Subchapter G. DIETITIAN-NUTRITIONISTS

§ 21.701. Definitions.

 The following words and terms, when used in this subchapter, have the following meanings, unless the content clearly indicates otherwise:

   ACN—American College of Nutrition.

   ADA—American Dietetic Association.

   Act—The Professional Nursing Law (63 P. S. § §  211—225), which provides for the licensing of Licensed Dietitian-Nutritionists.

   Approved—Approved by the Board.

   Approved program—Those educational programs accredited by the Commission on Accreditation for Dietetics Education or the American Council on Education for dietetics-nutrition education.

   Board—The State Board of Nursing of the Commonwealth.

   CADE—Commission on Accreditation for Dietetics Education—The organization recognized by the Council on Higher Education Accreditation and the United States Department of Education as the accrediting agency for education programs that prepare individuals for the practice of dietetics-nutrition.

   CBNS—Certification Board for Nutrition Specialists—The certification body of the ACN.

   CDR—Commission on Dietetic Registration—The credentialing agency for the ADA.

   CNS—Certified Nutrition Specialist—The title given to individuals who meet the requirements of the CBNS.

   CPE—Continuing professional education, required by the act for biennial license renewal.

   Deviate sexual intercourse—The term as defined in 18 Pa.C.S. §  3101 (relating to definitions).

   Indecent contact—The term as defined in 18 Pa.C.S. §  3101.

   LDN—Licensed dietitian-nutritionist—A person holding a current license under this subchapter to practice dietetics-nutrition in this Commonwealth.

   Patient—A person upon whom or with whom an LDN is practicing dietetics-nutrition, including a client. For purposes of §  21.704 (relating to matters related to allegations of sexual impropriety or violation), any conduct prohibited with a patient is also prohibited with an immediate family member or spouse of a patient.

   Professional relationship—The relationship through which a licensed dietitian-nutritionist provides professional food and nutrition services to a patient. The relationship continues, for purposes of §  21.704, for 30 days after termination of professional services by either the licensed dietitian-nutritionist or the patient.

   RD—Registered Dietitian—The title given to an individual who meets the requirements set forth by the CDR.

   Registration Examination for Registered Dietitians—A written academic examination developed, prepared, administered and scored by the CDR.

   Sexual impropriety—The term includes the following offenses:

     (i)   Making sexually demeaning or sexually suggestive comments about or to a patient, including comments about a patient’s body or undergarments.

     (ii)   Exposing a patient’s body or watching a patient dress or undress, unless the patient specifically requests assistance.

     (iii)   Examining or touching the body of a patient except in the appropriate performance of the LDN’s practice.

     (iv)   Discussing or commenting on a patient’s sexual history, preference or performance during consultation, except when the consultation is pertinent to the issue of sexual function or dysfunction or reproductive healthcare.

     (v)   Soliciting or accepting a date from a patient.

     (vi)   Discussing information about one’s sexual problems, preferences or fantasies.

   Sexual intercourse—The term as defined in 18 Pa.C.S. §  3101.

   Sexual violation—The term includes the following offenses:

     (i)   Engaging in sexual intercourse, indecent contact or deviate sexual intercourse with a patient during the professional relationship.

     (ii)   Encouraging the patient to masturbate in the presence of the dietitian-nutritionist or masturbating while a patient is present.

     (iii)   Providing or offering to provide drugs, herbs, nutritional supplements or treatment in exchange for indecent contact, sexual intercourse or deviate sexual intercourse.

 In this subchapter the Board:

   (1)  Provides for licensure of dietitian-nutritionists who meet the qualifications set forth in the act.

   (2)  Administers the act by providing rules and regulations for the practice of dietetics-nutrition.

   (3)  Provides rules and regulations for the conduct of licensees.

 (a)  A licensee may not engage in conduct constituting a sexual violation or sexual impropriety.

