Texas 2025 - 89th Regular

Texas House Bill HB4553 Compare Versions

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1	1		By: Ordaz H.B. No. 4553
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4	6		A BILL TO BE ENTITLED
5	7		AN ACT
6	8		relating to the mandatory reporting of birth outcomes by licensed
7	9		midwives in the State of Texas.
8	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	11		SECTION 1. This Act may be cited as Malik's Law.
10	12		SECTION 2. Section 203.154(b), Occupations Code, is amended
11	13		to read as follows:
12	14		SUBCHAPTER H. PRACTICE BY MIDWIFE
13	15		Sec. 203.351. INFORMED CHOICE AND DISCLOSURE REQUIREMENTS.
14	16		(a) A midwife shall disclose in oral and written form to a
15	17		prospective client the limitations of the skills and practices of a
16	18		midwife.
17	19		(b) The department shall prescribe the form of the informed
18	20		choice and disclosure statement required to be used by a midwife
19	21		under this chapter. The form must include:
20	22		(1) statistics of the midwife's experience as a
21	23		midwife;
22	24		(2) the date of the midwife's original licensure and
23	25		date of expiration;
24	26		(3) the date the midwife's cardiopulmonary
25	27		resuscitation certification expires;
26	28		(4) the midwife's compliance with continuing education
27	29		requirements;
28	30		(5) intermittent auscultation certification if
29	31		applicable
30	32		(6) a description of medical backup arrangements; and
31	33		(7) the legal responsibilities of a midwife, including
32	34		statements concerning newborn blood screening, ophthalmia
33	35		neonatorum prevention, and prohibited acts under Sections
34	36		203.401-203.403.
35	37		(c) The informed choice statement must include a statement
36	38		that state law requires a newborn child to be tested for certain
37	39		heritable diseases and hypothyroidism. The midwife shall disclose
38	40		to a client whether the midwife is approved to collect blood
39	41		specimens to be used to perform the tests. If the midwife is not
40	42		approved to collect the blood specimens, the disclosure must inform
41	43		the client of the midwife's duty to refer the client to an
42	44		appropriate health care facility or physician for the collection of
43	45		the specimens.
44	46		(d) The disclosure of legal requirements required by this
45	47		section may not exceed 500 words and must be in English and Spanish.
46	48		(e) A midwife shall disclose to a prospective or actual
47	49		client the procedure for reporting complaints to the department.
48	50		(f) a midwife shall disclose if they are under active
49	51		investigation by the department before client consents to care.
50	52		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended
51	53		by:
52	54		Acts 2005, 79th Leg., Ch. 1240 (H.B. 1535), Sec. 40, eff.
53	55		September 1, 2005.
54	56		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.027,
55	57		eff. September 1, 2015.
56	58		Sec. 203.352. PRENATAL AND CERTAIN MEDICAL CARE ENCOURAGED.
57	59		A midwife shall encourage a client to seek:
58	60		(1) prenatal care; and
59	61		(2) medical care through consultation or referral, as
60	62		specified by commission rules, if the midwife determines that the
61	63		pregnancy, labor, delivery, postpartum period, or newborn period of
62	64		a woman or newborn may not be classified as normal for purposes of
63	65		this chapter.
64	66		(3) Medical terms and practices addressed in this
65	67		chapter pertaining to maternal and neonatal health will reflect
66	68		definitions and practice standards as defined by the American
67	69		College of Obstetrics and Gynecology as well as the International
68	70		Confederation of Midwives, the American Academy of Pediatrics and
69	71		CDC guidelines.
70	72		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
71	73		Amended by:
72	74		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.028,
73	75		eff. September 1, 2015.
74	76		Sec. 203.353. PREVENTION OF OPHTHALMIA NEONATORUM. (a)
75	77		Subject to Subsection (b), unless the newborn child is immediately
76	78		transferred to a hospital because of an emergency, a midwife who
77	79		attends the birth of the child shall comply with Section 81.091,
78	80		Health and Safety Code.
