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H.B. 25





Sponsor: Jackie Biskupski

             6      LONG TITLE
             7      General Description:
             8          This bill modifies the Occupations and Professions Code by enacting the Direct-entry
             9      Midwife Act and makes related changes to the Health Care Providers Immunity from
             10      Liability Act.
             11      Highlighted Provisions:
             12          This bill:
             13          .    provides for licensing of Direct-entry midwives by the Division of Occupational and
             14      Professional Licensing;
             15          .    provides for definitions relating to the practice of Direct-entry midwifery;
             16          .    creates the Licensed Direct-entry Midwife Board and sets forth its membership and
             17      duties;
             18          .    requires the division to establish a Licensed Direct-entry Midwife Formulary
             19      Committee and a licensed Direct-entry midwife formulary to define which
             20      prescription drugs can be obtained and administered by licensed Direct-entry
             21      midwives and to provide guidelines for their use;
             22          .    provides for disciplinary action, including administrative penalties, against licensed
             23      Direct-entry midwives;
             24          .    defines and provides penalties for unlawful and unprofessional conduct;
             25          .    sets standards for consultation with, collaboration with, referral to, and transfer to
             26      other health care providers and sets standards for liability under those
             27      circumstances; and

             28          .    brings licensed Direct-entry midwives within the scope of the Health Care Providers
             29      Immunity From Liability Act.
             30      Monies Appropriated in this Bill:
             31          None
             32      Other Special Clauses:
             33          None
             34      Utah Code Sections Affected:
             35      AMENDS:
             36          58-13-2, as last amended by Chapter 3, Laws of Utah 2003
             37          58-13-3, as last amended by Chapter 207, Laws of Utah 2003
             38          78-14-3, as last amended by Chapter 280, Laws of Utah 2004
             39      ENACTS:
             40          58-77-101, Utah Code Annotated 1953
             41          58-77-102, Utah Code Annotated 1953
             42          58-77-201, Utah Code Annotated 1953
             43          58-77-202, Utah Code Annotated 1953
             44          58-77-203, Utah Code Annotated 1953
             45          58-77-301, Utah Code Annotated 1953
             46          58-77-302, Utah Code Annotated 1953
             47          58-77-303, Utah Code Annotated 1953
             48          58-77-304, Utah Code Annotated 1953
             49          58-77-401, Utah Code Annotated 1953
             50          58-77-501, Utah Code Annotated 1953
             51          58-77-502, Utah Code Annotated 1953
             52          58-77-503, Utah Code Annotated 1953
             53          58-77-601, Utah Code Annotated 1953
             54          58-77-602, Utah Code Annotated 1953
             55          58-77-603, Utah Code Annotated 1953
             57      Be it enacted by the Legislature of the state of Utah:
             58          Section 1. Section 58-13-2 is amended to read:

             59           58-13-2. Emergency care rendered by licensee.
             60          (1) A person licensed under Title 58, Occupations and Professions, to practice as any
             61      of the following health care professionals, who is under no legal duty to respond, and who in
             62      good faith renders emergency care at the scene of an emergency gratuitously and in good faith,
             63      is not liable for any civil damages as a result of any acts or omissions by the person in
             64      rendering the emergency care:
             65          (a) osteopathic physician;
             66          (b) physician and surgeon;
             67          (c) naturopathic physician;
             68          (d) dentist or dental hygienist;
             69          (e) chiropractic physician;
             70          (f) physician assistant;
             71          (g) optometrist;
             72          (h) nurse licensed under Section 58-31b-301 or 58-31c-102 ;
             73          (i) podiatrist;
             74          (j) certified nurse midwife;
             75          (k) respiratory therapist; [or]
             76          (l) pharmacist, pharmacy technician, and pharmacy intern[.]; or
             77          (m) Direct-entry midwife licensed under Section 58-77-301 .
             78          (2) (a) This Subsection (2) applies to health care professionals:
             79          (i) described in Subsection (1);
             80          (ii) who are under no legal duty to respond to the circumstances described in
             81      Subsection (2)(b);
             82          (iii) who are acting within the scope of the health care professional's license, or within
             83      the scope of practice as modified under Subsection 58-1-307 (4); and
             84          (iv) who are acting in good faith without compensation or remuneration as defined in
             85      Subsection 58-13-3 (2).
             86          (b) A health care professional described in Subsection (2)(a) is not liable for any civil
             87      damages as a result of any acts or omissions by the health care professional in rendering care as
             88      a result of:
             89          (i) implementation of measures to control the causes of epidemic and communicable

