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Regular Session, 2012
HOUSE BILL NO. 947
BY REPRESENTATIVES NANCY LANDRY, ADAMS, ARMES, BARROW, WESLEY
BISHOP, BROADWATER, BROSSETT, BROWN, BURFORD, CARMODY,
CHANEY, CONNICK, COX, HODGES, HUNTER, GIROD JACKSON, KATRINA
JACKSON, JEFFERSON, TERRY LANDRY, LEBAS, MORENO, PIERRE,
PRICE, PYLANT, REYNOLDS, SEABAUGH, SMITH, ST. GERMAIN,
THIBAUT, THIERRY, PATRICK WILLIAMS, AND WILLMOTT
HEALTH/MIDWIVES: Amends provisions relative to midwifery licensing
AN ACT1
To amend and reenact R.S. 37:3241(8) and (12), 3244(B) and (C), 3245(D)(1), and 3248 and2
to enact R.S. 37:3241(15) and (16), 3244(D), (E), (F), and (G), 3255(D), 3258, and3
3259, relative to the Midwife Practitioners Act; to provide for definitions; to further4
define the scope of practice as it relates to requirements for physician evaluations5
and examinations and risk management physician referrals; to provide authority for6
the issuance of a midwifery license to applicants who are members of certain7
midwifery certifying organizations; to exempt certain students participating in a8
board approved, accredited midwifery education program from the rules governing9
midwives; to provide authority for the board to accept an examination administered10
by the North American Registry of Midwives or other approved certifying11
examination; to establish professional liability and immunity for physicians12
performing risk assessments in certain settings; to provide for limitations on the13
Louisiana State Board of Nursing; and to provide for related matters.14
Be it enacted by the Legislature of Louisiana:15
Section 1. R.S. 37:3241(8) and (12), 3244(B) and (C), 3245(D)(1), and 3248 are16
hereby amended and reenacted and R.S. 37:3241(15) and (16), 3244(D), (E), (F), and (G),17
3255(D), 3258, and 3259 are hereby enacted to read as follows: 18 HLS 12RS-261 REENGROSSED
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§3241. Definitions1
As used in this Chapter, the following terms shall apply unless the context2
clearly states otherwise:3
* * *4
(8) "Licensed midwife" means a person who has completed all requirements5
of R.S. 37:3247, 3253, and 3255, has successfully completed the examination6
process, and is certified as a midwife by the North American Registry of Midwives7
along with being in good standing on the registry of licensed midwives maintained8
by the board.9
* * *10
(12) "Physician", except as provided in R.S. 37:3244(G) means a person who11
is currently practicing obstetrics and is licensed to practice medicine or osteopathy12
in Louisiana.13
* * *14
(15) "Certified professional midwife" means a person certified by the North15
American Registry of Midwives.16
(16) "Low risk patient" means an individual who is at low or normal risk of17
developing complications during pregnancy and childbirth as evidenced by the18
absence of any preexisting maternal disease or disease arising during pregnancy or19
such other conditions as the board may identify in rules.20
* * *21
§3244. Scope of practice 22
* * *23
B. The licensed midwife may provide care to low risk patients as defined by24
the board and as determined by physician evaluation and examination to be25
essentially normal for pregnancy and childbirth. Such care includes prenatal26
supervision and counseling; preparation for childbirth; and supervision and care27
during labor and delivery and care of the mother and the newborn in the immediate28 HLS 12RS-261 REENGROSSED
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postpartum period if progress meets criteria generally accepted as normal as defined1
by the board.2
C. The physician who performs the evaluation and examination required by3
this Section shall disclose the reason and effect of the evaluation and examination4
to the patient and midwife using a form developed by the board for this purpose.5
D. A licensed midwife shall refer to a physician for risk assessment a patient6
whose progress at any time during pregnancy or the postpartum period deviates from7
criteria generally accepted as normal as defined by the board, including but not8
limited to diseases such as gestational diabetes, and preeclampsia or conditions such9
as post-term pregnancy, forty-two weeks of completed pregnancy, multiple births,10
or breech presentation.11
E. A patient has the right to refuse a licensed midwife's referral to any12
physician; provided, however, that a licensed midwife shall not knowingly accept or13
thereafter maintain responsibility for the care of a woman who does not obtain14
physician referral or when the results of the referral indicate that she no longer15
qualifies as a low risk patient.16
F. Prior to providing any services, a licensed midwife shall obtain informed17
consent, in writing, of the patient in a manner and form prescribed by the board18
which shall include but not be limited to the following:19
(1) The name and license number of the licensed midwife.20
(2) The patient's name, address, telephone number, and the name of the21
patient's primary care provider if the patient has one.22
(3) A statement that the licensed midwife is not an advanced practice23
registered nurse midwife or physician.24
(4) A description of the education, training, continuing education, and25
experience of the licensed midwife.26
(5) A description of the licensed midwife's philosophy of practice.27
(6) A statement recognizing the obligation of the licensed midwife to provide28
the client, upon request, separate documents describing the law and regulations29 HLS 12RS-261 REENGROSSED
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governing the practice of midwifery, including the requirement for an evaluation and1
examination by a physician, the protocol for transfer or mandatory transfer, and the2
licensed midwife's personal written practice guidelines.3
(7) A description of the protocol for transfer to a hospital and disclosure of4
the hospital with which the licensed midwife has a current transfer agreement.5
(8) A complete and accurate description of the services to be provided to the6
