Citations Affected: IC 16-18-2-163; IC 16-34-2-1.1; IC 16-37-2; IC 16-38-4; IC 25-1;
IC 25-22.5; IC 25-23-1; IC 25-23.4; IC 34-6-2-81; IC 34-18-2; IC 34-30-2-99.7; IC 35-51-25-1.
Synopsis: Midwives. Conference committee report for EHB 1135. Requires the local health
officer to make a permanent record of the person in attendance at a birth and the location of the
birth. Includes complications resulting from a home delivery in the definition of "birth problems"
for purposes of the birth problems registry. Requires the state department of health to adopt rules
to establish reporting requirements regarding birth problems for home deliveries. Establishes the
midwifery committee to provide information and recommendations to the medical licensing
board (board) concerning the practice of midwifery by a certified direct entry midwife (CDEM).
Provides requirements that an applicant must meet before the board may issue a certificate for
a CDEM. Provides for the issuance of certificates beginning January 1, 2014, and sets
qualifications. Requires the board to: (1) establish continuing education requirements; (2)
develop peer review procedures; and (3) adopt certain rules concerning the competent practice
of a CDEM. Requires a physician to examine a client of a CDEM at least one time during the
client's first trimester and one time during the client's third trimester. Requires a CDEM to
collaborate with a physician. Allows a CDEM to administer certain prescription drugs only under
a physician's protocol or order. Establishes a Class D felony for practicing midwifery without a
certificate. Adds culpability standards to the crimes of practicing medicine or osteopathic
medicine and acting as a physician assistant without a license. Requires certain information to
be reported to the health finance commission. Makes technical and conforming changes. (This
conference committee report: (1) requires the pediatrics physician on the midwifery
committee to have experience as a collaborative home birth physician; (2) requires the
medical licensing board to adopt additional rules; (3) changes language requiring a CDEM
to collaborate with a physician; (4) makes changes to the requirements that the board may
exempt for existing midwives seeking a certificate to practice; (5) requires the midwifery
committee to make recommendations to the board concerning certain rules; (6) adds
requirements to the reciprocity standards; (7) allows a CDEM to administer certain drugs
under a physician's protocol; (8) requires certain reporting licensing to the health finance
commission; and (9) makes technical and conforming changes and resolves conflicts with
other acts.)
Effective: July 1, 2013.
MADAM PRESIDENT:
Your Conference Committee appointed to confer with a like committee from the House
upon Engrossed Senate Amendments to Engrossed House Bill No. 1135 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the House recede from its dissent from all Senate amendments and that
the House now concur in all Senate amendments to the bill and that the bill
be further amended as follows:
Delete everything after the enacting clause and insert the following:
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;
(6) a paramedic;
(7) an emergency medical technician;
(8) an advanced emergency medical technician; or
(9) an emergency medical responder, as defined by section 109.8
of this chapter.
The term includes an individual who is an employee or agent of a
health care provider acting in the course and scope of the individual's
employment.
(d) "Health care provider", for purposes of IC 16-40-4, means any
of the following:
(1) An individual, a partnership, a corporation, a professional
corporation, a facility, or an institution licensed or authorized by
the state to provide health care or professional services as a
licensed physician, a psychiatric hospital, a hospital, a health
facility, an emergency ambulance service (IC 16-31-3), an
ambulatory outpatient surgical center, a dentist, an optometrist, a
pharmacist, a podiatrist, a chiropractor, a psychologist, 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 blood bank, laboratory, community mental health center,
community mental retardation center, community health center,
or migrant health center.
(3) A home health agency (as defined in IC 16-27-1-2).
(4) A health maintenance organization (as defined in
IC 27-13-1-19).
(5) A health care organization whose members, shareholders, or
partners are health care providers under subdivision (1).
(6) A corporation, partnership, or professional corporation not
otherwise specified in 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.
(7) A person that is designated to maintain the records of a person
described in subdivisions (1) through (6).
(e) "Health care provider", for purposes of IC 16-45-4, has the
meaning set forth in 47 CFR 54.601(a).
concerning the abortion inducing drug.
(D) Objective scientific information of the risks of and
alternatives to the procedure or the use of an abortion inducing
drug, including:
(i) the risk of infection and hemorrhage;
(ii) the potential danger to a subsequent pregnancy; and
(iii) the potential danger of infertility.
