| OCCUPATIONS CODE
CHAPTER 203. MIDWIVES
SUBCHAPTER A. GENERAL PROVISIONS
Sec.A203.001. SHORT TITLE.
This chapter may be cited as the Texas Midwifery Act.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.002. DEFINITIONS. In this chapter:
(1) "Board" means the Texas Board of Health.
(2) "Certified nurse-midwife" means a person who is:
(A) a registered nurse under Chapter 301;
(B) recognized as an advanced nurse practitioner by the Board of Nurse Examiners; and
(C) certified by the American College of Nurse-Midwives.
(3) "Commissioner" means the commissioner of public health.
(4) "Department" means the Texas Department of Health.
(5) "Local health department" means a department of health created by the governing body of a municipality or a county
under Section 121.031, Health and Safety Code.
(6) "Midwife" means a person who practices midwifery and has met the documentation requirements established by this
chapter and midwifery board rules.
(7) "Midwifery" means the practice of:
(A) providing the necessary supervision, care, and advice to a woman during normal pregnancy, labor, and the
postpartum period;
(B) conducting a normal delivery of a child; and
(C) providing normal newborn care.
(8) "Newborn" means an infant from birth through the first six weeks of life.
(9) "Normal" means, as applied to pregnancy, labor, delivery, the postpartum period, and the newborn period, and as
defined by midwifery board rule, circumstances under which a
midwife has determined that a client is at a low risk of developing
complications.
(10) "Postpartum period" means the first six weeks
after a woman has given birth.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.003. FINDINGS. The legislature finds:
(1) a parent has the responsibility and right to give birth where and with whom the parent chooses;
(2) childbirth is a natural process of the human body and not a disease; and
(3) midwifery has been practiced in this state since the days of the Republic.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.004. APPLICABILITY. This chapter does not apply to:
(1) a certified nurse-midwife, a physician, or another health care professional licensed by the state and operating within
the scope of the person’s license;
(2) a natural childbirth trainer; or
(3) a person other than a midwife who assists childbirth in an emergency.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.005. EFFECT ON LOCAL ORDINANCES. This chapter does not prohibit a municipality from adopting a local ordinance or
rule to regulate the practice of midwifery in the municipality if
the ordinance or rule is compatible with and at least as strict as
this chapter and board rules.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.006. APPLICATION OF SUNSET ACT. The midwifery board is subject to Chapter 325, Government Code (Texas Sunset
Act). Unless continued in existence as provided by that chapter,
the midwifery board is abolished and this chapter expires September
1, 2005.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER B. MIDWIFERY BOARD
Sec.A203.051. MIDWIFERY BOARD. The board shall appoint a midwifery board that reports directly to the board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.052. APPOINTMENT OF MIDWIFERY BOARD.
(a) The midwifery board consists of nine members appointed as follows:
(1) three midwife members each of whom has at least three years’ experience in the practice of midwifery and not more
than one of whom is a licensed health care professional;
(2) one certified nurse-midwife member;
(3) one physician member who is certified by a
national professional organization of physicians that certifies obstetricians and gynecologists;
(4) one physician member who is certified by a national professional organization of physicians that certifies
family practitioners or pediatricians; and
(5) three members who represent the public and who are not practicing or trained in a health care profession, one of whom
is a parent with at least one child born with the assistance of a
midwife.
(b) Appointments to the midwifery board shall be made without regard to the race, color, disability, sex, religion, age,
or national origin of the appointee.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.053. ELIGIBILITY OF PUBLIC MEMBERS.
A person is not eligible for appointment as a public member of the midwifery
board if the person or the person’s spouse:
(1) is registered, certified, or licensed by an occupational regulatory agency in the field of midwifery;
(2) is employed by or participates in the management of a business entity or other organization regulated by the
midwifery board or receiving funds from the midwifery board;
(3) owns or controls, directly or indirectly, more than a 10 percent interest in a business entity or other
organization regulated by or receiving funds from the midwifery
board; or
(4) uses or receives a substantial amount of tangible
goods, services, or funds from the midwifery board, other than
compensation or reimbursement authorized by law for midwifery board
membership, attendance, or expenses.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.054. MEMBERSHIP AND EMPLOYEE RESTRICTIONS.
(a) In this section, "Texas trade association"
means a nonprofit, cooperative, and voluntarily joined association
of business or professional competitors in this state designed to
assist its members and its industry or profession in dealing with
mutual business or professional problems and in promoting their
common interest.
(b) An officer, employee, or paid consultant of a Texas trade association in the field of midwifery may not be a midwifery
board member or an employee of the midwifery board who is exempt
from the state’s position classification plan or is compensated at
or above the amount prescribed by the General Appropriations Act
for step 1, salary group A17, of the position classification salary
schedule.
