Legislators to vote on blocking naturopathic doctors’ licensing rule, eye doctors’ education rule

A variety of Chinese herbal medicine ingredients and a mortar and pestle. (Getty Images)

State lawmakers will vote Thursday on whether to kill an education rule for eye doctors because it refers to diversity training and to rewrite the licensing rule for Wisconsin’s newest licensed profession.

The Legislature’s Joint Committee for the Review of Administrative Rules (JCRAR) will conduct the vote on a paper ballot without meeting.

Both of the rules before the committee were submitted by the Department of Safety and Professional Services (DSPS), which oversees professional licenses and licensing boards.

The ballot motion before JCRAR members Thursday is to “indefinitely object” to a rule that revises the continuing education requirements for optometrists — health professionals licensed to practice primary vision care, including testing people’s vision and prescribing corrective lenses or other treatments.

Optometrists must have 30 hours of approved continuing education every two years. In March the state optometry board proposed a revised rule (CR-23-040) that would allow — but not require — one hour of “cultural competency or diversity training” as part of the 30.

The objection motion cites that provision.

In testimony submitted at a hearing on the rule in the Assembly health committee in May, Mike Tierney, the legislative liaison for DSPS, said that enabling health care professionals to learn about “the cultures, religions, traditions, beliefs, and ancestry of their patients is vital to identifying patients who are at risk or suffering from genetic disorders, identifying issues and potential underlying causes, and making the proper treatment decisions or referral to a genetic counselor or other medical professionals.”

Due to genetic differences, medical problems can affect people of different ethnic groups differently, while religious or cultural differences “also affect how a person will respond to a suggested course of treatment,” Tierney added.

He said the optometry board originally intended to require the cultural competency training but decided instead to make it optional.

“Literally, all the Board is doing in this rule [is] signaling to optometrists who wish to be at the top of their profession and provide the best patient care possible, that if they take a course, it will count,” Tierney testified.

The revised rule also would require one hour of training every two years on prescribing controlled substances responsibly. It adds an exemption to the requirement for optometrists who do not hold a federal registration allowing them to prescribe controlled substances.

The current optometry continuing education rule has no requirement for controlled substances prescription training. A requirement for two hours of training started in December 2019 and expired after two years in December 2021.

Tierney testified that only 184 of Wisconsin’s 1,286 practicing optometrists are licensed to prescribed medications. Those who are licensed only rarely prescribe controlled substances, he said. For practitioners who aren’t licensed to prescribe medications, the revision “exempts those optometrists from needing to obtain completely unnecessary continuing education regarding prescribing practices.”

The only other testimony at the May 22 hearing was from Cicero Action, the lobbying arm of a right-wing Texas policy organization, the Cicero Institute. The organization’s written testimony called “cultural competency” and “diversity training” “highly loaded ideological terms” and “divisive concepts” that the state should not include in its optometry training standards.

After the hearing Republicans on the Assembly health committee passed a motion objecting to the revised rule. Committee Democrats all voted against the objection.

“Continuing education should focus on advancing practitioners’ skills and knowledge, not on political diversity, equity, and inclusion training,” wrote Rep. Clint Moses (R-Menomonie), chair of the Assembly health committee, in a letter circulated Wednesday with the JCRAR motion to suspend the new rule.

Moses also wrote that reducing controlled substance prescription training “suggests that DSPS does not take the opioid abuse issue seriously.”

Cameron O’Connell, a member of Moses’ legislative staff, said in a phone interview Wednesday that Moses wasn’t opposed to training that directly taught about differences among ethnic groups relating to health risks or treatment, but that the representative believed training described in the rule was not relevant to the necessary skills for health professionals.

Naturopathic medicine license

The other rule up for a vote in the administrative rules committee Thursday involves the newly created license for naturopathic medicine practitioners, for whom Wisconsin first created a license in the 2021-22 legislative session.

The proposed licensing rule, CR 23-074, says applicants in 10 different circumstances may be required to submit to an oral exam during the application process.

The JCRAR motion singles out one of those circumstances for its objection: applicants who have “been convicted of a crime the circumstances of which substantially relate to the practice of naturopathic medicine.”

Mike Mikalsen, the chief of staff for Sen. Steve Nass (R-Whitewater), the administrative rules committee co-chair, said Nass and co-chair Rep. Adam Neylon (R-Pewaukee) objected to the oral exam as a departure from the framework in state law.

The state administrative rule code shows the same oral examination process has been part of the state medical licensing rule for more than 20 years, however.

In a memo to Nass’s office June 11, Tierney said the framework laid down in the naturopathic medicine license rule followed the framework in the licensing rule for medical doctors. The Wisconsin Examiner obtained a copy of the memo through an open records request.

“The provisions mentioned are not new provisions but provisions that have been utilized by other professional boards to execute the legislative intent,” Tierney wrote.

Under legislation enacted in 2018 under former Gov. Scott Walker, when a license applicant has been convicted of a crime, DSPS must investigate whether that crime is substantially related to the profession and whether the applicant has shown sufficient rehabilitation to be granted a license. The oral exam is part of the analysis, Tierney wrote.

State records also show no indication that anyone objected to the oral exam language during the hearings and comment period on the naturopathy rule or the emergency rule that preceded it.

The motion asks the new Naturopathic Medicine Examining Board to change its licensing rule by Friday afternoon. Based on the time required for an open meetings notice, it might be difficult for the board to meet that deadline, however.

Sen. Kelda Roys (D-Madison) said Wednesday Democrats on the committee had not been alerted to the complaints that the co-chairs raised and had not had an opportunity to discuss the issues before the scheduled vote Thursday.

Roys also said that the opposition to the cultural competence provision in the optometry continuing education rule showed “a fundamental misunderstanding about what cultural competence is about.”

The purpose, she argued, is making sure all patients are understood across diverse backgrounds. “It’s about making sure that people get what they need, especially in settings like health care and optometry.”

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