Amended in Senate September 6, 2013

Amended in Senate July 9, 2013

Amended in Senate June 13, 2013

Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1308

Introduced by Assembly Member Bonilla

February 22, 2013

An act to amend Sections begin delete 2507 and 2508 of end delete begin insert 2507, 2508, 2513, 2516, and 2519 of, and to add Section 2510 to, end insert 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. begin insert The act requires a midwife to immediately refer all complications to a physician and surgeon. end insert Under the act, a licensed midwife is required to make certain oral and written disclosures to prospective clients. begin insert Under the act, the board is authorized to suspend or revoke the license of a midwife for specified conduct, including unprofessional conduct consisting of, among other things, incompetence or gross negligence in carrying out the usual functions of a licensed midwife. end insert A violation of the act is a crime.

begin insert

This bill would, among other things, no longer require a physician and surgeon to supervise a licensed midwife. The bill would require, if a potential midwife client fails to meet the conditions of a normal pregnancy or childbirth, as defined, but still desires to be a client, that the licensed midwife refer the woman to a physician and surgeon for examination. The bill would require the board to adopt regulations specifying certain of those conditions. The bill would authorize the licensed midwife to assist the woman only if the physician and surgeon determines, after examination, that the risk factors presented by the woman’s disease or condition are not likely to significantly affect the course of pregnancy and childbirth. The bill would require a licensed midwife to immediately refer or transfer the client to a physician and surgeon if at any point during a pregnancy, childbirth, or postpartum care a client’s condition deviates from normal. The bill would authorize the licensed midwife to resume primary care of the client if the physician and surgeon determines that the client’s condition or concern has been resolved, and to provide concurrent care if the client’s condition or concern is not resolved, as specified.

end insert

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 begin delete and end delete begin insert . The bill end insert would require a licensed midwife to begin delete disclose end delete begin insert make additional disclosures end insert to prospective clients begin insert , including, among other things, end insert the specific arrangements for referral of complications to a physician and surgeon begin delete . Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program. end delete begin insert , and to obtain written, informed consent of those disclosures, as prescribed. By increasing the duties of a licensed midwife under the Licensed Midwifery Practice Act of 1993, the violation of which is a crime, the bill would impose a state-mandated local program. end insert begin insert The bill would authorize the board to suspend or revoke the license of a licensed midwife for failing, when required, to consult with a physician and surgeon, to refer a client to a physician and surgeon, or to transfer a client to a hospital. The bill would require, if a client is transferred to a hospital, that the hospital report each transfer of a planned out-of-hospital birth to, among others, the board, using a form developed by the board. end insert

begin delete

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.

end delete begin delete

This bill would delete that requirement.

end delete begin insert

Existing law requires a licensed midwife who assists, or supervises a student midwife in assisting, in childbirth that occurs in an out-of-hospital setting to annually report specified information to the Office of Statewide Health Planning and Development.

end insert begin insert

This bill would authorize the board, with input from the Midwifery Advisory Council, to adjust the data elements required to be reported to better coordinate with other reporting systems, as specified.

end insert begin insert

Existing law requires an approved midwifery education program to offer the opportunity for students to obtain credit by examination for previous midwifery education and clinical experience.

end insert begin insert

This bill would, beginning January 1, 2015, prohibit new licensees from substituting clinical experience for formal didactic education.

end insert

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 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.

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 begin delete an integrated end delete begin insert a collaborative end insert delivery model begin insert in which medical
professionals may freely consult on patient care to maximize
patient safety and positive outcomes end insert . For a variety of reasons, this
integration begin delete rarely occurs end delete begin insert does not always occur end insert , and creates a
barrier to the best and safest care possible. begin delete This is due, in part, to
the attempt to fit a midwifery model of care into a medical model
of care. end delete

SEC. 2.  

Section 2507 of the Business and Professions Code is
amended to read:

2507.  

