to chapter 
 18.12  147C; 
 18.13     (x) (y) nursing home administrators regulated pursuant to 
 18.14  chapter 144A; 
 18.15     (y) (z) optometrists regulated pursuant to chapter 148; 
 18.16     (z) (aa) osteopathic physicians regulated pursuant to 
 18.17  chapter 147; 
 18.18     (aa) (bb) pharmacists regulated pursuant to chapter 151; 
 18.19     (bb) (cc) physical therapists regulated pursuant to chapter 
 18.20  148; 
 18.21     (cc) (dd) physician assistants regulated pursuant to 
 18.22  chapter 147A; or 
 18.23     (dd) (ee) physicians and surgeons regulated pursuant to 
 18.24  chapter 147; 
 18.25     (ee) (ff) plumbers regulated pursuant to chapter 326; 
 18.26     (ff) (gg) podiatrists regulated pursuant to chapter 153; 
 18.27     (gg) (hh) practical nurses regulated pursuant to chapter 
 18.28  148; 
 18.29     (hh) (ii) professional fund raisers regulated pursuant to 
 18.30  chapter 309; 
 18.31     (ii) (jj) psychologists regulated pursuant to chapter 148; 
 18.32     (jj) (kk) real estate brokers, salespersons, and others 
 18.33  regulated pursuant to chapters 82 and 83; 
 18.34     (kk) (ll) registered nurses regulated pursuant to chapter 
 18.35  148; 
 18.36     (ll) (mm) securities brokers, dealers, agents, and 
 19.1   investment advisers regulated pursuant to chapter 80A; 
 19.2      (mm) (nn) steamfitters regulated pursuant to chapter 326; 
 19.3      (nn) (oo) teachers and supervisory and support personnel 
 19.4   regulated pursuant to chapter 125; 
 19.5      (oo) (pp) veterinarians regulated pursuant to chapter 156; 
 19.6      (pp) (qq) water conditioning contractors and installers 
 19.7   regulated pursuant to chapter 326; 
 19.8      (qq) (rr) water well contractors regulated pursuant to 
 19.9   chapter 103I; 
 19.10     (rr) (ss) water and waste treatment operators regulated 
 19.11  pursuant to chapter 115; 
 19.12     (ss) (tt) motor carriers regulated pursuant to chapter 221; 
 19.13     (tt) (uu) professional corporations regulated pursuant to 
 19.14  chapter 319A; 
 19.15     (uu) (vv) real estate appraisers regulated pursuant to 
 19.16  chapter 82B; 
 19.17     (vv) (ww) residential building contractors, residential 
 19.18  remodelers, residential roofers, manufactured home installers, 
 19.19  and specialty contractors regulated pursuant to chapter 326; 
 19.20     (4) any driver's license required pursuant to chapter 171; 
 19.21     (5) any aircraft license required pursuant to chapter 360; 
 19.22     (6) any watercraft license required pursuant to chapter 
 19.23  86B; 
 19.24     (7) any license, permit, registration, certification, or 
 19.25  other approval pertaining to a regulatory or management program 
 19.26  related to the protection, conservation, or use of or 
 19.27  interference with the resources of land, air, or water, which is 
 19.28  required to be obtained from a state agency or instrumentality; 
 19.29  and 
 19.30     (8) any pollution control rule or standard established by 
 19.31  the pollution control agency or any health rule or standard 
 19.32  established by the commissioner of health or any licensing rule 
 19.33  or standard established by the commissioner of human services.  
 19.34     Sec. 3.  Minnesota Statutes 1996, section 144.335, 
 19.35  subdivision 1, is amended to read: 
 19.36     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
 20.1   section, the following terms have the meanings given them: 
 20.2      (a) "Patient" means a natural person who has received 
 20.3   health care services from a provider for treatment or 
 20.4   examination of a medical, psychiatric, or mental condition, the 
 20.5   surviving spouse and parents of a deceased patient, or a person 
 20.6   the patient designates in writing as a representative.  Except 
 20.7   for minors who have received health care services pursuant to 
 20.8   sections 144.341 to 144.347, in the case of a minor, patient 
 20.9   includes a parent or guardian, or a person acting as a parent or 
 20.10  guardian in the absence of a parent or guardian. 
