Bill Text: HI SB2569 | 2014 | Regular Session | Introduced
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-Introduced.html
|
THE SENATE |
S.B. NO. |
2569 |
|
TWENTY-SEVENTH LEGISLATURE, 2014 |
|
|
|
STATE OF HAWAII |
|
|
|
|
|
|
|
|
||
|
|
||
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 no licensure, certification, or registration of home birth providers exists in Hawaii. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics believe that the safest place for delivery is in the hospital but respect the right of women to make an informed decision. However, Hawaii currently has no regulations for home birth safety; no educational requirements for home birth providers; and no requirements to inform mothers about the possible risks of home birth, in particular the risks of a high risk pregnancy home birth. Furthermore, no safety protocols exist for the selection of candidates for planned home birth and the transfer of care or referral from home birth provider to the hospital or physician.
The legislature also finds that national data reports a two to three fold increased risk of neonatal mortality with planned home birth versus hospital birth, and that multiple preventable neonatal deaths have occurred in Hawaii. The data further shows an increased risk of neonatal morbidity, including low Apgar scores and serious neurologic problems associated with planned home birth versus hospital birth.
The purpose of this Act is to improve home birth safety by establishing a home birth safety board, established as an advisory board to the Hawaii medical board, for licensure; requiring home birth providers to meet minimum educational and training requirements for midwives established by the American Midwifery Certification Board; establishing protocols for home birth safety; requiring collection of home birth data; and requiring that home birth providers fully inform their clients regarding their planned home birth so that they may make an informed decision.
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:
"Antepartum" means the period during pregnancy, before birth.
"Board" means the home birth safety board, established as an advisory board to the Hawaii medical board, that oversees the licensure and activity of home birth providers, including all midwives, physicians, and naturopathic physicians who desire to perform home deliveries.
"Client" means a person who retains the services of a certified nurse midwife, certified midwife, obstetrician, family medicine physician with training in obstetrics, or naturopathic physician for a planned home birth.
"Department" means the department of commerce and consumer affairs.
"Home birth" means a planned out-of-hospital birth.
"Home birth midwife" means a nurse midwife or midwife who has been certified by the American Midwifery Certification Board.
"Home birth provider" means a midwife, obstetrician-gynecologist, family medicine physician with training in obstetrics, or naturopathic physician that has met the educational, training, and other requirements for licensure to provide home delivery services.
"Home delivery services" means the care and management of women during the antepartum, intrapartum, and postpartum stages of pregnancy.
"Intrapartum" means the period during the birth process.
"Low-risk pregnancy" means a normal, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a normal uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by the American College of Obstetricians and Gynecologists for maternal, fetal, and neonatal care, and generally accepted by obstetric health care providers.
"Postpartum" means the period occurring between one hour to forty-two days after birth.
"Protocol" means a defined response to a specific clinical situation providing pathways to be followed by home birth providers who perform home deliveries and manage a particular issue or complication associated with a delivery.
"Referral or consultation" means the process by which the home birth provider directs a client to a licensed physician, who then determines, with the client, whether subsequent care shall be provided by the physician, the midwife, or through a collaboration between the physician and midwife.
"Transfer of care" means the transfer of care of the client to a medical facility or physician who then assumes the direct care of the client after the client arrives at the facility.
§ -2 Home birth safety board. (a) The department shall establish a home birth safety board, as an advisory board to the Hawaii medical board, for all home birth providers. The home birth safety board shall make recommendations on home birth safety pursuant to this chapter and report to the Hawaii medical board. The Hawaii medical board shall adopt rules and take all necessary actions pursuant to this chapter to assure the safety of home birth in Hawaii.
(b) The board shall consist of thirteen members appointed by the governor with the advice and consent of the senate, pursuant to section 26-34. The board shall consist of the following members:
(1) Two certified nurse midwives or certified midwives, as may be recommended by the Hawaii Chapter of the American College of Certified Nurse-Midwives;
(2) Two labor and delivery registered nurses, as may be recommended by the Hawaii Association of Women's Health, Obstetric, and Neonatal Nurses;
(3) Two obstetricians, as may be recommended by the American Congress of Obstetricians and Gynecologists- Hawaii Section;
(4) One maternal fetal medicine specialist, as may be recommended by the American Congress of Obstetricians and Gynecologists - Hawaii Section;
(5) One pediatrician, as may be recommended by the American Academy of Pediatrics – Hawaii Chapter;
(6) One neonatologist, as may be recommended by the American Academy of Pediatrics – Hawaii Chapter;
(7) One family medicine physician, as may be recommended by the Hawaii Academy of Family Physicians;
(8) One naturopathic physician;
(9) One department of health epidemiologist representing the director of health; and
(10) One public member.
