Citations Affected: IC 16-18-2-163; IC 16-34-2-1.1; IC 16-37-2;
IC 16-38-4-9; IC 25-1-5-3; IC 25-22.5; IC 25-23-1; IC 25-23.4;
IC 34-6-2; IC 34-18-2.
Synopsis: Midwives. Establishes the midwifery board (board). Sets
qualifications for a certified professional midwife (CPM). Requires the
board to: (1) develop peer review procedures; (2) require the purchase
of liability insurance as a condition for licensure if the board
determines liability insurance is sufficiently available; and (3) adopt
rules limiting the scope of practice of CPMs to nonhospital settings.
Makes it a Class B misdemeanor to practice midwifery without a
license. Adds culpability standards to the crimes of practicing medicine
or osteopathic medicine and acting as a physician assistant without a
license. Allows the board to specify circumstances under which a CPM
may administer certain prescription drugs. Allows certain individuals
to act under the supervision of a CPM. Requires the office of Medicaid
policy and planning to seek a waiver from the United States
Department of Health and Human Services to allow Medicaid
reimbursement for CPMs. Repeals the definition of "midwife" in the
medical malpractice law, and adds a definition of "certified nurse
midwife".
Effective: July 1, 2009.
January 15, 2009, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
professional corporation, facility, or institution acting in the
course and scope of the person's employment.
(2) A college, university, or junior college that provides health
care to a student, a faculty member, or an employee, and the
governing board or a person who is an officer, employee, or agent
of the college, university, or junior college acting in the course
and scope of the person's employment.
(3) A blood bank, community mental health center, community
mental retardation center, community health center, or migrant
health center.
(4) A home health agency (as defined in IC 16-27-1-2).
(5) A health maintenance organization (as defined in
IC 27-13-1-19).
(6) A health care organization whose members, shareholders, or
partners are health care providers under subdivision (1).
(7) A corporation, partnership, or professional corporation not
otherwise qualified under this subsection that:
(A) provides health care as one (1) of the corporation's,
partnership's, or professional corporation's functions;
(B) is organized or registered under state law; and
(C) is determined to be eligible for coverage as a health care
provider under IC 34-18 for the corporation's, partnership's, or
professional corporation's health care function.
Coverage for a health care provider qualified under this subdivision is
limited to the health care provider's health care functions and does not
extend to other causes of action.
(b) "Health care provider", for purposes of IC 16-35, has the
meaning set forth in subsection (a). However, for purposes of IC 16-35,
the term also includes a health facility (as defined in section 167 of this
chapter).
(c) "Health care provider", for purposes of IC 16-36-5, means an
individual licensed or authorized by this state to provide health care or
professional services as:
(1) a licensed physician;
(2) a registered nurse;
(3) a licensed practical nurse;
(4) an advanced practice nurse;
(5) a licensed certified nurse midwife or a certified professional
midwife;
(6) a paramedic;
(7) an emergency medical technician;
(8) an emergency medical technician-basic advanced;
pregnant woman upon whom the abortion is to be performed. Except
in the case of a medical emergency, consent to an abortion is voluntary
and informed only if the following conditions are met:
(1) At least eighteen (18) hours before the abortion and in the
presence of the pregnant woman, the physician who is to perform
the abortion, the referring physician or a physician assistant (as
defined in IC 25-27.5-2-10), an advanced practice nurse (as
defined in IC 25-23-1-1(b)), a certified professional midwife (as
defined in IC 25-23.4-1-4) or a certified nurse midwife (as
defined in IC 34-18-2-19) IC 34-18-2-6.5) to whom the
responsibility has been delegated by the physician who is to
perform the abortion or the referring physician has orally
informed the pregnant woman of the following:
(A) The name of the physician performing the abortion.
(B) The nature of the proposed procedure or treatment.
(C) The risks of and alternatives to the procedure or treatment.
(D) The probable gestational age of the fetus, including an
offer to provide:
(i) a picture or drawing of a fetus;
(ii) the dimensions of a fetus; and
(iii) relevant information on the potential survival of an
unborn fetus;
at this stage of development.
(E) The medical risks associated with carrying the fetus to
term.
