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AB-2682 Nurse-midwives: naturopathic doctors: alternative birth centers.(2017-2018)

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Date Published: 06/19/2018 04:00 AM
AB2682:v97#DOCUMENT

Amended  IN  Senate  June 18, 2018
Amended  IN  Assembly  May 22, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2682


Introduced by Assembly Member Burke

February 15, 2018


An act to amend Sections 650.01, 2746.2, 2746.5, 2746.51, 2746.52, and 3653 of, and to add Sections 2746.54 and 2746.55 to, the Business and Professions Code, and to amend Section 1204.3 of the Health and Safety Code, relating to healing arts. reproductive health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2682, as amended, Burke. Nurse-midwives: naturopathic doctors. 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 a an oral and written disclosure to a client and obtain a client’s written consent, as specified. The bill would provide that a violation of those provisions is not a crime. The
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.

(7)

(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.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 650.01 of the Business and Professions Code is amended to read:

650.01.
 (a) Notwithstanding Section 650, or any other provision of law, it is unlawful for a licensee to refer a person for laboratory, diagnostic nuclear medicine, radiation oncology, physical therapy, physical rehabilitation, psychometric testing, home infusion therapy, or diagnostic imaging goods or services if the licensee or his or her immediate family has a financial interest with the person or in the entity that receives the referral.
(b) For purposes of this section and Section 650.02, the following shall apply:
(1) “Diagnostic imaging” includes, but is not limited to, all X-ray, computed axial tomography, magnetic resonance imaging nuclear medicine, positron emission tomography, mammography, and ultrasound goods and services.
(2) A “financial interest” includes, but is not limited to, any type of ownership interest, debt, loan, lease, compensation, remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, between a licensee and a person or entity to whom the licensee refers a person for a good or service specified in subdivision (a). A financial interest also exists if there is an indirect financial relationship between a licensee and the referral recipient including, but not limited to, an arrangement whereby a licensee has an ownership interest in an entity that leases property to the referral recipient. Any financial interest transferred by a licensee to any person or entity or otherwise established in any person or entity for the purpose of avoiding the prohibition of this section shall be deemed a financial interest of the licensee. For purposes of this paragraph, “direct or indirect payment” shall not include a royalty or consulting fee received by a physician and surgeon who has completed a recognized residency training program in orthopedics from a manufacturer or distributor as a result of his or her research and development of medical devices and techniques for that manufacturer or distributor. For purposes of this paragraph, “consulting fees” means those fees paid by the manufacturer or distributor to a physician and surgeon who has completed a recognized residency training program in orthopedics only for his or her ongoing services in making refinements to his or her medical devices or techniques marketed or distributed by the manufacturer or distributor, if the manufacturer or distributor does not own or control the facility to which the physician is referring the patient. A “financial interest” shall not include the receipt of capitation payments or other fixed amounts that are prepaid in exchange for a promise of a licensee to provide specified health care services to specified beneficiaries. A “financial interest” shall not include the receipt of remuneration by a medical director of a hospice, as defined in Section 1746 of the Health and Safety Code, for specified services if the arrangement is set out in writing, and specifies all services to be provided by the medical director, the term of the arrangement is for at least one year, and the compensation to be paid over the term of the arrangement is set in advance, does not exceed fair market value, and is not determined in a manner that takes into account the volume or value of any referrals or other business generated between parties.
(3) For the purposes of this section, “immediate family” includes the spouse and children of the licensee, the parents of the licensee, and the spouses of the children of the licensee.
(4) “Licensee” means a physician as defined in Section 3209.3 of the Labor Code or a certified nurse-midwife as described in Article 2.5 (commencing with Section 2746) of Chapter 6.
(5) “Licensee’s office” means either of the following:
(A) An office of a licensee in solo practice.
(B) An office in which services or goods are personally provided by the licensee or by employees in that office, or personally by independent contractors in that office, in accordance with other provisions of law. Employees and independent contractors shall be licensed or certified when licensure or certification is required by law.
