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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
AMENDED
midwives; medication administration; advisory committee
(NOW: midwifery; prescriptions; naturopathic medical board)
Purpose
Transfers the regulatory oversight of licensed midwives from the Department of Health Services (DHS) to the Naturopathic Physicians Medical Board (Board). Outlines prescription administration authority and disclosure and reporting requirements for licensed midwives. Establishes the Arizona Midwifery Advisory Committee (Advisory Committee) in the Board.
Background
DHS licenses and regulates midwives in Arizona. The DHS Director must, by
rule: 1) define and describe, consistent with statute, 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 criteria for granting, denying, suspending and revoking a license
in order to protect the health and safety of the mother and child; and
4) describe and define reasonable and necessary minimum qualification for
midwives (A.R.S. Title 36,
Chapter 6, Article 7).
A
person applying for midwife licensure must: 1) disclose whether the applicant
has ever been convicted of a felony or a misdemeanor in Arizona or another
state or jurisdiction;
2) demonstrate that the applicant is at least 21 years of age; 3) document
completion of training in adult basic cardiopulmonary resuscitation through a
course recognized by the American Heart Association and neonatal resuscitation
through a course recognized by the American Academy of Pediatrics or American
Heart Association; 4) document a high school diploma, a high school equivalency
diploma, an associate degree or a higher degree; and 5) document certification
by the North American Registry of Midwives as a Certified Professional Midwife
(A.A.C.
R9-16-102).
The Board oversees the licensing and practice of naturopathic medicine in Arizona including administering and enforcing all provisions of the naturopathic medicine statutes and rules adopted by the Board (A.R.S. § 32-1504).
If the modification to midwife licensure fee requirements changes revenues, there may a fiscal impact to the state General Fund.
Provisions
Transfer from DHS to the Board
1. Transfers the regulatory oversight of licensed midwives from DHS to the Board.
2. Adds one licensed midwife who is appointed by the Governor to the Board who is:
a) a resident of Arizona for at least five years immediately preceding the appointment; and
b) a midwife who has engaged in a full-time practice of midwifery for at least five years immediately preceding the appointment.
3. States that the Board succeeds to the authority, powers, duties and responsibilities of DHS relating to the licensure and regulation of midwives.
4. States that the succession does not alter the effect of any actions that were taken or impair the valid obligations of DHS relating to the licensure and regulation of midwives in existence before the effective date.
5. States that all rules adopted by DHS remain in full force until superseded by administrative action by the Board.
6. States that all administrative matters, contracts and judicial and quasi-judicial actions, whether completed, pending or in process, of DHS relating to the licensure and regulation of midwives on the effective date are transferred to and retain the same status with the Board.
7. States that all certificates, licenses and other indicia of qualification and authority that were issued by DHS retain their validity for the duration of their terms of validity as provided by law.
8. States that all records and other property, data and investigative findings, obligations and appropriated monies that remain unexpended and unencumbered on the effective date of DHS relating to the licensure and regulation of midwives are transferred to the Board.
9. Allows the Board to spend any monies transferred from DHS relating to the licensure and regulation of midwives and any monies appropriated to Board in FY 2027.
Board Fund
10. Requires, beginning July 1, 2027, all monies deposited in the Board Fund for naturopathic physician licensing and regulation to be only used for licensing and regulating naturopathic physicians.
11. Requires, beginning July 1, 2027, all monies deposited in the Board Fund for midwife licensing and regulation to be only used for licensing and regulating midwives.
12. Requires the Board to establish a separate account for monies transferred to the Board Fund for midwife licensing and regulation.
Disciplinary Action
13. Allows the Board on its own motion to investigate any evidence that appears to show that a licensed midwife is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be mentally or physically unable to engage safely in the practice of midwifery.
14. Allows any person to report to the Board any information that appears to show that a licensed midwife:
a) is or may be medically incompetent;
b) is or may be guilty of unprofessional conduct; or
c) is or may be mentally or physically unable to engage safely in the practice of midwifery.
15. Requires any health care institution to report to the Board any information that appears to show that a licensed midwife:
a) is or may be medically incompetent;
b) is or may be guilty of unprofessional conduct; or
c) is or may be mentally or physically unable to engage safely in the practice of midwifery.
16. Deems it an act of unprofessional conduct for a licensed midwife to fail to make a required report.
17. Requires the Board or the Board Director to notify the licensed midwife as to the content of the complaint as soon as reasonable.
18. States that any person or entity that reports or provides information to the Board in good faith is not subject to an action for civil damages.
19. Prohibits the Board, if requested, from disclosing the name of a person who supplies information regarding a licensed midwife's drug or alcohol impairment.
