MD
Maryland Senate Bill SB854

Maryland 2025 Regular Session

Maryland Senate Bill SB854 Compare Versions

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33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
5- Underlining indicates amendments to bill.
6- Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7-amendment.
85 *sb0854*
96
107 SENATE BILL 854
118 J2 5lr3348
129 CF HB 838
1310 By: Senator Lewis Young
1411 Introduced and read first time: January 28, 2025
1512 Assigned to: Finance
16-Committee Report: Favorable with amendments
17-Senate action: Adopted
18-Read second time: February 28, 2025
1913
20-CHAPTER ______
14+A BILL ENTITLED
2115
2216 AN ACT concerning 1
2317
2418 Health Occupations – Licensed Direct–Entry Midwives – Revisions 2
2519
2620 FOR the purpose of altering the scope of practice of licensed direct–entry midwives; 3
2721 providing that the practice of direct–entry midwifery is independent and does not 4
2822 require oversight by another health care practitioner; repealing the requirement that 5
2923 licensed direct–entry midwives report certain information to the Direct–Entry 6
3024 Midwifery Advisory Committee; altering the disciplinary actions that may be taken 7
3125 against a licensed direct–entry midwife or an applicant for a license; continuing the 8
3226 Maryland Licensure of Direct–Entry Midwives Act in accordance with the provisions 9
3327 of the Maryland Program Evaluation Act (sunset law) by extending to a certain date 10
3428 the termination provisions relating to the Act; and generally relating to licensed 11
3529 direct–entry midwives. 12
3630
3731 BY repealing and reenacting, without amendments, 13
3832 Article – Health Occupations 14
3933 Section 8–6C–01(a), (d), (e), (f), and (p) 15
4034 Annotated Code of Maryland 16
4135 (2021 Replacement Volume and 2024 Supplement) 17
4236
4337 BY repealing and reenacting, with amendments, 18
4438 Article – Health Occupations 19
4539 Section 8–6C–01(n), 8–6C–02, 8–6C–03, 8–6C–04(a) and (b)(2)(x), 8–6C–08, 20
4640 8–6C–10, 8–6C–20(a), and 8–6C–26 21
4741 Annotated Code of Maryland 22
48- (2021 Replacement Volume and 2024 Supplement) 23 2 SENATE BILL 854
42+ (2021 Replacement Volume and 2024 Supplement) 23
43+
44+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 24
45+That the Laws of Maryland read as follows: 25
46+
47+Article – Health Occupations 26
48+ 2 SENATE BILL 854
49+
50+
51+8–6C–01. 1
52+
53+ (a) In this subtitle the following words have the meanings indicated. 2
54+
55+ (d) “Board” means the State Board of Nursing. 3
56+
57+ (e) “Committee” means the Direct–Entry Midwifery Advisory Committee 4
58+established under § 8–6C–11 of this subtitle. 5
59+
60+ (f) “Health care practitioner” means: 6
61+
62+ (1) An individual certified as a nurse–midwife or a nurse practitioner 7
63+under this title; or 8
64+
65+ (2) A physician licensed under Title 14 of this article. 9
66+
67+ (n) (1) “Patient” means [a woman] AN INDIVIDUAL for whom a licensed 10
68+direct–entry midwife performs services. 11
69+
70+ (2) “Patient” includes [a woman’s] AN INDIVIDUAL ’S newborn for the 12
71+purpose of perinatal or postpartum care. 13
72+
73+ (p) (1) “Practice direct–entry midwifery” means: 14
74+
75+ (i) Providing maternity care that is consistent with a midwife’s 15
76+training, education, and experience; and 16
77+
78+ (ii) Identifying and referring patients who require medical care to an 17
79+appropriate health care provider. 18
80+
81+ (2) “Practice direct–entry midwifery” includes the activities described in § 19
82+8–6C–02 of this subtitle. 20
83+
84+8–6C–02. 21
85+
86+ (a) The practice of direct–entry midwifery includes: 22
87+
88+ (1) Providing the necessary supervision, care, and advice to a patient 23
89+during a low–risk pregnancy, labor, delivery, and postpartum period; and 24
90+
91+ (2) Newborn care authorized under this subtitle that is provided in a 25
92+manner that is: 26
93+
94+ (i) Consistent with national direct–entry midwifery standards; and 27
95+ SENATE BILL 854 3
96+
97+
98+ (ii) Based on the acquisition of clinical skills necessary for the care 1
99+of pregnant women and newborns, including antepartum, intrapartum, and postpartum 2
100+care. 3
101+
102+ (b) The practice of direct–entry midwifery also includes: 4
103+
104+ (1) Obtaining informed consent to provide services to the patient; 5
105+
106+ (2) Discussing: 6
107+
108+ (i) Any general risk factors associated with the services to be 7
109+provided; 8
110+
111+ (ii) Any specific risk factors pertaining to the health and 9
112+circumstances of the individual patient; 10
113+
114+ (iii) Conditions that preclude care by a licensed direct–entry midwife; 11
115+and 12
116+
117+ (iv) The conditions under which consultation, transfer of care, or 13
118+transport of the patient must be implemented; 14
119+
120+ (3) Obtaining a health history of the patient and performing a physical 15
121+examination; 16
122+
123+ (4) Developing a written plan of care specific to the patient, to ensure 17
124+continuity of care throughout the antepartum, intrapartum, and postpartum periods, that 18
125+includes: 19
126+
127+ (i) A plan for the management of any specific risk factors pertaining 20
128+to the individual health and circumstances of the individual patient; and 21
129+
130+ (ii) A plan to be followed in the event of an emergency, including a 22
131+plan for transportation; 23
132+
133+ (5) Evaluating the results of patient care; 24
134+
135+ (6) Consulting and collaborating with a health care practitioner regarding 25
136+the care of a patient, and referring and transferring care to a health care provider, as 26
137+required; 27
138+
139+ (7) Referral of all patients, within 72 hours after delivery, to a pediatric 28
140+health care practitioner for care of the newborn; 29
141+
142+ (8) As approved by the Board: 30
143+
144+ (i) Obtaining and administering medications; and 31 4 SENATE BILL 854
49145
50146
51147
52- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
53-That the Laws of Maryland read as follows: 2
148+ (ii) Obtaining and using equipment and devices; 1
54149
55-Article – Health Occupations 3
150+ (9) Obtaining appropriate screening and testing, including laboratory 2
151+tests, urinalysis, and ultrasound; 3
56152
57-8–6C–01. 4
153+ (10) Providing [prenatal] care during the antepartum period, with 4
154+consultation or referral as required; 5
58155
59- (a) In this subtitle the following words have the meanings indicated. 5
156+ (11) Providing care during the intrapartum period, including: 6
60157
61- (d) “Board” means the State Board of Nursing. 6
158+ (i) Monitoring and evaluating the condition of the patient and fetus; 7
62159
63- (e) “Committee” means the Direct–Entry Midwifery Advisory Committee 7
64-established under § 8–6C–11 of this subtitle. 8
160+ (ii) [At the onset of active labor notifying the pediatric health care 8
