HB520: HB520 Georgia Licensed Midwife Act; enact

25 LC 55 0511 House Bill 520 By: Representatives Mathiak of the 82nd, Powell of the 33rd, Momtahan of the 17th, Williams of the 168th, Dempsey of the 13th, and others A BILL TO BE ENTITLED AN ACT To amend Title 31 of the Official Code of Georgia Annotated, re lating to health, so as to1 repeal in its entirety Chapter 26, relating to the practice of midwifery; to revise provisions2 relating to peer review to include midwives; to amend Title 43 of the Official Code of3 Georgia Annotated, relating to professions and businesses, so as to provide for the licensure4 and regulation of midwives; to provide for a short title; to provide for legislative findings;5 to provide for definitions; to provide for the creation of the Advisory Board for Licensed6 Midwives; to provide for its membership and duties; to provide for licensure requirements;7 to provide for renewal of licenses; to provide for the revocati on, suspension, denial, or8 refusal to issue or renew a license; to provide fines for viola tions; to provide for the9 promulgation of rules and regulations; to prohibit the practice of midwifery without a license;10 to provide exceptions; to provide for informed consent and written disclosures to clients; to11 limit the practice of midwifery; to provide for standards of ca re and liability in certain12 situations; to provide for prohibited acts; to authorize the fi ling of birth certificates; to13 provide for statutory construction; to provide for coverage; to provide for abatement; to14 provide for an exception under the "Georgia Registered Professi onal Nurse Practice Act";15 to provide for related matters; to provide for an effective date; to repeal conflicting laws; and16 for other purposes.17 H. B. 520 - 1 - 25 LC 55 0511 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:18 SECTION 1.19 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in20 paragraph (2) of Code Section 31-7-131, relating to definitions relative to peer review21 groups, by striking "and" at the end of subparagraph (L), by replacing the period at the end22 of subparagraph (M) with "; and", and by adding a new subparagraph to read as follows:23 "(N) A midwife."24 SECTION 2.25 Said title is further amended by repealing in its entirety Chapter 26, relating to the practice26 of midwifery, and designating said chapter as reserved.27 SECTION 3.28 Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,29 is amended by adding a new chapter to read as follows:30 "CHAPTER 24B31 43-24B-1.32 This chapter shall be known and may be cited as the 'Georgia Licensed Midwife Act.'33 43-24B-2.34 (a) The General Assembly finds that:35 (1) Parents are entitled to freedom in choosing their provider and setting for childbirth;36 (2) Some potential parents in this state desire alternatives to currently available hospital37 based maternity care;38 H. B. 520 - 2 - 25 LC 55 0511 (3) Trained and competent midwifery professionals can enhance health and safety during39 planned, out-of-hospital births;40 (4) Midwives are independent, autonomous healthcare providers who are trained in41 managing normal physiological births in the community setting;42 (5) Numerous counties in this state are underserved by obstetricians;43 (6) Midwives can assist women and their families with safe and effective childbirth44 while guiding the health, safety, and welfare of mothers and their offspring through the45 childbearing year; and46 (7) Regulating midwifery promotes access to safe and effective antepartum, intrapartum,47 and postpartum care.48 (b) The General Assembly, therefore, declares it to be the purpose of this chapter to protect49 the health, safety, and welfare of the public by providing for the licensure and regulation50 of the activities of midwives.51 43-24B-3.52 As used in this chapter, the term:53 (1) 'Advisory board' means the Advisory Board for Licensed Mid wives established54 pursuant to Code Section 43-24B-4.55 (2) 'Collaboration' means a process by which a licensed midwife and a physician or other56 appropriate healthcare provider jointly manage the care of a client, the requirements for57 which shall be defined by the advisory board.58 (3) 'Consultation' means a communication between a licensed midwife and a physician59 or appropriate healthcare provider with expertise in providing medical services to women60 during the prenatal, childbirth, and postpartum periods when assessing a condition during61 such periods.62 (4) 'Informed consent' means a written certification by the cl ient consenting to or63 declining procedures, protocols, and treatments or recommended diagnostic tests after full64 H. B. 520 - 3 - 25 LC 55 0511 disclosure of the current standard of care and its purpose, ben efits, known risks,65 contraindications, and associated risks, as well as any alternative options.66 (5) 'License' means a license issued pursuant to this chapter