Bill Text: HI SB2569 | 2014 | Regular Session | Amended
Bill Title: Home Birth Task Force; Home Birth Providers; Appropriation ($)
Spectrum: Strong Partisan Bill (Democrat 12-1)
Status: (Introduced - Dead) 2014-02-14 - Report adopted; Passed Second Reading, as amended (SD 1) and referred to WAM. [SB2569 Detail]
Download: Hawaii-2014-SB2569-Amended.html
|
THE SENATE |
S.B. NO. |
2569 |
|
TWENTY-SEVENTH LEGISLATURE, 2014 |
S.D. 1 |
|
|
STATE OF HAWAII |
Proposed |
|
|
|
|
|
|
|
||
|
|
||
A BILL FOR AN ACT
RELATING TO HOME BIRTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that the practice of midwifery has been a part of Hawaii's culture and tradition since before Hawaii joined the Union as a state. For personal, religious, and economic reasons, some Hawaii residents choose midwifery care.
The purpose of this Act is to preserve the rights of families to deliver their children in a setting of their choice; provide additional maternity care options for Hawaii's families; protect the public health, safety, and welfare; and provide a mechanism to assure quality care.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
"Chapter
HOME BIRTH PROVIDERS
§ -1 Definitions. As used in this part:
"Board" means the board of midwifery.
"Certified professional midwife" or "CPM" means a person who is certified by the North American Registry of Midwives or any successor organization.
"Client" means an woman under the care of a licensed midwife, as well as her fetus and newborn child.
"Department" means the department of commerce and consumer affairs.
"Licensed midwife" means an individual who holds a current license issued by the board pursuant to this chapter to engage in the practice of midwifery care in Hawaii.
"Midwifery education accreditation council" or "MEAC" means the organization established in 1991 and recognized by the U.S. department of education as an accrediting agency for midwifery education programs and institutions.
"Midwives Alliance of Hawaii" means the professional organization representing midwives in Hawaii.
"NACPM" means the National Association of Certified Professional Midwives.
"NACPM essential documents" means the documents adopted by NACPM that identify the nature of and standards of practice for responsible midwifery practice.
"NARM" means the North American Registry of Midwives.
"Practice of midwifery" means providing maternity care for women and their newborns during the antepartum, intrapartum, and postpartum periods. The postpartum period for both maternal and newborn care may not exceed six weeks from the date of delivery.
§ -2 Board of midwifery; established. (a) There is established in the department for administrative purposes a board of midwifery.
(b) The board shall consist of five members appointed by the governor, as follows:
(1) Three members who have at least three years of experience in the practice of midwifery, hold current CPM certification, and are eligible to become licensed pursuant to this chapter; provided that after the initial appointment, the three members shall be licensed pursuant to this chapter, actively practice midwifery in Hawaii for the duration of their appointment, and have been practicing midwives in Hawaii for at least three years immediately preceding their appointment;
(2) One member who is a licensed physician, is board certified in either obstetrics/gynecology or family medicine, maintains current hospital privileges, and has provided primary maternity care for at least twenty births in the twelve months prior to the appointment; and
(c) One member of the initial board shall be appointed for one year, one member of the initial board shall be appointed for two years, one member of the initial board shall be appointed for three years, one member of the initial board shall be appointed for four years, and one member of the initial board shall be appointed for five years. Thereafter, each board member shall serve for five years.
(d) In making appointments to the board, the governor's selection shall not be limited to nominations received; however, priority shall be given to nominations recommended by the Midwives Alliance of Hawaii.
(e) In the event of the death, resignation, or removal of any board member before the expiration of the term to which the board member is appointed, the vacancy shall be filled for the unexpired portion of the term in the same manner as the original appointment.
(f) Within thirty days after appointment of all initial members, the board shall hold a meeting and elect a chairperson. The board shall meet at least annually thereafter and may hold additional meetings at the call of the chairperson or at the written request of any two members of the board. Three members shall constitute a quorum. The vote of a majority of members present at a meeting in which a quorum is present shall determine the action of the board.
§ -3 Powers and duties. The board shall have the authority and the responsibility to:
(1) Receive applications for licensure; determine the qualifications of persons applying for licensure; provide licenses to applicants qualified under this chapter; and renew, suspend, revoke, and reinstate licenses;
(2) Establish and collect fees for examination of applicants for licensure and license renewal;
(3) Establish the minimum amount and type of continuing education to be required for each licensed midwife seeking renewal of the midwife's license;
(4) Investigate complaints against persons who are licensed under this chapter;
(5) Undertake, when appropriate, disciplinary proceedings and disciplinary action against persons licensed under this chapter;
(6) Adopt rules, pursuant to chapter 91, necessary to administer this chapter. To the degree they are consistent with this chapter, rules shall be consistent with the current job description for the profession published by NARM and consistent with standards regarding the practice of midwifery established by the NACPM or a successor organization;
(7) Authorize, by written agreement, the department to act as agent in its interest; and
(8) Provide such other services and perform such other functions as are consistent with this chapter and necessary to fulfill its responsibilities.
