Bill Text: DE HB319 | 2013-2014 | 147th General Assembly | Draft
Bill Title: An Act To Amend Titles 16 And 24 Of The Delaware Code Relating Of Midwifery.
Spectrum: Moderate Partisan Bill (Democrat 14-4)
Status: (Engrossed - Dead) 2014-06-25 - HS 1 for HB 319 - Passed by House of Representatives. Votes: Passed 27 YES 12 NO 1 NOT VOTING 1 ABSENT 0 VACANT [HB319 Detail]
Download: Delaware-2013-HB319-Draft.html
|
SPONSOR: |
Rep. Baumbach & Sen. McDowell & Sen. Peterson |
|
Reps. Bennett, Bolden, Mulrooney, Osienski, Outten, Paradee, B. Short, D. Short; Sens. Bushweller, Lopez, Townsend |
|
HOUSE OF REPRESENTATIVES 147th GENERAL ASSEMBLY |
|
HOUSE BILL NO. 319 |
|
AN ACT TO AMEND TITLES 16 AND 24 OF THE DELAWARE CODE RELATING OF MIDWIFERY. |
Section 1. Amend Chapter 17, Title 24 of the Delaware Code by adding new Subchapter XIII by making deletions as shown by strike through and insertions as shown by underline as follows:
Subchapter XIII. Midwifery.
§1799FF Definitions.
As used in this subchapter:
(1) "Board" means the Board of Medical Licensure and Discipline.
(2) "Certified Professional Midwife" or "CPM" means a practitioner who has been certified as an expert in facility or home birth and has met the standards of certification by the North American Registry of Midwives or its equivalent or successor.
(3) "Certified Nurse Midwife" or "CNM" means an Advanced Practice Nurse, CNM as defined in Chapter 19 of this Title.
(4) "Certified Midwife" or "CM" means a practitioner who has met the standards of certification by the American Midwifery Certification Board or its equivalent or successor, and who has documented out-of-hospital birthing experience sufficient to satisfy standards as shall be put forth by the Council.
(5) "Client" means a woman under the care of a midwife and her newborn.
(6) "Council" means the Midwife Advisory Council.
(7) "License" means, unless the context requires otherwise, a license issued by the Board to practice midwifery.
(8) "Licensed Midwife" or "Midwife" for purposes of this subchapter, means a person licensed under this chapter to practice midwifery.
(9) "Midwifery" means the practice of providing the necessary supervision, care, and advice to a client during normal pregnancy, labor, and the postpartum periods, and conducting deliveries on the midwife's own responsibility consistent with the provisions of this subchapter; including preventative measures, the identification of physical, social and emotional needs of the client.
§ 1799GG Subchapter limitations.
Nothing in this subchapter shall limit, preclude, or otherwise interfere with the professional activities of other individuals and healthcare providers who are allowed to practice obstetrics and gynecology.
§ 1799HH Midwife Advisory Council.
(a) The Board of Medical Licensure and Discipline shall form the Midwife Advisory Council (Council) which consists of 5 voting members. The members shall consist of 2 licensed midwives who possess a valid Certified Professional Midwife (CPM) credential from the North American Registry of Midwives (NARM) or other accrediting organization approved by the Council; 1 licensed midwife who possesses either a valid Certified Professional Midwife (CPM) credential from NARM, or a valid Certified Midwife (CM) credential from the American Midwifery Certification Board (AMCB); 1 Certified Nurse Midwife (CNM) as described in Chapter 19 of this Title; 1 practicing obstetrician with hospital admitting privileges who is a member of the American Congress of Obstetrics and Gynecology and certified by the American Board of Obstetrics and Gynecology; and 1 non-voting member who is a practicing pediatrician with hospital admitting privileges. The Council may elect officers as often as necessary.
(b) The Council members are each appointed by the Board of Medical Licensure and Discipline for a term of 3 years, subject to removal by the Governor for neglect of duty, malfeasance, or misfeasance in office, and may succeed himself or herself for 1 additional 3-year term; provided, however, that if a member is initially appointed to fill a vacancy, the member may succeed himself or herself for only 1 additional 3-year term.A person appointed to fill a vacancy on the Council is entitled to hold office for the remainder of the unexpired term of the former member. Each term of office expires on the date specified in the appointment; however, a Council member whose term of office has expired remains eligible to participate in Council proceedings until replaced by the Board. A person who has been twice appointed to the Council or who has served on the Council for 6 years within any 9-year period may not again serve until an interim period of at least 1 year was expired since the person last served.