 (b)  Engaging in conduct constituting a sexual violation or sexual impropriety is unprofessional conduct and will subject the licensee to disciplinary action under section 14 of the act (63 P. S. §  224).

 (c)  The consent of the patient to any sexual impropriety or sexual violation is not a defense to any disciplinary charge for violation of the act or this subchapter.

 (d)  Evidence of specific instances with individuals other than the licensee, opinion evidence or reputation evidence of a patient’s past sexual conduct is not admissible in proceedings brought under §  21.711 (relating to professional conduct). The Board may consider sexual relationships between the dietitian-nutritionist and the patient occurring prior to the professional relationship.

 (e)  A dietitian-nutritionist who attempts to raise as a defense an argument that conduct prohibited as a sexual violation or sexual impropriety was necessary or appropriate to the treatment of a patient shall be required to demonstrate competency in practice which relates directly to the treatment of sexual function or dysfunction. This competence may be demonstrated through educational training and supervised clinical experience.

 (a)  The following fees are charged by the Board for services to licensees:

 (b)  The following fees are charged by the Board to support its operations:

 (c)  In addition to the application fee prescribed in subsection (a), which is payable directly to the Board, a candidate for the Registration Examination for Registered Dietitians shall also pay an additional examination fee. A candidate may contact the Commission on Dietetic Registration, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995, www.cdrnet.org for more information regarding the examination and examination fee.

 (d)  In addition to the application fee prescribed in subsection (a), which is payable directly to the Board, a candidate for the Certification Board for Nutrition Specialists examination for Certified Nutrition Specialists shall also pay an additional examination fee. A candidate may contact the Certification Board for Nutrition Specialists, 300 South Duncan Avenue, Suite 225, Clearwater FL 33755, www.cbns.org for more information regarding the examination and examination fee.

   The provisions of this §  21.705 amended under sections 11.2 and 17.5 of The Professional Nursing Law (63 P. S. § §  221.2 and 667.5).

   The provisions of this §  21.705 amended August 20, 2010, effective August 21, 2010, 40 Pa.B. 4755. Immediately preceding text appears at serial page (346623).

   This section cited in 49 Pa. Code §  21.721 (relating to qualifications for licensure).

RESPONSIBILITIES OF THE LICENSED DIETITIAN-NUTRITIONIST

§ 21.711. Professional conduct.

 (a)  Licensed dietitian-nutritionists shall:

   (1)  Conduct themselves with honesty, integrity and fairness.

   (2)  Practice dietetics based on scientific principles and current information.

   (3)  Present substantiated information and interpret controversial information without personal bias, recognizing that legitimate differences of opinion exist.

   (4)  Provide information which will enable patients to make their own informed decisions regarding nutrition and dietetic therapy, including:

     (i)   The purpose and nature of any evaluation, treatment, educational or training procedure.

     (ii)   The estimated cost of each stage of a procedure or of the entire treatment.

     (iii)   The reasonable expectations of the professional relationship.

     (iv)   The right to withdraw from treatment at any time.

   (5)  Safeguard the patient’s dignity, the right to privacy and the confidentiality of patient information and make full disclosure about any limitations on the LDN’s abilities to guarantee full confidentiality. This standard does not prohibit or affect reporting responsibilities under 23 Pa.C.S. Chapter 63 (relating to Child Protective Services Law), the Older Adults Protective Services Act (35 P. S. § §  10211—10224) and other statutes which may mandate reporting of this information.

   (6)  Provide professional services with objectivity and with respect for the unique needs and values of individuals.

   (7)  Be alert to situations that might cause a conflict of interest or have the appearance of a conflict. The LDN shall provide full disclosure when a real or potential conflict of interest arises.

   (8)  Permit the use of their names for the purpose of certifying that dietetic services have been rendered only if they provided or supervised the provision of those services.

   (9)  Accurately present professional qualifications and credentials.

     (i)   Dietitian-nutritionists may use the title ‘‘Licensed Dietitian-Nutritionist’’ or abbreviation LDN only when they hold a current license issued by the Board.