(F) The availability of fetal ultrasound imaging and
auscultation of fetal heart tone services to enable the pregnant
woman to view the image and hear the heartbeat of the fetus
and how to obtain access to these services.
(2) At least eighteen (18) hours before the abortion, the pregnant
woman will be orally informed of the following:
(A) That medical assistance benefits may be available for
prenatal care, childbirth, and neonatal care from the local
office of the division of family resources.
(B) That the father of the unborn fetus is legally required to
assist in the support of the child. In the case of rape, the
information required under this clause may be omitted.
(C) That adoption alternatives are available and that adoptive
parents may legally pay the costs of prenatal care, childbirth,
and neonatal care.
(3) The pregnant woman certifies in writing, before the abortion
is performed, that the information required by subdivisions (1)
and (2) has been provided.
(b) Before an abortion is performed, the pregnant woman may, upon
the pregnant woman's request, view the fetal ultrasound imaging and
hear the auscultation of the fetal heart tone if the fetal heart tone is
audible.
registry administered by the state department. Information used from
other registries remains subject to the confidentiality restrictions on the
other registries.
unauthorized practice of medicine or osteopathic medicine, does not
apply to any of the following:
(1) A student in training in a medical school approved by the
board, or while performing duties as an intern or a resident in a
hospital under the supervision of the hospital's staff or in a
program approved by the medical school.
(2) A person who renders service in case of emergency where no
fee or other consideration is contemplated, charged, or received.
(3) A paramedic (as defined in IC 16-18-2-266), an emergency
medical technician-basic advanced (as defined in
IC 16-18-2-112.5), an emergency medical technician-intermediate
(as defined in IC 16-18-2-112.7), an emergency medical
technician (as defined in IC 16-18-2-112), or a person with
equivalent certification from another state who renders advanced
life support (as defined in IC 16-18-2-7) or basic life support (as
defined in IC 16-18-2-33.5):
(A) during a disaster emergency declared by the governor
under IC 10-14-3-12 in response to an act that the governor in
good faith believes to be an act of terrorism (as defined in
IC 35-41-1-26.5); and
(B) in accordance with the rules adopted by the Indiana
emergency medical services commission or the disaster
emergency declaration of the governor.
(4) Commissioned medical officers or medical service officers of
the armed forces of the United States, the United States Public
Health Service, and medical officers of the United States
Department of Veterans Affairs in the discharge of their official
duties in Indiana.
(5) An individual who is not a licensee who resides in another
state or country and is authorized to practice medicine or
osteopathic medicine there, who is called in for consultation by an
individual licensed to practice medicine or osteopathic medicine
in Indiana.
(6) A person administering a domestic or family remedy to a
member of the person's family.
(7) A member of a church practicing the religious tenets of the
church if the member does not make a medical diagnosis,
prescribe or administer drugs or medicines, perform surgical or
physical operations, or assume the title of or profess to be a
physician.
(8) A school corporation and a school employee who acts under
IC 34-30-14 (or IC 34-4-16.5-3.5 before its repeal).
practitioner status or the authority to perform patient services in
an independent practice in a profession.
(21) A hospital licensed under IC 16-21 or IC 12-25.
(22) A health care organization whose members, shareholders, or
partners are individuals, partnerships, corporations, facilities, or
institutions licensed or legally authorized by this state to provide
health care or professional services as:
(A) a physician;
(B) a psychiatric hospital;
(C) a hospital;
(D) a health maintenance organization or limited service
health maintenance organization;
(E) a health facility;
(F) a dentist;
(G) a registered or licensed practical nurse;
(H) a certified nurse midwife or a certified professional
midwife;
(I) an optometrist;
(J) a podiatrist;
(K) a chiropractor;
(L) a physical therapist; or
(M) a psychologist.
(23) A physician assistant practicing the physician assistant
profession under IC 25-27.5.
(24) A physician providing medical treatment under
IC 25-22.5-1-2.1.
(25) An attendant who provides attendant care services (as
defined in IC 16-18-2-28.5).
(26) A personal services attendant providing authorized attendant
care services under IC 12-10-17.1.
