GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1999

S	1 

SENATE BILL 875

Short Title:  Certified Professional Midwives.	(Public)

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Sponsors: Senators Lucas; Carter, Foxx, Gulley, Jordan, Kinnaird, Martin of Guilford, Metcalf, Perdue, and Robinson.

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Referred to:  Health Care.

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April 13, 1999

A BILL TO BE ENTITLED
AN ACT TO AUTHORIZE THE PRACTICE OF MIDWIFERY BY CERTIFIED PROFESSIONAL MIDWIVES.
The General Assembly of North Carolina enacts:
Section 1.  Chapter 90 of the General Statutes is amended by adding a new Article to read:
"ARTICLE 10B.
"Certified Professional Midwives.
"§ 90-178.17. Legislative findings.
The General Assembly finds that certified professional midwives should be allowed to practice in this State  because (i)	access to prenatal care and delivery services is limited by the inadequate number of providers; (ii) women should have the freedom to choose the manner, setting, and cost of giving birth; and (iii) it is in the best interest of women in this State to remove obstacles to responsible out-of-hospital deliveries and to encourage cooperation and consultation between licensed health care professionals and certified professional midwives.
"§ 90-178.18. Definitions.
The following definitions apply in this Article:
(1)	Approval. – Authorization from the North Carolina Supervisory Council of Certified Professional Midwives to practice midwifery in this State.
(2)	Council. – The North Carolina Supervisory Council of Certified Professional Midwives.
(3)	Certified Professional Midwife (CPM). – A person who has been certified by the North American Registry of Midwives (NARM) after having demonstrated his or her qualifications through the application process, written examination, and a skills assessment.
(4)	Intrapartum care. – The term includes assisting women during uncomplicated labor; assisting with the spontaneous delivery of infants in vertex presentation from 37 to 42 weeks gestation; performing amniotomy; and performing emergency episiotomies and repairing lacerations with the use of local anesthesia, as needed.
(5)	Midwifery. – The provision of prenatal, intrapartum, and postpartum care for women experiencing normal pregnancies and newborn care for their infants.
(6)	Newborn care. – The term includes providing routine assistance to newborns to establish respiration, including the use of oxygen if needed, and maintaining thermal stability; routine physical assessment including APGAR scoring; and eye prophylaxis for opthalmia neonatorum.
(7)	Postpartum care. – The term includes the management of the normal third stage of labor; repair of first and second degree lacerations resulting from childbirth; administration of oxytoxic drugs after delivery if an emergency situation exists; and the performance of evaluation examinations in the days and weeks following delivery.
(8)	Prenatal care. – The term includes obtaining historical and physical assessments of pregnant women; obtaining and assessing the results of routine laboratory tests; and supervising the use of prenatal vitamins, folic acid, iron, and nonprescription medicines.
"§ 90-178.19. Council created.
(a)	Composition and Terms. – The North Carolina Supervisory Council of Certified Professional Midwives is created.  The Council shall consist of seven members who shall serve staggered terms.  The initial Council members shall be selected on or before October 1, 1999, as follows:
(1)	The General Assembly, upon the recommendation of the President Pro Tempore of the Senate, shall appoint one certified professional midwife and one woman who has received care from a certified professional midwife, who shall serve a term of three years.
(2)	The General Assembly, upon the recommendation of the Speaker of the House of Representatives, shall appoint one physician who has experience working with midwives practicing in out-of-hospital settings, who shall serve a term of two years, and one woman who has received care from a certified professional midwife, who shall serve a term of two years.
(3)	The Governor shall appoint two certified professional midwives, who shall serve terms of one year, and one certified professional midwife, who shall serve a term of two years.
Upon the expiration of the terms of the initial Council members, members shall be elected by majority vote of certified professional midwives in good standing.  Members shall be elected to terms of three years and shall serve until their successors are appointed.  No member may serve more than two consecutive full terms.
(b)	Qualifications. – The certified professional midwife members shall hold current approvals from the Council, reside or be employed in this State, and remain in good standing with the Council during their terms.
(c)	Vacancies. – A vacancy shall be filled by majority vote of certified professional midwives in good standing.  Appointees to fill vacancies shall serve the remainder of the unexpired term and until their successors have been duly appointed and qualified.
(d)	Removal. – The Council may remove any of its members for neglect of duty, incompetence, or unprofessional conduct. A member subject to disciplinary proceedings in his or her capacity as a certified professional midwife shall be disqualified from participating in the official business of the Council until the charges have been resolved.
(e)	Compensation. – Each member of the Council shall receive per diem and reimbursement for travel and subsistence as provided in G.S. 93B-5.
(f)	Officers. – The officers of the Council shall be a chair, a vice-chair, and other officers deemed necessary by the Council to carry out the purposes of this Article. All officers shall be elected annually by the Council for two-year terms and shall serve until their successors are elected and qualified. No person may serve as chair for more than five consecutive years.
(g)	Meetings. – The Council shall hold its first meeting within 45 days after the appointment of its members, and shall hold at least two meetings each year to conduct business and to review the standards and rules previously adopted by the Council.  The Council shall establish the procedures for calling, holding, and conducting regular and special meetings. A majority of Council members constitutes a quorum.
"§ 90-178.20. Powers of the Council.
The Council shall have the power and duty to:
(1)	Administer this Article.
(2)	Issue interpretations of this Article.
(3)	Adopt, amend, or repeal rules as may be necessary to carry out the provisions of this Article.
(4)	Employ and fix the compensation of personnel that the Council determines is necessary to carry into effect the provisions of this Article and incur other expenses necessary to effectuate this Article.