20. Deems it an act of unprofessional conduct for a licensed midwife to fail to make a required report on the competence of a licensed midwife.
21. Requires the Board to report any health care institution that fails to make a required report on the competence of a licensed midwife to that institution's licensing agency.
22. Requires the Board or, if delegated, the Board Director to require any combination of mental, physical or oral or written medical competency examinations and conduct necessary investigations, including investigational interviews between representatives of the Board and the licensed midwife, to fully inform itself with respect to any information filed with the Board.
23. Allows the examinations to include biological fluid testing and psychological or psychiatric evaluation.
24. Allows the Board or, if delegated, the Board Director to require the licensed midwife, at the licensed midwife's expense, to undergo an assessment by a Board-approved rehabilitative, retraining or assessment program.
25. Allows the Board, if it finds that the public health, safety or welfare imperatively requires emergency action and incorporates a finding to that effect in its order, to restrict, limit or order a summary suspension of a license pending proceedings for revocation or other action.
26. Requires the Board, if it takes disciplinary action, to also serve the licensed midwife with a written notice that states the charges and that the licensed midwife is entitled to a formal hearing before the Board or an administrative law judge.
27. Allows the Board, after completing its investigation and a finding that the information provided is not of sufficient seriousness to merit disciplinary action against the licensed midwife, to take any of the following actions:
a) dismiss if, in the opinion of the Board, the information is without merit;
b) file a letter of concern; or
c) issue a nondisciplinary order requiring the licensed midwife to complete a prescribed number of hours of continuing education in an area or areas prescribed by the Board to provide the licensed midwife with the necessary understanding of current developments, skills, procedures or treatment.
28. Allows the Board, if it finds that it can take rehabilitative or disciplinary action without the presence of the licensed midwife at the formal interview, to enter into a consent agreement with the licensed midwife to limit or restrict the licensed midwife's practice or to rehabilitate the licensed midwife in order to protect the public and ensure the licensed midwife's ability to safely engage in the practice of midwifery.
29. Allows the Board to also require the licensed midwife to successfully complete a Board-approved rehabilitative, retraining or assessment program.
30. Allows the Board, if after completing its investigation it believes that the information is or may be true, to request a formal interview with the licensed midwife.
31. Allows the Board, if the licensed midwife refuses the invitation or accepts and the results indicate that grounds may exist for suspension of the licensed midwife's license for more than 12 months or revocation of the license, to issue a formal complaint and order that a hearing be held in accordance with the uniform administrative hearing procedures.
32. Allows the Board, if after completing a formal interview it finds the provided information is not of sufficient seriousness to merit suspension for more than 12 months or revocation of the license, to take the following actions:
a) dismiss if, in the opinion of the Board, the complaint is without merit;
b) file a letter of concern;
c) file a letter of reprimand;
d) issue a decree of censure which is an official action against the midwife's license that may include a requirement for restitution of fees to a patient resulting from a violation;
e) fix a period and terms of probation best adapted to protect the public health and safety and rehabilitate or educate the licensed midwife concerned which may include:
i. temporary license suspension for no more than 12 months;
ii. restriction of the midwife's license to practice midwifery; or
iii. a requirement for restitution of fees to a patient or education or rehabilitation at the licensed midwife's own expense; and
f) enter into an agreement with the licensed midwife to restrict or limit the licensed midwife's practice or medical activities in order to rehabilitate, retrain or assess the licensed midwife, protect the public and ensure the licensed midwife's ability to safely engage in the practice of midwifery, which may include the licensed midwife successfully completing a Board-approved rehabilitative, retraining or assessment program at the licensed midwife's own expense; and
g) issue a nondisciplinary order requiring the licensed midwife to complete a prescribed number of hours of continuing education in an area or areas prescribed by the Board to provide the licensed midwife with the necessary understanding of current developments, skills, procedures or treatment.
33. Requires the Board, if a licensed midwife fails to comply with the terms of a probation, to serve the licensed midwife with a written notice that states that the licensed midwife is subject to a formal hearing based on the information considered by the Board at the formal interview and any other acts or conduct alleged to be in violation of statute or rules adopted by the Board, including noncompliance with the terms of probation, a consent agreement or a stipulated agreement.
34. Requires the Board, if it finds that the information provided in an investigation warrants suspension or revocation of a license issued, to initiate formal proceedings in accordance with the uniform administrative hearing procedures.
