| 1 | 1 | | 23 LC 33 9252 |
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| 2 | 2 | | S. B. 81 |
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| 3 | 3 | | - 1 - |
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| 4 | 4 | | Senate Bill 81 |
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| 5 | 5 | | By: Senators Anderson of the 43rd, Butler of the 55th, Jones II of the 22nd, Jackson of the |
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| 6 | 6 | | 41st, Islam of the 7th and others |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to |
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| 10 | 10 | | 1 |
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| 11 | 11 | | repeal in its entirety Chapter 26, relating to the practice of midwifery; to amend Title 43 of2 |
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| 12 | 12 | | the Official Code of Georgia Annotated, relating to professions and businesses, so as to3 |
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| 13 | 13 | | provide for the licensure and regulation of community midwives; to provide for a short title;4 |
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| 14 | 14 | | to provide for legislative findings; to provide for definitions; to provide for the creation of5 |
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| 15 | 15 | | the State Board of Community Midwifery; to provide for its membership and duties; to6 |
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| 16 | 16 | | provide for the Secretary of State to consult with such board; to provide for regulation by the7 |
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| 17 | 17 | | Secretary of State; to provide for licensure requirements; to provide for informed consent and8 |
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| 18 | 18 | | written disclosures to clients; to provide for standards of liability in certain situations; to9 |
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| 19 | 19 | | authorize the filing of birth certificates; to provide for prohibited acts; to provide for statutory10 |
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| 20 | 20 | | construction; to amend Code Section 43-26-12 of the Official Code of Georgia Annotated,11 |
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| 21 | 21 | | relating to exceptions to the operation of the "Georgia Registered Professional Nurse Practice12 |
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| 22 | 22 | | Act," so as to provide for an exception relating to the practice of midwifery; to provide for13 |
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| 23 | 23 | | related matters; to provide for an effective date; to repeal conflicting laws; and for other14 |
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| 24 | 24 | | purposes.15 |
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| 25 | 25 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:16 |
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| 26 | 26 | | SECTION 1.17 23 LC 33 9252 |
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| 27 | 27 | | S. B. 81 |
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| 28 | 28 | | - 2 - |
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| 29 | 29 | | Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by |
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| 30 | 30 | | 18 |
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| 31 | 31 | | repealing in its entirety Chapter 26, relating to the practice of midwifery, and designating19 |
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| 32 | 32 | | said chapter as reserved.20 |
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| 33 | 33 | | SECTION 2.21 |
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| 34 | 34 | | Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,22 |
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| 35 | 35 | | is amended by adding a new chapter to read as follows:23 |
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| 36 | 36 | | "CHAPTER 24B |
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| 37 | 37 | | 24 |
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| 38 | 38 | | 43-24B-1.25 |
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| 39 | 39 | | This chapter shall be known and may be cited as the 'Georgia Community Midwife Act.'26 |
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| 40 | 40 | | 43-24B-2.27 |
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| 41 | 41 | | (a) The General Assembly finds that:28 |
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| 42 | 42 | | (1) Parents are entitled to freedom in choosing their provider and setting for childbirth;29 |
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| 43 | 43 | | (2) Some potential parents in this state desire alternatives to currently available hospital30 |
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| 44 | 44 | | based maternity care;31 |
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| 45 | 45 | | (3) Safe, planned out-of-hospital childbirth requires assistance by trained and competent32 |
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| 46 | 46 | | professionals;33 |
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| 47 | 47 | | (4) Community midwives are trained in managing normal physiological birth in the34 |
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| 48 | 48 | | community setting;35 |
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| 49 | 49 | | (5) Numerous counties in this state are underserved by obstetricians;36 |
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| 50 | 50 | | (6) Community midwives can assist women and their families with safe and effective37 |
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| 51 | 51 | | childbirth while guiding the health, safety, and welfare of women and their offspring38 |
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| 52 | 52 | | through the childbearing year; and39 23 LC 33 9252 |
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| 53 | 53 | | S. B. 81 |
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| 54 | 54 | | - 3 - |