(a) The license to practice midwifery authorizes the
begin delete holder, under the supervision of a licensed physician and surgeon, end delete
begin insert holder end insert to attend cases of normal begin delete childbirth end delete begin insert pregnancy and
childbirth, as defined in paragraph (1) of subdivision (b), end insert 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 begin delete midwife, under the
supervision of a licensed physician and surgeon who has current
practice or training in obstetrics, end delete begin insert midwife end insert to assist a woman in
childbirth begin delete so end delete begin insert as end insert long as progress meets criteria accepted as normal.
begin delete 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. end delete

begin delete

(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.

end delete

begin insert (1) end insert begin insert   end insert begin insert Except as provided in paragraph (2), a licensed midwife
shall only assist a woman in normal pregnancy and childbirth,
which is defined as meeting all of the following conditions: end insert

begin insert

(A) There is an absence of both of the following:

end insert begin insert

(i) Any preexisting maternal disease or condition likely to affect
the pregnancy.

end insert begin insert

(ii) Significant disease arising from the pregnancy.

end insert begin insert

(B) There is a singleton fetus.

end insert begin insert

(C) There is a cephalic presentation.

end insert begin insert

(D) The gestational age of the fetus is greater than 370⁄7 weeks
and less than 420⁄7 completed weeks of pregnancy.

end insert begin insert

(E) Labor is spontaneous or induced in an outpatient setting.

end insert begin insert

(2) If a potential midwife client meets the conditions specified
in subparagraphs (B) to (E), inclusive, of paragraph (1), but fails
to meet the conditions specified in subparagraph (A) of paragraph
(1), and the woman still desires to be a client of the licensed
midwife, the licensed midwife shall provide the woman with a
referral for an examination by a physician and surgeon trained in
obstetrics and gynecology. A licensed midwife may assist the
woman in pregnancy and childbirth only if an examination by a
physician and surgeon trained in obstetrics and gynecology is
obtained and the physician and surgeon who examined the woman
determines that the risk factors presented by her disease or
condition are not likely to significantly affect the course of
pregnancy and childbirth.

end insert begin insert

(3) The board shall adopt regulations pursuant to the
Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part of 1 of Division 3 of Title 2 of the
Government Code) specifying the conditions described in
subparagraph (A) of paragraph (1).

end insert begin insert

(c) (1) If at any point during a pregnancy, childbirth, or
postpartum care a client’s condition deviates from normal, the
licensed midwife shall immediately refer or transfer the client to
a physician and surgeon. The licensed midwife may consult and
remain in consultation with the physician and surgeon after the
referral or transfer.

end insert begin insert

(2) If a physician and surgeon determines that the client’s
condition or concern has been resolved such that the risk factors
presented by a woman’s disease or condition are not likely to
significantly affect the course of pregnancy or childbirth, the
licensed midwife may resume primary care of the client and resume
assisting the client during her pregnancy, childbirth, or postpartum
care.

end insert begin insert

(3) If a physician and surgeon determines the client’s condition
or concern has not been resolved as specified in paragraph (2),
the licensed midwife may provide concurrent care with a physician
and surgeon and, if authorized by the client, be present during the
labor and childbirth, and resume postpartum care, if appropriate.
A licensed midwife shall not resume primary care of the client.

end insert begin insert

(d) A licensed midwife shall not provide or continue to provide
midwifery care to a woman with a risk factor that will significantly
affect the course of pregnancy and childbirth, regardless of whether
the woman has consented to this care or refused care by a
physician or surgeon, except as provided in paragraph (3) of
subdivision (c).

end insert begin insert

(e) The practice of midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version of these means.

end insert

(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.

begin insert

(g) This article does not authorize a midwife to practice
medicine or to perform surgery.

end insert

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 begin insert as part of a client care plan, and obtain
informed consent for, end insert all of the following:

(1) All of the provisions of Section 2507.

begin insert

(2) The client is retaining a licensed midwife, not a certified
nurse midwife, and the licensed midwife is not supervised by a
physician and surgeon.

end insert begin insert

(3) The licensed midwife’s current licensure status and license
number.

