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H.B. 190 Enrolled

             1     

NURSE MIDWIFE PRACTICE ACT AMENDMENTS

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Derek E. Brown

             5     
Senate Sponsor: Curtis S. Bramble

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends provisions of the Nurse Midwife Practice Act.
             10      Highlighted Provisions:
             11          This bill:
             12          .    amends provisions related to a practice plan with a consulting physician;
             13          .    amends the definition of practice as a certified nurse midwife; and
             14          .    amends the unprofessional conduct provisions.
             15      Money Appropriated in this Bill:
             16          None
             17      Other Special Clauses:
             18          None
             19      Utah Code Sections Affected:
             20      AMENDS:
             21          58-44a-102, as last amended by Laws of Utah 2008, Chapter 382
             22          58-44a-502, as enacted by Laws of Utah 1998, Chapter 288
             23     
             24      Be it enacted by the Legislature of the state of Utah:
             25          Section 1. Section 58-44a-102 is amended to read:
             26           58-44a-102. Definitions.
             27          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             28          (1) "Administrative penalty" means a monetary fine imposed by the division for acts or
             29      omissions determined to constitute unprofessional or unlawful conduct in accordance with a


             30      fine schedule established by rule and as a result of an adjudicative proceeding conducted in
             31      accordance with Title 63G, Chapter 4, Administrative Procedures Act.
             32          (2) "Board" means the Certified Nurse Midwife Board created in Section 58-44a-201 .
             33          (3) "Consultation and Referral Plan" means a written plan jointly developed by a
             34      certified nurse midwife, as defined in Subsection [(6)] (7), and a consulting physician that
             35      permits the certified nurse midwife to prescribe schedule II-III controlled substances in
             36      consultation with the consulting physician.
             37          (4) "Consulting physician" means a physician and surgeon or osteopathic physician:
             38          (a) [licensed] with an unrestricted license as a physician;
             39          (b) qualified by education, training, and current practice in obstetrics, gynecology, or
             40      both to act as a consulting physician to a nurse midwife practicing under this chapter and
             41      providing intrapartum care or prescribing Schedule II-III controlled substances; and
             42          (c) who [has agreed under a practice plan to be] is available to consult with a nurse
             43      midwife, which [plan] does not include the consulting [physician's] physician being present at
             44      the time or place the nurse midwife is engaged in practice.
             45          (5) "Individual" means a natural person.
             46          (6) "Intrapartum referral plan":
             47          (a) means a written plan prepared by a nurse midwife describing the guidelines under
             48      which the nurse midwife will consult with a consulting physician, collaborate with a consulting
             49      physician, and refer patients to a consulting physician; and
             50          (b) does not require the nurse midwife to obtain the signature of a physician on the
             51      intrapartum referral plan.
             52          [(6)] (7) "Nurse midwife" means a person licensed under this chapter to engage in
             53      practice as a certified nurse midwife.
             54          [(7)] (8) "Physician" means a physician and surgeon or osteopathic surgeon licensed
             55      under [Title 58,] Chapter 67, Utah Medical Practice Act or Chapter 68, Utah Osteopathic
             56      Medical Practice Act.
             57          [(8)] (9) "Practice as a certified nurse midwife" means:


