1.1                          A bill for an act 
  1.2             relating to health occupations; clarifying licensure 
  1.3             requirements for the practice of midwifery; amending 
  1.4             Minnesota Statutes 1998, sections 147.09; 148.30; 
  1.5             148.31; and 148.32; proposing coding for new law in 
  1.6             Minnesota Statutes, chapter 148; repealing Minnesota 
  1.7             Rules, parts 5600.2000; and 5600.2100. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1998, section 147.09, is 
  1.10  amended to read: 
  1.11     147.09 [EXEMPTIONS.] 
  1.12     Section 147.081 does not apply to, control, prevent or 
  1.13  restrict the practice, service, or activities of:  
  1.14     (1) A person who is a commissioned medical officer of, a 
  1.15  member of, or employed by, the armed forces of the United 
  1.16  States, the United States Public Health Service, the Veterans 
  1.17  Administration, any federal institution or any federal agency 
  1.18  while engaged in the performance of official duties within this 
  1.19  state, if the person is licensed elsewhere.  
  1.20     (2) A licensed physician from a state or country who is in 
  1.21  actual consultation here.  
  1.22     (3) A licensed or registered physician who treats the 
  1.23  physician's home state patients or other participating patients 
  1.24  while the physicians and those patients are participating 
  1.25  together in outdoor recreation in this state as defined by 
  1.26  section 86A.03, subdivision 3.  A physician shall first register 
  2.1   with the board on a form developed by the board for that 
  2.2   purpose.  The board shall not be required to promulgate the 
  2.3   contents of that form by rule.  No fee shall be charged for this 
  2.4   registration.  
  2.5      (4) A student practicing under the direct supervision of a 
  2.6   preceptor while the student is enrolled in and regularly 
  2.7   attending a recognized medical school.  
  2.8      (5) A student who is in continuing training and performing 
  2.9   the duties of an intern or resident or engaged in postgraduate 
  2.10  work considered by the board to be the equivalent of an 
  2.11  internship or residency in any hospital or institution approved 
  2.12  for training by the board, provided the student has a residency 
  2.13  permit issued by the board under section 147.0391. 
  2.14     (6) A person employed in a scientific, sanitary, or 
  2.15  teaching capacity by the state university, the department of 
  2.16  children, families, and learning, or by any public or private 
  2.17  school, college, or other bona fide educational institution, or 
  2.18  the state department of health, whose duties are entirely of a 
  2.19  public health or educational character, while engaged in such 
  2.20  duties. 
  2.21     (7) Physician's assistants registered in this state.  
  2.22     (8) A doctor of osteopathy duly licensed by the state board 
  2.23  of osteopathy under Minnesota Statutes 1961, sections 148.11 to 
  2.24  148.16, prior to May 1, 1963, who has not been granted a license 
  2.25  to practice medicine in accordance with this chapter provided 
  2.26  that the doctor confines activities within the scope of the 
  2.27  license. 
  2.28     (9) Any person licensed by a health related licensing 
  2.29  board, as defined in section 214.01, subdivision 2, or 
  2.30  registered by the commissioner of health pursuant to section 
  2.31  214.13, including psychological practitioners with respect to 
  2.32  the use of hypnosis; provided that the person confines 
  2.33  activities within the scope of the license.  
  2.34     (10) A person who practices ritual circumcision pursuant to 
  2.35  the requirements or tenets of any established religion. 
  2.36     (11) A Christian Scientist or other person who endeavors to 
  3.1   prevent or cure disease or suffering exclusively by mental or 
  3.2   spiritual means or by prayer. 
  3.3      (12) A physician licensed to practice medicine in another 
  3.4   state who is in this state for the sole purpose of providing 
  3.5   medical services at a competitive athletic event.  The physician 
  3.6   may practice medicine only on participants in the athletic 
  3.7   event.  A physician shall first register with the board on a 
  3.8   form developed by the board for that purpose.  The board shall 
  3.9   not be required to adopt the contents of the form by rule.  The 
  3.10  physician shall provide evidence satisfactory to the board of a 
  3.11  current unrestricted license in another state.  The board shall 
  3.12  charge a fee of $50 for the registration.  
  3.13     (13) A psychologist licensed under section 148.907 or a 
  3.14  social worker licensed under section 148B.21 who uses or 
  3.15  supervises the use of a penile or vaginal plethysmograph in 
  3.16  assessing and treating individuals suspected of engaging in 
  3.17  aberrant sexual behavior and sex offenders. 
  3.18     (14) Any person issued a training course certificate or 
  3.19  credentialed by the emergency medical services regulatory board 
  3.20  established in chapter 144E, provided the person confines 
  3.21  activities within the scope of training at the certified or 
  3.22  credentialed level. 
  3.23     (15) A midwife licensed under sections 148.30 to 148.32 or 
  3.24  practicing midwifery within the exemptions of section 148.321. 
