BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: SB 408 Hearing Date: April 6,
2015
-----------------------------------------------------------------
|Author: |Morrell |
|----------+------------------------------------------------------|
|Version: |April 6, 2015 |
-----------------------------------------------------------------
----------------------------------------------------------------
|Urgency: |No |Fiscal: |Yes |
----------------------------------------------------------------
-----------------------------------------------------------------
|Consultant|Sarah Huchel |
|: | |
-----------------------------------------------------------------
Subject: Midwife assistants.
SUMMARY: Establishes minimum training requirements and duties that may
be performed by a midwife assistant.
Existing law:
1) Establishes the Medical Board of California (MBC) to enforce
the provisions of the Medical Practice Act. (Business and
Professions Code (BPC) Sections 2001and 2004)
2) Defines "medical assistant" as someone who may be unlicensed,
who performs basic administrative, clerical, and technical
supportive services for a physician, podiatrist, physician
assistant, nurse practitioner, or certified nurse-midwife.
(BPC § 2069)
3) Establishes training requirements and permitted functions for
medical assistants. (Title 16, California Code of
Regulations §§ 1366 et seq.)
4) Requires the MBC to create a Midwifery Advisory Council to
make recommendations on matters specified by MBC. (BPC §
2509)
5) Regulates the practice of licensed midwifery (BPC §§ 2505 et
seq.)
SB 408 (Morrell) Page 2
of ?
This bill:
1)Authorizes a midwife assistant to do all of the following:
a) 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. A
midwife assistant may also perform these tasks and services
in a licensed clinic upon the specific authorization of a
licensed midwife.
b) Perform venipuncture or skin puncture for the purposes
of drawing blood upon specific authorization and under the
supervision of a licensed midwife, if the midwife assistant
has met the educational and training requirements for
medical assistants, as specified. Requires each employer
of the assistant to retain a copy of any related
certificates as a record.
c) Administer medications orally, sublingually, topically,
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. The
licensed midwife shall verify the correct medication and
dosage before the midwife assistant administers medication.
d) Assist in immediate newborn care when a licensed midwife
is engaged in a concurrent activity that precludes the
licensed midwife from doing so.
e) Assist in placement of the device used for auscultation
of fetal heart tones when a licensed midwife is engaged in
a concurrent activity that precludes the licensed midwife
from doing so.
f) Collect by noninvasive techniques and preserve specimens
for testing, including, but not limited to, urine.
g) Assist patients to and from a patient examination room,
bed, or bathroom.
h) Assist patient in activities of daily living, such as
assisting with bathing or clothing.
SB 408 (Morrell) Page 3
of ?
i) Provide patient information and instructions as
authorized by the licensed midwife.
j) Collect and record patient data, including height,
weight, temperature, pulse, respiration rate, blood
pressure, and basic information about the presenting and
previous conditions.
aa) Perform simple laboratory and screening tests
customarily performed in a medical or midwife office.
bb) Perform additional midwife technical support services
under regulations and standards established by the MBC.
2)Shall not be construed as authorizing:
a) The licensure of midwife assistants.
b) The administration of local anesthetic agents by a
midwife assistant.
c) MBC to adopt any regulations that violate the
prohibitions on diagnosis or treatment, as specified.
d) A midwife assistant to perform any clinical laboratory
test or examination for which he or she is not authorized,
as specified
3)Prohibits the employment of a midwife assistant for inpatient
care in a licensed general acute care hospital.
4)Defines the following terms:
a) A "midwife assistant" is a person, who may be
unlicensed, who performs basic administrative, clerical,
and midwife technical supportive services, is at least 18
years of age, and has met the same minimum amount of
training hours established for a medical assistant. The
midwife assistant shall be issued a certificate by the
training institution or instructor indicating satisfactory
completion of the required training.
b) "Midwife technical supportive services" are simple,
SB 408 (Morrell) Page 4
of ?
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.
c) "Specific authorization" means a specific written order
prepared by the supervising midwife authorizing the
procedures to be performed on a patient, that shall be
placed in the patient's medical record, or a standing order
prepared by the supervising midwife authorizing the
procedures to be performed. A notation of the standing
order shall be placed in the patient's medical record.
d) "Supervision" means the supervision of procedures by a
licensed midwife, within his or her scope of practice, who
is physically present on the premises during the
performance of those procedures.
FISCAL
EFFECT: Unknown. This bill is keyed "fiscal" by Legislative
Counsel.
COMMENTS:
1. Purpose. This bill is sponsored by the Medical Board of
California (MBC) . According to the Author, it has been
brought to MBC's attention that licensed midwives need to
use, and are using, assistants. However, there is no
regulation of midwife assistants, and licensed midwives are
not authorized to use medical assistants. This bill creates
a regulatory framework for the qualifications of and services
that may be provided by midwife assistants modelled after
those for medical assistants.
2. Unregulated Current Practice. Licensed midwives are not
authorized to supervise medical assistants, but there is a
practice need for support. According to the sponsor,
licensed midwives are currently using assistants in various
forms; some use other licensed midwives as assistants, while
others use a midwife student who has an official agreement
with a midwifery school to provide clinical training. Others
may even use someone with no formal midwifery training or
SB 408 (Morrell) Page 5
of ?
someone that the licensed midwife has trained. This has led
to a wide variation in assistant quality and potentially
serious consumer protection issues. This issue was raised in
the MBC's 2012 Sunset Review Report and it was recommended
that legislation authorizing midwife assistants be pursued.
This bill is modeled on the current regulation of medical
assistants by the MBC. Medical assistants are unlicensed,
but certificated, individuals. A medical assistant must have
a high school diploma or GED equivalent and take a
certificate course at an approved school. The exact duration
of these programs vary, but San Francisco State University,
for example, requires 140 classroom hours and a clinical
externship. Medical assistants also must complete a minimum
of 60 hours of continuing education over 5 years.
This bill provides for the similar training, scope of
practice, and supervision of midwife assistants, as it
relates to a licensed midwife's practice needs.
3. Supervision by Certified Nurse Midwives. Current law allows
certified nurse midwives, but not licensed midwives, to
supervise medical assistants. This bill allows licensed
midwives, but not certified nurse midwives, to supervise
midwife assistants. Given that both licensed midwives and
certified nurse midwives practice in many of the same
non-hospital settings, it may be in the Author's interest to
explore allowing supervision by certified nurse midwives as
well, to reconcile potential staffing issues.
4. Arguments in Support. The Medical Board of California (MBC)
writes, "Putting training requirements in statute for midwife
assistants and parameters on what services can be provided by
midwife assistants furthers the Board's mission of consumer
protection and the Board is pleased to be able to sponsor
this important piece of legislation."
SUPPORT AND OPPOSITION:
Support:
Medical Board of California (Sponsor)
SB 408 (Morrell) Page 6
of ?
Jane Parker, Monterey County Supervisor, Fourth District
Opposition:
None received as of March 31, 2015.
-- END --