BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 408|
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THIRD READING
Bill No: SB 408
Author: Morrell (R)
Amended: 5/6/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/6/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Midwife assistants
SOURCE: Medical Board of California
DIGEST: This bill establishes minimum training requirements and
duties that may be performed by a midwife assistant.
Senate Floor Amendments of 5/6/15 authorize a certified
nurse-midwife to supervise midwife assistants.
ANALYSIS:
Existing law:
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1) Establishes the Medical Board of California (MBC) to enforce
the provisions of the Medical Practice Act. (Business and
Professions Code (BPC) §§ 2001 and 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.)
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 or
certified nurse-midwife. A midwife assistant may also
perform these tasks and services in a licensed clinic upon
the specific authorization of a licensed midwife or
certified nurse-midwife.
b) Perform venipuncture or skin puncture for the purposes
of drawing 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 specified. Requires each employer of the
assistant to retain a copy of any related certificates as a
record.
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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 or certified
nurse-midwife. The licensed midwife or certified
nurse-midwife shall verify the correct medication and
dosage before the midwife assistant administers medication.
d) Assist in immediate newborn care 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.
e) 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.
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.
i) Provide patient information and instructions as
authorized by the licensed midwife or certified
nurse-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 Medical
Board of California (MBC).
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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,
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 or certified nurse-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 or certified nurse-midwife, within his or
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her scope of practice, who is physically present on the
premises during the performance of those procedures.
Background
Licensed midwives are not authorized to supervise medical
assistants, but there is a practice need for support. According
to the sponsor, the MBC, 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 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 five years.
This bill provides for the similar training, scope of practice,
and supervision of midwife assistants, as it relates to a
licensed midwife's or certified nurse-midwife's practice needs.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
SUPPORT: (Verified5/7/15)
Medical Board of California (source)
American Nurses Association of California
Planned Parenthood
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Supervisor Jane Parker, Monterey County, Fourth District
OPPOSITION: (Verified5/7/15)
None received
ARGUMENTS IN SUPPORT: The 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."
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
5/8/15 15:09:21
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