  3.25     Sec. 2.  Minnesota Statutes 1998, section 148.30, is 
  3.26  amended to read: 
  3.27     148.30 [MIDWIFERY.] 
  3.28     Subdivision 1.  [GENERAL.] Within the meaning of sections 
  3.29  148.30 to 148.32 148.321, a person who shall publicly profess to 
  3.30  be a midwife or who, for a fee, shall assist or attend to women 
  3.31  a woman in pregnancy, childbirth, and postpartum, shall be 
  3.32  regarded as practicing midwifery.  Nothing in sections 148.30 to 
  3.33  148.32 shall apply to gratuitous emergency services or to 
  3.34  authorized medical practitioners.  
  3.35     Subd. 2.  [SCOPE OF PRACTICE.] The practice of midwifery 
  3.36  includes, but is not limited to: 
  4.1      (1) initial and ongoing assessment for suitability of 
  4.2   midwifery care; 
  4.3      (2) comprehensive prenatal care with attention to the 
  4.4   physical, nutritional, and emotional needs of the woman and her 
  4.5   family; 
  4.6      (3) attending and supporting the natural process of labor 
  4.7   and birth; 
  4.8      (4) postpartum care of the mother and newborn, including 
  4.9   physical and emotional assessment; and 
  4.10     (5) providing information and referrals to community 
  4.11  resources on childbirth preparation, breast-feeding, exercise, 
  4.12  nutrition, parenting, and care of the newborn. 
  4.13     Subd. 3.  [SPECIFIC AUTHORIZED SERVICES.] A midwife 
  4.14  licensed under sections 148.30 to 148.321 is authorized to 
  4.15  provide the specific services listed under this subdivision and 
  4.16  the provision of any of these services shall not be considered 
  4.17  the unlawful practice of medicine under section 147.081 or the 
  4.18  unauthorized practice of professional or practical nursing, as 
  4.19  referred to in section 148.283.  Specific midwife services 
  4.20  include, but are not limited to: 
  4.21     (1) episiotomy, in emergency situations; 
  4.22     (2) suture repair of first- or second-degree perineal 
  4.23  lacerations or episiotomies, with or without local anesthesia; 
  4.24     (3) administration of antihemorrhagic drugs by 
  4.25  intramuscular injection, for emergency control of postpartum 
  4.26  hemorrhage; 
  4.27     (4) use of suction devices; 
  4.28     (5) the use of oxygen; 
  4.29     (6) urinary catheterization; and 
  4.30     (7) local anesthesia for perineal repair. 
  4.31     Subd. 4.  [UNAUTHORIZED SERVICES.] The practice of 
  4.32  midwifery does not include:  
  4.33     (1) the use of any instrument at a childbirth, except such 
  4.34  instrument as is necessary in severing the umbilical cord or to 
  4.35  perform the services specified under subdivision 3; 
  4.36     (2) the assisting of childbirth by artificial, forcible, or 
  5.1   mechanical means; 
  5.2      (3) the removal of adherent placenta; or 
  5.3      (4) the administering, prescribing, advising, or employing, 
  5.4   either before or after any childbirth, of any drug other than a 
  5.5   disinfectant or cathartic, except as authorized under 
  5.6   subdivision 3.  
  5.7      Sec. 3.  Minnesota Statutes 1998, section 148.31, is 
  5.8   amended to read: 
  5.9      148.31 [LICENSES.] 
  5.10     Subdivision 1.  [LICENSE REQUIRED.] No person may engage in 
  5.11  the practice of midwifery unless the person is licensed as a 
  5.12  midwife in accordance with sections 148.30 to 148.321. 
  5.13     Subd. 2.  [APPLICATION.] A person desiring to practice 
  5.14  midwifery in this state, if not already authorized so to do, 
  5.15  shall apply to the state board of medical practice for a 
  5.16  license.  This license shall be granted upon the production of a 
  5.17  diploma from a school of midwifery recognized by the board, or 
  5.18  after examination of the applicant and compliance with other 
  5.19  requirements that the board may reasonably impose for the 
  5.20  protection of the public.  The board is authorized to adopt 
  5.21  rules as may be necessary to carry out the purposes of sections 
  5.22  148.30 to 148.32.  The board may delegate to another unit of 
  5.23  state government with that unit's consent, all or part of a 
  5.24  study to determine the appropriate level of regulation of 
  5.25  midwives and the content for any administrative rule deemed 
  5.26  appropriate by the board.  The board shall issue a license to 
  5.27  practice midwifery to a person who files a completed 
  5.28  application, pays all required fees, and satisfactorily meets 
  5.29  all requirements of this section. 