patient.7
(9) Whether the licensed midwife maintains a professional liability policy8
and if insurance is maintained a description of the liability conditions and limits of9
such insurance.10
(10) Any additional information or requirement which the board deems11
necessary to protect the health, safety, or welfare of the patient.12
C. G. A person may be issued a license as a licensed midwife, or permit as13
an apprentice midwife, or a senior apprentice midwife., such that:14
(1) A licensed midwife may provide any care or services provided for in R.S.15
37:3244(B) Subsection B of this Section.16
(2) A senior apprentice midwife may only provide care or services only17
under the supervision of a licensed physician, certified nurse midwife, or licensed18
midwife. 19
(3) An apprentice midwife may provide care or services only under the20
supervision of a licensed physician, certified nurse midwife, or licensed midwife.21
§3245. Permits and licenses 22
* * *23
D. Upon meeting the educational and clinical experience requirements24
provided by the board, a person may apply for a midwifery license by submitting the25
following:26
(1) An application for the license and to take the next qualifying27
examination; provided, however, the board may issue a midwifery license to an28
applicant who holds current certification by the North American Registry of29 HLS 12RS-261 REENGROSSED
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Midwives or such other certifying organization as the board may subsequently1
approve.2
* * *3
§3248. Persons not affected4
A. Any person authorized by the Louisiana State Board of Nursing to5
practice as a certified nurse midwife in the state shall not be affected by the6
provisions of this Chapter.7
B. Any student pursuing a course of study in an accredited midwifery8
education program that is approved by the board who provides midwifery services,9
provided that such services are an integral part of the student's course of study and10
are performed under the direct supervision of a physician, certified nurse midwife,11
or a licensed midwife, and the student is designated by a title which clearly indicates12
his status as a student or trainee.13
* * *14
§3255. Examination 15
* * *16
D. The examination administered by the North American Registry of17
Midwives, or such other certifying examination as the board may subsequently18
approve, shall be accepted by the board as a qualifying examination for purposes of19
midwifery licensure.20
* * *21
§3258. Professional liability22
A. Physician evaluation and examination as provided in R.S. 37:3244 shall23
be deemed to constitute a risk assessment. A physician performing a risk assessment24
is responsible only for determining that at the time of the risk assessment the25
individual is at low or normal risk of developing complications during pregnancy and26
childbirth.27
B. Physician risk assessment as defined in this Section shall not create either28
of the following:29 HLS 12RS-261 REENGROSSED
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(1) A physician-patient relationship or any legal duty, responsibility, or1
obligation by the physician to provide continuing care.2
(2) A legal relationship between the physician and the licensed midwife or3
any duty, responsibility, or obligation by the physician to supervise, collaborate,4
back-up, or oversee the licensed midwife's care of the patient.5
C. No physician or other health care provider as defined in R.S. 40:1299.41,6
no hospital as defined in R.S. 40:2102, or no institution, facility, or clinic licensed7
by the department shall be:8
(1) Deemed to have established a legal relationship with a licensed midwife9
solely by providing a risk assessment as defined in this Section or accepting a10
transfer of a patient from a licensed midwife.11
(2) Liable for civil damages arising out of the negligent, grossly negligent,12
or wanton or willful acts or omissions of the licensed midwife solely for providing13
a risk assessment as defined in this Section or accepting a transfer of a patient from14
a licensed midwife.15
§3259. Reporting16
A. Every licensed midwife shall report to the board semiannually in a17
manner and form prescribed by the board. The report shall be submitted within the18
months of January and July of each year and shall include all of the following:19
(1) The licensed midwife's name and license number.20
(2) The calendar year being reported.21
(3) The total number of clients served.22
(4) The total number and parish of live births attended as a primary23
caregiver.24
(5) The total number and parish of stillbirths attended as a primary caregiver.25
(6) The number of patients whose primary care was transferred to another26
health care provider during the antepartum period and the reason for each transfer.27
(7) The number, reason, and outcome for each elective hospital transfer.28 HLS 12RS-261 REENGROSSED
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(8) The number, reason, and outcome for each emergency transport of an1
expectant mother prior to labor.2
(9) A brief description of any complications resulting in the mortality of a3
mother or an infant.4
(10) Any other information prescribed by the board through rule or5
regulation.6
B. A licensed midwife shall report within forty-eight hours to the board any7
maternal, fetal, or neonatal mortality or morbidity in patients for whom care has been8
given. The report shall include the sex, weight, date and place of delivery, method9
of delivery, congenital anomalies of the fetus, and cause of death.10
C. In addition to the penalties set forth in R.S. 37:3256, any licensed midwife11
failing to satisfy the provisions of this Section shall be subject to a civil fine not to12
exceed one hundred dollars each day the report is filed late. In no case shall the fine13
exceed five hundred dollars.14
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Nancy Landry HB No. 947
Abstract: Revises statutory provisions relative to the Midwife Practitioners Act.
