PRIOR PRINTER'S NO. 2034 PRINTER'S NO. 2365
No. 1528 Session of 1990
INTRODUCED BY DAWIDA, STOUT, JONES, BELAN, HELFRICK, SHAFFER,
HOPPER, LYNCH, PUNT AND LEWIS, MARCH 20, 1990
SENATOR BELL, CONSUMER PROTECTION AND PROFESSIONAL LICENSURE, AS
AMENDED, JUNE 26, 1990
AN ACT
1 Regulating the practice of certain midwifery LAY-MIDWIFERY; <--
2 PROVIDING FOR THE LICENSURE OF LICENSED BIRTH ATTENDANTS; and
3 making repeals.
4 The purpose of this act, relating to the registration of <--
5 midwives, is IS TO REGISTER LAY-MIDWIVES AS LICENSED BIRTH <--
6 ATTENDANTS, TO AUTHORIZE REGULATIONS FOR QUALIFICATION AND
7 PRACTICE, to improve access to care for pregnant women and
8 babies and to enhance the Commonwealth's ability to provide
9 outreach services.
10 The General Assembly of the Commonwealth of Pennsylvania
11 hereby enacts as follows:
12 Section 1. Short title.
13 This act shall be known and may be cited as the Registered <--
14 Midwife Regulation LICENSED BIRTH ATTENDANT Law. <--
15 Section 2. Definitions.
16 The following words and phrases when used in this act shall
17 have the meanings given to them in this section unless the
18 context clearly indicates otherwise:
1 "Committee." The advisory committee for the practice of
2 midwifery provided for under this act.
3 "Department." The Department of Health of the Commonwealth.
4 "LAY-MIDWIFE." AN INDIVIDUAL PRACTICING LAY-MIDWIFERY PRIOR <--
5 TO THE DEADLINE FOR LICENSURE ESTABLISHED BY REGULATIONS
6 PROMULGATED UNDER SECTIONS 4 AND 5(A).
7 "Midwifery." "LAY-MIDWIFERY." The practice of assisting <--
8 childbearing women and their families during antepartum,
9 intrapartum, postpartum and WITH THE immediate care of the <--
10 newborn by persons other than physicians, surgeons MEDICAL <--
11 DOCTORS, OSTEOPATHIC PHYSICIANS or nurse-midwives licensed under
12 SECTION 35 OF the act of December 20, 1985 (P.L.457, No.112), <--
13 known as the Medical Practice Act of 1985.
14 "LICENSED BIRTH ATTENDANT." AN INDIVIDUAL LICENSED TO <--
15 PRACTICE LAY-MIDWIFERY UNDER THIS ACT.
16 "Plain people." Persons of Amish and Mennonite faiths.
17 "Secretary." The Secretary of Health of the Commonwealth.
18 Section 3. Advisory committee.
19 (a) Membership.--There shall be created an advisory
20 committee for the practice of midwifery, which will assist in <--
21 the development and practice of registered midwives LAY- <--
22 MIDWIFERY BY LICENSED BIRTH ATTENDANTS. The committee shall
23 consist of ten 11 members, to be appointed by the secretary <--
24 WITHIN 60 DAYS OF THE EFFECTIVE DATE OF THIS ACT. No member <--
25 shall serve more than two consecutive terms. Members appointed
26 to the committee shall serve without compensation, EXCEPT FOR <--
27 THE AMOUNT OF REASONABLE TRAVELING, HOTEL AND OTHER NECESSARY
28 EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES HEREUNDER,
29 IN ACCORDANCE WITH COMMONWEALTH REGULATIONS, and shall include:
30 (1) An obstetrician who is licensed to practice medicine <--
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1 OR OSTEOPATHIC MEDICINE in this Commonwealth and who has had <--
2 experience in working with registered midwives, formerly
3 known as lay-midwives. WHO HAS HAD EXPERIENCE WORKING WITH <--
4 LAY-MIDWIVES OR LICENSED BIRTH ATTENDANTS.
5 (2) A family practice physician who is licensed to <--
6 practice medicine OR OSTEOPATHIC MEDICINE in this <--
7 Commonwealth and who has had experience in working with <--
8 registered midwives, formerly known as lay-midwives. WORKING <--
9 WITH LAY-MIDWIVES OR LICENSED BIRTH ATTENDANTS.
10 (3) Two nurse-midwives who are licensed under LICENSED <--
11 UNDER SECTION 35 OF the act of December 20, 1985 (P.L.457,
12 No.112), known as the Medical Practice Act of 1985. One
13 nurse-midwife shall be from SHALL PRACTICE IN the eastern <--
14 part of Pennsylvania, and the other shall be from PRACTICE IN <--
15 the western part of Pennsylvania. At least one nurse-midwife <--
16 shall have experience in a rural setting. SHALL HAVE RENDERED <--
17 NURSE-MIDWIFERY SERVICES TO A RESIDENT OF A RURAL AREA.
18 (4) Five midwives who have at least three years' <--
19 experience as the primary midwife, one of whom must service
20 plain people. All five shall become registered under this act
21 within 60 days after regulations are promulgated hereunder.
