BILL ANALYSIS Ó
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|Hearing Date:July 1, 2013 |Bill No:AB |
| |1308 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 1308Author:Bonilla
As Amended: June 13, 2013Fiscal: Yes
SUBJECT: Midwifery
SUMMARY: Authorizes a licensed midwife to directly obtain supplies,
devices, obtain and administer drugs and diagnostic tests, 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 for
consultation.
Existing law:
1)Licenses and regulates some 300 licensed midwives under the Licensed
Midwifery Practice Act of 1993, by the MBC within the Department of
Consumer Affairs (DCA). (Business and Professions Code (BPC) § 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)Requires the 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))
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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: (BPC
§ 2508)
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 the MBC.
7)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: (Health and Safety Code
(HSC) § 1204.3)
a) Meet the standards for certification established by the
National Association of Childbearing Centers.
b) Require 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:
1)Authorizes a 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.
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 identify complications
necessitating referral to a physician and surgeon.
3)Expands the existing oral and written disclosures required of a
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licensed midwife to a prospective client to include the specific
arrangements for the referral of complications to a physician and
surgeon for consultation, and specifies that the licensed midwife
shall not be required to identify a specific physician and surgeon.
4)Makes legislative findings and declarations.
5)In addition to a physician and surgeon or a certified nurse-midwife,
also authorizes a licensed midwife to be present at a licensed
alternative birth center.
6)Makes a correcting change to refer to the American Association of
Birth Centers rather than the National Association of Childbearing
Centers.
FISCAL EFFECT: The May 8, 2013 Assembly Appropriations Committee
analysis cites negligible state costs. The MBC is already required by
statute to adopt regulations.
COMMENTS:
1. Purpose. This bill is sponsored by American Congress of
Obstetricians and Gynecologists, District IX, California .
According to the Author, the bill does the following:
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, they are often 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.
Requires the 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 MBC must
draft regulations, we allow for this revision to occur.
Clarifies that the regulations should identify complications
necessitating referral to a physician or surgeon for purposes of
a consultation. 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 and that
patients/clients understand ahead of time, what the referral
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process will entail.
Requires licensed midwives to include in their disclosure
the specific arrangements for the referral of complications to a
physician for a consultation. In this situation, a licensed
midwife may continue care of the client. Current law requires
disclosure of the specific arrangements of transfer of care of a
client. In this situation, the physician would maintain care of
the client/patient.
Allows licensed midwives to attend births at an alternative
birth center. Licensed midwives are the experts in out of
hospital births. It makes policy sense to authorize them to
attend births in this setting. Many attend births at birth
centers which are not licensed. Birth centers have optional
licensing requirements.
Makes a technical change to replace the "National
Association of Childbearing Centers" with the "American
Association of Birth Centers." The National Association of
Childbearing Centers changed its name in 2005.
1. Author's Statement. "The California Medical Board is responsible
for the oversight of licensed midwives in California. Licensed
midwives typically attend out of hospital births. There are many
issues regarding access to midwives and their scope of practice.
The Medical Board is under sunset review this year and has
recommended legislative action on several issues that it has been
unable to resolve in past discussions. AB 1308 addresses issues of
access to midwives and barriers that impede the practice of
licensed midwifery while increasing patient safety. The changes it
makes ensure licensed midwives have access to the tools they need
to practice safely and that patients have full information
regarding referrals during the course of a pregnancy."
2.Background on the Midwifery Program. A licensed midwife is an
individual who has been issued a license to practice midwifery by
the MBC. As provided under the law, the practice of midwifery
authorizes the licensee, under the supervision of a licensed
physician in active practice, to attend cases of normal childbirth
in a home, birthing clinic or hospital environment. Pathways to
midwife licensure include completion of a three-year postsecondary
education program in an accredited school approved by the MBC, or
through a Challenge Mechanism. (BPC § 2513). Prior to licensure,
all midwives must take and pass the North American Registry of
Midwives (NARM) examination.
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SB 1638 (Figueroa, Chapter 536, Statutes of 2006) required the MBC to
create and appoint a Midwifery Advisory Council. The MAC is made up
of licensed midwives (at least half of the MAC must be licensed
midwives), a Board Member, a physician and a member of the public
(currently an individual who has used a licensed midwife). The MBC
specifies issues for the MAC to discuss/resolve and the MAC also
identifies issues and obtains approval from the MBC to develop
solutions to the various matters. Some items that have been
discussed include physician supervision, challenge mechanisms,
required reporting and student midwives. SB 1638 also required
licensed midwives to make annual reports to OSHPD on specified
information regarding birth outcomes, and required the reported data
to be consolidated by OSHPD and reported back to the MBC for
inclusion in the MBC's annual report.
