Bill Text: HI HB1194 | 2025 | Regular Session | Amended
Bill Title: Relating To Midwives.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced) 2025-02-19 - Bill scheduled to be heard by FIN on Friday, 02-21-25 3:00PM in House conference room 308 VIA VIDEOCONFERENCE. [HB1194 Detail]
Download: Hawaii-2025-HB1194-Amended.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1194 |
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THIRTY-THIRD LEGISLATURE, 2025 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MIDWIVES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that the State first began regulating midwives in 1931 by establishing a registration requirement, which subsequently progressed to certification and finally, licensure. However, the regulation of midwives was repealed when, in 1998, nurse-midwives were placed under the purview of the board of nursing. Despite the lack of regulation, many individuals continued to practice midwifery and many families in the community sought out midwife services.
The legislature also finds that, per the Hawaii Regulatory Licensing Reform Act, the State is required to regulate professions or vocations where the health, safety, or welfare of the consumer may be jeopardized by the nature of the service offered by the provider. In 1999 and 2017, the legislature requested the state auditor to conduct a sunrise analysis to determine if regulation of midwives was warranted. While the sunrise analysis conducted in 1999 and reported in Auditor's Report No. 99-14 determined that it was premature to regulate midwives at that time, that report and the 2017 Auditor's Report No. 17-01 both determined that the nature of the maternity and prenatal services provided by a midwife may endanger the health and safety of women and newborns under the midwife's care and, therefore, the profession of midwifery should be subject to regulation. The Auditor's Report No. 17-01 in particular recommended the legislature consider establishing a mandatory licensing framework for all midwives. Recognizing the potential for harm to public health and safety posed by the unregulated practice of midwifery, the legislature passed Act 32, Session Laws of Hawaii 2019 (Act 32), and established a regulatory framework for the practice of midwifery that was subsequently codified as chapter 457J, Hawaii Revised Statutes (chapter 457J). Since the passage of Act 32, approximately forty-one individuals have been licensed under chapter 457J. These regulations are set to sunset on June 30, 2025, unless the legislature takes action to continue the regulation of midwives.
The legislature further finds that, as part of its sunset analysis, and reported in Auditor's Summary Report No. 25-03 (2025), the auditor found that the practice of midwifery posed a clear and significant potential harm to the health and safety of the public and that the State's policies regarding the regulation of certain types of professions support the continued regulation of the practice of midwifery in the form of full licensure.
The legislature affirms that the practice of midwifery under this Act does not include Native Hawaiian traditional practices performed by traditional Hawaiian healers. The legislature also affirms that practicing midwifery according to this Act does not impede one's ability to incorporate or provide cultural practices.
Accordingly, the purpose of this Act is to:
(1) Make regulatory laws for the practice of midwifery permanent;
(2) Clarify the scope of practice of midwifery and establish licensure requirements for certified midwives and certified professional midwives, including continuing education requirements;
(3) Grants global signature authority to midwives;
(4) Grant prescriptive authority to certified midwives and amend the list of approved legend drugs that may be administered;
(5) Establish peer review and data submission requirements for midwives;
(6) Affirm that the practice of midwifery does not include traditional native Hawaiian healing practices performed by traditional Hawaiian healers;
(7) Clarify exemptions from licensure and grounds for refusal to renew, reinstate, or restore licenses; and
(8) Clarify medical record availability and retention requirements for the purposes of medical torts.