(c) The Council shall promulgate rules and regulations governing the practice of midwifery, after public hearing and subject to the approval of the Board of Medical Licensure and Discipline. The Board must approve or reject within a reasonable amount of time proposed rules or regulations submitted to it by the Council. The Board shall not promulgate rules and regulations regarding midwifery except as are adopted by the Council.Such rules and regulations may include, but shall not be limited to:
(1) procedures for the examination of applicants and issuance of licenses to those applicants it finds qualified;
(2) licensing and licensing renewal requirements;
(3) permit requirements for apprentice midwives for a period of no more of two years
(4) standards for education and apprentice training programs and the procedures for denial, revocation, or suspension of such program for failure to meet or maintain the standards;
(5) continuing education requirements for licensed midwives;
(6) practice standards for licensed midwives that may include, but shall not be limited to:
i. adoption of ethical standards for licensed midwives and apprentice midwives;
iii. maintenance of records of care, including client charts;
iv. participation in peer review and additional training with physicians and nurses;
v. standardized informed consent, reporting, health history, and written emergency transport plan forms;
vii. identification of factors tending to create heightened delivery risk and, where appropriate, regulation of the scope of practice when a risk has been identified;
viii. description of the tools and equipment a midwife may and may not use during delivery; and
ix. drugs and tests the midwife is authorized to obtain and administer.
(d) License Suspension, Revocation, and nonrenewal
(1) The Council, after appropriate notice and hearing, may recommend to the Board of Medical Licensure and Discipline that the Board revoke, suspend, or refuse to issue a license, or place a licensee on probation, or otherwise discipline a licensee found guilty of unprofessional conduct. Unprofessional conduct includes, but is not limited to, fraud, deceit, incompetence, gross negligence, dishonesty, or other behavior in the licensee's professional activity which is likely to endanger the public health, safety, or welfare. The Council may recommend and Board may take necessary action against a midwife who is unable to practice midwifery with reasonable skill or safety to patients because of physical or mental illness, impairment or incompetence;including illness, impairment, or incompetence caused by or related to substance abuse. Disciplinary action or other action taken against a midwife must be in accordance with the procedures for disciplinary and other actions against physicians, including appeals as set forth in subchapter IV of this chapter except that a hearing panel for a complaint against a midwife consists of 3 members; 1 of the 3 shall be a physician member of the Board or Council; 2 of the 3 shall be unbiased midwife members of the Council; and if no conflict exists, 1 of the 2 Council midwife members shall be the Chair of the Council.
(2) If the Council receives a formal or informal complaint concerning the activity of a midwife and the Council members reasonably believe that the activity presents a clear and immediate danger to the public health, the Council may recommend that the Board issue an order temporarily suspending themidwife's license to practice, pending a hearing. An order temporarily suspending a license to practice may not be issued by the Board, unless the midwife or the midwife's attorney received at least 24 hours' written or oral notice prior to the temporary suspension so that the midwife or midwife's attorney can be heard in opposition to the proposed suspension, and unless at least 3 members of the Council and 5 members of the Board vote in favor of the temporary suspension. An order of temporary suspension pending a hearing may remain in effect for no longer than 60 days from the date of the issuance of the order unless the temporarily suspended midwife requests a continuance of the hearing date. If the midwife requests a continuance, the order of temporary suspension remains in effect until the hearing panel convenes and a decision is rendered.
a. A midwife whose license has been temporarily suspended pursuant to this section must be notified of the temporary suspension immediately and in writing. Notification consists of a copy of the complaint and the order of temporary suspension pending a hearing personally served upon the midwife or sent by certified mail, return receipt requested, to the midwife's last known address.
b. A midwife whose license to practice has been temporarily suspended pursuant to this section may request an expedited hearing by notifying the Council in writing.