(6) “Office of a group practice” means an office or offices in which two or more licensees are legally organized as a partnership, professional corporation, or not-for-profit corporation, licensed pursuant to subdivision (a) of Section 1204 of the Health and Safety Code, for which all of the following apply:
(A) Each licensee who is a member of the group provides substantially the full range of services that the licensee routinely provides, including medical care, consultation, diagnosis, or treatment through the joint use of shared office space, facilities, equipment, and personnel.
(B) Substantially all of the services of the licensees who are members of the group are provided through the group and are billed in the name of the group and amounts so received are treated as receipts of the group, except in the case of a multispecialty clinic, as defined in subdivision (l) of Section 1206 of the Health and Safety Code, physician services are billed in the name of the multispecialty clinic and amounts so received are treated as receipts of the multispecialty clinic.
(C) The overhead expenses of, and the income from, the practice are distributed in accordance with methods previously determined by members of the group.
(c) It is unlawful for a licensee to enter into an arrangement or scheme, such as a cross-referral arrangement, that the licensee knows, or should know, has a principal purpose of ensuring referrals by the licensee to a particular entity that, if the licensee directly made referrals to that entity, would be in violation of this section.
(d) No claim for payment shall be presented by an entity to any individual, third party payer, or other entity for a good or service furnished pursuant to a referral prohibited under this section.
(e) No insurer, self-insurer, or other payer shall pay a charge or lien for any good or service resulting from a referral in violation of this section.
(f) A licensee who refers a person to, or seeks consultation from, an organization in which the licensee has a financial interest, other than as prohibited by subdivision (a), shall disclose the financial interest to the patient, or the parent or legal guardian of the patient, in writing, at the time of the referral or request for consultation.
(1) If a referral, billing, or other solicitation is between one or more licensees who contract with a multispecialty clinic pursuant to subdivision (l) of Section 1206 of the Health and Safety Code or who conduct their practice as members of the same professional corporation or partnership, and the services are rendered on the same physical premises, or under the same professional corporation or partnership name, the requirements of this subdivision may be met by posting a conspicuous disclosure statement at the registration area or by providing a patient with a written disclosure statement.
(2) If a licensee is under contract with the Department of Corrections or the California Youth Authority, and the patient is an inmate or parolee of either respective department, the requirements of this subdivision shall be satisfied by disclosing financial interests to either the Department of Corrections or the California Youth Authority.
(g) A violation of subdivision (a) shall be a misdemeanor. The Medical Board of California or, for certified nurse-midwives, the Board of Registered Nursing, shall review the facts and circumstances of any conviction pursuant to subdivision (a) and take appropriate disciplinary action if the licensee has committed unprofessional conduct. Violations of this section may also be subject to civil penalties of up to five thousand dollars ($5,000) for each offense, which may be enforced by the Insurance Commissioner, Attorney General, or a district attorney. A violation of subdivision (c), (d), or (e) is a public offense and is punishable upon conviction by a fine not exceeding fifteen thousand dollars ($15,000) for each violation and appropriate disciplinary action, including revocation of professional licensure, by the Medical Board of California or other appropriate governmental agency.
(h) This section shall not apply to referrals for services that are described in and covered by Sections 139.3 and 139.31 of the Labor Code.
(i) This section shall become operative on January 1, 1995.

SEC. 2.

 Section 2746.2 of the Business and Professions Code is amended to read:

2746.2.
 (a) Each applicant shall show by evidence satisfactory to the board that he or she has met the educational standards established by the board or has at least the equivalent thereof.
(b) A certified nurse-midwife shall practice under the supervision of a licensed physician and surgeon or an experienced certified nurse-midwife for a minimum of 18 months in the period immediately following his or her licensure. A certified nurse-midwife who obtained his or her license prior to January 1, 2019, or who was licensed outside of California prior to January 1, 2019, shall be required to show that he or she has met the minimum supervision practice requirement.
(c) The board shall appoint a committee of qualified physicians and surgeons and nurses, including, but not limited to, obstetricians and nurse-midwives, to make recommendations to the board on all matters related to nurse-midwifery practice, including, but not limited to, education, disciplinary actions, appropriate standards of care, and other matters as specified by the board.