SECTION 2. Chapter 457J, Hawaii Revised Statutes, is amended by adding seven new sections to be appropriately designated and to read as follows:
"§457J-A Scope of
practice of midwifery. (a)
The scope of practice of midwifery means the full practice of midwifery,
regardless of
compensation or personal profit, as determined by the director, rules adopted
by the director, and midwifery standards established or recognized by the
director pursuant to this chapter. The
scope of practice of midwifery shall be based on and be consistent with a
midwife's education and national certification, including but not limited to:
(1) Evaluating the physical and psychosocial
health status of clients through a comprehensive health history, physical
examination, and risk assessment based on observation, inspection, palpation,
percussion, and auscultation, of the client or clients and using diagnostic
instruments and procedures;
(2) Formulating a diagnosis;
(3) Observation, assessment, development,
implementation, and evaluation of a plan of care;
(4) Providing education and counseling
related to the health promotion, disease prevention, and health care of midwife
clients, with a particular focus on a healthy pregnancy and childbirth, the
postpartum period, care of the newborn, and the family planning and
gynecological needs of midwife clients;
(5) Obtaining informed consent, as required
by section 671-3, in accordance with the midwife's professional requirements;
(6) Supervision and teaching of other
personnel;
(7) Teaching of
individuals, families, and groups;
(8) Provision of
midwifery services via telehealth;
(9) Administration,
evaluation, supervision, and coordination, including the delegation of
administrative and technical clinical tasks, of midwifery practice;
(10) Provision of
health care to the client in collaboration with other members of the health
care team as autonomous health care professionals providing the midwifery
component of health care;
(11) Serving as a consultant and resource of
midwifery clinical knowledge and skills to those involved directly or
indirectly in client care;
(12) Operating within a health care system
that provides for consultation, collaborative management, and referral with
other health care professionals;
(13) Referring clients who require care beyond
the scope of practice of the midwife to an appropriate health care provider or health
care facility, or both, equipped to address the client's health care needs;
(14) Initiating and maintaining accurate
records;
(15) Admitting and discharging clients for
inpatient care at facilities licensed in the State as birth centers;
(16) Participating in joint and periodic
evaluation of services rendered such as peer review, including chart reviews,
case reviews, client evaluations, and outcome of case statistics;
(17) Ordering, interpreting, and performing
diagnostic, screening, and therapeutic examinations, tests, and procedures as
authorized pursuant to this chapter and within the midwife's role, education,
and certification; and
(18) Use of reasonable judgment in carrying out prescribed medical orders of a licensed physician or osteopathic physician licensed pursuant to chapter 453 or an advanced practice registered nurse licensed pursuant to chapter 457; orders of a physician assistant licensed and practicing with physician supervision pursuant to chapter 453 and acting as the agent of the supervising physician; or orders of a midwife in accordance with this chapter.
(b) The scope of practice of
midwifery as a certified
midwife includes but is not limited to:
(1) Assessment and the diagnosis,
prescription, selection, and administration of therapeutic measures, including
over the counter drugs or legend drugs, or both, according to this chapter; the
provision of expedited partner therapy pursuant to section 453-52; and
controlled substances within the certified midwife's education, certification,
and role and in accordance with this chapter;
(2) The Standards for the Practice of
Midwifery, or successor document, of the American College of Nurse-Midwives and
American Midwifery Certification Board, or successor organizations; provided
that the American College of Nurse-Midwives and American Midwifery
Certification Board shall have no legal authority over the director and shall
have no legal authority or powers of oversight of the director in the exercise
of the director's powers and duties authorized by law;
(3) Assisting in surgery; and
(4) Admitting and discharging clients for
inpatient care at facilities licensed in the State as hospitals.
(c) The scope of practice of
midwifery as a certified
professional midwife includes but is not limited to:
(1) Assessment and the diagnosis, selection,
and administration of therapeutic measures according to the formulary authorized
by section 457J-11 within the certified professional midwife's education,
certification, and role; and
(2) The Essential Competencies for Midwifery Practice,
or successor document, as defined by the International Confederation of
Midwives, or successor organization; provided that the International
Confederation of Midwives shall have no legal authority over the director and
shall have no legal authority or powers of oversight of the director in the
exercise of the director's powers and duties authorized by law.
(d)
A midwife shall comply with the requirements of this chapter; recognize
limits of the midwife's training and experience and have transfer of care
protocols for situations that exceed the scope of authorized practice; consult
with or refer clients to other health care providers, as appropriate; and
participate in data submission and peer review requirements adopted by the
department; provided that peer review conducted outside of the department shall
not be used to replace investigations against a midwife licensed pursuant to
this chapter by the regulated industries complaints office.
§457J-B Care provided by midwives; requirements. (a) A midwife shall continually assess the
appropriateness of the planned location of birth and shall refer to the
American College of Nurse-Midwives Clinical Bulletin Number 61: Midwifery
Provision of Home Birth Services (November 2015), or succeeding document, for guidance,
taking into account the health and condition of the midwife's client; provided
that the American College of Nurse-Midwives shall have no legal authority or
powers of oversight over the director in the exercise of the director's powers
and duties authorized by law.
(b) If the midwife determines that a condition of
the midwife's client or clients is outside of the midwife's scope of practice,
the midwife shall refer the client or clients to an appropriate health care
provider or health care facility, or both, equipped to address the client's
health care needs; provided that the midwife shall collaborate with the client
or clients or the client's guardian to document what factors will necessitate a
change in birth settings to an emergency setting in response to emerging
conditions outside the scope of practice of the midwife.
(c) If the midwife is attending a birth at a
location without a physician and an operating room and determines during the
midwife's care that the client or clients faces imminent morbidity or
mortality, the midwife shall activate the 911 system and initiate transfer of
care protocols.
(d) If the midwife transfers care of the
midwife's client or clients during the intrapartum or immediate postpartum
period, the midwife shall provide the receiving provider with, at minimum, the
information regarding the midwife's client or clients listed on the transfer form
adopted by the department. The transfer
form may include reasons for the transfer, brief relevant clinical history, and
planned mode of transport.