 20.11     (b) "Provider" means (1) any person who furnishes health 
 20.12  care services and is licensed to furnish the services pursuant 
 20.13  to chapter 147, 147C, 148, 148B, 150A, 151, or 153; (2) a home 
 20.14  care provider licensed under section 144A.46; (3) a health care 
 20.15  facility licensed pursuant to this chapter or chapter 144A; (4) 
 20.16  a physician assistant registered under chapter 147A; and (5) an 
 20.17  unlicensed mental health practitioner regulated pursuant to 
 20.18  sections 148B.60 to 148B.71. 
 20.19     (c) "Individually identifiable form" means a form in which 
 20.20  the patient is or can be identified as the subject of the health 
 20.21  records. 
 20.22     Sec. 4.  Minnesota Statutes 1996, section 145.61, 
 20.23  subdivision 2, is amended to read: 
 20.24     Subd. 2.  [PROFESSIONAL.] "Professional" means a person 
 20.25  licensed or registered to practice a healing art under chapter 
 20.26  147, 147C, or 148, to practice dentistry under chapter 150A, to 
 20.27  practice as a pharmacist under chapter 151, or to practice 
 20.28  podiatry under chapter 153. 
 20.29     Sec. 5.  Minnesota Statutes 1996, section 146.23, 
 20.30  subdivision 7, is amended to read: 
 20.31     Subd. 7.  [EXEMPTION.] The provisions of subdivision 2 do 
 20.32  not apply to physicians and doctors of osteopathy licensed under 
 20.33  chapter 147 or naturopathic physicians licensed under chapter 
 20.34  147C. 
 20.35     Sec. 6.  Minnesota Statutes 1996, section 148B.60, 
 20.36  subdivision 3, is amended to read: 
 21.1      Subd. 3.  [UNLICENSED MENTAL HEALTH PRACTITIONER OR 
 21.2   PRACTITIONER.] "Unlicensed mental health practitioner" or 
 21.3   "practitioner" means a person who provides or purports to 
 21.4   provide, for remuneration, mental health services as defined in 
 21.5   subdivision 4.  It does not include persons licensed by the 
 21.6   board of medical practice under chapter 147 or 147C or 
 21.7   registered by the board of medical practice under chapter 147A; 
 21.8   the board of nursing under sections 148.171 to 148.285; the 
 21.9   board of psychology under sections 148.88 to 148.98; the board 
 21.10  of social work under sections 148B.18 to 148B.28; the board of 
 21.11  marriage and family therapy under sections 148B.29 to 148B.39; 
 21.12  or another licensing board if the person is practicing within 
 21.13  the scope of the license; or members of the clergy who are 
 21.14  providing pastoral services in the context of performing and 
 21.15  fulfilling the salaried duties and obligations required of a 
 21.16  member of the clergy by a religious congregation.  For the 
 21.17  purposes of complaint investigation or disciplinary action 
 21.18  relating to an individual practitioner, the term includes:  
 21.19     (1) persons employed by a program licensed by the 
 21.20  commissioner of human services who are acting as mental health 
 21.21  practitioners within the scope of their employment; 
 21.22     (2) persons employed by a program licensed by the 
 21.23  commissioner of human services who are providing chemical 
 21.24  dependency counseling services; persons who are providing 
 21.25  chemical dependency counseling services in private practice; and 
 21.26     (3) clergy who are providing mental health services that 
 21.27  are equivalent to those defined in subdivision 4. 
 21.28     Sec. 7.  Minnesota Statutes 1996, section 151.01, 
 21.29  subdivision 23, is amended to read: 
 21.30     Subd. 23.  [PRACTITIONER.] "Practitioner" means a licensed 
 21.31  doctor of medicine, licensed doctor of osteopathy duly licensed 
 21.32  to practice medicine, licensed naturopathic physician, licensed 
 21.33  doctor of dentistry, licensed doctor of optometry, licensed 
 21.34  podiatrist, or licensed veterinarian.  For purposes of sections 
 21.35  151.15, subdivision 4, 151.37, subdivision 2, paragraph (b), and 
 21.36  151.461, "practitioner" also means a physician assistant 
 22.1   authorized to prescribe, dispense, and administer under chapter 
 22.2   147A, or an advanced practice nurse authorized to prescribe, 
 22.3   dispense, and administer under section 148.235.  