161+practitioner that delivery is imminent; 9
65162
66- (f) “Health care practitioner” means: 9
163+ (iii)] Performing emergency procedures, including: 10
67164
68- (1) An individual certified as a nurse–midwife or a nurse practitioner 10
69-under this title; or 11
165+ 1. Administering approved medications; 11
70166
71- (2) A physician licensed under Title 14 of this article. 12
167+ 2. Administering intravenous fluids for stabilization; 12
72168
73- (n) (1) “Patient” means [a woman] AN INDIVIDUAL for whom a licensed 13
74-direct–entry midwife performs services. 14
169+ 3. Performing an emergency episiotomy; and 13
75170
76- (2) “Patient” includes [a woman’s] AN INDIVIDUAL ’S newborn for the 15
77-purpose of perinatal or postpartum care. 16
171+ 4. Providing care while on the way to a hospital under 14
172+circumstances in which emergency medical services have not been activated; 15
78173
79- (p) (1) “Practice direct–entry midwifery” means: 17
174+ [(iv)] (III) Activating emergency medical services for an emergency; 16
175+and 17
80176
81- (i) Providing maternity care that is consistent with a midwife’s 18
82-training, education, and experience; and 19
177+ [(v)] (IV) Delivering in an out–of–hospital setting; 18
83178
84- (ii) Identifying and referring patients who require medical care to an 20
85-appropriate health care provider. 21
179+ (12) Participating in peer review as required under § 8–6C–18(e)(2) of this 19
180+subtitle; 20
86181
87- (2) “Practice direct–entry midwifery” includes the activities described in § 22
88-8–6C–02 of this subtitle. 23
182+ (13) Providing care during the postpartum period, including: 21
89183
90-8–6C–02. 24
184+ (i) Suturing of first and second degree perineal or labial lacerations, 22
185+or suturing of an episiotomy with the administration of a local anesthetic; and 23
91186
92- (a) The practice of direct–entry midwifery includes: 25
187+ (ii) Making further contact with the patient within 48 hours, within 24
188+2 weeks, and at 6 weeks after the delivery to assess for hemorrhage, preeclampsia, 25
189+thrombo–embolism, infection, and emotional well–being; 26
93190
94- (1) Providing the necessary supervision, care, and advice to a patient 26
95-during a low–risk pregnancy, labor, delivery, and postpartum period; and 27
96- SENATE BILL 854 3
97-
98-
99- (2) Newborn care authorized under this subtitle that is provided in a 1
100-manner that is: 2
101-
102- (i) Consistent with national direct–entry midwifery standards; and 3
103-
104- (ii) Based on the acquisition of clinical skills necessary for the care 4
105-of pregnant women and newborns, including antepartum, intrapartum, and postpartum 5
106-care. 6
107-
108- (b) The practice of direct–entry midwifery also includes: 7
109-
110- (1) Obtaining informed consent to provide services to the patient; 8
111-
112- (2) Discussing: 9
113-
114- (i) Any general risk factors associated with the services to be 10
115-provided; 11
116-
117- (ii) Any specific risk factors pertaining to the health and 12
118-circumstances of the individual patient; 13
119-
120- (iii) Conditions that preclude care by a licensed direct–entry midwife; 14
121-and 15
122-
123- (iv) The conditions under which consultation, transfer of care, or 16
124-transport of the patient must be implemented; 17
125-
126- (3) Obtaining a health history of the patient and performing a physical 18
127-examination; 19
128-
129- (4) Developing a written plan of care specific to the patient, to ensure 20
130-continuity of care throughout the antepartum, intrapartum, and postpartum periods, that 21
131-includes: 22
132-
133- (i) A plan for the management of any specific risk factors pertaining 23
134-to the individual health and circumstances of the individual patient; and 24
135-
136- (ii) A plan to be followed in the event of an emergency, including a 25
137-plan for transportation; 26
138-
139- (5) Evaluating the results of patient care; 27
140-
141- (6) Consulting and collaborating with a health care practitioner regarding 28
142-the care of a patient, and referring and transferring care to a health care provider, as 29
143-required; 30
144- 4 SENATE BILL 854
145-
146-
147- (7) Referral of all patients, within 72 hours after delivery, to a pediatric 1
148-health care practitioner for care of the newborn; 2
149-
150- (8) As approved by the Board: 3
151-
152- (i) Obtaining and administering medications; and 4
153-
154- (ii) Obtaining and using equipment and devices; 5
155-
156- (9) Obtaining appropriate screening and testing, including laboratory 6
157-tests, urinalysis, and ultrasound; 7
158-
159- (10) Providing [prenatal] care during the antepartum period, with 8
160-consultation or referral as required; 9
161-
162- (11) Providing care during the intrapartum period, including: 10
163-
164- (i) Monitoring and evaluating the condition of the patient and fetus; 11
165-
166- (ii) [At the onset of active labor notifying the pediatric health care 12
167-practitioner that delivery is imminent; 13
168-
169- (iii)] Performing emergency procedures, including: 14
170-
171- 1. Administering approved medications; 15
172-
173- 2. Administering intravenous fluids for stabilization; 16
174-
175- 3. Performing an emergency episiotomy; and 17
176-
177- 4. Providing care while on the way to a hospital under 18
178-circumstances in which emergency medical services have not been activated; 19
179-
180- [(iv)] (III) Activating emergency medical services for an emergency; 20
181-and 21
182-
183- [(v)] (IV) Delivering in an out–of–hospital setting; 22
184-
185- (12) Participating in peer review as required under § 8–6C–18(e)(2) of this 23
186-subtitle; 24
187-
188- (13) Providing care during the postpartum period, including: 25
189-
190- (i) Suturing of first and second degree perineal or labial lacerations, 26
191-or suturing of an episiotomy with the administration of a local anesthetic; and 27
191+ (14) Providing routine care for the newborn for up to 72 hours after delivery, 27
192+exclusive of administering immunizations, including: 28
192193 SENATE BILL 854 5
193194
194195
195- (ii) Making further contact with the patient within 48 hours, within 1
196-2 weeks, and at 6 weeks after the delivery to assess for hemorrhage, preeclampsia, 2
197-thrombo–embolism, infection, and emotional well–being; 3
196+ (i) Immediate care at birth, including resuscitating as needed, 1
197+performing a newborn examination, and administering intramuscular vitamin K and eye 2
198+ointment for prevention of ophthalmia neonatorum; 3
198199
199- (14) Providing routine care for the newborn for up to 72 hours after delivery, 4
200-exclusive of administering immunizations, including: 5
200+ (ii) Assessing newborn feeding and hydration; 4
201201
202- (i) Immediate care at birth, including resuscitating as needed, 6
203-performing a newborn examination, and administering intramuscular vitamin K and eye 7