             90      diseases and other conditions significantly affecting the public health or necessary to protect
             91      the public health as set out in Title 26A, Chapter 1, Local Health Departments;
             92          (ii) investigating and controlling suspected bioterrorism and disease as set out in Title
             93      26, Chapter 23b, Detection of Public Health Emergencies Act; and
             94          (iii) responding to a national, state, or local emergency, a public health emergency as
             95      defined in Section 26-23b-102 , or a declaration by the President of the United States or other
             96      federal official requesting public health-related activities.
             97          (3) The immunity in Subsection (2) is in addition to any immunity or protection in state
             98      or federal law that may apply.
             99          Section 2. Section 58-13-3 is amended to read:
             100           58-13-3. Qualified immunity -- Health professionals -- Charity care.
             101          (1) (a) (i) The Legislature finds many residents of this state do not receive medical care
             102      and preventive health care because they lack health insurance or because of financial
             103      difficulties or cost.
             104          (ii) The Legislature also finds that many physicians, charity health care facilities, and
             105      other health care professionals in this state would be willing to volunteer medical and allied
             106      services without compensation if they were not subject to the high exposure of liability
             107      connected with providing these services.
             108          (b) The Legislature therefore declares that its intention in enacting this section is to
             109      encourage the provision of uncompensated volunteer charity health care in exchange for a
             110      limitation on liability for the health care facilities and health care professionals who provide
             111      those volunteer services.
             112          (2) As used in this section:
             113          (a) "Health care facility" means any clinic or hospital, church, or organization whose
             114      primary purpose is to sponsor, promote, or organize uncompensated health care services for
             115      people unable to pay for health care services.
             116          (b) "Health care professional" means individuals licensed under Title 58, Occupations
             117      and Professions, as physicians and surgeons, osteopaths, podiatrists, optometrists,
             118      chiropractors, dentists, dental hygienists, registered nurses, certified nurse midwives, [and]
             119      other nurses licensed under Section 58-31b-301 [.], and licensed Direct-entry midwives.
             120          (c) "Remuneration or compensation":

             121          (i) (A) means direct or indirect receipt of any payment by the physician and surgeon,
             122      health care facility, other health care professional, or organization, on behalf of the patient,
             123      including payment or reimbursement under medicare or medicaid, or under the state program
             124      for the medically indigent on behalf of the patient; and
             125          (B) compensation, salary, or reimbursement to the health care professional from any
             126      source for the health care professional's services or time in volunteering to provide
             127      uncompensated health care; and
             128          (ii) does not mean any grant or donation to the health care facility used to offset direct
             129      costs associated with providing the uncompensated health care such as medical supplies or
             130      drugs.
             131          (3) A health care professional who provides health care treatment at or on behalf of a
             132      health care facility is not liable in a medical malpractice action if:
             133          (a) the treatment was within the scope of the health care professional's license under
             134      this title;
             135          (b) neither the health care professional nor the health care facility received
             136      compensation or remuneration for the treatment;
             137          (c) the acts or omissions of the health care professional were not grossly negligent or
             138      willful and wanton; and
             139          (d) prior to rendering services, the health care professional disclosed in writing to the
             140      patient, or if a minor, to the patient's parent or legal guardian, that the health care professional
             141      is providing the services without receiving remuneration or compensation and that in exchange
             142      for receiving uncompensated health care, the patient consents to waive any right to sue for
             143      professional negligence except for acts or omissions which are grossly negligent or are willful
             144      and wanton.
             145          (4) A health care facility which sponsors, promotes, or organizes the uncompensated
             146      care is not liable in a medical malpractice action for acts and omissions if:
             147          (a) the health care facility meets the requirements in Subsection (3)(b);
             148          (b) the acts and omissions of the health care facility were not grossly negligent or
             149      willful and wanton; and
             150          (c) the health care facility has posted, in a conspicuous place, a notice that in
             151      accordance with this section the health care facility is not liable for any civil damages for acts