Board members who are licensed professionals in their respective fields shall hold current Hawaii licenses. Each member shall serve a three-year term; provided that upon initial appointment, four members shall be appointed for a term of one year, four members for a term of two years, and five members for a term of three years.
(c) The organization of the board shall be established by the members.
(d) Members of the board and members of the Hawaii medical board shall not be personally liable for any act committed in the performance of their official duties as board members, and shall not be personally liable for any court costs which accrue in any action by or against the board or Hawaii medical board.
§ -3 Licenses. (a) Beginning on July 1, 2015, the board shall issue licenses to applicants who:
(1) Provide current certification as:
(A) A certified nurse midwife or certified midwife certified by the American Midwifery Certification Board;
(B) A naturopathic physician having completed training commensurate with that of a licensed obstetrician-gynecologist or having certification by the American Midwifery Certification Board;
(C) An obstetrician-gynecologist certified by the American Board of Obstetrics and Gynecology; or
(D) A family medicine physician with documented training in obstetrics either during residency training or in an obstetrics fellowship and certified by the American Board of Family Medicine;
(2) Provide documentation of:
(A) Meeting the minimum education and training requirements of the American Midwifery Certification Board, including a graduate degree and post-degree training in midwifery; this education and training should include documentation of supervised participation as:
(i) The primary caregiver in at least fifty births;
(ii) Provision of at least one hundred prenatal examinations;
(iii) Provision of at least fifty postpartum examinations; and
(iv) Provision of at least fifty newborn examinations;
(B) Certification by the American Board of Obstetrics and Gynecology; or
(C) Certification by the American Board of Family Medicine and documentation of:
(i) Obstetrics training and education; or
(ii) Obstetrics fellowship training as reviewed and approved by the board;
(3) Provide current certification in adult and neonatal cardiopulmonary resuscitation;
(4) Provide current certification in neonatal resuscitation program training from a course approved by the American Academy of Pediatrics;
(5) Agree to comply with the informed consent requirement under section -8;
(6) Agree to follow safety protocols for planned home birth under rules set by the board;
(7) Agree to obtain at least twenty continuing education credits in board-approved courses or lectures in obstetrics every year;
(8) Agree to comply with data collection, timely birth certificate, and peer review requirements;
(9) Meet other requirements as established by the board; and
(10) Pay a licensure fee set by the board.
(b) The board shall renew licenses to applicants who have:
(1) Evidence of the required annual continuing education;
(2) Current certification in adult and neonatal cardiopulmonary resuscitation;
(3) Current neonatal resuscitation program certification;
(4) Submitted data on a form to be promulgated by rule and made available by the department of health to include, but not limited to, the number of:
(A) Women to whom care was provided since the date of the previously issued license;
(B) Home deliveries performed or supervised;
(C) Transfers to hospital or physician care;
(D) Transfers during labor, delivery, and immediately following birth; and
(E) Perinatal deaths; and
(5) Paid a renewal fee set by the board.
(c) Any license shall expire one year after the date of its issuance. The board may refuse to issue or renew any license under this section for one or any combination of causes stated in section -4(b).
(d) The board shall notify the applicant in writing of the reasons for a refusal to issue a license and shall advise the applicant of the applicant's right to file a complaint with the administrative hearing commission as provided by chapter 91. As an alternative to a refusal to issue or renew any license, the board may, at its discretion, issue a license, which is subject to probation, restriction, or limitation, to an applicant for one or any combination of causes stated in section -4(b). The board's order of probation, limitation, or restriction shall contain a statement of the discipline imposed, the basis for the discipline, the date such action shall become effective, and a statement that the applicant has thirty days to submit a written request for a hearing before the administrative hearing commission. If the board issues a probationary, limited, or restricted license to an applicant, either party may file a written petition with the administrative hearing commission within thirty days of the effective date of the probationary, limited, or restricted license seeking review of the board's determination. If no written request for a hearing is received by the administrative hearing commission within the thirty day period, the right to seek review of the board's decision shall be considered waived.
(e) Nothing in this section shall be construed to prohibit a certified nurse midwife or certified midwife, naturopathic physician, obstetrician-gynecologist, or family medicine physician licensed under this section from providing home delivery services, so long as such services are lawfully performed under such individual's scope of practice as authorized by law and regulation.
