Medical Association Receives Board of Midwifery Rule Withdrawal

The Medical Association joined with the Alabama Hospital Association, the Alabama Board of Nursing, the Alabama Department of Public Health and the Alabama Chapter-American Academy of Pediatrics recently offered comment to the Alabama Board of Midwifery’s proposed rules concerning the passage of Act No. 2017-282 in May 2017 (regarding licensed midwives). The Medical Association requested the Board withdraw the proposals at this time. Subsequently, the Medical Association attended a meeting of the Board on May 4, 2018, in which the Board took that advice and withdrew the rules to start the process anew.

Generally, the Medical Association commented that the proposed rules failed to properly follow the requirements under Act No. 2017-282 (the “Act”) and substantially failed to adequately protect the public. The Medical Association was successful when the Act passed the last day of the legislative session in May 2017, in requiring licensed midwives to use informed consent, maintain levels of liability insurance, and provide certain statistics annually. The proposed rules failed to provide a duty for the Board to enforce any of these requirements as well as enforce many other statutory requirements. In fact, the proposed rules failed to even provide a duty that the Board establishes the minimum levels of liability insurance, as specifically required under the Act.

Below are some of the items upon which the Medical Association commented:

• Under the proposed rules, a licensed midwife was to make a “reasonable effort” to contact a receiving health care professional or receiving institution in an emergency transfer. The Medical Association commented that a licensed midwife must make “every effort” to contact the institution. The Medical Association strongly objected to a licensed midwife simply calling 911 and washing his or her hands of the matter to effect a transfer.
• The Board proposed a rule that it would only look at conduct for licensed midwives in the previous 12 months in a complaint. The Medical Association commented that the Board should look to all conduct and that 12 months, considering a pregnancy is nine months, is grossly insufficient.
• The Board attempted in the proposed rules to create a formulary for prescription drugs when neither the Act nor any other law, allowed licensed midwives to use prescription drugs.
• Under the proposed rules, licensed midwives were attempting to provide certain care for newborns. The Medical Association pointed out that nowhere in Alabama law is licensed midwives authorized to provide newborn care. Instead, the Medical Association suggested licensed midwives stabilize and transfer any newborn needing medical care.
• The Board attempted to establish the name of the Act as the Childbirth Freedom Act when no such name was given.
• The proposed rules failed to follow the Alabama Administrative Procedures Act.

In other words, the Medical Association believed that substantial changes in the proposed rules were necessary and that they should be redrafted to follow the law and protect clients sufficiently. The Medical Association was successful in convincing the Board that withdrawal of the rules was appropriate at this time.