             152      or omissions except for those acts or omissions that are grossly negligent or are willful and
             153      wanton.
             154          (5) Immunity from liability under this section does not extend to the use of general
             155      anesthesia or care that requires an overnight stay in a general acute or specialty hospital
             156      licensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act.
             157          Section 3. Section 58-77-101 is enacted to read:

Part 1. General Provisions

             160          58-77-101. Title.
             161          This chapter is known as the "Direct-entry Midwife Act."
             162          Section 4. Section 58-77-102 is enacted to read:
             163          58-77-102. Definitions.
             164          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             165          (1) "Board" means the Licensed Direct-entry Midwife Board created in Section
             166      58-77-201 .
             167          (2) "Certified nurse-midwife" means a person licensed under Title 58, Chapter 44a,
             168      Nurse Midwife Practice Act.
             169          (3) "Client" means a woman under the care of a Direct-entry midwife and her fetus or
             170      newborn.
             171          (4) "Direct-entry Midwife" means an individual who is engaging in the practice of
             172      Direct-entry midwifery.
             173          (5) "Licensed Direct-entry midwife" means a person licensed under this chapter.
             174          (6) "Physician" means an individual licensed as a physician and surgeon, osteopathic
             175      physician, or naturopathic physician.
             176          (7) "Practice of Direct-entry midwifery" means practice that is in accordance with
             177      national professional midwifery standards and that is based upon the acquisition of clinical
             178      skills necessary for the care of pregnant women and newborns, including antepartum,
             179      intrapartum, postpartum, newborn, and limited interconceptual care and includes:
             180          (a) obtaining an informed consent to provide services;
             181          (b) obtaining a health history, including a physical examination;
             182          (c) developing a plan of care for a client;

             183          (d) evaluating the results of client care;
             184          (e) consulting and collaborating with and referring and transferring care to licensed
             185      health care professionals, as is appropriate, regarding the care of a client;
             186          (f) obtaining medications, as specified in this Subsection (7)(f) or by rule, to administer
             187      to clients, including:
             188          (i) prescription vitamins;
             189          (ii) Rho D immunolglobulin;
             190          (iii) CDC- or ACOG-recommended agents for Group B strep prophylaxis;
             191          (iv) sterile water;
             192          (v) IV fluids, excluding blood products;
             193          (vi) anti-hemorrhagic medications;
             194          (vii) oxygen;
             195          (viii) local anesthetics;
             196          (ix) vitamin K to prevent hemorrhagic disease of the newborn;
             197          (x) eye prophylaxis to prevent opthalmia neonatorum as required by law; and
             198          (xi) other medications that are not controlled substances as defined in Section 58-37-2
             199      and which are approved by the division in collaboration with the Licensed Direct-entry
             200      Midwife Formulary Committee;
             201          (g) obtaining food, food extracts, dietary supplements, as defined by the Federal Food,
             202      Drug, and Cosmetic Act, homeopathic remedies, plant substances that are not designated as
             203      prescription drugs or controlled substances, and over-the-counter medications to administer to
             204      clients;
             205          (h) obtaining and using appropriate equipment and devices such as Doppler, blood
             206      pressure cuff, phlebotomy supplies, instruments, and sutures;
             207          (i) obtaining appropriate screening and testing, including laboratory tests, urinalysis,
             208      and ultrasound;
             209          (j) managing the antepartum period;
             210          (k) managing the intrapartum period including:
             211          (i) monitoring and evaluating the condition of mother and fetus;
             212          (ii) performing emergency episiotomy; and
             213          (iii) delivering in any out-of-hospital setting;