§ -4 Complaints; administrative hearings. (a) Any complaint received by the board concerning a person who is licensed under section -3 shall be recorded as received and the date received. The board:
(1) Shall investigate all complaints concerning alleged violations of section -3;
(2) Shall investigate grounds for the suspension, revocation, or refusal to issue a license;
(3) May employ investigators who shall investigate complaints and make inspections and any inquiries as, in the judgment of the board, are appropriate to enforce section -3;
(4) May file a petition in the name of the state asking a court to issue a restraining order, an injunction or a writ of mandamus against any person who is or has been violating any of the provisions of section -3 or any lawful rule, order or subpoena of the board, in lieu of or in addition to any remedy provided in this section; and
(5) May file a complaint with the administrative hearing commission as provided in chapter 91 against any holder of any license issued under sections -3 if the evidence supports such action.
(b) The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 91 against any holder of a license required by section -3, or any individual who has failed to renew or has surrendered the individual's license for any one or any combination of the following causes:
(1) Use or unlawful possession of any controlled substance, as defined in chapter 712, or alcoholic beverage to an extent that such use impairs an individual's ability to perform home delivery services;
(2) Violation of the drug laws or regulations of this state, any other state, or the federal government;
(3) Final adjudication resulted in the individual being found guilty, or entering a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or the United States for any offense:
(A) Reasonably related to the qualifications, functions, or duties of a home birth provider;
(B) Where the essential element is fraud, dishonesty, or an act of violence; or
(C) Involving moral turpitude, whether or not a sentence is imposed;
(4) Use of fraud, deception, misrepresentation, or bribery in securing a license issued under section -3(a);
(5) Procurement or attempt to procure any fee, charge, tuition, or other compensation by fraud, deception, or misrepresentation;
(6) Incompetence, misconduct, gross negligence, fraud, misrepresentation, or dishonesty in the performance of the functions and duties of a home birth provider;
(7) Violation of, or assisting or enabling any person to violate, any provision of section -3 or any lawful regulation adopted under section -3;
(8) Impersonation of any person holding a license or allowing any person to use another individual's license;
(9) Disciplinary action against the holder of a license granted by another state, territory, federal agency, or country upon grounds for which revocation or suspension is authorized in this state;
(10) Judgment of insanity or incompetence by a court of competent jurisdiction;
(11) Assisting or enabling any individual to practice or offer to practice as a home birth provider who is not licensed and currently eligible to practice under section;
(12) Issuance of a license based upon a material mistake of fact;
(13) Violation of any professional trust or confidence;
(14) Use of any advertisement or solicitation which is false, misleading, or deceptive to the general public or individuals to whom the advertisement or solicitation is primarily directed;
(15) Commitment of unethical conduct as defined by the board; or
(16) Engagement in conduct detrimental to the health or safety of either the mother or infant, or both, as determined by the board.
After the filing of such complaint before the administrative hearing commission, the proceedings shall be conducted in accordance with the provisions of chapter 91.
(c) Upon a finding by the administrative hearing commission that the grounds provided in subsection (b) for disciplinary action are met, the board may perform one or more of the following:
(1) Warn, censure, or place the person named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed ten years;
(2) Suspend the person's license for a period not to exceed three years;
(3) Restrict or limit the person's license for an indefinite period of time;
(4) Revoke the person's license;
(5) Administer a public or private reprimand;
(6) Deny the person's application for a license;
(7) Permanently withhold issuance of a license; or
(8) Require the person to attend continuing educational courses and pass examinations as the board may direct.
(d) An individual whose license has been revoked shall wait at least one year from the date of revocation to apply for renewal. Renewal shall be granted at the discretion of the board after compliance with all requirements of section -3 relative to the licensing of the applicant for the first time.
§ -5 Rules; protocols. (a) The board will adopt rules and protocols related to standard home birth safety practices for the mother and newborn, including rules and protocols necessary to implement and administer sections -3 and -4. The board shall consider actions and rules in the following areas:
(1) Obtaining informed consent to provide services;
(2) Obtaining the client's complete health history;
(3) Developing a plan of care for a client;
(4) Evaluating the results of client care;
(5) Consulting and collaborating with licensed obstetricians or pediatricians;
(6) Referring and transferring care to licensed obstetricians or pediatricians;
(7) Obtaining medications and appropriate equipment for home birth safety and care to administer to clients;
(8) Obtaining appropriate standard of care prenatal screening and testing;
(9) Managing the antepartum period;
(10) Managing the intrapartum period, including:
(A) Monitoring and evaluating the condition of mother and fetus;
(B) Performing emergency episiotomy; and
(C) Delivering in an out-of-hospital setting;
(11) Managing the postpartum period including:
(A) Suturing of episiotomy; or
(B) First and second degree natural perineal and labial lacerations, including the administration of a local anesthetic;
(12) Managing the newborn period, including:
(A) Providing standard of care management and screening of the newborn; and
(B) Performing a normal newborn examination;
(13) Resuscitating a newborn;
(14) Providing limited interconceptual services in order to provide continuity of care, including:
(A) Breastfeeding support and counseling;
(B) Family planning; and
(C) Pap smears.