204-ointment for prevention of ophthalmia neonatorum; 8
202+ (iii) Performing metabolic screening and reporting on the screening 5
203+in accordance with the regulations related to newborn screenings that are adopted by the 6
204+Department; 7
205205
206- (ii) Assessing newborn feeding and hydration; 9
206+ (iv) Performing critical congenital heart disease screening and 8
207+reporting on the screening in accordance with the regulations related to newborn 9
208+screenings that are adopted by the Department; 10
207209
208- (iii) Performing metabolic screening and reporting on the screening 10
209-in accordance with the regulations related to newborn screenings that are adopted by the 11
210-Department; 12
210+ (v) If unable to perform the screening required under item (iii) or (iv) 11
211+of this item, referring the newborn to a pediatric health care practitioner to perform the 12
212+screening within 24 to 48 hours after delivery; and 13
211213
212- (iv) Performing critical congenital heart disease screening and 13
213-reporting on the screening in accordance with the regulations related to newborn 14
214-screenings that are adopted by the Department; 15
214+ (vi) Referring the infant to an audiologist for a hearing screening in 14
215+accordance with the regulations related to newborn screenings that are adopted by the 15
216+Department; 16
215217
216- (v) If unable to perform the screening required under item (iii) or (iv) 16
217-of this item, referring the newborn to a pediatric health care practitioner to perform the 17
218-screening within 24 to 48 hours after delivery; and 18
218+ (15) [Within 24 hours after delivery, notifying a pediatric health care 17
219+practitioner of the delivery; 18
219220
220- (vi) Referring the infant to an audiologist for a hearing screening in 19
221-accordance with the regulations related to newborn screenings that are adopted by the 20
222-Department; 21
221+ (16)] Within 72 hours after delivery: 19
223222
224- (15) [Within 24 hours after delivery, notifying a pediatric health care 22
225-practitioner of the delivery; 23
223+ (i) Transferring health records to the pediatric health care 20
224+practitioner, including documentation of the performance of the screenings required under 21
225+item (14)(iii) and (iv) of this subsection; and 22
226226
227- (16)] Within 72 hours after delivery: 24
227+ (ii) Referring the newborn to a pediatric health care practitioner; 23
228228
229- (i) Transferring health records to the pediatric health care 25
230-practitioner, including documentation of the performance of the screenings required under 26
231-item (14)(iii) and (iv) of this subsection; and 27
229+ [(17)] (16) Providing the following care of the newborn beyond the first 72 24
230+hours after delivery: 25
232231
233- (ii) Referring the newborn to a pediatric health care practitioner; 28
232+ (i) Weight checks and general observation of the newborn’s activity, 26
233+with abnormal findings communicated to the newborn’s pediatric health care practitioner; 27
234234
235- [(17)] (16) Providing the following care of the newborn beyond the first 72 29
236-hours after delivery: 30
235+ (ii) Assessment of newborn feeding and hydration; and 28
237236
238- (i) Weight checks and general observation of the newborn’s activity, 31
239-with abnormal findings communicated to the newborn’s pediatric health care practitioner; 32
237+ (iii) [Breastfeeding] LACTATION support and counseling; and 29
240238
241- (ii) Assessment of newborn feeding and hydration; and 33 6 SENATE BILL 854
239+ [(18)] (17) Providing limited services to the patient after the postpartum 30
240+period, including: 31
241+ 6 SENATE BILL 854
242+
243+
244+ (i) [Breastfeeding] LACTATION support and counseling; and 1
245+
246+ (ii) Counseling and referral for all family planning methods. 2
247+
248+ (c) The practice of direct–entry midwifery does not include: 3
249+
250+ (1) Pharmacological induction or augmentation of labor or artificial 4
251+rupture of membranes prior to the onset of labor; 5
252+
253+ (2) Surgical delivery or any surgery except an emergency episiotomy; 6
254+
255+ (3) Use of forceps or vacuum extractor; 7
256+
257+ (4) Except for the administration of a local anesthetic, administration of an 8
258+anesthetic; 9
259+
260+ (5) Administration of any kind of narcotic analgesic; or 10
261+
262+ (6) Administration of any prescription medication in a manner that 11
263+violates this subtitle. 12
264+
265+ (D) EXCEPT FOR A TRANSFER REQUIRED UNDER § 8–6C–03 OF THIS 13
266+SUBTITLE OR A CONSUL TATION REQUIRED UNDE R § 8–6C–04 OF THIS SUBTITLE , 14
267+THE PRACTICE OF DIRE CT–ENTRY MIDWIFERY IS I NDEPENDEN T AND DOES NOT 15
268+REQUIRE OVERSIGHT BY ANOTHER HEALTH CARE PRACTITIONER . 16
269+
270+8–6C–03. 17
271+
272+ A licensed direct–entry midwife may not assume or continue to take responsibility 18
273+for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care 19
274+to a health care practitioner for a patient who is already under the care of the licensed 20
275+direct–entry midwife, if any of the following disorders or situations is found to be present 21
276+at the initial interview or if any of the following disorders or situations occur as prenatal 22
277+care proceeds: 23
278+
279+ (1) Diabetes mellitus, including uncontrolled gestational diabetes; 24
280+
281+ (2) Hyperthyroidism treated with medication; 25
282+
283+ (3) Uncontrolled hypothyroidism; 26
284+
285+ (4) Epilepsy with seizures or antiepileptic drug use during the previous 12 27
286+months; 28
287+
288+ (5) Coagulation disorders; 29
289+
290+ (6) Chronic pulmonary disease; 30 SENATE BILL 854 7
242291
243292
244293
245- (iii) [Breastfeeding] LACTATION support and counseling; and 1
294+ (7) Heart disease in which there are arrhythmias or murmurs except when, 1
295+after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a 2
296+licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that 3
297+midwifery care may proceed; 4
246298
247- [(18)] (17) Providing limited services to the patient after the postpartum 2
248-period, including: 3
299+ (8) Hypertension, including pregnancy–induced hypertension (PIH); 5
249300
250- (i) [Breastfeeding] LACTATION support and counseling; and 4
301+ (9) Renal disease; 6
251302
252- (ii) Counseling and referral for all family planning methods. 5
303+ (10) Except as otherwise provided in § 8–6C–04(a)(11) of this subtitle, Rh 7
304+sensitization with positive antibody titer; 8
253305
254- (c) The practice of direct–entry midwifery does not include: 6
306+ (11) Previous uterine surgery, including a cesarean section or myomectomy; 9
255307
256- (1) Pharmacological induction or augmentation of labor or artificial 7
257-rupture of membranes prior to the onset of labor; 8
308+ (12) Indications that the fetus has died in utero; 10
258309
259- (2) Surgical delivery or any surgery except an emergency episiotomy; 9