(b) A person described in subsection (a)(9) through (a)(18) is not
excluded from the application of this article if:
(1) the person performs an act that an Indiana statute does not
authorize the person to perform; and
(2) the act qualifies in whole or in part as the practice of medicine
or osteopathic medicine.
(c) An employment or other contractual relationship between an
entity described in subsection (a)(21) through (a)(22) and a licensed
physician does not constitute the unlawful practice of medicine under
this article if the entity does not direct or control independent medical
acts, decisions, or judgment of the licensed physician. However, if the
direction or control is done by the entity under IC 34-30-15 (or
IC 34-4-12.6 before its repeal), the entity is excluded from the
application of this article as it relates to the unlawful practice of
medicine or osteopathic medicine.
(d) This subsection does not apply to a prescription or drug order for
a legend drug that is filled or refilled in a pharmacy owned or operated
by a hospital licensed under IC 16-21. A physician licensed in Indiana
who permits or authorizes a person to fill or refill a prescription or drug
order for a legend drug except as authorized in IC 16-42-19-11 through
IC 16-42-19-19 is subject to disciplinary action under IC 25-1-9. A
person who violates this subsection commits the unlawful practice of
medicine under this chapter.
(e) A person described in subsection (a)(8) shall not be authorized
to dispense contraceptives or birth control devices.
who desires to practice certified nurse midwifery shall present to the
board the applicant's license as a registered nurse and a diploma earned
by the applicant from a school of midwifery approved or licensed by
the board or licensing agency for midwives that is located in any state.
(b) The applicant shall submit to an examination in certified nurse
midwifery prescribed or administered by the board. If the application
and qualifications are approved by the board, the applicant is entitled
to receive a limited license that allows the applicant to practice
midwifery as a certified nurse midwife.
(c) The board shall adopt rules under IC 25-23-1-7: section 7 of this
chapter:
(1) defining the scope of practice for midwifery; of a certified
nurse midwife; and
(2) for implementing this section.
under subsection (a) after June 30, 2009, and before July 1, 2012,
is not required to be licensed under this article. However, a
certified professional midwife appointed to the board after June
30, 2009, and before July 1, 2012, under subsection (a), must be a
certified professional midwife.
Sec. 3. (a) The term of each board member is four (4) years.
(b) A board member may be reappointed for not more than
three (3) consecutive terms.
(c) A board member serves until the board member's successor
is appointed. A vacancy occurring in the membership of the board
for any cause shall be filled by appointment by the governor for the
unexpired term.
(d) Board members annually shall select a chairperson and a
vice chairperson from among the board's members.
Sec. 4. (a) The board shall meet at least one (1) time each year
at the call of the chairperson.
(b) Four (4) members of the board constitute a quorum.
(c) The affirmative vote of four (4) members of the board is
required for the board to take action.
Sec. 5. The health professions bureau shall provide staff support
for the board.
Sec. 6. The board shall do the following:
(1) Establish as a requirement for licensure as a certified
professional midwife the certified professional midwife (CPM)
credentials developed by the North American Registry of
Midwives or a successor organization.
(2) Establish fees for the licensure of certified professional
midwives.
(3) Establish annual continuing education requirements for
license renewal.
(4) Develop a peer review procedure, using as guidelines the
peer review procedures established by:
(A) the Indiana Midwives Association or a successor
organization; and
(B) the Midwives Alliance of North America or a successor
organization.
(5) Prescribe informed consent forms and other relevant
forms.
(6) Research the availability of liability insurance for certified
professional midwives and, if the board determines that
liability insurance is sufficiently available, require the
purchase of liability insurance as a condition for licensure.
Registry of Midwives.
Sec. 2. (a) The board shall set up formal education requirements
in addition to those required in section 1. The requirements must
include course material on:
(1) emergency life support procedures;
(2) identification of high risk births for mothers;
(3) identification of potential complications during labor; and
(4) other material the board specifies.
(b)The board may require an oral interview with the applicant
to assess the applicant's fitness to practice midwifery.
Sec. 3. The board shall grant a license to practice certified
professional midwifery to an applicant who satisfies the
requirements of sections 1 and 2 of this chapter.
