SRC-HRD H.B. 2088 75(R) BILL ANALYSIS
Senate Research Center H.B. 2088
By: Cuellar (Zaffirini)
Health & Human Services
5-12-97
Engrossed
DIGEST
Each year, a number of women in Texas turn to lay midwives as their
primary providers of childbirth services. This area of maternal health
care remains virtually unregulated, however, placing the lives of women
and their newborns at risk. There are also ambiguities in the current law
in regard to testing requirements for midwives, the definition of normal
pregnancy and infancy, state investigative authority, and the
administration of medication to prevent certain eye infections. This bill
would provide for increased regulation of midwifery in Texas.
PURPOSE
As proposed, H.B. 2088 provides for increased regulation of midwifery in
Texas.
RULEMAKING AUTHORITY
Rulemaking authority is granted to the Texas Midwifery Board under SECTION
4 (Section 8A, Article 4512i, V.T.C.S.) of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Sections 1(c)(1), (2), (11), (12), and (13), Article
4512i, V.T.C.S. (Texas Midwifery Act), to redefine "midwife" and
"midwifery," and define "normal" "newborn," and "postpartum period."
Removes the terms "normal childbirth," "newborn care," and "postpartum
care."
SECTION 2. Amends Section 3D(c), Article 4512i, V.T.C.S., to require the
program coordinator and chairman of the midwifery board, rather than the
Texas Board of Health (board), to notify the board, rather than the
governor, that a potential ground for removal exists.
SECTION 3. Amends Section 8, Article 4512i, V.T.C.S., to require the
midwifery board, subject to the approval of the board, to establish
requirements for basic, rather than approved, midwifery education and
midwifery continuing education, and establish eligibility requirements for
taking a comprehensive midwifery examination, rather than the final
examination of a basic midwifery education course, before initial
documentation, and approve a comprehensive midwifery examination that must
be passed before initial documentation. Deletes requirements regarding
qualifications for the instructors of certain courses and the issuance of
final examinations.
SECTION 4. Amends Section 8A, Article 4512i, V.T.C.S., to require the
midwifery board, subject to the approval of the board, to adopt
substantive and procedural rules as necessary for the documentation,
rather than identification, of midwives; to adopt rules prescribing the
standards for the practice of midwifery in this state, including standards
required for the delineation of findings that preclude a woman or newborn
from being classified as having a normal pregnancy, labor, delivery,
postpartum period, or newborn period; to adopt and implement substantive
and procedural rules as necessary to discipline midwives determined to be
in violation of this Act or otherwise a threat to the public health and
safety; and to adopt rules as necessary to establish eligibility for
reciprocity for initial documentation under this Act. Sets forth
requirements regarding rules adopted under Subsection (b)(7) of this
section. Makes nonsubstantive and conforming changes.
SECTION 5. Amends Section 9(a), Article 4512i, V.T.C.S., to require the
Texas Department of Health (department) to provide the manuals to each
documented midwife and to any other person on request.
SECTION 6. Amends Section 10(b), Article 4512i, V.T.C.S., to require the
person to provide the program coordinator with documentary evidence, at
the time of initial documentation, that the person has met all the
requirements for mandatory basic midwifery education as prescribed by
rules approved by the board and has passed the comprehensive midwifery
examination approved by the midwifery board. Deletes text authorizing the
person to also provide the program coordinator with a letter of
documentation.
SECTION 7. Amends Section 11, Article 4512i, V.T.C.S., to require the
midwifery board, with the approval of the board, to adopt a comprehensive
midwifery examination for persons regulated under this Act. Makes a
conforming change.
SECTION 8. Amends Section 12, Article 4512i, V.T.C.S., to require the
department to provide a letter of documentation to a person who fulfills
the requirements, rather than the educational requirements, for
documentation.
SECTION 9. Amends Section 15, Article 4512i, V.T.C.S., to require the
department to maintain a roster of all persons documented as midwives in
this state, rather than of all persons identified to practice midwifery.
Requires the roster to contain for each person the information required on
the documentation form of this Act and other information that the
department determines necessary to identify with accuracy each midwife who
is documented, rather than identified, under this Act. Requires the
information to be public information, rather than public record, as
defined in Chapter 5522, Government Code, rather than Chapter 424 of
Article 6252-17a, V.T.C.S.
SECTION 10. Amends Section 16(f), Article 4512i, V.T.C.S., to require a
midwife to encourage a client to seek medical care through consultation or
referral, as specified by rules adopted by the midwifery board, if the
midwife determines that the pregnancy, labor, delivery, postpartum period,
or newborn period of a woman or newborn may not be classified as "normal"
for purposes of this Act. Deletes text regarding the recognition by a
midwife of a sign or symptom of a complication to the client's childbirth.