             214          (l) managing the postpartum period including:
             215          (i) suturing of episiotomy or first and second degree natural perineal and labial
             216      lacerations, including the administration of a local anesthetic; and
             217          (ii) managing hemorrhage, including the administration of anti-hemorrhagic
             218      medications or IV fluids;
             219          (m) managing the newborn period including:
             220          (i) providing care for the newborn, including performing a normal newborn
             221      examination; and
             222          (ii) resuscitating a newborn;
             223          (n) providing limited interconceptual services in order to provide continuity of care
             224      including:
             225          (i) breastfeeding support and counseling;
             226          (ii) family planning, limited to natural family planning, cervical caps, and diaphragms;
             227      and
             228          (iii) pap smears, where all clients with abnormal results are to be referred to an
             229      appropriate licensed health care provider; and
             230          (o) executing the orders of a licensed health care professional, only within the
             231      education, knowledge, and skill of the Direct-entry midwife.
             232          (8) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-77-501 .
             233          (9) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-77-502 and as
             234      may be further defined by rule.
             235          Section 5. Section 58-77-201 is enacted to read:
Part 2. Board

             237          58-77-201. Board.
             238          (1) There is created the Licensed Direct-entry Midwife Board consisting of four
             239      licensed Direct-entry midwives and one member of the general public.
             240          (2) The board shall be appointed and serve in accordance with Section 58-1-201 .
             241          (3) (a) The duties and responsibilities of the board shall be in accordance with Sections
             242      58-1-202 and 58-1-203 .
             243          (b) The board shall designate one of its members on a permanent or rotating basis to:
             244          (i) assist the division in reviewing complaints concerning the unlawful or

             245      unprofessional conduct of a licensed Direct-entry midwife; and
             246          (ii) advise the division in its investigation of these complaints.
             247          (4) A board member who has, under Subsection (3), reviewed a complaint or advised
             248      in its investigation may be disqualified from participating with the board when the board serves
             249      as a presiding officer in an adjudicative proceeding concerning the complaint.
             250          (5) Qualified faculty, board members, and other staff of Direct-entry midwifery
             251      learning institutions may serve as one or more of the licensed Directed-entry midwives on the
             252      board.
             253          Section 6. Section 58-77-202 is enacted to read:
             254          58-77-202. Licensed Direct-entry Midwife Formulary Committee -- Adoption of
             255      licensed Direct-entry midwife formulary.
             256          (1) The division shall establish a Licensed Direct-entry Midwife Formulary Committee
             257      under Subsection 58-1-203 (1)(f) to make recommendations to the board and the division
             258      regarding which additional prescription drugs are appropriate for the scope of practice of
             259      licensed Direct-entry midwives and guidelines for their use.
             260          (2) The committee shall consist of five members as follows:
             261          (a) two licensed Direct-entry midwives;
             262          (b) one licensed physician who has professional experience consulting for and
             263      collaborating with Direct-entry midwives;
             264          (c) one certified nurse midwife who has professional experience consulting for and
             265      collaborating with Direct-entry midwives; and
             266          (d) one licensed pharmacist.
             267          (3) The committee members shall:
             268          (a) be appointed by the director of the division; and
             269          (b) serve without compensation, travel costs, or per diem for their services.
             270          (4) In accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act, the
             271      division shall adopt by rule a licensed Direct-entry midwife formulary which includes:
             272          (a) those additional prescription drugs which may be obtained and administered by
             273      licensed Direct-entry midwives as defined in Subsection 58-77-102 (7)(f)(xi); and
             274          (b) standards, conditions, and guidelines for use of the prescription drugs included in
             275      the formulary.

