Representative Carol Spackman Moss proposes the following substitute bill:




Chief Sponsor: Carol Spackman Moss

Senate Sponsor: ____________


8     General Description:
9          This bill amends provisions related to the practice of direct-entry midwifery.
10     Highlighted Provisions:
11          This bill:
12          ▸     requires an individual who practices direct-entry midwifery without a license to
13     comply with informed consent requirements; and
14          ▸     subject to certain conditions and procedures, gives the Division of Occupational and
15     Professional Licensing the authority to assess an administrative penalty upon an
16     individual who violates certain provisions related to the practice of direct-entry
17     midwifery.
18     Money Appropriated in this Bill:
19          None
20     Other Special Clauses:
21          None
22     Utah Code Sections Affected:
23     AMENDS:
24          58-77-501, as enacted by Laws of Utah 2005, Chapter 299
25          58-77-503, as enacted by Laws of Utah 2005, Chapter 299

26          58-77-601, as last amended by Laws of Utah 2014, Chapter 189

28     Be it enacted by the Legislature of the state of Utah:
29          Section 1. Section 58-77-501 is amended to read:
30          58-77-501. Unlawful conduct.
31          (1) In addition to the [definition in Subsection 58-1-501(1), "unlawful conduct"
32     includes] conduct that constitutes unlawful conduct under Subsection 58-1-501(1), it is
33     unlawful conduct for an individual who is not licensed under this chapter to:
34          (a) [representing or holding oneself out as a] represent or hold out that the individual is
35     a licensed direct-entry midwife [when not licensed under this chapter; and]; or
36          (b) [using] administer prescription medications, except oxygen, [while engaged] in the
37     practice of direct-entry midwifery [when not licensed under this chapter].
38          (2) (a) Except [as provided in Subsections (1)(a) and (b)] for conduct that constitutes
39     unlawful conduct under Subsection (1), it is lawful to practice direct-entry midwifery in the
40     state without being licensed under this chapter.
41          (b) The practice of direct-entry midwifery is not considered the practice of medicine,
42     nursing, or nurse-midwifery.
43          Section 2. Section 58-77-503 is amended to read:
44          58-77-503. Penalty for unlawful conduct -- Penalty for a violation by an
45     unlicensed direct-entry midwife.
46          [A person who violates the]
47          (1) An individual who engages in unlawful conduct [provisions] as defined in this
48     chapter is guilty of a class A misdemeanor.
49          (2) In addition to the division's authority to assess an administrative penalty under
50     Section 58-1-502, subject to Section 58-77-401, the division may assess an administrative
51     penalty, using a citation, of up to $5,000 for each violation upon an individual who is not
52     licensed under this chapter, if the individual:
53          (a) engages in conduct that constitutes unprofessional conduct or unlawful conduct
54     under this title or this chapter;
55          (b) violates Subsection 58-77-601(1) or (2); or
56          (c) violates Section 58-77-603.

57          (3) The division shall issue a citation described in Subsection (2) in writing with a
58     description of the violation.
59          (4) The division shall allow an individual to whom the division issues a citation under
60     Subsection (2) to contest the citation at an administrative hearing conducted under Title 63G,
61     Chapter 3, Utah Administrative Rulemaking Act, if the individual requests a hearing within 20
62     days after the day on which the division issues the citation.
63          (5) A citation the division issues under Subsection (2) shall become final if:
64          (a) at a hearing described in Subsection (4), the division determines the citation was
65     properly issued; or
66          (b) the individual fails to timely request an administrative hearing.
67          Section 3. Section 58-77-601 is amended to read:
68          58-77-601. Standards of practice -- Informed consent -- Licensed direct-entry
69     midwives -- Unlicensed direct-entry midwives.
70          [(1) (a) Prior to providing any services, a licensed Direct-entry midwife must obtain an
71     informed consent from a client.]
72          [(b) The consent must include:]
73          (1) Before an individual provides direct-entry midwifery services to a client, the
74     individual shall obtain from the client a written informed consent agreement that includes:
75          [(i)] (a) the individual's name and, if the individual is licensed as a direct-entry midwife
76     under this chapter, the individual's license number [of the Direct-entry midwife];
77          [(ii)] (b) the client's name, address, telephone number, and, if any, the client's primary
78     care provider[, if the client has one];
79          [(iii) the fact, if true, that the licensed Direct-entry midwife is not a certified nurse
80     midwife or a physician;]
81          (c) a list of the individual's midwifery licenses and certifications, if any;
82          (d) if the individual is not licensed as a direct-entry midwife under this chapter, a
83     statement that the individual is not licensed and that the individual's education and
84     qualifications have not been reviewed by the state;
85          [(iv)] (e) a description of the [licensed Direct-entry midwife's] individual's midwifery
86     education, training, continuing education, and experience [in midwifery];
87          [(v)] (f) a description of the [licensed Direct-entry midwife's] individual's peer review