  5.30     Subd. 3.  [CONTENT.] The application shall require the 
  5.31  applicant to submit the following information:  
  5.32     (1) the original or certified copy of a high school diploma 
  5.33  or evidence of equivalent education; 
  5.34     (2) the original or certified copy of the certified 
  5.35  professional midwife certificate from the North American 
  5.36  Registry of Midwives; 
  6.1      (3) evidence, satisfactory to the board, that the applicant 
  6.2   is of good moral character; and 
  6.3      (4) an unmounted recent photograph of the applicant with 
  6.4   the affidavit of the applicant on the reverse side stating that 
  6.5   the photograph is that of the applicant. 
  6.6      Subd. 4.  [DEADLINE.] The board shall issue a license 
  6.7   within 30 days of receipt of a complete application that meets 
  6.8   the requirements of this section. 
  6.9      Subd. 5.  [INELIGIBLE APPLICANT.] An applicant who the 
  6.10  board has determined to be ineligible for licensure shall be 
  6.11  notified of such determination and the grounds for ineligibility 
  6.12  and shall be granted a hearing in accordance with the provisions 
  6.13  of Minnesota Rules, part 5615.0300, by filing a statement of 
  6.14  issues with the board within 20 days after receipt of such 
  6.15  notice from the board.  After the hearing, the board shall 
  6.16  notify the applicant, in writing, of its decision. 
  6.17     Subd. 6.  [FEE.] Each applicant shall pay a reasonable fee 
  6.18  set by the board.  Fees paid to the board shall be deposited in 
  6.19  the special revenue fund. 
  6.20     Sec. 4.  [148.315] [LICENSE RENEWAL.] 
  6.21     All licenses to practice midwifery issued by the board must 
  6.22  be renewed every three years.  To renew a license, an applicant 
  6.23  must complete a renewal application and pay a reasonable fee set 
  6.24  by the board. 
  6.25     Sec. 5.  Minnesota Statutes 1998, section 148.32, is 
  6.26  amended to read: 
  6.27     148.32 [LICENSES; DENIAL, REVOCATION, REFUSAL GROUNDS FOR 
  6.28  DISCIPLINARY ACTION.] 
  6.29     All licenses to practice midwifery heretofore or hereafter 
  6.30  issued by the board of medical practice must be renewed and a 
  6.31  fee paid for each renewal as set by the board.  
  6.32     Subdivision 1.  [GROUNDS LISTED.] Licenses may be revoked, 
  6.33  suspended, conditioned, limited, qualified or restricted, or 
  6.34  renewals refused by the board for unprofessional or dishonorable 
  6.35  conduct, or neglect to make proper returns to agents of a board 
  6.36  of health as authorized under section 145A.04 of births, deaths, 
  7.1   puerperal fever, and other contagious diseases which includes, 
  7.2   but is not limited to, the following:  (1) conviction of the 
  7.3   crime of criminal abortion or of a crime involving moral 
  7.4   turpitude; (2) neglect or refusal to promptly make proper 
  7.5   returns to an agent of a board of health as authorized under 
  7.6   section 145A.04 of births, deaths, puerperal fever, or of a 
  7.7   contagious or infectious disease; or (3) failure to promptly 
  7.8   secure the attendance of a duly licensed physician in the case 
  7.9   of a retained placenta, convulsions, prolapse of the umbilical 
  7.10  cord, fever during the puerperium stage, inflammation or 
  7.11  discharge from the eyes of the newborn infant or whenever 
  7.12  abnormal or unhealthy symptoms appear either in the mother or 
  7.13  infant during pregnancy, childbirth, or puerperium. 
  7.14     Subd. 2.  [AUTOMATIC SUSPENSION.] A license to practice 
  7.15  midwifery is automatically suspended if (1) a guardian of the 
  7.16  person of a licensee is appointed by order of a court pursuant 
  7.17  to sections 525.54 to 525.61, for reasons other than the 
  7.18  minority of the licensee; or (2) the licensee is committed by 
  7.19  order of a court pursuant to chapter 253B.  The license remains 
  7.20  suspended until the licensee is restored to capacity by a court 
  7.21  and, upon petition by the licensee, the suspension is terminated 
  7.22  by the board after a hearing. 
  7.23     Sec. 6.  [148.321] [EXEMPTIONS.] 
  7.24     Sections 148.30 to 148.32 do not apply to: 
  7.25     (1) gratuitous emergency services; 
  7.26     (2) a registered nurse or a certified nurse midwife 
  7.27  licensed under sections 148.171 to 148.285; 
  7.28     (3) a physician licensed under chapter 147; 
  7.29     (4) a person practicing midwifery in connection with the 
  7.30  spiritual convictions and practices of an established church or 
  7.31  religious denomination; or 
  7.32     (5) a person practicing midwifery in connection with the 
  7.33  cultural traditions of an ethnic community. 
  7.34     Sec. 7.  [REPEALER.] 
  7.35     Minnesota Rules, parts 5600.2000; and 5600.2100, are 
  7.36  repealed.