HB2251 - 572R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 36-751, Arizona Revised Statutes, is amended to read:

START_STATUTE36-751. Definitions

In this article, unless the context otherwise requires:

1. "Department" means the department of health services.

2. "Director" means the director of the department of health services.

3. "Licensed midwife" means a midwife who is licensed pursuant to this article.

3. 4. "Midwife" means a person who delivers a baby or provides health care related to pregnancy, labor, delivery and postpartum care of the mother and her infant. END_STATUTE

Sec. 2. Section 36-755, Arizona Revised Statutes, is amended to read:

START_STATUTE36-755. Powers and duties of the director

A. The director may adopt rules necessary for the proper administration and enforcement of this article.

B. The director shall, by rule:

1. Define and describe, consistent with this article and the laws of this state, the duties and limits of the practice of midwifery.

2. Adopt standards with respect to the practice of midwifery designed to safeguard the health and safety of the mother and child.

3. Establish the criteria for granting, denying, suspending and revoking a license in order to protect the health and safety of the mother and child.

4. Describe and define reasonable and necessary minimum qualifications for licensed midwives, including:

(a) The ability to read and write.

(b) Knowledge of the fundamentals of hygiene.

(c) The ability to recognize abnormal or potentially abnormal conditions during pregnancy, labor and delivery and following birth.

(d) Knowledge of the laws of this state concerning reporting of births, prenatal blood tests and newborn screening and of the rules pertaining to midwifery.

(e) Education requirements.

(f) Age requirements.

C. The director shall consider the most recent midwifery job analysis issued by the North American registry of midwives when adopting or amending rules relating to the midwifery scope of practice. END_STATUTE

Sec. 3. Title 36, chapter 6, article 7, Arizona Revised Statutes, is amended by adding sections 36-761, 36-762 and 36-763, to read:

START_STATUTE36-761. Prescription drugs; dispensing and administration authority; storage; documentation

A. A licensed midwife who, in addition to the requirements for initial licensure, has proof of completion of a pharmacology course of at least eight continuing education units from a midwifery education accreditation council-accredited institution or a regionally accredited institution may dispense and administer the following medications, therapies and devices with the following limitations:

1. Antibiotics related to Group B streptococcus prophylaxis consistent with the United States centers for disease control and prevention guidelines or other current evidence-based guidelines.

2. The following antihemorrhagic medications for preventing and treating postpartum hemorrhage as defined by the American college of obstetricians and gynecologists:

(a) Oxytocin for preventing uterine atony during or immediately following the third stage of labor according to current evidence-based standards of care.

(b) Methylergonovine.

(d) Misoprostol.

(e) Tranexamic acid.

A licensed midwife may not use the antihemorrhagic medications specified in this paragraph to induce or augment labor. The licensed midwife shall initiate a transfer of care if an antihemorrhagic medication is administered for managing hemorrhage.

3. prophylactic ophthalmic medications for newborn eye care.

4. Intravenous fluids for the following:

(a) medication administration.

(b) Routine fluid administration.

5. Vitamin K prophylaxis for newborns.

6. Rho immune globulin.

7. Topical, intramuscular or subcutaneous local anesthetics for postpartum repair of first and second degree tears, lacerations or episiotomies. This PARAGRAPH does not include any schedule i controlled substance.

8. Oxygen and Compressed air for fetal or maternal distress and infant resuscitation.

9. Epinephrine for neonatal resuscitation consistent with the neonatal resuscitation program guidelines and to treat maternal allergic reactions.

10. Glucose gel administered orally for neonatal hypoglycemia.

11. Vitamins and minerals for correcting electrolyte imbalances, including B vitamins, calcium, magnesium, Dietary supplements, homeopathic remedies, plant substances that are not designated as prescription drugs or controlled substances, and over-the-counter medications.

12. Resuscitation supplies and equipment according to the current neonatal resuscitation program algorithm.

13. Medical supplies and equipment needed to administer the medications prescribed in this subsection.

14. Electronic breast pumps, Glucose monitors, compression stockings and pregnancy support belts or devices.

B. A licensed midwife may administer other prescription medications as prescribed by a physician who is licensed pursuant to title 32, chapter 13, 14 or 17, a registered nurse practitioner who is licensed pursuant to title 32, chapter 15 or a physician assistant who is licensed pursuant to title 32, chapter 25. A pharmacist who dispenses prescription medications prescribed pursuant to this subsection to a licensed midwife is not liable for any adverse reaction that is caused by the licensed midwife's method of use.

C. A licensed midwife may lawfully obtain, transport, administer and possess adequate quantities of the medications prescribed in subsection A of this section and the equipment normally required to administer those medications. The licensed midwife shall:

1. Store the medications prescribed in subsection A of this section as directed by the manufacturer. a licensed midwife may not administer a medication to any person after the listed expiration date.