The MBC approves midwifery schools by conducting a comprehensive
assessment to evaluate the school's educational program curriculum
and the program's academic and clinical preparation equivalent.
Schools wishing to obtain approval must submit supporting
documentation to verify that they meet the requirements of BPC §
2512.5. Currently, there are 11 approved midwifery schools. A
licensed midwife must complete 36 hours of continuing education
every two years in areas that fall within the scope of the practice
of midwifery as specified by the MBC.
The licensee population in the Midwifery Program is small and the
number of disciplinary actions filed against licensees is also
proportionally small with a total of 5 disciplinary actions being
filed over the past 3 fiscal years. Of the 4 disciplinary actions
that have been adjudicated, all have been resolved with either
revocation or license surrender.
3.Physician Supervision. As noted above, BPC § 2057 authorizes a
licensed midwife, under the supervision of a licensed physician and
surgeon who has current practice or training in obstetrics, 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.
BPC § 2507(f) requires the MBC, by July 1, 2003, to adopt regulations
defining the appropriate standard of care and level of supervision
required for the practice of midwifery. Due to the inability to
reach consensus on the supervision issue, the MBC bifurcated this
requirement and in 2006 adopted Standards of Care for Midwifery (CCR
§ 1379.19). Three previous attempts to resolve the physician
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supervision issue via legislation and/or regulation have been
unsuccessful due to the widely divergent opinions of interested
parties and their inability to reach consensus.
Although required by law, physician supervision is essentially
unavailable to licensed midwives performing home births, as
California physicians are generally prohibited by their malpractice
insurance companies from providing supervision of licensed midwives
who perform home births.
According to insurance providers, if physicians supervise or
participate in a home birth they will lose their insurance coverage
resulting in loss of hospital privileges. The physician supervision
requirement creates numerous barriers to care in that, if the
licensed midwife needs to transfer a patient/baby to the hospital,
many hospitals will not accept a patient transfer from a licensed
midwife as the primary provider who does not have a supervising
physician. California, along with Arkansas and Louisiana, are
currently the only states that require physician supervision of
licensed midwives. Among states that regulate midwives, most
require some sort of collaboration between the midwife and a
physician.
The MBC, through the MAC, 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. There is disagreement over the appropriate
level of physician supervision with licensed midwives expressing
concern with any limits being placed on their ability to practice
independently. The physician and liability insurance communities
have concerns over the safety of midwife-assisted homebirths.
Specifically, they are concerned with delays and/or the perceived
reluctance of midwives to refer patients when the situation warrants
referral or transfer of care. The MBC has stated that it ultimately
believes that the physician supervision requirement needs to be
addressed through the legislative process.
In the MBC oversight hearing earlier this year, staff recommended that
the MBC should reach a consensus with stakeholders on this issue and
then submit a specific legislative proposal to the Committee
regarding the appropriate level of supervision required for the
practice of midwifery.
Relative to the current bill, there has been a significant amount of
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talk about physician supervision. A number of licensed midwives and
those advocating for licensed midwives have strongly urged the
Author and the Committee to address physician supervision in this
bill. Recommendations have been to remove the physician supervision
requirement altogether or to replace it with some type of a
physician collaboration requirement.
To this point, physician supervision is not addressed in the bill. The
fact that it is not addressed does not mean that the bill is an
endorsement of what may be deemed to be an unworkable policy in the
law. It is simply that the issue is not addressed in the bill.
4.Diagnostic lab accounts. This bill echoes an issue raised by the MBC
in its Sunset Report. Licensed midwifes have difficulty securing
diagnostic lab accounts, even though they are legally allowed to
have lab accounts. Many labs require proof of physician
supervision. In addition, licensed midwives are not able to obtain
the medical supplies they have been trained and are expected to use
including: oxygen, necessary medications and medical supplies that
are included in approved licensed midwifery school curriculum (CCR §
1379.30). The inability for a licensed midwife to order lab tests
often means the patient will not obtain the necessary tests to help
the midwife monitor the patient during pregnancy. In addition, not
being able to obtain the necessary medical supplies for the practice
of midwifery adds additional risk to the licensed midwife's patient
and child.
The MBC, through the MAC held meetings regarding the lab order and
medical supplies/medication issues and has attempted to create
regulatory language to address this issue. However, based upon
discussions with interested parties, it appears the lab order and
medical supplies/medication issues will need to be addressed through
the legislative process.
This bill authorizes midwives to order supplies, drugs, tests and
devices without an ordering physician listed.
