Nurse-midwives: naturopathic doctors: alternative birth centers.

(1) The Nursing Practice Act provides for the licensure and regulation of registered nurses by the Board of Registered Nursing, which is within the Department of Consumer Affairs. A violation of the act is a crime. Existing law authorizes the board to appoint a committee of qualified physicians and nurses to develop standards for educational requirements, ratios of nurse midwives to supervising physicians, and associated matters. This bill would delete those provisions and would instead require the board to appoint a committee of physicians and surgeons and nurses to make recommendations to the board on all matters relating to midwifery practice, including, but not limited to, education and appropriate standards of care. (2) Existing law authorizes the holder of a certificate to practice nurse-midwifery to perform various functions under the supervision of a licensed physician and surgeon, including attending to cases of normal childbirth. Existing law defines the practice of nurse midwifery as the furthering or undertaking by any certified person, under the supervision of a physician and surgeon, to assist a woman in childbirth so long as progress meets criteria accepted as normal. This bill would delete the requirement that a certified nurse-midwife practice under the supervision of a physician and surgeon and would authorize a certified nurse-midwife to attend to cases of normal pregnancy and childbirth, a term that would be defined by the bill as satisfying specified conditions, including, among others, the absence of preexisting diseases or conditions or significant diseases arising from pregnancy. The bill, however, would authorize a certified nurse-midwife to attend to a case of childbirth if a preexisting disease or condition or significant disease arises if all other conditions are satisfied and the potential midwife client obtains an examination by a physician and surgeon. The bill would prohibit a certified nurse-midwife from providing or continuing to provide care to a woman with a risk factor that will adversely affect the course of pregnancy and childbirth. (3) Existing law authorizes a certified nurse-midwife to furnish drugs or devices, including controlled substances, in specified circumstances, including if drugs or devices are furnished or ordered incidentally to the provision of care in specified settings, including certain licensed health care facilities, birth centers, and maternity hospitals under physician and surgeon supervision. This bill would also authorize a certified nurse-midwife to furnish drugs or devices when care is rendered in a home and would authorize the furnishing or ordering of drugs or devices under standardized procedures and protocols rather than under physician and surgeon supervision. The bill would authorize a certified nurse-midwife to procure supplies and devices, obtain and administer diagnostic tests, order laboratory and diagnostic testing, and receive reports, as specified. This bill would make it a misdemeanor for a certified nurse-midwife to refer a person for specified laboratory and diagnostic testing, home infusion therapy, and imaging goods or services if the certified nurse-midwife or his or her immediate family member has a financial interest with the person receiving a referral. By expanding the scope of a crime, the bill would impose a state-mandated local program. (4) Existing law authorizes a certified nurse-midwife to perform and repair episiotomies and repair lacerations of the perineum in specified health care facilities only if specified conditions are met, including that the certified nurse-midwife's supervising physician and surgeon is credentialed to perform obstetrical care at the facility. This bill would delete those conditions. The bill would require a certified nurse-midwife to establish procedures that relate to the performance and repair of the perineum that, among other things, ensures that all complications are referred to a physician and surgeon immediately. (5) This bill would require a certified nurse-midwife who is not under the supervision of a physician and surgeon to provide an oral and written disclosure to a client and obtain a client's written consent, as specified. The bill would require each certified nurse-midwife who assists in or supervises in assisting in childbirth that occurs outside of a hospital to annually report specified information to the Office of Statewide Health Planning and Development, would require the office to annually report the information to the board, and would require the board to include the information in the board's annual report to the Legislature. The bill would provide that a violation of those provisions is not a crime. (6) Existing law, the Naturopathic Doctors Act, provides for the licensure and regulation of naturopathic doctors by the Naturopathic Medicine Committee in the Osteopathic Medical Board of California. The act authorizes a naturopathic doctor to perform naturopathic childbirth attendance subject to specified requirements and conditions. This bill would authorize a naturopathic doctor certified for the specialty practice of childbirth attendance to perform and repair episiotomies and lacerations of the perineum in certain health care facilities if specified conditions are met. (7) Under existing law, the State Department of Public Health licenses and regulates clinics, as defined. Existing law generally makes it a misdemeanor to violate any provision related to the licensure and regulation of clinics. Existing law requires an alternative birth center that is licensed as an alternative birth center specialty clinic to meet specified requirements, including requiring the presence of at least 2 attendants during birth, one of whom is required to be a physician and surgeon, a licensed midwife, or a certified nurse-midwife. This bill would require an alternative birth center to be licensed as an alternative birth center specialty clinic. By expanding the scope of a crime, the bill would impose a state-mandated local program. (8) 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.