310+ (13) Premature labor (gestation less than 37 weeks); 11
260311
261- (3) Use of forceps or vacuum extractor; 10
312+ (14) Multiple gestation; 12
262313
263- (4) Except for the administration of a local anesthetic, administration of an 11
264-anesthetic; 12
314+ (15) Noncephalic presentation at or after 38 weeks; 13
265315
266- (5) Administration of any kind of narcotic analgesic; or 13
316+ (16) Placenta previa or abruption; 14
267317
268- (6) Administration of any prescription medication in a manner that 14
269-violates this subtitle. 15
318+ (17) Preeclampsia; 15
270319
271- (D) EXCEPT FOR A TRANSFER REQUIRED UN DER § 8–6C–03 OF THIS 16
272-SUBTITLE OR A CONSUL TATION REQUIRED UNDE R § 8–6C–04 OF THIS SUBTITLE , 17
273-THE THE PRACTICE OF DIRECT –ENTRY MIDWIFERY IS I NDEPENDENT AND DOES NOT 18
274-REQUIRE OVERSIGHT BY ANOTHER HEALTH CARE PRACTITIONER . 19
320+ (18) [Severe anemia, defined as hemoglobin less than 10 g/dL; 16
275321
276-8–6C–03. 20
322+ (19)] Uncommon diseases and disorder s, including Addison’s disease, 17
323+Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, 18
324+scleroderma, rheumatoid arthritis, periarteritis nodosa, AND Marfan’s syndrome[, and 19
325+other systemic and rare diseases and disorders]; 20
277326
278- A licensed direct–entry midwife may not assume or continue to take responsibility 21
279-for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care 22
280-to a health care practitioner for a patient who is already under the care of the licensed 23
281-direct–entry midwife, if any of the following disorders or situations is found to be present 24
282-at the initial interview or if any of the following disorders or situations occur as prenatal 25
283-care proceeds: 26
327+ [(20)] (19) AIDS/HIV; 21
284328
285- (1) Diabetes mellitus, including uncontrolled gestational diabetes; 27
329+ [(21)] (20) Hepatitis [A through G and non–A through G]; 22
286330
287- (2) Hyperthyroidism treated with medication; 28
331+ [(22)] (21) Acute toxoplasmosis infection, if the patient is symptomatic; 23
288332
289- (3) Uncontrolled hypothyroidism; 29 SENATE BILL 854 7
333+ [(23)] (22) Acute Rubella infection during pregnancy; 24
334+
335+ [(24)] (23) Acute cytomegalovirus infection, if the patient is symptomatic; 25
336+
337+ [(25)] (24) Acute Parvovirus infection, if the patient is symptomatic; 26
338+ 8 SENATE BILL 854
339+
340+
341+ [(26)] (25) Alcohol abuse, substance abuse, or prescription abuse during 1
342+pregnancy; 2
343+
344+ [(27)] (26) Continued daily tobacco use into the second trimester; 3
345+
346+ [(28)] (27) Thrombosis; 4
347+
348+ [(29)] (28) Inflammatory bowel disease that is not in remission; 5
349+
350+ [(30)] (29) Primary genital herpes simplex virus infection during the third 6
351+trimester or active genital herpes lesions at the time of labor; 7
352+
353+ [(31) Significant fetal congenital anomaly; 8
354+
355+ (32)] (30) Ectopic pregnancy; OR 9
356+
357+ [(33) Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or 10
358+
359+ (34)] (31) Post term maturity (gestational age 42 0/7 weeks and beyond). 11
360+
361+8–6C–04. 12
362+
363+ (a) A licensed direct–entry midwife shall consult with a health care practitioner, 13
364+and document the consultation, the recommendations of the consultation, and the 14
365+discussion of the consultation with the client, if any of the following conditions are present 15
366+during [prenatal] THE COURSE OF care: 16
367+
368+ (1) Significant mental disease, including depression, bipolar disorder, 17
369+schizophrenia, and other conditions that impair the ability of the patient to participate 18
370+effectively in the patient’s care or that require the use of psychotropic drugs to control the 19
371+condition; 20
372+
373+ (2) Second or third trimester bleeding; 21
374+
375+ (3) Intermittent use of alcohol into the second trimester; 22
376+
377+ (4) Asthma; 23
378+
379+ (5) Diet–controlled gestational diabetes; 24
380+
381+ (6) History of genetic problems, intrauterine death after 20 weeks’ 25
382+gestation, or stillbirth; 26
383+
384+ (7) Abnormal pap smear; 27
385+
386+ (8) Possible ectopic pregnancy; 28 SENATE BILL 854 9
290387
291388
292389
293- (4) Epilepsy with seizures or antiepileptic drug use during the previous 12 1
294-months; 2
390+ (9) Tuberculosis; 1
295391
296- (5) Coagulation disorders; 3
392+ (10) Controlled hypothyroidism, being treated with thyroid replacement and 2
393+euthyroid, and with thyroid test numbers in the normal range; 3
297394
298- (6) Chronic pulmonary disease; 4
395+ (11) Rh sensitization with positive antibody titer; 4
299396
300- (7) Heart disease in which there are arrhythmias or murmurs except when, 5
301-after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a 6
302-licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that 7
303-midwifery care may proceed; 8
397+ (12) Breech presentation between 35 and 38 weeks; 5
304398
305- (8) Hypertension, including pregnancy–induced hypertension (PIH); 9
399+ (13) Transverse lie or other abnormal presentation between 35 and 38 6
400+weeks; 7
306401
307- (9) Renal disease; 10
402+ (14) Premature rupture of membranes at 37 weeks or less; 8
308403
309- (10) Except as otherwise provided in § 8–6C–04(a)(11) of this subtitle, Rh 11
310-sensitization with positive antibody titer; 12
404+ (15) Small for gestational age or large for gestational age fetus; 9
311405
312- (11) (10) Previous uterine surgery, including a cesarean section or 13
313-myomectomy; 14
406+ (16) Polyhydramnios or oligohydramnios; 10
314407
315- (12) (11) Indications that the fetus has died in utero; 15
408+ (17) Previous LEEP procedure or cone biopsy; 11
316409
317- (13) (12) Premature labor (gestation less than 37 weeks); 16
410+ (18) Previous obstetrical problems, including uterine abnormalities, 12
411+placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or 13
412+preterm delivery for any reason; 14
318413
319- (14) (13) Multiple gestation; 17
414+ (19) Postterm maturity (41 0/7 to 6/7 weeks gestational age); 15
320415
321- (15) (14) Noncephalic presentation at or after 38 weeks; 18
416+ (20) Inflammatory bowel disease, in remission; [or] 16
322417
323- (16) (15) Placenta previa or abruption; 19
418+ (21) Active genital herpes lesions during pregnancy; 17
324419
325- (17) (16) Preeclampsia; 20
420+ (22) SEVERE ANEMIA , AS DEFINED AS HEMOGL OBIN LESS THAN 10 18
421+G/DL AND UNRESPONSIVE TO TREATMENT ; 19
326422
327- (18) (17) [Severe anemia, defined as hemoglobin less than 10 g/dL: 21
423+ (23) PREPREGNANCY BODY MAS S INDEX (BMI) OF LESS THAN 18.5 OR 20
424+35 OR MORE; OR 21
328425
329- (I) THAT HAS BEEN MEASURE D AFTER TREATMENT ; OR 22
426+ (24) SIGNIFICANT FETAL CON GENITAL ANOMALY . 22
330427
331- (II) BASED ON BLOOD TESTS PERFORMED AT OR AFTE R 36 23
332-WEEKS; 24
428+ (b) Subject to subsection (c) of this section, a licensed direct–entry midwife shall 23
