BILL ANALYSIS Ó
AB 1308
Page 1
Date of Hearing: April 23, 2013
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Richard S. Gordon, Chair
AB 1308 (Bonilla) - As Amended: March 21, 2013
SUBJECT : Midwifery
SUMMARY : Authorizes a midwife to directly obtain supplies,
order testing, and receive reports that are necessary to his or
her practice of midwifery; requires the Medical Board of
California (MBC) to revise and adopt regulations defining the
supervision requirements between a physician and a midwife; and
requires a midwife to disclose his or her arrangements for the
referral of complications to a physician. Specifically, this
bill :
1)Authorizes a midwife to directly obtain supplies, order
testing, and receive reports that are necessary to his or her
practice of midwifery and consistent with his or her scope of
practice.
2)Requires the MBC, 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.
3)Expands the existing oral and written disclosures required of
a licensed midwife to a prospective client to include the
specific arrangements for the referral of complications to a
physician and surgeon.
4)Makes Legislative findings and declarations.
5)States that no reimbursement is required by this act pursuant
to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
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EXISTING LAW :
1)Establishes the Licensed Midwifery Practice Act of 1993, which
provides for the licensure of midwives by the MBC. (Business
and Professions Code (BPC) Section 2505 et seq.)
2)Creates the Midwifery Advisory Council (MAC) which is required
to make recommendations on matters specified by MBC. (BPC
2509)
3)Defines the practice of midwifery as the furthering or
undertaking by any licensed midwife, under the supervision of
a licensed physician who has current practice or training in
obstetrics, to assist a woman in childbirth so long as
progress meets criteria accepted as normal. (BPC 2507)
4)Required MBC to adopt regulations defining the appropriate
standard of care and level of supervision required for the
practice of midwifery by July 1, 2003. (BPC 2507 (f))
5)Permits a licensed midwife 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
supervision of a licensed physician and surgeon. (BPC 2507
(a))
6)Requires a licensed midwife to disclose orally and in writing:
a) The scope of a midwife's practice, as specified;
b) Whether the licensed midwife has liability coverage;
c) 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; and,
d) The procedure for reporting complaints to MBC. (BPC
2508)
FISCAL EFFECT : Unknown
AB 1308
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COMMENTS :
1)Purpose of this bill . This bill would enact multiple changes
to clarify and facilitate the practice of midwifery:
permitting a midwife to directly obtain supplies, order
testing, and receive reports that are necessary to his or her
practice; requiring MBC to revise and adopt regulations
defining supervision requirements between a physician and a
midwife; and requiring a midwife to disclose his or her
arrangements for the referral of complications to a physician.
This bill is sponsored by the American Congress of
Obstetricians and Gynecologists.
2)Author's statement . According to the author, "Midwives were
first licensed in 1993. MBC was charged with crafting
regulations to implement the licensing, reporting, and other
facets of this policy change. Unfortunately, there are some
issues that MBC has not been able to address?. AB 1308
endeavors to address some of these issues.
"Specifically, this bill authorizes midwives to order
supplies, drugs, tests, and devices without an ordering
physician listed. Currently, this is included in the scope of
practice for licensed midwives, however, in the field many
times they are unable to get access to supplies, drugs, and
tests because the supplier requires listing of an ordering
physician. This authority should help provide clarity to what
should already be permissible.
"The bill also requires MBC to revise regulations regarding
licensed midwives before July 1, 2015. With the advent of
this legislation, regulations may need to be modified to
account for any changes. By pushing back the deadline by when
the Medical Board must draft regulations, we allow for this
revision to occur.
"Amendments also clarify that the regulations should identify
complications necessitating referral to a physician or
surgeon. As medicine advances and we learn more about
underlying health conditions and risk factors, it is important
that the Medical Board continue to explore this topic."
3)Long-standing problems with clarifying physician supervision
requirements . A licensed midwife is an individual who has
AB 1308
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been issued a license to practice midwifery by MBC. The
practice of midwifery authorizes the licensee, under the
supervision of a licensed physician, to attend cases of normal
childbirth, in a home, birthing clinic, or hospital
environment.
