Part XXXVIII.
Texas Midwifery Board
Chapter 831.
Midwifery
With the approval of the Texas Board of Health, the Texas Midwifery
Board (board) adopts new §§831.11, 831.31, 831.101, and 831.161
concerning the documentation and regulation of midwives. Specifically, the
sections cover Annual Documentation; Education; Administration of Oxygen;
and Complaint Review. Sections 831.11, 831.31, 831.101, and 831.161 are adopted
with changes to the proposed text as published in the January 1, 1999, issue
of the
Texas Register
(24 TexReg 36).
Effective December 1, 1998, the Midwifery Program and the Midwifery Board
were administratively transferred from the Texas Department of Health (department),
Women's Health Division, to the Professional Licensing and Certification Division
of the department. The rules were located in 25 Texas Administrative Code
(TAC), and the department adopted the repeal of 25 TAC §§37.175,
37.178, and 37.180 in order that the new sections may be adopted by the Texas
Midwifery Board, which is listed as an independent board under 22 TAC. The
repeal of 25 TAC §§37.175, 37.178, and 37.180 can be found in this
same issue of the
Texas Register
in the Adopted
Rules section.
The new sections implement the applicable provisions of the Texas Midwifery
Act (the Act), Texas Civil Statutes, Article 4512i, §8A(b), which authorizes
the board to adopt rules concerning documentation and educational requirements
for midwives; processing of complaints concerning midwives; and any additional
rules necessary to implement any duty imposed by the Act, subject to the approval
of the Texas Board of Health.
New §831.11 establishes procedures for documentation by reciprocity;
prescribes conditions for denial, revocation, suspension or surrender of documentation;
and establishes standards for documentation of persons with criminal convictions
and for documentation after revocation, suspension, or surrender. New §831.31
establishes procedures for approving, denying, or revoking approval of midwifery
basic education and continuing education courses; establishes an approved
comprehensive midwifery exam and procedures for approval, denial, or revocation
of approval for other comprehensive exams; and establishes procedures for
the investigation and disposition of complaints concerning currently approved
courses or exams. New §831.101 establishes procedures for the intrapartum
and postpartum administration of oxygen by midwives. New §831.161 establishes
procedures for complaint investigation and disposition; categories of complaints;
and disciplinary sanctions, including revocation of documentation and administrative
penalties.
Minor editorial changes were made to improve the accuracy of the sections.
The following comments were received concerning the proposed sections.
Following each comment is the board's response and any resulting change(s).
Comment: Concerning §831.11(d)(2)(A), several commentors stated that
reference to Athe American College of Nurse Midwifery (ACNM) exam" should
be deleted. The commentors emphasized that the ACNM Core Competencies upon
which this exam is based are inconsistent with the Midwives Alliance of North
America (MANA) Core Competencies upon which approved basic midwifery education
courses in Texas must be based, and that the type of practice for which the
ACNM exam is designed to ensure competency is incompatible with the current
standards of practice for documented midwives in Texas.
Response: The board agrees and has amended the section accordingly.
Comment: Concerning §831.11(d)(2)(A), one commentor stated that the
reference to Athe American College of Nurse Midwifery (ACNM) exam@ should
be deleted as unnecessary at this time, becasue no school located in Texas
currently offers training leading to certified midwife (CM) status, and there
are only seven ACNM CMs in the United States.
Response: The board agrees and has amended the section accordingly.
Comment: Concerning §831.11(d)(2)(A), several other commentors suggested
that the reference to Athe American College of Nurse Midwifery (ACNM) exam@
should be deleted as unnecessary because a CM who wishes to practice in Texas
may become a Certified Professional Midwife (CPM) by meeting the requirements
of the North American Registry of Midwives (NARM). One commentor also pointed
out that NARM has established a relatively inexpensive mechanism for certification
of CMs as CPMs.
Response: The board agrees and has amended the section accordingly.
Comment: Concerning §831.11(d)(2)(A), one commentor supported inclusion
of language to authorize approval of a CM course as a basic midwifery education
course, and suggested that the section should also refer to the ACNM Core
Competencies.
Response: The board disagrees and has deleted the reference to "the American
College of Nurse Midwifery (ACNM) exam" as unnecessary.
