UPDATE/MODERNIZE/MIDWIFERY PRACTICE ACT.

View NCGA Bill Details2013-2014 Session
House Bill 204 (Public) Filed Monday, March 4, 2013
A BILL TO BE ENTITLED AN ACT REQUIRING THE JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON HEALTH AND HUMAN SERVICES TO STUDY WHETHER CERTIFIED NURSE MIDWIVES SHOULD BE GIVEN MORE FLEXIBILITY IN THE PRACTICE OF MIDWIFERY.
Intro. by Stevens, Burr, Glazier, Hamilton.

Status: Re-ref Com On Rules, Calendar, and Operations of the House (House Action) (May 15 2013)

SOG comments (1):

Long title change

House committee substitute to the second edition changed the long title. Original long title was A BILL TO BE ENTITLED AN ACT TO UPDATE AND MODERNIZE THE MIDWIFERY PRACTICE ACT.

 

 

H 204

Bill Summaries:

  • Summary date: May 15 2013 - More information

    House committee substitute makes the following changes to the 2nd edition.

    Changes the long title.

    Deletes the provisions of the 2nd edition in their entirety and provides for the following:

    Directs the Joint Legislative Oversight Committee on Health and Human Services to create a new subcommittee to study whether certified nurse midwives should be given more flexibility in the practice of midwifery. The Chair of the Committee will appoint members to the subcommittee and can appoint members of the public, in addition to any members of the General Assembly.

    The subcommittee will be tasked with studying whether a certified nurse midwife should be allowed to practice midwifery in collaboration with, rather than under the supervision of, a licensed physician engaged in the practice of obstetrics.

    The subcommittee will submit a final report of its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services no later than April 1, 2014, with the Committee submitting a final report to the 2014 Regular Session of the 2014 General Assembly by May 15, 2014.


  • Summary date: May 8 2013 - More information

    House committee substitute makes the following changes to the 1st edition.

    Adds a whereas clause.

    Amends GS 90-18.7, Limitations on nurse-midwives, making conforming changes, inserting "certified" before "nurse-midwife" throughout the section.

    Amends GS 90-178.2, Definitions, to reinstate the term "interconceptional care" and delete "family planning" from the definition for interconceptional care. Expands the same definition, including gynecologic care and management of common health problems as types of interconceptional care. Amends the definitions for the terms intrapartum care, midwifery, newborn care, postpartum care, and prenatal care. Deletes the term and definition for primary care from the section.

    Amends GS 90-178.3, Regulation of midwifery, providing that certified nurse-midwives (CNMs) must consult, collaborate with, or refer to other providers licensed under this Article if indicated by the health status of the patient (previously, section required CNMs to practice within a health care system that provided for consultation, collaborative management, or referral. Also required midwifery standards to be consistent with the standards of care established by the American College of Nurse-Midwives, as well as requiring certified nurse-midwives to provide each patient with information regarding or referral to other providers and services at the request of the patient or when required care is outside the scope of the midwife's practice). Also deletes provision that provided that individuals engaging in the practice of midwifery without a license are in violation of this Article and Article 1 of GS Chapter 90.

    Amends GS 90-178.4(a), making technical and clarifying changes, replacing "pursuant" with "under" throughout the subsection.

    Amends GS 90-178.4, deleting the provisions of the previous edition and adding two new subsections as follows. Deletes proposed language and provisions for GS 90-178.4(a1), found in the previous edition, replacing them with two new subsections, GS 90-178.4(a1) and (a2), requiring CNMs attending planned births outside a hospital setting to obtain written informed consent from the patient, which must include (1) risk information, (2) assumption of risk by the patient, (3) patient agreement to transfer to a health care facility if deemed necessary by the CNM, and (4) a disclosure if the CNM is not covered by liability insurance. Also requires a CNM attending a planned birth outside a hospital setting to provide the patient a specific, detailed transfer plan to a hospital.

    Amends GS 90-178.4(b), making technical and clarifying changes and deleting the requirement that the joint subcommittee must adopt rules for establishing physician supervision of the CNM. Provides that rules will be adopted regarding the form and contents of applications, which will include information regarding the applicant's education and certification by the American Midwifery Certification Board (was, American College of Nurse Midwives).

