STATE OF WEST VIRGINIA



PRELIMINARY PERFORMANCE REVIEW OF THE



The Board of Licensed Dietitians



OFFICE OF LEGISLATIVE AUDITOR

Performance Evaluation and Research Division

Building 1, Room W-314

State Capitol Complex



CHARLESTON, WEST VIRGINIA 25305

(304) 347-4890



October 1999




ISSUE AREA 1: Regulation Not Needed to Protect the Public

Chapter 4, Article 10, Section 2 of the Code finds, "...that agencies and programs have been created without demonstrable evidence that their benefits to the public clearly justify their creation." It is the primary finding of this review that the West Virginia Board of Licensed Dietitians provides no demonstrable net benefit to West Virginia's public. In 30-1A-1,



The Legislature finds that regulation should be imposed on an occupation or profession only when necessary for the protection of public health and safety. [Emphasis Added]



A major consideration of the Legislative Auditor in this review was the following question contained in 4-10-11(4):



The extent to which there would be significant and discernable adverse effects on the public health, safety or welfare if the agency were abolished.



Discontinuing regulation of dietitians would have no unfavorable effect on the West Virginia public because: no harm has been demonstrated in West Virginia or nationwide, regulation can be evaded at will, the State has no practical disciplinary powers upon 87% of licensees, little if any value is added by the West Virginia credential and other protections exist to protect the public.



No Demonstrable Public Need



The West Virginia Board of Licensed Dietitians has never disciplined a licensee or even received a complaint against a licensee. While the Board has received inquires regarding non- licensed individuals offering services to the public, none have documented public harm. Nationally, the scene is much the same: three other states came to the same conclusion as has the Legislative Auditor; regulation of dietitians is unnecessary.



Colorado Sunrise - 1993



The review found that no state had disciplined a dietitian/nutritionist for actions considered harmful to the public and passage of regulation would not provide discernible public protection. Regulation would only restrict use of specific titles. These arguments also apply to West Virginia's Board.



Hawaii Sunrise - 1995



Review found that the interests of the professional association were "inappropriately and unfairly" incorporated and legislation would have been biased in favor of the professional association because the legislation would have 1) exempted registered dietitians from licensing, 2) required the same number of supervised experience hours as is required for one to be a registered dietitian, and 3) allow registered dietitians wishing to be licensed to do so automatically; all of which West Virginia statute allows. The review found that regulation could not be recommended because it was not established as necessary to protect the public. The report found that the suggested regulation would bring unsure benefits and found few substantiated incidents of "nutrition practitioners" harming the public.



Georgia Sunset - 1988



The review found that the need for the Board was questionable. It found no documentation of harm to Georgians by either licensed or unlicenced dietitians. Further it concluded existing public protection from voluntary licensure can be achieved through registration with the American Dietetic Association (ADA). Georgia's Legislature re-established the Board in 1994.



The Office of the Legislative Auditor contacted the ADA. The ADA's Washington, D.C. based Government Affairs Division was asked for the most serious complaints it had received from across the nation against Registered Dietitians. According to the ADA's web site the Government Affairs Division works with state and federal legislators, departments and agencies on public policy issues affecting the practice of dietetics. The ADA provided documentation addressing the need for licensure. While incidents are discussed in which persons were harmed as a result of receiving poor advice, they do not represent issues which could have reasonably been prevented by the West Virginia Board. For example, football coaches and relatives are likely to dispense advice whether doing so is subject to Board regulation or not. An abundance of the examples provided represent situations in which "nutritionists" or persons selling vitamins and supplements may have caused or contributed to a person's being harmed. As the Board currently exists, these matters would not have been subject to the Board's control. Other examples of "quackery" can be made in which persons may be violating other laws and the scopes of practice of other licensed professions, defrauding consumers and other activities which would be illegal regardless of the Board's existence. See Appendix A for a complete copy of materials submitted by the ADA (as of October 12, 1999), less materials subject to copyright considerations which have been cited at the end of the Appendix.