SECTION 11. Amends Article 4512i, V.T.C.S., by adding Section 16A, as
follows:
Sec. 16A. PREVENTION OF OPHTHALMIA NEONATORUM. Requires a midwife who
attends the birth of a child, unless the newborn is immediately
transferred to a hospital because of an emergency, to administer to that
child prophylaxis approved by the board for the prevention of ophthalmia
neonatorum as required under Section 81.091, Health and Safety Code.
SECTION 12. Amends Section 17, Article 4512i, V.T.C.S., to set forth
prohibitions for a midwife.
SECTION 13. Amends Article 4512i, V.T.C.S., by adding Section 17A, as
follows:
Sec. 17A. GROUNDS FOR DISCIPLINARY ACTION; REFUSAL TO ISSUE LETTER OF
DOCUMENTATION. Authorizes the board, with the recommendation of the
midwifery board, to discipline a documented midwife and to refuse to issue
a letter of documentation to an individual for certain reasons. Requires
the board to inform the midwifery board of, and provide the midwifery
board an opportunity for input in, each stage of a disciplinary proceeding
initiated by the board under this Act, including the imposition of an
administrative penalty under Section 18E of this Act.
SECTION 14. Amends Section 18(a), Article 4512i, V.T.C.S., to provide that
a person required to be documented under this Act commits an offense if
the person, rather than midwife, knowingly or intentionally takes
practices midwifery without proper documentation issued under this Act.
Deletes text regarding failure to take certain action.
SECTION 15. Amends Section 18B(a), 4512i, V.T.C.S., to authorize the
attorney general or a district, county, or city attorney, upon the
recommendation of the midwifery board and at the request of the
commissioner of health, to institute a civil action in district court to
collect a civil penalty from a person who is required to be documented
under this Act and who knowingly or intentionally has practiced midwifery
without proper documentation issued under this Act, or in violation of an
order of the midwifery board or while the person's documentation was
suspended or revoked.
SECTION 16. Amends Section 18D, Article 4512i, to set forth requirements
regarding rules adopted under this subsection to provide for the release
of any relevant midwifery or medical record to the midwifery board under
certain circumstances.
SECTION 17. Amends Section 4512i, V.T.C.S., by adding Section 18E, as
follows:
Sec. 18E. ADMINISTRATIVE PENALTY. Authorizes the department to assess an
administrative penalty against a person who violates this Act or a rule
adopted under this Act. Sets forth provisions regarding the amount and
assessment of the penalty. Sets forth provisions applicable if, after
investigation of a possible violation and the facts surrounding that
possible violation, the department determines that a violation has
occurred. Sets forth requirements regarding written notice of the
violation to the person alleged to have committed the violation. Sets
forth provisions regarding receipt of notice, acceptance of the
determination, and hearing on the determination. Sets forth requirements
for the hearings examiner. Authorizes the commissioner of health or that
commissioner's designee, based on the findings of fact and conclusion of
law and the recommendations of the hearings examiner, by order, to find
that a violation has occurred and to assess a penalty or to find that no
violation has occurred. Requires the department to give notice of the
order under Subsection (j) of this section to the person notified, and
sets forth requirements regarding the notice. Sets forth requirements
regarding the payment of the penalty and filing a petition for judicial
review. Sets forth provisions regarding a person who without paying the
penalty, files a petition for judicial review. Sets forth provisions
regarding judicial review and the resulting judgment of the court. Sets
forth provisions regarding an administrative penalty collected under this
section. Authorizes the department to assess reasonable expenses and
costs against a person in an administrative hearing under certain
conditions, and sets forth related provisions. Authorizes the attorney
general to recover, under certain conditions, on behalf of the attorney
general and the department, reasonable expenses and costs. Defines
"reasonable expenses and costs." Sets forth requirements regarding costs
and expenses collected under this section.
SECTION 18. Amends Section 483.001(c), Health and Safety Code, to redefine
"prescription."
SECTION 19. Amends Section 483.041(c), Health and Safety Code, to provide
that Subsection (a) does not apply to the possession of a dangerous drug
in the usual course of business or practice or in the performance of
official duties by a documented midwife or agent or employee of a
documented midwife, who obtains oxygen for administration to a mother or
newborn or who obtains a dangerous drug for the administration of
prophylaxis to a newborn for the prevention of ophthalmia neonatorum in
accordance with Section 16A, Article 4512i, V.T.C.S.
SECTION 20. Repealer: Sections 10(e)-(i), Article 4512i, V.T.C.S.
(Approved Course; Number of Courses; Spanish; Expired; Competent
Performance--Educational Requirements).
SECTION 21. Effective date: September 1, 1997.
SECTION 22. Emergency clause.