(E) That human physical life begins when a human ovum is
fertilized by a human sperm.
(F) The probable gestational age of the fetus at the time the
abortion is to be performed, including:
(i) a picture 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.
(G) That objective scientific information shows that a fetus
can feel pain at or before twenty (20) weeks of postfertilization
age.
(H) The medical risks associated with carrying the fetus to
term.
(I) 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.
(J) That the pregnancy of a child less than fifteen (15) years of
age may constitute child abuse under Indiana law if the act
included an adult and must be reported to the department of
child services or the local law enforcement agency under
IC 31-33-5.
(2) At least eighteen (18) hours before the abortion, the pregnant
woman will be informed orally and in writing of the following:
(A) That medical assistance benefits may be available for
prenatal care, childbirth, and neonatal care from the county
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.
(D) That there are physical risks to the pregnant woman in
having an abortion, both during the abortion procedure and
after.
(E) That Indiana has enacted the safe haven law under
IC 31-34-2.5.
(F) The:
(i) Internet web site address of the state department of
health's web site; and
(ii) description of the information that will be provided on
the web site and that are;
described in section 1.5 of this chapter.
(3) The pregnant woman certifies in writing, on a form developed
by the state department, before the abortion is performed, that:
(A) the information required by subdivisions (1) and (2) has
been provided to the pregnant woman;
(B) the pregnant woman has been offered by the provider the
opportunity to view the fetal ultrasound imaging and hear the
auscultation of the fetal heart tone if the fetal heart tone is
audible and that the woman has:
(i) viewed or refused to view the offered fetal ultrasound
imaging; and
(ii) listened to or refused to listen to the offered auscultation
of the fetal heart tone if the fetal heart tone is audible; and
(C) the pregnant woman has been given a written copy of the
printed materials described in section 1.5 of this chapter.
(4) 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)), or a midwife (as defined in
IC 34-18-2-19) to whom the responsibility has been delegated by
the physician who is to perform the abortion or the referring
physician has provided the pregnant woman with a color copy of
the informed consent brochure described in section 1.5 of this
chapter by printing the informed consent brochure from the state
department's Internet web site and including the following
information on the back cover of the brochure:
(A) The name of the physician performing the abortion and the
physician's medical license number.
(B) An emergency telephone number where the physician or
the physician's designee may be contacted twenty-four (24)
hours a day, seven (7) days a week.
(C) A statement that follow-up care by the physician or the
physician's designee who is licensed under IC 25-22.5 is
available on an appropriate and timely basis when clinically
necessary.
(b) Before an abortion is performed, the provider shall perform, and
the pregnant woman shall view, the fetal ultrasound imaging and hear
the auscultation of the fetal heart tone if the fetal heart tone is audible
unless the pregnant woman certifies in writing, on a form developed by
the state department, before the abortion is performed, that the
pregnant woman:
(1) does not want to view the fetal ultrasound imaging; and
(2) does not want to listen to the auscultation of the fetal heart
tone if the fetal heart tone is audible.
applying for, or will be applying for, an initial license or an initial
certificate under one (1) of the following:
(1) IC 25-2.5 (acupuncturists).
(2) IC 25-10 (chiropractors).
(3) IC 25-13 (dental hygienists).
(4) IC 25-14 (dentists).
(5) IC 25-14.5 (dietitians).
(6) IC 25-17.3 (genetic counselors).
(7) IC 25-19 (health facility and residential care facility
administrators).
(8) IC 25-21.8 (massage therapists).
(9) IC 25-22.5 (physicians).
(10) IC 25-23 (nurses).
(11) IC 25-23.4 (certified direct entry midwives).
(11) (12) IC 25-23.5 (occupational therapists).
(12) (13) IC 25-23.6 (social workers, marriage and family
therapists, and counselors).
(13) (14) IC 25-24 (optometrists).
(14) (15) IC 25-26 (pharmacists).
(15) (16) IC 25-27 (physical therapists).
(16) (17) IC 25-27.5 (physician assistants).
(17) (18) IC 25-29 (podiatrists).
(18) (19) IC 25-33 (psychologists).
(19) (20) IC 25-34.5 (respiratory care practitioners).
(20) (21) IC 25-35.6 (speech pathologists and audiologists).
(21) (22) IC 25-38.1 (veterinarians).