79	81		(b) A midwife in attendance at childbirth who is unable to
80	82		apply prophylaxis as required by Section 81.091, Health and Safety
81	83		Code, due to the objection of the parent, managing conservator, or
82	84		guardian of the newborn child does not commit an offense under that
83	85		section and is not subject to any criminal, civil, or
84	86		administrative liability or any professional disciplinary action
85	87		for failure to administer the prophylaxis. The midwife in
86	88		attendance at childbirth shall ensure that the objection of the
87	89		parent, managing conservator, or guardian is entered into the
88	90		medical record of the child.
89	91		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
90	92		Amended by:
91	93		Acts 2017, 85th Leg., R.S., Ch. 1105 (H.B. 4007), Sec. 1.002,
92	94		eff. September 1, 2017.
93	95		Sec. 203.354. NEWBORN SCREENING. (a) Each midwife who
94	96		attends the birth of a child shall cause the newborn screening tests
95	97		to be performed on blood specimens taken from the child as required
96	98		by Chapter 33, Health and Safety Code.
97	99		(b) A midwife may collect blood specimens for the newborn
98	100		screening tests if the midwife has been approved by the department
99	101		to collect the specimen. The commission shall adopt rules
100	102		establishing the standards for approval. The standards must
101	103		recognize completion of a course of instruction that includes the
102	104		blood specimen collection procedure or verification by
103	105		appropriately trained health care providers that the midwife has
104	106		been instructed in the blood collection procedures.
105	107		(c) A midwife who is not approved to collect blood specimens
106	108		for newborn screening tests shall refer a client and her newborn to
107	109		an appropriate health care facility or physician for the collection
108	110		of the blood specimen and submission of the specimen to the
109	111		department.
110	112		(d) If the midwife has been approved by the department to
111	113		collect blood specimens under this section, the collection by the
112	114		midwife of blood specimens for the required newborn screening tests
113	115		does not constitute the practice of medicine as defined by
114	116		Subtitle B.
115	117		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
116	118		Amended by:
117	119		Acts 2005, 79th Leg., Ch. 1240 (H.B. 1535), Sec. 41, eff.
118	120		September 1, 2005.
119	121		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.029,
120	122		eff. September 1, 2015.
121	123		Sec. 203.355. SUPPORT SERVICES. (a) In this section:
122	124		(1) "Clinical services" include prenatal, postpartum,
123	125		child health, and family planning services.
124	126		(2) "Local health unit" means a division of a
125	127		municipal or county government that provides limited public health
126	128		services under Section 121.004, Health and Safety Code.
127	129		(3) "Public health district" means a district created
128	130		under Subchapter E, Chapter 121, Health and Safety Code.
129	131		(b) The Department of State Health Services and a local
130	132		health department, a public health district, or a local health unit
131	133		shall provide clinical and laboratory support services to a
132	134		pregnant woman or a newborn who is a client of a midwife if the
133	135		midwife is required to provide the services under this chapter.
134	136		(c) The laboratory services must include the performance of
135	137		the standard serological tests for syphilis and the collection of
136	138		blood specimens for newborn screening tests for phenylketonuria,
137	139		hypothyroidism, and other heritable diseases as required by law.
138	140		(d) The provider may charge a reasonable fee for the
139	141		services. A person may not be denied the services because of
140	142		inability to pay.
141	143		(e) If available, appropriately trained personnel from
142	144		local health departments, public health districts, and local health
143	145		units shall instruct licensed midwives in the approved techniques
144	146		for collecting blood specimens to be used to perform newborn
145	147		screening tests.
146	148		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
147	149		Amended by:
148	150		Acts 2005, 79th Leg., Ch. 1240 (H.B. 1535), Sec. 42, eff.
149	151		September 1, 2005.
150	152		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.030,
151	153		eff. September 1, 2015.