Sec. 4. (a) A license issued under this chapter expires three (3)
years after the date of issuance. Failure to renew a license on or
before the expiration date makes the license invalid without any
action by the board.
(b) The procedures and fees for renewal are set by the board.
(c) To be eligible for the renewal of a license issued under this
chapter, an individual must meet continuing education
requirements set by the board.
Sec. 5. The board:
(1) shall adopt rules under IC 4-22-2 to set the fees for
issuance of a license under this article; and
(2) may adopt rules under IC 4-22-2 to set other fees the
board considers necessary to administer this article.
Sec. 6. After July 1, 2012, only an individual who is licensed
under this article may use the title "certified professional
midwife".
Sec. 7. The board may deny, suspend, or revoke a license issued
under this article to an individual who does any of the following:
(1) Uses alcohol or drugs to a degree that impairs the
individual's practice of midwifery.
(2) Engages in unprofessional conduct as defined by the
board's rules.
(3) Commits an act or makes an omission constituting gross
negligence arising from the practice of midwifery.
(4) Obtains a certified professional midwife license through
fraud.
(5) Violates this article or a rule adopted under this article by
the board.
Sec. 8. The board shall provide notice and a hearing under
IC 4-21.5 to an individual licensed under this article before the
board may deny, suspend, or revoke the individual's license under
section 7 of this chapter.
Sec. 9. The board may impose a civil penalty of not more than
five hundred dollars ($500) on an individual licensed under this
article who commits an act or makes an omission described in
section 7 of this chapter.
Sec. 10. The board may issue a license to an individual who is
licensed as a midwife in another state with requirements that the
board determines are at least equal to the licensing requirements
of this article.
Sec. 11. (a) This section does not apply to an individual who has
a limited license under IC 25-23-1-13.1 to practice midwifery as a
certified nurse midwife.
(b) After July 1, 2012, an individual who knowingly or
intentionally practices midwifery without a license required under
this article commits a Class B misdemeanor.
Chapter 4. Informed Consent for the Practice of Certified
Professional Midwifery
Sec. 1. All the following must occur before a certified
professional midwife may accept a client for midwifery care:
(1) The certified professional midwife must provide the
potential client with an informed disclosure of practice form
prescribed by the board under section 3 of this chapter.
(2) The potential client must sign and date the form.
(3) The certified professional midwife must sign and date the
form.
(4) If the potential client refuses a procedure or treatment
required by law, the potential client must so indicate on a
separate procedure or treatment form.
(5) The certified professional midwife must have an
emergency plan for the care of the client if an emergency
arises.
(6) The certified professional midwife must make an effort to
have a written agreement with a physician to provide for
backup care for the client. The backup physician should be
located in an area close to where the delivery will occur. The
board shall set standards for determining:
(A) the type of effort sufficient to have a written agreement
with a physician to provide for backup care for the client;
and
(B) the geographic area close enough to the planned
location of the delivery to make the backup physician a
reasonable choice to provide backup care.
The board shall, in cooperation with the medical licensing
board or professional organizations of physicians, develop a
list of physicians willing to provide backup care and make the
list available to certified professional midwives.
Sec. 2. A certified professional midwife may not perform on a
client a specific procedure or treatment that is not described on the
informed disclosure of practice form described in section 1 of this
chapter until both of the following occur:
(1) The specific procedure or treatment is disclosed to the
client in writing on a form that is separate from the informed
disclosure of practice form.
(2) The client agrees to the procedure or treatment by signing
the procedure or treatment form.
Sec. 3. (a) The board shall prescribe the written form for the
informed disclosure of practice.
(b) The informed disclosure of practice form must be in writing
and must contain the following information:
(1) A description of the certified professional midwife's
education and training in midwifery, including completion of
continuing education courses and participation in the peer
review process.
(2) The certified professional midwife's experience level in the
field of midwifery.
(3) The certified professional midwife's philosophy of
practice.
(4) Antepartum, intrapartum, and postpartum conditions
requiring consultation, transfer of care, and transport to a
hospital.
(5) The emergency medical backup plan, including the
emergency plan and the agreement with a physician for
backup care required under section 1 of this chapter.
(6) The services to be provided to the client by the certified
professional midwife.