 22.4      Sec. 8.  Minnesota Statutes 1996, section 214.23, 
 22.5   subdivision 1, is amended to read: 
 22.6      Subdivision 1.  [COMMISSIONER OF HEALTH.] The board shall 
 22.7   enter into a contract with the commissioner to perform the 
 22.8   functions in subdivisions 2 and 3.  The contract shall provide 
 22.9   that: 
 22.10     (1) unless requested to do otherwise by a regulated person, 
 22.11  a board shall refer all regulated persons infected with HIV or 
 22.12  HBV to the commissioner; 
 22.13     (2) the commissioner may choose to refer any regulated 
 22.14  person who is infected with HIV or HBV as well as all 
 22.15  information related thereto to the person's board at any time 
 22.16  for any reason, including but not limited to:  the degree of 
 22.17  cooperation and compliance by the regulated person; the 
 22.18  inability to secure information or the medical records of the 
 22.19  regulated person; or when the facts may present other possible 
 22.20  violations of the regulated persons practices act.  Upon request 
 22.21  of the regulated person who is infected with HIV or HBV the 
 22.22  commissioner shall refer the regulated person and all 
 22.23  information related thereto to the person's board.  Once the 
 22.24  commissioner has referred a regulated person to a board, the 
 22.25  board may not thereafter submit it to the commissioner to 
 22.26  establish a monitoring plan unless the commissioner of health 
 22.27  consents in writing; 
 22.28     (3) a board shall not take action on grounds relating 
 22.29  solely to the HIV or HBV status of a regulated person until 
 22.30  after referral by the commissioner; and 
 22.31     (4) notwithstanding sections 13.39 and 13.41 and chapters 
 22.32  147, 147A, 147C, 148, 150A, 153, and 214, a board shall forward 
 22.33  to the commissioner any information on a regulated person who is 
 22.34  infected with HIV or HBV that the department of health requests. 
 22.35     Sec. 9.  Minnesota Statutes 1996, section 604A.01, 
 22.36  subdivision 2, is amended to read: 
 23.1      Subd. 2.  [GENERAL IMMUNITY FROM LIABILITY.] (a) A person 
 23.2   who, without compensation or the expectation of compensation, 
 23.3   renders emergency care, advice, or assistance at the scene of an 
 23.4   emergency or during transit to a location where professional 
 23.5   medical care can be rendered, is not liable for any civil 
 23.6   damages as a result of acts or omissions by that person in 
 23.7   rendering the emergency care, advice, or assistance, unless the 
 23.8   person acts in a willful and wanton or reckless manner in 
 23.9   providing the care, advice, or assistance.  This subdivision 
 23.10  does not apply to a person rendering emergency care, advice, or 
 23.11  assistance during the course of regular employment, and 
 23.12  receiving compensation or expecting to receive compensation for 
 23.13  rendering the care, advice, or assistance. 
 23.14     (b) For the purposes of this section, the scene of an 
 23.15  emergency is an area outside the confines of a hospital or other 
 23.16  institution that has hospital facilities, or an office of a 
 23.17  person licensed to practice one or more of the healing arts 
 23.18  under chapter 147, 147A, 147C, 148, 150A, or 153.  The scene of 
 23.19  an emergency includes areas threatened by or exposed to 
 23.20  spillage, seepage, fire, explosion, or other release of 
 23.21  hazardous materials, and includes ski areas and trails.  
 23.22     (c) For the purposes of this section, "person" includes a 
 23.23  public or private nonprofit volunteer firefighter, volunteer 
 23.24  police officer, volunteer ambulance attendant, volunteer first 
 23.25  provider of emergency medical services, volunteer ski patroller, 
 23.26  and any partnership, corporation, association, or other entity.  
 23.27     (d) For the purposes of this section, "compensation" does 
 23.28  not include payments, reimbursement for expenses, or pension 
 23.29  benefits paid to members of volunteer organizations. 
 23.30     Sec. 10.  Minnesota Statutes 1996, section 604A.015, is 
 23.31  amended to read: 
 23.32     604A.015 [SCHOOL BUS DRIVER IMMUNITY FROM LIABILITY.] 
 23.33     A school bus driver who, while on duty, provides emergency 
 23.34  care, advice, or assistance at the scene of an emergency or 
 23.35  during transit to a location where professional medical care can 
 23.36  be rendered, is not liable in ordinary negligence, for any civil 
 24.1   damages as a result of acts or omissions to the person to whom 
 24.2   assistance is rendered by the school bus driver in rendering the 
 24.3   emergency care, advice, or assistance.  For the purposes of this 
 24.4   section, the scene of an emergency is an area outside the 
 24.5   confines of a hospital or other institution that has hospital 
 24.6   facilities, or an office of a person licensed to practice one or 
 24.7   more of the healing arts under chapter 147, 147C, 148, 150A, or 
 24.8   153.