Licensure Update: September 2020

A Message from Academy President Linda T. Farr, RDN, CSOWM, LD, FAND

09/23/2020 - This is an update for nutrition and dietetics practitioners on the Academy's work on licensure, particularly in Florida, since the most recent communication on July 28.

Introduction
The Academy believes that medical nutrition therapy and other complex nutrition and dietetics services should only be provided by individuals who have at minimum the specialized education and training of RDNs or meet state licensure standards. Since 1917, we have committed to improving Americans' health. Our efforts are also focused on reducing the dangers of unscientific, medically unnecessary treatment by requiring that individuals practicing nutrition and dietetics are qualified to do so. Like physicians, pharmacists, nurses and other health care professionals, this means we will continually and effectively fight for state licensure laws to reduce the risk of harm to the public from incompetent or unqualified providers.

As our Affiliates across the country know, there are some highly organized and well-funded groups that oppose regulation, spending many years and hundreds of thousands of dollars to weaken or eliminate these important consumer protections whenever and wherever possible. They are challenging consumer protection laws in state capitols and federal courthouses without regard for the harm that will ensue. Because the provision of medical nutrition therapy by incompetent or unqualified practitioners causes harm, licensure must prevail.

Florida Lawsuit
One such example is the ongoing constitutional challenge to Florida's Dietetics and Nutrition Practice Act in the Kokesch Del Castillo v. Secretary, Florida Department of Health lawsuit that has the potential to impact practice in Florida and elsewhere. A prominent legal group opposed to licensure for all professionals — not just dietitians and nutritionists, but physicians, lawyers and psychologists, among others — filed a lawsuit in federal court in Florida on behalf of a health coach who illegally sought to provide medical nutrition therapy, arguing that regulating her practice violated her First Amendment right to freedom of speech.

This broad interpretation would directly impact states' ability to regulate any health care professional providing telehealth or engaging in verbal counseling, or any other patient encounter not involving physical contact. Such an interpretation would put licensure laws for health care professions in Florida and across the country at risk and must be rejected.

The argument was dismissed in July 2019, with the federal court judge holding that Florida's legislature acted appropriately in protecting the health and safety of Floridians by requiring a license to practice nutrition and dietetics.

The dismissal was appealed to the 11th U.S. Circuit Court of Appeals. The appellate ruling is expected at any time. Neither the Academy nor the Florida affiliate is legally involved in the Castillo lawsuit. But we will continue to closely monitor this litigation and provide expert testimony and guidance whenever possible.

Although we stand confident that the lower court was correct in its holding, we know from experience, these groups will want to claim victory on some level and spread inaccurate media narratives. The Academy has a comprehensive plan and is working with Affiliates, similar health care organizations and other groups with an interest in protecting consumers from harm to communicate our position to the public, health care professionals, legislators and the news media.

Academy's Ongoing Efforts to Support Consumer Protection
The Academy and its Affiliates have had many notable successes, particularly in the past two years, enacting and defending narrowly tailored nutrition and dietetics licensure laws across the country. Such laws are aligned with our Model Practice Act. These efforts allow consumers to better access qualified licensed dietitians and nutritionists across state lines or via telehealth and they ensure consumers receive safe and effective services. We have successfully fought efforts in Florida, Iowa, Missouri, Montana, New Jersey, North Carolina and North Dakota to undermine consumer protections. The Academy is working closely with 26 Affiliates to help them enact, improve, defend and strengthen state regulations governing the practice of nutrition and dietetics to ensure the protection of the public.

In addition, the Academy created and released the Incident Reporting Tool earlier this year. Patients, members of the public and health care practitioners can now easily document examples of successful nutrition care, showing the value of qualified practitioners, in addition to documenting incidents of harm or unethical practice. This tool is not intended to replace state regulation of the profession, but rather, to support it. As the Del Castillo case demonstrates, concrete examples, gathered using the IRT, will provide further evidence to help ensure decision makers have an informed understanding of the nutrition and dietetics profession and why the practice must be regulated.

Additional Information
Read more about this issue:

• Florida's New Licensure Law (July 28, 2020)
• Florida Governor Signs Licensure Law (July 6, 2020)
• Academy Statement on Today's Florida Licensure Vote (March 12, 2020)
• Academy Statement on Florida Licensure Lawsuit (July 19, 2019)

Next Steps: Strength in Numbers
Please share this message and resources with your colleagues and — if you are not already doing so — contact your affiliate's legislative representative and volunteer: Take part in advocacy activities, get to know your elected officials and share with everyone the importance of ensuring that those who practice nutrition and dietetics are qualified to do so. There is strength in numbers! The Academy will always advocate for licensure laws that ensure nutrition care is provided by knowledgeable, credentialed experts like you.