HOUSE DOCKET, NO. 94810        FILED ON: 6/24/2010

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4810

The Commonwealth of Massachusetts

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In the Year Two Thousand Ten

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An Act RELATIVE TO CERTIFIED PROFESSIONAL MIDWIVES AND ENHANCING THE PRACTICE OF NURSE-MIDWIVES..

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Subsection (d) of section 7 of chapter 94C of the general laws, as appearing in the 2008 Official Edition, is hereby amended by adding the following clause:-

(11)  A midwife who utilizes controlled substances pursuant to section 275 of chapter 112; provided, however, that a wholesale distributor or pharmacist may dispense such substances to a licensed midwife for subsequent administration to clients only if such midwife provides the wholesale distributor or pharmacist with the midwife’s certification of qualification to administer such controlled substances.

SECTION 2. Subsection (g) of said section 7 of chapter 94C of the general laws, as so appearing, is hereby amended by striking out the third paragraph and inserting in place thereof the following paragraph:-

The commissioner shall promulgate regulations which provide for the registration of certified nurse-midwives, as provided in section 80G of chapter 112, to issue written prescriptions in accordance with regulations as provided for in section 80B of chapter 112.  Prior to promulgating such regulations, the commissioner shall consult with the board of registration in nursing and the board of registration in medicine with regard to those schedules of controlled substances for which certified nurse-midwives may be registered.

SECTION 3. Section 80C of chapter 112 of the General Laws is hereby repealed.

SECTION 4. Said chapter 112, as appearing in the 2008 Official Edition is hereby amended by striking out section 80G and inserting in place thereof the following section:-

Section 80G. A nurse authorized to practice as a certified nurse-midwife may order and interpret tests, therapeutics and prescribe medications in accordance with regulations promulgated by the board and subject to the provisions of subsection (g) of section 7 of chapter 94C.

SECTION 5. Chapter 112 of the General Laws is hereby amended by adding the following 20 sections:-

Section 259.  As used in sections 260 to 277, inclusive of this chapter, the following words shall, unless the context requires otherwise, have the following meanings:-

“Board”, the board of registration in medicine, established under section 10 of chapter 13.

“Certified nurse-midwife”, a nurse with advanced training who is authorized to practice by the board of registration in nursing as a nurse midwife and who is certified by the American Midwifery Certification Board.

“Client”, a woman under the care of a midwife and her fetus or newborn.

“Committee”, the committee on midwifery, established under section 261.

“Licensed midwife”, a person licensed under sections 260 to 277 to practice midwifery and who holds a valid Certified Professional Midwife credential from the North American Registry of Midwives.

“Midwifery” 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 sections 260 to 277; including preventative measures, the identification of physical, social and emotional needs of the client.

Section 260.  Nothing in sections 259 through 277 inclusive, shall limit or regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or advanced emergency medical technician.  The practice of midwifery shall not constitute the practice of medicine, certified nurse-midwifery, or emergency medical care to the extent that a midwife advises, attends, or assists a woman during pregnancy, labor, natural childbirth, or the postpartum period.

Section 261. (a) The board of registration in medicine shall form a committee on midwifery. Committee members shall be appointed as follows: 8 members shall be appointed by the governor, 5 of whom shall be midwives who possess a valid Certified Professional Midwife credential from the North American Registry of Midwives; 1 of whom shall be a licensed physician who is an obstetrician certified by the American Congress of Obstetrics and Gynecology and who has been actively involved with the practice of midwifery for at least 2 years, 1 of whom shall be a certified nurse-midwife chosen from a list of nominees provided by the Massachusetts Chapter of the American College of Nurse-Midwives, and 1 of whom shall be from the general public who shall not be engaged in or have a financial interest in the delivery of health services; 1 member shall be appointed by the board.