A Legislative Services paralegal searched Westlaw for appeals cases going back to 1944. The engine searches the case summaries for the key words dietitians (or dieticians) and harm or death. This search technique should have identified all appealed cases going back to 1944, in which these keywords would have appeared in the case summary. Thus, the search was not limited to t he parties to a given appeal, but the case summary. No cases indicated dietitians harming or causing death to the public.



Regulation Evaded at Will/No Scope of Practice(1)



Individuals can choose whether to be regulated or not by the choice of title under which they practice. One's work tasks may be the same as another regulated by the Board, but since the title used is not "dietitian" or "licensed dietitian" the Board does not require licensure. While further exclusions exist for registered dietitians, those practicing in weight loss clinics, health food stores and educational institutions, no person would have to be licensed provided that person does not practice under the titles "dietitian" or "licensed dietitian". Were licensure needed, the public would receive protection from services, not titles.



The Board has interpreted its Code of Ethics as representing a scope of practice. However, the Code of Ethics fails to proscribe which work only an LD is legally authorized to provide. According to a legal opinion from Legislative Services,



While the code of ethics describes required actions by licensed dietitians, it is not interpretative of any legislative mandate precluding unlicenced persons from performing any specified activity.



See Appendix B for the legal opinion in its entirety. Appendix C contains the section of the Code of Ethics which has been represented by the Board as its scope of practice.



In the Board's statute, 30-35-1,



(a) After the thirtieth day of June, one thousand nine hundred ninety-seven, anyone who represents or implies to the public by use of the title "dietitian" or "licensed dietitian" or any other title intended to convey the impression that he or she is authorized to practice dietetics in this state must be licensed pursuant to this article.

(b) No person may use any title, sign, card or other device which indicates that such person is a licensed dietitian unless expressly authorized and licensed pursuant to the provisions of this article: Provided, That a dietitian registered by the commission on dietetic registration may use the title of registered dietitian: Provided, however, That the requirements and provisions of this article do not apply to any person employed as a cook at any public or private educational institution in this state.

(c) Nothing in this article may be construed to affect individuals who furnish nutrition information on food, food materials or dietary supplements or who engage in explanation to customers about food, food materials or dietary supplements in connection with the marketing and distribution of those products and who do not use the title "dietitian" or "licensed dietitian." [Emphasis added]



Titles that could imply state endorsement, such as "nutritionist", are not regulated. A person could choose to call themselves a "nutritionist", and not be licensed by the Board. According to the 1998-99 Occupational Outlook Handbook, the general educational requirements for both nutritionists and dietitians are the same and they perform essentially the same work.



According to the 1998-99 Occupational Outlook Handbook,



Dietitians and nutritionists plan nutrition programs and supervise the preparation and serving of meals. They help prevent and treat illnesses by promoting healthy eating habits, scientifically evaluating clients' diets, and suggesting diet modifications, such as less for those with high blood pressure or reduced fat and sugar intake for those who are overweight.



The Handbook goes on to say that occupations such as health educators, nurses, home economists, and food service managers have work tasks much like dietitians and nutritionists. None of these are regulated. Essentially what this means is anyone who wishes to perform the same or similar work can, provided they do not use the title "dietitian" or "licensed dietitian". However, even licensees and those in the business are unsure of the Board's scope on titles, as the inquiries below illustrate. (Paraphrased from Board Documentation.)



May 1998 Inquiry: Licensee concerned about a person who referred to herself as a Dr. of Nutrition and asked if our Board would have any jurisdiction over this person's practice.

Board Action: The Board determined that our statute did not allow us to intervene because the individual was not calling herself a "dietitian".



March 1998 Inquiry: Licensee wanted to know if the licensure law indicated anything regarding verbal doctor's orders.

