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Bill 3237

                    Current Status

Bill Number:                      3237
Type of Legislation:              General Bill GB
Introducing Body:                 House
Introduced Date:                  19990112
Primary Sponsor:                  Altman
All Sponsors:                     Altman
Drafted Document Number:          l:\council\bills\psd\7112ac99.doc
Companion Bill Number:            304
Residing Body:                    House
Current Committee:                Medical, Military, Public and Municipal 
                                  Affairs Committee 27 H3M
Subject:                          Dietetics, licensure and regulation of; 
                                  Dieticians and Nutritionists, Dietetics 
                                  Committee established


                        History

Body    Date      Action Description                     Com     Leg Involved
______  ________  ______________________________________ _______ ____________
House   19990112  Introduced, read first time,           27 H3M
                  referred to Committee
House   19990106  Prefiled, referred to Committee        27 H3M


                             Versions of This Bill

TO AMEND CHAPTER 47, TITLE 40, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO PHYSICIANS, SURGEONS, AND OSTEOPATHS, AND THE STATE BOARD OF MEDICAL EXAMINERS, BY ADDING ARTICLE 7 SO AS TO PROVIDE FOR THE LICENSURE AND REGULATION OF DIETETICS; TO ESTABLISH THE COMMITTEE OF DIETETICS AS AN ADVISORY COMMITTEE TO THE BOARD AND TO PROVIDE FOR ITS POWERS AND DUTIES; TO ESTABLISH FEES; AND TO PROVIDE PENALTIES.

Whereas, the General Assembly finds that the practice of dietetics (Medical Nutrition Therapy) in South Carolina affects the public health, safety, and welfare and should be subject to regulation and control in the public interest to protect the public from the unauthorized and unqualified practice of dietetics and from unprofessional conduct by persons licensed to practice dietetics; and

Whereas, the General Assembly also recognizes the practice of dietetics to be a dynamic and changing art and science, the practice of which is continually evolving to embrace contemporary ideas and more sophisticated methods to ensure patient health and progress; and

Whereas, the General Assembly further expresses its intent that nothing in this act may be construed to allow, authorize, or otherwise permit a practitioner of dietetics to practice medicine, surgery, or any other form of licensed medical care. Now, therefore,

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. Chapter 47, Title 40 of the 1976 Code is amended by adding:

Section 40-47-805. This article may be cited as the 'South Carolina Dietetics Practice Act'.

Section 40-47-810. As used in this article:

(1) 'Board' means the State Board of Medical Examiners.

(2) 'Committee' means the Committee of Dietetics which is established by this article as an advisory committee responsible to the board.

(3) 'Dietetics' or 'nutrition' means the integration and application of principles derived from the science of nutrition, biochemistry, physiology, food, and management and from behavioral and social sciences to achieve and maintain a healthy status. The primary function of dietetic practice is the provision of nutrition care services.

(4) 'Licensed dietitian' means an individual licensed in good standing to practice dietetics or nutrition pursuant to the provisions of this article. For purposes of this article, 'dietitian' is synonymous with 'nutritionist'.

(5) 'Medical director' means a physician licensed to practice medicine in this State.

(6) 'Nutrition care services' or 'medical nutrition therapy' means any part or all of the following:

(a) assessing the nutritional needs of individuals and groups and determining resources and constraints in the practice setting;

(b) establishing priorities, goals, and objectives that meet nutritional needs and are consistent with available resources and constraints;

(c) providing nutritional counseling in health and disease;

(d) developing, implementing, and managing nutrition care systems;

(e) evaluating, making changes in, and maintaining appropriate standards of quality in food and nutrition services;

(f) transcribing a verbal order into patient records for cosignature by the ordering physician and implementing of the physicians' written and verbal orders which pertain to the practice of dietetics, if this practice is specifically authorized by the medical director and the health care facility where the care is taking place. In the delivery of dietetic home care this practice must be authorized specifically by the physician sponsor.

