Yours, Mine and…Ours?

1. Yours, Mine and…Ours? Licensure – Whose is it Anyway? Georgianna Walker, MS, RD, LRD Chair, ND BODP NDAND/NDNC Spring Convention April 23, 2014

2. Objectives • Appreciate & value the history of licensure for dietitians/LNs in North Dakota • Differentiate between the roles of the BODP and the state affiliate • Identify steps to take when submitting a complaint • Confidently speak to the purpose of licensure

3. History • Licensure in ND since 1985 • The “need” for licensure tied to 3rd party reimbursement • Key players • Supporters vs. opposition • Compromises • Exemptions for various health care providers • Exemptions for those who sell nutrition products • Addition of LN definition

4. History LRD • Hot pink T-shirts with bold black letters • How we became “LRDs” • One of the 1st states to achieve licensure • Set the pace nationally

5. Types of Licensure • Title Protection • Use of particular title limited to those licensed by the state • Low level of regulation, no practice exclusivity • Certification • State requires credential from specified professional entity • Educational component • Illegal to use “certified” title without credentials • Occasionally includes practice exclusivity www.eatright.org/scope/DefinitionofTerms

6. Types of Licensure • Licensure-most restrictive • Educational attainment, competency exam • Title protection & practice exclusivity, time limited • ND has this!!! www.eatright.org/scope/DefinitionofTerms

7. ND Dietetic Practice Law • Defines standards for Dietitian & Licensed Nutritionist • Good definitions for “dietetics”, “nutrition assessment”, “nutrition care services” (NDCC 43-44-06) • RD definition includes provision of nutrition assessment and nutrition care services • License is required to practice as a dietitian • Restricts the practice of nutrition assessment and nutrition care services to licensed dietitians (note exceptions) • LN practice is not as protected d/t the definition

8. Exceptions • Doctors, nurses, pharmacists, dentists • Must practice consistent with the standards of their profession • Can’t use titles of LRD or LN • Students of dietetics or those gaining experience for a license • Someone who provides services under supervision of the LRD • In the armed forces

9. Exceptions • Qualified RD/LN but practice <10 days/yr in ND • When application is pending before BODP • Educators, home economists within scope of practice • People who sell food & supplements • Limited to advising of products to meet normal nutritional needs

10. ND Dietetic Practice Law • Infringement of the law • Use of LRD/LN titles without a license • Provision of nutrition assessment/nutrition care services as defined in the law, without a license • Non-RD health care professionals would be judged within the accepted standards of their profession • Caution: Weight loss advice may fall under normal nutrition needs counseling

11. Licensure Is A State Issue • Licensing board is a state entity • Legislation enacted at the state level • Part of the state’s legal code (Century Code in ND) • Appointed by the Governor • CHARGED WITH : • Protection of the public • Self monitoring of the profession • National professional organization does not have legal authority in the state

12. Licensure Is A State Issue • Legal authority resides with the state’s attorney general • Non-compliance = You’ve broken the law! • Violations recorded on your permanent record • BODP MUST report to National Practitioner Data Bank

13. What Does the BODP Do??? • Manage and oversee the licensing process • Monitor & investigate performance of licensed RDs/LNs as needed • Investigate others who infringe on the practice area • Investigate complaints & concerns from practitioners and public

14. Professional Standards • From the legal viewpoint licensed professionals are: • Expected to practice within accepted standards of the profession. • Evaluated by a group of their peers in case of complaint • BODP is the state-appointed entity that performs the peer review • Evaluate in light of Code of Ethics, Scope of Practice, Standards of Professional Performance • www.eatright.org/practice • Self-monitoring of the profession

15. Complaint Process: When To File • RD or LN: unethical practice, out of scope of practice, practice that causes harm to the public • Other professionals out of their scope of practice or causing harm • Non-professionals practicing within RD scope of practice • Any time you have 1st hand knowledge of unethical and/or nutrition practice that has the potential to cause harm

16. Complaint Process: Who & What?? • Who should report harm? • Anyone from the public • RDs & LNs who understand their scope of practice • You have a responsibility to report (Code of Ethics) • What should be reported? • Violations of the dietetic practice law • Incidents that create potential/real medical harm to the public • Incidents that create potential/real financial harm to the public

17. Examples of Harm • Internet website offering raw food diets, nutritional counseling and MNT to cure specific diseases (DM, heart disease, allergies), owner claimed to be a RD. Investigation found that she had no nutrition credentials, was a fitness model, and self taught raw foodist • Licensed RD 1)loaned over $2,000 to patient and reflected the balance of the loan on bills for professional services rendered and 2) failed to present a patient with a complete accounting of her bills. • RD failed to renew her license within the specified time frame, after 2 reminders, license lapsed and a notice was sent to employer. Since the health care facility requires all professional employees to be licensed, the RD was unable to work for nearly a week until fees were paid and licensed re-instated.