5.Oversight Hearings of the Medical Board of California (MBC) and SB
304. Earlier this year, this Committee, along with the Assembly
Business, Professions and Consumer Protection Committee, conducted
oversight hearings to review 14 regulatory boards within the DCA.
The Committees began the review of these licensing agencies in March
and conducted three days of hearings. Seven bills, authored by
Senator Curren D. Price Jr., were introduced to implement
legislative changes recommended in the Committees' Background/Issue
Papers for all of the agencies reviewed this year. As a part of the
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review of the MBC, the Committees reviewed the MBC's administration
of the licensed midwifery program and recommendations were made for
a number of the programs and operations of the MBC.
As a result, SB 304 (Price) was introduced to address a number of
issues raised in the Sunset Oversight hearings. As a result, the
two bills, AB 1308 and SB 304, work in concert with one another
regarding midwifery issues. The following summarizes issues
directly related to licensed midwives in the bill:
a) Clarify Midwifery Education and Clinical Training. BPC § 2514
authorizes a "bona fide student" who is enrolled or participating
in a midwifery education program or who is enrolled in a program
of supervised clinical training to engage in the practice of
midwifery as part of that course of study if: 1) the student is
under the supervision of a physician or a licensed midwife who
holds a clear and unrestricted California midwife license and who
is present on the premises at all times client services are
provided, and 2) the client is informed of the student's status.
There has been disagreement between the MBC and some members of
the midwifery community regarding what constitutes a "bona fide
student." The MBC believes the current statute is very clear
regarding a student midwife.
Some members of the midwifery community hold that an individual who
has executed a formal agreement to be supervised by a licensed
midwife, but is not formally enrolled in any approved midwifery
education program, qualifies the individual as a student in
apprenticeship training. Many midwives consider that an
individual may follow an "apprenticeship pathway" to licensure.
A Task Force consisting of members of the Midwifery Advisory
Council has recently been formed to examine this issue. However,
the issue of students/apprenticeships may need to be addressed by
legislation, and SB 304 has been amended to clarify when an
individual is considered a bona fide student, and to clarify that
a written agreement does not meet the requirement of a program of
supervised clinical training.
b) Supervision of Midwifery Students by Certified Nurse-Midwives.
The MBC's MAC has indicated that BPC § 2514 does not include
certified nurse midwives (CNM) as being able to supervise
midwifery students. The MBC recommended amending the law to
include CNMs, who are licensed by the Board of Registered Nursing
(BRN), as individuals who can supervise midwifery students.
Currently both physicians and CNMs are identified as being able
to sign off on clinical experience for license midwife students
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pursuant to BPC § 2513, but supervision of training is not
specifically identified in law. Accordingly, SB 304 has been
amended to include CNMs as those who may supervise midwifery
students.
6.Related Legislation. SB 304 (Price, 2013) as it relates to
midwifery, clarifies that a "bona fide student" means an individual
who is enrolled and participating in a midwifery education program
or who is enrolled in a program of supervised clinical training as
part of a board-approved postsecondary midwifery education program,
and includes certified nurse-midwives as one of those who may
supervise midwifery students.
SB 304 makes a number of additional changes to enhance the MBC's
ability to take action against dangerous doctors. The bill revises
the Vertical Enforcement (VE) pilot program in state Attorney
General's (AG's) office in which MBC investigators are paired with
AG prosecutors from the beginning of the complaint investigation
through the prosecution of the case, and deletes the January 1, 2014
sunset date, thus making VE a permanent program. The bill
additionally transfers the investigators from the MBC to the AG's
office, in keeping with the recommendation of the MBC enforcement
monitor made in 2005. This will locate investigators and
prosecutors in the same unit, under the same management, and allow
full coordination throughout the enforcement process.
SB 304 further makes a number of other enhancements to enable the MBC
to more effectively carry out its mandates to protect consumers in a
timely manner: requires Medical Malpractice cases reported to the
MBC to be immediately referred for investigation, cutting up to 2
months off of these types of cases; requires medical facilities
using electronic records to produce those records within 15 days
when a signed patient release is given for an investigation;
requires a quicker exchange of information about expert witness
testimony in disciplinary cases, helping to stop defense lawyers
from sandbagging and delaying cases; doubles the timeframe for the
Board to file a formal accusation against a doctor, when that
doctor's license is suspended by a judge, enabling the MBC to more
quickly get a dangerous doctor out of practice without having to
first put together a complete case for a formal disciplinary action;
authorizes the MBC to immediately require a doctor to cease
practicing medicine when the doctor fails to comply with an order by
the MBC to submit to psychiatric or medical evaluation of the
doctor's fitness to practice medicine; and makes other changes
related to the MBC's regulatory programs. ( Status : This bill is
awaiting hearing before the Assembly Business, Professions and
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Consumer Protection Committee.)