to engage in the practice of67 midwifery.68 (6) 'Licensed midwife' or 'licensee' means an individual licensed under this chapter who69 is engaging in the practice of midwifery.70 (7) 'Practice of midwifery' means assistance given, in exchang e for compensation, to71 women during pregnancy, birth, and the postpartum period, inclu ding well-woman72 screening and education. Such assistance may be provided in ou t-of-hospital settings,73 such as a private home or a birth center. Such assistance, whi ch is provided within a74 network of relationships with other maternity care providers wh o may provide75 consultation and collaboration when needed, includes:76 (A) Providing care, education, counseling, and support to wome n and their families77 throughout pregnancy, birth, and the postpartum period; identif ying unique physical78 social and emotional needs; recognizing abnormal conditions requiring the services of79 a healthcare provider such as a physician, physician assistant, or advanced practice80 registered nurse and developing a plan for consultation and ref erral when such81 conditions arise; and providing emergency care and support for mothers and babies82 until additional assistance is available;83 (B) Ordering prenatal, postpartum, and well-woman laboratory analyses performed by84 a licensed laboratory for screening purposes; ordering obstetric ultrasounds; obtaining85 and using appropriate equipment and devices such as a Doppler u ltrasound, blood86 pressure cuff, and phlebotomy supplies, instruments, and sutures; obtaining, carrying, 87 and administering antihemorrhagic agents including but not limi ted to Pitocin88 (oxytocin), misoprostol and methergine, intravenous fluids for stabilization of the89 laboring person, magnesium sulfate, terbutaline, neonatal injec table vitamin K,90 newborn antibiotic eye prophylaxis, oxygen, intravenous antibio tics for Group B91 H. B. 520 - 4 - 25 LC 55 0511 Streptococcal antibiotic prophylaxis, Rho(D) immune globulin, l ocal anesthetic,92 epinephrine, and other drugs or supplies approved by the adviso ry board; provided,93 however, that nothing in this subparagraph shall be interpreted to include the94 prescribing of medications;95 (C) Managing the postpartum period, including the suturing of an episiotomy and the96 suturing of first and second degree natural perineal and labial lacerations, including the97 administration of a local anesthetic;98 (D) Managing the newborn period, including:99 (i) Providing care for a newborn baby, including performing a normal newborn baby100 examination;101 (ii) Resuscitating a newborn baby; and102 (iii) Performing newborn screenings;103 (E) Providing limited interconception services in order to provide continuity of care,104 including:105 (i) Breastfeeding support and counseling;106 (ii) Family planning, limited to natural family planning, cerv ical caps, and107 diaphragms; and108 (iii) Pap smears, where each client with an abnormal result is to be referred to an109 appropriate licensed healthcare provider; and110 (F) Executing the orders of a physician, if the orders are wit hin the education,111 knowledge, and skill of the licensed midwife.112 (8) 'Qualified instructor' means an individual who:113 (A) Holds a license under this chapter; or114 (B) Is a licensed healthcare provider who has at least five years of experience or who115 has participated in 50 documented births as the primary healthcare provider.116 H. B. 520 - 5 - 25 LC 55 0511 (9) 'Referral' means a request made by a licensed midwife to a physician or other117 healthcare provider for an assessment of a mother or her offspring in order to determine118 appropriate care.119 43-24B-4.120 (a) There is created within the division the Advisory Board for Licensed Midwives which121 shall consist of six members.122 (b) The Governor shall appoint all members of the advisory board as follows:123 (1) Four licensed midwives;124 (2) One physician with experience collaborating in out-of-hospital birth; and125 (3) One member of the general public who has used the services of a licensed midwife126 in this state.127 (c) The members of the advisory board shall serve for terms of two years and may succeed128 themselves.129 (d) Any vacancy on the advisory board shall be filled in the same manner as the regular130 appointments.131 (e) The Governor may remove members of the advisory board for incompetence, neglect132 of duty, unprofessional conduct, conviction of any felony, failure to meet the qualifications133 of this chapter, or committing any act prohibited by this chapter.134 (f) The advisory board shall elect a chairperson from among its membership and may elect135 other officers at the discretion of the advisory board, who shall each serve for one year.136 (g) The advisory board shall meet at least once per year or as otherwise called by the137 chairperson.138 43-24B-5.139 The advisory board shall issue a