SEC. 3.

 Section 2746.5 of the Business and Professions Code is amended to read:

2746.5.
 (a) The certificate to practice nurse-midwifery authorizes the holder to attend cases of normal pregnancy and childbirth and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn.
(b) As used in this chapter, the practice of nurse-midwifery constitutes the furthering or undertaking by any certified nurse-midwife to assist a woman in childbirth so long as progress meets criteria accepted as normal.
(c) Normal pregnancy and childbirth is defined as meeting all of the following conditions:
(1) There is a single fetus.
(2) There is a cephalic presentation.
(3) The gestational age of the fetus is greater than 37 weeks and less than 42 weeks of pregnancy at the time of delivery.
(4) Labor is spontaneous or induced in an outpatient setting.
(5) There is an absence of both of the following:
(A) A preexisting disease or condition that adversely affects the pregnancy.
(B) Significant disease arising from the pregnancy.
(d) Notwithstanding subdivision (c), if a potential midwife client meets the conditions specified in paragraphs (1) to (4), inclusive of subdivision (c), but fails to meet the condition specified in paragraph (5) of subdivision (c), the certified nurse-midwife shall provide the client with a referral for an examination by a physician and surgeon trained in obstetrics and gynecology and, after the examination is obtained, may assist the client in pregnancy and childbirth.
(e) (1) If, at any point during pregnancy, childbirth, or postpartum care, a client’s condition deviates from the conditions of normal pregnancy and childbirth, the certified nurse-midwife shall immediately refer or transfer the client to a physician and surgeon. The certified nurse-midwife shall consult and remain in consultation with the physician and surgeon after the referral or transfer throughout the pregnancy.
(2) If a physician and surgeon determines that the client’s condition has been resolved such that the risk factors presented by a client’s disease or condition are not likely to adversely affect the course of pregnancy or childbirth, the certified nurse-midwife may resume primary care of the client and resume assisting the client during her pregnancy, childbirth, or postpartum care.
(3) If a physician and surgeon determines, after consulting with the attending certified nurse-midwife, that the client’s condition has not been resolved as specified in paragraph (2), or the client fails to meet any of the conditions specified in paragraph (1), the certified nurse-midwife shall only provide care under the supervision of a licensed physician and surgeon and, if authorized by the client, be present during the labor and childbirth, and resume postpartum care, if appropriate. A certified nurse-midwife shall not resume primary care of the client until a physician and surgeon determines the client’s condition has been resolved as specified in paragraph (2).
(f) A certified nurse-midwife shall not provide or continue to provide midwifery care to a client with a risk factor that will adversely affect the course of pregnancy and childbirth, regardless of whether the client has consented to this care or refused care by a physician or surgeon, except as provided in subdivision (d).
(g) (1) Notwithstanding any other law, a certified nurse-midwife shall refer to, or transfer care to, a physician and surgeon in any of the following situations:
(A) The condition is beyond the certified nurse-midwife’s scope of practice.
(B) There is evidence that a condition or disease will adversely affect the health or life of the mother or fetus and a physician surgeon has not determined that the client’s condition has been resolved as specified in paragraph (2) of subdivision (e).
(C) The necessary resources and personnel are not available in the setting of care.
(2) All complications and emergencies shall be referred to a physician and surgeon immediately.
(3) Referrals and transfers required by paragraph (1) shall be documented in the client record.
(h) The practice of nurse-midwifery does not include the assisting of childbirth by any artificial, forcible, or mechanical means, nor the performance of any version procedure.
(i) As used in this article, “supervision” shall not be construed to require the physical presence of the supervising physician.
(j) A certified nurse-midwife is not authorized to practice medicine and surgery by the provisions of this chapter.
(k) Any regulations promulgated by a state department that affect the scope of practice of a certified nurse-midwife shall be developed in consultation with the board.

SEC. 4.