(e) If the midwife's client, or the midwife's
client's guardian declines assistance from appropriate licensed health care
providers or the 911 system, the midwife shall continually urge the client or
the client's guardian to transfer care to an appropriate licensed health care
provider and may continue to provide care to save the life of the client or the
newborn; provided that the midwife shall only perform actions within the midwife's
scope of practice.
§457J-C License renewal continuing education
requirement. (a) Beginning July 1, 2026, each midwife shall
provide documentation of successful completion of thirty contact hours during
the prior triennium of appropriate continuing education that is related to the
practice of midwifery.
(b) Each licensee practicing as a certified midwife shall provide
documentation of successful completion of continuing education that is from
accredited colleges or universities or approved by an organization recognized
by the Continuing Education Policy, or successor document, of the American
Midwifery Certification Board, or successor organization; provided that a
minimum of eight hours of continuing education shall be in pharmacology.
(c)
Each licensee
practicing as a certified professional midwife shall provide documentation of
successful completion of continuing education that is from an accredited
college or university or granted by an accrediting organization recognized by
the North American Registry of Midwives, or successor organization; provided
that six hours of continuing education shall include treatment of
shock/intravenous therapy and suturing.
(d)
This section shall not apply to a licensee who has graduated from a
midwifery program approved by the director within the twelve months prior to
the renewal date of the licensee's first license renewal period.
(e)
The director may extend the deadline for compliance with the continuing
education requirements established by this section on a case-by-case basis;
provided that prior to the expiration of a license, the midwife seeking an
extension shall submit a written request for the extension and any
documentation required by the director to substantiate the reason for an
extension of the deadline for compliance with the continuing education
requirements established by this section.
(f)
Each licensee shall maintain the licensee's continuing education records
for no less than six years.
(g)
The director may conduct random audits of licensees to determine
compliance with the continuing education requirement. The director shall provide written notice of
an audit to all licensees randomly selected for audit. Within sixty days of notification, the
licensee shall provide the director with documentation verifying compliance
with the continuing education requirement established by this section.
§457J-D Global signature authority. Midwives
shall be authorized to sign, certify, or endorse all documents relating to
health care provided for their clients within their scope of practice,
including workers' compensation verification documents, temporary disability
insurance forms, verification and evaluation forms of the department of human
services and department of education, verification and authorization forms of
the department of health, and physical examination forms; provided that nothing
in this section shall be construed to expand the scope of practice of midwifery.
§457J-E Prescriptive authority. (a) Prescriptive authority shall be granted
solely to midwives practicing as certified midwives and shall not be granted to
midwives practicing as certified professional midwives. Midwives practicing as certified midwives
shall only prescribe those drugs appropriate to midwifery care as recognized by
the director and in accordance with the current exclusionary formulary defined
by the board of nursing for advanced practice registered nurses.
(b)
Only a midwife practicing as a certified midwife may communicate,
represent, or imply in any manner, including through the use of a sign, card,
or device, that the person is a midwife who is authorized to prescribe.
(c)
A midwife practicing as a certified midwife shall comply with all
applicable federal and state laws, regulations, and rules relating to the
prescription, dispensing, and administration of drugs. A midwife practicing as a certified midwife
shall only prescribe and administer over the counter drugs, legend drugs, and
controlled substances pursuant to this chapter and chapter 329. A midwife practicing as a certified midwife
may request, receive, and dispense a manufacturer's prepackaged samples of over
the counter and non-controlled legend drugs to patients under the midwife's
care; provided that the midwife practicing as a certified midwife shall not
request, receive, or sign for samples of controlled substances. A midwife practicing as a certified midwife
may prescribe, order, and dispense medical devices and equipment that are
appropriate to the midwife's scope of practice and plan and initiate a
therapeutic regimen that includes nutritional, diagnostic, and supportive
services including home health care, hospice, and physical and occupational
health.
(d)
Prescriptions issued by a midwife practicing as a certified midwife
shall be written in accordance with section 329-38.
(e)
It shall be a violation of this chapter for a midwife practicing as a
certified professional midwife to communicate, represent, or imply in any
manner, including through the use of any sign, card, or device, that the person
is a midwife with prescriptive authority.
§457J-F Reporting requirements. (a) Every midwife licensed pursuant to this chapter who does not possess
professional liability insurance shall report in writing any settlement or
arbitration award of a claim or action for damages for death or personal injury
caused by negligence, error, or omission in practice, or the unauthorized
rendering of professional services. The
report shall be submitted to the midwives licensing program within thirty days
after any written settlement agreement has been reduced to writing and signed
by all the parties or within thirty days after service of the arbitration award
on the parties.