(b) As used in this chapter, "national criminal history background
check" means the criminal history record system maintained by the
Federal Bureau of Investigation based on fingerprint identification or
any other method of positive identification.
(c) An individual applying for an initial license or initial certificate
specified in subsection (a) shall submit to a national criminal history
background check at the cost of the individual.
(d) The state police department shall release the results of a national
criminal history background check conducted under this section to the
Indiana professional licensing agency.
(e) A board, a commission, or a committee may conduct a random
audit and require an individual seeking a renewal of a license or a
certificate specified in subsection (a) to submit to a national criminal
history background check at the cost of the individual.
IC 34-30-14 (or IC 34-4-16.5-3.5 before its repeal).
(9) A chiropractor practicing the chiropractor's profession under
IC 25-10 or to an employee of a chiropractor acting under the
direction and supervision of the chiropractor under IC 25-10-1-13.
(10) A dental hygienist practicing the dental hygienist's profession
under IC 25-13.
(11) A dentist practicing the dentist's profession under IC 25-14.
(12) A hearing aid dealer practicing the hearing aid dealer's
profession under IC 25-20.
(13) A nurse practicing the nurse's profession under IC 25-23.
However, a certified registered nurse anesthetist (as defined in
IC 25-23-1-1.4) may administer anesthesia if the certified
registered nurse anesthetist acts under the direction of and in the
immediate presence of a physician.
(14) An optometrist practicing the optometrist's profession under
IC 25-24.
(15) A pharmacist practicing the pharmacist's profession under
IC 25-26.
(16) A physical therapist practicing the physical therapist's
profession under IC 25-27.
(17) A podiatrist practicing the podiatrist's profession under
IC 25-29.
(18) A psychologist practicing the psychologist's profession under
IC 25-33.
(19) A speech-language pathologist or audiologist practicing the
pathologist's or audiologist's profession under IC 25-35.6.
(20) An employee of a physician or group of physicians who
performs an act, a duty, or a function that is customarily within
the specific area of practice of the employing physician or group
of physicians, if the act, duty, or function is performed under the
direction and supervision of the employing physician or a
physician of the employing group within whose area of practice
the act, duty, or function falls. An employee may not make a
diagnosis or prescribe a treatment and must report the results of
an examination of a patient conducted by the employee to the
employing physician or the physician of the employing group
under whose supervision the employee is working. An employee
may not administer medication without the specific order of the
employing physician or a physician of the employing group.
Unless an employee is licensed or registered to independently
practice in a profession described in subdivisions (9) through
(18), nothing in this subsection grants the employee independent
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;
SECTION 2, AND SEA 246-2013, SECTION 2, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2013]: Sec. 7. (a) The
board shall do the following:
(1) Adopt rules and forms necessary to implement this article that
concern, but are not limited to, the following areas:
(A) Qualification by education, residence, citizenship,
training, and character for admission to an examination for
licensure or by endorsement for licensure.
(B) The examination for licensure.
(C) The license or permit.
(D) Fees for examination, permit, licensure, and registration.
(E) Reinstatement of licenses and permits.
(F) Payment of costs in disciplinary proceedings conducted by
the board.
(2) Administer oaths in matters relating to the discharge of the
board's official duties.
(3) Enforce this article and assign to the personnel of the agency
duties as may be necessary in the discharge of the board's duty.
(4) Maintain, through the agency, full and complete records of all
applicants for licensure or permit and of all licenses and permits
issued.
(5) Make available, upon request, the complete schedule of
minimum requirements for licensure or permit.
(6) Issue, at the board's discretion, a temporary permit to an
applicant for the interim from the date of application until the
next regular meeting of the board.
(7) Issue an unlimited license, a limited license, or a temporary
medical permit, depending upon the qualifications of the
applicant, to any applicant who successfully fulfills all of the
requirements of this article.
(8) Adopt rules establishing standards for the competent practice
of medicine, osteopathic medicine, or any other form of practice
regulated by a limited license or permit issued under this article.
(9) Adopt rules regarding the appropriate prescribing of Schedule
III or Schedule IV controlled substances for the purpose of weight
reduction or to control obesity.
(10) Adopt rules establishing standards for office based
procedures that require moderate sedation, deep sedation, or
general anesthesia.
(11) Adopt rules or protocol establishing the following:
(A) An education program to be used to educate women with
high breast density.