429+arrange immediate emergency transfer to a hospital if: 24
333430
334- (19) (18)] Uncommon diseases and disorders, including Addison’s disease, 25
335-Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, 26
336-scleroderma, rheumatoid arthritis, periarteritis nodosa, AND Marfan’s syndrome[, and 27
337-other systemic and rare diseases and disorders]; 28 8 SENATE BILL 854
431+ (2) The patient or newborn is determined to have any of the following 25
432+conditions during labor, delivery, or the immediate postpartum period: 26
433+
434+ (x) [Obvious] LIFE–THREATENING congenital anomalies; 27 10 SENATE BILL 854
338435
339436
340437
341- [(20)] (19) AIDS/HIV; 1
438+8–6C–08. 1
342439
343- [(21)] (20) Hepatitis [A through G and non–A through G]; 2
440+ (a) A licensed direct–entry midwife shall develop a general written plan for their 2
441+practice for: 3
344442
345- [(22)] (21) Acute toxoplasmosis infection, if the patient is symptomatic; 3
443+ (1) Emergency transfer of a patient, newborn, or both; 4
346444
347- [(23)] (22) Acute Rubella infection during pregnancy; 4
445+ (2) Transport of a newborn to a newborn nursery or neonatal intensive care 5
446+nursery; and 6
348447
349- [(24)] (23) Acute cytomegalovirus infection, if the patient is symptomatic; 5
448+ (3) Transport of a patient to an appropriate hospital with a labor and 7
449+delivery unit. 8
350450
351- [(25)] (24) Acute Parvovirus infection, if the patient is symptomatic; 6
451+ (b) The Committee shall review and recommend approval to the Board of the plan 9
452+required under subsection (a) of this section. 10
352453
353- [(26)] (25) Alcohol abuse, substance abuse, or prescription abuse during 7
354-pregnancy; 8
454+ (c) [The plan required under subsection (a) of this section shall be provided to any 11
455+hospital identified in the plan. 12
355456
356- [(27)] (26) Continued daily tobacco use into the second trimester; 9
457+ (d)] (1) In addition to the general written plan required under subsection (a) of 13
458+this section, a licensed direct–entry midwife shall prepare a plan that is specific to each 14
459+patient and share the plan with the patient. 15
357460
358- [(28)] (27) Thrombosis; 10
461+ (2) The plan required under paragraph (1) of this subsection shall: 16
359462
360- [(29)] (28) Inflammatory bowel disease that is not in remission; 11
463+ (i) Include procedures and processes to be undertaken in the event 17
464+of an emergency for the mother, the newborn, or both; 18
361465
362- [(30)] (29) Primary genital herpes simplex virus infection during the third 12
363-trimester or active genital herpes lesions at the time of labor; 13
466+ (ii) Identify the hospital closest to the address of the planned home 19
467+birth that has a labor and delivery unit; 20
364468
365- [(31) (30) Significant fetal congenital anomaly THAT DIRECTLY IMPACT S 14
366-THE BIRTHING PROCESS OR REQUIRES IMMEDIAT E EMERGENCY CARE , AS 15
367-DETERMINED BY THE BOARD IN REGULATIONS ; 16
469+ (iii) Include a care plan for the newborn; and 21
368470
369- (32)] (30) (31) Ectopic pregnancy; OR 17
471+ (iv) Identify the pediatric health care practitioner who will be 22
472+[notified after delivery in accordance with § 8–6C–02(b)(15) of this subtitle to receive the 23
473+transfer of care of the newborn] RECEIVING THE HEALTH RECORDS OF THE NEWBO RN 24
474+IN ACCORDANCE WITH § 8–6C–02(B)(15) OF THIS SUBTITLE . 25
370475
371- [(33) Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or 18
476+ [(e)] (D) (1) The Board, in consultation with stakeholders, shall develop a 26
477+standard form for use in all cases in which a transfer occurs during prenatal care, labor, or 27
478+postpartum. 28
372479
373- (34)] (31) (32) Post term maturity (gestational age 42 0/7 weeks and 19
374-beyond). 20
375-
376-8–6C–04. 21
377-
378- (a) A licensed direct–entry midwife shall consult with a health care practitioner, 22
379-and document the consultation, the recommendations of the consultation, and the 23
380-discussion of the consultation with the client, if any of the following conditions are present 24
381-during [prenatal] THE COURSE OF care: 25
382-
383- (1) Significant mental disease, including depression, bipolar disorder, 26
384-schizophrenia, and other conditions that impair the ability of the patient to participate 27 SENATE BILL 854 9
480+ (2) The form shall include the medical information needed by the health 29
481+care practitioner receiving the patient. 30
482+ SENATE BILL 854 11
385483
386484
387-effectively in the patient’s care or that require the use of psychotropic drugs to control the 1
388-condition; 2
485+ [(f)] (E) [(1)] After a decision to transport a patient has been made, the 1
486+licensed direct–entry midwife shall: 2
389487
390- (2) Second or third trimester bleeding; 3
488+ [(i)] (1) Call the receiving health care provider; 3
391489
392- (3) Intermittent use of alcohol into the second trimester; 4
490+ [(ii)] (2) Inform the health care provider of the incoming patient; 4
491+and 5
393492
394- (4) Asthma; 5
493+ [(iii) Accompany the patient to the hospital.] 6
395494
396- (5) Diet–controlled gestational diabetes; 6
495+ [(2)] (3) [On arrival at the hospital, the licensed direct–entry midwife 7
496+shall provide] PROVIDE: 8
397497
398- (6) History of genetic problems, intrauterine death after 20 weeks’ 7
399-gestation, or stillbirth; 8
498+ (i) To the staff of the hospital: 9
400499
401- (7) Abnormal pap smear; 9
500+ 1. The standard form developed under subsection (e) of this 10
501+section; and 11
402502
403- (8) Possible ectopic pregnancy; 10
503+ 2. The [complete] medical records of the patient OR 12
504+NEWBORN, AS REQUESTED BY THE RECEIVING HEALTH CAR E PROVIDER; and 13
404505
405- (9) Tuberculosis; 11
506+ (ii) To the accepting health care practitioner, a verbal summary of 14
507+the care provided to the patient by the licensed direct–entry midwife. 15
406508
407- (10) Controlled hypothyroidism, being treated with thyroid replacement and 12
408-euthyroid, and with thyroid test numbers in the normal range; 13
509+8–6C–10. 16
409510
410- (11) Rh sensitization with positive antibody titer; 14
511+ (a) [On or before October 1 each year, a licensed direct–entry midwife shall report 17
512+to the Committee, in a form specified by the Board, the following information regarding 18
513+cases in which the licensed direct–entry midwife assisted during the previous fiscal year 19
514+when the intended place of birth at the onset of care was an out–of–hospital setting: 20
411515
412- (12) Breech presentation between 35 and 38 weeks; 15
516+ (1) The total number of patients served as primary caregiver at the onset 21
517+of care; 22
413518
414- (13) Transverse lie or other abnormal presentation between 35 and 38 16
415-weeks; 17
519+ (2) The number, by county, of live births attended as primary caregiver; 23