(b)
Failure to comply with this section shall be an offense punishable by a
fine of no less than $100 for the first offense, $250 to $500 for the second
offense, and $500 to $1,000 for any subsequent offense.
§457J-G Peer
review requirements; license renewal. (a) Beginning June 30, 2029, each midwife shall,
as a condition of license renewal:
(1) Participate in a Hawaii based peer review
committee during each triennium subject
to the requirements of section 624-25.5; and
(2) Attest that the midwife has completed a
peer review for a minimum of five of the midwife's clinical cases from the
prior triennium, with at least two midwives licensed in the State who were not
involved in the clinical cases under review participating in the peer review
process; and
(3) Attest that the midwife has completed a
peer review within ninety days of any case that includes conditions outside of
the midwife's scope of practice; uterine rupture; or maternal or neonatal
hospitalization for infection, blood transfusion, intensive care unit
admission, infant failure to thrive, neonatal Apgar Score of less than seven at
five minutes, emergent transfer of care, or mortality.
(b)
If the midwife has served fewer than five clients in the prior
triennium, the requirements of subsection (a)(2) may be waived upon a
determination by the department; provided that if the requirements of
subsection (a)(2) are waived, the midwife shall participate in the review of
five cases of another midwife practicing in the State.
(c)
The midwife shall receive written confirmation of participation in a
peer review process from the Hawaii based peer review committee and shall
maintain copies of the midwife's participation records.
§457J-H Data
submission requirements; license renewal.
(a) Beginning June 30, 2029, a midwife shall, as
a condition of license renewal:
(1) Submit data on all courses of care for
every gestational parent and newborn under the midwife's care to a national or
state research organization approved by the department. If a gestational parent declines to participate
in the collection of data, the midwife shall follow the protocol of the
approved national or state research organization; and
(2) Attest that the midwife has submitted
data annually during the prior triennium.
(b)
The data submission requirements may be waived if the midwife attests
that the midwife has not provided midwifery care to any clients during the
prior triennium.
(c)
The midwife shall receive written confirmation of participation in data
submission from the national or state research organization and shall maintain
copies of the midwife's participation records."
SECTION 3. Section 26H-4, Hawaii Revised Statutes, is amended to read as follows:
"§26H-4 Repeal dates for newly enacted professional
and vocational regulatory programs.
(a) Any professional or
vocational regulatory program enacted after January 1, 1994, and listed in this
section shall be repealed as specified in this section. The auditor shall perform an evaluation of
the program, pursuant to section 26H-5, prior to its repeal date.
(b) Chapter 466L (appraisal management companies) shall be repealed on June 30, 2023.
[(c) Chapter 457J (midwives) shall be repealed on
June 30, 2025.]"
SECTION 4. Section 329-1, Hawaii Revised Statutes, is amended as follows:
1. By adding a new definition to be appropriately inserted and to read:
""Licensed midwife practicing as a certified midwife" means a person licensed under chapter 457J who is registered under this chapter to administer or prescribe a controlled substance; provided that a licensed midwife practicing as a certified midwife shall not be authorized to request, receive, or sign for professional controlled substance samples."
2. By amending the definition of "designated member of the health care team" to read:
""Designated member of the health care team" includes physician assistants, advanced practice registered nurses, licensed midwives practicing as certified midwives, and covering physicians who are authorized under state law to prescribe drugs."
3. By amending the definition of "practitioner" to read:
""Practitioner" means:
(1) A physician, dentist, veterinarian, scientific investigator, or other person licensed and registered under section 329-32 to distribute, dispense, or conduct research with respect to a controlled substance in the course of professional practice or research in this State;
(2) An advanced
practice registered nurse with prescriptive authority licensed and registered
under section 329-32 to prescribe and administer controlled substances in the
course of professional practice in this State; [and]
(3) A licensed
midwife practicing as a certified midwife licensed and registered under section
329-32 to prescribe and administer controlled substances in the course of professional
practice in this State; and
[(3)] (4)
A pharmacy, hospital, or other institution licensed, registered,
or otherwise permitted to distribute, dispense, conduct research with respect
to or to administer a controlled substance in the course of professional
practice or research in this State."
SECTION 5. Section 453-51, Hawaii Revised Statutes, is amended by amending the definition of "health professional" to read as follows:
""Health professional" means any of the following:
(1) A person licensed or otherwise authorized by law to practice medicine or surgery under this chapter and whose scope of practice includes the diagnosis and treatment of sexually transmitted diseases;
(2) An advanced
practice registered nurse with prescriptive authority under chapter 457 and
duly licensed in the State; [or]
(3) A licensed
midwife practicing as a certified midwife with prescriptive authority under
chapter 457J and duly licensed in the State; or
[(3)] (4) For the purpose of dispensing antibiotic
therapy under this section, a pharmacist who is licensed or otherwise
authorized to engage in the practice of pharmacy under chapter 461."