88     process, if any;
89          [(vi)] (g) the [licensed Direct-entry midwife's philosophy of] individual's practice
90     philosophy;
91          [(vii)] (h) (i) a promise to provide the client, upon request, [separate documents
92     describing the rules governing licensed Direct-entry midwifery practice, including a list of
93     conditions indicating the need for consultation, collaboration, referral, transfer or mandatory
94     transfer, and the licensed Direct-entry midwife's personal written practice guidelines;] a
95     description of the requirements governing the practice of direct-entry midwifery; and
96          [(viii) a medical back-up or transfer plan;]
97          (ii) if the individual is not licensed under this chapter, a statement that the individual is
98     not subject to the rules governing licensed direct-entry midwives and that a failure to follow the
99     rules could increase the risk to the client and the client's child;
100          (i) a plan to address any medical issues the client experiences during pregnancy, labor,
101     or childbirth, including a plan for transportation of the client to a hospital, if necessary;
102          [(ix) a description of the services provided to the client by the licensed Direct-entry
103     midwife;]
104          [(x) the licensed Direct-entry midwife's current legal status;]
105          [(xi) the availability of a grievance process;]
106          [(xii) client and licensed Direct-entry midwife signatures and the date of signing; and]
107          (j) a separate copy of a publication, created by the board in collaboration with the
108     division, that describes each type of midwife that may legally practice in Utah, and each
109     midwife type's scope of practice and minimum educational requirements; and
110          (k) if the individual is unlicensed, a statement that it is unlawful for the individual to
111     carry or administer prescription medications other than oxygen;
112          (l) a description of administrative grievance processes available through the division;
113          (m) the individual's signature and date of signing;
114          (n) the client's signature and date of signing; and
115          [(xiii)] (o) a statement that discloses whether the [licensed Direct-entry midwife]
116     individual is covered by a professional liability insurance policy.
117          (2) An individual who provides direct-entry midwifery services to a client shall retain
118     the consent agreement described in Subsection (1) for at least 10 years after the day on which

119     the client gives birth.
120          [(2)] (3) A licensed direct-entry midwife shall:
121          (a) (i) limit the licensed direct-entry midwife's practice to a normal pregnancy, labor,
122     postpartum, newborn and interconceptual care, which for purposes of this section means a
123     normal labor:
124          (A) that is not pharmacologically induced;
125          (B) that is low risk at the start of labor;
126          (C) that remains low risk [through out] throughout the course of labor and delivery;
127          (D) in which the infant is born spontaneously in the vertex position between 37 and 43
128     completed weeks of pregnancy; and
129          (E) except as provided in Subsection [(2)] (3)(a)(ii), in which after delivery, the mother
130     and infant remain low risk; and
131          (ii) the limitation of Subsection [(2)] (3)(a)(i) does not prohibit a licensed direct-entry
132     midwife from delivering an infant when there is:
133          (A) intrauterine fetal demise; or
134          (B) a fetal anomaly incompatible with life; and
135          (b) appropriately recommend and facilitate consultation with, collaboration with,
136     referral to, or transfer or mandatory transfer of care to a licensed health care professional when
137     the circumstances require that action in accordance with this section and standards established
138     by division rule.
139          [(3)] (4) If after a client has been informed that she has or may have a condition
140     indicating the need for medical consultation, collaboration, referral, or transfer and the client
141     chooses to decline, then the licensed direct-entry midwife shall:
142          (a) terminate care in accordance with procedures established by division rule; or
143          (b) continue to provide care for the client if the client signs a waiver of medical
144     consultation, collaboration, referral, or transfer.
145          [(4)] (5) If after a client has been informed that she has or may have a condition
146     indicating the need for mandatory transfer, the licensed direct-entry midwife shall, in
147     accordance with procedures established by division rule, terminate the care or initiate transfer
148     by:
149          (a) calling 911 and reporting the need for immediate transfer;

150          (b) immediately transporting the client by private vehicle to the receiving provider; or
151          (c) contacting the physician to whom the client will be transferred and following that
152     physician's orders.
153          [(5)] (6) The standards for consultation and transfer are the minimum standards that a
154     licensed Direct-entry midwife must follow. A licensed Direct-entry midwife shall initiate
155     consultation, collaboration, referral, or transfer of a patient sooner than required by
156     administrative rule if in the opinion and experience of the licensed Direct-entry midwife, the
157     condition of the client or infant warrant a consultation, collaboration, referral, or transfer.
158          [(6) For the period from 2006 through 2011, a licensed Direct-entry midwife must
159     submit outcome data to the Midwives' Alliance of North America's Division of Research on the
160     form and in the manner prescribed by rule.]
161          (7) This chapter does not mandate health insurance coverage for midwifery services.