license to engage in the pract ice of midwifery to any140 individual who meets the requirements of this chapter.141 H. B. 520 - 6 - 25 LC 55 0511 43-24B-6.142 (a) Each applicant for a license under this chapter shall:143 (1) Submit an application in a form prescribed by the division;144 (2) Pay an application fee as determined by the advisory board;145 (3) Furnish to the advisory board a full set of fingerprints t o enable a criminal146 background investigation to be conducted on the applicant so as to determine the147 applicant's suitability to be a licensed midwife. The advisory board shall submit the148 applicant's fingerprints to the Georgia Crime Information Cente r. If no disqualifying149 record is identified at the state level, the Georgia Crime Information Center is authorized150 to submit the fingerprints to the Federal Bureau of Investigation for a national criminal151 history check. The Georgia Crime Information Center shall notify the advisory board in152 writing of the results of such criminal background investigation, which shall be used by153 the advisory board for the exclusive purpose of carrying out its responsibilities under this154 chapter, shall not be a public record, shall be privileged, and shall not be disclosed to any155 other person or agency;156 (4) Hold a current certification in adult cardiopulmonary resu scitation (CPR) and157 neonatal resuscitation from an organization recognized by the advisory board;158 (5) Provide documentation of successful completion of a pharmacology course approved159 by the advisory board; and160 (6) Hold a current certification in good standing from a midwi fery organization161 recognized by the advisory board, such as the North American Registry of Midwives, the162 American Midwifery Certification Board, or any successor organizations.163 (b) The advisory board, in its discretion, may issue a license to an applicant who does not164 meet the requirements of paragraph (6) of subsection (a) of this Code section but who:165 (1) Has received midwifery training, which shall include experience in initial obstetrical166 exams, prenatal care, births, newborn examinations, and postpar tum care, from a167 qualified instructor for at least three years; participated in at least 50 documented births;168 H. B. 520 - 7 - 25 LC 55 0511 and achieved a passing score on an examination approved by the advisory board relating169 to the practice of midwifery;170 (2) Has been engaged in the practice of midwifery for at least 25 years; or171 (3) Is licensed to engage in the practice of midwifery in another jurisdiction whose laws,172 in the opinion of the advisory board, require qualifications an d maintain standards173 substantially the same as those of this state for licensed midwives.174 43-24B-7.175 (a) A license issued by the advisory board shall be renewed every two years if the licensee176 is not in violation of this chapter at the time of application for renewal and has completed177 20 hours of continuing education approved by the advisory board since the license was178 issued or last renewed.179 (b) Each individual licensed under this chapter is responsible for renewing his or her180 license before the expiration date.181 43-24B-8.182 (a) The advisory board may revoke, suspend, deny, or refuse to issue or renew a license;183 place a licensee on probation; or issue a letter of admonition upon proof that the licensee184 or applicant has:185 (1) Procured or attempted to procure a license by fraud, decei t, misrepresentation,186 misleading omission, or material misstatement of fact;187 (2) Been convicted of a felony or of any crime involving moral turpitude as provided188 under state law;189 (3) Willfully or negligently acted in a manner inconsistent with the health or safety of190 persons under such licensee's care;191 H. B. 520 - 8 - 25 LC 55 0511 (4) Had a license to practice a business or profession suspend ed or revoked or has192 otherwise been subject to discipline related to such licensee's practice of a business or193 profession in any other jurisdiction;194 (5) Committed a fraudulent act that materially affects the fit ness of the licensee or195 applicant to practice a business or profession;196 (6) Excessively or habitually used alcohol or drugs, provided that the advisory board197 shall not discipline a licensee under this paragraph if such li censee is enrolled in a198 substance abuse program approved by the advisory board; or199 (7) A physical or mental disability that renders such licensee incapable of safely200 engaging in the practice of midwifery.201 (b) The advisory board is authorized to conduct investigations into allegations of conduct202 described in subsection (a) of this Code section.203 (c) In addition to revoking, suspending, denying, or refusing to renew a license, the204 advisory board may fine a licensee found to have violated any provision of this chapter or205 any rule