SECTION 6. Section 457J-1, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-1[]] Findings and purpose.
The legislature finds that:
(1) Midwives offer reproductive
health care and maternity and newborn care [from the antepartum period
through the intrapartum period to the postpartum period;] to clients
seeking midwifery services;
(2) The improper
practice of midwifery poses a significant risk of harm to [the mother or
newborn,] any client receiving midwifery services and may result in
death; and
(3) The regulation of
the practice of midwifery is reasonably necessary to protect the health,
safety, and welfare of [mothers] persons choosing midwifery services
and their newborns."
SECTION 7. Section 457J-2, Hawaii Revised Statutes, is amended as follows:
1. By adding five new definitions to be appropriately inserted and to read:
""Accredited birth
facility" means a hospital that has been accredited by The Joint
Commission or a birth center that has been accredited by the Commission for the
Accreditation of Birth Centers.
"American College of Nurse-Midwives" means the professional
association that represents and sets the standards for practice through core
competencies and scope of practice for certified nurse-midwives/certified
midwives in the United States.
"Peer review" means the candid
review and evaluation, subject to section 624-25.5, of the practice of
midwifery. "Peer review"
includes but is not limited to reviewing the care provided by midwives, making
recommendations for quality improvement, and identifying areas where additional
education or skills training is needed.
"Practice of midwifery" means the independent provision of care,
including initial and ongoing comprehensive assessment, diagnosis, and
treatment during pregnancy, childbirth, and the postpartum period; sexual and
reproductive health; gynecologic health; family planning services, including
preconception care; primary care for individuals from adolescence through the
lifespan, healthy newborns, and adults according to the midwife's scope of
practice for all persons seeking midwifery care in all settings through the
performance of professional services commensurate with the educational
preparation and demonstrated competency of the individual having specialized
training, and skill based on the principles of the biological, physical,
behavioral, and sociological sciences and midwifery theory, whereby the
individual shall be accountable and responsible to the client for the quality
of midwifery care rendered. "Practice
of midwifery" does not include traditional healing practices performed by:
(1) A traditional Hawaiian healer under article
XII, section 7 of the Hawaii state constitution; or
(2) An individual who has been recognized as a traditional Hawaiian healer by any council of kupuna convened by Papa Ola Lokahi.
"Telehealth" means the use of
telecommunications as that term is defined in section 269-1 including but not
limited to real-time video conferencing-based communication, secure interactive
and non-interactive web-based communication, and secure asynchronous
information exchange, to transmit client health care information, including
diagnostic-quality digital images and laboratory results for health care
interpretation and diagnosis, for the purpose of delivering enhanced health
care services and information to parties separated by distance. Standard telephone contacts, facsimile
transmissions, or electronic mail texts, in combination or by themselves, do
not constitute a telehealth service for the purposes of this chapter."
2. By amending the definitions of "interconception" and "International Confederation of Midwives" to read:
""Interconception"
means care provided to [mothers] birthing people between
pregnancies to improve health outcomes for [women,] birthing people
and newborns[, and children].
"International Confederation of
Midwives" means the accredited nongovernmental organization and
representative of midwives and midwifery to organizations worldwide to achieve
common goals in the care of [mothers] birthing people and
newborns."
3. By amending the definition of "postpartum" to read:
""Postpartum" means
the period of time immediately after and up to [eight] six weeks
following [the] birth [of the baby]."
4. By repealing the definition of "midwifery":
[""Midwifery" means the provision of one or more of the
following services:
(1) Assessment, monitoring, and care during pregnancy, labor, childbirth,
postpartum and interconception periods, and for newborns, including ordering
and interpreting screenings and diagnostic tests, and carrying out appropriate
emergency measures when necessary;
(2) Supervising the conduct of labor and childbirth; and
(3) Provision of advice and information regarding the progress of childbirth
and care for newborns and infants."]
