Emergency services and care: nurse-midwives.

In Section 1317.10 (Stanford Hospital provision), a subsection was removed that broadly stated nothing in the section should be construed to require physician supervision of a nurse-midwife providing emergency services within their scope of licensure. The remaining provision is more specific, limiting the exemption to the labor and delivery unit, obstetric triage, or dedicated emergency obstetric evaluation unit.

The Legislative Counsel's Digest was reformatted and cleaned up: 'as amended' was removed from the header, and some garbled text in the existing law description was corrected. No substantive policy change in the digest content.

The amendment to Section 311 of the Business and Professions Code, which allowed the Department of Consumer Affairs director to create an interdepartmental committee, was removed entirely. This provision was unrelated to the bill's core purpose regarding nurse-midwife emergency care.

A new subdivision (n) was added to Section 1317.1 of the Health and Safety Code explicitly stating that physician supervision is not required for a licensed nurse-midwife in the labor and delivery unit, obstetric triage, or dedicated emergency obstetric evaluation unit when providing care authorized by Section 2746.5, or when specifically requested by the treating physician to provide obstetric consultation.

A new subdivision (e) was added to Section 1317.10 of the Health and Safety Code (the Stanford-specific provision) with the same no-physician-supervision language for nurse-midwives in labor and delivery, obstetric triage, or dedicated emergency obstetric evaluation units.

The fiscal committee vote changed from 'no' to 'yes' and the state-mandated local program designation changed from 'no' to 'yes,' indicating the bill now carries recognized fiscal and local mandate implications.

The bill now amends Health and Safety Code Sections 1317.1 and 1317.10 in addition to the original Business and Professions Code Section 311, expanding its scope from a minor administrative cleanup to health care emergency services policy.

New subdivision (n) of Health and Safety Code Section 1317.1 specifies that nurse-midwives licensed under Business and Professions Code Section 2746.5 do not require physician supervision when providing emergency services and care within their authorized scope of licensure.

New Health and Safety Code Section 1317.10 allows Stanford Hospital and Clinics and Lucile Packard Children's Hospital at Stanford to be treated as a single licensed facility for active labor emergencies, subject to conditions including a formal agreement between the hospitals, clinical determination of active labor before transfer, patient right to refuse transfer, and a prepared transport plan with trained escorts.

A new Section 3 states that no state reimbursement is required under Article XIII B of the California Constitution because the act changes the definition of a crime. The fiscal committee designation changed from 'no' to 'yes' and state-mandated local program changed from 'no' to 'yes','indicating the bill now carries fiscal implications.

The full text of Health and Safety Code Section 1317.1 was rewritten, incorporating existing definitions (emergency services and care, emergency medical condition, active labor, hospital, stabilization, psychiatric emergency medical condition, etc.) and adding the new nurse-midwife independence provision as subdivision (n).

The original nonsubstantive amendment to Business and Professions Code Section 311 (changing 'him' to 'the director' and 'such the committee' to 'the committee') was retained but moved to the end of the bill.