Senate BillNo. 408


Introduced by Senator Morrell

February 25, 2015


An act to add Section 2516.5 to the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL’S DIGEST

SB 408, as introduced, Morrell. Midwife assistants.

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. The act requires a midwife to immediately refer all complications to a physician and surgeon. A violation of the act is a crime.

This bill would authorize a midwife assistant to perform certain assistive activities under the supervision of a licensed midwife, including the administration of medicine, the withdrawing of blood, and midwife technical support services. The bill would define terms for these purposes. The bill would prohibit a midwife assistant from being employed for inpatient care in a licensed general acute care hospital. By adding new requirements and prohibitions to the act, the violation of which would be a crime, the bill would impose a state-mandated local program.

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:

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SECTION 1.  

Section 2516.5 is added to the Business and
2Professions Code
, to read:

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2516.5.  

(a) As used in this section, the following definition
4apply:

5(1) “Midwife assistant” means a person, who may be unlicensed,
6who performs basic administrative, clerical, and midwife technical
7supportive services in accordance with this chapter for a licensed
8midwife, is at least 18 years of age, and has had at least the
9minimum amount of hours of appropriate training pursuant to
10standards established by the board for a medical assistant pursuant
11to Section 2069. The midwife assistant shall be issued a certificate
12by the training institution or instructor indicating satisfactory
13completion of the required training. Each employer of the midwife
14assistant or the midwife assistant shall retain a copy of the
15certificate as a record.

16(2) “Midwife technical supportive services” means simple
17routine medical tasks and procedures that may be safely performed
18by a midwife assistant who has limited training and who functions
19under the supervision of a licensed midwife.

20(3) “Specific authorization” means a specific written order
21prepared by the supervising midwife authorizing the procedures
22to be performed on a patient, which shall be placed in the patient’s
23medical record, or a standing order prepared by the supervising
24midwife authorizing the procedures to be performed. A notation
25of the standing order shall be placed in the patient’s medical record.

26(4) “Supervision” means the supervision of procedures
27authorized by this section by a licensed midwife, within his or her
28scope of practice, who is physically present on the premises during
29the performance of those procedures.

30(b) Notwithstanding any other provision of law, a midwife
31assistant may do all of the following:

32(1) Administer medication only by intradermal, subcutaneous,
33or intramuscular injections and perform skin tests and additional
P3    1technical support services upon the specific authorization and
2supervision of a licensed midwife. A midwife assistant may also
3perform all these tasks and services in a clinic licensed in
4accordance with subdivision (a) of Section 1204 of the Health and
5Safety Code upon the specific authorization of a licensed midwife.

6(2) Perform venipuncture or skin puncture for the purposes of
7withdrawing blood upon specific authorization and under the
8supervision of a licensed midwife if the midwife assistant has met
9the educational and training requirements for medical assistants
10as established in Section 2070. Each employer of the assistant shall
11retain a copy of any related certificates as a record.

12(3) Perform the following midwife technical support services:

13(A) Administer medications orally, sublingually, topically,
14vaginally, or rectally, or by providing a single dose to a patient for
15immediate self-administration, and administer oxygen at the
16direction of the supervising licensed midwife. The licensed midwife
17shall verify the correct medication and dosage before the midwife
18assistant administers medication.

19(B) Assist in performing neonatal resuscitation.

20(C) Assist in auscultation of fetal heart tones when a licensed
21midwife is engaged in a concurrent activity that precludes the
22licensed midwife from doing so.

23(D) Collect by noninvasive techniques and preserve specimens
24for testing, including, but not limited to, urine.

25(E) Assist patients to and from a patient examination room, bed,
26or bathroom.

27(F) Assist patient in activities of daily living, such as assisting
28with bathing or clothing.

29(G) As authorized by the licensed midwife, provide patient
30information and instructions.

31(H) Collect and record patient data, including height, weight,
32temperature, pulse, respiration rate, blood pressure, and basic
33information about the presenting and previous conditions.

34(I) Perform simple laboratory and screening tests customarily
35performed in a medical or midwife office.

36(4) Perform additional midwife technical support services under
37regulations and standards established by the board.

38(c) (1) Nothing in this section shall be construed as authorizing
39the licensure of midwife assistants. Nothing in this section shall
40be construed as authorizing the administration of local anesthetic
P4    1agents by a midwife assistant. Nothing in this section shall be
2construed as authorizing the board to adopt any regulations that
3violate the prohibitions on diagnosis or treatment in Section 2052.

4(2) Nothing in this section shall be construed as authorizing a
5midwife assistant to perform any clinical laboratory test or
6examination for which he or she is not authorized under Chapter
73 (commencing with Section 1200).

8(d) Notwithstanding any other law, a midwife assistant shall
9not be employed for inpatient care in a licensed general acute care
10hospital as defined in subdivision (a) of Section 1250 of the Health
11and Safety Code.

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SEC. 2.  

No reimbursement is required by this act pursuant to
13Section 6 of Article XIII B of the California Constitution because
14the only costs that may be incurred by a local agency or school
15district will be incurred because this act creates a new crime or
16infraction, eliminates a crime or infraction, or changes the penalty
17for a crime or infraction, within the meaning of Section 17556 of
18the Government Code, or changes the definition of a crime within
19the meaning of Section 6 of Article XIII B of the California
20Constitution.



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