9.9.1 Legislation
- Business and Professions Code Section 4925-4934 known as the Acupuncture License Share Act 1976.
9.9.2 Definitions
`Acupuncture' is defined in the Act to mean the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalise physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion.
9.9.3 Governing Body
Acupuncturists are required to be licensed by the Division of Licensing of the Medical Board of California.
9.9.4 Titles
An unlicensed person cannot hold her/himself out to be an acupuncturist, and this includes using words or titles or descriptions of services that incorporate words such as acupuncture, Oriental Medicine, etc., or by representing that the person is trained as an expert in the field of acupuncture, Oriental Medicine or Chinese Medicine.
In an opinion obtained from the Attorney General, it is concluded that a licensed acupuncturist may not use the titles `OMD' or the title `Oriental Medical Doctor' in advertising unless she or he can document proof of a Doctorate in Oriental Medicine. The initials or title must be used in conjunction with the title of Licensed or Certified Acupuncturist.3
9.9.5 Practice of Acupuncture by Other Health Care Practitioners
Acupuncture is considered to be within the scope of medical doctors, with no specified training, but not within the scope of the practice of chiropractors as the chiropractic statue specifies that chiropractors may not penetrate tissue.3
9.9.6 Infection Control
The rules made by the Board specify standards for offices, clean needle technique and needle disposal.3
9.9.7 Practice of Traditional Chinese Medicine by Other Health Care Providers
A licensed acupuncturist is authorised to engage in the practice of acupuncture and to perform or prescribe the use of Oriental massage, acupressure, breathing techniques, exercise, or nutrition, including the incorporation of drugless substances and herbs as dietary supplements to promote health. Nothing in that description prohibits a non-licensed acupuncturist or other healing arts licensee from performing or prescribing the use of Oriental massage, breathing techniques, exercises or nutrition to promote health, so long as those activities are not performed or prescribed in connection with the practice of acupuncture.
9.9.8 Eligibility Requirements
Qualifications for the issue of a license are standard requirements relating to age, educational and training programs, Board examination and clinical internship.
9.9.9 Continuing Education
The Committee establishes standards for continuing education for acupuncturists, who until 1 January 1996 were required to complete 15 hours of continuing education and since that time have been required to complete 30 hours every two years as a condition of renewal of certification.
The Acupuncture Committee of the Board is required to establish standards for the approval of schools and colleges offering education and training and the practice of acupuncture including standards for the faculty in those schools and colleges and tutorial programs. Within three years of that initial approval, the program is to receive full institutional approval under the education code in the field of traditional Oriental medicine.
9.10.1 Legislation
- Section 61-14A-1 et seq., NMSA, 1978 as amended. `The Acupuncture and Oriental Medicine Act'.
9.10.2 Definitions
The Act provides: "Acupuncture means the use of needles inserted into the human body by piercing of the skin and the use of all allied techniques of oriental medicine, both traditional and modern, for the diagnosis, prevention, cure or correction of any disease or pain by means of controlling and regulating the flow and balance of energy in the body so as to restore the body to its proper functioning and state of health. As used in this sub-section `techniques of oriental medicine' include but are not limited to moxibustion, herbology, dietary and nutritional counselling, body work and breathing and exercise techniques".
Rules made by the Board under the Act set out a list of accepted treatment modalities and services including ion cord therapy, shiatsu, therapeutic exercises, herbs, homeopathics, x-rays, CT scans, MRI, blood and other laboratory tests and ultrasound.
9.10.3 Governing Body
The Act creates the Board of Acupuncture and Oriental Medicine comprising 4 licensed acupuncturists and 3 public members appointed by the Governor. The Board is empowered to enforce the provisions of the Act, create necessary rules and regulations and adopt a Code of Ethics. In addition it has inspectorial powers and may conduct hearings on disciplinary matters. The Board may also adopt rules requiring continuing education.
9.10.4 Titles
From 1 July 1994 the title Doctor of Oriental Medicine superseded the use of all titles that included the words `medical doctor' or the initials `M.D.', unless the person is a licensed medical doctor.
9.10.5 Practice of Acupuncture by Other Health Care Providers
Generally, health care practitioners may practise within the scope of their practice but cannot refer to or promote themselves as acupuncturists unless licensed under the Act.
9.10.6 Education
- Requirements of the Acupuncture School are divided between those who have commenced training before 30 September 1993 (1800 hours) and those who started their training after that date (2400 hours).