c. As soon as possible after the issuance of an order temporarily suspending a midwife's license to practice pending a hearing, the Council Chair shall appoint a 3-member hearing panel consisting of 3 members; 1 of the 3 shall be a physician member of the Board; 2 of the 3 shall be unbiased midwife members of the Council. After notice to the midwife pursuant this section, the hearing panel shall convene within 60 calendar days of the date of the issuance of the order of temporary suspension to consider the evidence regarding the matters alleged in the complaint. If a midwife requests an expedited hearing, the hearing panel shall convene within 15 calendar days of the receipt by the Council of the request. The 3-member panel shall conduct a hearing in accordance with the procedures set forth in §1734 of this title and shall render a decision within 15 calendar days of the hearing.
d. In addition to making findings of fact, the hearing panel shall also determine whether the facts found by it constitute a clear and immediate danger to public health. If the hearing panel determines that the facts found constitute a clear and immediate danger to public health, the order of temporary suspension must remain in effect until the Board, pursuant to §1734(g) of this title, deliberates and reaches conclusions of law based upon the findings of fact made by the hearing panel. An order of temporary suspension may not remain in effect for longer than 60 days from the date of the decision rendered by the hearing panel unless the suspended midwife requests an extension of the order pending a final decision of the Board. Upon the final decision of the Board, an order of temporary suspension is vacated as a matter of law and is replaced by the disciplinary action, if any, ordered by the Board.
(e) The Council shall meet quarterly and as needed. The Council shall present to the Board the names of individuals qualified to be licensed and shall recommend disciplinary action against licensees as necessary, and shall suggest changes in operations or regulations pursuant to § 1799HH. The Board shall approve or reject these recommendations within a reasonable time period.The Council shall keep minutes of its meetings which shall be available to the public upon FOIA request, except that information discussed by the Council concerning a mother or child which is private in nature or which would tend to reveal the identity of a client of a midwife shall be discussed in executive session pursuant to 29 Del. C. Chapter 100.
§1799II Licensure.
(a) To be eligible for licensure by the council as a midwife, an applicant shall:
(1) be at least 21 years of age;
(2) may not have been assessed any administrative penalties regarding the applicant's practice of midwifery, including but not limited to fines, formal reprimands, license suspension or revocation—except for license suspension or revocation for non-payment of license renewal fee or unlicensed practice penalties assessed prior to the establishment of the Council—and probationary limitations;
(3) may not have been convicted of or may not have admitted under oath to having committed a crime substantially related to the practice of midwifery;
(4) be a graduate of a high school or its equivalent;
(5) possess a valid CPM credential from NARM, a valid CM credential from the AMCB, or another valid credential from another accrediting organization approved by the Council;
(6) meet minimum educational requirements prescribed by the Council which may include but shall not be limited to studying obstetrics; neonatal pediatrics; basic sciences; female reproductive anatomy and physiology; behavioral sciences; childbirth education; community care; obstetrical pharmacology; epidemiology; gynecology; repair of child delivery trauma such as vaginal lacerations and episiotomies; family planning; genetics; embryology; neonatology; the medical and legal aspects of midwifery; nutrition during pregnancy and lactation; breast feeding; and such other requirements prescribed by the Council;
(7) meet practical experience requirements prescribed by the Council, which may include but shall not be limited to specific numbers of prenatal visits, post-partum follow-up exams, attendance at live births as an observer and primary birth attendant under supervision, performance of newborn examinations, performance of laceration repairs, performance of postpartum visits, and observation of in-hospital births. The training required under this section may include training both in hospitals and alternative birth settings.
(b) The Council may waive any of the requirements of subsection (a) of this section if its finds all of the following by clear and convincing evidence:
(1) The applicant's education, training, qualifications, and conduct have been sufficient to overcome the deficiency or deficiencies in meeting the requirements of this section;
(2) The applicant is capable of practicing midwifery in a competent and professional manner;
(3) The granting of the waiver will not endanger the public health, safety, or welfare;
(4) For waiver of a misdemeanor conviction or violation, and for waiver of a felony for the practice of unlicensed midwifery prior to June 30, 2014, at the time of the application the applicant may not be incarcerated, on work release, on probation, on parole or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution and community service.