Comment: Concerning §831.11(d)(2)(A), one commentor asked that the
language be clarified to show who had Aapproved@ a basic midwifery education
course.
Response: The board agrees and has amended the section by adding the phrase,
Aapproved by the Midwifery Board@.
Comment: Concerning §831.11(d)(2)(A), several commentors stated that
the AACNM exam@ should properly be called Athe ACNM Certification Council,
Inc. (ACC) exam@, because it is administered by the ACNM Certification Council,
Inc. (ACC).
Response: The board acknowledges the clarification, but the complete reference
to the "ACNM exam" has been deleted as unnecessary. No change was made as
a result of this comment.
Comment: Concerning §831.11(d)(2), several commentors requested that
the board retain the power to waive compliance with this requirement for initial
documentation based upon an applicant's petition showing good cause. The commenters
added that reciprocity through NARM is becoming much more expensive, and stated
that some states such as Florida utilize portions of the NARM process for
licensing or credentialing midwives, but do not require the CPM.
Response: The board disagrees with the commentors. The board believes that
national midwifery certification provides a high, consistent, and fair standard
and should remain the only alternate route to initial documentation in Texas
for midwives trained out of state. No change was made as a result of this
comment.
Comment: Concerning §831.11(d)(2)(A), one commentor suggested that
midwives certified by the ACNM Certification Council should be allowed to
practice in Texas by presenting evidence of that certification. The commentor
suggested the section should be amended as follows: Acertification by NARM
as a certified professional midwife (CPM) or by ACC as a certified midwife
(CM) and completion of a continuing education course . . . .A.
Response: The board disagrees because the education and training of a CM
is very different from the education and training appropriate to the scope
of practice afforded a documented midwife in Texas. Any CM who wishes to practice
in Texas should do so by becoming a CPM. No change was made as a result of
this comment.
Comment: Concerning §831.11(d)(2), one commentor praised the rules
for not including CM certification, describing the ACNM Core Competencies
as neither adequate nor appropriate for home birth practice.
Response: The board acknowledges the comment and will require a CM seeking
documentation in Texas to become a CPM.
Comment: Concerning §831.11(d)(6), one commentor suggested that the
initial documentation fee should be payable in quarterly installments because
midwives also must pay the cost of the CPM application process or a continuing
education course, in addition to the fee for the NARM written exam.
Response: The board disagrees because the Texas Midwifery Act requires
individuals to apply annually by submitting an application and annual documentation
fee set by the Midwifery Board. The Act does not authorize quarterly installment
payments. No change was made as a result of this comment.
Comment: Concerning §831.11(e), one commentor suggested that midwives
should be allowed to document for a two-year period, rather than annually.
Response: The board disagrees because the Texas Midwifery Act, §13,
mandates annual documentation. No change was made as a result of this comment.
Comment: Concerning §831.11(e), several commentors stated that the
rules should authorize the board to temporarily exempt a midwife from one
or more of the requirements for redocumentation, including continuing education,
CPR certification, and neonatal resuscitation certification. The commentors
described one midwife documented in Texas who is currently doing missionary
work in a remote area in Africa where no CPR or neonatal resuscitation courses
are available as an example of the need for this change.
Response: The board disagrees because the Midwifery Act, §10, does
not authorize the board to exempt applicants for redocumentation from the
requirements for CPR certification and, by extension, neonatal resuscitation.
However, the board does not believe temporary exemption of applicants from
redocumentation requirements is necessary, even if legally permissible, because
the requirements apply only to midwives practicing in Texas. No change was
made as a result of the comment.
Comment: Concerning §831.11(e)(2), a commentor stated that the rules
should afford midwives the option of obtaining 30 hours of continuing midwifery
education every three years in addition to obtaining 10 hours per year.
Response: The board disagrees. Based on past experience, the board believes
that a significant number of midwives will wait until the third year and then
rush to complete their continuing education. Tracking continuing education
hours over a three-year period, particularly for those midwives who subsequently
allow their documentation to lapse, would also constitute an unnecessary administrative
burden. No change was made as a result of this comment.
Comment: Concerning §831.11(e)(2), one commentor stated that recertification
as a CPM should be accepted for credit as continuing education hours.
