BILL NUMBER: SB 408	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 6, 2015
	AMENDED IN SENATE  APRIL 6, 2015

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 
holder, under the supervision of a licensed physician and surgeon,
as specified,   holder  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     Licensed
  Midwifery Practice Act of 1993  requires a midwife to
 immediately  refer  all complications
 to a physician and  surgeon.   surgeon
under prescribed circumstances.  A violation of the 
act   Licensed Midwifery Practice Act of 1993  is a
crime. 
   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. 
   This bill would authorize a midwife assistant to perform certain
assistive activities under the supervision of a licensed 
midwife,   midwife or certified nurse-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,   Licensed Midwifery Practice Act of 1993, 
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
 midwife,   midwife or certified nurse-midwife,
 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  midwife.  
midwife or certified nurse-midwife. 
   (3) "Specific authorization" means a specific written order
prepared by the supervising midwife  or supervising nurse-midwife
 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  or supervising
nurse-midwife  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  midwife,  
midwife or certified nurse-midwife,  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  midwife.   midwife or
certified nurse-midwife.  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  midwife. 
 midwife or certified nurse-midwife. 
   (2) Perform venipuncture or skin puncture for the purposes of
withdrawing blood upon specific authorization and under the
supervision of a licensed midwife  or certified nurse-midwife,
 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  midwife.   midwife or
certified nurse-midwife.  The licensed midwife  or certified
nurse-midwife  shall verify the correct medication and dosage
before the midwife assistant administers medication.
   (B) Assist in immediate newborn care when the licensed midwife
 or certified nurse-midwife  is engaged in a concurrent
activity that precludes the licensed midwife  or certified
nurse-midwife  from doing so.
   (C) Assist in placement of the device used for auscultation of
fetal heart tones when a licensed midwife  or certified
nurse-midwife  is engaged in a concurrent activity that
precludes the licensed midwife  or certified nurse-midwife 
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  midwife,  
midwife or certified nurse-midwife,  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.