California Licensed Naturopathic Doctor ND Bus. & Prof. Code § 3610 Attorney Fee Petition Mechanics: Naturopathic Medicine Committee License Verification at naturopathic.ca.gov as Primary Welch Anchor (THE ONLY § 3610 ND Page — DISTINCT FROM Medical Doctor MD § 2052, Licensed Acupuncturist LAc § 4935, and Licensed Midwife LM § 2507; AANP Code of Ethics Advisory [PURE KETCHUM]; CNME Standards for Naturopathic Medical Education Advisory [PURE KETCHUM]; TWO PRIVATE STANDARDS ON ONE PAGE), CCP § 1021.5 Private Attorney General Mandatory Attorney Fees

Statutory Framework: Bus. & Prof. Code § 3610 and NMC ND License — Scope of Practice, Unlicensed Practice Prohibition, AANP Code of Ethics Advisory [PURE KETCHUM], CNME Standards Advisory [PURE KETCHUM], and CCP § 1021.5 Mandatory Attorney Fees

California Bus. & Prof. Code § 3610 — within the Naturopathic Doctors Act (§§ 3610 et seq.) — requires that any person who practices naturopathic medicine in California hold a valid ND license issued by the Naturopathic Medicine Committee (NMC). The Naturopathic Doctors Act defines the scope of naturopathic medicine to encompass: diagnosis and treatment of human health conditions through naturopathic methods; clinical nutrition and therapeutic diets including macronutrient and micronutrient prescription and high-dose nutritional supplementation protocols; botanical medicine including prescription of botanical preparations at therapeutic doses, herbal tinctures, botanical extracts, and botanical standardized preparations; homeopathic prescription; physical medicine including naturopathic manipulation, hydrotherapy, and exercise therapy; minor surgery within the ND scope including removal of superficial lesions, abscess drainage, and wound care; prescription of naturopathic formulary medications under the SB 538 (2019) expanded scope including certain antibiotics, bioidentical hormones, thyroid preparations, and low-risk Schedule V controlled substances with DEA registration; and intravenous nutritional therapy. A California ND license requires completion of a CNME-accredited naturopathic medical program (four-year doctoral program) and passage of NPLEX (Naturopathic Physicians Licensing Examinations) Parts I (Biomedical Sciences) and II (Core Clinical Science Examination).

AANP CODE OF ETHICS ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH AN AANP CODE OF ETHICS ADVISORY — PURE KETCHUM: The American Association of Naturopathic Physicians (AANP, founded 1985, Washington DC) is the national professional organization for licensed naturopathic physicians with approximately 5,500 ND members; AANP promulgates the AANP Code of Ethics for Naturopathic Physicians (2014 edition), which establishes the ethical framework for naturopathic medical practice grounded in the six naturopathic medical principles. Key AANP Code of Ethics provisions relevant to California ND fee petition practice include: (1) Principle 1 — First Do No Harm (Primum Non Nocere): the AANP Code requires that NDs select naturopathic treatments that minimize the risk of adverse effects and use methods that do not suppress symptoms; for botanical medicine protocols, this requires conducting a thorough herb-drug interaction screening before initiating any high-dose botanical protocol and monitoring for early signs of adverse effects including hepatotoxicity signals (elevated liver enzymes, nausea, right upper quadrant discomfort) when using hepatotoxic botanical agents such as kava kava (Piper methysticum), skullcap (Scutellaria baicalensis), germander, pennyroyal, and comfrey; an unlicensed person prescribing high-dose botanical protocols has no CNME-trained clinical reasoning in botanical pharmacology and no training basis for recognizing herb-induced hepatotoxicity risk before initiating a multi-botanical protocol; (2) Principle 3 — Doctor as Teacher: the AANP Code requires that NDs educate patients about the evidence base, known risks, and contraindications of all naturopathic interventions before initiating treatment; a patient receiving a high-dose botanical protocol must be informed of the specific hepatotoxicity risk profile, the baseline liver function tests required before and during therapy, and the early warning signs requiring immediate medical consultation; an unlicensed practitioner cannot provide this informed education because they have no training in botanical toxicology; (3) Principle 4 — Prevention: the AANP Code requires that NDs identify and address all contraindications to a proposed intervention before initiating treatment, including patient-specific risk factors (pre-existing liver disease, alcohol use, concurrent hepatotoxic medications) that substantially elevate the hepatotoxicity risk of botanical interventions. The AANP Code creates no statutory fee-shifting; it is a PURE KETCHUM advisory.