(c) A person who is the spouse of an officer, manager, or paid consultant of a Texas trade association in the field of
midwifery may not be a midwifery board member and may not be an
employee of the midwifery board who is exempt from the state’s
position classification plan or is compensated at or above the
amount prescribed by the General Appropriations Act for step 1,
salary group A17, of the position classification salary schedule.
(d)A person may not serve as a midwifery board member or act as the general counsel to the midwifery board if the person is
required to register as a lobbyist under Chapter 305, Government
Code, because of the person’s activities for compensation on behalf
of a profession related to the operation of the midwifery board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.055. TERMS. Members of the midwifery board serve for staggered terms of six years. The terms of three members expire
on January 31 of each odd-numbered year.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.056. OFFICERS. The midwifery board shall elect one of the public members of the midwifery board as presiding
officer and one of the other members of the midwifery board as vice
presiding officer.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.057. GROUNDS FOR REMOVAL. (a) It is a ground for removal from the midwifery board that a member:
(1) does not have at the time of appointment the
qualifications required by Section 203.052;
(2) does not maintain during service on the midwifery
board the qualifications required by Section 203.052;
(3) violates a prohibition established by Section
203.053 or 203.054;
(4) cannot, because of illness or disability,
discharge the member’s duties for a substantial part of the member’s
term; or
(5) is absent from more than half of the regularly
scheduled midwifery board meetings that the member is eligible to
attend during a calendar year unless the absence is excused by
majority vote of the midwifery board.
(b) The validity of an action of the midwifery board is not
affected by the fact that it is taken when a ground for removal of a
midwifery board member exists.
(c) If the program coordinator has knowledge that a
potential ground for removal exists, the program coordinator shall
notify the presiding officer of the midwifery board of the ground.
The program coordinator and presiding officer of the midwifery
board shall then notify the board that a potential ground for
removal exists.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.058. COMPENSATION; REIMBURSEMENT.
A member may not receive compensation for service on the midwifery board. Each
member is entitled to receive $50 for each meeting the member
attends and the per diem and travel allowance authorized for state
employees.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.059. MEETINGS. (a) The midwifery board shall meet at least semiannually.
(b) The midwifery board shall meet at other times at the
call of the midwifery board or the board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER C. PROGRAM COORDINATOR AND PERSONNEL
Sec.A203.101. PROGRAM COORDINATOR.
The department shall,
with the approval of the board and after consultation with the
midwifery board, employ a coordinator for the midwifery program and
the staff necessary to administer the program.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.102. DUTIES OF PROGRAM COORDINATOR.
The program coordinator shall supervise the staff in the performance of
administrative duties, including:
(1) keeping the minutes of midwifery board meetings; and
(2) maintaining:
(A) records about basic midwifery education courses and continuing midwifery education courses;
(B) a roster of midwives documented under Section 203.251; and
(C) a record of each person who receives documentation under this chapter.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.103. DIVISION OF RESPONSIBILITIES.
The midwifery board shall develop and implement policies that clearly define the
respective responsibilities of the midwifery board and the staff of
the midwifery board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.104. EQUAL EMPLOYMENT OPPORTUNITY POLICY; REPORT.
(a) The program coordinator or the program coordinator’s designee shall prepare and maintain a written policy statement to
ensure implementation of an equal employment opportunity program
under which all personnel transactions are made without regard to
race, color, disability, sex, religion, age, or national origin.
The policy statement must include:
(1) personnel policies, including policies related to recruitment, evaluation, selection, application, training, and
promotion of personnel that are in compliance with Chapter 21,
Labor Code;
(2) a comprehensive analysis of the midwifery board workforce that meets federal and state guidelines;
(3) procedures by which a determination can be made of
significant underuse in the midwifery board workforce of all
persons for whom federal or state guidelines encourage a more
equitable balance; and
(4) reasonable methods to appropriately address those
areas of underuse.
(b) A policy statement prepared under Subsection (a) must:
(1) cover an annual period;
(2) be updated annually;
(3) be reviewed by the Commission on Human Rights for
compliance with Subsection (a)(1); and
(4) be filed with the governor.
(c) The governor shall deliver a biennial report to the
legislature based on the information received under Subsection (b).
The report may be made separately or as a part of another biennial
report made to the legislature.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER D. POWERS AND DUTIES OF MIDWIFERY BOARD, BOARD, AND
DEPARTMENT
Sec.A203.151. RULEMAKING AUTHORITY OF MIDWIFERY
BOARD.