(b) Members of the committee shall be appointed for a term of 3 years, except that of the members of the first committee, 4 members shall be appointed for terms of 3 years, and 3 members shall be appointed for terms of 2 years. No member may be appointed to more than 2 consecutive full terms, provided, however, that a member appointed for less than a full term may serve 2 full terms in addition to such of a part of a full term, and a former member shall again be eligible for appointment after a lapse of 1 or more years.

(c) Any member of the committee may be removed by the governor for neglect of duty, misconduct or malfeasance or misfeasance in office after being given a written statement of the charges against him and sufficient opportunity to be heard thereon.  Upon the death or removal for cause of a member of the committee, the governor shall fill the vacancy for the remainder of that member’s term.

(d) The committee shall meet not less than 4 times per calendar year.  At its first meeting and annually thereafter, the committee shall elect from among its members a chairperson, a vice-chairperson and a secretary who shall each serve for 1 year and until a successor is appointed and qualified.  Committee members shall serve without compensation but shall be reimbursed for actual and reasonable expenses incurred in the performance of their duties.

Section 262.  The committee shall make and publish such rules and regulations as it may deem necessary for the proper conduct of its duties.  The commissioner may review and approve rules and regulations proposed by the committee.  Such rules and regulations shall be deemed approved unless disapproved within 15 days of submission to the commissioner; provided, however, that any such disapproval shall be in writing setting forth the reasons for such disapproval.

Section 263. The committee shall keep a full record of its proceedings and keep a register of all persons registered and licensed by it, which shall be available for public inspection.  The register shall contain the name of every living registrant, the registrant’s last known place of business and last known place of residence, and the date and number of the registrant’s registration and certificate as a licensed midwife.  The committee shall make an annual report containing a full and complete account of all its official acts during the preceding year, including a statement of the condition of midwifery in the commonwealth.

Section 264. The committee shall:

examine applicants and issue licenses to those applicants it finds qualified;

adopt regulations establishing licensing and licensing renewal requirements;

issue permits to apprentice midwives;

investigate complaints against persons licensed under this chapter;

hold hearings and order the disciplinary sanction of a person who violates this chapter or a regulation of the committee;

approve education, training, and apprentice programs that meet the requirements of this chapter and of the committee and deny, revoke, or suspend approval of such programs for failure to meet the requirements;

adopt standards for approved midwifery education and training;

adopt professional continuing education requirements for licensed midwives;

develop practice standards for licensed midwives that shall include, but not be limited to:

adoption of ethical standards for licensed midwives and apprentice midwives;

maintenance of records of care, including client charts;

participation in peer review; and

development of standardized informed consent, reporting and written emergency transport plan forms.

Section 265.  A person who desires to be licensed and registered as a midwife shall apply to the committee in writing on an application form prescribed and furnished by the committee.  The applicant shall include in the application statements under oath satisfactory to the committee showing that the applicant possesses the qualifications required by section 267 preliminary to the examination required by section 266.  At the time of filing the application, an applicant shall pay to the board a fee which shall be set by the secretary of administration and finance.

Section 266.  (a) The committee shall examine applicants for licensure and shall conduct at least 2 examinations in each calendar year.  The committee shall establish examination and testing procedures to enable it to determine the competency of persons applying for licensure as a midwife.

(b) The examination shall consist of 2 parts:

a written examination designed to test knowledge of theory regarding pregnancy and childbirth and to test clinical judgment in midwifery management; and

a practical examination designed to demonstrate the mastery of skills necessary for the practice of midwifery.

(c) An applicant who has failed the examination shall not retake the examination for a period of 6 months.  An applicant who has failed the examination more than 1 time may not retake the examination unless the applicant has participated in or successfully competed further education and training programs as prescribed by the committee.

Section 267.  (a)  To be eligible for examination, registration and licensure by the committee as a midwife, an applicant shall:

be at least 21 years of age;

be of good moral character;

be a graduate of a high school or its equivalent;

possess a valid Certified Professional Midwife credential from the North American Registry of Midwives.