Board Action: The licensure law does not include definitive directives. The law prevents people from claiming to be a dietitian if they are not licensed.



Feb. 1998 Inquiry: [Person 1] with Wheeling Hospital's Wellness program asked about the legality of conducting nutritional analysis if the person was not a L. D. .

Board Action: The person cannot represent themselves as a Licensed Dietitian but could conduct a nutritional analysis because our bill does not define a scope of practice.



June 1997 Inquiry: A dietitian from Marshall was concerned about the notification to MD's re: who is licensed to provide nutritional counseling. The issue centered around a physical therapist providing various types of diet counseling.

Board Action: A FYI article was sent to the medical association for inclusion in their State newsletter.



Based on a review of yellow page advertisements for eight West Virginia directories, under the headings "dietitians" and "nutritionists", (Table 1) only one had an individual advertising the LD credential. The "Nutritional Consultant", is not required to be licensed as enforced by the Board.



Table 1

Sample of Yellow Page Telephone Directory Listings

City Dietitians Nutritionists
Beckley (1999) None None
Bluefield/Princeton (1996) None None
Kanawha/Putnam (2000) None Four - 1 Individual "Nutritional Consultant," 3 Groups
Clarksburg (1999) None None
Huntington (1999) None None
Parkersburg (1999) One - RD, LD, CDE None
Martinsburg/Berkeley Springs (2000) None None
Wheeling (1999) None One - WIC Program


Without a scope of practice it is impossible to conclude what services require public protection. The enigma lies in determining which of these roles warrant public protection, how that protection will be provided (by employer, by state licensure authority, by accrediting body, by health care program, etc.), and how to provide such protection without adversely affecting society. Determining what a reasonable scope of practice would be is even more enigmatic. It is fairly easy to identify what it is that "dietitians" do. Some provide general dietary counseling in holistic primary care facilities. Others provide specific dietary advice in heart and renal clinics, for example. Many serve as cooks and/or meal planners, while others prepare and oversee tube feedings, a matter of basic life support.



Little Practical Disciplinary Power Over 87% of Licensees



According to a legal opinion from Legislative Services, the provision "That a dietitian registered by the commission on dietetic registration may use the title of registered dietitian..." allows one working under the title Registered Dietitian to do so without being licensed by the state board. No registered dietitian would have to be licensed in order to practice in the State. Despite this the majority of current licensees are RD's.



Board statistics indicate 87% of licensees are registered with the national professional association and 11% of licensees were grand fathered for having met educational and experience criteria (allowed until June 30, 1997.) The final two percent of licensees hold provisional licenses. Provisional licenses are given to individuals who have completed educational requirements but may

not have completed experiential requirements or passed the professional association examination (licensing requirements are discussed later in further detail). Chart 1 shows the percentages of licensees by profile.

RD's are not required to be licensed, or a situation like the following could occur. An individual holds both an LD and an RD title. The individual is disciplined by the Board and loses their LD status. However, the individual could retain their RD status and continue to practice. Thus, the Board cannot stop someone from continuing to offer services to the West Virginia public that it deemed abusive or harmful when the license was taken.



Little if Any Value Added by West Virginia Credential



When the State of Georgia surveyed its licensed dietitians in 1988, 98% (112 of 114) said they did not think Georgia consumers know the difference between a "licensed dietitian" and a "registered dietitian". Indeed, in West Virginia a consumer would not need to know the difference because the requirements are one in the same as shown in Table 2.



Table 2
Educational and Professional Requirements LD RD
Complete approved course work in food and nutrition and a bachelor's degree from a U.S. regionally accredited university, college, or foreign equivalent.
Complete an approved pre-professional experience or internship. Typically an internship will last about 6 months or is coordinated with completion of undergraduate studies.
Pass a national, written examination administered by the Commission on Dietetic Registration. (Must have met first two requirements to sit for exam.)