adopted by the advisory board under this chapter in an amount of not less than206 $100.00 nor more than $500.00 for each such violation.207 (d) The provisions of Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,'208 shall be applicable to the advisory board and the provisions of this chapter.209 (e) Any person may file a complaint with the advisory board wi th respect to a licensed210 midwife.211 43-24B-9.212 (a) The advisory board may promulgate any rules and regulations necessary to carry out213 the provisions of this chapter.214 (b) The advisory board may act as a facilitator of the state-w ide dissemination of215 information concerning the practice of midwifery and the services of licensed midwives.216 H. B. 520 - 9 - 25 LC 55 0511 43-24B-10.217 (a) Except as provided in subsection (b) of this Code section, no person shall engage in the218 practice of midwifery in this state unless such person holds a license issued by the advisory219 board pursuant to Code Section 43-24B-5.220 (b) A person may engage in the practice of midwifery in this state without a license if:221 (1) The person is a licensed healthcare practitioner and the services provided are within222 the scope of the person's license; or223 (2)(A) The person does not advertise that the person is a licensed midwife; and224 (B) The person discloses the following to each client on an in formed disclosure225 document that is signed by the client:226 (i) That the person does not possess a license to engage in the practice of midwifery227 in this state;228 (ii) That the person's education and qualifications have not b een reviewed by the229 state;230 (iii) That the person is not authorized to carry and administer potentially life-saving231 medications;232 (iv) A plan for transporting the client to the hospital if a problem arises during labor233 or childbirth; and234 (v) That the client will not have recourse through a complaint process conducted by235 a professional licensing board.236 (c) Any individual engaging in the practice of midwifery without a license in violation of237 this Code section shall be subject to a fine of not less than $100.00 nor more than $500.00238 for each such violation.239 H. B. 520 - 10 - 25 LC 55 0511 43-24B-11.240 (a) Prior to engaging in the practice of midwifery with a client, a licensed midwife shall241 obtain informed consent from such client and retain a copy of such informed consent for242 at least four years.243 (b) A licensed midwife shall be authorized to file a birth certificate for each birth that such244 licensed midwife provides services in connection with in accordance with the laws of this245 state.246 43-24B-12.247 A licensed midwife shall:248 (1) Limit his or her practice to pregnancy, labor, delivery, and postpartum, newborn, and249 interconception care that is not a pharmacologically induced labor and in which the infant250 is born spontaneously between 37 and 43 completed weeks of gest ation; provided,251 however, that the limitation contained in this paragraph shall not prohibit a licensed252 midwife from delivering an infant when there is intrauterine fe tal demise or a fetal253 anomaly incompatible with life; and254 (2) Appropriately recommend and facilitate consultation or collaboration with or referral255 or transfer of care to a licensed healthcare professional when the circumstances require256 such action in accordance with this chapter and standards established by advisory board257 rule.258 43-24B-13.259 (a) If, after a client has been informed that she has or may have a condition indicating the260 need for medical consultation, collaboration, referral, or transfer, and the client declines a261 referral or transfer of care, the licensed midwife shall:262 (1) Terminate care in accordance with procedures established by advisory board rule; or263 H. B. 520 - 11 - 25 LC 55 0511 (2) Continue to provide care for the client if the client signs an informed consent waiver264 of medical consultation, collaboration, referral, or transfer. A licensed midwife shall not265 be held liable when such informed consent waiver is signed.266 (b) If, after a client has been informed that she has or may have a condition indicating the267 need for immediate transfer, and the client declines such trans fer, the licensed midwife268 shall, in accordance with procedures established by advisory board rule, terminate the care269 or initiate transfer by:270 (1) Calling 9-1-1 and reporting the need for immediate transfer;271 (2) Immediately transporting the client by private vehicle to the receiving provider; or272 (3) Contacting the physician to whom the client will be transferred and following such273 physician's orders.274 (c) The standards for consultation and transfer provided in this Code section represent the275 minimum requirements that a licensed midwife must adhere to. A licensed midwife shall276 initiate consultation or collaboration