35. Subjects any licensed midwife, who after a formal hearing is found by the Board to be guilty of unprofessional conduct, mentally or physically unable to safely engage in the practice of midwifery or medically incompetent, to censure, probation, suspension or revocation of a license or any combination under any conditions as the Board deems appropriate for the protection of the public health and safety and just in the circumstance.
36. Allows the Board to charge the costs of formal hearings to the licensed midwife whom the Board finds to be in violation of statute.
37. Requires the Board, if during any investigation, the Board determines that a criminal violation may have occurred involving the delivery of health care, to make the evidence of violations available to the appropriate criminal justice agency for its consideration.
38. States that notice of a complaint and hearing is effective by a true copy of it being sent by certified mail to the licensed midwife's last known address of record in the Board's files.
39. States that notice of the complaint and hearing is complete on the date of its deposit in the mail.
40. Allows the Board to accept the surrender of an active license from a licensed midwife who admits in writing to any of the following:
a) being unable to safely engage in the practice of midwifery;
b) having committed an act of unprofessional conduct; or
c) having violated statute or a board rule.
41. Allows the Board to administer the oath to all witnesses.
42. Requires the Board to keep a written transcript of all oral testimony submitted at the hearing and the original or a copy of all other evidence submitted.
43. Allows the Board to waive the technical rules of evidence at any hearing conducted in accordance with statute.
44. Allows an appeal to the Maricopa County Superior Court to be taken from decisions of the Board in accordance with statutes governing the judicial review of administrative decisions.
Investigations
45. Specifies that the Board, in connection with an investigation or as a result of submitted information, at all reasonable times, may examine documents, reports, records and other physical evidence of the person the Board is investigating wherever located that relate to the conduct, competency or mental and physical ability of a midwife to safely practice midwifery.
46. States that for the purpose of all investigations and proceedings conducted by the Board:
a) the Board on its own initiative or on application of any person involved in the investigation may issue subpoenas to require the attendance and testimony of witnesses or to demand the production for examination or copying of documents or any other physical evidence that relates to the competence, unprofessional conduct or mental or physical ability of a licensed midwife to safely practice midwifery;
c) the Board must revoke, limit or modify a subpoena if, in the Board's opinion, the evidence required does not relate to covered unlawful practices, is not relevant to the charge that is the subject matter of the hearing or investigation or does not describe with sufficient particularity the physical evidence required to be produced;
d) any member of the Board or any agent designated by the Board may administer oaths or affirmations, examine witnesses and receive evidence;
e) any person appearing before the Board may be represented by counsel; and
f) on application by the Board or by the person subpoenaed, the superior court may issue an order to either:
i. require the subpoenaed person to appear before the Board or the duly authorized agent to produce evidence relating to the matter under investigation; or
ii. revoke, limit or modify the subpoena if in the court's opinion the evidence demanded does not relate to covered unlawful practices, is not relevant to the charge that is the subject matter of the hearing or investigation or does not describe with sufficient particularity the evidence whose production is required.
47. States that any other law that makes communications between a licensed midwife and a licensed midwife's patient privileged does not apply to investigations or proceedings conducted in accordance with statutory procedures.
48. Requires the Board to keep in confidence the names of any patients whose records are reviewed during the course of investigations and proceedings.
49. Allows the count to find a person who does not comply with a subpoena issued in accordance with investigative procedures to be in contempt of court.
Prescription Dispensing and Administration Authority
50. Allows 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 to dispense and administer the following medications, therapies and devices with the following limitations:
a) antibiotics related to Group B Streptococcus Prophylaxis consistent with the U.S. Centers for Disease Control and Prevention guidelines or other current evidence-based guidelines;
b) the following antihemorrhagic medications for preventing and treating postpartum hemorrhage as defined by the American College of Obstetricians and Gynecologists:
i. oxytocin for preventing uterine atony during or immediately following the third stage of labor according to current evidence-based standards of care;
ii. methylergonovine;
iii. carboprost tromethamine;
iv. misoprostol; and
v. tranexamic acid;
c) prophylactic ophthalmic medications for newborn eye care;
d) intravenous fluids for the following:
i. medication administration;
ii. routine fluid administration; and
iii. treating hypovolemic shock while awaiting emergency medical service;
e) vitamin K prophylaxis for newborns;
f) rho immune globulin;
g) topical, intramuscular or subcutaneous local anesthetics for postpartum repair of first and second degree tears, lacerations or episiotomies, excluding any Schedule I controlled substance;
h) oxygen and compressed air for fetal or maternal distress and infant resuscitation;
i) epinephrine for neonatal resuscitation consistent with the neonatal resuscitation program guidelines and to treat maternal allergic reactions;
j) glucose gel administered orally for neonatal hypoglycemia;
k) 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;
l) resuscitation supplies and equipment according to the current neonatal resuscitation program algorithm;
m) medical supplies and equipment needed to administer authorized medications; and
n) electronic breast pumps, glucose monitors, compression stockings and pregnancy support belts or devices.