According to a 2013 report by the California Senate Business,
Professions, and Economic Development (BPED) Committee,
physician supervision is essentially unavailable to licensed
midwives performing home births because California physicians
are generally prohibited by their malpractice insurance
companies from providing supervision of licensed midwives who
perform home births.
Existing law previously required MBC to adopt regulations by
July 1, 2003 defining both the appropriate standard of care
and the level of supervision required for the practice of
midwifery. Due to its inability to reach a consensus on the
supervision issue, the MBC bifurcated this requirement, and in
2006 adopted the Standards of Care for Midwifery. BPED
reported that three previous attempts to resolve the physician
supervision issue through legislation and/or regulation have
been unsuccessful due to the widely divergent opinions of
interested parties.
The MBC, through its Midwifery Advisory Council, has held many
meetings regarding physician supervision of licensed midwives
and has attempted to create regulations to address this issue.
The concepts of collaboration, such as required consultation,
referral, transfer of care, and physician liability have been
discussed among the interested parties with little success.
Despite midwives' inability to obtain physician supervision,
midwives are currently performing midwifery without sanction
by MBC because administrative courts have determined that it
is unfair to enforce the physician supervision requirement
because physician supervision is practically unobtainable.
This bill aims to restart those discussions by creating a
deadline for MBC to establish supervision guidelines. And in
light of the current imperfections with the supervision
guidelines, this bill also requires midwives to explicitly
disclose to the patient his or her arrangements for the
referral of complications to a physician
AB 1308
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4)Supplies, testing, and results . According to the author, some
licensed midwives are impeded by the supervision requirement
because many drug, testing, and device suppliers require the
name of an ordering physician to fulfill requests, thereby
delaying or blocking midwives' ability to obtain supplies,
order tests, and receive results. Licensed midwives who are
unable to establish an account with a local medical supply
company may have to order drugs and supplies from out of state
at significantly increased expense, or obtain them from
another licensed midwife.
Continuity of care becomes an important patient issue in areas
where licensed midwives are unable to establish laboratory
accounts or refer patients for ultrasounds because patients
then have to see a different provider. This may increase
costs and cause delay for patients, and can affect
time-sensitive testing windows, such as for the genetic
screening done in early pregnancy. According to the author, in
some cases patients refuse to seek out these laboratory tests
when they would have consented to them had they been available
through their licensed midwife.
This bill would explicitly authorize midwives to order the
tools necessary and appropriate to their practice without
naming a supervising physician.
5)Arguments in support . The American Congress of Obstetricians
and Gynecologists write, "For the twenty years licensed
midwives have been authorized to practice in California, there
never has been a workable system where licensed midwives and
medical professionals can work together. This system failure
is bad for licensed midwives, physicians, MBC (whom is
responsible for regulating licensed midwives), hospitals,
hospital staff and most importantly, the pregnant woman, her
pregnancy and family?[T]he American Congress of Obstetricians
and Gynecologists, District IX, who has been working with the
Medical Board and licensed midwives for years to develop
workable regulations, without success, is concerned the issue
of licensed midwifery might not get the attention it needs and
deserves. Given this situation, ACOG-IX decided to sponsor a
bill by Assemblymember Bonilla.
"We do not yet know how we will be able to redefine the
relationship to a more workable one due to the many factors to
AB 1308
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be considered. So, we are starting with the very practical
issues which impede the licensed midwives' ability to
practice, including the ability to obtain needed supplies and
tests within their scope of practice, without the need for a
named physician supervisor."
6)Previous legislation . SB 1638 (Figueroa), Chapter 536,
Statutes of 2006. SB 1638 required MBC to create and appoint
the MAC, and required licensed midwives to make annual reports
to the Office of Statewide Health Planning and Development
containing specified information regarding the births the
midwife assisted in delivering during the prior year.
SB 1950 (Figueroa), Chapter 1085, Statutes of 2002, required
MBC to adopt regulations by July 1, 2003, defining the
appropriate standard of care and level of supervision
required for the practice of midwifery.
SB 1479 (Figueroa), Chapter 303, Statutes of 2000, revised and
expanded the information a licensed midwife is required to
disclose to prospective clients.
REGISTERED SUPPORT / OPPOSITION :
Support
American Congress of Obstetricians and Gynecologists (sponsor)
Opposition
None on file
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301