416520
417- (14) Premature rupture of membranes at 37 weeks or less; 18
521+ (3) The number, by county, of cases of fetal demise, infant deaths, and 24
522+maternal deaths attended as primary caregiver at the discovery of the demise or death; 25
418523
419- (15) Small for gestational age or large for gestational age fetus; 19
524+ (4) The number of women whose primary care was transferred to another 26
525+health care practitioner during the antepartum period and the reason for transfer; 27
420526
421- (16) Polyhydramnios or oligohydramnios; 20
422-
423- (17) Previous LEEP procedure or cone biopsy; 21
424-
425- (18) Previous obstetrical problems, including uterine abnormalities, 22
426-placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or 23
427-preterm delivery for any reason; 24
428-
429- (19) Postterm maturity (41 0/7 to 6/7 weeks gestational age); 25
430-
431- (20) Inflammatory bowel disease, in remission; [or] 26
432- 10 SENATE BILL 854
527+ (5) The number, reason for, and outcome of each nonemergency hospital 28
528+transfer during the intrapartum or postpartum period; 29
529+ 12 SENATE BILL 854
433530
434531
435- (21) Active genital herpes lesions during pregnancy EXCEPT AS REQUIRED 1
436-BY § 8–6C–03(29) OF THIS SUBTITLE; 2
532+ (6) The number, reason for, and outcome of each urgent or emergency 1
533+transport of an expectant mother in the antepartum period; 2
437534
438- (22) SEVERE ANEMIA , AS DEFINED AS HEMOGL OBIN LESS THAN 10 3
439-G/DL AND UNRESPONSIVE TO TREATMENT ; 4
535+ (7) The number, reason for, and outcome of each urgent or emergency 3
536+transport of an infant or mother during the intrapartum or immediate postpartum period; 4
440537
441- (23) (22) PREPREGNANCY BODY MAS S INDEX (BMI) OF LESS THAN 5
442-18.5 OR 35 OR MORE; OR 6
538+ (8) The number of planned out–of–hospital births at the onset of labor and 5
539+the number of births completed in an out–of–hospital setting; 6
443540
444- (24) (23) SIGNIFICANT FETAL CONGENITAL ANO MALY. 7
541+ (9) A brief description of any complications resulting in the morbidity or 7
542+mortality of a mother or a neonate; and 8
445543
446- (b) Subject to subsection (c) of this section, a licensed direct–entry midwife shall 8
447-arrange immediate emergency transfer to a hospital if: 9
544+ (10) Any other information required by the Board in regulations. 9
448545
449- (2) The patient or newborn is determined to have any of the following 10
450-conditions during labor, delivery, or the immediate postpartum period: 11
546+ (b) The Board shall send a written notice of noncompliance to each licensee who 10
547+fails to meet the reporting requirements under subsection (a) of this section. 11
451548
452- (x) [Obvious] LIFE–THREATENING SIGNIFICANT congenital 12
453-anomalies THAT DIRECTLY AFFECT DELIVERY OR IMMEDIAT E POSTPARTUM CARE OR 13
454-REQUIRE IMMEDIATE EM ERGENCY CARE , AS DETERMINED BY THE BOARD IN 14
455-REGULATIONS; 15
549+ (c) A licensed direct–entry midwife who fails to comply with the reporting 12
550+requirements under this section shall be prohibited from license renewal until the 13
551+information required under subsection (a) of this section is reported. 14
456552
457-8–6C–08. 16
553+ (d) The Committee shall maintain the confidentiality of any report submitted 15
554+under subsection (a) of this section. 16
458555
459- (a) A licensed direct–entry midwife shall develop a general written plan for their 17
460-practice for: 18
556+ (e)] Notwithstanding any other provision of law, a licensed direct–entry midwife 17
557+shall be subject to the same reporting requirements as other health care practitioners who 18
558+provide care to individuals in accordance with this title. 19
461559
462- (1) Emergency transfer of a patient, newborn, or both; 19
560+ [(f)] (B) A licensed direct–entry midwife attending an out–of–hospital delivery 20
561+shall: 21
463562
464- (2) Transport of a newborn to a newborn nursery or neonatal intensive care 20
465-nursery; and 21
563+ (1) For any live birth, complete and submit a birth certificate in accordance 22
564+with § 4–208 of the Health – General Article; and 23
466565
467- (3) Transport of a patient to an appropriate hospital with a labor and 22
468-delivery unit. 23
566+ (2) For any death, make all medical records available and communicate 24
567+relevant circumstances of the death to the individual responsible for completing the 25
568+certificate of death under § 4–212 or § 4–213 of the Health – General Article. 26
469569
470- (b) The Committee shall review and recommend approval to the Board of the plan 24
471-required under subsection (a) of this section. 25
570+8–6C–20. 27
472571
473- (c) [The plan required under subsection (a) of this section shall be provided to any 26
474-hospital identified in the plan. 27
572+ (a) Subject to the hearing provisions of § 8–317 of this title, the Board may deny 28
573+a license OR GRANT A LICENSE , INCLUDING A LICENSE SUBJECT TO A REPRIMA ND, 29
574+PROBATION, OR SUSPENS ION, to an applicant, reprimand a licensee, place a licensee on 30
575+probation, or suspend or revoke [a] THE license OF A LICENSEE if the applicant or licensee: 31
475576
476- (d)] (1) In addition to the general written plan required under subsection (a) of 28
477-this section, a licensed direct–entry midwife shall prepare a plan that is specific to each 29
478-patient and share the plan with the patient. 30
479-
480- (2) The plan required under paragraph (1) of this subsection shall: 31 SENATE BILL 854 11
577+ (1) Fraudulently or deceptively obtains or attempts to obtain a license for 32
578+the applicant or for another; 33 SENATE BILL 854 13
481579
482580
483581
484- (i) Include procedures and processes to be undertaken in the event 1
485-of an emergency for the mother, the newborn, or both; 2
582+ (2) Fraudulently or deceptively uses a license; 1
486583
487- (ii) Identify the hospital closest to the address of the planned home 3
488-birth that has a labor and delivery unit; 4
584+ (3) Is disciplined by a licensing, military, or disciplinary authority in the 2
585+State or in any other state or country or is convicted or disciplined by a court in the State 3
586+or in any other state or country for an act that would be grounds for disciplinary action 4
587+under the Board’s disciplinary statutes; 5
489588
490- (iii) Include a care plan for the newborn; and 5
589+ (4) Is convicted of or pleads guilty or nolo contendere to a felony or to a 6
590+crime involving moral turpitude, whether or not any appeal or other proceeding is pending 7
591+to have the conviction or plea set aside; 8
491592
492- (iv) Identify the pediatric health care practitioner who will be 6
493-[notified after delivery in accordance with § 8–6C–02(b)(15) of this subtitle to receive the 7
494-transfer of care of the newborn] RECEIVING THE HEALTH RECORDS OF THE NEWBO RN 8