152	154		Sec. 203.356. IMMUNITY. (a) A physician, a registered
153	155		nurse, or other person who, on the order of a physician, instructs a
154	156		midwife in the approved techniques for collecting blood specimens
155	157		to be used for newborn screening tests is immune from liability
156	158		arising out of the failure or refusal of the midwife to:
157	159		(1) collect the specimens in the approved manner; or
158	160		(2) submit the specimens to the Department of State
159	161		Health Services in a timely manner.
160	162		(b) A physician who issues an order directing or instructing
161	163		a midwife is immune from liability arising out of the failure or
162	164		refusal of the midwife to comply with the order if, before the
163	165		issuance of the order, the midwife provided the physician with
164	166		evidence satisfactory to the department of compliance with this
165	167		chapter.
166	168		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
167	169		Amended by:
168	170		Acts 2005, 79th Leg., Ch. 1240 (H.B. 1535), Sec. 43, eff.
169	171		September 1, 2005.
170	172		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.031,
171	173		eff. September 1, 2015.
172	174		Sec. 203.357. ADDITIONAL INFORMATION REQUIRED. (a) The
173	175		department may require information in addition to that required by
174	176		Section 203.253 if it determines the additional information is
175	177		necessary and appropriate to ascertain the nature and extent of
176	178		midwifery in this state. The department may not require
177	179		information regarding any act that is prohibited under this
178	180		chapter.
179	181		(b) The department shall prescribe forms for the additional
180	182		information and shall distribute those forms directly to each
181	183		midwife. Each midwife must complete and return the forms to the
182	184		department as requested.
183	185		(c) Information received under this section may not be made
184	186		public in a manner that discloses the identity of any person to whom
185	187		the information relates. The information is not public information
186	188		as defined by Chapter 552, Government Code.
187	189		Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
188	190		Amended by:
189	191		Acts 2015, 84th Leg., R.S., Ch. 838 (S.B. 202), Sec. 1.032,
190	192		eff. September 1, 2015.
191	193		Sec. 203.358. MANDATORY REPORTING OF BIRTH OUTCOMES.
192	194		(a) Reporting Requirement.
193	195		(1) A licensed midwife shall submit a Birth & Outcomes Report to
194	196		the Department of State Health Services (DSHS) Vital Statistics
195	197		and Texas Department of Licensing and Regulation within 10 days of
196	198		attending any birth in a home, birthing center, or other
197	199		non-hospital setting.
198	200		(2) The report shall be mandatory for every birth attended by a
199	201		midwife, regardless of whether:
200	202		a. The newborn or mother survives;
201	203		b. The newborn or mother is transferred to a hospital;
202	204		c. The midwife was the primary or assisting provider
203	205		d. Intrapartum death; or
204	206		e. The complications leading to a poor outcome were deemed
205	207		"unforeseen medical circumstances."
206	208		(3) If a midwife is involved in a birth, but another midwife files
207	209		the report, all midwives present must co-sign and verify the
208	210		report. A failure to do so constitutes a violation under this
209	211		section.
210	212		(b) Required Report Contents. Each report must include:
211	213		1. Midwife Information:
212	214		a. Full name and Texas midwifery license number of the
213	215		attending midwife(s).
214	216		2. Birth Details:
215	217		a. The planned and actual location of the birth,
216	218		b. The gestational age at birth,
217	219		c. The type of birth vaginal, assisted vaginal, cesarean
218	220		after transfer,
219	221		d. The APGAR scores at one, five, and ten minutes,
220	222		e. The birth weight,
221	223		f. Whether the birth was an attempted vaginal delivery
222	224		after cesarean, including how many previous
223	225		cesareans the client had prior to attempting VBAC and
224	226		the incision type(s),
225	227		g. How many gestation single, twin, or multiples, and
226	228		h. Breech positioning.