§ -4 Rulemaking. (a) The rules adopted by the board shall:
(1) Allow a midwife to obtain and administer, during the practice of midwifery, the following:
(A) Oxygen;
(B) Oxytocin as a postpartum antihemorrhagic agent;
(C) Injectable local anesthetic for the repair of lacerations that are no more extensive than second degree;
(D) Antibiotics for group b streptococcus prophylaxis consistent with guidelines of the United States Centers for Disease Control and Prevention;
(E) Epinephrine administered via a metered dose auto-injector;
(F) Intravenous fluids for stabilization of the woman;
(G) Rho(d)immune globulin;
(H) Vitamin K; and
(I) Eye prophylactics to the baby;
(2) Prohibit the use of other legend drugs, except those of a similar nature and character as determined by the board to be consistent with the practice of midwifery; provided that use of those drugs shall be allowed only if at least one hundred twenty days' advance notice of the proposal to allow the use of such drugs is given to the board of pharmacy and the board of medicine and neither board objects to the addition of such drugs to the midwifery formulary;
(3) Define a protocol for use by licensed midwives of drugs approved in paragraphs (1) and (2) that shall include methods of obtaining, storing, and disposing of such drugs and an indication for use, dosage, route of administration, and duration of treatment;
(4) Define a protocol for medical waste disposal; and
(5) Establish scope and practice standards for antepartum, intrapartum, postpartum, and newborn care that shall, at a minimum:
(A) Prohibit a licensed midwife from providing care for a client with a history of disorders, diagnoses, conditions, or symptoms that include:
(i) Placental abnormality;
(ii) Multiple gestation;
(iii) Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first;
(iv) Birth under thirty-seven weeks and after forty-two completed weeks' gestational age;
(v) A history of more than one prior cesarean section, a cesarean section within eighteen months of the current delivery, or any cesarean section that was surgically closed with a classical or vertical uterine incision;
(vi) Rh or other blood group or platelet sensitization, hematological, or coagulation disorders;
(vii) A body mass index of forty or higher at the time of conception;
(viii) Prior chemotherapy or radiation treatment for a malignancy;
(ix) Previous pre-eclampsia resulting in premature delivery;
(x) Cervical insufficiency; or
(xi) HIV positive status;
(B) Prohibit a licensed midwife from providing care for a client with a history of the following disorders, diagnoses, conditions, or symptoms unless such disorders, diagnoses, conditions, or symptoms are being treated, monitored, or managed by a physician licensed pursuant to chapter 453:
(i) Diabetes;
(ii) Thyroid disease;
(iii) Epilepsy;
(iv) Hypertension;
(v) Cardiac disease;
(vi) Pulmonary disease;
(vii) Renal disease;
(viii) Gastrointestinal disorders;
(ix) Previous major surgery of the pulmonary system, cardiovascular system, urinary tract, or gastrointestinal tract;
(x) Abnormal cervical cytology;
(xi) Sleep apnea;
(xii) Previous bariatric surgery;
(xiii) Hepatitis; or
(xiv) History of illegal drug use or excessive prescription drug use;
(C) Require a licensed midwife to recommend that a client see a physician licensed under chapter 453 and to document and maintain a record as required by section -10, if the client has a history of disorders, diagnoses, conditions, or symptoms that include:
(i) Previous complicated pregnancy;
(ii) Previous cesarean section;
(iii) Previous pregnancy loss in second or third trimester;
(iv) Previous spontaneous premature labor;
(v) Previous pre-term rupture of membranes;
(vi) Previous pre-eclampsia;
(vii) Previous hypertensive disease of pregnancy;
(viii) Parvo;
(ix) Toxo;
(x) CMV;
(xi) HSV;
(xii) Previous maternal/newborn group b streptococcus infection;
(xiii) A body mass index of at least thirty-five but less than forty at the time of conception;
(xiv) Underlying family genetic disorders with potential for transmission; or
(xv) Psychosocial situations that may complicate pregnancy;
(D) Require a licensed midwife to facilitate the immediate transfer to a hospital for emergency care for disorders, diagnoses, conditions, or symptoms that include:
(i) Maternal fever in labor;
(ii) Suggestion of fetal jeopardy such as bleeding, meconium, or abnormal fetal heart tones;
(iii) Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first;
(iv) Second stage labor after two hours of initiation of pushing when the mother has had a previous cesarean section;
(v) Current spontaneous premature labor;
(vi) Current pre-term premature rupture of membranes;
(vii) Current pre-eclampsia;
(viii) Current hypertensive disease of pregnancy;
(ix) Continuous uncontrolled bleeding;
(x) Bleeding that necessitates the administration of more than two doses of oxytocin or other antihemorrhagic agent;
(xi) Delivery injuries to the bladder or bowel;
(xii) Grand mal seizure;
(xiii) Uncontrolled vomiting;
(xiv) Coughing or vomiting of blood;
(xv) Severe chest pain; or
(xvi) Sudden onset of shortness of breath and associated labored breathing.