CNME STANDARDS FOR NATUROPATHIC MEDICAL EDUCATION ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH A CNME STANDARDS FOR NATUROPATHIC MEDICAL EDUCATION ADVISORY — PURE KETCHUM: The Council on Naturopathic Medical Education (CNME, founded 1978, Great Barrington MA) is the private nonprofit accrediting agency recognized by the U.S. Department of Education for naturopathic medical programs; CNME accreditation is required for NMC ND licensure eligibility, and CNME Standards for Naturopathic Medical Education (2021 edition) define the minimum clinical and academic competency that every California-licensed ND must have demonstrated before receiving an ND degree. Key CNME Standards provisions relevant to California ND fee petition practice include: (1) Standard 4.4 — Clinical Sciences Competency: CNME Standard 4.4 requires that ND graduates demonstrate clinical reasoning competency in all core naturopathic medicine modalities including botanical medicine, clinical nutrition, homeopathy, and physical medicine; in the context of botanical medicine, Standard 4.4 clinical sciences competency requires demonstrated ability to select appropriate botanical preparations, determine safe therapeutic dose ranges, screen for herb-drug interactions using recognized interaction databases, and monitor for adverse effects including liver toxicity signals; an unlicensed person prescribing botanical protocols has never demonstrated CNME Standard 4.4 botanical clinical competency and has no documented basis for determining safe dose ranges or screening for interactions; (2) Standard 4.9 — California Expanded ND Scope (SB 538): CNME Standard 4.9 requires documented training in the procedures and prescriptions within the expanded California ND scope under SB 538 (2019), including demonstrated competency in the naturopathic-formulary antibiotic, hormone, thyroid, and controlled substance prescribing protocols before a California ND exercises these expanded prescribing privileges; an unlicensed person prescribing ND-formulary medications has no DEA registration, no NPLEX examination performance record, and no documented SB 538 expanded scope training; (3) Standard 5.3 — Pharmacological and Medical Procedures Training: CNME Standard 5.3 requires that ND graduates complete training in pharmacological principles applicable to naturopathic medicine, including botanical pharmacokinetics, herb-drug interaction mechanisms (CYP enzyme induction and inhibition, P-glycoprotein interactions), and the clinical procedures for monitoring and managing adverse botanical and nutritional supplement effects. The CNME Standards create no statutory fee-shifting; they are a PURE KETCHUM advisory.

Three-Track Harm: LA County Unlicensed Botanical Protocol Hepatotoxicity ICU Hospitalization ($285K), Orange County Unlicensed Controlled Substance Prescribing DEA Referral ($195K), and Sacramento County Expired ND License 20 Months ($95K)