    Amends GS 90-178.5, making a technical change.

    Amends GS 90-178.7(b) to provide that any person practicing midwifery without being approved and registered under Article 10A of GS Chapter 90 will not collect a fee for services provided. Any person practicing without being duly approved will be guilty of a Class 3 misdemeanor. Also establishes that any person practicing midwifery without proper approval and who holds himself or herself out as being approved as such will be guilty of a Class I felony.

    Amends GS 90-178.8, making clarifying and technical changes, and providing that  physicians, physician assistants, or nurses will not be held liable for civil damages arising from any medical care or treatment in specified situations; however, each will remain liable for his or her own independent negligent acts. Similarly, provides that no health care facility licensed under GS 122C or 131E is liable for any civil damages arising from medical care or treatment it provides in specified situations; however, the facility will remain liable for its own independent negligent acts.

     


  • Summary date: Mar 4 2013 - More information

    Amends GS 90 by adding new section, GS 90-19.7, Limitations on nurse-midwives, providing that nurse-midwives approved under Article 10A of GS Chapter 90 may use the title certified nurse-midwife. Others that hold themselves out as such are in violation. Certified nurse-midwives are authorized to write prescriptions if (1) the individual has been approved by the joint subcommittee of the North Carolina Medical Board and the Board of Nursing(subcommittee) established under GS 90-178.4; (2) the subcommittee has assigned an i.d. number to the nurse-midwife, which appears on the written prescription; (3) written instructions about indications and contraindications for prescribing drugs and policy for periodic review of the drugs prescribed have been provided to the nurse-midwife by the subcommittee.

    Directs the subcommittee to adopt rules for approving individual nurse-midwifes to write prescriptions, with any limitations deemed in the best interest of patient health and safety.

    Amends GS 90-178.2, Definitions, by adding and defining certified nurse-midwife, intrapartum care, and primary care. Deletes Interconceptional care term and definition. Updates, adds language to, and makes technical and conforming changes to midwifery, newborn care, postpartum care, and prenatal care definitions.

    Amends GS 90-178.3, Regulation of midwifery, by stating that a person engaging in the unapproved pactice of midwifery is not only in violation of Article 10A of GS 90 but also in violation of practicing medicine without a license.  Requires certified nurse-midwives to practice within a health care system that provides for consultation, collaborative management, or referral. Midwifery standards must be consistent with the standards of care established by the American College of Nurse-Midwives. Each nurse midwife must provide each patient with information regarding or referral to other providers and services at the request of the patient or when requried care is outside the scope of the midwife's practice.

    Amends GS 90-178.4(a), altering the makeup of the subcommitte. Requires that  seven additional members of the subcommittee consist of five certified nurse-midwives  appointed by the recommendation of the NC Affilaite of the Amercian College of Nurse-Midwives, and two physicians actively engaged in the practice of obstetrics (was, four additional members, two certified midwives, and two obstetricians who have worked with certified midwives).

    Amends GS 90-178.4, addding a new subsection requiring the subcommittee to adopt rules requiring a certified nurse-midwife that attends a planned birth outside of a hospital to obtain a signed informed consent agreement from the patient. Information about the certified nurse-midwife's liability insurance coverage must be included.

    Amends GS 90-178.5, Qualification for approval, requiring the submittal of certification by the American Midwifery Certification Board (was, American College of Nurse Midwives). Makes other technical and conforming changes.

    Amends GS 90, by adding a new section, GS 90-178.8, Limit vicarious liability, limiting the liability of physicians, physician assistants, or nurses licensed under GS 90 from being held liable for civil damages as a result of medical care given to a woman or infant in an emergency situation when the emergency situation arises during the delivery or birth of the infant as a consequence of care provided by a nurse mid-wife approved under GS 90, who attends a planned birth outside of a hospital setting. Also limits the liability of health care facilities licensed under GS 122C and 131E in the same manner. Liability is not limited in cases of gross negligence or wanton misconduct.


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