The Legislative Auditor posed the following question to the Board's Chair: What benefit is there in being an LD that being an RD does not provide? The response provided was from the American Dietetic Association. Quoting from this publication,



State recognition protects the public by setting the standards for individuals to provide safe, reliable nutrition advice. Since the RD credential is a voluntary credential which the state cannot force individuals to possess, state recognition validates that individuals have obtained the proper education and experience to provide nutrition counseling, whether or not they choose to pursue the R..D. credential. [Emphasis added]



The West Virginia Board of Licensed Dietitians is forcing licensees to have the RD credential. Thus it is not voluntary. Requiring both titles is repetitive and a duplication of process and does not provide the West Virginia public with any more protection than if individuals were voluntarily obtaining their RD credential.



Other Protection Exists



Few individuals offer dietetic services to the public directly. In 1995 a survey was performed by the American Dietetic Association, and only 3.3% of dietitians were in private practice, offering their services directly to the public. Hospitals or other health care providers employed 67.3% of dietitians; 19.1% worked for public health programs or in educational facilities; and 10.6% worked for organizations, non-profit and for profit. As these numbers indicate most would be required to meet their employers' standards.



Some employers' hiring standards are enhanced by federal provisions for certain facilities receiving federal monies. According to 42CFR483, Requirements for States and Long Term Care Facilities, "Skilled nursing facilities participating in Medicare must meet certain specified requirements;..." One of these requirements is that "The facility must employ a qualified dietitian either full-time, part-time, or on a consultant basis" to provide dietary services. According to the requirements,



A qualified dietitian is one who is qualified based upon either registration by the Commission on Dietetic Registration of the American Dietetic Association, or on the basis of education, training, or experience in identification of dietary needs, planning, and implementation of dietary programs.



The credential from the West Virginia Board of Licensed Dietitians does not enhance public protection. The license requires the same standards and is repetitive; few practioners are not governed by employer standards. Further, dietitians practice in a vast array of settings. Such settings include nursing homes, hospitals, public health clinics, health maintenance organizations, prisons, company cafeterias, wellness programs and sports teams. Certain work situations like those working in renal or pediatric clinics require special levels of qualification.



Implied Need For License



In an April 1997 letter sent to "All dietitians in the State of West Virginia, to nutritionists with the Women and Infant Childrens' (WIC) Department, and to West Virginia Home Demonstration Agents", the Board writes,



West Virginia Code - Chapter 30, Article 35, Section 1 - states that after June 30, 1997:



Anyone who represents or implies to the public by use of the title 'dietitian' or'licensed dietitian' or any other title intended to convey the impression that he or she is authorized to practice dietetics in this state must be licensed pursuant to this article.



These individuals would not necessarily have to be licensed. Letters to West Virginia hospitals and health care facilities from the Board in November 1998 also give this misleading impression that employee dietitians must be licensed. The letters do not mention broad exemptions for registration with the national association and employment setting or providing of nutrition advice exemptions. They are not told that the only enforcement is the use of the titles "dietitian" and "licensed dietitian". Instead they are sent an application package. The application for active license requires verification that the applicant is a dietitian registered by the Commission on Dietetic Registration. Thus, the Board is requiring anyone seeking a license in the State to be an RD.(2) Statute does not require, nor does it give the Board authority to require, state licensees to belong to the ADA.



Board Only Has Discretionary Duties



The powers and duties of the Board are detailed in 30-35-4(a) of Code. However, 30-35-4(b) states, "The board created in this article has only discretionary duties."



A board of licensure with the discretion to issue and renew licenses, take disciplinary action and maintain records of proceedings, for example, could be considered moot. In order for a Board to fulfill the "fundamental purpose of licensure", protecting the public, it must have required duties.



Conclusion



Without a need to protect the public's health and safety, a licensure board should not exist. 30-1A-1 states



...regulation should be imposed on an occupation or profession only when necessary for the protection of public health and safety.



