| June 15, 2012

A letter writing campaign is underway by Ontario’s naturopathic doctors to the Premier of the Province, Hon. Dalton McGuinty. They assert that the proposed regulations to the Naturopathy Act are too restrictive and do not allow naturopaths to use all of their skills and training to treat their patients. Compared with other jurisdictions and signals from the Ministry of Health, the Transitional Council of the College of Naturopaths of Ontario, who prepared the proposed regulations, seems out of step with the future of health care.

Naturopathy has a long history of regulation in Ontario. Naturopathic medicine was first regulated in Ontario in 1923 under the Medicine Act and then in 1925 under the Drugless Practitioners Act and regulations under that Act. The Naturopathy Act in 2007 established the legislation under which naturopaths could conduct their “controlled acts” in the practice of medicine. These acts are deemed to carry sufficient risk of harm such that they could only be performed by an authorized health professional. Naturopaths have been authorized to communicate a diagnosis, administer substances by injection or inhalation, spinal manipulation, blood draws, conducting internal examinations and prescribing, dispensing, compounding and selling substances to patients.

It has been some time since the Naturopathy Act was passed in 2007.  Regulations that govern the practice of naturopathic medicine have been under development by the appointed Transitional Council of the College of Naturopaths of Ontario since then. In December 2011, they presented their proposed regulations of the authorized acts to the Minister of Health and Long-Term Care.

With the release of the proposed regulations, the naturopathic doctors in Ontario have resorted to a letter writing campaign to the Premier because they feel that the dialog between them and the Transitional College has broken down. They feel that the regulations are too restrictive and will hamper their efforts to utilize their skills and training to treat their patients.

They may be right. The proposed regulations are significantly different from other jurisdictions such as British Columbia and California. Naturopaths in these areas can use more diagnostic tools and treatments than their Ontario colleagues. In British Columbia, naturopaths can administer substances by irrigation, enteral instillation and use a hyperbaric chamber. They can use diagnostic ultrasound and X-rays (including CAT scans), defibrillation during the course of cardiac care and perform minor surgery. They can test for and conduct desensitization treatments for allergies. In California, they can use any diagnostic tools if a naturopath is trained including mammography and bone densitometry.

The Transitional Council of the College of Naturopaths of Ontario have taken a burdensome approach to regulating the substances that naturopaths can use for treatment.  They have published three schedules of substances that can be prescribed, dispensed, compounded, sold or administered. As the Government of Canada has found, administering a list of allowable substances requires a lot of effort. The substances allowed under the Food and Drugs Act were listed in Schedule F. Every time a new substance was introduced, a regulatory amendment was necessary. The Canadian government recognized this administrative burden under the Red Tape Reduction initiative and have eliminated its need under the omnibus Bill C-38. In contrast, British Columbia issued a list of substances that cannot be used. This is a more stable list than what is proposed in Ontario. It is a mystery as to why the Transitional Council would use such an outdated mechanism.

Perhaps the answer to the Transitional Council’s actions can be found in their rationales for the proposed regulations. The text speaks of reducing harms from performance of  ”controlled acts”. It also cites a history of complaints and discipline against naturopaths. It would seem that the Transitional Council took a risk reduction approach to the regulations. The best way to reduce the risks associated with the “controlled acts” is to not have them performed at all or in a very restricted sense. In so doing, they have reduced the roles that naturopaths can play in providing health care to patients. The proposed regulations are restricting the practice of Ontario naturopaths to levels that are below par with other jurisdictions.

Not too long ago the Ministry of Health and Long-Term Care re-tooled its mandate with an emphasis on an integrated health care system that delivers good care where people need it. The proposed naturopath regulations seem to fly in the face of this. Integrated health systems give people choices to the health services they want and eliminate silos, gaps and wasted time. Provincial Premiers are discussing expanded roles for nurse practitioners as one example of articulating this vision. The proposed regulations for the Ontario naturopaths are restrictive and out of step with the current vision for the future of health care.