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| 55 | 55 | | (7) Regulating community midwifery promotes access to safe and effective antepartum,40 |
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| 56 | 56 | | intrapartum, and postpartum care.41 |
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| 57 | 57 | | (b) The General Assembly, therefore, declares it to be the purpose of this chapter to protect42 |
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| 58 | 58 | | the health, safety, and welfare of the public by providing for the licensure and regulation43 |
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| 59 | 59 | | of the activities of community midwives.44 |
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| 60 | 60 | | 43-24B-3.45 |
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| 61 | 61 | | As used in this chapter, the term:46 |
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| 62 | 62 | | (1) 'Board' means the State Board of Community Midwifery created pursuant to Code47 |
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| 63 | 63 | | Section 43-24B-4.48 |
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| 64 | 64 | | (2) 'Certified nurse midwife' means a midwife who is an advanced practice registered49 |
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| 65 | 65 | | nurse.50 |
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| 66 | 66 | | (3) 'Community midwife' means:51 |
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| 67 | 67 | | (A) A skilled practitioner who provides specialized care to women and their infants52 |
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| 68 | 68 | | during antenatal, childbirth, and postpartum periods in out-of-hospital community birth53 |
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| 69 | 69 | | settings; or54 |
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| 70 | 70 | | (B) An individual licensed under this chapter who is engaging in the practice of55 |
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| 71 | 71 | | community midwifery.56 |
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| 72 | 72 | | (4) 'Consultation' means a communication between a community midwife and a57 |
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| 73 | 73 | | physician, a certified nurse midwife, or another licensed healthcare provider with58 |
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| 74 | 74 | | expertise in providing medical services to women during the prenatal, childbirth, and59 |
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| 75 | 75 | | postpartum periods when assessing a condition during such periods.60 |
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| 76 | 76 | | (5) 'Informed consent' means a written certification by the client consenting to61 |
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| 77 | 77 | | procedures, protocols, and treatments or recommended diagnostic tests after full62 |
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| 78 | 78 | | disclosure of the current standard of care and its purpose, benefits, known risks,63 |
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| 79 | 79 | | contraindications, and associated risks, as well as any alternative options.64 23 LC 33 9252 |
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| 80 | 80 | | S. B. 81 |
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| 81 | 81 | | - 4 - |
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| 82 | 82 | | (6) 'License' means a license issued pursuant to this chapter to engage in the practice of65 |
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| 83 | 83 | | community midwifery.66 |
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| 84 | 84 | | (7) 'Practice of community midwifery' means assistance given, in exchange for67 |
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| 85 | 85 | | compensation, to women during the prenatal, childbirth, and postpartum periods,68 |
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| 86 | 86 | | including well-woman screening and education. Midwifery services may be provided in69 |
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| 87 | 87 | | out-of-hospital settings, such as a private home. Such services, which are provided70 |
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| 88 | 88 | | within a network of relationships with other maternity care providers who may provide71 |
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| 89 | 89 | | consultation and collaboration when needed, include:72 |
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| 90 | 90 | | (A) Providing care, education, counseling, and support to women and their families73 |
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| 91 | 91 | | throughout pregnancy, birth, and the postpartum period; identifying unique physical74 |
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| 92 | 92 | | social and emotional needs; recognizing abnormal conditions requiring the services of75 |
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| 93 | 93 | | a healthcare provider such as a physician, physician assistant, or advanced practice76 |
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| 94 | 94 | | registered nurse and developing a plan for consultation and referral when such77 |
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| 95 | 95 | | conditions arise; and providing emergency care and support for women and babies until78 |
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| 96 | 96 | | additional assistance is available;79 |
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| 97 | 97 | | (B) Ordering prenatal, postpartum, and well-woman laboratory analyses performed by80 |
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| 98 | 98 | | a licensed laboratory for screening purposes; ordering obstetric ultrasounds; obtaining81 |
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| 99 | 99 | | and using appropriate equipment and devices such as a Doppler ultrasound, blood82 |
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| 100 | 100 | | pressure cuff, and phlebotomy supplies, instruments, and sutures; ordering obstetric83 |