end insert begin insert

(4) The practice settings in which the licensed midwife practices.

end insert begin delete

(2)

end delete

begin insert (5) end insert  If the licensed midwife does not have liability coverage for
the practice of midwifery, he or she shall disclose that fact. begin insert The
licensed midwife shall disclose to the client that many physicians
and surgeons do not have liability insurance coverage for services
provided to someone having a planned out-of-hospital birth. end insert

begin insert

(6) The acknowledgment that if the client is advised to consult
with a physician and surgeon, failure to do so may affect the
client’s legal rights in any professional negligence actions against
a physician and surgeon, licensed health care professional, or
hospital.

end insert begin insert

(7) There are conditions that are outside of the scope of practice
of a licensed midwife that will result in a referral for a consultation
from, or transfer of care to, a physician and surgeon.

end insert begin delete

(3)

end delete

begin insert ( end insert begin insert 8) end insert  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.

begin delete

(4)

end delete

begin insert ( end insert begin insert 9) end insert  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 begin insert , and end insert begin insert recommendations
for preregistration at a hospital that has obstetric emergency
services and is most likely to receive the transfer end insert .

begin insert

(10) If, during the course of care, the client is informed that she
has or may have a condition indicating the need for a mandatory
transfer, the licensed midwife shall initiate the transfer.

end insert begin delete

(5)

end delete

begin insert (11) end insert  The begin insert availability of the text of laws regulating licensed
midwifery practices and the end insert procedure for reporting complaints to
the Medical Board of California begin insert , which may be found on the
Medical Board of California’s Internet Web site end insert .

begin insert

(12) Consultation with a physician and surgeon does not alone
create a physician-patient relationship or any other relationship
with the physician and surgeon. The informed consent shall
specifically state that the licensed midwife and the consulting
physician and surgeon are not employees, partners, associates,
agents, or principals of one another. The licensed midwife shall
inform the patient that he or she is independently licensed and
practicing midwifery and in that regard is solely responsible for
the services he or she provides.

end insert

(b) The disclosure begin insert and consent end insert shall be signed by both the
licensed midwife and the client and a copy of the disclosure begin insert and
consent end insert shall be placed in the client’s medical record.

(c) The Medical Board of California may prescribe the form for
the written disclosure begin insert and informed consent end insert statement required to
be used by a licensed midwife under this section.

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 2510 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2510. end insert   

If a client is transferred to a hospital, the licensed
midwife shall provide records, including prenatal records, and
speak with the receiving physician and surgeon about labor up to
the point of the transfer. The hospital shall report each transfer
of a planned out-of-hospital birth to the Medical Board of
California and the California Maternal Quality Care Collaborative
using a standardized form developed by the board.

end insert

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 2513 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2513.  

(a) An approved midwifery education program shall
offer the opportunity for students to obtain credit by examination
for previous midwifery education and clinical experience. The
applicant shall demonstrate, by practical examination, the clinical
competencies described in Section 2514 or established by
regulation pursuant to Section 2514.5. The midwifery education
program’s credit by examination policy shall be approved by the
board, and shall be available to applicants upon request. The
proficiency and practical examinations shall be approved by the
board. begin insert Beginning January 1, 2015, new licensees shall not
substitute clinical experience for formal didactic education. end insert

(b) Completion of clinical experiences shall be verified by a
licensed midwife or certified nurse-midwife, and a physician and
surgeon, all of whom shall be current in the knowledge and practice
of obstetrics and midwifery. Physicians and surgeons, licensed
midwives, and certified nurse-midwives who participate in the
verification and evaluation of an applicant’s clinical experiences
shall show evidence of current practice. The method used to verify
clinical experiences shall be approved by the board.

(c) Upon successful completion of the requirements of
paragraphs (1) and (2), the applicant shall also complete the
licensing examination described in paragraph (1) of subdivision
(a) of Section 2512.5.

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 2516 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2516.  