             276          Section 7. Section 58-77-203 is enacted to read:
             277          58-77-203. Licensed Direct-entry Midwife Temporary Rules Committee -- Rules
             278      recommendations.
             279          (1) The division shall establish a Licensed Direct-entry Midwife Temporary Rules
             280      Committee under this section to make recommendations to the board and division regarding
             281      the condition types listed in Subsection 58-77-601 (2).
             282          (2) The committee shall consist of the following six members appointed by the director
             283      of the division:
             284          (a) three Direct-entry midwives;
             285          (b) one licensed physician who has professional experience consulting for and
             286      collaborating with Direct-entry midwives;
             287          (c) one certified nurse midwife who has professional experience consulting for and
             288      collaborating with Direct-entry midwives; and
             289          (d) a licensed physician or certified nurse midwife who has practiced obstetrics or
             290      midwifery in an out-of-hospital setting.
             291          (3) The director of the division shall appoint one of the three Direct-entry midwives to
             292      serve as committee chair.
             293          (4) Committee members shall serve without compensation and may not receive travel
             294      costs or per diem for their services on the committee.
             295          (5) Qualified committee members may also serve on the Licensed Direct-entry
             296      Midwife Formulary Committee and the Licensed Direct-entry Midwife Board established
             297      under this chapter.
             298          (6) The director shall make appointments to the committee by July 1, 2005, and the
             299      committee shall cease to function after March 31, 2006.
             300          (7) (a) The committee shall recommend rules under Subsection (1) based on
             301      convincing evidence presented to the committee.
             302          (b) At least four members must vote in the affirmative on any recommendation made
             303      by the committee to the board or the division.
             304          (c) If the committee is unable to complete its recommendations by March 31, 2006, it
             305      shall develop a recommended plan of action which, along with its work product and
             306      responsibilities, shall be transferred to the board on April 1, 2006.

             307          Section 8. Section 58-77-301 is enacted to read:
Part 3. Licensure

             309          58-77-301. Licensure.
             310          The division shall issue to a person who qualifies under this chapter a license as a
             311      licensed Direct-entry midwife.
             312          Section 9. Section 58-77-302 is enacted to read:
             313          58-77-302. Qualifications for licensure.
             314          Each applicant for licensure as a licensed Direct-entry midwife shall:
             315          (1) submit an application in a form prescribed by the division;
             316          (2) pay a fee as determined by the department under Section 63-38-3.2 ;
             317          (3) be of good moral character;
             318          (4) hold a Certified Professional Midwife certificate in good standing with the North
             319      American Registry of Midwives or equivalent certification approved by the division in
             320      collaboration with the board;
             321          (5) hold current adult and infant CPR and newborn resuscitation certifications through
             322      an organization approved by the division in collaboration with the board; and
             323          (6) provide documentation of successful completion of an approved pharmacology
             324      course as defined by division rule.
             325          Section 10. Section 58-77-303 is enacted to read:
             326          58-77-303. Term of license -- Expiration -- Renewal.
             327          (1) (a) The division shall issue each license under this chapter in accordance with a
             328      two-year renewal cycle established by rule.
             329          (b) The division may by rule extend or shorten a renewal period by as much as one year
             330      to stagger the renewal cycles it administers.
             331          (2) Each license automatically expires on the expiration date shown on the license
             332      unless the individual renews it in accordance with Section 58-1-308 .
             333          (3) At the time of renewal, the licensed Direct-entry midwife shall be in current
             334      compliance with the requirements of Section 58-77-302 .
             335          Section 11. Section 58-77-304 is enacted to read:
             336          58-77-304. Parents' rights.
             337          Nothing in this chapter abridges, limits, or changes in any way the right of parents to

             338      deliver their baby where, when, how, and with whom they choose, regardless of licensure
             339      under this chapter.
             340          Section 12. Section 58-77-401 is enacted to read:
Part 4. Licensure Denial and Discipline

             342          58-77-401. Grounds for denial of license -- Disciplinary proceedings.
             343          Grounds for refusing to issue a license to an applicant, for refusing to renew a license,
             344      for revoking, suspending, restricting, or placing on probation a license, for issuing a public or
             345      private reprimand, and for issuing a cease and desist order shall be in accordance with Section
             346      58-1-401 .
             347          Section 13. Section 58-77-501 is enacted to read:
Part 5. Unlawful and Unprofessional Conduct -- Penalties

             349          58-77-501. Unlawful conduct.
             350          (1) In addition to the definition in Subsection 58-1-501 (1), "unlawful conduct"
             351      includes:
             352          (a) representing or holding oneself out as a licensed Direct-entry midwife when not
             353      licensed under this chapter; and
             354          (b) using prescription medications, except oxygen, while engaged in the practice of
             355      Direct-entry midwifery when not licensed under this chapter.
             356          (2) (a) Except as provided in Subsections (1)(a) and (b), it is lawful to practice
             357      Direct-entry midwifery in the state without being licensed under this chapter.
             358          (b) The practice of Direct-entry midwifery is not considered the practice of medicine,
             359      nursing, or nurse-midwifery.
             360          Section 14. Section 58-77-502 is enacted to read:
             361          58-77-502. Unprofessional conduct.
             362          In addition to the definition in Subsection 58-1-501 (2), "unprofessional conduct"
             363      includes:
             364          (1) failing to obtain informed consent as described in Subsection 58-77-601 (1);
             365          (2) disregarding a client's dignity or right to privacy as to her person, condition,
             366      possessions, or medical record;
             367          (3) failing to file or record any medical report as required by law, impeding, or
             368      obstructing the filing or recording of the report, or inducing another to fail to file or record the