'Nutrition care services' does not include the retail sale of food products or vitamins and minerals.

Section 40-47-815. Individuals holding themselves out to be dietitians and nutritionists employed to provide dietetic and medical nutrition therapy for inpatients, outpatients, and home patients must be licensed in accordance with this article.

Section 40-47-820. This article does not apply to:

(1) a health care professional who is licensed by the State, or who by passage of an examination certified by the National Council of Health certifying agencies has proven to be competent in one or more of the functions included in the definition of dietetics or medical nutrition therapy, as long as the person does not represent himself or herself as a dietitian or nutritionist;

(2) a dietitian serving in the armed forces or the public health service of the United States or employed by the Department of Veterans Affairs when performing duties associated with that service or employment;

(3) a student or trainee working under the direct supervision of a licensed dietitian while fulfilling an experience requirement or pursuing a course of study to meet requirements for licensure, for a limited period of time as determined by the committee, with the approval of the board;

(4) a person aiding the practice of dietetics, if the person works under the direct supervision of a licensed dietitian and performs only support activities that do not require formal academic training in the basic food, nutrition, chemical, biological, behavioral, and social sciences that are used in the practice of dietetics;

(5) an employee of or a person who contracts with the State, a political subdivision of the State, or a local school administrative unit while engaged in the practice of dietetics within the scope of that employment;

(6) a retailer who does not hold himself or herself out to be a dietitian when that retailer furnishes nutrition information to customers on food, food materials, dietary supplements, and other goods sold at his retail establishment, in connection with the marketing and distribution of those goods;

(7) a person who provides weight control services if a dietitian registered by the Commission on Dietetic Registration of the American Dietetic Association or a dietitian licensed in another state that has licensure requirements that are equivalent to the requirements in this State:

(a) has reviewed the service;

(b) is available for consultation; and

(c) approves a change in the service prior to its initiation. (8) an employee or independent contractor of a hospital or health care facility licensed by this State;

(9) an herbalist, or other person who does not hold himself or herself out to be a dietitian, when that person furnishes nutritional information on food, food materials, or dietary supplements or when that person furnishes nonfraudulent, specific nutritional information and counseling about reported or historical use of herbs, vitamins, minerals, amino acids, carbohydrates, sugars, enzymes, food concentrates, or other foods.

Section 40-47-825. Nothing in this article may be construed to require direct third-party reimbursement to persons licensed under this article.

Section 40-47-830. (A) There is created the Committee of Dietetics as an advisory committee to the board which consists of nine members to be appointed by the board as follows:

(1) Two members must be physicians licensed to practice in this State and who have a special interest and knowledge in the diagnosis, assessment, and treatment of nutrition-related medical problems;

(2) Two members shall represent the public at large and may not be:

(a) a dietitian;

(b) an agent or employee of a person engaged in the profession of dietetics;

(c) a licensed health care professional or enrolled in a program to become a licensed health care professional;

(d) an agent or employee of a health care institution, a health care insurer, or a health care professional school;

(e) a member of any allied health care profession or enrolled in a program to become a member of an allied health care profession;

(f) the spouse of an individual in subitem (a)-(e).

(3) Five members must be dietitians, licensed to practice in this State, one of whom must be:

(a) a professional whose primary practice is clinical dietetics;

(b) a professional whose primary practice is community or public health dietetics;

(c) a professional whose primary practice is consulting in dietetics;

(d) a professional whose primary practice is in management of nutritional services;

(e) an educator on the faculty of a college or university, specializing in the field of dietetics.

(B) The appointment of the five dietitian members of the committee must be based upon a recommendation to the board by dietitians licensed to practice under this article. This recommendation must be based upon an annual election conducted by the board or delegated to the committee by the board. A person licensed under this article is eligible to participate in the election. Those participating in the election shall elect from among themselves three candidates for each open seat to be presented as nominees to the board. The board shall, at its regular annual meeting, fill the vacancies from among the list of nominees. The board shall plan and implement the appointments in as practical a manner as it considers feasible, so no more than two seats expire in any one year.