(a) Subject to the approval of the board, the midwifery
board shall:
(1) adopt substantive and procedural rules necessary
for the documentation of midwives;
(2) adopt rules prescribing the standards for the
practice of midwifery in this state, including standards for:
(A) the delineation of findings that preclude a
woman or newborn from being classified as having a normal
pregnancy, labor, delivery, postpartum period, or newborn period;
and
(B) administration of oxygen by a midwife to a
mother or newborn;
(3) adopt rules prescribing:
(A) the type of courses and number of hours
required to meet the basic midwifery education course and
continuing midwifery education course requirements; and
(B) minimum standards for the approval and
revocation of approval of:
(i) basic midwifery education courses and
continuing midwifery education courses; and
(ii) instructors or facilities used in
basic midwifery education courses and continuing midwifery
education courses;
(4) adopt rules prescribing a procedure for reporting
and processing complaints relating to the practice of midwifery in
this state;
(5) adopt and implement substantive and procedural
rules as necessary to discipline midwives determined to be in
violation of this chapter or otherwise a threat to the public health
and safety;
(6) adopt rules as necessary to establish eligibility
for reciprocity for initial documentation under this chapter; and
(7) adopt other rules necessary to implement a duty
imposed on the board or the department under this chapter.
(b) The rules adopted under Subsection (a)(5) must include
rules relating to:
(1) warnings provided to midwives for a violation of
this chapter or rules adopted under this chapter;
(2) agreed orders for additional education by
midwives;
(3) recommendations or requirements for medical or
psychological treatment, including treatment related to substance
abuse by a midwife; and
(4) restrictions on the practice of a midwife,
including practice limitations and the suspension and revocation of
documentation, and placement of a midwife on probation.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.152. FEES.
(a) Subject to the approval of the
board, the midwifery board by rule shall establish reasonable and
necessary fees that, in the aggregate, produce sufficient revenue
to cover the costs of administering this chapter.
(b) The midwifery board may not set a fee for an amount less
than the amount of that fee on September 1, 1993.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.153. MANUALS.
(a) Subject to the approval of the
board, the midwifery board shall issue basic information manuals
for the practice of midwifery. The midwifery board shall approve
the basic information manuals and instructor manuals that may be
used in basic midwifery education courses.
(b) The department shall provide the manuals to each
documented midwife and to any other person on request.
(c) A basic information manual must include information
about:
(1) the knowledge necessary to practice as a midwife;
(2) the basic education and continuing education
requirements for a midwife;
(3) the legal requirements and procedures relating to
midwifery;
(4) the standards of practice as a midwife; and
(5) other information or procedures required by the
midwifery board or the board.
(d) The department may charge a fee for each manual not to
exceed $10. The department shall make the manual available in
English and Spanish.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.154. ANNUAL REPORT; REPORTS ON
MIDWIFERY.
(a) The department shall file annually with the
governor and the presiding officer of each house of the legislature
a complete and detailed written report accounting for all funds
received and distributed by the midwifery board during the
preceding fiscal year.
(b) The report under Subsection (a) must be in the form and
reported in the time provided by the General Appropriations Act.
(c) Subject to the approval of the board, the midwifery
board shall prepare and publish reports on the practice of
midwifery in this state, including statistical reporting of infant
fetal morbidity and mortality.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.155. COMPLAINT PROCEDURE AND
INVESTIGATION.
(a) The midwifery board shall adopt rules
concerning the investigation of a complaint filed with the
midwifery board.
(b) The rules adopted under Subsection (a) must:
(1) distinguish among categories of complaints;
(2) ensure that a person who files a complaint has an
opportunity to explain the allegations made in the complaint; and
(3) provide for the release of any relevant midwifery
or medical record to the midwifery board, without the necessity of
consent by the midwife’s client, as necessary to conduct an
investigation of a complaint.
(c) The midwifery board by rule shall:
(1) adopt a form to standardize information concerning
complaints made to the midwifery board; and
(2) prescribe information to be provided to a person
when the person files a complaint with the midwifery board.
(d) The midwifery board shall provide reasonable assistance
to a person who wishes to file a complaint with the midwifery board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.156. DUTIES OF BOARD AND DEPARTMENT.
(a) The
board shall review and act on materials submitted by the midwifery
board for approval not later than the 60th day after the date the
materials are submitted.
(b) The department, with the recommendation of the
midwifery board, shall:
(1) implement rules governing:
(A) basic midwifery education courses and
continuing midwifery education courses; and
(B) approval of instructors or facilities used in
offering basic midwifery education courses and continuing
midwifery education courses;
(2) prepare and distribute basic midwifery
information and instructor manuals; and
(3) enter into agreements necessary to carry out this
chapter.
(c) The department shall:
(1) establish a program for documentation as a midwife
as prescribed by board rules;
(2) pay the salaries of the program coordinator and
any additional staff the department determines to be necessary;
and
(3) provide office space and supplies for the program
coordinator and other staff.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.157. ROSTER; NOTICE TO COUNTY
OFFICIALS.
(a) The department shall maintain a roster of each
person documented as a midwife in this state.