Response: The board disagrees. Options otherwise available to midwives
seeking NARM recertification include obtaining 30 hours of continuing education
over a three-year period, which would contradict §831.11(e)(2). No change
was made as a result of this comment.
Comment: Concerning §831.11(e)(5), commentor suggested that a sliding
fee scale should be established for midwives who work in Texas for only a
few weeks each year. The commenter added that some out-of-state midwives come
to Texas annually to provide relief (e.g., in birthing centers), but do not
regularly practice midwifery in the state.
Response: The board disagrees. The legal and administrative requirements
for documentation are not affected by the amount of time a midwife practices
in Texas or the number of clients attended per year. No change was made as
a result of this comment.
Comment: Concerning §831.11(h)(1)(B), one commentor suggested adding
Aor the current ACNM Core Competencies and Standards of Practice.@
Response: The board disagrees because the education and training of a CM
is very different from the education and training appropriate to the scope
of practice afforded a documented midwife in Texas, and would not constitute
appropriate midwifery continuing education for the purposes of this section.
No change was made as a result of this comment.
Comment: Concerning §831.11(i)(12), one commentor stated that the
phrase Ademonstrated lack of personal or professional character@ is too vague
and should be specifically defined.
Response: The board disagrees. "Demonstrated lack of personal or professional
character" constitutes a legally valid basis for disciplinary action against
a documented midwife without specifically listing each type of conduct. However,
the board may not take disciplinary action in any case unless Texas Department
of Health's Licensing and Certification Division has presented sufficient
evidence to substantiate a violation. No change has been made as a result
of this comment.
Comment: Concerning §831.31(e)(1), one commentor suggested deleting
Ain Texas.@
Response: The board disagrees and will not accept applications for approval
from basic midwifery education courses located outside the State of Texas.
The appropriate route to documentation in Texas for midwives trained at out-of-state
schools is through completion of a national midwifery certification process.
No change has been made as a result of this comment.
Comment: Concerning §831.31(e)(2)(C)(i), one commenter suggested that
in order to facilitate the establishment of an ACNM-accredited (CM) training
program for certified midwives in Texas at some future date, the section should
be amended as follows: A. . . (MANA) or the ACNM Core Competencies and Standards
of Practice and the current Texas Midwifery Basic Information Manual@.
Response: The board disagrees because the ACNM Core Competencies and Standards
of Practice are very different from the MANA Core Competencies and Standards
of Practice, and thus are not appropriate to the scope of practice afforded
a documented midwife in Texas. The Midwifery Board should not regulate an
ACNM-accredited training program for certified midwives due to these differences.
No change was made as a result of this comment.
Comment: Concerning §831.31(e)(2)(C)(ii), one commenter suggested
that in order to facilitate the establishment of an ACNM-accredited training
program for certified midwives in Texas at some future date, the section should
be amended as follows: A. . . (NARM) or the ACNM Certification Council, Inc.
(ACC); and;A.
Response: The board disagrees because the ACNM Core Competencies and Standards
of Practice are very different from the MANA Core Competencies and Standards
of Practice, and thus are not appropriate to the scope of practice afforded
a documented midwife in Texas. The board should not regulate an ACNM-accredited
training program for certified midwives due to these differences. No change
was made as a result of this comment.
Comment: Concerning §831.31(e)(2)(C)(ii), one commentor stated that
the section does not describe how a school's ability to prepare a student
to become certified by NARM will be assessed. The commentor suggested that
a school's assessment should reflect student performance on the NARM written
exam.
Response: The board agrees that a school's performance must be assessed
as a part of the course approval process, but disagrees that this level of
specificity is required in rule. No change was made as a result of this comment.
Comment: Concerning §831.31(e)(2)(D)(ii), one commentor suggested
that the clause should be amended to enable nurse-midwives to serve as course
supervisors for basic midwifery education courses.
Response: The board's use of the word Amidwifery@ was originally intended
to include nurse-midwives. The board agrees that a certified nurse-midwife
would be an appropriately trained person to supervise a basic midwifery education
course, and has amended the section accordingly.
Comment: Concerning §831.31(e)(2)(F), one commenter suggested that
in order to facilitate the establishment of an ACNM-accredited training program
for certified midwives in Texas at some future date, the section should be
amended as follows: A... certified by NARM or the ACNM Certification Council,
Inc. (ACC), including successful completion . . . ".