Present law (R.S. 37:3241(8)) defines "licensed midwife" as meaning a person who has
completed all requirements of present law, has successfully completed the examination
process, and is in good standing on the registry of licensed midwives maintained by the
board.
Proposed law retains present law and adds a requirement that a licensed midwife be certified
as midwife by the North American Registry of Midwives in addition to being in good
standing on the registry of licensed midwives maintained by the board.
Present law (R.S. 37:3241(12)) defines "physician" as meaning a person who is currently
practicing obstetrics and is licensed to practice medicine or osteopathy in La.
Proposed law excludes licensed midwives, apprentice midwives, and senior apprentice
midwives from the definition of "physician".
Proposed law (R.S. 37:3241(15)) defines "certified professional midwife" as meaning a
person certified by the North American Registry of Midwives.
Proposed law (R.S. 37:3241(16)) defines "low risk patient" as meaning an individual who
is at low or normal risk of developing complications during pregnancy and childbirth as HLS 12RS-261 REENGROSSED
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evidenced by the absence of any preexisting maternal disease or disease arising during
pregnancy or such other conditions as the board may identify in rules.
Present law (R.S. 37:3244(B)) authorizes a licensed midwife to care for low risk patients as
determined by physician evaluation and examination to be essentially normal for pregnancy
and childbirth.
Proposed law specifies that the care provided to low risk patients, who are declared to be
essentially normal for pregnancy and childbirth, will be determined by the board.
Proposed law (R.S. 37:3244(C)) requires the physician who performs the evaluation and
examination required by proposed law to disclose the reason and effect of the evaluation and
examination to the patient and midwife using a form developed by the board for this
purpose.
Proposed law (R.S. 37:3244(D)) requires a licensed midwife to refer a patient to a physician
for risk assessment when the patient's progress at any time during pregnancy or the
postpartum period deviates from criteria generally accepted as normal as defined by the
board, including but not limited to diseases such as gestational diabetes, and preeclampsia
or conditions such as post-term pregnancy, 42 weeks of completed pregnancy, multiple
births, or breech presentation.
Proposed law (R.S. 37:3244(E)) allows a patient to refuse a licensed midwife's referral to
any physician; however, provides that a licensed midwife must not knowingly accept or
maintain responsibility for the care of a woman who does not obtain physician referral or
when the results of the referral indicate that she no longer qualifies as a low risk patient.
Proposed law (R.S. 37:3244(F)) requires a licensed midwife to obtain written, informed
consent of the patient prior to providing any services. Further, requires that such information
be provided on a form prescribed by the board which shall include but not be limited to the
following:
(1)The name and license number of the licensed midwife.
(2)The patient's name, address, telephone number, and the name of the patient's primary
care provider if the patient has one.
(3)A statement that the licensed midwife is not an advanced practice registered nurse
midwife or physician.
(4)A description of the education, training, continuing education, and experience of the
licensed midwife.
(5)A description of the licensed midwife's philosophy of practice.
(6)A statement recognizing the obligation of the licensed midwife to provide the client,
upon request, separate documents describing the law and regulations governing the
practice of midwifery, including the requirement for an evaluation and examination
by a physician, the protocol for transfer or mandatory transfer, and the licensed
midwife's personal written practice guidelines.
(7)A description of the protocol for transfer to a hospital and disclosure of the hospital
with which the licensed midwife has a current transfer agreement.
(8)A complete and accurate description of the services to be provided to the patient. HLS 12RS-261 REENGROSSED
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(9)Whether the licensed midwife maintains a professional liability policy and if
insurance is maintained, a description of the liability conditions and limits of such
insurance.
(10)Any additional information or requirement which the board deems necessary to
protect the health, safety, or welfare of the patient.