- An Apprenticeship Scheme requires a minimum of 1800 hours of training over not less than three years.
- Experience alone is not sufficient for the granting of a license under the Act.
- Licensing requirements include National Commission for the Certification of Acupuncturists (NCCA) and State exams.
- No regulations relating to continuing education have been adopted to date.
- 9.11.1 Legislation
- Education Law, Title 8, The Professions, Article 160 - Acupuncture, 1991.
9.11.2 Definition of Acupuncture
`Profession of Acupuncture' is defined as "the treating, by means of mechanical, thermal or electrical stimulation effected by the insertion of needles or by the application of heat, pressure or electrical stimulation at a point or combination of points on the surface of the body predetermined on the basis of the theory of physiological interrelationship of body organs with an associated point or combination of points for diseases, disorders and disfunctions of the body for the purpose of achieving a therapeutic or prophylactic effect".
9.11.3 Governing Body
The State Board for Acupuncture is an advisory body to the New York State Board of Regents. The Board for Acupuncture comprises 4 licensed acupuncturists, 4 licensed physicians certified to practise acupuncture and 3 public members.
9.11.4 Titles
Generally, a person may list any degree they have earned from a recognised institution. Only a person licensed under that Article is entitled to use the title `Licensed Acupuncturist'.
9.11.5 Practice of Acupuncture by other Health Care Practitioners
There are separate provisions in the Act that relate to the Office of Alcoholism and Substance Abuse Services and requirements governing the practice of acupuncture in certified or licensed alcoholism or substance abuse facilities. People providing these services are required to operate under the general supervision of a physician or dentist certified to practise acupuncture or a person licensed to practise acupuncture in New York State.
A `specialist's assistant-acupuncture' is entitled to practise under supervision. Licensed physicians, osteopaths, and dentists must be certified to practise acupuncture and must be appropriately trained.
9.11.6 Eligibility Requirements
Licensing requires a combination of clinical and academic training.
9.11.7 Supervision or Referral Requirements
"Each acupuncturist licensed pursuant to this article shall advise each patient as to the importance of consulting with a licensed physician regarding the patient's condition and shall keep on file with the patient's records, a form attesting to the patient's notice of such advice".
9.11.8 Professional Misconduct
Article 130, Sub-article 3, Professional Misconduct, General Provisions relate to professional misconduct for all professions that are licensed under Title 8.
The definitions of professional misconduct are similar in scope to Australian health professional legislation, including incompetence, impairment, drug addiction, permitting an unlicensed person to perform activities requiring a license and practising while a license is suspended.
Public Health Law, Article 2, The Department of Health, Title 2A, Professional Medical Conduct, establishes a State board for professional medical conduct. The board has no fewer than 18 physicians licensed in the State for at least five years, at least two of whom are to be physicians who dedicate a significant portion of their practice to the use of non-conventional medical treatments, and who may be nominated by New York State Medical Associations dedicated to the advancement of such treatments.
These boards conduct disciplinary proceedings in all professional medical misconduct matters.
9.11.9 Notes to the Legislation
In 1995, the licensing plan originally established in 1974 was replaced by what was described as `an orderly system of acupuncture licensure similar to the licensure system for other health professionals as regulated by the regents and the Department of Education.'
Editorial notes to the Act state that as a result of the recommendations of the New York State Commission on Acupuncture in 1974, the practice of acupuncture has been recognised as a science and the availability of acupuncture services has been recognised as a need for health care consumers in New York State.
The editorial note in the New York legislation is indicative of the philosophy underpinning the regulatory approach in that jurisdiction: TCM is embraced as a legitimate and viable complement to health care services and is regulated for the same reasons as are other health care professions, for the protection of the public and assurance of quality service.
9.12.1 Legislation
- Medical Treatment Act 1973.
9.12.2 Summary
The Korean Medical Treatment Act is a very detailed piece of legislation that creates a framework for the registration of `medical persons' meaning, a doctor, dentist, herb doctor, midwife or nurse who have been licensed by the Minister of Health and Social Affairs.
The duties of doctors, dentists and herb doctors within their specialities are essentially the same although restricted to within their particular field.
9.12.3 Qualifications
Herb doctors are required to hold specific qualifications, (not set out in the Act), that relate to a national examination conducted each year by the Minister.