A transfer of care shall be accompanied by the client's medical record, the licensed midwife's assessment of the client's current condition, and a description of the care provided by the licensed midwife prior to transfer; and
(E) Establish a written plan for the emergency transfer and transport required in subparagraph (D) and for notifying the hospital to which a client will be transferred in the case of an emergency. If a client is transferred in an emergency, the licensed midwife shall notify the hospital when the transfer is initiated and accompany the client to the hospital if feasible, or communicate by telephone with the hospital if unable to be present personally, and shall provide the client's medical record. The record shall include the client's name, address, list of diagnosed medical conditions, list of prescription or over the counter medications regularly taken, history of previous allergic reactions to medications, client's current medical condition, description of the care provided by the midwife, and next of kin contact information; and
(6) Establish and operate a system of peer review for licensed midwives that shall include but not be limited to the appropriateness, quality, utilization, and ethical performance of midwifery care.
(b) The rules adopted by the board shall not:
(1) Require a licensed midwife to have a nursing degree or diploma;
(2) Require a licensed midwife to practice midwifery under the supervision of another health care provider, except as a condition imposed by disciplinary proceedings by the board;
(3) Require a licensed midwife to enter into an agreement, written or otherwise, with another health care provider, except as a condition imposed in disciplinary proceedings by the board;
(4) Limit the location where a licensed midwife may practice midwifery;
(5) Allow a licensed midwife to use vacuum extraction or forceps as an aid in the delivery of a newborn;
(6) Grant a licensed midwife prescriptive privilege; or
(7) Allow a licensed midwife to perform abortions.
§ -5 Licensure; penalty. (a) The board shall grant a license to any individual who submits a completed application, pays the required license fee as established by the board, and meets the qualifications set forth in section -6.
(b) All licenses issued under this chapter shall be for a term of one year and shall expire on the birthday of the licensee unless renewed in the manner prescribed by rule.
(c) It is a misdemeanor for any person to assume or use the title or designation "licensed midwife", "L.M.", or any other title, designation, words, letters, abbreviations, sign, card, or device to indicate to the public that such person is licensed to practice midwifery pursuant to this chapter unless that person is so licensed. Any person who pleads guilty to or is found guilty of a second or subsequent offense under this subsection shall be guilty of a felony.
(d) Except as provided in section -7, on and after January 1, 2016, it shall be a misdemeanor for any person to engage in the practice of midwifery without a license. Any person who pleads guilty to or is found guilty of a second or subsequent offense under this subsection shall be guilty of a felony.
§ -6 Qualifications for licensure. (a) A person shall be eligible to be licensed as a midwife if the person:
(1) Provides proof of current certification as a CPM by NARM or a successor organization;
(2) Files a board approved application for licensure and pays the required fees; and
(3) Provides documentation of successful completion of board approved MEAC accredited courses in pharmacology, the treatment of shock/IV therapy, and suturing specific to midwives.
(b) For any midwife who has been continuously practicing midwifery in Hawaii for at least five years prior to July 1, 2013, the qualifications for licensure in subsection (a)(1) of this section may be waived by the board if such midwife provides the following documentation to the board:
(1) Primary attendance at seventy-five births within the past ten years, ten of which occurred in the two years immediately preceding the application for licensure;
(2) Successful completion of board approved courses in cardiopulmonary and neonatal resuscitation, in addition to the completion of the courses listed in subsection (a)(3); and
(3) Complete practice data for the two years preceding the application for licensure on a form provided by the board.
(c) Any midwife who wishes to qualify for the waiver provided in subsection (b) shall apply for licensure and provide the required documentation before January 1, 2016.