(5)	Examine and determine the qualifications and fitness of applicants for approval, renewal of approval, and reciprocal approval.
(6)	Issue, renew, deny, suspend, or revoke approvals and carry out any disciplinary actions authorized by this Article.
(7)	Set fees for approval, approval renewal, and other services deemed necessary to carry out the purposes of this Article.
(8)	Maintain a current list of all persons who have been approved as a certified professional midwife under this Article.
(9)	Address problems and concerns of practicing certified professional midwives in order to promote safety for the citizens of this State.
(10)	Conduct investigations for the purpose of determining whether violations of this Article or grounds for disciplining holders exist.
(11)	Maintain a record of all proceedings and make available to all approved certified professional midwives and other concerned parties an annual report of all Council action.
(12)	Adopt a seal containing the name of the Council for use on all official documents and reports issued by the Council.
"§ 90-178.21. Requirements of approval; exemptions.
(a)	On or after January 1, 2000, no person shall practice midwifery as defined in G.S. 90-178.18 unless that person has been approved by the Council as provided in this Article.
(b)	The provisions of this Article do not apply to:
(1)	A midwife licensed under Article 10A of this Chapter.
(2)	A physician licensed under Article 1 of this Chapter when engaged in the practice of medicine as defined by law.
(3)	The performance of medical acts by a physician assistant or nurse practitioner when performed in accordance with the rules of the North Carolina Medical Board.
(4)	The practice of nursing by a registered nurse engaged in the practice of nursing as defined by law.
(5)	The rendering of child birth assistance in an emergency situation.
(6)	The rendering of childbirth assistance by a person whose religious beliefs are contrary to the requirements of this Article and the person renders assistance at the request of a parent.
"§ 90-178.22. Qualifications for approval.
An applicant shall be approved to practice as a certified professional midwife if the applicant meets all of the following qualifications:
(1)	Is at least 18 years old.
(2)	Completes an application on a form provided by the Council.
(3)	Submits evidence of certification by the North American Registry of Midwives.
(4)	Pays the required fee under G.S. 90-178.24.
"§ 90-178.23. Approval based on experience; nonresident approval; reciprocity.
(a)	The Council may grant, upon application and payment of proper fees, approval to a person who resides in this State and has been approved to practice as a certified professional midwife in another state whose standards of competency are substantially equivalent to those provided in this Article.
(b)	The Council may grant, upon application and payment of proper fees, approval to a nonresident if the person meets the requirements of this Article or the person resides in a state that recognizes approvals issued by the Council.
"§ 90-178.24. Expenses; fees.
(a)	All fees payable to the Council shall be deposited in the name of the Council in financial institutions designated by the Council as official depositories and shall be used to pay all expenses incurred in carrying out the purposes of this Article.
(b)	All salaries, compensation, and expenses incurred or allowed to carry out the purposes of this Article shall be paid by the Council exclusively out of the fees received by the Council as authorized by this Article or funds received from other sources. In no case shall any salary, expense, or other obligation of the Council be charged against the State treasury.
(c)	The Council shall establish fees not exceeding the following amounts:
(1)	Issuance of approval		$200.00
(2)	Renewal of approval	$150.00
(3)	Reinstatement	$200.00
(4)	Late fee	$ 25.00.
"§ 90-178.25. Issuance and renewal of approval.
The Council shall approve a person to practice as a certified professional midwife, upon payment of the fee required in G.S. 90-178.24, if the person has satisfactorily met the requirements of this Article as administered by the Council. All approvals to practice shall expire three years after the date they were issued unless renewed.  All applications for renewal shall be filed with the Council and shall be accompanied by the renewal fee as required by G.S. 90-178.24.  An approval that has expired for failure to renew may be reinstated after the applicant pays the late and reinstatement fees as required by G.S. 90-178.24.
"§ 90-178.26. Suspension, revocation, and refusal to renew approval.
(a)	The Council may require remedial education, issue a letter of reprimand, or deny, refuse to renew, suspend, or revoke an application for approval or an approval if the applicant or  person who has been approved:
(1)	Gives false information or withholds material information from the Council in procuring or attempting to procure an approval.
(2)	Gives false information or withholds material information from the Council during the course of an investigation conducted by the Council.
(3)	Has been convicted of or pled guilty or no contest to a crime that indicates the person is unfit or incompetent to practice midwifery as defined in this Article or that indicates the person has deceived, defrauded, or endangered the public.
(4)	Has a habitual substance abuse or mental impairment that interferes with his or her ability to provide appropriate care as established by this Article or rules adopted by the Council.
(5)	Has demonstrated gross negligence, incompetency, or misconduct in the practice of midwifery as defined in this Article.
(6)	Has had an application for approval or an approval to practice midwifery in another jurisdiction denied, suspended, or revoked  for reasons that would be grounds for similar action in this State.
(7)	Has willfully violated any provision of this Article or rules adopted by the Council.
(b)	The taking of any action authorized under subsection (a) of this section may be ordered by the Council after a hearing is held in accordance with Article 3A of Chapter 150B of the General Statutes.  The Council may reinstate a revoked approval if it finds that the reasons for revocation no longer exist and that the person can reasonably be expected to perform the services authorized under this Article in a safe manner.
"§ 90-178.27. Enjoining illegal practices.
The Council may apply to the superior court for an order enjoining violations of this Article.  Upon a showing by the Council that any person has violated this Article, the court may grant injunctive relief."
Section 2. This act is effective when it becomes law.