 Section 2746.51 of the Business and Professions Code is amended to read:

2746.51.
 (a) Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1) The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A) Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B) Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C) Care rendered, consistent with the certified nurse-midwife’s educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(D) Care rendered in a home.
(2) The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by a physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A) Which certified nurse-midwife may furnish or order drugs or devices.
(B) Which drugs or devices may be furnished or ordered and under what circumstances.
(C) The extent of physician and surgeon supervision.
(D) The method of periodic review of the certified nurse-midwife’s competence, including peer review, and review of the provisions of the standardized procedure.
(3) If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4) The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under standardized procedures and protocols. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A) Collaboration on the development of the standardized procedure or protocol.
(B) Approval of the standardized procedure or protocol.
(C) Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b) (1) The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2) The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section. The board shall establish the requirements for satisfactory completion of this paragraph.
(3) A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4) A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5) Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c) Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1) The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2) When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d) Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term “furnishing” in this section shall include the following:
(1) The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2) Transmitting an order of a supervising physician and surgeon.
(e) “Drug order” or “order” for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to “prescription” in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(f) Notwithstanding any other law, a certified nurse-midwife may directly procure supplies and devices, obtain and administer diagnostic tests, order laboratory and diagnostic testing, and receive reports that are necessary to his or her practice as a certified nurse-midwife within his or her scope of practice.

SEC. 5.

 Section 2746.52 of the Business and Professions Code is amended to read:

2746.52.
 (a) Notwithstanding Section 2746.5, the certificate to practice nurse-midwifery authorizes the holder to perform and repair episiotomies, and to repair first-degree and second-degree lacerations of the perineum.
(b) A certified nurse-midwife shall establish procedures that relate to the performance and repair of episiotomies and the repair of first-degree and second-degree lacerations of the perineum that shall do both of the following:
(1) Ensure that all complications are referred to a physician and surgeon immediately.
(2) Ensure immediate care of clients who are in need of care beyond the scope of practice of the certified nurse-midwife, or emergency care for times when a physician and surgeon is not on the premises.

SEC. 6.

 Section 2746.54 is added to the Business and Professions Code, to read:

2746.54.
 (a) A certified nurse-midwife who is not under the supervision of a physician or surgeon shall disclose in oral and written form to a prospective client as part of a client care plan, and obtain informed consent for, all of the following:
(1) The client is retaining a certified nurse-midwife and the certified nurse-midwife is not supervised by a physician and surgeon.
(2) The certified nurse-midwife’s current licensure status and license number.
(3) The practice settings in which the certified nurse-midwife practices.
(4) If the certified nurse-midwife does not have liability coverage for the practice of midwifery, he or she shall disclose that fact. If the certified nurse-midwife is assisting an out-of-hospital birth, he or she shall disclose to the client that many physicians and surgeons do not have liability insurance coverage for services provided to someone having a planned out-of-hospital birth.
(5) There are conditions that are outside of the scope of practice of a certified nurse-midwife that will result in a referral for a consultation from, or transfer of care to, a physician and surgeon.
(6) The specific arrangements for the referral of complications to a physician and surgeon for consultation. The certified nurse-midwife shall not be required to identify a specific physician and surgeon.
(7) The specific arrangements for the transfer of care during the prenatal period, hospital transfer during the intrapartum and postpartum periods, and access to appropriate emergency medical services for mother and baby if necessary, and recommendations for preregistration at a hospital that has obstetric emergency services and is most likely to receive the transfer.
(8) If, during the course of care, the client is informed that she has or may have a condition indicating the need for a mandatory transfer, the certified nurse-midwife shall initiate the transfer.
(9) The availability of the text of laws regulating certified nurse-midwifery practices and the procedure for reporting complaints to the Board of Registered Nursing, which may be found on the Board of Registered Nursing’s Internet Web site.
(10) Consultation with a physician and surgeon does not alone create a physician-patient relationship or any other relationship with the physician and surgeon. The certified nurse-midwife shall inform the patient that he or she is independently licensed and practicing midwifery and in that regard is solely responsible for the services he or she provides.
(b) The disclosure and consent shall be signed by both the certified nurse-midwife and the client and a copy of the disclosure and consent shall be placed in the client’s medical record.
(c) The board, in consultation with the Midwifery Advisory Council, may prescribe the form for the written disclosure and informed consent statement required to be used by a certified nurse-midwife under this section.

