THIRTIETH LEGISLATURE, 2019
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO THE LICENSURE OF MIDWIVES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The purpose of this Act is to resolve the lapse in regulation of midwifery and to regulate midwives engaged in the practice of midwifery by establishing licensure and regulatory requirements under the department of commerce and consumer affairs. The legislature notes that practicing midwifery according to this Act does not impede one's ability to incorporate or provide cultural practices.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
§ -1 Definitions. As used in this chapter:
"Certified professional midwife" means a person who holds a current and valid national certification as a Certified Professional Midwife from the North American Registry of Midwives, or any successor organization.
"Client" means a person under the care of a licensed midwife, as well as the person's fetus and newborn child.
"Department" means the department of commerce and consumer affairs.
"Director" means the director of commerce and consumer affairs.
"Informed Consent" means the consent obtained following a thorough and easily understood explanation of the information to the mother or the mother’s guardian.
"North American Registry of Midwives" means the organization that sets national standards for the certified professional midwife credential.
"Prenatal" means the period of time from conception to the onset of labor.
"Traditional Midwife" means an individual who is acting as a traditional midwife, focusing particularly on low-risk pregnancy, and does not use legend drugs and devices, does not advertise as a midwife, and provides the required disclosures to clients that the individual is practicing midwifery in this State without a license to practice midwifery, and the client has provided informed consent.
§ -2 Midwife licensure program. There is established a licensed midwife program within the department to be administered by the director.
§ -3 Powers and duties of the director. In addition to any other powers and duties authorized by law, the director shall have the powers and duties to:
(1) Grant permission to a person to use the title of certified professional midwife and engage in the practice of midwifery in this State pursuant to this chapter and the rules adopted pursuant thereto;
(2) Adopt, amend, or repeal rules pursuant to chapter 91 to carry out the purposes of this chapter;
(3) Administer, coordinate, and enforce this chapter and rules adopted pursuant thereto;
(4) Discipline a licensee for any cause described by this chapter or for any violation of rules or refuse to license a person for failure to meet the licensing requirements for any cause that would be grounds for disciplining a licensee; and
(5) Appoint an advisory committee to assist with the implementation of this chapter and the rules adopted thereto. The advisory committee shall consist of the following:
(B) An obstetrician-gynecologist; and
(C) Two public members who have either received midwifery services or have an interest in the rights of consumers of midwifery services and who have never been a primary attendant or assistant at a birth.
§ -4 License required. (a) No person shall engage in the practice of midwifery, or use the title "licensed certified professional midwife", "midwife", "certified professional midwife" or the abbreviation "C.P.M.", or any other words, letters, abbreviations, or insignia indicating or implying that the person is a licensed certified professional midwife without a valid license issued pursuant to this chapter. The director may begin to accept applications for licensure beginning on July 1, 2019. Provisional licensure may be granted pursuant to section -6; provided that all persons engaged in the practice of midwifery, as provided by this chapter, shall be licensed by January 1, 2024.
(b) Nothing in this section shall preclude a person holding a national certification as a midwife from identifying the person as holding such certification, so long as the person is not practicing midwifery or professing to be authorized to practice midwifery in the State unless that person is licensed in accordance with this chapter.
§ -5 Exemptions. (a) Licensure shall not be required of:
(1) Any licensed person doing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery; provided the person does not purport to be a midwife;
(2) A student midwife providing midwifery services who is currently enrolled in a midwifery educational program under the direct supervision of a qualified midwife preceptor;
(3) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; and
(4) A person acting as a traditional midwife.
(b) Nothing in this chapter shall prohibit healing practices by traditional Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and childcare as recognized by any council of kupuna convened by Papa Ola Lokahi. Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii.
§ -6 Provisional licensure. The director shall grant, upon application and payment of proper fees, provisional licensure to those persons that satisfy the licensing requirements but have not yet acquired a license pursuant to section -5; provided that a provisional license shall expire on January 1, 2024, or upon a person receiving full licensure, whichever is sooner.
§ -7 Fees; disposition. (a) Application, examination, reexamination, license, renewal, late renewal penalty fees, and other reasonable and necessary fees relating to administration of this chapter, none of which are refundable, shall be as provided in rules adopted by the director.
(b) Each applicant shall pay a licensing fee upon application for an initial or renewal of license.
(c) Pursuant to section 26-9(l), the director may establish fees for the restoration of a license, penalty fees, and any other fees required for the administration of this chapter by rule.
(d) All fees collected pursuant to this chapter shall be deposited by the director to the credit of the compliance resolution fund established pursuant to section 26-9(o).