             58          (a) practice as a registered nurse as defined in Section 58-31b-102 , and as consistent
             59      with the education, training, experience, and current competency of the licensee; [and]
             60          (b) practice of nursing within the generally recognized scope and standards of nurse
             61      midwifery as defined by rule and consistent with professionally recognized preparations and
             62      educational standards of a certified nurse midwife by a person licensed under this chapter,
             63      which practice includes [the authority to]:
             64          (i) having a safe mechanism for obtaining medical consultation, collaboration, and
             65      referral with one or more consulting physicians who have agreed to consult, collaborate, and
             66      receive referrals, but who are not required to sign a written document regarding the agreement;
             67          (ii) providing a patient with information regarding other health care providers and
             68      health care services and referral to other health care providers and health care services when
             69      requested or when care is not within the scope of practice of a certified nurse midwife; and
             70          (iii) maintaining written documentation of the parameters of service for independent
             71      and collaborative midwifery management and transfer of care when needed; and
             72          (c) the authority to:
             73          (i) elicit and record a patient's complete health information, including physical
             74      examination, history, and laboratory findings commonly used in providing obstetrical,
             75      gynecological, and well infant services to a patient;
             76          (ii) assess findings and upon abnormal findings from the history, physical examination,
             77      or laboratory findings, manage the treatment of the patient, collaborate with the consulting
             78      physician or another qualified physician, or refer the patient to the consulting physician or to
             79      another qualified physician as appropriate;
             80          (iii) diagnose, plan, and implement appropriate patient care, including the
             81      administration and prescribing of:
             82          (A) prescription drugs;
             83          (B) schedule IV-V controlled substances; and
             84          (C) schedule II-III controlled substances in accordance with a consultation and referral
             85      plan;


             86          (iv) evaluate the results of patient care;
             87          (v) consult as is appropriate regarding patient care and the results of patient care;
             88          (vi) manage the intrapartum period according to accepted standards of nurse midwifery
             89      practice and a written [practice and referral plan] intrapartum referral plan, including
             90      performance of routine episiotomy and repairs, and administration of anesthesia, including
             91      local, pudendal, or paracervical block anesthesia, but not including general anesthesia and
             92      major conduction anesthesia;
             93          (vii) manage the postpartum period;
             94          (viii) provide gynecological services;
             95          (ix) provide noncomplicated newborn and infant care to the age of one year; and
             96          (x) represent or hold oneself out as a certified nurse midwife, or nurse midwife, or use
             97      the title certified nurse midwife, nurse midwife, or the initials C.N.M., N.M., or R.N.
             98          [(9) "Practice and referral plan" means a written plan entered into with a consulting
             99      physician and detailing guidelines by which a certified nurse midwife consults, collaborates,
             100      and refers patients.]
             101          (10) "Unlawful conduct" is defined in Sections 58-1-501 and 58-44a-501 .
             102          (11) "Unlicensed assistive personnel" means any unlicensed person, regardless of title,
             103      to whom tasks are delegated by a licensed certified nurse midwife in accordance with the
             104      standards of the profession as defined by rule.
             105          (12) "Unprofessional conduct" is defined in Sections 58-1-501 and 58-44a-502 and as
             106      may be further defined by rule.
             107          Section 2. Section 58-44a-502 is amended to read:
             108           58-44a-502. Unprofessional conduct.
             109          "Unprofessional conduct" includes:
             110          (1) disregard for a patient's dignity or right to privacy as to his person, condition,
             111      possessions, or medical record;
             112          (2) engaging in an act, practice, or omission which when considered with the duties
             113      and responsibilities of a certified nurse midwife does or could jeopardize the health, safety, or


             114      welfare of a patient or the public;
             115          (3) failure to confine one's practice as a certified nurse midwife to those acts or
             116      practices permitted by law;
             117          (4) failure to file or record any medical report as required by law, impeding or
             118      obstructing the filing or recording of such a report, or inducing another to fail to file or record
             119      such a report;
             120          (5) breach of a statutory, common law, regulatory, or ethical requirement of
             121      confidentiality with respect to a person who is a patient, unless ordered by the court;
             122          (6) failure to pay a penalty imposed by the division; [and]
             123          (7) prescribing a schedule II-III controlled substance without a consulting physician[.];
             124      and
             125          (8) (a) failure to have and maintain a safe mechanism for obtaining medical
             126      consultation, collaboration, and referral with a consulting physician, including failure to
             127      identify one or more consulting physicians in the written documents required by Subsection
             128      58-44a-102 (9)(b)(iii); or
             129          (b) representing that the certified nurse midwife is in compliance with Subsection
             130      (8)(a) when the certified nurse midwife is not in compliance with Subsection (8)(a).


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