495-IN ACCORDANCE WITH § 8–6C–02(B)(15) OF THIS SUBTITLE . 9
593+ (5) Willfully and knowingly: 9
496594
497- [(e)] (D) (1) The Board, in consultation with stakeholders, shall develop a 10
498-standard form for use in all cases in which a transfer occurs during prenatal care, labor, or 11
499-postpartum. 12
595+ (i) Files a false report or record of an individual under the licensee’s 10
596+care; 11
500597
501- (2) The form shall include the medical information needed by the health 13
502-care practitioner receiving the patient. 14
598+ (ii) Gives any false or misleading information about a material 12
599+matter in an employment application; 13
503600
504- [(f)] (E) [(1)] After a decision to transport a patient has been made, the 15
505-licensed direct–entry midwife shall: 16
601+ (iii) Fails to file or record any health record that is required by law; 14
506602
507- [(i)] (1) Call the receiving health care provider; 17
603+ (iv) Obstructs the filing or recording of any health record as required 15
604+by law; or 16
508605
509- [(ii)] (2) Inform the health care provider of the incoming patient; 18
510-and 19
606+ (v) Induces another person to fail to file or record any health record 17
607+as required by law; 18
511608
512- [(iii) (3) Accompany the patient to the hospital. IF DETERMINED 20
513-TO BE APPROPRIATE BY THE LICENSED DIRECT –ENTRY MIDWIFE AND TH E 21
514-RECEIVING HEALTH CAR E PROVIDER; AND] 22
609+ (6) Knowingly does any act that has been determined by the Board, in its 19
610+regulations, to exceed the scope of practice authorized to the individual under this subtitle; 20
515611
516- [(2)] (3) (4) [On arrival at the hospital, the licensed direct–entry midwife 23
517-shall provide] PROVIDE: 24
612+ (7) Provides professional services while: 21
518613
519- (i) To the staff of the hospital: 25
614+ (i) Under the influence of alcohol; or 22
520615
521- 1. The standard form developed under subsection (e) (D) of 26
522-this section; and 27
616+ (ii) Using any narcotic or controlled dangerous substance, as defined 23
617+in § 5–101 of the Criminal Law Article, or other drug that is in excess of therapeutic 24
618+amounts or without valid medical indication; 25
523619
524- 2. The [complete] medical records of the patient OR 28
525-NEWBORN, AS DETERMINED BY THE BOARD IN REGULATIONS AND AS REQUESTED 29
526-BY THE RECEIVING HEALTH CARE PROVIDER; and 30
527- 12 SENATE BILL 854
620+ (8) Does an act that is inconsistent with generally accepted professional 26
621+standards in the practice of direct–entry midwifery; 27
528622
623+ (9) Is grossly negligent in the practice of direct–entry midwifery; 28
529624
530- (ii) To the accepting health care practitioner, a verbal summary of 1
531-the care provided to the patient by the licensed direct–entry midwife. 2
625+ (10) Has violated any provision of this title; 29
532626
533-8–6C–10. 3
534-
535- (a) [On or before October 1 each year, a licensed direct–entry midwife shall report 4
536-to the Committee, in a form specified by the Board, the following information regarding 5
537-cases in which the licensed direct–entry midwife assisted during the previous fiscal year 6
538-when the intended place of birth at the onset of care was an out–of–hospital setting: 7
539-
540- (1) The total number of patients served as primary caregiver at the onset 8
541-of care; 9
542-
543- (2) The number, by county, of live births attended as primary caregiver; 10
544-
545- (3) The number, by county, of cases of fetal demise, infant deaths, and 11
546-maternal deaths attended as primary caregiver at the discovery of the demise or death; 12
547-
548- (4) The number of women whose primary care was transferred to another 13
549-health care practitioner during the antepartum period and the reason for transfer; 14
550-
551- (5) The number, reason for, and outcome of each nonemergency hospital 15
552-transfer during the intrapartum or postpartum period; 16
553-
554- (6) The number, reason for, and outcome of each urgent or emergency 17
555-transport of an expectant mother in the antepartum period; 18
556-
557- (7) The number, reason for, and outcome of each urgent or emergency 19
558-transport of an infant or mother during the intrapartum or immediate postpartum period; 20
559-
560- (8) The number of planned out–of–hospital births at the onset of labor and 21
561-the number of births completed in an out–of–hospital setting; 22
562-
563- (9) A brief description of any complications resulting in the morbidity or 23
564-mortality of a mother or a neonate; and 24
565-
566- (10) Any other information required by the Board in regulations. 25
567-
568- (b) The Board shall send a written notice of noncompliance to each licensee who 26
569-fails to meet the reporting requirements under subsection (a) of this section. 27
570-
571- (c) A licensed direct–entry midwife who fails to comply with the reporting 28
572-requirements under this section shall be prohibited from license renewal until the 29
573-information required under subsection (a) of this section is reported. 30
574-
575- (d) The Committee shall maintain the confidentiality of any report submitted 31
576-under subsection (a) of this section. 32 SENATE BILL 854 13
627+ (11) Submits a false statement to collect a fee; 30 14 SENATE BILL 854
577628
578629
579630
580- (e)] Notwithstanding any other provision of law, a licensed direct–entry midwife 1
581-shall be subject to the same reporting requirements as other health care practitioners who 2
582-provide care to individuals in accordance with this title REPORTING REQUIREMEN TS 3
583-ADOPTED BY THE BOARD IN REGULAT IONS IN CONSULTATION WITH THE 4
584-COMMITTEE AND ANY OTH ER STAKEHOLDERS DETE RMINED APPROPRIATE B Y THE 5
585-BOARD. 6
631+ (12) Is physically or mentally incompetent; 1
586632
587- [(f)] (B) A licensed direct–entry midwife attending an out–of–hospital delivery 7
588-shall: 8
633+ (13) Knowingly fails to report suspected child abuse in violation of § 5–704 2
634+of the Family Law Article; 3
589635
590- (1) For any live birth, complete and submit a birth certificate in accordance 9
591-with § 4–208 of the Health – General Article; and 10
636+ (14) Except in an emergency life–threatening situation where it is not 4
637+feasible or practicable, fails to comply with the Centers for Disease Control and 5
638+Prevention’s guidelines on universal precautions; 6
592639
593- (2) For any death, make all medical records available and communicate 11
594-relevant circumstances of the death to the individual responsible for completing the 12
595-certificate of death under § 4–212 or § 4–213 of the Health – General Article. 13
640+ (15) Is in independent practice and fails to display the notice required under 7
641+§ 8–6C–23 of this subtitle; 8
596642
597-8–6C–20. 14
643+ (16) Is habitually intoxicated; 9
598644
599- (a) Subject to the hearing provisions of § 8–317 of this title, the Board may deny 15