SECTION 8. Section 457J-6, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-6[]] Exemptions. (a) [A person may practice midwifery without a
license to practice midwifery if the] This chapter shall not apply to a
person who is:
(1) A certified nurse-midwife holding a valid license under chapter 457;
(2) Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery;
(3) A student [midwife]
who is currently enrolled in [a] an accredited midwifery
educational program and under the direct supervision of a qualified
midwife preceptor; provided that the practice of midwifery is incidental to
the program of study engaged by the student;
[(4) A person
rendering aid in an emergency where no fee for the service is contemplated,
charged, or received; or
(5) A person acting
as a birth attendant on or before July 1, 2023, who:
(A) Does
not use legend drugs or devices, the use of which requires a license under the
laws of the State;
(B) Does
not advertise that the person is a licensed midwife;
(C) Discloses
to each client verbally and in writing on a form adopted by the department,
which shall be received and executed by the person under the birth attendant's
care at the time care is first initiated:
(i) That
the person does not possess a professional license issued by the State to
provide health or maternity care to women or infants;
(ii) That
the person's education and qualifications have not been reviewed by the State;
(iii) The
person's education and training;
(iv) That
the person is not authorized to acquire, carry, administer, or direct others to
administer legend drugs;
(v) Any
judgment, award, disciplinary sanction, order, or other determination that
adjudges or finds that the person has committed misconduct or is criminally or
civilly liable for conduct relating to midwifery by a licensing or regulatory
authority, territory, state, or any other jurisdiction; and
(vi) A
plan for transporting the client to the nearest hospital if a problem arises
during the client's care; and
(D) Maintains
a copy of the form required by subparagraph (C) for at least ten years and
makes the form available for inspection upon request by the department.
(b) Nothing in this chapter shall prohibit
healing practices by traditional Hawaiian healers engaged in traditional
healing practices of prenatal, maternal, and child care as recognized by any
council of kupuna convened by Papa Ola Lokahi.
Nothing in this chapter shall limit, alter, or otherwise adversely
impact the practice of traditional Native Hawaiian healing pursuant to the
Constitution of the State of Hawaii.
(c) Nothing in this chapter shall prohibit a
person from administering]
(4) Providing traditional Hawaiian healing practices
as a:
(A) A traditional Hawaiian healer under
article XII, section 7 of the Hawaii state constitution; or
(B) An individual who has been recognized as
a traditional Hawaiian healer by any council of kupuna convened by Papa Ola
Lokahi;
(5) Providing
services in the case of emergency or the domestic administration of family
remedies; or
(6) Administering
care to [a] the person's spouse, domestic partner, parent,
sibling, or child."
SECTION 9. Section 457J-8, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-8[]] Application for license as a midwife. (a)
To obtain a license under this chapter, the applicant shall provide:
(1) An application for licensure;
(2) The required fees;
[(3) Proof of
current, unencumbered certification as a:
(A) Certified
professional midwife; or
(B) Certified
midwife;
(4) For certified
professional midwives, proof of a successful completion of a formal midwifery
education and training program that is either:
(A) An
educational program or pathway accredited by the Midwifery Education
Accreditation Council; or
(B) A
midwifery bridge certificate issued by the North American Registry of Midwives
for certified professional midwife applicants who either obtained certification
before January 1, 2020, through a non-accredited pathway, or who have
maintained licensure in a state that does not require accredited education;
(5)] (3) A copy of current certification in
cardiopulmonary resuscitation of the adult and infant/child by the American
Heart Association, Red Cross, or American Safety and Health Institute Basic
Life Support that includes a hands-on skill component; provided that the
certification shall be current at the time of application and remain valid
throughout the license period;
(4) A
copy of current certification in a neonatal resuscitation program of the
American Academy of Pediatrics that includes a hands-on skills component;
provided that the certification shall be current at the time of application and
remain valid throughout the license period;
(5) If
applicable, evidence of any licenses held or once held in other jurisdictions
indicating the status of the license and documenting any disciplinary
proceedings pending or taken by any jurisdiction;
(6) Information
regarding any conviction of any crime which has not been annulled or expunged;
[and]
(7) Any other
information the department may require to investigate the applicant's
qualifications for licensure[.];
(8) Any additional requirements adopted by
the director; and
(9) Evidence of qualifications for licensure.
(b)
Evidence of qualifications for licensure as a certified midwife shall
consist of the following:
(1) Proof of current, unencumbered certification
as a certified midwife by the American Midwifery Certification Board or a
successor organization;
(2) Proof of successful completion of a
graduate-level midwifery program accredited by the Accreditation Commission for
Midwifery Education, or successor organization, leading to a master's degree or
higher as a midwife; and
(3) Proof of successful completion of at
least thirty contact hours, as part of a master's degree program or higher from
a college or university accredited by the Accreditation Commission for
Midwifery Education, or successor organization, of advanced pharmacology
education, including advanced pharmacotherapeutics that is integrated into the
curriculum, within three years immediately preceding the date of
application. If the advanced
pharmacology education in a master's degree program was completed prior to the
three-year time period immediately preceding the date of application, then one
of the following shall be completed within the three-year time period
immediately preceding the date of application for initial prescriptive
authority:
(A) At least thirty contact hours of advanced
pharmacology, including advanced pharmacotherapeutics, from a college or
university accredited by the Accreditation Commission for Midwifery Education,
or successor organization; or
(B) At least thirty contact hours of
continuing education in advanced pharmacology, including advanced
pharmacotherapeutics, approved by the Continuing Education Policy, or successor
document, of the American Midwifery Certification Board, or successor organization;
provided that the continuing education pharmacology contact hours shall be
related to the applicant's scope of midwifery practice.