51. Prohibits a licensed midwife from using the antihemorrhagic medications to induce or augment labor.
52. Requires the licensed midwife to initiate a transfer of care if an antihemorrhagic medication is administered for managing hemorrhage.
53. States that a pharmacist who dispenses prescription medications in compliance with statute to a licensed midwife is not liable for any adverse reaction that is caused by the licensed midwife's method of use.
54. Allows a licensed midwife to lawfully obtain, transport, administer and possess adequate quantities of authorized medications and the equipment normally required to administer those medications.
55. Requires the licensed midwife to:
a) store the authorized medications as directed by the manufacturer; and
b) record in the patient's chart each use of medication and the medication's lot number and expiration date.
56. Prohibits a licensed midwife from administering a medication to any person after the listed expiration date.
Advisory Committee
57. Establishes the Advisory Committee in Board to:
a) assist in examining applicants for a midwifery license, if requested;
b) collaborate with and assist the Board in disciplinary matters, if requested; and
c) perform any other required duties, at the direction of the Board.
58. Requires the Board to appoint the members of the Advisory Committee, which must be composed of no more than 11 of the following members:
a) at least five licensed midwives;
b) two licensed certified nurse midwives; and
c) two physicians who are licensed to practice allopathic, naturopathic or osteopathic medicine, one of whom is board-certified in obstetrics and one of whom is board-certified in pediatrics.
59. Requires the Board to solicit physician applications from state medical societies and associations for the two physician members of the Advisory Committee.
60. States that the Advisory Committee members are not eligible for compensation or reimbursement of expenses.
61. Requires the Advisory Committee to meet at least four times each year, once per quarter.
62. Requires the Advisory Committee, at the direction of the Board, to conduct a review of sentinel events occurring during the course of prenatal, intrapartum or postpartum care provided by licensed midwives in Arizona.
63. Allows the Advisory Committee, at the direction of the Board, to convene an emergency meeting when a case or sentinel event requires timely review or action to protect the public health and safety.
64. Requires the Advisory Committee, following the review of a sentinel event, to make recommendations to the Board regarding whether the care provided was:
a) consistent with community standards;
b) consistent with community standards but outside the scope of practice; or
c) outside of community standards and requiring corrective action.
65. Allows the Advisory Committee, for care determined to be outside of community standards or the scope of practice, to recommend one or more of the following to the Board:
a) additional continuing education requirements;
b) mentoring or supervised practice;
c) administrative civil penalties;
d) restriction or suspension of a license; or
e) revocation of a license.
66. Requires the Advisory Committee, at the direction of the Board, to review midwife care disclosure reports submitted in accordance with statute.
67. Allows the Advisory Committee, at the direction of the Board, to recommend modifications to the disclosure reporting requirements to the Board to support quality improvement and patient safety.
Disclosure and Reporting Requirements
68. Requires each licensed midwife, at the initiation of care, to disclose to each patient whether the licensed midwife maintains professional liability insurance.
69. Requires the disclosure to be included in the informed consent document and acknowledged by the patient's signature.
70. Requires each licensed midwife, by January 31 of each year, to file a report with the Board, of if delegated, the Board Director, in a format prescribed by the Board, the following information, not including any individually identifiable health information of a patient, for the preceding calendar year:
a) the number of women for whom the licensed midwife provided care;
b) the number of deliveries the licensed midwife attended as primary midwife;
c) the number, reason for and outcome of each transfer or transport of a patient in the antepartum, intrapartum or immediate postpartum periods;
d) the number of perinatal deaths, including both:
i. maternal deaths occurring during pregnancy and through the first month of postpartum; and
ii. neonatal deaths occurring through the first month of life;
e) the number and outcome of breech births and vaginal births after cesarean;
f) the number of births that occurred more than 25 miles from a hospital that provides obstetrics services;
g) the number of fetal deaths after 20 weeks' gestation; and
h) the licensed midwife's full name, license number and county.
71. States that each perinatal death reported in the annual reports to the Board must include the cause of death, if known, and a description of the circumstances surrounding the death.
72. Requires a licensed midwife to additionally report to the Board:
a) a perinatal mortality within 72 hours after the death; and
b) a sentinel event within 14 days after the event.
73. Allows the information reported to the Board by a licensed midwife to be inspected, copied, obtained or provided to the Advisory Committee for research and evidence.
