SRC-HRD C.S.H.B. 2088 75(R)BILL ANALYSIS
Senate Research CenterC.S.H.B. 2088
By: Cuellar (Zaffirini)
Health & Human Services
5-17-97
Committee Report (Substituted)
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, C.S.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 and standards for administration of
oxygen to a mother or newborn by a midwife; 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. Requires a midwife certified by the North
American Registry of Midwives, notwithstanding Subsection (a)(6), that in
an identification statement or advertisement, uses "certified" as part of
the midwife's title, to include in the statement or advertisement that the
midwife is certified by the North American Registry of Midwives and is not
certified by the State of Texas.
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 midwifery board to discipline a documented
midwife and to refuse to issue a letter of documentation to an individual
for certain reasons.
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, at the request
of the midwifery board or 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 midwifery board 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 midwifery board or its designee 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 midwifery board, 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
midwifery board 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 midwifery board 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, midwifery board, 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.
SUMMARY OF COMMITTEE CHANGES
SECTION 12.
Amends Section 17, Article 4512i, V.T.C.S., to undelete proposed deleted
text in proposed Subsection (6) and set forth a new provision regarding an
exception. Redesignates proposed Subdivision (7) as Subdivision (8) and
removes certain proposed text. Undeletes proposed deleted text in
proposed Subsection (7) and redesignates that text under Subdivision (9).
Makes conforming changes. Adds Subsection (b) regarding certification by
the North American Registry of Midwives.
Amendment 1.
Page 3, line 18, add "and standards for administration of oxygen to a
mother or newborn by a midwife" after "newborn period."
Page 8, line 10, add "or the administration of oxygen in accordance with
rules of the midwifery board" after neonatorum."
Page 9, line 25, delete the letter "(a)."
Page 9, line 25-26, delete "board, with the recommendation of the
midwifery board," and substitute "midwifery board."
Page 10, line 26, delete Subsection (b) in its entirety.
Page 11, lines 22-23, and delete the underlined language. Delete the
strike out of "At." On line 23 insert "midwifery board or" before
"commissioner."
Page 12, line 23, change "department: to midwifery board."
Page 13, line 3, change "department: to midwifery board."
Page 14, line 25, change "department: to midwifery board."
Page 16, line 6, change "department: to midwifery board."
Page 16, line 7, change "department: to midwifery board."
Page 16, line 8, change "department: to midwifery board."
Page 16, line 17, change "department: to midwifery board."
Page 17, line 5, change "department: to midwifery board."
Page 17, line 16, change "department: to midwifery board."
Page 17, line 24, change "department: to midwifery board."
Page 18, line 4, change "department: to midwifery board."
Page 13, line 3, change "department" to "midwifery board or its designee."
Page 13, line 14, change "department" to "midwifery board or its designee."
Page 13, line 26, change "department" to "midwifery board or its designee."
Page 14, line 3, change "department" to "midwifery board or its designee."
Page 14, line 8, change change "department" to "midwifery board or its
designee."
Page 14, lines 3 and 4, change "commissioner of health or the
commissioner's designee" to "midwifery board."
Page 14, lines 15-16, change "commissioner of health or the commissioner's
designee" to "midwifery board."
Page 14, lines 21-22, change "commissioner of health or the commissioner's
designee" to "midwifery board."
Page 18, line 2, change "commissioner of health or the commissioner's
designee" to "midwifery board."
Page 18, line 9, insert ",midwifery board," after the second "attorney
general."
Page 18, line 12, insert ",midwifery board," after "department."