(a) Each licensed midwife who assists, or supervises a
student midwife in assisting, in childbirth that occurs in an
out-of-hospital setting shall annually report to the Office of
Statewide Health Planning and Development. The report shall be
submitted no later than March 30, begin delete with the first report due in March
2008, end delete for the prior calendar year, in a form specified by the board
and shall contain all of the following:

(1) The midwife’s name and license number.

(2) The calendar year being reported.

(3) The following information with regard to cases in California
in which the midwife, or the student midwife supervised by the
midwife, assisted during the previous year when the intended place
of birth at the onset of care was an out-of-hospital setting:

(A) The total number of clients served as primary caregiver at
the onset of care.

begin delete

(B) The total number of clients served with collaborative care
available through, or given by, a licensed physician and surgeon.

end delete begin delete

(C) The total number of clients served under the supervision of
a licensed physician and surgeon.

end delete begin delete

(D)

end delete

begin insert ( end insert begin insert B) end insert  The number by county of live births attended as primary
caregiver.

begin delete

(E)

end delete

begin insert ( end insert begin insert C) end insert  The number, by county, of cases of fetal demise, infant
deaths, and maternal deaths attended as primary caregiver at the
discovery of the demise or death.

begin delete

(F)

end delete

begin insert ( end insert begin insert D) end insert  The number of women whose primary care was transferred
to another health care practitioner during the antepartum period,
and the reason for each transfer.

begin delete

(G)

end delete

begin insert ( end insert begin insert E) end insert  The number, reason, and outcome for each elective hospital
transfer during the intrapartum or postpartum period.

begin delete

(H)

end delete

begin insert ( end insert begin insert F) end insert  The number, reason, and outcome for each urgent or
emergency transport of an expectant mother in the antepartum
period.

begin delete

(I)

end delete

begin insert ( end insert begin insert G) end insert  The number, reason, and outcome for each urgent or
emergency transport of an infant or mother during the intrapartum
or immediate postpartum period.

begin delete

(J)

end delete

begin insert ( end insert begin insert H) end insert  The number of planned out-of-hospital births at the onset
of labor and the number of births completed in an out-of-hospital
setting.

begin delete

(K)

end delete

begin insert ( end insert begin insert I) end insert  The number of planned out-of-hospital births completed in
an out-of-hospital setting that were any of the following:

(i) Twin births.

(ii) Multiple births other than twin births.

(iii) Breech births.

(iv) Vaginal births after the performance of a cesarean section.

begin delete

(L)

end delete

begin insert ( end insert begin insert J) end insert  A brief description of any complications resulting in the
morbidity or mortality of a mother or a neonate.

begin delete

(M)

end delete

begin insert ( end insert begin insert K) end insert  Any other information prescribed by the board in
regulations.

(b) The Office of Statewide Health Planning and Development
shall maintain the confidentiality of the information submitted
pursuant to this section, and shall not permit any law enforcement
or regulatory agency to inspect or have copies made of the contents
of any reports submitted pursuant to subdivision (a) for any
purpose, including, but not limited to, investigations for licensing,
certification, or regulatory purposes.

(c) The office shall report to the board, by April 30, those
licensees who have met the requirements of subdivision (a) for
that year.

(d) The board shall send a written notice of noncompliance to
each licensee who fails to meet the reporting requirement of
subdivision (a). Failure to comply with subdivision (a) will result
in the midwife being unable to renew his or her license without
first submitting the requisite data to the Office of Statewide Health
Planning and Development for the year for which that data was
missing or incomplete. The board shall not take any other action
against the licensee for failure to comply with subdivision (a).

(e) The board, in consultation with the office and the Midwifery
Advisory Council, shall devise a coding system related to data
elements that require coding in order to assist in both effective
reporting and the aggregation of data pursuant to subdivision (f).
The office shall utilize this coding system in its processing of
information collected for purposes of subdivision (f).