             369      report;
             370          (4) breaching a statutory, common law, regulatory, or ethical requirement of
             371      confidentiality with respect to a person who is a client, unless ordered by the court;
             372          (5) inappropriately delegating Direct-entry midwifery duties;
             373          (6) using advertising or an identification statement that is false, misleading, or
             374      deceptive;
             375          (7) using in combination with the term "midwife" the term "nurse" or another title,
             376      initial, or designation that falsely implies that the Direct-entry midwife is licensed as a certified
             377      nurse midwife, registered nurse, or licensed practical nurse; and
             378          (8) submitting a birth certificate known by the person to be false or fraudulent.
             379          Section 15. Section 58-77-503 is enacted to read:
             380          58-77-503. Penalty for unlawful conduct.
             381          A person who violates the unlawful conduct provisions defined in this chapter is guilty
             382      of a class A misdemeanor.
             383          Section 16. Section 58-77-601 is enacted to read:
Part 6. Standards of Practice

             385          58-77-601. Standards of practice.
             386          (1) (a) Prior to providing any services, a licensed Direct-entry midwife must obtain an
             387      informed consent from a client.
             388          (b) The consent must include:
             389          (i) the name and license number of the Direct-entry midwife;
             390          (ii) the client's name, address, telephone number, and primary care provider, if the
             391      client has one;
             392          (iii) the fact, if true, that the licensed Direct-entry midwife is not a certified nurse
             393      midwife or a physician;
             394          (iv) all sections required by the North American Registry of Midwives in its informed
             395      consent guidelines, including:
             396          (A) a description of the licensed Direct-entry midwife's education, training, continuing
             397      education, and experience in midwifery;
             398          (B) a description of the licensed Direct-entry midwife's peer review process;
             399          (C) the licensed Direct-entry midwife's philosophy of practice;

             400          (D) a promise to provide the client, upon request, separate documents describing the
             401      rules governing licensed Direct-entry midwifery practice, including a list of conditions
             402      indicating the need for consultation, collaboration, referral, transfer or emergency transfer, and
             403      the licensed Direct-entry midwife's personal written practice guidelines;
             404          (E) a medical back-up or transfer plan;
             405          (F) a description of the services provided to the client by the licensed Direct-entry
             406      midwife;
             407          (G) the licensed Direct-entry midwife's current legal status;
             408          (H) the availability of a grievance process; and
             409          (I) client and licensed Direct-entry midwife signatures and the date of signing; and
             410          (v) whether the licensed Direct-entry midwife is covered by a professional liability
             411      insurance policy.
             412          (2) A licensed Direct-entry midwife shall appropriately recommend and facilitate
             413      consultation with, collaboration with, referral to, or transfer or emergency transfer of care to a
             414      licensed health care professional when the circumstances require that action in accordance with
             415      standards established by division rule.
             416          (3) If after a client has been informed that she has or may have a condition indicating
             417      the need for medical consultation, collaboration, referral, or transfer and the client chooses to
             418      decline, then the licensed Direct-entry midwife shall:
             419          (a) terminate care in accordance with procedures established by division rule; or
             420          (b) continue to provide care for the client if the client signs a waiver of medical
             421      consultation, collaboration, referral, or transfer.
             422          (4) If after a client has been informed that she has or may have a condition indicating
             423      the need for emergency transfer, the licensed Direct-entry midwife shall initiate transfer by:
             424          (a) calling 911 and reporting the need for immediate transfer;
             425          (b) immediately transporting the client by private vehicle to the receiving provider; or
             426          (c) contacting the physician to whom the client will be transferred and following that
             427      physician's orders.
             428          (5) This chapter does not mandate health insurance coverage for midwifery services.
             429          Section 17. Section 58-77-602 is enacted to read:
             430          58-77-602. Immunity and liability.

