BILL ANALYSIS Ó
AB 1308
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Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1308 (Bonilla) - As Amended: March 21, 2013
Policy Committee: Business,
Professions and Consumer Protection Vote: 11-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill authorizes a midwife to directly obtain supplies,
order testing, and receive reports necessary to midwifery
practice; 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 arrangements for the referral of
complications to a physician.
FISCAL EFFECT
Negligible state costs. MBC is already required by statute to
adopt regulations.
COMMENTS
1)Rationale . This bill seeks to clarify and facilitate the
practice of midwifery. A licensed midwife is required by
statute to practice under a physician's supervision. MBC
adopted the Standards of Care for Midwifery in 2006 but the
Board's efforts to promulgate regulations defining the level
of supervision have not been successful. Licensed midwives
face difficulty ordering supplies, ordering lab tests and
receiving the results of those tests, because suppliers and
labs often require the name of an ordering physician. By
explicitly authorizing these functions in statute, one barrier
faced by midwives will be removed. Addressing the regulations
issued in statute is intended to restart discussions by
creating a deadline for MBC to establish supervision
guidelines. This bill also requires midwives to explicitly
disclose to the patient the midwife's arrangements for
AB 1308
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referral of complications to a physician. This bill is
sponsored by the American Congress of Obstetricians and
Gynecologists.
2)Long-standing problems with clarifying physician supervision
requirements . According to MBC's 2012 Sunset Review Report,
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, MBC bifurcated this requirement, and in
2006 adopted the Standards of Care for Midwifery.
MBC reported 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.
Despite midwives' inability to obtain physician supervision,
midwives are currently performing midwifery without sanction by
MBC because administrative courts have determined it is unfair
to enforce the physician supervision requirement when physician
supervision is practically unobtainable.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081