(b) The roster shall contain for each person the information
required on the documentation form under this chapter and other
information the department determines necessary to accurately
identify each documented midwife. The information is public
information as defined by Chapter 552, Government Code.
(c) The department shall provide each county clerk and each
local registrar of births in a county with the name of each midwife
practicing in the county.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER E. PUBLIC INTEREST INFORMATION AND COMPLAINT PROCEDURES
Sec.A203.201. PUBLIC INTEREST NFORMATION.
(a) The
midwifery board shall prepare information of public interest
describing the functions of the midwifery board and the procedures
by which complaints are filed with and resolved by the midwifery
board.
(b) The midwifery board shall make the information
available to the public and appropriate state agencies.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.202. COMPLAINTS.
(a) The midwifery board by
rule shall establish methods by which consumers and service
recipients are notified of the name, mailing address, and telephone
number of the midwifery board for the purpose of directing
complaints to the midwifery board. The midwifery board may provide
for that notice:
(1) on each registration form, application, or
disclosure and informed consent form of a person regulated by the
midwifery board;
(2) on a sign prominently displayed in the place of
business of each person regulated by the midwifery board; or
(3) in a bill for service provided by a person
regulated by the midwifery board.
(b) The midwifery board shall list with its regular
telephone number the toll-free telephone number established under
other state law that may be called to present a complaint about a
health professional.
(c) The midwifery board shall keep an information file about
each complaint filed with the midwifery board.
(d) The midwifery board’s information file shall be kept
current and contain a record for each complaint of:
(1) each person contacted in relation to the
complaint;
(2) a summary of findings made at each step of the
complaint process; and
(3) other relevant information.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.203. PUBLIC PARTICIPATION.
(a) The midwifery
board shall develop and implement policies that provide the public
with a reasonable opportunity to appear before the midwifery board
and to speak on any issue under the midwifery board’s jurisdiction.
(b) The midwifery board shall prepare and maintain a written
plan that describes how a person who does not speak English may be
provided reasonable access to the midwifery board’s programs.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER F. DOCUMENTATION REQUIREMENTS
Sec.A203.251. DOCUMENTATION REQUIRED.
(a) A person may
not practice midwifery unless the person holds a documentation
letter issued under this chapter.
(b) The department shall provide a documentation letter to
each person who fulfills documentation requirements.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.252. INITIAL DOCUMENTATION.
(a) At the time of
initial documentation, an applicant for documentation must provide
the program coordinator with documentary evidence that the person
has:
(1) satisfied each requirement for basic midwifery
education; and
(2) passed the comprehensive midwifery examination.
(b) The initial documentation must be issued before the
midwife begins to practice midwifery and may be issued at any time
during the year.
(c) The term of the initial documentation begins on the date
the requirements are met and extends through December 31 of the year
practices midwifery must apply to the department to be documented
as a midwife. The application must:
(1) be accompanied by a nonrefundable application fee;
and
(2) include information required by board rules.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.254. BASIC MIDWIFERY EDUCATION. Subject to the
approval of the board, the midwifery board shall establish
requirements for basic midwifery education.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.255. EXAMINATION.
(a) The midwifery board, with
the approval of the board, shall:
(1) adopt a comprehensive midwifery examination for
persons regulated under this chapter that must be passed before
initial documentation; and
(2) establish eligibility requirements for persons
taking a comprehensive midwifery examination.
(b) The midwifery board shall have an independent testing
professional validate any written portion of the examination.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.256. TRAINING IN NEWBORN SCREENING AND BASIC LIFE
SUPPORT CARDIOPULMONARY RESUSCITATION. A person who practices
midwifery in this state must provide the program coordinator with
satisfactory evidence that the person:
(1) is trained to perform the newborn screening tests
under Section 203.354 or has made arrangements for the performance
of those tests; and
(2) holds:
(A) a current certificate issued by the American
Heart Association in basic life support cardiopulmonary
resuscitation; or
(B) another form of certification acceptable to
the department that demonstrates proficiency in basic life support
cardiopulmonary resuscitation for adults and children.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER G. DOCUMENTATION RENEWAL
Sec.A203.301. APPLICATION FOR DOCUMENTATION RENEWAL.
An
applicant for renewal of documentation must apply annually as
provided in Section 203.253.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.302. LATE APPLICATION FOR RENEWAL.
(a) The
department may accept an application for documentation renewal that
is filed not later than the expiration date of a grace period
established by board rule. The grace period may not exceed the 60th
day after the expiration date of a person’s documentation.
(b) The department may charge a late filing fee that must be
paid in addition to the application fee.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.303. STAGGERED RENEWAL DATES.
(a) The midwifery
board by rule may adopt a system under which documentations expire
on various dates during the year.
(b) For the year in which the documentation expiration date
is changed, documentation fees payable on the original expiration
date shall be prorated on a monthly basis so that each documented
midwife pays only that portion of the documentation fee that is
allocable to the number of months during which the documentation is
valid.