(C) The members shall serve for terms of four years and until their successors are appointed and qualify. Vacancies must be filled in the manner of the original appointment for the unexpired portion of a term. The board, after notice and opportunity for hearing, may remove a member of the committee for neglect of duty, incompetence, revocation or suspension of license, or other dishonorable conduct. Members of the committee shall receive mileage, subsistence, and per diem provided by law for state boards, commissions, and committees for each meeting attended. No member may serve more than one full four-year term consecutively but is eligible for reappointment two years from the date the full four-year term expires.

Section 40-47-835. The committee shall meet at lease twice each year and at other times as its rules provide. Five members constitute a quorum; however, no more than three of the five may be dietitians. At its initial meeting the committee shall elect from its membership a chairman, vice-chairman, and a secretary to serve for one-year terms. The committee may propose rules regarding dietetics necessary to perform its duties, and these duties must be reviewed and approved by the board prior to adoption.

Section 40-47-840. The board may employ staff as necessary for the performance of its duties under this article and may expend its funds for any purpose the board considers necessary for the proper performance of its duties under this article.

Section 40-47-845. The board shall receive and account for all monies collected under the provisions of this article and shall pay the monies to the State Treasurer for deposit in the state general fund.

Section 40-47-850. (A) The committee has the responsibility of evaluating the qualifications and supervising the examinations of applicants for licensure and making appropriate recommendations to the board.

(B) The board may issue subpoenas, examine witnesses, and administer oaths and may investigate allegations of practices violating this article.

(C) The committee:

(1) shall recommend regulations to the board relating to professional conduct to carry out the policy of this article including, but not limited to, professional licensure and the establishment of ethical standards of practice for persons holding a license to practice dietetics in this State;

(2) shall conduct hearings and keep records and minutes necessary to carry out its functions;

(3) shall provide notice of all hearings authorized under this article pursuant to the South Carolina Administrative Procedures Act;

(4) shall determine the qualifications and make appropriate recommendations regarding issuance of licenses to qualified dietitians;

(5) shall recommend to the board whether to issue or renew licenses under the conditions prescribed in this article;

(6) may recommend continuing professional education to the board;

(7) shall keep a record of its proceedings and a register of all persons licensed. The register shall include the name of every license holder and the last known place of employment and residence. The board annually shall compile and make available a list of dietitians licensed to practice in this State. An interested person may obtain a copy of this list upon request to the board and payment of an amount fixed by the board;

(8) shall make an annual report to the board containing an account of the duties performed, actions taken, and appropriate recommendations;

(9) shall hear all disciplinary cases and recommend findings of fact, conclusions, and sanctions to the board. The board shall conduct a final order hearing at which it makes a final decision.

Section 40-47-855. An applicant for licensure as a dietitian shall file a written application on forms provided by the board showing to the satisfaction of the committee and the board that the applicant:

(1) is of good moral character; and

(2) has successfully completed the requirements for current registration as a registered dietitian by the Commission on Dietetic Registration; or

(3) has passed an examination as prescribed by the board and has received a post-baccalaureate degree from a regionally accredited college or university or a master's degree in human nutrition, nutrition education, foods and nutrition, public health nutrition, or an equivalent major course of study as approved by the board upon the recommendation of the committee.

Section 40-47-860. An applicant for licensure who has obtained his or her education outside of the United States and its territories must meet the requirements for current registration as a registered dietitian by the Commission on Dietetic Registration.

