1. DIETETIC LICENSURE, ENFORCEMENT AND PUBLIC POLICY…. AN OHIO PERSPECTIVE

2. OBJECTIVES To discuss the importance of licensure To discuss the responsibilities of licensees to report violations To discuss enforcement issues and title protection To discuss licensure in the university setting To discuss licensure in other states regarding teleconferencing To discuss legislation and public policy

3. Do you think licensure is important? What if no one had to have a driver’s license and anyone could drive? What if anyone could practice medicine as a physician because there were no set requirements for education? What if anyone could provide medical nutritional therapy in a clinical setting?

4. Licensure is in place to safely regulate professions as well as some of the daily things individuals do

5. The purpose of the Board is to protect the public interest through its licensure and professional discipline of dietitians and to provide a professional environment that encourages the delivery of quality nutritional information and medical nutrition therapy within the State of West Virginia Promulgate rules in accordance with the provisions of chapter twenty-nine of the state code to implement and effectuate the provisions of this article, including but not limited to, legislative rules establishing the following: a code of professional ethics continuing education requirements and standards examination, licensure and renewal requirements of duly qualified applicants procedures and guidelines for the suspension or revocation of a license Importance of licensure

6. 46 states regulate the practice of nutrition and dietetics in some form Registration Certification Licensure See CDR at www.cdrnet.org/licensure/agencylist.htm www.cdrnet.org/licensure/agencylist.htm

7. In the State of Ohio, as part of the licensed dietitians’ standards of practice, they are required to report violations of the Dietetic Practice Act. Specifically OAC 4759-6-02(K)(2) states: Shall report alleged violations of the laws, rules and standards to the state board of dietetics. Reporting of Violations

8. In order to safely protect the public, alleged violations must be reported. The Ohio Board of Dietetics accepts anonymous complaints. If the complaint is anonymous there can not be follow up with the complainant for any further details which may affect the outcome of the investigation. Also, it is difficult to have a hearing without the complainant.

9. In Ohio, the types of penalties relating to violations for: Licensees –Deny, suspend, revoke licenses, impose conditions, enter into consent agreement Non-Licensees – File court actions – injunctions, criminal charges, etc. *Board actions are reported in Communiqué newsletter annually. Enforcement Issues / Title Protection

10. Cases investigated by the Ohio Board of Dietetics for FY 2011: 87 cases investigated: Of these 87 investigated cases, 94% were against licensees and the other 6% were against individuals not eligible for a license Examples of violations against licensees were for unlicensed practice, unlicensed practice because of failure to renew and violations of moral character. Examples of violations against individuals not eligible for a license were against fitness facilities and wellness centers.

11. Official Board actions include: 2 consent agreements entered 0 Cease and Desist letters sent 4 licenses issued with advisory letters for unlicensed practice

12. In Ohio titles protected include: Licensed Dietitian or Dietitian (similar in WVa) Any other words, abbreviations, letters, insignia, tending to indicate the practice of dietetics (only in WVa if practicing) “Nutritionist”, “Nutrition Counselor”, “Nutrition Educator” (only in WVa if practicing)

13. General Non-Medical Nutrition Information: Principles of good nutrition and food preparation Foods to be included in the normal daily diet The essential nutrients needed by the body Recommended amounts of essential nutrients The actions of nutrients on the body The effects of deficiencies or excesses of nutrients Food and supplements that are good sources of essential nutrients

14. The following administrative or management dietitians are required to be licensed in Ohio: Dietitians involved with the development of care practice standards for delivery of nutrition services Dietitians involved in the development and implementation of critical pathways Dietitians involved in the development and implementation of nutritional protocols/guidelines Dietitians responsible for supervision of dietary personnel who are involved in any of the above listed activities Licensure in the University / Dietary settings

15. Dietetic Educators of practitioners in college or university settings may or may not need to be licensed. If the educators are responsible for providing supervision of the clinical practice of the dietetic student then licensure is mandatory.

16. The State of Ohio interprets the requirement of licensure based on where the patient/client resides. For example, if a dietitian from West Virginia is providing medical nutrition therapy via teleconferencing to clients in Ohio then Ohio would require that the West Virginia dietitian have a valid, current Ohio dietetic license. Other states may differ from this interpretation so check with each individual state that you may be providing medical nutritional therapy in to determine the need for licensure. You can refer to the CDR website (www.cdrnet.org) to view all states that require licensure to practice dietetics.www.cdrnet.org Licensure in other states regarding teleconferencing

17. Monitor State legislation introduced in the General Assembly that affects dietetics to determine need for action Continue member involvement at the State and Federal level Update and maintain legislative contacts for state legislators Update and maintain grass root liaisons for federal legislators Encourage member responses to Action Alerts Communicate pertinent legislative issues and their impact on dietetic practice to members on a regular basis Support ADA Legislative issues Legislation / Public Policy

18. Safeguard the Dietetic Practice Act HB 259 in Ohio, “health freedom” legislation Our primary concern is that HB 259 is devoid of any requirements for minimum education, training, competency testing or standards of practice for persons who practice alternative medical therapies—and who would be able to engage in activities that currently require a license. The only prohibited activities listed are sixteen activities which include providing enteral and parenteral nutrition, performing surgery, prescribing narcotics, to name a few. HB 259 also states that the practitioner must provide a notice to the consumer that they are not licensed, certified, or otherwise authorized by the State of Ohio to practice a health care profession. This places the burden only upon the consumer to somehow be able to judge whether the practitioner’s credentials are true, and if the education relates to the service provided. In short, HB 259 allows them to do anything within the currently licensed medical professions except the sixteen prohibited activities, as long as they provide the consumer notice. Although proponents may have told you that the bill does not change the scope of practice for any of the affected professions, this bill does change the scope of practice for dietitians as well as increase the potential for endangering the public

19. HB 251 in Ohio, “Oriental Medicine” legislation Language modified to assure only GNMNI is provided. Identify and respond to opportunities for nutrition professionals in Health Care Reform activity Strengthen WVDA relationships with the Governor’s office, State legislative leaders and key agency contacts