74. Requires the annual report to the Board to replace the report required by each licensed midwife following termination of care for each patient.
75. Requires the data that is collected in the annual reports to the Board, by September 1 of each year, to be:
a) shared with the Speaker of the House of Representatives, the President of the Senate and the Governor; and
b) posted on the Board's public website.
Miscellaneous
76. Repeals the statutory cap for midwifery licensure and application fees.
77. Clarifies that a person desiring to obtain a license to practice midwifery must apply to the Board in writing.
78. Clarifies that the Board Director must adopt rules to describe and define reasonable and necessary minimum qualifications for licensed midwives.
79. Defines individually identifiable health information as having the same meaning prescribed in the federal Health Insurance Portability and Accountability Act privacy standards.
80. Defines licensed midwife as a midwife licensed in accordance with statute.
81. Defines sentinel event as an unexpected, serious patient safety incident resulting in death, permanent harm or a significant risk of harm.
82. Includes, in the definition of sentinel event, both of the following:
a) maternal sentinel events, including:
i. maternal deaths during the pregnancy through 30 days postpartum;
ii. maternal intensive care unit admission in the first 120 hours postpartum;
iii. uterine rupture;
iv. postpartum hemorrhage requiring a blood transfusion; and
v. shoulder dystocia with brachial plexus injury; and
b) neonatal sentinel events, including:
i. neonatal deaths in the first 30 days of life;
ii. neonatal intensive care unit admission within 120 hours after birth, not including observation-only admissions or admissions for congenital anomalies;
iii. a birth weight of less than 2,500 grams;
iv. an Apgar score of less than seven at five minutes; and
v. respiratory distress requiring prolonged ventilation.
83. Designates this legislation as the Jordan and Mack Terry Act.
84. Makes technical and conforming changes.
85. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Removes the requirement for the DHS Director to consider the most recent midwifery job analysis issued by the North American Registry of Midwives when adopting or amending rules related to the midwifery scope of practice.
2. Removes the authorization for a licensed midwife to administer other prescription medications as prescribed by a licensed physician, a registered nurse practitioner or a licensed physician assistant.
3. Specifies, for the two physician Advisory Committee members, that one be board-certified in obstetrics and one be board-certified in pediatrics.
4. Removes the requirement for the Advisory Committee to make recommendations to the DHS Director when adopting or amending rules relating to the midwifery scope of practice.
5. Specifies that the Advisory Committee, following the review of a sentinel event, must make recommendations to DHS regarding whether the care provided was consistent with community standards but outside the scope of practice, rather than outside the scope of practice as defined by DHS in rule.
6. Specifies that the Advisory Committee, for care determined to be outside community standards or the scope of practice, rather than only outside community standards, may recommend one or more prescribed disciplinary actions to DHS.
7. Adds the following to the annual report to DHS required for each licensed midwife:
a) maternal deaths occurring during pregnancy and through the first month postpartum; and
b) neonatal deaths occurring through the first month of life.
8. States that each perinatal death reported in the annual reports to DHS must include the cause of death, if known, and a description of the circumstances surrounding the death.
a) shared with the Speaker of the House of Representatives, the President of the Senate and the Governor; and
b) posted on DHS's public website.
10. Modifies the definition of sentinel event.
Amendments Adopted by Committee of the Whole
1. Transfers the regulatory oversight of licensed midwives from DHS to the Board.
2. Outlines succession procedures and expenditure authority relating to the transfer of the regulatory oversight of licensed midwifes from DHS to the Board.
3. Adds one licensed midwife who is appointed by the Governor as a member of the Board.
4. Requires, beginning July 1, 2027, all monies deposited in the Board Fund for naturopathic physician licensing and regulation to be only used for licensing and regulating naturopathic physicians.
5. Requires, beginning July 1, 2027, all monies deposited in the Board Fund for midwife licensing and regulation to be only used for licensing and regulating midwives.
6. Requires the Board to establish a separate account for monies transferred to the Board Fund for midwife licensing and regulation.
7. Applies the statutory investigative and disciplinary procedures prescribed for naturopathic physicians to licensed midwives.
8. Removes the statutory cap on midwife licensure and application fees.
9. Specifies that the Advisory Committee is established under the Board, rather than under DHS.
10. States that the Advisory Committee's duties are at the discretion of the Board.
11. Makes technical and conforming changes.
House Action Senate Action
HHS 2/16/26 DPA 11-1-0-0 RAGE 3/25/26 DPA 7-0-0
3rd Read 3/5/26 42-8-9-0-1
Prepared by Senate Research
June 10, 2026
JT/ci