(7) The certified professional midwife's current licensure
status and pertinent legal ramifications.
(8) A detailed explanation of treatments and procedures.
(9) A detailed description of the risks and expected benefits of
midwifery care.
(10) The availability of a grievance process in a case in which
a client is dissatisfied with the performance of the certified
professional midwife.
(11) A statement that under IC 25-23.4-6 a health care
provider (as defined in IC 34-18-2-14 or IC 27-12-2-14 before
its repeal) may not be held jointly or severally liable for the
acts or omissions of a:
(A) certified professional midwife; or
(B) licensed physician who has entered into a collaborative
agreement under IC 25-23.4-5 with a certified professional
midwife, for the acts or omissions of the licensed physician
while the physician assists or collaborates with the certified
professional midwife to perform midwifery.
Sec. 4. A certified professional midwife may not disclose
information obtained from a client during a professional
consultation except under the following conditions:
(1) The client or the client's personal representative or
guardian provides written consent.
(2) The information concerns the commission of a crime or
the threat of imminent danger.
(3) The client:
(A) is a minor and is the victim of a crime;
(B) brings a cause of action against the midwife;
(C) waives the confidentiality privilege; or
(D) is seeking emergency care.
(4) Any other condition allowed by law.
Sec. 5. (a) A certified professional midwife shall provide an
annual report to the board regarding each birth that the certified
professional midwife assists. A report must summarize the
following on a form prescribed by the board:
(1) Vital statistics.
(2) Scope of care.
(3) Transport information.
(4) Physician referral.
(b) A certified professional midwife may not reveal the identity
of the clients referred to in a report under subsection (a).
Sec. 6. (a) Except as provided in subsection (b), a certified
professional midwife may not prescribe, dispense, or administer
prescription drugs.
(b) A certified professional midwife may administer:
(1) vitamin K, either orally or through intramuscular
injection;
(2) postpartum antihemorrhagic drugs in emergency
situations;
FOLLOWS [EFFECTIVE JULY 1, 2009]: Sec. 14. "Health care
provider" means any of the following:
(1) An individual, a partnership, a limited liability company, a
corporation, a professional corporation, a facility, or an institution
licensed or legally authorized by this state to provide health care
or professional services as a physician, a psychiatric hospital, a
hospital, a health facility, an emergency ambulance service
(IC 16-18-2-107), a dentist, a registered or licensed practical
nurse, a physician assistant, a certified nurse midwife, a
certified professional midwife, an optometrist, a podiatrist, a
chiropractor, a physical therapist, a respiratory care practitioner,
an occupational therapist, a psychologist, a paramedic, an
emergency medical technician-intermediate, an emergency
medical technician-basic advanced, or an emergency medical
technician, or a person who is an officer, employee, or agent of
the individual, partnership, corporation, professional corporation,
facility, or institution acting in the course and scope of the
person's employment.
(2) A college, university, or junior college that provides health
care to a student, faculty member, or employee, and the governing
board or a person who is an officer, employee, or agent of the
college, university, or junior college acting in the course and
scope of the person's employment.
(3) A blood bank, community mental health center, community
mental retardation center, community health center, or migrant
health center.
(4) A home health agency (as defined in IC 16-27-1-2).
(5) A health maintenance organization (as defined in
IC 27-13-1-19).
(6) A health care organization whose members, shareholders, or
partners are health care providers under subdivision (1).
(7) A corporation, limited liability company, partnership, or
professional corporation not otherwise qualified under this section
that:
(A) as one (1) of its functions, provides health care;
(B) is organized or registered under state law; and
(C) is determined to be eligible for coverage as a health care
provider under this article for its health care function.
Coverage for a health care provider qualified under this
subdivision is limited to its health care functions and does not
extend to other causes of action.
JULY 1, 2009]: IC 34-6-2-81; IC 34-18-2-19.
of the waiver requested under subsection (c), the office shall file an
affidavit with the governor's office and the budget committee
attesting to the fact that the waiver has been approved.
(f) The office shall implement subsection (b) not later than
ninety (90) days after the governor's office and the budget
committee receive the affidavit described in subsection (e).
(g) This SECTION expires July 1, 2013.