(c) On renewal of the documentation on the new expiration
date, the total documentation renewal fee is payable.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.304. CONTINUING MIDWIFERY
EDUCATION. (a) Subject to the approval of the board, the
midwifery board shall establish requirements for continuing
midwifery education, including a minimum number of hours of
continuing education required to renew a documentation under this
chapter.
(b) On renewal of the documentation, a midwife must provide
the program coordinator with evidence, acceptable under board
rules, of completion of continuing midwifery education as
14
prescribed by the midwifery board.
(c) The midwifery board by rule shall develop a process to
evaluate and approve continuing education courses.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.305. REQUIRED ATTENDANCE AT SPECIFIC MIDWIFERY
EDUCATION COURSES. The midwifery board may assess the continuing
education needs of documented midwives and may require documented
midwives to attend continuing midwifery education courses
specified by the midwifery board.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER H. PRACTICE BY MIDWIFE
Sec.A203.351. INFORMED CHOICE AND DISCLOSURE
REQUIREMENTS. (a) A midwife shall disclose in oral and written
form to a prospective client the limitations of the skills and
practices of a midwife.
(b) The midwifery board shall prescribe the form of the
informed choice and disclosure statement required to be used by a
midwife under this chapter. The form must include:
(1) statistics of the midwife’s experience as a
midwife;
(2) the date the midwife’s documentation expires;
(3) the date the midwife’s cardiopulmonary
resuscitation certification expires;
(4) the midwife’s compliance with continuing education
requirements;
(5) a description of medical backup arrangements; and
(6) the legal responsibilities of a midwife, including
statements concerning newborn blood screening, ophthalmia
neonatorum prevention, and prohibited acts under Sections
203.401-203.403.
(c) The informed choice statement must include a statement
that state law requires a newborn child to be tested for certain
heritable diseases and hypothyroidism. The midwife shall disclose
to a client whether the midwife is approved to collect blood
specimens to be used to perform the tests. If the midwife is not
approved to collect the blood specimens, the disclosure must inform
the client of the midwife’s duty to refer the client to an
15
appropriate health care facility or physician for the collection of
the specimens.
(d) The disclosure of legal requirements required by this
section may not exceed 500 words and must be in English and Spanish.
(e) A midwife shall disclose to a prospective or actual
client the procedure for reporting complaints to the department.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.352. PRENATAL AND CERTAIN MEDICAL CARE
ENCOURAGED. A midwife shall encourage a client to seek:
(1) prenatal care; and
(2) medical care through consultation or referral, as
specified by midwifery board rules, if the midwife determines that
the pregnancy, labor, delivery, postpartum period, or newborn
period of a woman or newborn may not be classified as normal for
purposes of this chapter.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.353. PREVENTION OF OPHTHALMIA NEONATORUM. Unless
the newborn child is immediately transferred to a hospital because
of an emergency, a midwife who attends the birth of the child shall
comply with Section 81.091, Health and Safety Code.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.354. NEWBORN SCREENING. (a) Each midwife who
attends the birth of a child shall cause the newborn screening tests
to be performed on blood specimens taken from the child as required
by Chapter 33, Health and Safety Code.
(b) A midwife may collect blood specimens for the newborn
screening tests if the midwife has been approved by the department
to collect the specimen. The board shall adopt rules establishing
the standards for approval. The standards must recognize
completion of a course of instruction that includes the blood
specimen collection procedure or verification by appropriately
trained health care providers that the midwife has been instructed
in the blood collection procedures.
(c) A midwife who is not approved to collect blood specimens
for newborn screening tests shall refer a client and her newborn to
an appropriate health care facility or physician for the collection
of the blood specimen and submission of the specimen to the
16
department.
(d) If the midwife has been approved by the department to
collect blood specimens under this section, the collection by the
midwife of blood specimens for the required newborn screening tests
does not constitute the practice of medicine as defined by Subtitle
B.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.355. SUPPORT SERVICES. (a) In this section:
(1) "Clinical services" include prenatal, postpartum,
child health, and family planning services.
(2) "Local health unit" means a division of a
municipal or county government that provides limited public health
services under Section 121.004, Health and Safety Code.
(3) "Public health district" means a district created
under Subchapter E, Chapter 121, Health and Safety Code.
(b) The department and a local health department, a public
health district, or a local health unit shall provide clinical and
laboratory support services to a pregnant woman or a newborn who is
a client of a midwife if the midwife is required to provide the
services under this chapter.
(c) The laboratory services must include the performance of
the standard serological tests for syphilis and the collection of
blood specimens for newborn screening tests for phenylketonuria,
hypothyroidism, and other heritable diseases as required by law.
(d) The provider may charge a reasonable fee for the
services. A person may not be denied the services because of
inability to pay.
