SB 667: Healing arts: pregnancy and childbirth.

(1)Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs for the licensure and regulation of the practice of nursing. A violation of the act is a crime. Existing law requires the board to issue a certificate to practice nurse-midwifery to a person who meets specified qualifications. Existing law authorizes a certified nurse-midwife to attend cases of low-risk pregnancy and childbirth and to provide prenatal, intrapartum, and postpartum care, including interconception care, family planning care, and immediate care for the newborn, as specified. Existing law authorizes a certified nurse-midwife to practice with a physician and surgeon under mutually agreed-upon policies and protocols, as specified, to provide a patient with care outside of that scope of services or to provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium.

This bill would revise and recast those provisions to, among other things, authorize a certified nurse-midwife, pursuant to policies and protocols that are mutually agreed upon with a physician and surgeon, as specified, to provide a patient with care outside of that scope of services, to provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium, or to furnish or order a Schedule II or III controlled substance, as specified. The bill would include care for common gynecologic conditions, as specified, in the scope of services a certified nurse-midwife is authorized to perform without policies and protocols that are mutually agreed upon with a physician and surgeon. The bill would additionally authorize a general acute care hospital, as defined, or a special hospital specified as a maternity hospital, as defined, to grant privileges to a certified nurse-midwife, allowing them to admit and discharge patients upon their own authority if in accordance with organized medical staff bylaws of that facility and within the nurse-midwifes scope of practice.

Existing law generally authorizes a certified nurse-midwife to furnish drugs or devices incidentally to the provision of care and services described above that the certified nurse-midwife is authorized to perform and care rendered to persons within certain settings, subject to specified requirements and exceptions. Among those requirements is that a certified nurse-midwife follow standardized procedures or protocols if they furnish or order Schedule IV or V controlled substances or drugs or devices for services other than attending cases of low-risk pregnancy and childbirth or providing prenatal, intrapartum, and postpartum care, as specified. Existing law requires those standardized procedures or protocols to specify which nurse-midwife is authorized to furnish or order drugs or devices, which drugs or devices may be furnished or ordered and under what circumstances, and the method of periodic review of the certified nurse-midwifes competence, as specified, and review of the provisions of the standardized procedure. Existing law requires a certified nurse-midwife to follow a patient-specific protocol approved by a physician and surgeon if the certified nurse-midwife furnishes or orders Schedule II or III controlled substances for any condition. Existing law requires the patient-specific protocol to address the diagnosis of the illness, injury, or condition for which a Schedule II controlled substance is to be furnished.

This bill would revise and recast those provisions to remove references to standardized procedures or protocols and patient-specific protocols. Instead, the bill would require the above-described policies and protocols that a certified nurse-midwife is required to follow for certain care to contain provisions governing the furnishing or ordering of drugs or devices for services other than attending cases of low-risk pregnancy and childbirth or providing prenatal, intrapartum, and postpartum care, as specified.

Existing law authorizes a certified nurse-midwife to procure supplies and devices, obtain and administer diagnostic tests, obtain and administer nonscheduled drugs consistent with the provision of services authorized to be performed without policies and protocols mutually agreed upon with a physician and surgeon, order laboratory and diagnostic testing, and receive reports, as specified. Existing law imposes various requirements on a prescriber, as defined, for dispensing drugs and dangerous devices, including that the drug or device is necessary in the treatment of the condition for which the prescriber is attending the patient.

This bill would additionally authorize a certified nurse-midwife to dispense drugs when attending cases of low-risk pregnancy and childbirth or providing prenatal care, intrapartum care, postpartum care, or care for common gynecologic conditions, pursuant to the above-described requirements on prescribers. The bill would add a certified nurse-midwife to the definition of prescriber for purposes of those requirements.

(2)Existing law prohibits, except as specified, a person from performing a clinical laboratory test or examination classified as waived or classified as of moderate complexity under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) unless the test or examination is performed under the overall operation and administration of the laboratory director, as specified. Existing law defines laboratory director for this purpose.

This bill would amend the definition of laboratory director to include a nurse-midwife serving as a director of a laboratory that performs only testing and examinations classified as waived or a provider-performed microscopy authorized within the scope of the nurse-midwifes certificate to practice.

(3)Existing law requires a claimant for unemployment compensation disability benefits to establish medical eligibility for each uninterrupted period of disability by filing a first claim for disability benefits supported by the certificate of a treating physician or practitioner that establishes the sickness, injury, or pregnancy of the employee, or the condition of the family member that warrants the care of the employee. Existing law defines the term practitioner to mean certain healing arts professions, as specified, including, as to normal pregnancy or childbirth, a midwife, nurse-midwife, or nurse practitioner.

This bill would revise the part of the definition of practitioner relating to normal pregnancy or childbirth to include, instead, as to pregnancy, childbirth, or postpartum conditions consistent with the scope of their professional licensure, a midwife, nurse-midwife, or nurse practitioner.

(4)This bill would incorporate additional changes to Section 2746.5 of the Business and Professions Code proposed by SB 345 to be operative only if this bill and SB 345 are enacted and this bill is enacted last.

(5)This bill would incorporate additional changes to Section 2708 of the Unemployment Insurance Code proposed by AB 575 to be operative only if this bill and AB 575 are enacted and this bill is enacted last.