§ -6 Planned home birth. (a) Planned home births shall be offered only to clients with low risk pregnancies. The board shall:
(1) Limit the licensed home birth providers' practice to a normal, low risk pregnancy, labor, postpartum, newborn, and interconceptual care including:
(A) Low risk pregnancy and normal antepartum care;
(B) No previous uterine scar or cesarean section;
(C) Labor that is low risk at the start of labor, remains low risk throughout the course of labor and delivery, and is not pharmacologically induced or augmented;
(D) Pregnancy in which the singleton infant is born spontaneously in the vertex position between thirty-seven and forty-one and six-sevenths completed weeks of pregnancy; and
(E) The mother and infant remain low risk after delivery;
(2) Appropriately recommend and facilitate consultation with, collaboration with, referral to, or transfer or mandatory transfer of care to a licensed physician when the circumstances require action in accordance with this section and standards established by board rules.
Ideally, the out-of-hospital birth shall occur within thirty minutes from a hospital able to perform cesarean sections. The above limitations do not prohibit a licensed home birth provider from delivering an infant when there is an intrauterine fetal demise or a fetal anomaly incompatible with life, but only after an appropriate written consultation with a licensed obstetrician or maternal fetal medicine specialist.
(b) The board shall adopt, amend, repeal, and enforce rules necessary for the proper administration and enforcement of this section. The rules adopted by the board shall, at a minimum:
(1) Prohibit a licensed home birth provider from providing care for a high risk pregnancy with any one or more pregnancy disorders, diagnoses, conditions, or symptoms determined by the board, including but not limited to:
(A) Previous cesarean section or uterine scar;
(B) Multiple gestation;
(C) Breech or any other non-vertex presentation at greater than or equal to thirty-six weeks;
(D) Hypertension, diabetes, or other medical condition constituting a high risk pregnancy as determined by the board;
(E) Preterm labor; or
(F) Other high risk conditions as determined by the board;
(2) Require a licensed home birth provider to recommend that a client seek care with a licensed obstetrician and to document and maintain in the client's record a history of any disorder, diagnosis, conditions, or symptoms considered to be a high risk pregnancy as determined by rules and home birth safety protocols adopted by the board; and
(3) Require the licensed home birth provider to develop a means for timely consultation with, referral, or transfer to a hospital, or a licensed obstetrician or pediatrician, whenever there are significant deviations from normal in either the mother or the infant.
§ -7 Referral; transfer of care. (a) For home birth safety, the board shall adopt administrative rules regarding conditions that require:
(1) Mandatory transfer of patient care before the onset of labor to a physician upon evidence of certain maternal or fetal conditions;
(2) Mandatory consultation with a physician and initiation of immediate emergency transport to a medical facility when certain maternal or fetal conditions exist on initial or subsequent intrapartum or postpartum assessment; or
(3) Other medical conditions deemed by the board to necessitate referral or transfer of care.
(b) The board may revoke, suspend, or condition the license of a home birth provider if the board finds the home birth provider has failed to refer clients or newborns in need of care, or at risk of needing care beyond the abilities of the home birth provider, to an appropriate health care professional.