(e) Fees assessed pursuant to this chapter shall be used to defray costs incurred by the department in implementing this chapter and shall be managed in accordance with section 26-9(l). § -8 Application for license as a certified professional midwife. (a) To obtain a license under this chapter, the applicant shall provide:
(1) An application for licensure;
(2) The required fees;
(3) Proof of current, unencumbered certification as a certified profession midwife with the North American Registry of Midwives;
(4) If applicable, evidence of any licenses held or once held in other jurisdictions indicating the statistics of the license and documenting any disciplinary proceedings pending or taken by any jurisdiction;
(5) Information regarding any conviction of any crime which has not been annulled or expunged; and
(6) Any other information the department may require to investigate the applicant's qualifications for license.
§ -9 Issuance of license. The director may issue a license to any person who meets all licensure requirements and pays the appropriate fees.
§ -10 Renewals. (a) Every license issued under this chapter shall be renewed triennially on or before June 30, with the first renewal deadline occurring on June 30, 2027. Failure to renew a license shall result in a forfeiture of the license. Licenses which have been so forfeited may be restored within one year of the expiration date upon payment of renewal and penalty fees. Failure to restore a forfeited license within one year of the date of its expiration shall result in the automatic termination of the license and relicensure may be subject to the person applying as a new applicant and satisfying again all licensing requirements in place at the time of application.
(b) Every license renewal, reinstatement, or restoration shall be subject to the provisions of section -11.
§ -11 Grounds for refusal to renew, reinstate or restore and for revocation, suspension, denial, or condition of licenses. In addition to any other acts or conditions provided by law, the director may refuse to renew, reinstate or restore, or may deny, revoke, suspend, or condition in any manner, any license for any one or more of the following acts or conditions on the part of the licensee or the applicant thereof:
(1) Failure to meet or maintain the conditions and requirements necessary to qualify for the granting of a license;
(2) Engaging in false, fraudulent, or deceptive advertising, or making untruthful or improbable statements;
(3) Being addicted to, dependent on, or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, opium, or cocaine, or other drugs or derivatives of a similar nature;
(4) Practicing as a licensed midwife while impaired by alcohol, drugs, physical disability, or mental instability;
(5) Procuring a license through fraud, misrepresentation, or deceit;
(6) Aiding and abetting an unlicensed person to directly or indirectly perform activities requiring a license;
(7) Professional misconduct, incompetence, gross negligence, or manifest incapacity in the practice of the licensed profession or vocation;
(8) Failure to maintain a record or history of competency, trustworthiness, fair dealing, and financial integrity;
(9) Conduct or practice contrary to recognized standards of ethics for the practice of midwifery;
(10) Violating any condition or limitation upon which a conditional or temporary license was issued;
(11) Engaging in business under a past or present license issued pursuant to this chapter, in a manner causing injury to one or more members of the public;
(12) Failure to comply, observe, or adhere to any law in a manner such that the director deems the applicant or holder to be an unfit or improper person to hold a license;
(13) Revocation, suspension, or other disciplinary action by another state or federal agency against a licensee or applicant for any reason provided by the licensing laws or this section;
(14) Criminal conviction, whether by nolo contendere or otherwise, of a penal crime directly related to the qualifications, functions, or duties of the licensed midwife;
(15) Failure to report in writing to the director any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty days of the disciplinary decision;
(16) Employing, utilizing, or attempting to employ or utilize at any time any person not licensed under this chapter where licensure is required; or
(17) Violating this chapter, any other applicable licensing laws, or any rule or order of the director.
§ -12 Registration required. All currently practicing midwives offering services shall file with the director of commerce and consumer affairs an application for registration on a form prescribed by the director which shall include:
(1) Number of births;
(2) Number of years practiced;
(3) Training; and
(4) Disclosure of bad outcomes;
provided that all currently practicing midwives must attain full licensure pursuant to this chapter by January 1, 2024.
SECTION 3. There is appropriated out of the compliance resolution fund established pursuant to section 26-9(o), Hawaii Revised Statutes the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 to implement the licensure of midwives as required by this Act.
The sums appropriated shall be expended by the department of commerce and consumer affairs for the purposes of this Act.
SECTION 4. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 5. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 6. This Act shall take effect on July 1, 2050.
Licensure; Midwives; Department of Commerce and Consumer Affairs; Appropriation
Establishes licensure of midwives. Exempts Native Hawaiian healers from licensure requirements. Requires registration for current practicing midwives by 1/1/2024, and thereafter full licensure must be obtained. Provides provisional licensure until full licensure can be obtained. Appropriates funds from the compliance resolution fund. Effective 7/1/2050. (SD1)
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