22 (4) THREE LAY-MIDWIVES WHO HAVE ASSISTED WITH A MINIMUM <--
23 OF 200 BIRTHS, WITH A MINIMUM OF TEN YEARS OF PRIMARY CARE
24 PRACTICE, AND, TWO LAY-MIDWIVES WHO HAVE ASSISTED WITH A
25 MINIMUM OF 100 BIRTHS, WITH A MINIMUM OF FIVE YEARS OF
26 PRIMARY CARE PRACTICE. AT LEAST ONE SHALL PRACTICE AMONG
27 PLAIN PEOPLE, AND ALL FIVE SHALL BECOME LICENSED UNDER THIS
28 ACT AS LICENSED BIRTH ATTENDANTS PURSUANT TO REGULATIONS
29 PROMULGATED HEREUNDER. FOLLOWING THE DEADLINE FOR LICENSURE
30 ESTABLISHED PURSUANT TO SECTION 5(A), ALL APPOINTEES TO THE
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1 COMMITTEE SHALL BE LICENSED BIRTH ATTENDANTS.
2 (5) One individual who has utilized midwifery TWO <--
3 INDIVIDUALS WHO HAVE UTILIZED LAY-MIDWIFERY care for at least
4 one pregnancy and birth. EITHER PARENT SHALL BE ELIGIBLE FOR <--
5 APPOINTMENT.
6 (b) Terms.--The initial term of the obstetrician shall be
7 for three years. The initial term of one nurse-midwife shall be
8 for three years. The initial term of two midwives LAY-MIDWIVES <--
9 shall be for three years. All other initial appointments shall
10 be for a term of two years. The term for all subsequent
11 appointments shall be two years. No member shall serve more than
12 two terms.
13 (C) QUORUM AND CHAIRPERSON.--A MAJORITY OF THE APPOINTED <--
14 MEMBERS OF THE COMMITTEE SHALL CONSTITUTE A QUORUM FOR PURPOSES
15 OF FORMULATING ADVICE TO THE SECRETARY. THE COMMITTEE SHALL
16 ANNUALLY SELECT A CHAIRPERSON FROM AMONG ITS MEMBERS.
17 Section 4. Regulations.
18 The secretary, with (A) AUTHORITY OF SECRETARY.--THE <--
19 SECRETARY, WITH AND UPON RECEIPT OF the advice of the committee,
20 shall promulgate regulations relative to TO IMPLEMENT THIS ACT, <--
21 INCLUDING, but not limited to:
22 (1) Qualifications for the practice of midwifery. LAY- <--
23 MIDWIFERY BY LICENSED BIRTH ATTENDANTS, WHICH SHALL INCLUDE,
24 BUT NOT BE LIMITED TO, APPRENTICESHIP AND EXPERIENCE
25 EQUIVALENTS FOR FORMAL EDUCATIONAL TRAINING. THE SECRETARY
26 SHALL PROHIBIT PRACTICE OR LICENSURE BY INDIVIDUALS WHO: HAVE
27 BEEN CONVICTED OF A CRIME RELATING TO OR ARISING OUT OF THE
28 PRACTICE OF A LICENSED PROFESSION; HAVE HAD A LICENSE TO
29 PRACTICE AN OCCUPATION OR PROFESSION REVOKED; OR, WHO HAVE
30 BEEN CONVICTED OF A CRIME RELATING TO OR ARISING OUT OF THE
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1 UNLAWFUL DISPENSING OR DISTRIBUTION OF A CONTROLLED
2 SUBSTANCE, UNLESS TEN YEARS HAVE ELAPSED FROM THE DATE OF
3 CONVICTION OR REVOCATION. AS USED IN THIS PARAGRAPH, THE TERM
4 "CONVICTED" SHALL INCLUDE A JUDGMENT, A PLEA OF GUILTY, A
5 PLEA OF NOLO CONTENDERE, OR RECEIPT OF PROBATION WITHOUT
6 VERDICT, DISPOSITION IN LIEU OF TRIAL OR ACCELERATED
7 REHABILITATIVE DISPOSITION.
8 (2) Recognition of midwifery training LAY-MIDWIFERY <--
9 TRAINING AND EXAMINATION programs.
10 (3) Procedures in the practice of midwifery, including <--
11 policies for professional direction and supervision.
