Amended in Senate May 6, 2015

Amended in Senate April 6, 2015

Senate Bill No. 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 amended, Morrell. Midwife assistants.

The Licensed Midwifery Practice Act of 1993 provides for the licensing and regulation of midwives by the Medical Board of California. The license to practice midwifery authorizes the begin delete holder, under the supervision of a licensed physician and surgeon, as specified, end delete begin insert holder end insert 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 begin delete act end delete begin insert end insert begin insert Licensed Midwifery Practice Act of 1993 end insert requires a midwife to begin delete immediately end delete refer begin delete all complications end delete to a physician and begin delete surgeon. end delete begin insert surgeon under prescribed circumstances. end insert A violation of the begin delete act end delete begin insert Licensed Midwifery Practice Act of 1993 end insert is a crime.

begin insert

The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and authorizes the board to issue a certificate to practice nurse-midwifery to a person who meets educational standards established by the board or the equivalent of those educational standards. The Nursing Practice Act authorizes a certified nurse-midwife, under the supervision of a licensed physician and surgeon, 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, and provides that the practice of nurse-midwifery constitutes the furthering or undertaking by a certified person, under the supervision of a licensed physician and surgeon who has current practice or training in obstetrics, to assist a woman in childbirth so long as progress meets criteria accepted as normal.

end insert

This bill would authorize a midwife assistant to perform certain assistive activities under the supervision of a licensed begin delete midwife, end delete begin insert midwife or certified nurse-midwife, end insert 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 begin delete act, end delete begin insert Licensed Midwifery Practice Act of 1993, end insert 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:

SECTION 1.  

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

2516.5.  

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

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

(2) “Midwife technical supportive services” means simple
routine medical tasks and procedures that may be safely performed
by a midwife assistant who has limited training and who functions
under the supervision of a licensed begin delete midwife. end delete begin insert midwife or certified
nurse-midwife. end insert

(3) “Specific authorization” means a specific written order
prepared by the supervising midwife begin insert or supervising nurse-midwife end insert
authorizing the procedures to be performed on a patient, which
shall be placed in the patient’s medical record, or a standing order
prepared by the supervising midwife begin insert or supervising nurse-midwife end insert
authorizing the procedures to be performed. A notation of the
standing order shall be placed in the patient’s medical record.

(4) “Supervision” means the supervision of procedures
authorized by this section by a licensed begin delete midwife, end delete begin insert midwife or
certified nurse-midwife, end insert within his or her scope of practice, who
is physically present on the premises during the performance of
those procedures.

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

(1) Administer medication only by intradermal, subcutaneous,
or intramuscular injections and perform skin tests and additional
technical support services upon the specific authorization and
supervision of a licensed begin delete midwife. end delete begin insert midwife or certified
nurse-midwife. end insert A midwife assistant may also perform all these
tasks and services in a clinic licensed in accordance with
subdivision (a) of Section 1204 of the Health and Safety Code
upon the specific authorization of a licensed begin delete midwife. end delete begin insert midwife or
certified nurse-midwife. end insert

(2) Perform venipuncture or skin puncture for the purposes of
withdrawing blood upon specific authorization and under the
supervision of a licensed midwife begin insert or certified nurse-midwife, end insert if
the midwife assistant has met the educational and training
requirements for medical assistants as established in Section 2070.
Each employer of the assistant shall retain a copy of any related
certificates as a record.

(3) Perform the following midwife technical support services:

(A) Administer medications orally, sublingually, topically, or
rectally, or by providing a single dose to a patient for immediate
self-administration, and administer oxygen at the direction of the
supervising licensed begin delete midwife. end delete begin insert midwife or certified nurse-midwife. end insert
The licensed midwife begin insert or certified nurse-midwife end insert shall verify the
correct medication and dosage before the midwife assistant
administers medication.

(B) Assist in immediate newborn care when the licensed
midwife begin insert or certified nurse-midwife end insert is engaged in a concurrent
activity that precludes the licensed midwife begin insert or certified
nurse-midwife end insert from doing so.

(C) Assist in placement of the device used for auscultation of
fetal heart tones when a licensed midwife begin insert or certified
nurse-midwife end insert is engaged in a concurrent activity that precludes
the licensed midwife begin insert or certified nurse-midwife end insert from doing so.

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

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

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

(G) As authorized by the licensed begin delete midwife, end delete begin insert midwife or certified
nurse-midwife, end insert provide patient information and instructions.

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

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

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

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

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

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

SEC. 2.  

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.