18. Do not report to: • State or national Academy staff • Friends • State legislator • Barriers to reporting • Complacency (someone else will do it) • Unaware of process • Concern about confidentiality • Intimidation, lack of confidence Complaint Process:Where Do You Report? To the State Licensing Board (ND BODP)

19. Complaints:How To Report • Use the Complaint Form provided by the BODP • www.ndbodp.com • Describe incident in your own words • Use detail, copies of pertinent documents • If including patient records • Remove patient identifiers • Dates, times, type of service should be included • Sign & date!! • Anonymous complaints may not be processed

20. Yours, Mine and…Ours? Licensure – Whose is it Anyway? Michelle Hoppman RD, LRD, CDE Consumer Protection Coordinator NDAND/NDNC Spring Convention April 23, 2014

21. The Purpose of Licensure Dietitians and Nutritionists

22. Member Impact & Advocacy • For the public… • Ensures access to quality health care • Enhances public health & safety • Upholds licensure statutes • For the profession… • Increased opportunities • Increased professional recognition • Right person for the job(?) • Fair marketplace

23. NDBODP & the NDAND • North Dakota Board of Dietetic Practice (NDBODP) • Regulatory Body which consists of 5 board members who are appointed by the governor of North Dakota • The NDBODP licenses dietitians and nutritionists • Meets at least one time per year • North Dakota Academy of Nutrition & Dietetics (NDAND) • Non regulatory, educational, advocating • Mission: The North Dakota Academy of Nutrition and Dietetics is the advocate of the dietetic profession, serving the public through the promotion of optimal nutrition, health and well-being.

24. Propose of Licensure Licensure is vital to achieving the Academy’s vision and mission for its members. • Licensure for dietitians and nutritionists • Protects the Consumer against potential harm • Ensure dietitian / nutritionist: • Registration • Education • Qualification • Agree to Code of Ethics

25. Consumer Protection Coordinator (CPC) • CPC: Is a liaison between the NDAND and the NDBODP • Volunteer Position; Non Voting Member • Affiliate member relationship with Academy (CPLS) • Point of contact on consumer protection and licensure issues • Monitor state environment and develop state action plan

26. CPC Job Duties • Attend all licensure board meetings and report back to the affiliate board; • Monitor the status of RD licensure board terms of office; • Assist affiliate board with recommendations to the governor for appointments to the licensure board; • Monitor consumer protection issues and their impact on the affiliate’s licensure statute and related issues; • Participate in Academy consumer protection issues meetings, Webinars and Licensure Forum calls; • Monitor the overall licensure board structure with regard to professional representation roles; • Develop a plan for increasing the reporting of documented harm and success and effectiveness stories of RDs; • Train affiliate members and leadership (affiliate board & Public Policy Panel) on consumer protection and licensure issues impacting the profession.

27. The Affiliate-CPC Contact your CPC to: CPC

28. Consumer Protection • Safety and protection of the public • Requiring minimum standards & qualifications • Access to quality health care (Health Care Reform) • State oversight and regulation • Coverage Resource: The Academy of Nutrition & Dietetics

29. Consumer Protection “If You See Something, Say Something” The dietetics practitioner considers the health, safety, and welfare of the public at all times. The dietetics practitioner will report inappropriate behavior or treatment of a client by another dietetics practitioner or other professionals.” Resource: the Academy Code of Ethics

30. The Future of Licensure • Anti-licensure activities • Increasing creation & use of nutrition credentials, certifications, titles • “Dietitian” often associated only with clinical settings; no legal definition of “nutritionist” • Should all healthcare practitioners be able to practice nutrition to the level of their expertise? • Can we as a profession expand our horizons to accommodate an array of qualified nutrition professionals?

31. The Future of Licensure in ND • Our law needs: • Aggressive wording that deals with internet, intrastate, international practice issues • Definitions for: MNT, “nutritionist”, scope of practice • Updated Code of Ethics • Should we plan to revise & update our law? • Not recommended by the Academy • FACT: Anyone can bring existing legislation to the floor for reconsideration!! • MN dietetic practice law renewed without difficulty • Cautiously consider?

32. QUESTIONS? Thank You!