12 (3) PROTOCOLS FOR PROFESSIONAL PRACTICE BY LICENSED <--
13 BIRTH ATTENDANTS, INCLUDING REQUIREMENTS FOR PROFESSIONAL
14 ASSISTANCE AND SUPERVISION IN MEDICAL EMERGENCIES, CONSISTENT
15 WITH SECTION 9.
16 (4) Procedures for the registration of midwives and <--
17 LICENSURE OF LICENSED BIRTH ATTENDANTS, FOR the issuance of <--
18 certificates of registered midwifery. LICENSES AND FOR THE <--
19 BIENNIAL RENEWAL OF LICENSES.
20 (5) Grievance procedures and peer review. <--
21 (5) CRITERIA AND PROCEDURES FOR THE LIMITATION, <--
22 SUSPENSION OR REVOCATION OF LICENSES ISSUED UNDER THE ACT,
23 AND FOR PEER REVIEW, IN ACCORDANCE WITH THE PROVISIONS OF 2
24 PA.C.S. (RELATING TO ADMINISTRATIVE LAW AND PROCEDURE).
25 (6) Recordkeeping and reporting REQUIREMENTS. <--
26 (7) APPROPRIATE FEES. <--
27 (B) REVIEW.--ALL REGULATIONS PROMULGATED UNDER THIS ACT
28 SHALL BE SUBJECT TO THE ACT OF JUNE 25, 1982 (P.L.633, NO.181),
29 KNOWN AS THE REGULATORY REVIEW ACT.
30 Section 5. Registration. <--
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1 The secretary shall register for the practice of midwifery
2 any person applying for such registration who meets the
3 qualifications pursuant to section 4(1). A certificate of
4 registration
5 SECTION 5. APPLICATIONS FOR LICENSURE; PRACTICE PENDING <--
6 REGULATIONS.
7 (A) APPLICATIONS.--ANY PERSON PRACTICING LAY-MIDWIFERY SHALL
8 APPLY FOR LICENSURE WITHIN 90 DAYS OF ADOPTION OF FINAL FORM
9 REGULATIONS PROMULGATED UNDER SECTION 4. A LICENSE shall be
10 issued by the secretary to each person registered under this <--
11 section. The fee shall be set by the secretary with the advice
12 of the committee. QUALIFYING UNDER THAT SECTION WITHIN 60 DAYS <--
13 THEREAFTER, UNLESS OTHERWISE EXTENDED BY THE SECRETARY BY
14 REGULATION. AFTER THAT DATE, NO PERSON SHALL PRACTICE LAY-
15 MIDWIFERY WITHOUT A VALID, UNEXPIRED LICENSE AS A LICENSED BIRTH
16 ATTENDANT.
17 (B) PRACTICE PENDING REGULATIONS.--LAY-MIDWIVES ON THE
18 EFFECTIVE DATE OF THIS ACT MAY CONTINUE TO PRACTICE, PRIOR TO
19 THE PROMULGATION OF REGULATIONS UNDER SUBSECTION (A) AND SECTION
20 4, IF THEY:
21 (1) OTHERWISE COMPLY WITH THE REQUIREMENTS OF THIS ACT;
22 (2) HAVE ASSISTED WITH A MINIMUM OF 50 BIRTHS, AND HAVE
23 A MINIMUM OF TWO YEARS OF PRIMARY CARE PRACTICE; AND
24 (3) FILE WITH THE SECRETARY, WITHIN 30 DAYS OF THE
25 EFFECTIVE DATE OF THIS ACT, PROTOCOLS OF AGREEMENT FOR
26 EMERGENCY ASSISTANCE EXECUTED BY A LICENSED MEDICAL DOCTOR OR
27 OSTEOPATHIC PHYSICIAN.
28 Section 6. Disclosure.
29 Before a midwife LAY-MIDWIFE OR LICENSED BIRTH ATTENDANT can <--
30 accept a client, the midwife SHE shall inform the client in <--
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1 writing of their HER education and experience, EXPERIENCE, <--
2 PROTOCOLS FOR EMERGENCY ASSISTANCE AND LACK OF MALPRACTICE
3 INSURANCE.
4 Section 7. Report.
5 The committee shall report AT LEAST annually to the secretary <--
6 concerning the practice of midwifery LAY-MIDWIFERY in this <--
7 Commonwealth. The report shall include any REGULATORY <--
8 recommendations of the committee to increase the quality and
9 safety of midwife LAY-MIDWIFERY services and generally to assure <--
10 competence in the practice.