The Act recognises graduates from foreign colleges majoring in the herb medical science who have been awarded the degree of a Bachelor of Herb Medical Science together with graduates from foreign schools recognised by the Minister who have obtained a license as a herb doctor in the foreign country.
Specialist medical qualifications are provided through a course of training by the Minister and are available to doctors, dentists and herb doctors. Only medical persons with such qualifications are able to hold themselves out to be specialists in the relevant field.
Eligibility for licensing is affected by problems such as mental illness, drug addiction, bankruptcy, imprisonment on matters relating to public health and medical treatment, failure to fulfil the conditions of a license, allowing another to use the certificate of license.
9.12.4 Practice
Only licensed medical persons are permitted to conduct medical treatment. Only a herb doctor is to engage in herbal medical treatment and herbal guidance of public health. A medical person (including herb doctors) is not permitted to refuse a request for medical treatment without reason, and is required to take `the best measures' for emergency patients. Only a medical person (or other designated individuals) may dispose of human tissue.
There are detailed requirements relating to the provision of a diagnosis, or written result of autopsy in relation to patients. A record book for medical treatment in relation to treatment conducted and opinions in relation to all patients must be kept.
The Act details how permits for medical institutions are to be obtained, bed numbers determined and other details relating to the standards of facilities.
9.12.5 Advertising
Prohibitions relating to advertising include: fraudulent or exaggerated claims; advertising of medical treatment by people other than a medical institutions and medical persons; and claims relating to the ability and treatment methods of a specific medical person. The results of preventive medical and clinical research can only be advertised to the general public for academic and scientific purposes.
9.12.6 Disciplinary Structure
All disputes on medical treatment are conciliated first by a Local Medical Examination Conciliation Committee and ultimately, if not resolved at that level, by a Central Medical Examination Conciliation Committee. Both Committees have the power to require witnesses and parties to attend and make statements, to inspect documents and to enquire broadly in order to investigate the facts.
9.12.7 Medical Assistants
There are special provisions relating to `quasi medical persons' including bone setters, acupuncturists, and moxibustionists who were licensed before the commencement of the Medical Treatment Act in 1973. These quasi medical persons are able to continue practising under the new Act, and all the provisions relating to medical persons and medical institutions apply to quasi medical persons with necessary changes.
9.12.8 Penalties
The penalty provisions range from fines to imprisonment depending on the offence committed. For example a person who lends her/his certificate of license, or violates the provisions relating to interfering with medical treatment techniques or conducting medical treatment while unlicensed, attracts a substantial monetary fine or imprisonment.
9.13.1 Legislation
- Medical Registration Act 1953.
9.13.2 Summary
The only reference to Chinese medicine in existing legislation found was in the registration of medical practitioners. The Medical Registration Act 1953 sets out the framework in which medical practitioners can apply for registration. This Act specifically states that nothing within its provisions are to "be construed to prohibit or prevent the practice of systems of therapeutics according to Malay, Chinese or Indian method".
In 1994 the Singapore Government established a committee to review the current practice of TCM and to recommend measures "to safeguard patient interest and safety, and to enhance the standard of training of TCM practitioners". The committee's September 1995 recommendations, which have been accepted by Government, are similar to those recommended by the Hong Kong working party. The TCM community is asked to raise its own standards by upgrading the quality of recruitment and training and by greater self-regulation. The need for statutory regula tion will be assessed within five years.4
9.13.3 Herbal Medicine
As at 1993, there are no controls over the import and export of herbs. Few herbs are prohibited from sale, and there is no registration of toxic or potentially dangerous herbs. However, (unspecified) legislation prohibits the adulteration of herbs by Western pharmaceuticals and contamination by toxic metals. In addition proprietary Chinese medicine is subject to controls relating to advertising and labelling, with routine inspections of complaints conducted to enforce the law.1
9.14.1 Legislation
- Medical Act 1971.
9.14.2 Summary
The Malaysian Medical Act 1971 adopts a similar style of registration for medical practitioners to the model used in Australia.
In general terms, a person who is not registered as a medical practitioner under that Act is guilty of an offence if she/he `wilfully and falsely' uses titles such as physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary, or any other title, name or description (or instrument) that is designed to induce a person to believe that the practitioner is qualified to practise medicine or surgery according to modern scientific methods.
However, the Act specifically allows a person to practise systems of therapeutics according to purely Malay, Chinese, Indian or other native methods, and to demand reasonable charges in respect of such practice, providing they do not induce clients into believing that they are qualified to practise medicine or surgery according to modern scientific methods.