SEC. 7.

 Section 2746.55 is added to the Business and Professions Code, to read:

2746.55.
 (a) Each certified nurse-midwife who assists in, or supervises in assisting, childbirth that occurs in an out-of-hospital setting shall annually report to the Office of Statewide Health Planning and Development. The report shall be submitted no later than March 30, for the prior calendar year, in a form specified by the board and shall contain all of the following:
(1) The certified nurse-midwife’s name and license number.
(2) The calendar year being reported.
(3) The following information with regard to cases in California in which the certified nurse-midwife, or midwife supervised by the certified nurse-midwife, assisted during the previous year when the intended place of birth at the onset of care was an out-of-hospital setting:
(A) The total number of clients served as primary caregiver at the onset of care.
(B) The number by county of live births attended as primary caregiver.
(C) The number, by county, of cases of fetal demise, infant deaths, and maternal deaths attended as primary caregiver at the discovery of the demise or death.
(D) The number of women whose primary care was transferred to another health care practitioner during the antepartum period, and the reason for each transfer.
(E) The number, reason, and outcome for each elective hospital transfer during the intrapartum or postpartum period.
(F) The number, reason, and outcome for each urgent or emergency transport of an expectant mother in the antepartum period.
(G) The number, reason, and outcome for each urgent or emergency transport of an infant or mother during the intrapartum or immediate postpartum period.
(H) The number of planned out-of-hospital births at the onset of labor and the number of births completed in an out-of-hospital setting.
(I) The number of planned out-of-hospital births completed in an out-of-hospital setting that were any of the following:
(i) Twin births.
(ii) Multiple births other than twin births.
(iii) Breech births.
(iv) Vaginal births after the performance of a cesarean section.
(J) A brief description of any complications resulting in the morbidity or mortality of a mother or a neonate.
(K) Any other information prescribed by the board in regulations.
(b) The Office of Statewide Health Planning and Development shall maintain the confidentiality of the information submitted pursuant to this section, and shall not permit any law enforcement or regulatory agency to inspect or have copies made of the contents of any reports submitted pursuant to subdivision (a) for any purpose, including, but not limited to, investigations for licensing, certification, or regulatory purposes.
(c) The office shall report to the board, by April 30, those licensees who have met the requirements of subdivision (a) for that year.
(d) The board shall send a written notice of noncompliance to each licensee who fails to meet the reporting requirement of subdivision (a). Failure to comply with subdivision (a) will result in the certified nurse-midwife being unable to renew his or her license without first submitting the requisite data to the office for the year for which that data was missing or incomplete. The board shall not take any other action against the licensee for failure to comply with subdivision (a).
(e) The board, in consultation with the office and the Midwifery Advisory Council, shall devise a coding system related to data elements that require coding in order to assist in both effective reporting and the aggregation of data pursuant to subdivision (f). The office shall utilize this coding system in its processing of information collected for purposes of subdivision (f).
(f) The office shall report the aggregate information collected pursuant to this section to the board by July 30 of each year. The board shall include this information in its annual report to the Legislature. The report shall be submitted in compliance with Section 9795 of the Government Code.
(g) The board, with input from the Midwifery Advisory Council, may adjust the data elements required to be reported to better coordinate with other reporting systems, including the reporting system of the Midwives Alliance of North America (MANA), while maintaining the data elements unique to California. To better capture data needed for the report required by this section, the concurrent use of systems, including MANA’s, by certified nurse midwives nurse-midwives is encouraged.
(h) Notwithstanding any other law, a violation of this section shall not be a crime.

SEC. 8.