(B) Standards for providing an annual screening or diagnostic
test for a woman who is at least forty (40) years of age and
who has been determined to have high breast density.
As used in this subdivision, "high breast density" means a
condition in which there is a greater amount of breast and
connective tissue in comparison to fat in the breast.
(12) Adopt rules establishing standards and protocols for the
prescribing of controlled substances.
Midwives or a successor organization.
(2) Subject to IC 25-1-8-2, establish fees to administer this
article.
(3) Establish annual continuing education requirements to
renew a certified direct entry midwife's certificate, which
must include continuing education in pharmacology. The
requirements established under this subdivision must provide
for at least fifteen (15) hours of continuing education every
twelve (12) months.
(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 North American Registry of Midwives or a
successor organization.
(b) The board shall, after receiving recommendations from the
committee, do the following:
(1) In addition to the requirements under IC 25-23.4-5, adopt
rules under IC 4-22-2 to provide for adequate collaboration
between a certified direct entry midwife and a collaborating
physician.
(2) Adopt rules under IC 4-22-2 that define the competent
practice for certified direct entry midwives. Rules adopted
under this subdivision must limit the practice of certified
direct entry midwives to nonhospital settings.
(3) Adopt rules under IC 4-22-2 that establish standards for
an emergency plan of care, including that a plan must allow
for the timely provision of emergency care at a hospital.
(4) In addition to the requirements under IC 25-23.4-4-1(a)(6),
adopt rules under IC 4-22-2 to set standards for determining
the geographic area close enough to the planned location of
the delivery to make the collaborating physician a reasonable
choice to provide backup care.
(5) In addition to the requirements under IC 25-23.4-5-1(b),
adopt rules under IC 4-22-2 to establish standards or
conditions that require additional review of a certified direct
entry midwife's client encounters by the collaborating
physician.
(6) Adopt rules under IC 4-22-2 to determine the number of
certified direct entry midwives with whom a physician may
collaborate.
(7) In addition to the requirements under IC 25-23.4-6-1(b),
establish the conditions that require a certified direct entry
midwife to refer a client for an examination by a physician.
(8) Adopt rules under IC 4-22-2, establishing the health
conditions that require a referral to a physician under
IC 25-23.4-6-1(c).
(c) The board may not adopt rules to grant a certified direct
entry midwife prescriptive authority other than the authority
specified in IC 25-23.4-4-5.
Sec. 7. The committee may propose rules to the board for
adoption. The board shall adopt rules under IC 4-22-2 to
administer this article.
Chapter 3. Certified Direct Entry Midwifery Certificates
Sec. 0.5. This chapter is effective beginning January 1, 2014.
Sec. 1. (a) This section does not apply to an individual who has
a license under IC 25-23-1-13.1 to practice midwifery as a certified
nurse midwife and is practicing within the scope of that license.
(b) After July 1, 2014, an individual may not engage in the
practice of midwifery unless:
(1) the individual is issued a certificate by a board under
IC 25-1-5 and is acting within the scope of the person's
license; or
(2) the individual has a certified direct entry midwife
certificate under this article and has a collaborative
agreement with a physician as set forth in this article.
(c) To become certified as a certified direct entry midwife, an
applicant must satisfy the following requirements:
(1) Be at least twenty-one (21) years of age.
(2) Possess at least:
(A) an associate degree in nursing, associate degree in
midwifery accredited by the Midwifery Education
Accreditation Council (MEAC), or other similar science
related associate degree; or
(B) a bachelor's degree;
from a postsecondary educational institution.
(3) Satisfactorily complete educational curriculum approved
by:
(A) the Midwifery Education Accreditation Council
(MEAC) or a successor organization; or
(B) the educational equivalent of a Midwifery Education
Accreditation Council curriculum approved by the board.
(4) Acquire and document practical experience as outlined in
the Certified Professional Midwife credentialing process in
accordance with the standards of the North American
Registry of Midwives or a successor organization.
(5) Obtain certification by an accredited association in adult
cardiopulmonary resuscitation that is approved by the board.
(6) Complete the program sponsored by the American
Academy of Pediatrics in neonatal resuscitation, excluding
endotracheal intubation and the administration of drugs.