§ -7 Exemptions. This chapter shall not apply to any of the following:
(1) Certified nurse midwives authorized under the board of nursing to practice in Hawaii, unless a certified nurse midwife chooses to become a licensed midwife. Certified nurse midwives who are licensed midwives shall be subject to chapter 457, as well as to this chapter;
(2) Student midwives in training under the direct supervision of licensed midwives as required by NARM;
(3) A person, in good faith, engaged in the practice of the religious tenets of any church or religious act where no fee is contemplated, charged, or received; whose license to practice midwifery has not been revoked; and who has not pleaded guilty to or been found guilty of a felony for a violation of section -5;
(4) A person administering a remedy, diagnostic procedure, or advice as specifically directed by a physician;
(5) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received;
(6) A person administering care to a member of such person's family; and
(7) The practice of a profession by individuals who are licensed, certified, or registered under other laws of this State and are performing services within the authorized scope of practice.
§ -8 Fees. (a) All fees received pursuant to this chapter shall be paid to the department and deposited in the state treasury to the credit of the compliance resolution fund. All costs and expenses incurred pursuant to this chapter shall be charged against and paid from the compliance resolution fund. In no case shall any salary, expense, or other obligation of the board be charged against the general fund.
(b) The fee for licensure shall not exceed $1,000.
§ -9 Client protection. A licensed midwife or applicant for licensure, renewal, or reinstatement shall not:
(1) Disregard a client's dignity or right to privacy as to the client's person, condition, possessions, or medical record;
(2) Breach any legal requirement of confidentiality with respect to a client, unless ordered by a court of law;
(3) Submit a birth certificate known by the person to be false or fraudulent, or wilfully make or file false or incomplete reports or records in the practice of midwifery;
(4) Fail to provide information sufficient to allow a client to give fully informed consent;
(5) Engage in the practice of midwifery while impaired because of the use of alcoholic beverages or drugs; or
(6) Violate any other standards of conduct as determined by the board in rules adopted for the regulation of the practice of midwifery.
§ -10 Disclosure; recordkeeping. (a) Before initiating care, a licensed midwife shall obtain a signed informed consent agreement from each client, acknowledging receipt, at minimum, of the following:
(1) The licensed midwife's training and experience;
(2) Instructions for obtaining a copy of the rules adopted by the board pursuant to this chapter;
(3) Instructions for obtaining a copy of the NACPM essential documents and NARM job description;
(4) Instructions for filing complaints with the board;
(5) Notice of whether or not the licensed midwife has professional liability insurance coverage;
(6) A written protocol for emergencies, including hospital transport that is specific to each individual client;
(7) A description of the procedures, benefits, and risks of home birth, primarily those conditions that may arise during delivery; and
(8) Any other information required by rules adopted by the board.
(b) All licensed midwives shall maintain a record of signed informed consent agreements for each client for a minimum of nine years after the last day of care for each client.
(c) Before providing care for a client who has a history of disorders, diagnoses, conditions, or symptoms identified in section -4(a)(5)(B), the licensed midwife shall provide written notice to the client that the client shall obtain care from a physician licensed pursuant to chapter 453 as a condition to the client's eligibility to obtain maternity care from the licensed midwife. Before providing care for a client who has a history of disorders, diagnoses, conditions, or symptoms identified in section -4(a)(5)(C), or who has had a previous cesarean section, the licensed midwife shall provide written notice to the client that the client is advised to consult with a physician licensed pursuant to chapter 453 during her pregnancy. The midwife shall obtain the client's signed acknowledgment of receipt of this notice.
(d) Any licensed midwife submitting an application to renew a license shall compile and submit to the board complete practice data for the twelve months immediately preceding the date of the application. The information shall be provided in form and content as prescribed by rule of the board and shall include but not be limited to:
(1) The number of clients to whom care has been provided by the licensed midwife;
(2) The number of deliveries performed by the licensed midwife;
(3) The apgar scores of the infants delivered by the licensed midwife;
(4) The number of prenatal transfers;
(5) The number of transfers during labor, delivery, and immediately following birth;
(6) Any perinatal deaths; and
(7) Other morbidity statistics as required by the board.
§ -11 Immunity from vicarious liability. No physician, hospital, emergency room personnel, emergency medical technician, or ambulance personnel shall be liable in any civil action arising out of any injury resulting from an act or omission of a licensed midwife, even if the health care provider has consulted with or accepted a referral from the licensed midwife. A physician who consults with a licensed midwife but who does not examine or treat a client of the midwife shall not be deemed to have created a physician-patient relationship with the client."
SECTION 3. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 5. This Act shall take effect on January 1, 2016.
Report Title:
Board of Midwifery; Midwives; License
Description:
Establishes the board of midwifery to adopt rules and protocols for midwives and licensure of midwives. Requires midwives to be licensed and meet minimum educational and training requirements. Requires the board to investigate complaints concerning violations of its rules and to take disciplinary action when necessary. Limits home births to clients with low-risk pregnancies. Requires licensed midwives to use informed consent agreements with their clients and to follow record keeping and reporting requirements. Effective 1/1/2016. (Proposed SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