This review found nothing to substantiate continuance of the Board of Licensed Dietitians, therefore, the sole reason for existence is not applicable.



Recommendation 1



The Legislature should consider terminating the West Virginia Board of Licensed Dietitians pursuant to the Sunset Law.





ISSUE AREA 2: The Board is Inaccessible to the Public



Contrary to state law and the underlying purpose of professional licensure boards, the West Virginia Board of Dietitians has failed to make itself available to the public. The Board lacks phone listings, a permanent address, and an Internet site.



West Virginia Code 30-1-12 states:



To promote access, the secretary of every board shall ensure that the address and telephone number of the board are included every year in the state government listings of the Charleston area telephone directory. Every board shall regularly evaluate the feasibility of adopting additional methods of providing public access, including, but not limited to, listings in additional telephone directories, toll-free telephone numbers, facsimile and computer-based communications. [Emphasis Added]



The Board is not accessible to the public. Neither a telephone number nor an address is available in the white, yellow or blue pages of the Kanawha-Putnam telephone directory, through the WV Capitol directory, the 1998 Blue Book, or even through an Internet site. A number for the Board can be obtained through the little known capitol assistance line (304-558-3456).



The Board also lacks a permanent office address. The home address of one of the members is used to receive the Board's mail. The address will need to be changed when the member's term ends.(3) While this report is not advocating the creation of a Board office, the lack of a permanent office address also impairs public accessibility.



In the June 1999 Board meeting, the Chair discussed with the other Board members the Legislative Auditor's concern for the lack of a telephone listing providing for public access. In July, the Board obtained an 800 number devoted solely to the Board as well as a dedicated FAX line. The Legislative Auditor commends the Board's efforts to be more accessible to both the public and licensees.



The regulatory function of the Board may have been compromised by its inaccessibility to the public. The Board has never handled a complaint against a licensed dietitian. (Inquiries, as referred to by the Board, made by licensees are mentioned in Issue 1). However, in July 1998 the Board was made aware that an individual was practicing under a "lifted" RD number. The Legislative Auditor was informed the individual whose RD number was lifted was also licensed by the State (according to licensee roster the person is not an LD). As the individual who was practicing illegally had been fired, the Board felt the matter was sufficiently closed and took no action to prosecute as is allowed under 30-35-14(a),



It is a misdemeanor for any person, corporation, or association to: ... (3) Represent or imply to the public that he or she is authorized to use the title "dietitian" or "licensed dietitian" or any other title intended to convey that impression, unless duly licensed pursuant to the provisions of this article;....(b) Any person, corporation or association who violates the provisions of subsection (a) of this section is guilty of a misdemeanor and, upon conviction thereof, shall be fined not less than fifty dollars nor more than one hundred dollars.



If the Legislature chooses not to terminate, the following recommendations are made:



Recommendation 2



The Board should comply with 30-1-12 by listing its new toll-free telephone number and mailing address in the Government section of the Charleston area telephone directory. The Board is encouraged to publish its fax number as well as identifying other ways to increase public access.



ISSUE AREA 3: The Board Has Inconsistently Complied With the Open Meetings Law



West Virginia Code 6-9A-1, as amended, declares the purpose and intent of the Open Meetings Law. It reads as follows:



The Legislature hereby finds and declares that public agencies in this state exist for the singular purpose of representing citizens of this state in governmental affairs, and it is, therefore, in the best interests of the people of this state for the proceedings of public agencies to be conducted openly, with only a few clearly defined exceptions. The Legislature hereby further finds and declares that the citizens of this state do not yield their sovereignty to the government agencies which serve them. The people in delegating authority do not give their public servants the right to decide what is good for them to know and what is not good for them to know. The people insist on remaining informed so that they may retain control over the instruments of government created by them.



Further, West Virginia Code 6-9A-3, as amended, states:



Each governing body of the executive branch of the state shall file a notice of any meeting with the secretary of state for publication in the state register.



