.19 Code of Ethics.

A. Naturopathic doctors shall concern themselves primarily with the welfare of the patient.

B. A naturopathic doctor who suffers from a physical, mental, or emotional impairment, including substance abuse, that impacts the individualís ability to practice naturopathic medicineshall seek professional treatment and refrain from the practice of naturopathic medicine until the impairment no longer exists or reasonable accommodations can be made.

C. A naturopathic doctor shall:

(1) Use professional discretion and integrity in relationships with a member of the health care community;

(2) Be professional in conduct, with honesty, integrity, self-respect, and fairness;

(3) Remain free from conflict of interest while fulfilling the objectives and maintaining the integrity of the naturopathic doctor profession;

(4) Provide accurate fee information to the patient, the individual responsible for payment for treatment, and the insurer;

(5) At all times respect the patientís dignity, autonomy, and privacy;

(6) Practice naturopathic medicine only as defined in the scope of practice set forth in Health Occupations Article, §14-5F-14(a), Annotated Code of Maryland;

(7) Cooperate with any lawful investigation conducted by the Board, including:

(a) Furnishing information requested in a timely manner as directed by the Board;

(b) Complying with a subpoena;

(c) Responding to a complaint at the request of the Board; and

(d) Providing meaningful and timely access to relevant patient records; and

(8) Report to the Board conduct in the practice of naturopathic medicine that indicates a violation of:

(a) This chapter;

(b) Health Occupations Article, Title 14-5F, Annotated Code of Maryland; or

(c) Any other law, including, but not limited to, aiding or abetting the unauthorized practice of naturopathic medicine.

D. A naturopathic doctor may not:

(1) Misrepresent credentials, qualifications, or affiliations and shall attempt to correct others who misrepresent the naturopathic doctorís credentials, qualifications, or affiliations;

(2) Knowingly engage in or condone behavior that is fraudulent, dishonest, or deceitful, or involves moral turpitude;

(3) Engage in a commercial activity which conflicts with the duties of a naturopathic doctor;

(4) Perform naturopathic medicine on a patient if a contraindication against naturopathic doctor treatment exists;

(5) Discriminate against a patient or a health care provider based on race, religion, age, gender, sexual orientation, national origin, or disability;

(6) Intimidate, threaten, influence, or attempt to influence any person regarding any violation of law or regulation; or

(7) Aid or abet any individual violating or attempting to violate any provision of law or regulation.

E. A naturopathic doctor shall:

(1) Use professional judgment in the use of evaluation and treatment procedures;

(2) Decline to administer treatment if the naturopathic doctor believes that a treatment is contraindicated or unjustified;

(3) Terminate a professional relationship with a patient in an appropriate manner, such as:

(a) Providing the patient with sufficient notice to permit the patient to obtain the services of another professional;

(b) Assisting the patient by providing referrals if appropriate; or

(c) Continuing to provide emergency treatment to the patient if treatment is required before a reasonable time has passed to allow the patient to obtain the services of another health care provider;

(4) Maintain a written record of treatment of the patient under the naturopathic doctorís care for at least:

(a) 5 years after the termination of treatment; and

(b) 5 years after the patient becomes 18 years old, if applicable;

(5) Make the written records of treatment available to the patient upon request, in compliance with applicable laws for disclosure of medical records;

(6) Make arrangements for another professional to provide for the needs of the patient during anticipated absences when the naturopathic doctor is unavailable to the patient;

(7) Make referrals only to other qualified and duly licensed health care providers;

(8) Accurately inform the patient, other health care professionals, and the public of the limitations of the practice of naturopathic medicine;

(9) Adequately assess the patient to determine if contraindications against naturopathic medical treatment exist and refer the patient to an appropriate health care practitioner;

(10) Exercise independent professional judgment in the treatment or evaluation of the patient regardless of whether the patient was referred by another health care provider;

(11) Ensure clear and concise professional communications with patients regarding:

(a) Nature and duration of treatment;

(b) Diagnoses;

(c) Costs;

(d) Billing; and

(e) Insurance; and

(12) Administer fair and equitable fees to patients regardless of status or insurance.

F. A naturopathic doctor may not:

(1) Accept a client for treatment, or continue unnecessary treatment, when the patient cannot be reasonably expected to benefit from the treatment;

(2) Receive remuneration from, or provide remuneration to, or split a fee, for either making or accepting a referral of the patient to or from another health care provider;

(3) Make a guarantee or promise about the efficacy of a particular treatment, the naturopathic doctorís practice, or the result of a treatment unless supported by scientific principles accepted by the profession; or

(4) Exploit the professional relationship by:

(a) Continuing treatment unnecessarily; or

(b) Charging for a service:

(i) Not provided; or

(ii) Different from those actually provided.

G. A naturopathic doctor shall:

(1) Maintain professional boundaries, even when the patient initiates crossing the boundaries of the professional relationship; and

(2) Respect and maintain professional boundaries and respect the patientís reasonable expectation of professional conduct.

H. A naturopathic doctor may not:

(1) Exploit a relationship with a patient, staff member, or student for the naturopathic doctorís personal advantage including, but not limited to, a personal, sexual, romantic, or financial relationship;

(2) Engage in a sexually intimate act with a patient; or

(3) Engage in sexual misconduct, which includes, but is not limited to:

(a) Therapeutic deception;

(b) Non-bona-fide treatment; and

(c) A sexually exploitative relationship.

I. A naturopathic doctor may not engage in inappropriate behavior with other practice staff including sexual advances, harassment, discrimination, exploitation, retaliation, and other unprofessional conduct.

J. A naturopathic doctor shall:

(1) Respect and maintain the privacy and confidentiality of the patient;

(2) Disclose the patientís records or information about the patient only with the patientís consent or as required by law;

(3) Adequately safeguard confidential patient information, including storage and disposal of records;

(4) Provide sufficient information to a patient to allow the patient to make an informed decision regarding treatment, including:

(a) The purpose and nature of an evaluation or treatment regimen;

(b) Alternatives to treatment;

(c) Side effects and benefits of a treatment regimen proposed and alternatives to that treatment;

(d) The estimated cost of treatment and alternatives to treatment;

(e) The right of the patient to:

(i) Withdraw from treatment at any time, including the risks associated with withdrawing from treatment;

(ii) Decline to participate in treatment if an aspect of the treatment will be recorded, documented, photographed, observed, or otherwise used in an educational program; or

(iii) Terminate any treatment contract at any time, for any or no reason, with no fee or penalty incurred;

(5) Obtain the full informed consent of a patient participating in a human research program, without communicating a direct or implied penalty for the patientís refusal to participate in the program and with due regard for the patientís autonomy and dignity;

(6) Comply with applicable federal and state laws for human research programs; and

(7) Promptly and efficiently respond to any patient or Board request for records.

K. A naturopathic doctor shall:

(1) Obtain additional training, information, and supervision as needed to perform a new technique or service in a new specialty area or when employing a new treatment modality; and

(2) Be current in the qualifications to practice, including meeting continuing education requirements as set forth in Regulation 11 of this chapter.

L. The naturopathic doctor may not perform a treatment or provide a service that the naturopathic doctor is not qualified to perform or which is beyond the scope of the naturopathic doctorís education, training, capabilities, experience, and scope of practice.

M. A naturopathic doctor may not construe any failure to specify a particular ethical, legal, or professional duty in this chapter as a denial of the existence of other ethical, legal, or professional duties or responsibilities that are equally as important and generally recognized in the naturopathic medicine profession.

N. A violation in this chapter may result in the Board taking action pursuant to Health Occupations Article, §14-5F-18, Annotated Code of Maryland.