600-a license OR GRANT A LICENSE , INCLUDING A LICENSE SUBJECT TO A REPRIMA ND, 16
601-PROBATION, OR SUSPENSION , to an applicant, reprimand a licensee, place a licensee on 17
602-probation, or suspend or revoke [a] THE license OF A LICENSEE if the applicant or licensee: 18
645+ (17) Is addicted to, or habitually abuses, any narcotic or controlled 10
646+dangerous substance as defined in § 5–101 of the Criminal Law Article; 11
603647
604- (1) Fraudulently or deceptively obtains or attempts to obtain a license for 19
605-the applicant or for another; 20
648+ (18) Fails to cooperate with a lawful investigation conducted by the Board; 12
606649
607- (2) Fraudulently or deceptively uses a license; 21
650+ (19) Is expelled from the rehabilitation program established pursuant to § 13
651+8–208 of this title for failure to comply with the conditions of the program; 14
608652
609- (3) Is disciplined by a licensing, military, or disciplinary authority in the 22
610-State or in any other state or country or is convicted or disciplined by a court in the State 23
611-or in any other state or country for an act that would be grounds for disciplinary action 24
612-under the Board’s disciplinary statutes; 25
653+ (20) Engages in conduct that violates the professional code of ethics; 15
613654
614- (4) Is convicted of or pleads guilty or nolo contendere to a felony or to a 26
615-crime involving moral turpitude, whether or not any appeal or other proceeding is pending 27
616-to have the conviction or plea set aside; 28
655+ (21) Is professionally incompetent; 16
617656
618- (5) Willfully and knowingly: 29
657+ (22) Practices direct–entry midwifery without a license, before obtaining or 17
658+renewing a license, including any period when the license has lapsed; 18
619659
620- (i) Files a false report or record of an individual under the licensee’s 30
621-care; 31
660+ (23) After failing to renew a license or after a license has lapsed, commits 19
661+any act that would be grounds for disciplinary action under this section; 20
622662
623- (ii) Gives any false or misleading information about a material 32
624-matter in an employment application; 33 14 SENATE BILL 854
663+ (24) Violates regulations adopted by the Board or an order from the Board; 21
664+
665+ (25) Performs an act that is beyond the licensee’s knowledge and skills; 22
666+
667+ (26) Fails to submit to a criminal history records check in accordance with § 23
668+8–303 of this title; 24
669+
670+ (27) When acting in a supervisory position, directs another licensed 25
671+direct–entry midwife to perform an act that is beyond the licensed direct–entry midwife’s 26
672+knowledge and skills; or 27
673+
674+ (28) Fails to file a report required under this subtitle. 28
675+
676+8–6C–26. 29 SENATE BILL 854 15
625677
626678
627679
628- (iii) Fails to file or record any health record that is required by law; 1
680+ Subject to the evaluation and reestablishment provisions of the Maryland Program 1
681+Evaluation Act, and subject to the termination of this subtitle under § 8–802 of this title, 2
682+this subtitle and all regulations adopted under this subtitle shall terminate and be of no 3
683+effect after July 1, [2025] 2030. 4
629684
630- (iv) Obstructs the filing or recording of any health record as required 2
631-by law; or 3
632-
633- (v) Induces another person to fail to file or record any health record 4
634-as required by law; 5
635-
636- (6) Knowingly does any act that has been determined by the Board, in its 6
637-regulations, to exceed the scope of practice authorized to the individual under this subtitle; 7
638-
639- (7) Provides professional services while: 8
640-
641- (i) Under the influence of alcohol; or 9
642-
643- (ii) Using any narcotic or controlled dangerous substance, as defined 10
644-in § 5–101 of the Criminal Law Article, or other drug that is in excess of therapeutic 11
645-amounts or without valid medical indication; 12
646-
647- (8) Does an act that is inconsistent with generally accepted professional 13
648-standards in the practice of direct–entry midwifery; 14
649-
650- (9) Is grossly negligent in the practice of direct–entry midwifery; 15
651-
652- (10) Has violated any provision of this title; 16
653-
654- (11) Submits a false statement to collect a fee; 17
655-
656- (12) Is physically or mentally incompetent; 18
657-
658- (13) Knowingly fails to report suspected child abuse in violation of § 5–704 19
659-of the Family Law Article; 20
660-
661- (14) Except in an emergency life–threatening situation where it is not 21
662-feasible or practicable, fails to comply with the Centers for Disease Control and 22
663-Prevention’s guidelines on universal precautions; 23
664-
665- (15) Is in independent practice and fails to display the notice required under 24
666-§ 8–6C–23 of this subtitle; 25
667-
668- (16) Is habitually intoxicated; 26
669-
670- (17) Is addicted to, or habitually abuses, any narcotic or controlled 27
671-dangerous substance as defined in § 5–101 of the Criminal Law Article; 28
672-
673- (18) Fails to cooperate with a lawful investigation conducted by the Board; 29 SENATE BILL 854 15
674-
675-
676-
677- (19) Is expelled from the rehabilitation program established pursuant to § 1
678-8–208 of this title for failure to comply with the conditions of the program; 2
679-
680- (20) Engages in conduct that violates the professional code of ethics; 3
681-
682- (21) Is professionally incompetent; 4
683-
684- (22) Practices direct–entry midwifery without a license, before obtaining or 5
685-renewing a license, including any period when the license has lapsed; 6
686-
687- (23) After failing to renew a license or after a license has lapsed, commits 7
688-any act that would be grounds for disciplinary action under this section; 8
689-
690- (24) Violates regulations adopted by the Board or an order from the Board; 9
691-
692- (25) Performs an act that is beyond the licensee’s knowledge and skills; 10
693-
694- (26) Fails to submit to a criminal history records check in accordance with § 11
695-8–303 of this title; 12
696-
697- (27) When acting in a supervisory position, directs another licensed 13
698-direct–entry midwife to perform an act that is beyond the licensed direct–entry midwife’s 14
699-knowledge and skills; or 15
700-
701- (28) Fails to file a report required under this subtitle. 16
702-
703-8–6C–26. 17
704-
705- Subject to the evaluation and reestablishment provisions of the Maryland Program 18
706-Evaluation Act, and subject to the termination of this subtitle under § 8–802 of this title, 19
707-this subtitle and all regulations adopted under this subtitle shall terminate and be of no 20
708-effect after July 1, [2025] 2030. 21
709-
710- SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 22
711-1, 2025. 23
685+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 5
686+1, 2025. 6
712687