2. Record in the patient's chart each use of medication and the medication's lot number and expiration date. END_STATUTE

START_STATUTE36-762. Arizona midwifery advisory committee; membership; duties; scope of practice; modification; sentinel events; definition

A. The Arizona midwifery advisory committee is established in the department to assist in examining applicants for a midwifery license, if requested, to collaborate with and assist the director in disciplinary matters, if requested, and to perform any other duties prescribed in this article.

b. The director shall appoint the members of the advisory committee, which shall be composed of not more than eleven of the following members:

1. At least five licensed midwives.

2. Two certified nurse midwives who are licensed pursuant to title 32, chapter 15.

3. Two physicians who are licensed pursuant to title 32, chapter 13, 14 or 17 and who are board certified in obstetrics, pediatrics or family medicine. The director shall solicit physician applications from state medical societies and associations.

4. One consumer of midwifery care.

c. Advisory committee members are not eligible for compensation or reimbursement of expenses.

d. The advisory committee shall meet at least four times each year, once per quarter.

e. The advisory committee shall make recommendations to the director when adopting or amending rules relating to the midwifery scope of practice.

f. a licensed midwife who is interested in modifying the midwifery scope of practice must submit a report to the advisory committee that contains at least the following:

1. A description of the issue and why an addition to the midwifery scope of practice is necessary, including the extent to which consumers need and will benefit from a licensed midwife's ability to provide this additional health care service.

2. The available evidence-based research that demonstrates that licensed midwives are competent to perform the proposed health care service.

3. The extent to which a change in the midwifery scope of practice may harm the public, including the extent to which a change in the scope of practice will restrict entry into the practice of midwifery.

g. If a majority of a quorum of the advisory committee members votes to approve a change in the midwifery scope of practice pursuant to subsection f of this section, the advisory committee shall provide the director with its recommendations for a possible rule change.

H. The advisory committee shall conduct a review of sentinel events occurring during the course of prenatal, intrapartum or postpartum care provided by licensed midwives in this state.

I. The advisory committee may convene emergency meetings when a case or sentinel event requires timely review or action to protect the public health and safety.

J. Following the review of a sentinel event, the advisory committee shall make recommendations to the department regarding whether the care provided was:

1. Consistent with community standards.

2. Consistent with community standards but outside the scope of practice as defined by the department in rule.

3. Outside of community standards and requiring corrective action.

K. For care determined to be outside of community standards under subsection J of this section, the advisory committee may recommend one or more of the following to the department:

1. Additional continuing education requirements.

2. Mentoring or supervised practice.

3. Administrative civil penalties.

4. Restriction or suspension of a license.

5. Revocation of a license.

L. The advisory committee shall review midwife reports submitted pursuant to section 36-763 and may recommend modifications to reporting requirements to the department to support quality improvement and patient safety.

M. For the purposes of this section, "sentinel event":

1. Means an unexpected, serious patient safety incident resulting in death, permanent harm or a significant risk of harm.

2. includes both:

(a) Maternal sentinel events, including:

(i) Maternal death.

(ii) Maternal intensive care unit admission.

(iii) Uterine rupture.

(iv) Postpartum hemorrhage requiring a blood transfusion.

(v) Shoulder dystocia with brachial plexus injury.

(b) Neonatal sentinel events, including:

(i) Neonatal intensive care unit admission within seventy-two hours after birth, not including observation-only admissions or admissions for congenital anomalies.

(ii) A birth weight of less than two thousand five hundred grams.

(iii) An apgar score of less than seven at five minutes.

(iv) Respiratory distress requiring prolonged ventilation.END_STATUTE

START_STATUTE36-763. Disclosure; reporting requirements; definitions

A. At the initiation of care, eAch licensed midwife shall disclose to each patient whether the licensed midwife maintains professional liability insurance. This disclosure shall be included in the informed consent document and acknowledged by the patient's signature.

B. on or before January 31 each year, Each licensed midwife shall file a report with the department, in a format prescribed by the department, the following information, not including any individually identifiable health information of a patient, for the preceding calendar year:

1. The number of women for whom the licensed midwife provided care.

2. The number of deliveries the licensed midwife attended as primary midwife.

3. The number, reason for and outcome of each transfer or transport of a patient in the antepartum, intrapartum or immediate postpartum periods.

4. The number of perinatal deaths, including the cause of death and a description of the circumstance.

5. The number and outcome of breech births and vaginal births after cesarean.

6. The number of births that occurred more than twenty-five miles from a hospital that provides obstetrics services.

7. The number of fetal deaths after twenty weeks' gestation.

8. The licensed midwife's full name, license number and county.

C. In addition to the reporting required in subsection B of this section, a licensed midwife shall report to the department:

1. A perinatal mortality within seventy-two hours after the death.

2. A sentinel event within fourteen days after the event.

D. The information reported to the department pursuant to subsections B and C of this SECTION may be inspected, copied, obtained or provided to the advisory committee for research and evidence.

E. The report required by subsection B of this section replaces the report required by each licensed midwife following the termination of care for each patient.

F. For the purposes of this section:

1. "Individually identifiable health information" has the same meaning prescribed in section 36-3801.

2. "Sentinel event" has the same meaning prescribed in section 36-762. END_STATUTE

Sec. 4. Short title

This act may be cited as the "Jordan and Mack Terry Act".