11 Section 8. Public information.
12 The secretary shall, with the advice of the committee,
13 provide the public with such information, relative to <--
14 registration, INFORMATION ABOUT the practice of midwifery LAY- <--
15 MIDWIFERY, THE DIFFERENCES BETWEEN LICENSED BIRTH ATTENDANTS,
16 NURSE-MIDWIVES AND PHYSICIANS, and the education of health care
17 teams, as he deems sufficient to enable the public to make <--
18 informed decisions in selecting a competent registered midwife. <--
19 Section 9. Coordination with other health care providers; <--
20 LIMITATIONS ON LIABILITY.
21 (A) COOPERATION.--The secretary shall take appropriate <--
22 steps, INCLUDING, WHERE APPROPRIATE, THE PROMULGATION OF <--
23 REGULATIONS, to ensure that hospitals, physicians, NURSE- <--
24 MIDWIVES, emergency care personnel and other medical HEALTH care <--
25 providers in this Commonwealth are aware of this act and shall <--
26 not restrict backup to registered midwives DO NOT RESTRICT <--
27 BACKUP TO LAY-MIDWIVES OR LICENSED BIRTH ATTENDANTS. The
28 secretary shall receive and acknowledge ACT UPON reports of <--
29 problems resulting from lack of cooperation between other health
30 care providers and registered midwives LAY-MIDWIVES OR LICENSED <--
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1 BIRTH ATTENDANTS that may endanger the life and health of
2 mothers and newborns.
3 (B) LIMITATION ON LIABILITY.--LICENSED HEALTH CARE PROVIDERS <--
4 OR FACILITIES RENDERING EMERGENCY CARE TO A PATIENT OF A LAY-
5 MIDWIFE OR A LICENSED BIRTH ATTENDANT SHALL BE LIABLE FOR CIVIL
6 DAMAGES OR ADMINISTRATIVE ACTION ONLY TO THE EXTENT THAT THOSE
7 DAMAGES ARE A RESULT OF GROSS NEGLIGENCE OR WILLFUL OR WANTON
8 ACTS OR OMISSIONS BY THE HEALTH CARE PROVIDER. THIS LIMITATION
9 SHALL NOT APPLY WHERE THE HEALTH CARE PROVIDER HAD PREVIOUSLY
10 DIAGNOSED OR TREATED THE PATIENT FOR A CONDITION RELEVANT TO THE
11 CURRENT EMERGENCY.
12 SECTION 10. INVESTIGATIONS; INJUNCTIONS.
13 (A) INVESTIGATIONS.--THE SECRETARY, WITH THE ADVICE OF THE
14 COMMITTEE, SHALL HAVE THE AUTHORITY TO INVESTIGATE OR CAUSE TO
15 BE INVESTIGATED ALL VIOLATIONS OF THIS ACT AND ITS IMPLEMENTING
16 REGULATIONS, AND TO PROCEED, THEREAFTER, PURSUANT TO REGULATIONS
17 PROMULGATED UNDER SECTION 4(A)(5).
18 (B) INJUNCTIONS.--THE UNLAWFUL PRACTICE OF LAY-MIDWIFERY MAY
19 BE ENJOINED BY COMMONWEALTH COURT ON PETITION OF THE SECRETARY.
20 HE SHALL NOT BE REQUIRED TO SHOW THAT ANY PERSON IS INDIVIDUALLY
21 INJURED. IF IT IS FOUND THAT THE INDIVIDUAL COMPLAINED OF HAS
22 ENGAGED IN THE UNLAWFUL PRACTICE OF LAY-MIDWIFERY, THE COURT
23 SHALL ENJOIN HER FROM SO PRACTICING UNLESS AND UNTIL SHE HAS
24 BEEN DULY LICENSED.
25 Section 10 11. Repeals. <--
26 (a) Absolute.--The following acts and parts of acts are
27 repealed:
28 Act of April 4, 1929 (P.L.160, No.155), referred to as the
29 Midwife Regulation Law.
30 (b) Inconsistent.--The following acts and parts of acts are
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1 repealed insofar as they are inconsistent with this act:
2 Act of December 20, 1985 (P.L.457, No.112), known as the
3 Medical Practice Act of 1985.
4 Section 11 12. Effective date. <--
5 This act shall take effect immediately.
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