Bill Text: CA AB1308 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Midwifery.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2013-10-10 - Chaptered by Secretary of State - Chapter 665, Statutes of 2013. [AB1308 Detail]

Download: California-2013-AB1308-Amended.html

---

BILL NUMBER: AB 1308	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 9, 2013
	AMENDED IN SENATE  JUNE 13, 2013
	AMENDED IN ASSEMBLY  MARCH 21, 2013

INTRODUCED BY   Assembly Member Bonilla

                        FEBRUARY 22, 2013

   An act to amend Sections 2507 and 2508 of the Business and
Professions Code, and to amend Section 1204.3 of the Health and
Safety Code, relating to professions and vocations.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1308, as amended, Bonilla. Midwifery.
   Existing law, the Licensed Midwifery Practice Act of 1993,
provides for the licensing and regulation of midwives by the Board of
Licensing of the Medical Board of California. The license to
practice midwifery authorizes the holder, under the supervision of a
licensed physician and surgeon, as specified, to attend cases of
normal childbirth and to provide prenatal, intrapartum, and
postpartum care, including family-planning care, for the mother, and
immediate care for the newborn. Under the act, a licensed midwife is
required to make certain oral and written disclosures to prospective
clients. A violation of the act is a crime.
   This bill would additionally authorize a licensed midwife to
directly obtain supplies and devices, obtain and administer drugs and
diagnostic tests, order testing, and receive reports that are
necessary to his or her practice of midwifery and consistent with his
or her scope of practice and would require a licensed midwife to
disclose to prospective clients the specific arrangements for
referral of complications to a physician and surgeon.  Because a
violation of that requirement would be a crime, the bill would impose
a state-mandated local program. 
   Existing law requires the board, by July 1, 2003, to adopt
regulations defining the appropriate standard of care and level of
supervision required for the practice of midwifery.
   This bill would  require the board, by July 1, 2015, to
revise and adopt regulations defining the appropriate standard of
care and level of supervision required for the practice of midwifery
and identifying complications necessitating referral to a physician
and surgeon   delete that requirement  .
   Existing law requires a licensed alternative birth center, and a
licensed primary care clinic that provides services as an alternative
birth center, to meet specified requirements, including 
requiring  the presence of at least 2 attendants during
birth, one of whom shall be either a physician and surgeon or a
certified nurse-midwife.
   This bill would provide that a licensed midwife may also satisfy
that requirement. 
   By expanding the disclosures a licensed midwife is required to
make to prospective clients, this bill would expand the scope of a
crime thereby imposing a state-mandated local program. 
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares the following:
   (a) Licensed midwives have been authorized to practice since 1993
under Senate Bill 350 (Chapter 1280 of the Statutes of 1993), which
was authored by Senator Killea. Additional legislation, Senate Bill
1950 (Chapter 1085 of the Statutes of 2002), which was authored by
Senator Figueroa, was needed in 2002 to clarify certain practice
issues. While the midwifery license does not specify or limit the
practice setting in which licensed midwives may provide care, the
reality is that the majority of births delivered by licensed midwives
are planned as home births.
   (b) Planned home births are safer when care is provided as part of
an integrated delivery model. For a variety of reasons, this
integration rarely occurs, and creates a barrier to the best and
safest care possible. This is due, in part, to the attempt to fit a
midwifery model of care into a medical model of care.
  SEC. 2.  Section 2507 of the Business and Professions Code is
amended to read:
   2507.  (a) The license to practice midwifery authorizes the
holder, under the supervision of a licensed physician and surgeon, to
attend cases of normal childbirth and to provide prenatal,
intrapartum, and postpartum care, including family-planning care, for
the mother, and immediate care for the newborn.
   (b) As used in this article, the practice of midwifery constitutes
the furthering or undertaking by any licensed midwife, under the
supervision of a licensed physician and surgeon who has current
practice or training in obstetrics, to assist a woman in childbirth
so long as progress meets criteria accepted as normal. All
complications shall be referred to a physician and surgeon
immediately. The practice of midwifery does not include the assisting
of childbirth by any artificial, forcible, or mechanical means, nor
the performance of any version.
   (c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician and
surgeon.
   (d) The ratio of licensed midwives to supervising physicians and