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| 101 | 101 | | ultrasounds; obtaining and administering antihemorrhagic agents including but not84 |
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| 102 | 102 | | limited to Pitocin (oxytocin), misoprostol and methergine, intravenous fluids for85 |
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| 103 | 103 | | stabilization of the laboring person, magnesium sulfate, terbutaline, neonatal injectable86 |
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| 104 | 104 | | vitamin K, newborn antibiotic eye prophylaxis, oxygen, intravenous antibiotics for87 |
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| 105 | 105 | | Group B Streptococcal antibiotic prophylaxis, Rho(D) immune globulin, local88 |
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| 106 | 106 | | anesthetic, epinephrine, and other drugs or supplies approved by the Secretary; and89 |
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| 107 | 107 | | administering a specific drug prescribed by a physician or other authorized healthcare90 |
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| 108 | 108 | | provider for a client of a community midwife;91 23 LC 33 9252 |
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| 109 | 109 | | S. B. 81 |
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| 110 | 110 | | - 5 - |
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| 111 | 111 | | (C) Managing the postpartum period, including the suturing of an episiotomy and the92 |
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| 112 | 112 | | suturing of first and second degree natural perineal and labial lacerations, including the93 |
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| 113 | 113 | | administration of a local anesthetic;94 |
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| 114 | 114 | | (D) Managing the newborn period, including:95 |
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| 115 | 115 | | (i) Providing care for a newborn baby, including performing a normal newborn baby96 |
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| 116 | 116 | | examination;97 |
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| 117 | 117 | | (ii) Resuscitating a newborn baby; and98 |
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| 118 | 118 | | (iii) Performing newborn screenings;99 |
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| 119 | 119 | | (E) Providing limited interconceptual services in order to provide continuity of care,100 |
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| 120 | 120 | | including:101 |
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| 121 | 121 | | (i) Breastfeeding support and counseling;102 |
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| 122 | 122 | | (ii) Family planning, limited to natural family planning, cervical caps, and103 |
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| 123 | 123 | | diaphragms; and104 |
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| 124 | 124 | | (iii) Pap smears, where each client with an abnormal result is to be referred to an105 |
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| 125 | 125 | | appropriate licensed healthcare provider; and106 |
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| 126 | 126 | | (F) Executing the orders of a physician, if the orders are within the education,107 |
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| 127 | 127 | | knowledge, and skill of the community midwife.108 |
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| 128 | 128 | | (8) 'Referral' means a request made by a community midwife to a physician or other109 |
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| 129 | 129 | | healthcare provider for an assessment of a client or her offspring in order to determine110 |
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| 130 | 130 | | appropriate care.111 |
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| 131 | 131 | | (9) 'Secretary' means the Secretary of State or his or her designee.112 |
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| 132 | 132 | | 43-24B-4.113 |
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| 133 | 133 | | (a) There is created within the division the State Board of Community Midwifery which114 |
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| 134 | 134 | | shall consist of five members.115 |
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| 135 | 135 | | (b) The Governor shall appoint all members of the board as follows:116 |
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| 136 | 136 | | (1) Four community midwives; and117 23 LC 33 9252 |
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| 137 | 137 | | S. B. 81 |
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| 138 | 138 | | - 6 - |
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| 139 | 139 | | (2) One member of the general public.118 |
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| 140 | 140 | | (c) The members of the board shall serve for terms of two years and may succeed119 |
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| 141 | 141 | | themselves.120 |
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| 142 | 142 | | (d) Any vacancy on the board shall be filled in the same manner as the regular121 |
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| 143 | 143 | | appointments.122 |
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| 144 | 144 | | (e) The Governor may remove members of the board for incompetence, neglect of duty,123 |
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| 145 | 145 | | unprofessional conduct, conviction of any felony, failure to meet the qualifications of this124 |
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| 146 | 146 | | chapter, or committing any act prohibited by this chapter.125 |
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| 147 | 147 | | (f) Each member of the board shall serve without compensation and at no cost to the state.126 |
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| 148 | 148 | | (g) The board shall elect a chairperson from among its membership, and may elect other127 |