 Section 3653 of the Business and Professions Code is amended to read:

3653.
 (a) Naturopathic childbirth attendance does not include the use or performance of any of the following:
(1) Forceps delivery.
(2) General or spinal anesthesia.
(3) Cesarean section delivery.
(4) Episiotomies, except to the extent that they meet the same supervision requirements set forth in subdivision (c).
(b) Naturopathic childbirth attendance does not mean the management of complications in pregnancy, labor, delivery, or the neonatal period. All complications shall be referred to an obstetrician or other licensed physician and surgeon as appropriate.
(c) A naturopathic doctor certified for the specialty practice of naturopathic childbirth attendance may perform and repair episiotomies, and repair first-degree and second-degree lacerations of the perineum, in a licensed general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, and a licensed alternative birth center, as defined in paragraph (4) of subdivision (b) of Section 1204 of the Health and Safety Code, if all of the following conditions are met:
(1) The supervising physician and surgeon and any backup physician and surgeon is credentialed to perform obstetrical care in the facility.
(2) The episiotomies are performed pursuant to protocols developed and approved by all of the following:
(A) The supervising physician and surgeon.
(B) The naturopathic doctor certified for the specialty practice of naturopathic childbirth attendance.
(C) The director of the obstetrics department or the director of the family practice department, or both, if a physician and surgeon in the obstetrics department or the family practice department is a supervising physician and surgeon, or an equivalent person if there is no specifically identified obstetrics department or family practice department.
(D) The interdisciplinary practices committee, if applicable.
(E) The facility administrator or his or her designee.
(3) The protocols, and the procedures which shall be developed pursuant to the protocols, shall relate to the performance and repair of episiotomies and the repair of first-degree and second-degree lacerations of the perineum, and shall do all of the following:
(A) Ensure that all complications are referred to a physician and surgeon immediately.
(B) Ensure immediate care of patients who are in need of care beyond the scope of practice of the certified nurse-midwife, or emergency care for times when the supervising physician and surgeon is not on the premises.
(C) Establish the number of naturopathic doctors certified for the specialty practice of naturopathic childbirth attendance that a supervising physician and surgeon may supervise.

SEC. 9.

 Section 1204.3 of the Health and Safety Code is amended to read:

1204.3.
 (a) An alternative birth center that is shall be licensed as an alternative birth center specialty clinic pursuant to paragraph (4) of subdivision (b) of Section 1204 and shall, as a condition of licensure, and a primary care clinic licensed pursuant to subdivision (a) of Section 1204 that provides services as an alternative birth center shall, meet all of the following requirements:
(1) Be a provider of comprehensive perinatal services as defined in Section 14134.5 of the Welfare and Institutions Code.
(2) Maintain a quality assurance program.
(3) Meet the standards for certification established by the American Association of Birth Centers, or at least equivalent standards as determined by the state department.
(4) In addition to standards of the American Association of Birth Centers regarding proximity to hospitals and presence of attendants at births, meet both of the following conditions:
(A) Be located in proximity, in time and distance, to a facility with the capacity for management of obstetrical and neonatal emergencies, including the ability to provide cesarean section delivery, within 30 minutes from time of diagnosis of the emergency.
(B) Require the presence of at least two attendants at all times during birth, one of whom shall be a physician and surgeon, a licensed midwife, or a certified nurse-midwife.
(5) Have a written policy relating to the dissemination of the following information to patients:
(A) A summary of current state laws requiring child passenger restraint systems to be used when transporting children in motor vehicles.
(B) A listing of child passenger restraint system programs located within the county, as required by Section 27362 of the Vehicle Code.
(C) Information describing the risks of death or serious injury associated with the failure to utilize a child passenger restraint system.
(b) The state department shall issue a permit to a primary care clinic licensed pursuant to subdivision (a) of Section 1204 certifying that the primary care clinic has met the requirements of this section and may provide services as an alternative birth center. Nothing in this section shall be construed to require that a licensed primary care clinic obtain an additional license in order to provide services as an alternative birth center.
(c) (1) Notwithstanding subdivision (a) of Section 1206, no place or establishment owned or leased and operated as a clinic or office by one or more licensed health care practitioners and used as an office for the practice of their profession, within the scope of their license, shall be represented or otherwise held out to be an alternative birth center licensed by the state unless it meets the requirements of this section.
(2) Nothing in this subdivision shall be construed to prohibit licensed health care practitioners from providing birth related services, within the scope of their license, in a place or establishment described in paragraph (1).

SEC. 9.SEC. 10.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.