     (ii)   LDNs are subject to disciplinary action for aiding another person in violating any Board requirement or aiding another person in representing himself as an LDN when that person is not currently licensed.

   (10)  Document and maintain accurate records in accordance with the acceptable and prevailing standard of recordkeeping. Discussion of a patient’s sexual practices, preferences and performance shall be fully documented in the patient’s chart, when applicable.

 (b)  The licensed dietitian-nutritionist may not:

   (1)  Knowingly aid, abet or assist another person to violate or circumvent a law or Board regulation.

   (2)  Discriminate, while providing dietitian-nutritionist services, on the basis of age, marital status, gender, sexual preferences, race, ethnicity, religion, diagnosis, socioeconomic status or disability.

   (3)  Knowingly permit another individual to use his license for any purpose.

   (4)  Misappropriate equipment, materials, property, drugs or money from an employer or patient.

   (5)  Solicit, borrow or misappropriate money, materials or property from a patient.

   (6)  Leave an assignment prior to the proper reporting and notification to the appropriate department head or personnel.

   (7)  Falsify or knowingly make incorrect entries into the patient’s record or other related documents.

   (8)  Engage in conduct defined as a sexual violation or sexual impropriety in the course of a professional relationship.

   (9)  Advertise in a false or misleading manner. Statements which qualify as false or misleading include the following:

     (i)   Statements containing a misrepresentation of facts.

     (ii)   Statements likely to mislead or deceive because in context the statements make only a partial disclosure of the relevant facts.

     (iii)   Statements intended to, or likely to, create false or unjustified expectations of favorable results.

     (iv)   Statements relating to fees without reasonable disclosure of all relevant variables so that the statements would be misunderstood by or would be deceptive to a layperson.

     (v)   Statements conveying the impression that the LDN could influence improperly any public body, official, corporation or person on behalf of the patient.

     (vi)   Statements containing a representation or implication that is likely to cause a reasonable person to misunderstand or to be deceived, or fail to contain reasonable warnings or disclaimers necessary to make a representation or implication not deceptive.

     (vii)   Statements containing representations that the LDN is willing to perform any procedure that is illegal under the laws or regulations of the Commonwealth or the United States.

   (10)  Practice when:

     (i)   The LDN has engaged in any substance abuse that could affect the LDN’s practice.

     (ii)   The LDN has been adjudged by a court to be mentally incompetent.

     (iii)   The LDN has an emotional or mental disability that affects his practice in a manner that could harm the patient.

   (11)  Accept a client or patient for treatment or continue treatment unnecessarily, if benefit cannot reasonably be expected to accrue.

   (12)  Accept or receive, or both, remuneration for making or accepting referrals.

   This section cited in 49 Pa. Code §  21.704 (relating to matters related to allegations of impropriety or violation).

LICENSURE REQUIREMENTS

§ 21.721. Qualifications for licensure.

 (a)  An individual may apply for licensure as a dietitian-nutritionist by submitting a written application on forms provided by the Board and remitting the application fee set forth in §  21.705 (relating to fees).

 (b)  To obtain licensure, an applicant must meet the qualifications set forth in section 6(b)(1)—(4) of the act (63 P. S. §  216(b)(1)—(4)), which include:

   (1)  Evidencing good moral character.

   (2)  Receipt of a baccalaureate or higher degree from a Board-approved program or equivalent program as set forth in section 5(b) and (c) of the act (63 P. S. §  215(b) and (c)).

   (3)  Completion of a planned continuous preprofessional experience of at least 900 hours under appropriate supervision.

 The Board approves educational programs that meet the requirements of section 6(b)(2) of the act (63 P. S. §  216(b)(2)) that are approved by CADE or the ACN. The Board approves the Registration Examination for Registered Dietitians and Examination of the Certification Board for Nutrition Specialists as the examinations which an applicant may complete to satisfy section 6(b)(4) of the act.