Notwithstanding the provisions of section 172 of chapter 6, the committee shall obtain all available criminal offender record information from the criminal history systems board on an applicant by means of fingerprint checks, and from the Federal Bureau of Investigation for a national criminal history records check. The information obtained thereby may be used by the committee to determine the applicant's eligibility for licensing under this chapter.  Receipt of criminal history record information by a private entity is prohibited.  If the committee determines that such information has a direct bearing on the applicant’s ability to serve as a midwife, such information may serve as a basis for the denial of the application;

meet minimum educational requirements which shall include studying obstetrics; neonatal pediatrics; basic sciences; female reproductive anatomy and physiology; behavioral sciences; childbirth education; community care; obstetrical pharmacology; epidemiology; gynecology; 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 committee;

meet practical experience requirements prescribed by the committee, including 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 shall include training in either hospitals, alternative birth settings or both.  The Department of Public Health shall assist the committee in facilitating access to hospital training for approved midwifery programs.

Section 268. The committee shall annually administer an examination designed to measure the qualifications necessary in order to safely utilize the pharmaceutical agents provided for in section 275.  Such examination shall be open upon application to any midwife licensed under the provisions of this chapter and to any person who meets the qualifications for examination under section 267; provided, however, that each applicant shall furnish to the committee satisfactory evidence of the completion of a qualifying course of study relating to the safe and proper administration of approved pharmaceutical agents as determined by the committee.

Section 269.  (a) The committee shall issue a permit to practice as an apprentice midwife to a person who:

is at least 18 years of age;

is a graduate of a high school or its equivalent; and

has been accepted into a program of education, training, and apprenticeship approved by the committee under section 264.

(b) A permit application under this section shall include information the committee may require.  The permit shall be valid for a term of 2 years and may be renewed in accordance with regulations adopted by the board.

(c) An apprentice midwife may perform all the activities of a licensed midwife if supervised in a manner prescribed by the committee by:

a licensed midwife who has practiced in this state for at least 2 years and who meets the standards for qualification as a midwifery instructor approved by the committee under section 264;

a physician licensed in this state with an obstetrical practice at the time of undertaking the apprenticeship; or

a certified nurse-midwife licensed by the board of registration in nursing in this state with an obstetrical practice at the time of undertaking the apprenticeship.

Section 270.  The committee may enter into agreements with medical or midwifery examination boards of other states and territories of the United States, the District of Columbia, and Puerto Rico, having qualifications and standards at least as high as those of the commonwealth, providing for reciprocal licensing in this state, without further examination, of persons who hold a valid license granted by written examination in the other state or territory, who have been licensed to practice for at least 5 years, and who apply and remit fees as provided for in section 265.

Section 271.  (a) The committee may, after a hearing pursuant to chapter 30A, revoke, suspend, or cancel the license of a midwife, or reprimand or censure a midwife if it finds upon proof satisfactory to the committee that such midwife:

fraudulently procured licensure as a midwife;

violated any provision of law relating to the practice of medicine or midwifery, or any rule or regulation adopted thereunder;

acted with gross misconduct in the practice of midwifery or of practicing midwifery fraudulently, or beyond its authorized scope, or with gross incompetence, or with gross negligence on a particular occasion or negligence on repeated occasions;

practiced midwifery while the ability to practice is impaired by alcohol, drugs, physical disability or mental instability;

was habitually drunk or being or having been addicted to, dependent on, or a habitual user of narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effects;

knowingly permitted, aided or abetted an unlicensed person to perform activities requiring a license for purposes of fraud, deception or personal gain;

has been convicted of a criminal offense which reasonably calls into question the ability to practice midwifery;

violated any rule or regulation of the committee;

acted in a manner which is professionally unethical according to ethical standards of the profession of midwifery; or

violated any provision of sections 260 to 278.

(b) No person filing a complaint or reporting information pursuant to this section or assisting the committee or board at its request in any manner in discharging its duties and functions shall be liable in any cause of action arising out of receiving such information or assistance, providing the person making the complaint or reporting or providing such information or assistance does so in good faith and without malice.