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| 149 | 149 | | officers at the discretion of the board, who shall each serve for one year.128 |
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| 150 | 150 | | (h) The board shall meet at least once per year or as otherwise called by the chairperson.129 |
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| 151 | 151 | | 43-24B-5.130 |
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| 152 | 152 | | The board shall issue a license to engage in the practice of community midwifery to any131 |
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| 153 | 153 | | individual who meets the requirements of this chapter.132 |
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| 154 | 154 | | 43-24B-6.133 |
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| 155 | 155 | | (a) Each applicant for a license under this chapter shall meet the following requirements:134 |
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| 156 | 156 | | (1) Submit an application in a form prescribed by the division;135 |
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| 157 | 157 | | (2) Pay a fee as determined by the board;136 |
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| 158 | 158 | | (3) Have satisfactory results from a criminal background check conducted by the137 |
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| 159 | 159 | | Georgia Crime Information Center and the Federal Bureau of Investigation, as138 |
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| 160 | 160 | | determined by the board. Application for a license under this Code section shall139 |
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| 161 | 161 | | constitute express consent and authorization for the board to perform such criminal140 |
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| 162 | 162 | | background check. Each applicant who submits an application for licensure agrees to141 |
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| 163 | 163 | | provide the board with any and all information necessary to run such criminal142 23 LC 33 9252 |
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| 164 | 164 | | S. B. 81 |
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| 165 | 165 | | - 7 - |
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| 166 | 166 | | background check, including, but not limited to, classifiable sets of fingerprints. The143 |
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| 167 | 167 | | applicant shall be responsible for all fees associated with the performance of such144 |
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| 168 | 168 | | background check;145 |
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| 169 | 169 | | (4) Hold a current certification as a certified community midwife or a certified146 |
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| 170 | 170 | | professional midwife, including having passed the examination required for certification147 |
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| 171 | 171 | | or an equivalent certification, from a midwifery organization recognized by the board;148 |
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| 172 | 172 | | (5) Hold current certification in adult cardiopulmonary resuscitation from an149 |
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| 173 | 173 | | organization recognized by the board; and150 |
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| 174 | 174 | | (6) Provide documentation of successful completion of an approved pharmacology151 |
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| 175 | 175 | | course as defined by board rule.152 |
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| 176 | 176 | | (b) The board, in its discretion, may issue a license to an applicant who does not meet all153 |
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| 177 | 177 | | of the requirements of subsection (a) of this Code section but who has been engaged in the154 |
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| 178 | 178 | | practice of community midwifery for at least ten years and has at least 50 documented155 |
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| 179 | 179 | | births.156 |
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| 180 | 180 | | 43-24B-7.157 |
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| 181 | 181 | | (a) A license issued by the board shall be renewed every three years if the licensee is not158 |
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| 182 | 182 | | in violation of this chapter at the time of application for renewal.159 |
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| 183 | 183 | | (b) Each individual licensed under this chapter is responsible for renewing his or her160 |
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| 184 | 184 | | license before the expiration date.161 |
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| 185 | 185 | | 43-24B-8.162 |
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| 186 | 186 | | (a) The Secretary shall seek the advice of the board regarding the establishment of rules163 |
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| 187 | 187 | | and regulations and the implementation of requirements relating to licensure, license164 |
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| 188 | 188 | | renewal, discipline, continuing education, and other issues related to the practice of165 |
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| 189 | 189 | | midwifery in accordance with this chapter.166 23 LC 33 9252 |
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| 190 | 190 | | S. B. 81 |
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| 191 | 191 | | - 8 - |
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| 192 | 192 | | (b) The Secretary shall consult with the board prior to setting or changing fees as provided167 |
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| 193 | 193 | | for in this chapter.168 |
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| 194 | 194 | | (c) The board may act as a facilitator of state-wide dissemination of information169 |