with or referral or tran sfer of a client to a licensed277 healthcare provider or facility at an earlier stage than mandated by administrative rule if,278 based on the licensed midwife's professional judgment and experience, the health status of279 the mother or infant necessitates such action.280 43-24B-14.281 (a) If a licensed midwife initiates consultation or collaborat ion with or the referral or282 transfer of a client to a licensed healthcare provider or facil ity, the responsibility of the283 provider or facility for the client shall not begin until the client is physically within the care284 of such provider or facility.285 (b) A licensed healthcare provider who examines a licensed midwife's client shall only be286 liable for the actual examination and shall not be held accountable for the client's decision287 to pursue an out-of-hospital birth or the services of a licensed midwife.288 H. B. 520 - 12 - 25 LC 55 0511 (c)(1) A licensed healthcare provider may, upon receiving a br iefing or data from a289 licensed midwife, issue a medical order for the licensed midwif e's client, without that290 client being an explicit patient of such provider.291 (2) Regardless of the advice given or order issued, the respon sibility and liability for292 caring for the client shall be that of the licensed midwife.293 (3) The provider giving the order shall be responsible and lia ble only for the294 appropriateness of the order, given the briefing or data received.295 (4) The issuing of an order for a licensed midwife's client sh all not constitute a296 delegation of duties from the other provider to the licensed midwife.297 (d) A licensed midwife shall be solely responsible for the administration of medications298 by such licensed midwife as authorized under this chapter.299 43-24B-15.300 A licensed midwife shall not be authorized to:301 (1) Administer a prescription drug to a client in a manner that violates this chapter;302 (2) Effect any type of surgical delivery except for the cuttin g of an emergency303 episiotomy;304 (3) Administer any type of epidural, spinal, or caudal anesthetic or any type of narcotic305 analgesic; or306 (4) Use forceps or a vacuum extractor.307 43-24B-16.308 Nothing in this chapter shall be construed to abridge or limit in any way the right of a309 parent or parents to deliver a fetus where, when, how, and with whom they choose.310 43-24B-17.311 (a) Nothing in this chapter shall be construed to prevent:312 H. B. 520 - 13 - 25 LC 55 0511 (1) Any licensed healthcare professional from engaging in the authorized scope of313 practice of his or her profession;314 (2) Members of a pregnant woman's family from providing incidental care;315 (3) Representatives of a pregnant woman's culture from providing care consistent with316 the tenets or practices of such culture or representatives of a pregnant woman's religion317 from providing care consistent with practices of such religion; provided, however, that318 such representatives shall not hold themselves out as licensed midwives unless such319 representatives are licensed under this chapter; or320 (4) Precepted apprentices, student midwives, and midwifery assistants from providing321 midwifery services under the supervision and in the physical pr esence of a licensed322 midwife.323 (b) The practice of midwifery shall not constitute the practice of medicine in this state.324 (c) Nothing in this chapter shall be construed to change the r egulation of physicians as325 provided for in the laws of this state.326 43-24B-18.327 Any health insurance policy, health maintenance organization plan, or other form of health328 insurance coverage, including Medicaid, that covers maternity care shall not deny coverage329 for maternity care provided by a licensed midwife in any settin g and shall reimburse330 maternity care by a licensed midwife at the same rate as for other providers of maternity331 care covered by the policy, plan, or coverage.332 43-24B-19.333 Any violation of this chapter or any rules and regulations adopted pursuant to this chapter334 is declared to be a public nuisance subject to abatement as pro vided in Code Section335 31-5-9."336 H. B. 520 - 14 - 25 LC 55 0511 SECTION 4.337 Said title is further amended in subsection (a) of Code Section 43-26-12, relating to338 exceptions to the operation of the "Georgia Registered Professional Nurse Practice Act," by339 striking "and" at the end of subparagraph (E) of paragraph (9), by replacing the period at the340 end of paragraph (10) with "; and", and by adding a new paragraph to read as follows:341 "(11) The practice of midwifery by a licensed midwife pursuant to Chapter 24B of this342 title."343 SECTION 5.344 This Act shall become effective upon its approval by the Governor or upon its becoming law345 without such approval.346 SECTION 6.347 All laws and parts of laws in conflict with this Act are repealed.348 H. B. 520 - 15 -