             431          (1) If a Direct-entry midwife seeks to consult with, refer, or transfer a client to a
             432      licensed health care provider or facility, the responsibility of the provider or facility for the
             433      client does not begin until the client is physically within the care of the provider or facility.
             434          (2) A licensed health care provider who examines a Direct-entry midwife's client is
             435      only liable for the actual examination and cannot be held accountable for the client's decision to
             436      pursue an out-of-hospital birth or the services of a Direct-entry midwife.
             437          (3) (a) A licensed health care provider may, upon receiving a briefing data from a
             438      Direct-entry midwife, issue a medical order for the Direct-entry midwife's client, without that
             439      client being an explicit patient of the provider.
             440          (b) Regardless of the advice given or order issued, the responsibility and liability for
             441      caring for the client is that of the Direct-entry midwife.
             442          (c) The provider giving the order is responsible and liable only for the appropriateness
             443      of the order given the data received.
             444          (d) The issuing of an order for a Direct-entry midwife's client does not constitute a
             445      delegation of duties from the other provider to the Direct-entry midwife.
             446          Section 18. Section 58-77-603 is enacted to read:
             447          58-77-603. Prohibited practices.
             448          A Direct-entry midwife may not:
             449          (1) administer a prescription drug to a client, other than those specified in Subsections
             450      58-77-102 (7) and 58-77-602 (3)(a);
             451          (2) effect any type of surgical delivery except for the cutting of an emergency
             452      episiotomy;
             453          (3) administer any type of epidural, spinal, or caudal anesthetic, or any type of narcotic
             454      analgesia; or
             455          (4) induce abortion.
             456          Section 19. Section 78-14-3 is amended to read:
             457           78-14-3. Definitions.
             458          As used in this chapter:
             459          (1) "Audiologist" means a person licensed to practice audiology under Title 58,
             460      Chapter 41, Speech-language Pathology and Audiology Licensing Act.
             461          (2) "Certified social worker" means a person licensed to practice as a certified social

             462      worker under Section 58-60-205 .
             463          (3) "Chiropractic physician" means a person licensed to practice chiropractic under
             464      Title 58, Chapter 73, Chiropractic Physician Practice Act.
             465          (4) "Clinical social worker" means a person licensed to practice as a clinical social
             466      worker under Section 58-60-205 .
             467          (5) "Commissioner" means the commissioner of insurance as provided in Section
             468      31A-2-102 .
             469          (6) "Dental hygienist" means a person licensed to practice dental hygiene as defined in
             470      Section 58-69-102 .
             471          (7) "Dentist" means a person licensed to practice dentistry as defined in Section
             472      58-69-102 .
             473          (8) "Division" means the Division of Occupational and Professional Licensing created
             474      in Section 58-1-103 .
             475          (9) "Future damages" includes damages for future medical treatment, care or custody,
             476      loss of future earnings, loss of bodily function, or future pain and suffering of the judgment
             477      creditor.
             478          (10) "Health care" means any act or treatment performed or furnished, or which should
             479      have been performed or furnished, by any health care provider for, to, or on behalf of a patient
             480      during the patient's medical care, treatment, or confinement.
             481          (11) "Health care facility" means general acute hospitals, specialty hospitals, home
             482      health agencies, hospices, nursing care facilities, assisted living facilities, birthing centers,
             483      ambulatory surgical facilities, small health care facilities, health care facilities owned or
             484      operated by health maintenance organizations, and end stage renal disease facilities.
             485          (12) "Health care provider" includes any person, partnership, association, corporation,
             486      or other facility or institution who causes to be rendered or who renders health care or
             487      professional services as a hospital, health care facility, physician, registered nurse, licensed
             488      practical nurse, nurse-midwife, licensed Direct-entry midwife, dentist, dental hygienist,
             489      optometrist, clinical laboratory technologist, pharmacist, physical therapist, podiatric
             490      physician, psychologist, chiropractic physician, naturopathic physician, osteopathic physician,
             491      osteopathic physician and surgeon, audiologist, speech-language pathologist, clinical social
             492      worker, certified social worker, social service worker, marriage and family counselor,