During the Board's existence (1996-April 1999), it has met 21 times (as determined by Board provided minutes). However, only ten (48%) open meeting notices have been filed with the Secretary of State's Office during this period. The Board's September 1997 meeting minutes, its eighth meeting, indicate the Board was aware of the need to file notices with the Secretary of State. "[Chair] stated that she will send a notice to [the Director of the Administrative Law Division of the Secretary of State's Office] notifying her of our Board meetings so that they may be made public." Table 3 on the next page shows the minutes of the Board compared to the record of open meeting notices filed with the Secretary of State as well as the Board's record of notices filed. As the table illustrates, there is little variance between the Secretary of State's record and the Board's record. Notices were just not filed with the Secretary of State's Office. This is evident by the number of meetings for which minutes occur but even the Board did not have record of notice. From the September 1997 meeting forward, the Board maintained a higher standard of compliance with the Open Meetings Law.Table 3

Meetings and Sunshine Notices
Minutes Notice in State Register Notices Provided to Review Staff by Board
1/22/97 None None
3/7/97 None None
3/14/97 None None
5/2/97 None None
5/21/97 None None
6/25/97 None None
8/13/97 None None
9/26/97 None 9/26/97
10/24/97 None 10/24/97
11/21/97 None None
1/8/98 None None
2/12/98 2/12/98 2/12/98
3/20/98 3/20/98 3/20/98
4/16/98 4/16/98 4/16/98
5/18/98 5/18/98 5/18/98
7/22/98 7/22/98 7/22/98
8/24/98 None None
10/7/98 10/7/98 10/7/98
Canceled 12/2/98 12/2/98
1/5/99 None 1/5/99
2/24/99 2/24/99 2/24/99
3/31/99 3/31/99
4/14/99 4/14/99 None



The office of the Legislative Auditor posed the question, "Why is there inconsistency in your submission of meeting notices to the Secretary of State's Office?" In response, the Chair expressed:



I was so sure that I had kept these from the beginning...I find I did not..but, I do know that in the beginning we were prompt in sending them. I suppose I just did not realize the importance of keeping a confirmation of FAX. Starting with the June 30th meeting, we will be certain to do so. [Ellipsis marks from original correspondence].



The discrepancy then appears not to be a lack of awareness but a lack of Board emphasis on complying with the Open Meetings Law. The Open Meetings Law applies to all public bodies for the purpose of public accountability. There is no documentation to suggest that anyone other than the members themselves are routinely aware of upcoming meetings.



Some actions could be voided by a court because of noncompliance with the Open Meetings Law while others would fall outside of the statute of limitations. Civil action can be taken according to the provisions of 6-9A-6 provided,



The circuit court in the county where the public agency regularly meets has jurisdiction to enforce this article upon civil action commenced by any citizen of this state within one hundred twenty days after the action complained of was taken or the decision complained of was made.[Emphasis added]



Additionally, criminal action could be taken if found to be a willful act, (a misdemeanor punishable up to $500) provided the lapsed time does not exceed one year (61-11-9).



Recommendation 3



The Board should keep its commitment to file Open Meeting notices consistently as required by law.



ISSUE AREA 4: Board Requires Payment of Fees by Cashier's Check or Money Order



The license issued by the Board provides individuals with the right to practice as a "dietitian" or "licensed dietitian" in West Virginia. Until this August, when the Board reversed its requirement, all fees had to be paid by a money order or cashier's check. If an applicant or licensee sent payment by personal check, it was returned. As a result a license could have been denied or rather suspended pending receipt of payment by cashier's check or money order. During this time an individual would have been violating statute if they continued to practice under the State's title. This required payment method is unnecessary. The Board could simply not grant a license (mail it) until payment clears.