227	229		3. Complications & Interventions:
228	230		a. Any neonatal resuscitation performed, and fetal
229	231		complications including:
230	232		1. Presence of meconium,
231	233		2. Ruptured membranes up to and including five hours,
232	234		more than 10 hours and more than 20hrs,
233	235		3.Length of time and number of any fetal
234	236		decelerations incidents occurring less than 110
235	237		beats per minute,
236	238		4. History of decreased growth during pregnancy,
237	239		5. Shoulder Dystocia,
238	240		6. Meconium Aspiration Syndrome,
239	241		7. Hypoxic-Ischemic Encephalopathy, and
240	242		8. Sepsis.
241	243		b. Any maternal complications, including:
242	244		1. Postpartum hemorrhage (>1,000 mL),
243	245		2. Hypertensive crisis/eclampsia,
244	246		3. Infection/sepsis,
245	247		4. Retained placenta,
246	248		5. Uterine rupture,
247	249		6. Abnormal labor patterns/stalling of labor, or
248	250		7. Any other significant maternal morbidities.
249	251		4. Hospital Transfers:
250	252		a. If the mother or newborn was transferred to a
251	253		hospital:
252	254		1. The time elapsed from birth to transfer,
253	255		2. The name of the receiving hospital, and
254	256		3. The reason for transfer.
255	257		5. Survival Status:
256	258		Status shall be reported regardless of where the demise
257	259		occurred and shall include intrapartum death
258	260		a. Whether the newborn survived, and if not, the date of
259	261		death, and
260	262		b. Whether the mother survived, and if not, the date of
261	263		death.
262	264		6. Verification & Accountability:
263	265		a. If more than one midwife attended, all must sign and
264	266		verify the report.
265	267		(c) Data Verification and Audits.
266	268		(1) Texas Department of Licensing and Regulation shall conduct
267	269		random audits of Birth & Outcomes Reports to ensure compliance and
268	270		accuracy.
269	271		(2) Hospitals shall be required to report all deaths and
270	272		morbidities linked to midwife-attended births to DSHS Vital
271	273		Statistics, which shall cross-check the data with
272	274		midwife-submitted reports. Any missing reports will trigger an
273	275		investigation.
274	276		(3) A failure to report a transfer resulting in death or severe
275	277		morbidity shall be treated as a violation under this section.
276	278		(d) Enforcement and Penalties.
277	279		(1) Failure to Report:
278	280		A midwife who fails to submit a report within the required 10-day
279	281		period shall be subject to:
280	282		a. First offense: Written warning and remedial training in
281	283		reporting and medical recording provided by Texas
282	284		Department of Licensing and Regulation.
283	285		b. Second offense: A fine of up to $1,000 per day for each day
284	286		the report is overdue enforced by Texas Department of
285	287		Licensing and Regulation, and
286	288		c. Third offense: License suspension to be enforced by Texas
287	289		Department of Licensing and Regulation.
288	290		(2) False or Incomplete Reporting:
289	291		A midwife who knowingly submits false or incomplete information
290	292		shall be subject to:
291	293		a. A fine of up to $5,000 per violation.
292	294		b. A mandatory review of all past reports submitted by the
293	295		midwife, and
294	296		c. License revocation for repeated violations without
295	297		renewal.
296	298		(3) Avoidance of Accountability:
297	299		a. If a midwife surrenders their license while under
298	300		investigation, they shall remain subject to enforcement
299	301		actions, including fines, civil, and criminal penalties,
300	302		for two years following license surrender.
301	303		(e) Rulemaking Authority.
302	304		The Executive Commissioner of Texas Department of Licensing and
303	305		Regulation and the Department of State Health Services Vital
304	306		Statistics shall adopt rules necessary to implement this section,
305	307		including:
306	308		a. Including data of out of hospital Birth & Outcomes Reports
307	309		with yearly infant and maternal mortality statistics
308	310		separate from hospital statistics.
309	311		b. Defining protocols for investigating noncompliance with
310	312		this section, and
311	313		c. Publicly displaying de-identified statistics on maternal
312	314		and neonatal outcomes from midwife-attended births in
313	315		Texas.
314	316		SECTION 3. This Act takes effect September 1, 2025.