(7) Comply with the birth requirements of the Certified
Professional Midwife credentialing process, observe an
additional twenty (20) births, be directly supervised by a
physician for twenty (20) births, assist with an additional
twenty (20) births, and act as the primary attendant for an
additional twenty (20) births.
(8) Provide proof to the board that the applicant has obtained
the Certified Professional Midwife credential as administered
by the North American Registry of Midwives or a successor
organization.
(9) Present additional documentation or certifications
required by the board. The board may adopt standards that
require more training than required by the North American
Registry of Midwives.
(10) Maintain sufficient liability insurance.
(d) The board may exempt an applicant from the following:
(1) The education requirements in subsection (c)(2) if the
applicant provides proof to the board that the applicant is
enrolled in a program that will satisfy the requirements of
subsection (c)(2). An exemption under this subdivision applies
for an individual for not more than two (2) years. This
subdivision expires June 30, 2016.
(2) The education requirements in subsection (c)(3) if the
applicant provides:
(A) proof to the board that the applicant has delivered over
one hundred (100) births as a primary attendant; and
(B) a letter of reference from a licensed physician with
whom the applicant has informally collaborated.
This subdivision expires June 30, 2014.
(3) The requirement that a physician directly supervise
twenty (20) births in subsection (c)(7) if the applicant
provides:
(A) proof to the board that the applicant has delivered over
one hundred (100) births as a primary attendant; and
(B) a letter of reference from a licensed physician with
whom the applicant has informally collaborated.
This subdivision expires June 30, 2014.
Sec. 2. The board shall, after receiving recommendations from
the committee, do the following:
(1) Determine the education that satisfies the requirements in
section 1 of this chapter.
(2) Establish formal education requirements in addition to
those required in section 1 of this chapter. The requirements
must include course material on:
(A) emergency life support procedures;
(B) identification of high risk births for mothers;
(C) identification of potential complications during labor;
and
(D) other material the board specifies.
Sec. 3. The board shall issue a certificate to practice certified
direct entry midwifery to an applicant who satisfies the
requirements of sections 1 and 2 of this chapter.
Sec. 4. (a) A certificate issued under this chapter expires after
two (2) years, on a date established by the licensing agency. Failure
to renew a certificate on or before the expiration date makes the
certificate invalid without any action by the board.
(b) To be eligible for the renewal of a certificate issued under
this chapter, an individual must:
(1) meet continuing education requirements set by the board;
(2) maintain a Certified Professional Midwife credential; and
(3) maintain sufficient liability insurance.
Sec. 5. After July 1, 2014, only an individual who is issued a
certificate under this article may use the title "certified direct
entry midwife".
Sec. 6. The board may issue a certificate to an individual who is
licensed or certified as a midwife in another state if:
(1) the board determines that the midwife has fulfilled
requirements that are at least equal to the certification
requirements of this article;
(2) the midwife holds a license or certificate in good standing
from another state and the midwife has practiced for at least
three (3) out of the past five (5) years under the license or
certificate;
(3) the midwife discloses to the board any judgment or
settlement of malpractice and the board makes a
determination that the judgment or settlement does not affect
the midwife's ability to practice as a midwife; and
(4) the midwife does not have a conviction in the previous five
(5) years that has a direct bearing on the midwife's ability to
practice competently.
Sec. 7. (a) This section does not apply to an individual who has
a license under IC 25-23-1-13.1 to practice midwifery as a certified
nurse midwife.
(b) After July 1, 2014, an individual who knowingly or
intentionally practices midwifery without a certificate required
under this article commits a Class D felony.
Chapter 4. Informed Consent for the Practice of Certified
Direct Entry Midwifery
Sec. 1. (a) All the following must occur before a certified direct
entry midwife may accept a client for midwifery care:
(1) The certified direct entry midwife must provide the
potential client with an informed disclosure of practice form.
(2) The potential client must sign and date the form.
(3) The certified direct entry 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 direct entry midwife must have an
emergency plan for the care of the client if an emergency
arises. As part of the emergency plan, the client must sign a
release of the client's medical records that allows the certified
direct entry midwife to provide the client's medical records to
a physician if an emergency arises.
(6) Subject to rules adopted under IC 25-23.4-2-6(b)(5), the
certified direct entry midwife must have a collaborative
agreement with a physician to provide for consultation and
care for the client. The physician shall examine the client at
least one (1) time during the client's first trimester and one (1)
time during the client's third trimester. The collaborating
physician should be located in an area close to where the
delivery will occur.