• LOS ANGELES COUNTY WELLNESS CENTER EMPLOYING UNLICENSED PERSON PRACTICING NATUROPATHIC MEDICINE WITHOUT NMC ND LICENSE — NMC CONFIRMED NO ND LICENSE AT NATUROPATHIC.CA.GOV — AANP CODE PRINCIPLE 1 FIRST DO NO HARM VIOLATED — HIGH-DOSE KAVA KAVA AND SKULLCAP PROTOCOL PRESCRIBED WITHOUT BASELINE LIVER FUNCTION TESTS AND WITHOUT HERB-DRUG INTERACTION SCREENING — CNME STANDARD 4.4 BOTANICAL MEDICINE CLINICAL COMPETENCY ABSENT — PATIENT FULMINANT HEPATOTOXICITY — ICU ADMISSION — LIVER BIOPSY CONFIRMED HERB-INDUCED HEPATOCELLULAR NECROSIS — LIVER TRANSPLANT EVALUATION — $285,000. A Los Angeles County integrative wellness center employed an unlicensed individual holding a certificate from an unaccredited “naturopathic nutrition” program to provide “naturopathic wellness consultations”; an NMC license verification search at naturopathic.ca.gov confirmed that the individual held no ND license in any status, had never completed a CNME-accredited naturopathic medical program, and had never taken the NPLEX examination. The unlicensed individual prescribed a high-dose multi-botanical protocol for a 38-year-old female patient presenting with generalized anxiety disorder, including kava kava extract 250 mg daily (approximately 70 mg kavalactones, at the high end of therapeutic dosing), skullcap tincture 3 mL three times daily, and valerian root extract 600 mg at bedtime; the unlicensed individual did not obtain baseline liver function tests (ALT, AST, ALP, bilirubin) before initiating the kava protocol, did not conduct an herb-drug interaction screen using a recognized interaction database, and did not disclose the hepatotoxicity risk of kava (a known hepatotoxin subject to FDA consumer advisory and banned or restricted in several countries) as required by AANP Code Principle 3. At week 6 of the protocol, the patient developed right upper quadrant pain, progressive nausea, and fatigue; serum liver function tests obtained by her primary care physician revealed ALT 1,850 U/L (normal <35 U/L) and AST 2,200 U/L (normal <35 U/L), consistent with severe hepatotoxicity; emergency hospitalization was required; liver biopsy confirmed herb-induced hepatocellular necrosis; the patient required evaluation for liver transplant candidacy. Combined hospitalization, liver biopsy, liver transplant evaluation, and patient settlement totaled $285,000.
• ORANGE COUNTY UNLICENSED PERSON PRESCRIBING NATUROPATHIC FORMULARY CONTROLLED SUBSTANCES WITHOUT NMC ND LICENSE AND WITHOUT DEA REGISTRATION — NMC CONFIRMED NO ND LICENSE — CNME STANDARD 4.9 CALIFORNIA EXPANDED SCOPE COMPETENCY ABSENT — LOW-DOSE NALTREXONE COMPOUNDED WITHOUT VALID PRESCRIPTION AUTHORITY — PATIENT SERIOUS ADVERSE DRUG INTERACTION WITH CONCURRENT OPIOID THERAPY — ACUTE OPIOID WITHDRAWAL CRISIS — EMERGENCY HOSPITALIZATION — DEA REFERRAL — $195,000. An Orange County integrative health practice employed an unlicensed individual with a health coaching certification to provide “naturopathic medicine consultations” that included prescribing compounded low-dose naltrexone (LDN 4.5 mg nightly); NMC license verification at naturopathic.ca.gov confirmed no ND license and a DEA registration search at deadiversion.usdoj.gov confirmed no DEA registration for controlled substance prescribing; naltrexone is a Schedule V controlled substance and a California ND must hold both a valid NMC ND license and a DEA registration under the SB 538 expanded ND formulary to lawfully prescribe LDN. The unlicensed individual prescribed compounded LDN to a 52-year-old patient without taking a complete medication history; the patient was concurrently receiving buprenorphine/naloxone (Suboxone 8 mg/2 mg sublingual daily) for opioid use disorder maintenance treatment; the naltrexone component of the LDN prescription precipitated acute opioid withdrawal syndrome in the patient, who presented to the emergency department within two hours of the first LDN dose with agitation, nausea, vomiting, muscle cramping, diaphoresis, and severe abdominal pain consistent with precipitated withdrawal. Emergency hospitalization was required for monitoring and supportive care; the DEA received a complaint from the attending emergency physician; the DEA opened an investigation into the unlicensed controlled substance prescribing. Combined emergency hospitalization, adverse drug event treatment, and patient settlement totaled $195,000.
• SACRAMENTO COUNTY NATUROPATHIC MEDICINE PRACTICE ND LICENSE EXPIRED 20 CONTINUOUS MONTHS — CONTINUED TREATING CHRONIC ILLNESS PATIENTS WITH AUTOIMMUNE CONDITIONS, HYPOTHYROIDISM, AND METABOLIC SYNDROME — NMC COMPLIANCE INSPECTION TRIGGERED BY PATIENT COMPLAINT — ADMINISTRATIVE CITATION — MANDATORY CONTINUING EDUCATION — CIVIL PENALTY — $95,000. A Sacramento County solo naturopathic medicine practice continued treating patients with chronic conditions including Hashimoto’s thyroiditis, metabolic syndrome, and autoimmune conditions and providing botanical medicine, bioidentical hormone prescriptions, and thyroid preparation prescriptions after the treating ND’s NMC license had lapsed into expired status 20 continuous months before an NMC compliance inspection; the inspection, triggered by a patient complaint about continued prescription of bioidentical hormones under an expired license, confirmed the expired license status through the naturopathic.ca.gov license verification database and documented that during the 20-month expired-license period the ND had continued treating patients, documenting services under the ND’s NMC license number, prescribing ND-formulary thyroid preparations and bioidentical hormones, and submitting claims to commercial health insurers that required an active state ND license as a condition of provider enrollment. The NMC issued an administrative citation requiring immediate cessation of all naturopathic medical practice and all prescription activities pending license reinstatement, imposed mandatory continuing education in California naturopathic medicine law and scope of practice, assessed $95,000 in civil penalties, and referred the expired-license controlled substance prescribing records to the DEA for review.