9.15.1 Legislation
- Local Government (Miscellaneous Provisions) Act 1982.
9.15.2 Summary
Part 8 of the Local Government (Miscellaneous Provisions) Act 1982 (the Act) includes provisions relating to acupuncture (Clause 14). In order to practise, an acupuncturist must be registered with a local authority, and their premises must also be registered, except where the acupuncturist `sometimes visits people to give them treatment at their request'.
Local authorities may make by-laws relating to cleanliness and fitting of premises, the cleanliness of registered acupuncturists and their assistants, and the cleansing and where appropriate sterilisation of instruments materials and equipment used in connection with the practice of acupuncture.
If acupuncture is practised by or under the supervision of a registered medical practitioner or dentist, then the requirements of the section do not apply.
References
1. WFAS (World Federation of Acupuncture-Moxibustion Societies) Legislative Working Committee Report, November 1993.
2. Report of the Working Party on Chinese Medicine. Government of Hong Kong, October 1994.
3. Mitchell BB Acupuncture and Oriental Medicine Laws. Washington DC: National Acupuncture Foundation. 1995.
4. Traditional Chinese Medicine. A Report by the Committee on Traditional Chinese Medicine. Ministry of Health, Singapore, October 1995.
Chapter 9: Regulation of TCM in Australia and Overseas
- Overview:
- Regulatory approaches in different countries may be seen as a continuum, from a highly regulated model where practitioners are licensed and supervising boards are established to maintain standards and oversee qualifications (a model adopted in Australia for the registration of other health professions); to a virtual absence of regulation, where any person may set up a practice of TCM, constrained only by the prospect of personal liability for negligence and breach of contract, and general provisions relating to poisons and therapeutic goods.
- Overseas trends indicate that increasing numbers of jurisdictions are introducing occupational regulation of TCM practitioners to supplement the various forms of regulation on the materials and the conduct of TCM practice.
- Australia:
- No provisions specifically govern the practice of TCM, however TCM practitioners are regulated by provisions of Medical Practice, Therapeutic Goods and Poisons legislations and by regulations and guidelines governing skin penetration.
- The manufacture and supply of prepared therapeutic goods and poisons are regulated.
- Raw Chinese medicinal substances are not adequately regulated by current legislation.
- Acupuncture, like body piercing and tattooing, is subject to infection control provisions or those relating to regulation of premises.
- China:
- TCM is highly regulated. Regulations apply to the qualifications required for TCM practice, to the establishment of TCM hospitals, from where the practice of TCM may be conducted.
- Korea:
- There is a highly regulated system for herbal doctors. The relevant Act makes it compulsory for such doctors to belong to the Herb Doctors Association.
- Malaysia, Hong Kong and Singapore:
- TCM practitioners are self-regulated. They are exempted from medical regulation by reference to the ethnic or cultural source of their system of medicine. For instance in Hong Kong, only TCM practitioners of the Chinese race are exempt from the Medical Registration Ordinance, and in Malaysia and Singapore the exemption applies to persons who practise therapeutics according to purely Malay, Chinese, Indian or other native methods.
- Both Hong Kong and Singapore have recently examined the need for regulation of TCM. Hong Kong is moving towards a system of dual recognition, where both medical doctors and TCM practitioners will be registered and supervised by two separate and distinct professional Boards and licensing regimes.
- United States:
- 27 States have enacted specific legislation for the practice of acupuncture. In many, this covers the broader concept of `Oriental Medicine'. A further four States permit the practice of acupuncture under the supervision of a medical doctor. A small number have adopted regulation similar to that applied to medical practitioners in Australia, restricting use of title to those with full TCM qualifications.
- Nevada has adopted licensing of TCM practitioners. This covers all modalities of TCM, but distinguishes between an acupuncturist and practitioner of herbal medicine. `Oriental Medicine' is defined as a healing art based on the flow and balance of energy in the body and includes acupuncture, herbal medicine and `other services approved by the Board'. The licensing Board has the power to approve colleges and schools offering formal training in TCM, and it maintains control over curriculum.
- Canada:
- Occupational regulation of TCM is variable. The province of Alberta, as one example, has introduced occupational regulation of acupuncturists.
- United Kingdom:
- There is no national government sponsored regulation of TCM. However, in order to practise, an acupuncturist must be registered with a local government authority, and their premises must also be registered.