(c)
Evidence of qualifications for licensure as a certified professional
midwife shall consist of the following:
(1) Proof of current and valid certification
as a certified professional midwife by the North American Registry of Midwives
or a successor organization; and
(2) Proof of successful completion of a
formal midwifery education and training program as follows:
(A) A midwifery educational program or
pathway accredited by the Midwifery Education Accreditation Council, or
successor organization, or another nationally recognized accrediting agency
approved by the United States Department of Education; or
(B) A midwifery bridge certificate issued by
the North American Registry of Midwives, or successor organization, for
certified professional midwife applicants who obtained certification before
January 1, 2020."
SECTION 10. Section 457J-10, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-10[]] Renewals. (a)
Every license issued under this chapter shall be renewed triennially on
or before June 30, with the first renewal deadline occurring on June 30,
2023. Failure to renew a license shall
result in a forfeiture of the license.
Licenses [which] that have been so forfeited may be
restored within one year of the expiration date upon payment of renewal and
penalty fees. Failure to restore a
forfeited license within one year of the date of its expiration shall result in
the automatic termination of the license.
Relicensure after termination shall require the person to apply as a new
applicant and again satisfy all licensing requirements in place at the time of
the new application.
(b) For each license renewal, the licensee shall:
(1) Pay all
required nonrefundable fees;
(2) Submit a
completed renewal application;
(3) Provide
documentation of successful completion during the prior triennium of
appropriate continuing education as required pursuant to section 457J-C;
(4) Provide
a copy of current certification in cardiopulmonary resuscitation of the adult
and infant/child by the American Heart Association, Red Cross, or American
Safety and Health Institute Basic Life Support that includes a hands-on skill
component; provided that the certification shall be current at the time of
application and remain valid throughout the license period;
(5) Provide
a copy of current certification in a neonatal resuscitation program of the
American Academy of Pediatrics that includes a hands-on skills component;
provided that the certification shall be current at the time of application and
remain valid throughout the license period;
(6) By June 30,
2029, and every triennium thereafter, complete the peer review requirements of
457J-G; and
(7) By June 30, 2029, and every triennium thereafter, complete the data submission requirements of 457J-H."
SECTION 11. Section 457J-11, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-11[]] Authority to purchase and administer
certain legend drugs and devices.
(a) A midwife licensed under this
chapter may purchase and administer non-controlled legend drugs and devices
that are used in pregnancy, birth, postpartum care, newborn care, or
resuscitation, and that are deemed integral to providing care to the public by
the department.
(b) Legend drugs authorized under subsection (a) are limited for:
(1) Neonatal use to prophylactic ophthalmic medications, vitamin K, epinephrine for neonatal resuscitation per neonatal resuscitation guidelines, and oxygen; and
(2) Maternal use to
antibiotics for Group B Streptococcal antibiotic prophylaxis per guidelines
adopted by the Centers for Disease Control and Prevention[,];
postpartum antihemorrhagics[,]; Rho(D) immune globulin[,];
epinephrine for anaphylactic reaction to an administered medication[,];
intravenous fluids[,]; amino amide local anesthetic[,];
nitrous oxide for pain relief when used in an accredited birth facility and in
accordance with facility policies; non-hormonal contraceptives; hormonal implants pursuant to any
manufacturer certification requirements, as prescribed by a licensed health
care provider with prescriptive authority under this chapter, chapter 453, or
section 457-8.6; and oxygen.
Legend drugs authorized under subsection (a)
shall not be used to induce, stimulate, or augment labor during the first or
second stages of labor or before labor.
(c) Legend devices authorized under subsection (a) are limited to devices for:
(1) Injection of medications;
(2) The administration of intravenous fluids;
(3) Adult and infant resuscitation;
(4) Rupturing amniotic membranes;
(5) Repairing vaginal
tears; [and]
(6) Postpartum
hemorrhage[.]; and
(7) Mechanical,
non-pharmacologic cervical dilation when used at or after thirty-nine weeks
gestation in pregnancy.
(d)
A pharmacist who dispenses drugs and devices to a midwife as authorized
by this section and in conformity with chapter 461 is not liable for any
adverse reactions caused by the midwife's administration of legend drugs and
devices.