7.Prior Legislation. SB 1575 (B&P Comm., Chapter 799, Statutes of
2012) was an omnibus bill which established a retired license status
for licensed midwives.
SB 1638 (Figueroa, Chapter 536, Statutes of 2006) required the MBC to
create and appoint a MAC. Required licensed midwives to make
specified annual reports to OSHPD regarding birth outcomes;
required a licensed midwife who assists or supervises childbirth
occurring in an out-of-hospital setting to annually report to OSHPD
specified information regarding his or her practice for the previous
year; and required the data to be consolidated by OSHPD and
reported back to the MBC for inclusion in the Board's annual report.
SB 1950 (Figueroa, Chapter 1085, Statutes of 2002) required the MBC
to adopt regulations defining the appropriate standard of care and
level of supervision required for the practice of midwifery.
SB 1479 (Figueroa, Chapter 303, Statutes of 2000) expanded the
disclosures required to be given by licensed midwives and also
required midwives to register birth certificates for home births.
SB 350 (Killea, Chapter 1280, Statutes of 1993) enacted the
"Licensed Midwifery Practice Act of 1993" to provide for the
licensing and regulation of non-nurse and non-physician assistant
midwives by the MBC.
8.Arguments in Support. The American Congress of Obstetricians and
Gynecologists, District IX, California (ACOG) who is the Sponsor of
the bill states: "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 seamlessly work together. This system failure is bad for
licensed midwives, physicians, the Medical Board (whom is
responsible for regulating license midwives), hospitals, hospital
staff and most importantly, the pregnant woman, her pregnancy and
family." ACOG decided to sponsor the bill in an effort to address
some of the problematic issues relating to licensed midwives and
physicians. According to ACOG, the bill began with some of the most
direct issues that present barriers to licensed midwifery care.
ACOG believes the bill in its current form better implements the
intent of the law, by being clear that licensed midwives may obtain
the tools they need to practice their profession and that they are
able to practice in alternative birth center settings.
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ACOG states that physician supervision as called for in the statute has
been difficult to impossible to obtain for various reasons. In
reality the liability issues are such that if a physician should
work with a license midwife or patient for a planned home birth, and
that any lawsuit could financially devastate a physician due to lack
of insurance coverage. ACOG states that they are not intending to
fault insurance companies who determine it is too risky to cover
this exposure. ACOG feels that "somehow we must find a solution for
an integrated system where the physician is not at risk of losing
all of their personal assets by working with this population."
According to ACOG, "physicians must work very discretely and
carefully with license midwives to try to create boundaries as to
their relationship in and attempt to work within the confines of the
liability coverage."
9.Support if Amended. The California Association of Midwives (CAM) has
a support if amended position on the bill. Previously CAM had
expressed a support position, because they were hopeful the bill
would be amended to address their needs and concerns. However
because the bill contains a provision that reinstates a requirement
that the MBC adopt regulations for physician supervision. CAM
states: "Specifically, AB 1308 currently imposes a requirement on
the Medical Board to adopt 'regulations defining the appropriate
standard of care and level of supervision required for the practice
of midwifery.' (See page 3, line 34-36)." CAM indicates that if
the bill is amended to remove the above-referenced requirement, CAM
will support the bill. CAM reiterates that its primary objective is
to eliminate the physician supervision requirement for licensed
midwives in BPC § 2507, "which has proven to be an unworkable
restraint on the profession." CAM finally states: "Although
removing the new rulemaking requirement will not, standing alone,
eliminate all problems posed by BPC § 2507, it will allow other
positive aspects of AB 1308 to go into effect for the benefit of
licensed midwives."
The Medical Board of California (MBC) also is concerned with the bill
as it related to the amendments which would require MBC to adopt
regulations by July 1, 2015, stating: "The bill would also require
the Board ot adopt regulations to address physician supervision and
to identify complications necessitating referral to a physician;
however, in the past the Board has been unsuccessful in endeavors to
adopt regulations regarding physician supervision. The Board is
supportive of this bill if it is amended to better clarify what the
supervision requirements should be in statute, versus in regulation.
10.Arguments in Opposition. California Families for Access to Midwives
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(CFAM), a statewide nonprofit coalition committed to improving the
health of mothers and babies in California by protecting and
increasing access to midwifery care. CFAM argues that the bill
threatens Californians access to outofhospital maternity care by
restating and implementing the unobtainable (and previously
unenforced) requirement that licensed midwives have physician
supervision... It is time for Califo11.rnia law to be modernized to
match the practical reality of out-ofhospital maternity care, and
AB1308 is a step in the wrong direction. CFAM further states that
the physician supervision requirement prevents MediCal from
recognizing midwives as independent providers, and therefore serves
as a barrier to access for low-income families and families of
color, despite the demonstrable benefits of midwifery care."