(e) If available, appropriately trained personnel from
local health departments, public health districts, and local health
units shall instruct documented midwives in the approved techniques
for collecting blood specimens to be used to perform newborn
screening tests.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.356. IMMUNITY. (a) A physician, a registered
nurse, or other person who, on the order of a physician, instructs a
midwife in the approved techniques for collecting blood specimens
to be used for newborn screening tests is immune from liability
17
arising out of the failure or refusal of the midwife to:
(1) collect the specimens in the approved manner; or
(2) submit the specimens to the department in a timely
manner.
(b) A physician who issues an order directing or instructing
a midwife is immune from liability arising out of the failure or
refusal of the midwife to comply with the order if, before the
issuance of the order, the midwife provided the physician with
evidence satisfactory to the board of compliance with this chapter.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.357. ADDITIONAL INFORMATION REQUIRED. (a) The
midwifery board may require information in addition to that
required by Section 203.253 if it determines the additional
information is necessary and appropriate to ascertain the nature
and extent of midwifery in this state. The midwifery board may not
require information regarding any act that is prohibited under this
chapter.
(b) With the approval of the midwifery board, the department
shall prescribe forms for the additional information and shall
distribute those forms directly to each midwife. Each midwife must
complete and return the forms to the department as requested.
(c) Information received under this section may not be made
public in a manner that discloses the identity of any person to whom
the information relates. The information is not public information
as defined by Chapter 552, Government Code.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER I. PROHIBITED PRACTICES AND GROUNDS FOR DISCIPLINARY
ACTION
Sec.A203.401. PROHIBITED PRACTICES. A midwife may not:
(1) provide midwifery care in violation of midwifery
board rule, except in an emergency that poses an immediate threat to
the life of a woman or newborn;
(2) administer a prescription drug to a client other
than:
(A) a drug administered under the supervision of
a licensed physician in accordance with state law;
(B) prophylaxis approved by the board to prevent
18
ophthalmia neonatorum; or
(C) oxygen administered in accordance with
midwifery board rule;
(3) use forceps or a surgical instrument for a
procedure other than cutting the umbilical cord or providing
emergency first aid during delivery;
(4) remove placenta by invasive techniques;
(5) use a mechanical device or medicine to advance or
retard labor or delivery; or
(6) make on a birth certificate a false statement or
false record in violation of Section 195.003, Health and Safety
Code.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.402. PROHIBITED REPRESENTATION. A midwife may
not:
(1) except as provided by Section 203.403, use in
connection with the midwife’s name a title, abbreviation, or
designation tending to imply that the midwife is a ’registered’ or
’certified’ midwife as opposed to one who is documented under this
chapter;
(2) advertise or represent that the midwife is a
physician or a graduate of a medical school unless the midwife is
licensed to practice medicine by the Texas State Board of Medical
Examiners;
(3) use advertising or an identification statement
that is false, misleading, or deceptive; or
(4) except as authorized by rules adopted by the Board
of Nurse Examiners, use in combination with the term ’midwife’ the
term ’nurse’ or another title, initial, or designation that implies
that the midwife is licensed as a registered nurse or vocational
nurse.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 553, Sec. 2.015, eff. Feb. 1, 2004.
Sec.A203.403. PROHIBITED USE OF TITLE. (a) A midwife
certified by the North American Registry of Midwives who uses
"certified" as part of the midwife’s title in an identification
statement or advertisement must include in the statement or
19
advertisement a statement that the midwife is certified by the
North American Registry of Midwives.
(b) A midwife may not use an identification statement or
advertisement that would lead a reasonable person to believe that
the midwife is certified by a governmental entity.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.404. GROUNDS FOR DISCIPLINARY ACTION. (a) The
midwifery board may discipline a documented midwife and may refuse
to issue a letter of documentation to an applicant who:
(1) violates this chapter or a rule adopted under this
chapter;
(2) submits false or misleading information to the
midwifery board, the board, or the department;
(3) is convicted of a misdemeanor involving moral
turpitude or a felony;
(4) uses alcohol or drugs intemperately;
(5) engages in unprofessional or dishonorable conduct
that may reasonably be determined to deceive or defraud the public;
(6) is unable to practice midwifery with reasonable
skill and safety because of illness, disability, or psychological
impairment;
(7) is determined by a court judgment to be mentally
impaired;
(8) submits a birth or death certificate known by the
person to be false or fraudulent or engages in another act that
violates Title 3, Health and Safety Code, or a rule adopted under
that title;
(9) violates Chapter 244, Health and Safety Code, or a
rule adopted under that chapter; or
(10) fails to practice midwifery in a manner
consistent with the public health and safety.