Section 272.  When accepting a client for care, a midwife shall obtain the client’s informed consent, which shall be evidenced by a written statement in a form prescribed by the committee and signed by both the midwife and the client.  The form shall certify that full disclosure has been made and acknowledged by the client as to each of the following items, with the client’s acknowledgement evidenced by a separate signature adjacent to each item in addition to the client’s signature and the date at the end of the form:

the name, address, telephone number, and license number of the licensed midwife;

a description of the midwife’s education, training, and experience in midwifery;

the nature and scope of the care to be given, including a description of the ante partum, intrapartum, and postpartum conditions requiring consultation, transfer of care, or transport to a hospital;

a copy of the medical emergency or transfer plan particular to each client; the right of the client to file a complaint with the committee and instructions on how to file a complaint with the committee;

a statement indicating that the client's records and any transaction with the license midwife are confidential;

a disclosure of whether the licensed midwife carries malpractice or liability insurance; and

any further information as required by the committee.

Section 273.  A midwife shall prepare, in a form prescribed by the committee, a written plan for the appropriate delivery of emergency care.  The plan shall address the following:

consultation with other health care providers;

emergency transfer; and

access to neonatal intensive care units and obstetrical units or other patient care areas.

Section 274. (a) The midwife shall only accept and provide care to those women who are expected to have a normal pregnancy, labor, and delivery, as defined by the committee.

(b) A midwife shall provide an initial and ongoing screening to ensure that each client receives safe and appropriate care.  As part of the initial screening to determine whether any contraindications are present, the midwife shall take a detailed health history as defined by the committee.  

(c) The midwife must be able at all times to recognize the warning signs of abnormal or potentially abnormal conditions necessitating referral to a physician. If a midwife determines at any time during the course of the pregnancy that a woman’s condition may preclude attendance by the midwife, the client shall be referred to an appropriate licensed health care provider. 

(d) As part of the initial screening and ongoing screening, a midwife shall recommend that the client undergo clinical tests as required by the committee from an appropriate health care provider.  The midwife shall include these results in the client’s record.

(f) If the client is delivering at home, the midwife shall ensure that the home is safe and hygienic and meets standards set forth by the committee.

(g) A midwife shall not perform any operative or surgical procedures except for episiotomy or suture repair of episiotomy or first or second degree perineal lacerations.

Section 275.  A midwife qualified by examination under the provisions of section 268 may obtain and administer prophylactic ophthalmic medication, anti-hemorrhagic medications, vitamin K, Rho immune globulin, intravenous fluids, oxygen for fetal distress and infant resuscitation, and local anesthetic and may administer such other drugs or medications as prescribed by a physician or certified nurse-midwife.  A pharmacist who dispenses such drugs to a licensed midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.

Section 276.  When a birth occurs with a licensed midwife in attendance, the midwife shall prepare and file a birth certificate as required by chapter 46.  Failure of a midwife to prepare and file the birth certificate constitutes grounds for the suspension or revocation of a license granted under this chapter.

Section 277.  No physician duly registered under the provisions of sections 2, 2A, 9, 9A or 9B, no physician assistant duly registered under the provisions of section 9I or the physician assistant’s employing or supervising physician, and no nurse duly registered or licensed under the provisions of section 74, 74A or 76, providing medical treatment to a woman or infant due to an emergency arising during the delivery or birth as a consequence of the care received by a midwife licensed under chapter 112 shall be held liable for any civil damages as a result of such medical care or treatment, other than gross negligence or willful or wanton misconduct, resulting from the attempt to render such emergency care, nor shall he be liable to a hospital for its expenses if, under such emergency conditions, he orders a person hospitalized or causes his admission.  No health care facility licensed under chapter 111, providing medical treatment to a woman or infant due to an emergency arising during the delivery or birth as a consequence of the care received by a midwife licensed under chapter 112, shall be held liable for any civil damages as a result of such medical care or treatment resulting from the attempt to render such emergency care.