             493      practitioner of obstetrics, or others rendering similar care and services relating to or arising out
             494      of the health needs of persons or groups of persons and officers, employees, or agents of any of
             495      the above acting in the course and scope of their employment.
             496          (13) "Hospital" means a public or private institution licensed under Title 26, Chapter
             497      21, Health Care Facility Licensing and Inspection Act.
             498          (14) "Licensed Direct-entry midwife" means a person licensed under the Direct-entry
             499      Midwife Act to practice midwifery as defined in Section 58-77-102 .
             500          [(14)] (15) "Licensed practical nurse" means a person licensed to practice as a licensed
             501      practical nurse as provided in Section 58-31b-301 .
             502          [(15)] (16) "Malpractice action against a health care provider" means any action against
             503      a health care provider, whether in contract, tort, breach of warranty, wrongful death, or
             504      otherwise, based upon alleged personal injuries relating to or arising out of health care rendered
             505      or which should have been rendered by the health care provider.
             506          [(16)] (17) "Marriage and family therapist" means a person licensed to practice as a
             507      marriage therapist or family therapist under Sections 58-60-305 and 58-60-405 .
             508          [(17)] (18) "Naturopathic physician" means a person licensed to practice naturopathy
             509      as defined in Section 58-71-102 .
             510          [(18)] (19) "Nurse-midwife" means a person licensed to engage in practice as a nurse
             511      midwife under Section 58-44a-301 .
             512          [(19)] (20) "Optometrist" means a person licensed to practice optometry under Title 58,
             513      Chapter 16a, Utah Optometry Practice Act.
             514          [(20)] (21) "Osteopathic physician" means a person licensed to practice osteopathy
             515      under Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
             516          [(21)] (22) "Patient" means a person who is under the care of a health care provider,
             517      under a contract, express or implied.
             518          [(22)] (23) "Pharmacist" means a person licensed to practice pharmacy as provided in
             519      Section 58-17b-301 .
             520          [(23)] (24) "Physical therapist" means a person licensed to practice physical therapy
             521      under Title 58, Chapter 24a, Physical Therapist Practice Act.
             522          [(24)] (25) "Physician" means a person licensed to practice medicine and surgery under
             523      Title 58, Chapter 67, Utah Medical Practice Act.

             524          [(25)] (26) "Podiatric physician" means a person licensed to practice podiatry under
             525      Title 58, Chapter 5a, Podiatric Physician Licensing Act.
             526          [(26)] (27) "Practitioner of obstetrics" means a person licensed to practice as a
             527      physician in this state under Title 58, Chapter 67, Utah Medical Practice Act, or under Title 58,
             528      Chapter 68, Utah Osteopathic Medical Practice Act.
             529          [(27)] (28) "Psychologist" means a person licensed under Title 58, Chapter 61,
             530      Psychologist Licensing Act, to practice psychology as defined in Section 58-61-102 .
             531          [(28)] (29) "Registered nurse" means a person licensed to practice professional nursing
             532      as provided in Section 58-31b-301 .
             533          [(29)] (30) "Representative" means the spouse, parent, guardian, trustee,
             534      attorney-in-fact, or other legal agent of the patient.
             535          [(30)] (31) "Social service worker" means a person licensed to practice as a social
             536      service worker under Section 58-60-205 .
             537          [(31)] (32) "Speech-language pathologist" means a person licensed to practice
             538      speech-language pathology under Title 58, Chapter 41, Speech-language Pathology and
             539      Audiology Licensing Act.
             540          [(32)] (33) "Tort" means any legal wrong, breach of duty, or negligent or unlawful act
             541      or omission proximately causing injury or damage to another.

Legislative Review Note
    as of 12-7-04 8:41 AM

Based on a limited legal review, this legislation has not been determined to have a high
probability of being held unconstitutional.

Office of Legislative Research and General Counsel

Interim Committee Note
    as of 12-08-04 9:31 AM

The Health and Human Services Interim Committee recommended this bill.

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