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| 195 | 195 | | concerning professional midwifery services.170 |
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| 196 | 196 | | (d) The board shall provide analysis of disciplinary actions taken, appeals and denials, and171 |
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| 197 | 197 | | revocation of licenses at least once per year.172 |
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| 198 | 198 | | 43-24B-9.173 |
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| 199 | 199 | | (a) Prior to engaging in the practice of community midwifery with a client, a community174 |
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| 200 | 200 | | midwife shall obtain informed consent from such client.175 |
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| 201 | 201 | | (b) Such informed consent shall include:176 |
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| 202 | 202 | | (1) The name and license number of the community midwife;177 |
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| 203 | 203 | | (2) The client's name, address, telephone number, and primary care provider, if the client178 |
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| 204 | 204 | | has one;179 |
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| 205 | 205 | | (3) A description of the community midwife's education, training, continuing education,180 |
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| 206 | 206 | | and experience in midwifery;181 |
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| 207 | 207 | | (4) A description of the community midwife's peer review process;182 |
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| 208 | 208 | | (5) The community midwife's philosophy of practice;183 |
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| 209 | 209 | | (6) A promise to provide the client, upon request, with separate documents describing184 |
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| 210 | 210 | | the rules governing the practice of community midwifery, including a list of conditions185 |
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| 211 | 211 | | indicating the need for consultation, collaboration, referral, transfer, or mandatory186 |
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| 212 | 212 | | transfer, and the community midwife's personal written practice guidelines;187 |
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| 213 | 213 | | (7) A medical emergency transfer plan;188 |
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| 214 | 214 | | (8) A description of the services provided to the client by the community midwife;189 |
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| 215 | 215 | | (9) The availability of a grievance process;190 |
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| 216 | 216 | | (10) The signatures of the client and community midwife and the dates of signature; and191 23 LC 33 9252 |
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| 217 | 217 | | S. B. 81 |
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| 218 | 218 | | - 9 - |
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| 219 | 219 | | (11) Whether the community midwife is covered by a professional liability insurance192 |
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| 220 | 220 | | policy.193 |
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| 221 | 221 | | (c) The community midwife shall retain a copy of such informed consents for at least four194 |
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| 222 | 222 | | years.195 |
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| 223 | 223 | | (d) A community midwife shall be authorized to file a birth certificate for each birth in196 |
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| 224 | 224 | | accordance with the laws of this state.197 |
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| 225 | 225 | | 43-24B-10.198 |
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| 226 | 226 | | (a) If a community midwife seeks consultation with or refers or transfers a client to a199 |
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| 227 | 227 | | licensed healthcare provider or facility, the responsibility of the provider or facility for the200 |
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| 228 | 228 | | client shall not begin until the client is physically within the care of such provider or201 |
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| 229 | 229 | | facility.202 |
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| 230 | 230 | | (b) A licensed healthcare provider who examines a community midwife's client shall only203 |
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| 231 | 231 | | be liable for the actual examination and shall not be held accountable for the client's204 |
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| 232 | 232 | | decision to pursue an out-of-hospital birth or the services of a community midwife.205 |
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| 233 | 233 | | (c)(1) A licensed healthcare provider may, upon receiving a briefing or data from a206 |
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| 234 | 234 | | community midwife, issue a medical order for the community midwife's client, without207 |
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| 235 | 235 | | that client being an explicit patient of such provider.208 |
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| 236 | 236 | | (2) Regardless of the advice given or order issued, the responsibility and liability for209 |
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| 237 | 237 | | caring for the client shall be that of the community midwife.210 |
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| 238 | 238 | | (3) The provider giving the order shall be responsible and liable only for the211 |
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| 239 | 239 | | appropriateness of the order, given the briefing or data received.212 |
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| 240 | 240 | | (4) The issuing of an order for a community midwife's client shall not constitute a213 |