Personal checks are routinely accepted by the State for payment of personal income taxes, vehicle licenses and licenses for amusement ride operation. Provisions can be specified in the Board's rules or statute for recovery of any costs as well as any fines the Board would wish to impose. For example, the Department of Motor Vehicles has the following provision in 17A-2-23,



If a check tendered to the department of motor vehicles is returned to the department unpaid for any reason, there shall be a penalty of ten dollars to be paid to the department in addition to the amount due the department.



While the additional cost of money orders/cashier's checks are not great, ($2 to $5 at local banks), the additional costs are ultimately passed on to consumers and licensees view the matter as one of distrust. The following passages from licensees' letters to the Board indicate their displeasure with the provision. In an April 1997 letter from a licensed dietitian,



I wonder if it is necessary to require notarized materials and certified checks. Aside from being an inconvenience, it seems unnecessary in that the national organization will verify our registration status through our CDR numbers.



In a June 9, 1999 memo to the Board two licensees write,



We would like to express our displeasure regarding the Board of Licensed Dietitians' requirement that the licensure renewal fee be paid only by cashier's check or money order, and that the renewal form be notarized. Not only is this an unnecessary inconvenience, it is also insulting that the Board, which is supposed to verify our professional credibility, would not trust our personal and professional integrity.



Yet another licensee writes in a June 15, 1999 letter,



I fail to understand why West Virginia requires a money order or cashier's check for payment of licensure fees. Bordering states, i.e., Ohio and Kentucky have no problem accepting personal checks.



The Board changed its policy of not accepting payment by personal checks during the course of this review. Not issuing a license until payment clears insures payment. Further, statute allows the Board to impose fines to compensate for any returned checks.



Recommendation 4



The Board should consider amending its' rules to include a returned check policy.



ISSUE AREA 5: Board Has Abdicated Continuing Education Responsibilities to the Professional Association



In the general provisions applicable to all boards, 30-1-7a, boards are to establish continuing education requirements that include course content, course approval, hours required and reporting periods. The Board is not meeting its obligation to establish course content or approve courses.



New written rules need to be developed with respect to continuing education. The legislative rules implemented this July will require licensed dietitians to complete twenty hours of continuing education every two years. The rules indicate this continuing education will be approved by the Association. According to the Chair it is easier for the Board to have the Association approve continuing education as licensees are already providing proof of continuing education hours to the Association. (To maintain the title RD 75 hours every five years). Allowing the Association to determine which continuing education hours are approved may provide the potential for Association only courses to be approved.



Not only are continuing education hours being approved by the Association, the standards for continuing education are being set by the Association. The Board was not able to provide the Legislative Auditor with these standards. Carte blanche approval exists for continuing education offered by the Association and possibly the Association only. While the standards may be sufficient to protect the public it should not be the Association's decision. The provision for the Association to approve continuing education and set standards allows a group not sovereign to West Virginia to determine what is sufficient for the specific needs of the West Virginia public. The Board must not lose sight that its primary concern is the West Virginia citizen and not to benefit the profession.



The Board is intended to monitor the professional practice of dietitians. The importance of retaining Board independence from the professional association cannot be understated. Developing consistent policy will help to eliminate bias and promote Board compliance with statutory requirements for continuing education. The Board has abdicated basic responsibility to the professional association and allowed for avoidable subjectivity in licensure matters. This issue should not be construed to suggest that the Board should give no credence to the Association's continuing education standards and determinations, but rather retain its own authority to make these decisions.



Recommendation 5



The Board should immediately begin complying with 30-1-7a establishing and maintaining its own continuing education requirements, preferably in legislative rule. The Legislature may wish to consider amending the current rule to ensure continuing education will be approved by the Board, not the American Dietetic Association.

1. Scope of practice as used in this report means a description of those duties which may not be provided by unlicensed persons.

2. Only those with a provisional license, good for up to three years, do not have to be a full RD. These individuals must have completed the education requirement but need not have fulfilled the experience requirement.

3. Statute does not permit Board members to be reappointed to their posts.