Present law (R.S. 37:3245(D)(1)) in pertinent part, specifies that upon meeting the
educational and clinical experience requirements, which include an application for the
license and taking the next qualifying examination, provided by the board, a person may
apply for a midwifery license.
Proposed law allows the board to issue a midwifery license to an applicant who holds current
certification by the North American Registry of Midwives or such other certifying
organization as the board subsequently approves.
Proposed law (R.S. 37:3248(B)) excludes from the application of midwifery laws any
student pursuing a course of study in an accredited and board-approved midwifery education
program who provides midwifery services, provided that such services are an integral part
of the student's course of study, that are performed under the direct supervision of a
physician, certified nurse midwife, or a licensed midwife, and the student is designated by
a title which clearly indicates his status as a student or trainee.
Proposed law (R.S. 37:3255(D)) authorizes the board to accept as a qualifying examination
for purposes of midwifery licensure an examination administered by the North American
Registry of Midwives, or such other certifying examination as the board subsequently
approves.
Proposed law (R.S. 37:3258(A)) specifies that a risk assessment is any physician evaluation
and examination conducted in accordance with the law governing the scope of practice.
Further provides that the physician performing a risk assessment is only responsible for
determining that at the time of such assessment the individual is at low or normal risk of
developing complications during pregnancy and childbirth.
Proposed law (R.S. 37:3258(B)) provides that a physician risk assessment, as defined by
proposed law, does not create either of the following:
(1)A physician-patient relationship or any legal duty, responsibility, or obligation by the
physician to provide continuing care.
(2)A legal relationship between the physician and the licensed midwife or any duty,
responsibility, or obligation by the physician to supervise, collaborate, back-up, or
oversee the licensed midwife's care of the patient.
Proposed law (R.S. 37:3258(C)) specifies that no physician or health care provider as
defined by statute, no hospital as defined by statute, or no institution, facility, or clinic
licensed by the department can be:
(1)Deemed to have established a legal relationship with a licensed midwife solely by
providing a risk assessment as defined in proposed law or accepting a transfer of a
patient from a licensed midwife.
(2)Liable for civil damages arising out of the negligent, grossly negligent, or wanton or
willful acts or omissions of the licensed midwife solely for providing a risk
assessment as defined in proposed law or accepting a transfer of a patient from a
licensed midwife. HLS 12RS-261 REENGROSSED
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are additions.
Proposed law (R.S. 37:3259) requires every licensed midwife to report to the board
semiannually in a manner and form prescribed by the board. Requires the report to be
submitted within the months of Jan. and July of each year and it must include all of the
following:
(1)The licensed midwife's name and license number.
(2)The calendar year being reported.
(3)The total number of clients served.
(4)The total number and parish of live births attended as a primary caregiver.
(5)The total number and parish of stillbirths attended as a primary caregiver.
(6)The number of patients whose primary care was transferred to another health care
provider during the antepartum period, and the reason for each transfer.
(7)The number, reason, and outcome for each elective hospital transfer.
(8)The number, reason, and outcome for each emergency transport of an expectant
mother prior to labor.
(9)A brief description of any complications resulting in the mortality of a mother or an
infant.
(10)Any other information prescribed by the board through rule or regulation.
Requires a licensed midwife to report within 48 hours to the board any maternal, fetal, or
neonatal mortality or morbidity in patients for whom care has been given. Also, requires the
report include the sex, weight, date and place of delivery, method of delivery, congenital
anomalies of the fetus, and cause of death.
Specifies that in addition to the penalties set forth in present law, any licensed midwife
failing to satisfy the provisions of proposed law will be subject to a civil fine not to exceed
$100 each day the report is filed late; however, specifies that in no case will the fine exceed
$500.
(Amends R.S. 37:3241(8) and (12), 3244(B) and (C), 3245(D)(1) and 3248; Adds R.S.
37:3241(15) and (16), 3244(D), (E), (F), and (G), 3255(D), 3258, and 3259)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill.
1. Made technical changes.
2. Removed a provision which authorized a midwife to seek a risk assessment from
an OBGYN, who did not practice obstetrics, or a physician who practiced family
medicine if the patient had been referred to two independent physicians for a risk
assessment.
3. Removed a provision which prevented the Board of Nursing from using the legal
practice of midwifery as the basis for any action against a person licensed by the
board. HLS 12RS-261 REENGROSSED
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4. Added a provision that requires a licensed midwife to obtain written, informed
consent of the patient on a form prescribed by the board that includes certain
enumerated information.
5. Added certified nurse midwives to the list of health care professionals that are
authorized to provide direct supervision over students who provide midwifery
services.
6. Added a provision that establishes reporting requirements for midwives.