Section 40-47-865. (A) The committee may recommend to the board that it revoke, suspend, or impose any other reasonable limitation on practice if any of the following unprofessional, unethical, or illegal conduct of the dietitian is likely to endanger the health, welfare, or safety of the public:

(1) using a false, fraudulent, or forged statement or engaging in a fraudulent, deceitful, or dishonest act in connection with any of the licensure requirements;

(2) having an addiction to alcohol or drugs to such an extent as to render the licensee unfit to practice dietetics;

(3) having been convicted for the illegal or unauthorized practice of dietetics;

(4) knowingly performing any act which in any way assists an unlicensed person to practice dietetics;

(5) having a physical or mental disability which renders further practice by the licensee dangerous to the public;

(6) violating the code of ethics for the profession of dietetics;

(7) engaging in any dishonorable, unethical, or unprofessional conduct that is likely to deceive or harm the public;

(8) using a false or fraudulent statement in any document connected with the practice of dietetics;

(9) intentionally violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation or conspiring to violate any provision of this article;

(10) committing an act, during the course of practice conducted pursuant to a license issued under this article, that constitutes fraud, dishonest dealing, illegality, incompetence, or gross negligence.

(B) The suspension, revocation, or imposition of probationary conditions upon a dietitian may be recommended by the committee to the board after a hearing is conducted in accordance with the Administrative Procedures Act. A transcribed record of the hearing must be made.

(C) A dietitian aggrieved by a decision of the committee or board under this section may appeal the decision to an administrative law judge in accordance with the Administrative Procedures Act.

Section 40-47-870. (A) A license issued under this article is subject to biennial renewal and expires unless renewed in the manner prescribed in regulation. The committee may recommend additional requirements for license renewal which provide evidence of continued competency. The board may provide for the late renewal of a license upon payment of a late fee.

(B) An inactive license is subject to expiration and may be renewed as provided in this section, but renewal does not entitle the dietitian, while the license remains inactive, to engage in the licensed activity of dietetics or to hold himself or herself out as a dietitian. If a license suspended on disciplinary grounds is reinstated, the dietitian, as a condition or reinstatement, shall pay the renewal fee and any applicable late fee.

Section 40-47-875. The board and the committee shall prescribe fees in amounts recommended by the committee for:

(1) initial licensure;

(2) renewal of license fee;

(3) late renewal fee.

The fees must be set in such an amount as to reimburse the State to the extent feasible for the cost of services rendered by the board.

Section 40-47-880. (A) It is unlawful for a person not licensed under this article, or whose license has been suspended or revoked by the board, to hold himself or herself out as a dietitian, nutritionist, licensed dietitian, or licensed nutritionist, alone or in combination, or use the letters 'LD', 'LN', 'LDN' or any facsimile or combination in any words, letters, abbreviations, or insignia. A person who violates this section is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned for not more than ninety days, or both.

(B) For the purpose of any investigation or proceeding under this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of any documents or records which the board considers relevant to the inquiry. In the face of contumacy by, or refusal to obey a subpoena issued to any person, an administrative law judge, upon application by the board, may issue an order requiring the person to appear before the board or the person designated by it, produce documentary evidence, and give other evidence concerning the matter under inquiry.

(C) When the board has sufficient evidence that any person is violating a provision of this article, it may, in addition to all other remedies, order the person to immediately desist and refrain from this conduct. The board may apply to an administrative law judge for an injunction restraining the person from this conduct. The administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the manner considered proper. No bond may be required of the board as a condition to the issuance of an injunction or order contemplated by this section.

(D) Every communication, whether oral or written, made by or on behalf of a person or firm to the board or a person designated by the board to investigate or otherwise hear matters relating to the revocation, suspension, or other restriction on a license holder, whether by way of complaint or testimony, is privileged. No action or proceeding, civil or criminal, may lie against the person or firm for the communication except upon proof that the communication was made with malice.

(E) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or as prohibiting the respondent from normal access to the charges and evidence filed against him as a part of due process under the law."

SECTION 2. (A) Initial recommendations for appointment to the Committee of Dietetics established pursuant to this act must be made within forty-five days after the effective date of this act, and the Board of Medical Examiners shall appoint the Committee of Dietetics within ninety days after the effective date of this act.

(B) Of the initial appointees to the committee, two professional members, one public member, and one physician shall serve terms of two years.

SECTION 3. This act takes effect upon approval by the Governor.

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