 (a)  A license issued under section 5(e) of the act (63 P. S. §  215(e)) or under this subchapter will be valid from the date of issuance through September 30, 2006, following the issuance of the license. Each subsequent license renewal will be valid for 2 years from October 1 through September 30.

 (b)  When applying for renewal of licensure, an LDN shall:

   (1)  Complete the renewal application, including disclosing a license to practice dietetics-nutrition in any other state, territory, possession or country.

   (2)  Pay the required fee as set forth in §  21.705 (relating to fees).

   (3)  Submit proof to the Board that the LDN has satisfactorily completed a minimum of 30 hours of CPE approved by the Board in accordance with §  21.724 (relating to continuing education) during the 2 calendar years immediately preceding the application for renewal.

 (a)  Prior to renewal. One hour of CPE credit will be given for each 50-minute clock hour of CPE activity. Each LDN shall complete 30 CPE credits during the 2 calendar years immediately preceding the application for license renewal. If any activity overlaps two renewal periods, the date of completion of the activity determines the date in which the activity can be reported.

 (b)  Board-approved continuing professional education. The Board will accept for completion of the CPE requirement substantive learning experiences, subject to the limitations in paragraph (2) relating to the field of nutrition and dietetics which are not designed for the public and which are sponsored by the ADA, the ACN, by individual state dietetic associations, if the association is a member of the ADA or ACN, by approved college or dietetic programs under §  21.722 (relating to education and examination of applicants) when a certificate of attendance is issued, and courses related to the practice of dietetics-nutrition offered by the Accreditation Council for Continuing Medical Education, the Accreditation Council on Pharmaceutical Education, the American Osteopathic Association and the American Medical Association.

   (1)  In addition to lecture-based CPE courses, LDNs may apply to the Board for approval of CPE credit and the Board may, upon review by the LDN Committee, grant credit for the following:

     (i)   Case presentations, such as grand rounds or patient case studies.

     (ii)   Academic coursework and research studies approved by an institutional review board.

     (iii)   Interactive workshops.

     (iv)   Lecturers and seminars.

     (v)   Residency and Fellowship programs which are at the post baccalaureate level, and are sponsored by a United States regionally accredited college or university, or an institution accredited/approved by the Joint Committee on Accreditation of Healthcare Organizations or the National Committee for Quality Assurance.

   (2)  The Board will not accept for completion of the CPE requirement the following:

     (i)   Academic coursework or programs on office management skills, or entrepreneurship, strategic business planning, computer skills, except courses directly related to the practice of dietetics-nutrition such as accessing nutrient analysis databases.

     (ii)   Attendance at exhibits manned by detail personnel.

     (iii)   Journal clubs.

     (iv)   Professional leadership, such as holding an elective office in a dietetics or dietetics-related organization.

     (v)   Professional reading for which there is no evaluative test submitted and no certificate of completion or CPE unit awarded.

 (c)  Documentation. The licensee shall retain documentation of completion of Board-approved continuing education (as set forth in subsection (b)) for at least 5 years and shall submit this documentation upon request of the Board.

 (d)  Waiver. An LDN who can demonstrate to the Board a verified hardship may request a waiver of CPE requirements for a single biennial period. It shall be the duty of each licensee seeking waiver to notify the Board in writing and request the waiver, at least 60 days prior to the end of the biennial renewal period, which will be granted, denied, or granted in part.

 An LDN may request that his license be placed on inactive status. The licensee will not be required to remit the biennial renewal fee during the period when the license is on inactive status. In order to return to active status, the licensee shall submit proof of completion of a minimum of 30 hours of approved CPE in the biennial period preceding the request for reactivation and pay applicable fees. A person who requests an active status license who has been on inactive status for 5 consecutive years shall satisfy the requirements of section 6(b)(4) of the act (63 P. S. §  216(b)(4)), unless the person demonstrates that he has an active license to practice in another state or has had an RD registration or a CNS certification for at least 2 out of the last 5 years.