(5) For waiver of any other felony conviction, more than 5 years have elapsed since the date of the conviction. At the time of the application the applicant may not be incarcerated, on work release, on probation, on parole or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution and community service; and
(c) Any termination, revocation, or suspension of a certification from NARM, AMCB, or other Midwifery certifying organization, or discipline from the same must be promptly reported to the Council.
(d) Licensure must be renewed every two years.
(e) The Council shall obtain all available criminal offender record information from the criminal history systems board for an applicant by means of fingerprint checks, and from the Federal Bureau of Investigation for a national criminal history records check. Except for unlicensed practice of Midwifery established prior to the passage of this subchapter, the information obtained thereby may be used by the council to determine the applicant's eligibility for licensing under this chapter. Receipt of criminal history record information by a private entity is prohibited.
§1799JJ. Physician Midwife Relationship
(1) Consultation between midwife and a physician or other medical professional does not alone create a physician-patient relationship or any other relationship with the physician.
(2) Screening by a physician for the purposes of determining risk does not alone create a physician-patient relationship or any other relationship with the physician.
(3) Upon the successful transfer of a patient from a midwife to a licensed physician, no liability or cause of action relating to the care of the client prior to the successful transfer of the client may be attributed to the physician. The licensed midwife may consult and remain in consultation with the physician and client after the transfer.
(4) If a physician determines that the client's condition or concern has been resolved such that the risk factors presented by a woman's disease or condition are not likely to significantly affect the course of pregnancy or childbirth, the licensed midwife may resume primary care of the client and resume assisting the client during her pregnancy, childbirth, or postpartum care.
(5) If a physician determines the Client's condition or concern has not been resolved as specified in paragraph (4), the licensed midwife may provide concurrent care with a physician and surgeon and, if authorized by the Client, be present during the labor and childbirth, and resume postpartum care, if appropriate. No liability or cause of action relating to the care of the client during treatment by a physician prior to the resumption of postpartum care may be attributed to the midwife.
(6) A licensed midwife shall not provide or continue to provide midwifery care to a client with a risk factor that renders her ineligible for midwifery care under the then-existing standards promulgated by the Council, regardless of whether the client has consented to this care or refused care by a physician.If a midwife advises a mother to pursue a hospital or doctor-supervised birth, but the mother refuses or is unable to pursue a hospital or doctor-supervised birth, the midwife may attend after obtaining the informed consent of the mother if the consent complies with the Council's promulgated rules and regulations.
Section 2. Amend §3121(e), Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows and redesignating accordingly:
(e) When a birth occurs outside an institution, the certificate shall note whether such a birth was pre-planned to occur outside of an institution, and the certificate shall be prepared and filed by one of the following in the indicated order of priority:
(1) The physician in attendance at or immediately after the birth, or in the absence of such a person;
(2)The midwife in attendance at or immediately after the birth;
Section 3.This Act shall take effect immediately after its enactment into law.
SYNOPSIS
|
As existing law has failed to make licensed midwifery services available to Delaware mothers who do not belong to very specific religious sects, a public process was followed in 2013-2014 to identify a better system, incorporating both Delaware systems, and other states' best practices for midwifery licensure. This public process included a broad cross-section of interested stakeholders. This bill establishes a Midwifery Advisory Council, which reports to the Board of Medical Licensure and Discipline.The Council is responsible for 1) procedures for the issuance of a midwife license, 2) license renewal process, 3) apprentice midwife permit requirements, 4) standards for education and apprentice training programs, 4) continuing education requirements for licensed midwives, and 5) practice standards for licensed midwives.Practice standards include many areas which will be developed by the Council through a public process.The Council is also responsible for considering, and recommending to the Board the suspension and revocation of midwifery licenses. There are several requirements to be licensed as a Delaware midwife, one of which is holding at least one of the following two national midwife credentials:CPM, Certified Professional Midwife, and CM, a Certified Midwife.Note that Certified Nurse Midwives (CNMs) are already regulated in the Delaware Code. Section 2 of the bill requires that when a birth is planned to occur outside of an institution, this fact will be noted when the birth is reported to the State. |