(b) The midwifery board may discipline a documented midwife
and may refuse to issue a letter of documentation to an applicant
for a disciplinary action taken by another jurisdiction that
affects the person’s authority to practice midwifery, including a
suspension, a revocation, or another action.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
20
Sec.A203.405. EMERGENCY SUSPENSION. (a) The midwifery
board or a three-member committee of midwifery board members
designated by the midwifery board shall temporarily suspend the
letter of documentation of a documented midwife if the midwifery
board or committee determines from the evidence or information
presented to it that continued practice by the documented midwife
would constitute a continuing and imminent threat to the public
welfare.
(b) A letter of documentation may be suspended under this
section without notice or hearing on the complaint if:
(1) action is taken to initiate proceedings for a
hearing before the State Office of Administrative Hearings
simultaneously with the temporary suspension; and
(2) a hearing is held as soon as practicable under this
chapter and Chapter 2001, Government Code.
(c) The State Office of Administrative Hearings shall hold a
preliminary hearing not later than the 14th day after the date of
the temporary suspension to determine if there is probable cause to
believe that a continuing and imminent threat to the public welfare
still exists. A final hearing on the matter shall be held not later
than the 61st day after the date of the temporary suspension.
Added by Acts 2003, 78th Leg., ch. 326, Sec. 1, eff. Sept. 1, 2003.
SUBCHAPTER J. ADMINISTRATIVE PENALTY
Sec.A203.451. IMPOSITION OF ADMINISTRATIVE PENALTY. The
midwifery board may impose an administrative penalty on a person
who violates this chapter or a rule adopted under this chapter.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.452. AMOUNT OF ADMINISTRATIVE PENALTY. (a) The
amount of the administrative penalty may not exceed $1,000 for each
violation. Each day a violation continues is a separate violation.
(b) The amount shall be based on:
(1) the seriousness of the violation;
(2) the history of previous violations;
(3) the amount necessary to deter a future violation;
(4) efforts made to correct the violation; and
(5) any other matter that justice may require.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
21
Sec.A203.453. NOTICE OF VIOLATION AND PENALTY. (a) If,
after investigation of a possible violation and the facts
surrounding that possible violation, the midwifery board or its
designee determines that a violation has occurred, the midwifery
board or its designee shall give written notice of the violation to
the person alleged to have committed the violation.
(b) The notice must:
(1) include a brief summary of the alleged violation;
(2) state the amount of the proposed administrative
penalty; and
(3) inform the person of the person’s right to a
hearing on the occurrence of the violation, the amount of the
penalty, or both.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.454. PENALTY TO BE PAID OR HEARING
REQUESTED. (a) Not later than the 20th day after the date the
person receives the notice under Section 203.453, the person may:
(1) accept the midwifery board or its designee’s
determination and the proposed administrative penalty; or
(2) make a written request for a hearing on that
determination.
(b) If the person accepts the midwifery board or its
designee’s determination, the midwifery board by order shall
approve the determination and require the person to pay the
proposed penalty.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.455. HEARING. (a) If the person timely requests
a hearing, the midwifery board or its designee shall set a hearing
and give written notice of the hearing to the person. The midwifery
board or its designee may employ a hearings examiner for this
purpose.
(b) The hearings examiner shall make findings of fact and
conclusions of law and promptly issue to the midwifery board a
proposal for decision as to the occurrence of the violation and the
amount of the proposed administrative penalty.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.456. DECISION BY MIDWIFERY BOARD. (a) Based on
22
the findings of fact, conclusions of law, and proposal for
decision, the midwifery board by order may determine that:
(1) a violation has occurred and impose an
administrative penalty; or
(2) a violation did not occur.
(b) The midwifery board shall give notice of the midwifery
board’s order to the person. The notice must include:
(1) separate statements of the findings of fact and
conclusions of law;
(2) the amount of any penalty assessed; and
(3) a statement of the right of the person to judicial
review of the midwifery board’s order.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.457. OPTIONS FOLLOWING DECISION: PAY OR
APPEAL. (a) Not later than the 30th day after the date the
midwifery board’s order becomes final, the person shall:
(1) pay the administrative penalty;
(2) pay the penalty and file a petition for judicial
review contesting the fact of the violation, the amount of the
penalty, or both; or
(3) without paying the penalty, file a petition for
judicial review contesting the fact of the violation, the amount of
the penalty, or both.
(b) Within the 30-day period, a person who acts under
Subsection (a)(3) may:
(1) stay enforcement of the penalty by:
(A) paying the penalty to the court for placement
in an escrow account; or
(B) giving to the court a supersedeas bond that
is approved by the court and that:
(i) is for the amount of the penalty; and
(ii) is effective until judicial review of
the order is final; or
(2) request the court to stay enforcement of the
penalty by:
(A) filing with the court a sworn affidavit of
the person stating that the person is financially unable to pay the
23
amount of the penalty and is financially unable to give the
supersedeas bond; and
(B) giving a copy of the affidavit to the
midwifery board by certified mail.