(7) The certified direct entry midwife must provide the client
with a list of options for additional screening and assessments,
including visits to a physician.
(8) The certified direct entry midwife must maintain medical
records on the client through the entire course of care and
transfer the medical records to a treating physician if an
emergency arises. The medical records must contain all the
forms that are required under this subsection.
(b) A certified direct entry midwife may not have a minor as a
client unless the minor's parent or guardian has agreed in writing
to use the certified direct entry midwife and all other requirements
of this article have been met.
Sec. 2. (a) A certified direct entry 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.
(b) If the potential client refuses a procedure or treatment
required by law, the client must so indicate on a separate
procedure or treatment form, which must be maintained in the
client's medical records.
Sec. 3. The informed disclosure of practice form must be in
writing and must contain the following information:
(1) A description of the certified direct entry midwife's
education and training in midwifery, including completion of
continuing education courses and participation in the peer
review process.
(2) The certified direct entry midwife's experience level in the
field of midwifery.
(3) The certified direct entry midwife's philosophy of practice.
(4) Antepartum, intrapartum, and postpartum period
conditions requiring consultation, transfer of care, and
transport to a hospital.
(5) The emergency medical backup plan, including the
emergency plan and the collaborative 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
direct entry midwife and that a physician is required to
examine the client at least one (1) time during the client's first
trimester and one (1) time during the client's third trimester.
(7) The certified direct entry midwife's current status of
certification under this article.
(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
direct entry midwife.
(11) A statement that if the client is advised by the certified
direct entry midwife or a collaborating physician that the
client is or has become at risk (as described in IC 25-23.4-6),
the certified direct entry midwife:
(A) shall refer the client to a physician for consultation;
(B) may refuse to provide or continue care; and
(C) may transfer care of the client to a physician.
(12) A statement disclosing whether or not the certified direct
entry midwife maintains liability insurance.
(13) That state certification of a certified direct entry midwife
does not ensure that a home setting for delivery of a child is
safe.
(14) A statement that the client understands that the client is
waiving the right to sue a physician or health care provider
for the acts or omissions of the client's certified direct entry
midwife.
Sec. 4. (a) Before March 31 every year, a certified direct entry
midwife shall provide an annual report to the board regarding
each birth the previous year that the certified direct entry midwife
assisted. 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 direct entry midwife may not reveal the identity
of the clients referred to in a report under subsection (a).
(c) The board shall compile the data from the reports collected
under subsection (a) and submit the data to the state department
of health.
Sec. 5. (a) Except as provided in subsection (b), a certified direct
entry midwife may not dispense or administer prescription drugs.
(b) A certified direct entry midwife may carry and administer
the following medications under a protocol issued and agreed to by
a physician licensed under IC 25-22.5:
(1) Postpartum antihemorrhagic drugs in emergency
situations.
(2) Local anesthetics by infiltration or topical application,
only for postpartum repair of lacerations, tears, and
episiotomy.
(3) Oxygen.
(4) Prophylactic antibiotics for Group B Strep (also known as
Beta Strep).
(c) A certified direct entry midwife may not administer a drug
intravenously and may, with a physician's order, administer the
following:
(1) Vitamin K, either orally or through intramuscular
injection.
(2) Rhogam.
(3) Prophylactic ophthalmic antibiotics.
The board may adopt rules under IC 4-22-2 specifying the
circumstances under which a certified direct entry midwife may
administer the substances listed in this subsection.
Sec. 6. After a client has given birth, the certified direct entry
midwife shall:
(1) provide the client with a statement indicating that the
newborn infant should be examined by a pediatrician or
family practice physician for checkups beginning within two
(2) weeks after birth; and
(2) identify with the client a pediatrician or family practice
physician for the care of the infant.
Chapter 5. Physician Collaboration with Certified Direct Entry
Midwives
Sec. 1. (a) A certified direct entry midwife must have a
collaborating agreement with a physician licensed under
IC 25-22.5. Collaboration under this chapter does not require the
physical presence of the physician at the time and the place at
which the certified direct entry midwife renders services.