(e) Nothing in this section shall preclude a midwife practicing as a certified professional midwife from carrying out the prescribed medical orders of a licensed physician or osteopathic physician licensed pursuant to chapter 453 or advanced practice registered nurse licensed pursuant to chapter 457; orders of a physician assistant licensed and practicing with physician supervision pursuant to chapter 453, and acting as the agent of the supervising physician; or orders of a recognized midwife practicing as a certified midwife in accordance with this chapter."
SECTION 12. Section 457J-12, Hawaii Revised Statutes, is amended to read as follows:
"[[]§457J-12[]] Grounds for refusal to grant, renew,
reinstate, or restore licenses and for revocation, suspension, denial, or
condition of licenses. In addition
to any other acts or conditions provided by law, the director may refuse to
grant, renew, reinstate, or restore, or may deny, revoke, suspend, or condition
in any manner, any license for any one or more of the following acts or
conditions on the part of the licensee or the applicant thereof:
(1) Failing to meet or maintain the conditions and requirements necessary to qualify for the granting of a license;
(2) Failing to notify the department in writing that the licensee's certification as a certified professional midwife or as a certified midwife is no longer current or unencumbered within thirty days of the change in status;
(3) Engaging in false, fraudulent, or deceptive advertising, or making untruthful or improbable statements;
(4) Being addicted to,
dependent on, or a habitual user of [a narcotic, barbiturate,
amphetamine, hallucinogen, opium, or cocaine, or other drugs or derivatives of
a similar nature; illicit substances, or abusing controlled substances,
or both;
(5) Practicing as a [licensed]
midwife while impaired by, at minimum, alcohol, drugs, non-accommodated
physical disability, or mental instability;
(6) Procuring a license through fraud, misrepresentation, or deceit;
(7) Aiding and abetting an unlicensed person to directly or indirectly perform activities requiring a license;
(8) Engaging in professional misconduct as defined by the program in accordance with its own rules, incompetence, gross negligence, or manifest incapacity in the practice of midwifery;
(9) Failing to maintain a record or history of competency, trustworthiness, fair dealing, and financial integrity;
(10) Engaging in conduct or practice contrary to recognized standards of ethics for the practice of midwifery;
(11) Violating any condition or limitation upon which a conditional license was issued;
(12) Engaging in business under a past or present license issued pursuant to this chapter, in a manner causing injury to one or more members of the public;
(13) Failing to comply, observe, or adhere to any law in a manner such that the director deems the applicant or licensee to be an unfit or improper person to hold a license;
(14) Having a revocation, suspension, or other disciplinary action by a territory, or by another state or federal agency against a licensee or applicant for any reason provided by the licensing laws or this section;
(15) Having a criminal
conviction, whether by nolo contendere or otherwise, of a penal crime directly
related to the qualifications, functions, or duties of a [licensed]
midwife;
(16) Failing to report in writing to the director any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty days of the disciplinary decision;
(17) Employing, utilizing, or attempting to employ or utilize at any time any person not licensed under this chapter where licensure is required;
(18) Violating this chapter, any other applicable licensing laws, or any rule or order of the director; or
(19) Using or removing without authorization controlled substances or drugs, including diverting or attempting to divert drugs or controlled substances for unauthorized use."
SECTION 13. Section 671-1, Hawaii Revised Statutes, is amended by amending the definition of "health care provider" to read as follows:
""Health care
provider" means a physician, osteopathic physician, surgeon, or physician
assistant licensed under chapter 453[, a]; podiatrist licensed
under chapter 463E[, a]; health care facility as defined in
section 323D-2[,]; midwife licensed under chapter 457J; and the
employees of any of them. Health care
provider shall not mean any nursing institution or nursing service conducted by
and for those who rely upon treatment by spiritual means through prayer alone,
or employees of the institution or service."
SECTION 14. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 15. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
SECTION 16. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 17. This Act shall take effect on July 1, 3000.
Report Title:
Midwives; Practice of Midwifery; Scope of Practice; Traditional Hawaiian Healing Practices; Certified Midwives; Certified Professional Midwives; Licensure; Requirements; License Renewal; Prescriptive Authority; Peer Review; Data Submission; Medical Records
Description:
Makes laws regulating midwives and the practice of midwifery permanent. Clarifies the scope of practice of midwifery. Establishes licensure requirements for certified midwives and certified professional midwives. Establishes continuing education requirements. Grants global signature authority to midwives. Grants prescriptive authority to licensed midwives practicing as certified midwives and amends the list of approved legend drugs that may be administered. Establishes peer review and data submission requirements. Affirms that the practice of midwifery does not include traditional Hawaiian healers performing traditional Hawaiian healing practices. Clarifies exemptions from licensure and grounds for refusal to renew, reinstate, or restore licenses. Clarifies medical record availability and retention requirements for the purposes of medical torts. Effective 7/1/3000. (HD1)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