(f) The office shall report the aggregate information collected
pursuant to this section to the board by July 30 of each year. The
board shall include this information in its annual report to the
Legislature.

begin insert

(g) The board, with input from the Midwifery Advisory Council,
may adjust the data elements required to be reported to better
coordinate with other reporting systems, including the reporting
system of the Midwives Alliance of North America (MANA), while
maintaining the data elements unique to California. To better
capture data needed for the report required by this section, the
concurrent use of systems, including MANA’s, by licensed midwives
is encouraged.

end insert begin delete

(g)

end delete

begin insert ( end insert begin insert h) end insert  Notwithstanding any other begin delete provision of end delete law, a violation of
this section shall not be a crime.

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Section 2519 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2519.  

The board may suspend or revoke the license of a
midwife for any of the following:

(a) Unprofessional conduct, which includes, but is not limited
to, all of the following:

(1) Incompetence or gross negligence in carrying out the usual
functions of a licensed midwife.

(2) Conviction of a violation of Section 2052, in which event,
the record of the conviction shall be conclusive evidence thereof.

(3) The use of advertising begin delete which end delete begin insert that end insert is fraudulent or misleading.

(4) Obtaining or possessing in violation of law, or prescribing,
or except as directed by a licensed physician and surgeon, dentist,
or podiatrist administering to himself or herself, or furnishing or
administering to another, any controlled substance as defined in
Division 10 (commencing with Section 11000) of the Health and
Safety Code or any dangerous drug as defined in Article 8
(commencing with Section 4210) of Chapter 9 of Division 2 of
the Business and Professions Code.

(5) The use of any controlled substance as defined in Division
10 (commencing with Section 11000) of the Health and Safety
Code, or any dangerous drug as defined in Article 8 (commencing
with Section 4210) of Chapter 9 of Division 2 of the Business and
Professions Code, or alcoholic beverages, to an extent or in a
manner dangerous or injurious to himself or herself, any other
person, or the public or to the extent that such use impairs his or
her ability to conduct with safety to the public the practice
authorized by his or her license.

(6) Conviction of a criminal offense involving the prescription,
consumption, or self-administration of any of the substances
described in paragraphs (4) and (5), or the possession of, or
falsification of, a record pertaining to, the substances described in
paragraph (4), in which event the record of the conviction is
conclusive evidence thereof.

(7) Commitment or confinement by a court of competent
jurisdiction for intemperate use of or addiction to the use of any
of the substances described in paragraphs (4) and (5), in which
event the court order of commitment or confinement is prima facie
evidence of such commitment or confinement.

(8) Falsifying, or making grossly incorrect, grossly inconsistent,
or unintelligible entries in any hospital, patient, or other record
pertaining to the substances described in subdivision (a).

(b) Procuring a license by fraud or misrepresentation.

(c) Conviction of a crime substantially related to the
qualifications, functions, and duties of a midwife, as determined
by the board.

(d) Procuring, aiding, abetting, attempting, agreeing to procure,
offering to procure, or assisting at, a criminal abortion.

(e) Violating or attempting to violate, directly or indirectly, or
assisting in or abetting the violation of, or conspiring to violate
any provision or term of this chapter.

(f) Making or giving any false statement or information in
connection with the application for issuance of a license.

(g) Impersonating any applicant or acting as proxy for an
applicant in any examination required under this chapter for the
issuance of a license or a certificate.

(h) Impersonating another licensed practitioner, or permitting
or allowing another person to use his or her license or certificate
for the purpose of providing midwifery services.

(i) Aiding or assisting, or agreeing to aid or assist any person
or persons, whether a licensed physician or not, in the performance
of or arranging for a violation of any of the provisions of Article
12 (commencing with Section 2221) of Chapter 5.

begin insert

(j)  Failing to do any of the following when required pursuant
to Section 2507:

end insert begin insert

(1)  Consult with a physician and surgeon.

end insert begin insert

(2)  Refer a client to a physician and surgeon.

end insert begin insert

(3)  Transfer a client to a hospital.

end insert

begin delete SEC. 4. end delete
begin insert SEC. 8. end insert   

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).

begin delete SEC. 5. end delete
begin insert SEC. 9. end insert   

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.