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| 241 | 241 | | delegation of duties from the other provider to the community midwife.214 |
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| 242 | 242 | | (d) A licensed healthcare provider shall not be held civilly liable for rendering emergency215 |
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| 243 | 243 | | medical services that arise from prohibited conduct or from care rendered under a waiver216 23 LC 33 9252 |
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| 244 | 244 | | S. B. 81 |
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| 245 | 245 | | - 10 - |
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| 246 | 246 | | as specified, unless the emergency medical services constitute gross negligence or reckless217 |
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| 247 | 247 | | disregard for the client.218 |
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| 248 | 248 | | (e) A community midwife shall be solely responsible for the use of medications under this219 |
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| 249 | 249 | | chapter.220 |
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| 250 | 250 | | 43-24B-11.221 |
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| 251 | 251 | | A community midwife shall not be authorized to:222 |
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| 252 | 252 | | (1) Administer a prescription drug to a client in a manner that violates this chapter;223 |
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| 253 | 253 | | (2) Effect any type of surgical delivery except for the cutting of an emergency224 |
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| 254 | 254 | | episiotomy;225 |
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| 255 | 255 | | (3) Administer any type of epidural, spinal, or caudal anesthetic, or any type of narcotic226 |
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| 256 | 256 | | analgesia;227 |
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| 257 | 257 | | (4) Use forceps or a vacuum extractor; or228 |
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| 258 | 258 | | (5) Manually remove the placenta, except in an emergency that presents an immediate229 |
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| 259 | 259 | | threat to the life of the woman.230 |
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| 260 | 260 | | 43-24B-12.231 |
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| 261 | 261 | | Nothing in this chapter shall be construed to abridge, limit, or change in any way the right232 |
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| 262 | 262 | | of a parent or parents to deliver a fetus where, when, how, and with whom they choose.233 |
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| 263 | 263 | | 43-24B-13.234 |
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| 264 | 264 | | Nothing in this chapter shall be construed to prevent:235 |
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| 265 | 265 | | (1) Any licensed healthcare professional from engaging in the authorized scope of236 |
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| 266 | 266 | | practice of his or her profession;237 |
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| 267 | 267 | | (2) Members of a pregnant woman's family from providing incidental care;238 |
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| 268 | 268 | | (3) Representatives of a pregnant woman's culture from providing care consistent with239 |
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| 269 | 269 | | the tenets or practices of such culture or representatives of a pregnant woman's religion240 23 LC 33 9252 |
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| 270 | 270 | | S. B. 81 |
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| 271 | 271 | | - 11 - |
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| 272 | 272 | | from providing care consistent with practices of such religion; provided, however, that241 |
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| 273 | 273 | | such representatives shall not hold themselves out as community midwives; or242 |
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| 274 | 274 | | (4) Precepted apprentices, student midwives, and midwifery assistants from providing243 |
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| 275 | 275 | | midwifery services under the supervision and in the physical presence of a community244 |
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| 276 | 276 | | midwife."245 |
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| 277 | 277 | | SECTION 3.246 |
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| 278 | 278 | | Code Section 43-26-12 of the Official Code of Georgia Annotated, relating to exceptions to247 |
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| 279 | 279 | | the operation of the "Georgia Registered Professional Nurse Practice Act," is amended in248 |
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| 280 | 280 | | subsection (a) by deleting "and" at the end of paragraph (9), by replacing the period at the249 |
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| 281 | 281 | | end of paragraph (10) with "; and", and by adding a new paragraph to read as follows:250 |
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| 282 | 282 | | "(11) The practice of community midwifery by a community midwife pursuant to251 |
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| 283 | 283 | | Chapter 24B of this title."252 |
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| 284 | 284 | | SECTION 4.253 |
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| 285 | 285 | | This Act shall become effective upon its approval by the Governor or upon its becoming law254 |
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| 286 | 286 | | without such approval.255 |
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| 287 | 287 | | SECTION 5.256 |
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| 288 | 288 | | All laws and parts of laws in conflict with this Act are repealed.257 |
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