12.Concern Among Licensed Midwives. The Committee has received a
number of communications from licensed midwives and families
expressing concern that AB 1308 would ultimately prohibit licensed
midwives from practicing or working with expectant mothers who
desire in-home births. This concern stems from the provision of
existing law which specifies that a midwife is to practice under the
supervision of a licensed physician and surgeon. This concern has
been raised in conjunction with the provision in SB 304 which would
transfer the investigators from the MBC to the Office of the
Attorney General's Health Quality Enforcement Section.
The concern is that moving the investigators from the MBC to the AG's
office would "take enforcement away from the MBC, and result in the
Department of Justice taking action against licensed midwives who do
not have a supervising physician." It has been expressed that the
MBC has not pursued disciplinary cases against licensed midwives who
do not have a physician supervisor because the MBC clearly
understands that physician supervision is simply unworkable as the
law now exists. The fear is that once the investigators are
transferred to the AG's office, they will now pursue disciplinary
actions against licensed midwives.
However, these concerns are based upon a misunderstanding of how the
MBC's enforcement process would work under SB 304. SB 304 only
transfers investigators to the AG's office. This is done so that
investigators who work the case and attorneys who prosecute the MBC
enforcement cases can work together in the same office under the
same management and organizational structure. In this way, the
timeliness and quality of disciplinary cases will be enhanced. SB
304 does not transfer the enforcement process out from under the
MBC. First, complaints will still be filed by consumers with the
MBC and the MBC's enforcement analysts will still review cases for
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jurisdiction and validity. Cases will still be reviewed by the
MBC's expert reviewers, and cases will only be sent for
investigation at the AG's office if it is first determined by the
MBC that an investigation needs to be opened. The AG's office will
not open investigations independent of the MBC. Second, once an
investigation is completed, and a case has been prepared for filing
a disciplinary action, the MBC's executive director must sign off on
the case in order for the disciplinary case to go forward. Third,
when disciplinary action is initiated against a licensee and a case
is heard before an administrative law judge and a proposed decision
is rendered, the MBC must adopt the proposed decision in order for
the decision to become final. In short, the MBC initiates the
investigation, the MBC executive director signs off on the case once
the investigation is completed and the MBC adopts the final decision
in a case. Clearly the MBC makes the critical decisions at the
beginning, in the middle and at the end of an enforcement case. The
AG's office will simply not be taking action against a licensed
midwife independently from the MBC.
13.Working Toward Solutions. The Sponsor has indicated that this bill
is still a work in progress and that the greater goal is to achieve
a solution where physicians and licensed midwives can work together
in an acceptable way where the licensed midwife and pregnant woman
can freely consult with medical professionals and have systems in
place in case of complications and transfer to the hospital if
needed. The Sponsor states, "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 be considered. If we are able to find resolution
prior to the end of session, we expect the bill to be brought back
before this committee." Finally, recognizing that the bill will be
changing, the Sponsors commit to working with the Senate and
Assembly Business and Professions Committees, as well as with the
MBC and the licensed midwives.
It should be noted that once this measure is voted out of this
Committee, there will not be another chance to review this measure
unless the bill is completely rewritten or is considered as a new
bill. Making substantive amendments to this measure as it moves
through the Legislature is not sufficient justification for the bill
to be referred back to this Committee for consideration or a
subsequent vote. The members of this Committee may wish to direct
Committee staff to work closely with the Author and other
stakeholders to come to agreement on changes to the bill.
14.Recommended Technical Amendment. Discussions of this bill between
Committee staff, the Author's staff, the MBC and the California
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Association of Midwives have determined that the requirement in the
bill for the MBC to adopt regulations under BPC § 2507 (g) is not
needed. It is noted that the MBC already has broad authority under
the Medical Practice Act to adopt, amend or repeal in accordance
with the Administrative Procedure Act those regulations necessary to
enable it to carry into the effect the provisions of the Act. (BPC
§ 2018). Therefore, the following technical amendment to strike out
paragraph (g) from Section 2507 will be offered as an Author's
amendment in Committee.
On page 3, strike out lines 31 through 37, inclusive.
SUPPORT AND OPPOSITION:
Support:
American Congress of Obstetricians and Gynecologists, District IX,
California (Sponsor
Support if Amended:
California Association of Midwives
Medical Board of California
Numerous Individuals
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Opposition:
California Families for Access to Midwives
Consultant:G. V. Ayers