(b) Subject to rules adopted under IC 25-23.4-2-6(b)(6), a
collaborating physician shall review the patient encounters that the
certified direct entry midwife has with a patient who is the client
of the certified direct entry midwife:
(1) at any time when requested by the physician; and
(2) at the time of the client's visit with the physician during
the first and third trimesters, at least the following
percentages of the patient charts:
(A) For the first year that the individual is a certified
direct entry midwife, one hundred percent (100%).
(B) For the second year that the individual is a certified
direct entry midwife, fifty percent (50%).
(C) For the third year that the individual is a certified
direct entry midwife, twenty-five percent (25%).
Sec. 2. A physician collaborating with a certified direct entry
midwife under this chapter shall do the following:
(1) Register with the board the physician's intent to
collaborate with a certified direct entry midwife. The
registration must include the following:
(A) The name, the business address, and the telephone
number of the collaborating physician.
(B) The name, the business address, and the telephone
number of the certified direct entry midwife.
(C) Any other information required by the board.
The registration must be updated annually.
(2) File the written collaborative agreement, which is signed
by the certified direct entry midwife and the collaborating
physician, with the board.
(3) Submit a statement to the board that the physician will
collaborate with the certified direct entry midwife in
accordance with the rules adopted by the board.
Sec. 3. The collaborating physician may not have a disciplinary
action restriction that limits the physician's ability to collaborate
with a certified direct entry midwife.
Sec. 4. A certified direct entry midwife shall notify the board of
any changes or additions to the collaborating physicians not more
than thirty (30) days after the change or addition.
Sec. 5. The requirements for collaboration between a certified
direct entry midwife and a collaborating physician under this
chapter are subject to rules adopted under IC 25-23.4-2-6(b)(1).
Chapter 6. Management of At-Risk Clients
Sec. 1. (a) Subject to rules adopted under IC 25-23.4-2-6(b)(6),
a certified direct entry midwife must provide an initial screening
of a client that includes an assessment of health conditions that
require a referral to a physician under subsection (c).
(b) Subject to rules adopted under IC 25-23.4-2-6(b)(8), a
certified direct entry midwife shall refer a client to a physician in
the client's first and third trimester of pregnancy.
(c) If a client has a health condition that makes the client at risk,
the certified direct entry midwife shall, subject to rules adopted
under IC 28-23.4-2-6(b)(9):
(1) refer the client to a licensed physician; and
(2) consult with the physician concerning the client's care.
Sec. 2. (a) If the certified direct entry midwife, physician, and
client agree that the certified direct entry midwife may continue to
provide services to the at-risk client, the certified direct entry
midwife shall enter into a written collaborative plan of treatment
with the collaborating physician.
(b) The collaborative plan of treatment under subsection (a)
must be in writing and include the following provisions:
(1) The circumstances that would require consultation or
referral with a physician.
(2) The circumstances that would require transfer of
responsibility for the primary care of the at-risk client.
(3) The services to be provided by the certified direct entry
midwife and the licensed physician.
Chapter 7. Hospital Services
Sec. 1. This article may not be construed to require a hospital to
extend clinical privileges to a certified direct entry midwife.
Chapter 8. Liability
Sec. 1. A hospital licensed under IC 16-21 may not be held
jointly or severally liable for the acts or omissions of a certified
direct entry midwife.
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, psychiatric hospital,
hospital, health facility, emergency ambulance service (IC
16-18-2-107), dentist, registered or licensed practical nurse,
physician assistant, certified nurse midwife, optometrist,
podiatrist, chiropractor, physical therapist, respiratory care
practitioner, occupational therapist, psychologist, paramedic,
advanced emergency medical technician, or 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.
established by IC 2-5-23-3.
(b) The commission shall study during the 2013 interim the
following issues:
(1) Facilitating the availability of liability insurance for
certified direct entry midwives who are certified under
IC 25-23.4, as added by this act.
(2) Whether the requirement that a collaborative agreement
filed with the medical licensing board affects a physician's
willingness to enter into a collaborative agreement with a
certified direct entry midwife.
(c) The Indiana Perinatal Quality Improvement Collaborative,
with the Indiana State Medical Association, shall make
recommendations to the commission not later September 15, 2013,
concerning home birth deliveries.
(d) This SECTION expires December 31, 2013.
S
igned by:
____________________________ ____________________________
Representative Lehe Senator Miller Patricia
Chairperson
____________________________ ____________________________
Representative Brown C Senator Breaux
House Conferees Senate Conferees