§ -8 Informed consent. Before accepting care, the licensed home birth provider shall present, explain, and sign an informed consent document to each client during their first meeting, which shall include but not be limited to:
(1) The name and license of the home birth provider, including the effective dates of the licensure;
(2) The client's name, address, phone number, birth date, and primary care provider, if the client has one;
(3) A specific description of the licensed home birth provider's education, training, and qualifications;
(4) A description of the planned home birth care, including the definition of a low risk, normal pregnancy;
(5) The benefits and risks associated with childbirth in the setting selected by the client, including an increased risk of neonatal mortality associated with home birth;
(6) A statement advising the client to obtain standard-of-care prenatal testing either through the home birth provider or a licensed physician;
(7) A recommendation that the client see a licensed obstetrician at least once during the pregnancy;
(8) A complete health history sheet, including the client's:
(A) Medical conditions;
(B) Surgeries;
(C) Previous pregnancies;
(D) Allergies;
(E) Screening for possible hereditary diseases;
(F) Physical examination;
(G) Nutritional status; and
(H) A written assessment of risk factors;
(9) A written care plan specific to the client to ensure the continuity of care throughout the antepartum, intrapartum, and postpartum periods, which must review the conditions under which consultation, including the transfer of care or emergent transport of the client, may be implemented;
(10) A statement about whether the licensed home birth provider has malpractice or liability insurance coverage;
(11) The following statement: "Assumption of risk. The state hereby finds, determines, and declares that the authority granted by this licensure for the provision of home birth services does not constitute an endorsement of such practices, and that it is incumbent upon the individual seeking home birth services to determine the qualifications of her provider, the possible risks involved for the individual and her baby, and make her own informed decision."; and
(12) A statement that full disclosure of this information has been made, all of the client's questions have been answered, and a copy of this consent document has been given to the client and a copy retained in the client's record.
The informed consent document shall be signed and dated by the client and the home birth provider as evidence that the document has been received and explained, and kept by the home birth provider as part of the client's permanent medical record.
§ -9 Peer review. (a) Licensed home birth providers are accountable to the board, their peers, and the public for safe, competent, ethical practice, including but not limited to the licensed home birth provider's participation in the peer review process and any required mortality and morbidity reporting. The results of these individual evaluations can be distributed to influence professional policy development, education, and practice. A licensed home birth provider shall report the following to the board, and request and participate in peer review in the following specific situations:
(1) There has been a death or significant morbidity to a client or child;
(2) The home birth provider has acted outside the protocols provided by this act or administrative rules; or
(3) There has been an intrapartum transfer of care to a hospital or physician.
(b) Any peer review report identifying areas for improvement shall be reviewed, with a peer review plan for improvement and follow-up made in appropriate cases. A licensed health care professional or facility may release clinical and demographic data concerning home births performed in the State to a peer review organization. Facilities and professionals who have submitted information or addenda through the peer review process may review and comment on the peer review report and follow-up plan.
§ -10 Record keeping and reporting requirements. (a) Every licensed home birth provider who intends to provide home birth services for a client shall file a notice of intent to deliver at home with the department of health within fourteen days of entering into any agreement to provide such services. The forms for filing the notice of intent to home deliver shall be promulgated by rule and made available by the department. The department shall maintain a permanent database of all home deliveries done under the care of licensed home birth providers, which shall be made available to the home birth safety board.
(b) The licensed home birth provider shall complete a certificate of birth registration and file it with the department within ten days of the birth of any child in the State. No licensed home birth provider shall register nor enable any other party to register any child not born in the State as a Hawaii birth. Failure to meet these vital records regulations shall be grounds for disciplinary action.
(c) Any licensed home birth provider submitting an application to renew a license shall compile and submit to the board a complete practice data summary for the twelve months immediately preceding the date of the application. Such information shall be provided in form and content as prescribed by rule of the board.
(d) Each licensed home birth provider who assists, or supervises a person acting under their orders to assist, in normal childbirth shall annually report this activity to the board. The summary report shall contain, at a minimum, the following data and other information as promulgated by the board:
(1) The home birth provider's name and license number;
(2) The calendar year being reported; and
(3) Information regarding cases in which the home birth provider, or someone supervised by the home birth provider, assisted in the previous year as determined by the board, including information on the number of clients, births, transfers, reasons for transfer, birth outcome, complications, and other information required by the board.
(e) Licensed home birth providers shall report to the board and department of health any maternal, fetal, or neonatal mortality or serious morbidity within twenty-four hours. Failure of a home birth provider to submit required reports constitutes grounds to deny renewal of license."
SECTION 3. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 4. This Act shall take effect upon its approval.
|
INTRODUCED BY: |
_____________________________ |
|
|
|
Report Title:
Home Birth Safety Board; Midwives; License
Description:
Establishes the home birth safety board to adopt rules and protocols for home birth providers. Requires home birth providers to be licensed beginning on 7/1/2015 and to meet minimum educational and training requirements. Requires the home birth safety board to investigate complaints concerning violations of its regulations and to take disciplinary action when necessary. Limits home births to clients with normal, low-risk pregnancies. Requires licensed home birth providers to use informed consent documents with their clients and to follow record keeping and reporting requirements.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