surgeons shall not be greater than four individual licensed midwives
to one individual supervising physician and surgeon.
   (e) A midwife is not authorized to practice medicine and surgery
by this article.
   (f) A midwife is authorized to directly obtain supplies and
devices, obtain and administer drugs and diagnostic tests, order
testing, and receive reports that are necessary to his or her
practice of midwifery and consistent with his or her scope of
practice. 
   (g) The board shall, not later than July 1, 2015, revise and adopt
in accordance with the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code), regulations defining the appropriate standard
of care and level of supervision required for the practice of
midwifery and identifying complications necessitating referral to a
physician and surgeon. 
  SEC. 3.  Section 2508 of the Business and Professions Code is
amended to read:
   2508.  (a) A licensed midwife shall disclose in oral and written
form to a prospective client all of the following:
   (1) All of the provisions of Section 2507.
   (2) If the licensed midwife does not have liability coverage for
the practice of midwifery, he or she shall disclose that fact.
   (3) The specific arrangements for the referral of complications to
a physician and surgeon for consultation. The licensed midwife shall
not be required to identify a specific physician and surgeon.
   (4) The specific arrangements for the transfer of care during the
prenatal period, hospital transfer during the intrapartum and
postpartum periods, and access to appropriate emergency medical
services for mother and baby if necessary.
   (5) The procedure for reporting complaints to the Medical Board of
California.
   (b) The disclosure shall be signed by both the licensed midwife
and the client and a copy of the disclosure shall be placed in the
client's medical record.
   (c) The Medical Board of California may prescribe the form for the
written disclosure statement required to be used by a licensed
midwife under this section.
  SEC. 4.  Section 1204.3 of the Health and Safety Code is amended to
read:
   1204.3.  (a) An alternative birth center that is licensed as an
alternative birth center specialty clinic pursuant to paragraph (4)
of subdivision (b) of Section 1204 shall, as a condition of
licensure, and a primary care clinic licensed pursuant to subdivision
(a) of Section 1204 that provides services as an alternative birth
center shall, meet all of the following requirements:
   (1) Be a provider of comprehensive perinatal services as defined
in Section 14134.5 of the Welfare and Institutions Code.
   (2) Maintain a quality assurance program.
   (3) Meet the standards for certification established by the
American Association of Birth Centers, or at least equivalent
standards as determined by the state department.
   (4) In addition to standards of the American Association of Birth
Centers regarding proximity to hospitals and presence of attendants
at births, meet both of the following conditions:
   (A) Be located in proximity, in time and distance, to a facility
with the capacity for management of obstetrical and neonatal
emergencies, including the ability to provide cesarean section
delivery, within 30 minutes from time of diagnosis of the emergency.
   (B) Require the presence of at least two attendants at all times
during birth, one of whom shall be a physician and surgeon, a
licensed midwife, or a certified nurse-midwife.
   (5) Have a written policy relating to the dissemination of the
following information to patients:
   (A) A summary of current state laws requiring child passenger
restraint systems to be used when transporting children in motor
vehicles.
   (B) A listing of child passenger restraint system programs located
within the county, as required by Section 27362 of the Vehicle Code.

   (C) Information describing the risks of death or serious injury
associated with the failure to utilize a child passenger restraint
system.
   (b) The state department shall issue a permit to a primary care
clinic licensed pursuant to subdivision (a) of Section 1204
certifying that the primary care clinic has met the requirements of
this section and may provide services as an alternative birth center.
Nothing in this section shall be construed to require that a
licensed primary care clinic obtain an additional license in order to
provide services as an alternative birth center.
   (c) (1) Notwithstanding subdivision (a) of Section 1206, no place
or establishment owned or leased and operated as a clinic or office
by one or more licensed health care practitioners and used as an
office for the practice of their profession, within the scope of
their license, shall be represented or otherwise held out to be an
alternative birth center licensed by the state unless it meets the
requirements of this section.
   (2) Nothing in this subdivision shall be construed to prohibit
licensed health care practitioners from providing birth related
services, within the scope of their license, in a place or
establishment described in paragraph (1).
  SEC. 5.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.