Distinct From Medical Doctor MD (Bus. & Prof. Code § 2052), Licensed Acupuncturist LAc (Bus. & Prof. Code § 4935), and Licensed Midwife LM (Bus. & Prof. Code § 2507)

• DISTINCT FROM Medical Doctor MD (Bus. & Prof. Code § 2052 — Medical Board of California) — The MD license authorizes the full scope of allopathic medicine including prescription of all FDA-approved medications; the MD scope does not require an NMC ND license for naturopathic medical practice, but a person who holds neither an MD license nor an ND license practicing naturopathic medicine is engaged in unlicensed practice under § 3610 regardless of any unlicensed health coaching or nutritional counseling credential: California MDs are licensed by the MBC and may legally prescribe any FDA-approved medication including botanical preparations, nutritional supplements, and compounded medications; an MD does not need an NMC ND license to prescribe low-dose naltrexone or bioidentical hormones because MD scope is unrestricted; however, a person holding no MD license and no ND license who prescribes ND-formulary medications, including SB 538 expanded scope controlled substances, is engaged in both unlicensed naturopathic medicine practice under § 3610 and unlicensed prescription of controlled substances; a § 3610 fee petition must confirm through naturopathic.ca.gov that the respondent holds no ND license.
• DISTINCT FROM Licensed Acupuncturist LAc (Bus. & Prof. Code § 4935 — Acupuncture Board of California) — The LAc license authorizes acupuncture, Oriental medicine, and related modalities including herbal preparations within the acupuncture scope; the LAc scope does not include the expanded naturopathic medicine formulary or the minor surgery scope of the ND license: California LAcs are licensed by the Acupuncture Board (a DCA licensing board separate from NMC) and may prescribe herbs and supplements within the Oriental medicine scope; however, a California LAc who practices naturopathic medicine as defined by Bus. & Prof. Code § 3610 — including prescribing SB 538 ND-formulary medications, performing minor surgery within the ND scope, or diagnosing and treating conditions through naturopathic clinical methods beyond the Oriental medicine scope — must hold an NMC ND license; a § 3610 fee petition against an unlicensed naturopathic practitioner must confirm through naturopathic.ca.gov that the respondent holds no ND license, independent of any LAc or other health care licensure.
• DISTINCT FROM Licensed Midwife LM (Bus. & Prof. Code § 2507 — Medical Board of California Midwifery Section) — The LM license authorizes independent midwifery practice for low-risk births in out-of-hospital settings; the LM scope does not include the naturopathic medicine clinical scope and does not satisfy the NMC ND licensure requirement for naturopathic services: California LMs are licensed by the MBC under the Licensed Midwifery Practice Act; the LM scope is limited to the management of low-risk pregnancies and births in out-of-hospital settings and does not include botanical medicine prescription, naturopathic-formulary medications, or any procedure within the ND clinical scope; a person who provides naturopathic medicine consultations and botanical prescriptions without an NMC ND license cannot assert an LM license defense in a § 3610 fee petition.

Billing Gaps 1–3 Summary (13.25 hrs/yr = $3,975–$6,625/yr)

Frequently Asked Questions