(c) If the midwifery board receives a copy of an affidavit
under Subsection (b)(2), the midwifery board may file with the
court a contest to the affidavit not later than the fifth day after
the date the copy is received.
(d) The court shall hold a hearing on the facts alleged in
the affidavit as soon as practicable and shall stay the enforcement
of the penalty on finding that the alleged facts are true. The
person who files an affidavit has the burden of proving that the
person is financially unable to pay the penalty and to give a
supersedeas bond.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.458. COLLECTION OF PENALTY. (a) If the person on
whom the administrative penalty is imposed does not comply with
Section 203.457, the penalty may be collected.
(b) The midwifery board may assess reasonable expenses and
costs against a person in an administrative hearing if, as a result
of the hearing, an administrative penalty is assessed against the
person. The person shall pay expenses and costs assessed under this
subsection not later than the 30th day after the date the order of
the midwifery board requiring the payment of expenses and costs is
final. The midwifery board may refer the matter to the attorney
general for collection of the expenses and costs.
(c) If the attorney general brings an action against a
person to enforce an administrative penalty assessed under this
chapter and the person is found liable for an administrative
penalty, the attorney general may recover, on behalf of the
attorney general, the midwifery board, and the department,
reasonable expenses and costs.
(d) In this section, reasonable expenses and costs includes
expenses incurred by the department, the midwifery board, and the
attorney general in the investigation, initiation, or prosecution
of an action, including reasonable investigative costs, court
costs, attorney’s fees, witness fees, and deposition expenses.
24
(e) Costs and expenses collected under this section shall be
deposited in the state treasury to the credit of a special account
that may be appropriated only to the department. Section 403.095,
Government Code, does not apply to the account.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.459. DETERMINATION BY COURT. (a) If a court
sustains the determination that a violation occurred, the court may
uphold or reduce the amount of the administrative penalty and order
the person to pay the full or reduced penalty.
(b) If the court does not sustain the determination that a
violation occurred, the court shall order that a penalty is not
owed.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.460. REMITTANCE OF PENALTY AND
INTEREST. (a) If, after judicial review, the administrative
penalty is reduced or not imposed by the court, the court shall:
(1) order the midwifery board to remit to the person
the appropriate amount, plus accrued interest, if the person paid
the penalty; or
(2) order the release of the bond in full if the
penalty is not imposed or order the release of the bond after the
person pays the penalty imposed if the person posted a supersedeas
bond.
(b) The interest paid under Subsection (a)(1) is accrued at
the rate charged on loans to depository institutions by the New York
Federal Reserve Bank. The interest shall be paid for the period
beginning on the date the penalty is paid and ending on the date the
penalty is remitted.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.461. ADMINISTRATIVE PROCEDURE. A proceeding
under this subchapter to impose an administrative penalty is
subject to Chapter 2001, Government Code.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
SUBCHAPTER K. OTHER PENALTIES AND ENFORCEMENT PROVISIONS
Sec.A203.501. CIVIL PENALTY. (a) A person is liable for a
civil penalty if the person is required to be documented under this
chapter and the person knowingly or intentionally practices
25
midwifery:
(1) without documentation or while the documentation
is suspended or revoked; or
(2) in violation of a midwifery board order.
(b) A civil penalty under this section may not exceed $250
for each violation. Each day of violation may constitute a separate
violation for purposes of penalty assessment. In determining the
amount of the penalty, the court shall consider:
(1) the person’s history of previous violations;
(2) the seriousness of the violation;
(3) any hazard to the health and safety of the public;
and
(4) the demonstrated good faith of the person charged.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.502. INJUNCTIONS. (a) In this section, "health
authority" means a physician who administers state and local laws
regulating public health under Chapter 121, Health and Safety Code.
(b) If the commissioner or a health authority determines
that a person has violated this chapter and that the violation
creates an immediate threat to the health and safety of the public,
the commissioner or the health authority, with the concurrence of
the commissioner, may request the attorney general or a district,
county, or city attorney to bring an action in a district court for
a restraining order to restrain the violation.
(c) If a person has violated this chapter, the commissioner
or a health authority, with the concurrence of the commissioner,
may bring an action in a district court for an injunction to
prohibit the person from continuing the violation.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.503. VENUE. (a) Venue for a civil action brought
under Section 203.451 or 203.452 is in the county in which the
defendant resides or in the county in which the violation occurred.
(b) Venue for the civil action may be changed only after a
good faith effort has been made to address the violation in the
county in which venue is proper.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Sec.A203.504. CRIMINAL PENALTY. (a) A person commits an
26
offense if the person is required to be documented under this
chapter and the person knowingly practices midwifery without
documentation.
(b) An offense under this section is a Class C misdemeanor.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
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