Response: The board disagrees because the ACNM Core Competencies and Standards
of Practice are very different from the MANA Core Competencies and Standards
of Practice, and thus are not appropriate to the scope of practice afforded
a documented midwife in Texas. The board should not regulate an ACNM-accredited
training program for certified midwives due to these differences. No change
was made as a result of this comment.
Comment: Concerning §831.31(e)(2)(F), one commentor stated that the
proposed wording appears to make the school rather than the student responsible
for securing a preceptor, and that some problematic students may be difficult
to integrate into midwifery practice. The commentor suggested amending the
section to require only that schools must Aoffer@ or Amake available@ rather
than "provide" clinical experience/preceptorship.
Response: The board acknowledges that some students will encounter difficulties
entering midwifery practice but believes that the school should be responsible
for providing the required clinical experience. Any difficulties presented
by problematic students should be addressed through individual school policy.
No change was made as a result of this comment.
Comment: Concerning §831.31(e)(2)(F), one commentor suggested that
a minimum number of hours should be prescribed for the completion of clinical
course work, in keeping with the NARM Position Statement on AEducational Requirements
for the Certified Professional Midwife (CPM)@ which requires that the clinical
component be at least one year in duration, the equivalent to at least 1360
clinical contact hours under the supervision of a preceptor(s).
Response: The board agrees and has amended the section accordingly.
Comment: Concerning §831.31(e)(2)(G), one commentor stated that certified
nurse midwives or physicians should serve as preceptors only if there is no
midwife with a home birth practice available.
Response: The board disagrees. Administrators of basic midwifery education
courses should be able to select physicians, certified nurse midwives, certified
professional midwives, or documented midwives to serve as preceptors. The
commentor's concern about home birth is addressed by §831.31(e)(2)(F)(ii),
which requires each student to complete at least 10 out-of-hospital births
as the primary midwife under supervision. No change was made as a result of
this comment.
Comment: Concerning §831.31(e)(2)(G), one commentor stated that Acertified
midwives@ should be added.
Response: The board disagrees. Since Acertified midwives@ are not authorized
to practice midwifery in Texas unless they are already Adocumented midwives@,
the proposed amendment is unnecessary. No change was made as a result of this
comment.
Comment: Concerning §831.31(e)(2)(G)(i), one commentor stated that
documented midwives serving as preceptors should meet the same standards as
preceptors described in the NARM Position Statement on AEducational Requirements
for the Certified Professional Midwife (CPM)@; i.e., practice as a primary
attendant without supervision for a minimum of 50 out-of-hospital births,
and a minimum of three years.
Response: The board disagrees. Adoption of the higher standard would impose
an unnecessary hardship on some midwives in rural areas, who might not be
able to find a preceptor locally with the requisite experience. Retaining
the current language would not, however, preclude an education course from
imposing more stringent requirements upon preceptors approved by the course,
such as those for CPM preceptors. No change was made as a result of this comment.
Comment: Concering §831.31(e)(4)(A)(ii), one commentor stated that
a course curriculum should also be required to include content references
to Athe NARM Written Test Specifications@ to assure that the course adequately
prepares a student to become certified as a CPM. The commentor stated that
this must have been an inadvertent omission, as the ANARM Skills Test Specifications@
are already included. The commentor also stated that perhaps the NARM AWritten
Examination Primary Reference List@ and AWritten Examination Secondary Reference
List@ should also be added to assure that all appropriate subjects were covered.
Response: The board agrees that specific content references to "the NARM
Written Test Specifications" should be required and has amended the section
accordingly. However, the board disagrees that initial applications for course
approval should be required to include specific content references to the
NARM References Lists. Since all the books on those lists are in English,
such a requirement would also present a barrier to a person seeking approval
for a course taught in Spanish.
Comment: Concerning §831.31(e)(4)(A)(ii)(I), one commenter suggested
that in order to facilitate the establishment of an ACNM-accredited training
program for certified midwives in Texas at some future date, the section should
be amended as follows: "MANA Core Competencies or ACNM Core Competencies."
Response: The board disagrees because the ACNM Core Competencies and Standards
of Practice are very different from the MANA Core Competencies and Standards
of Practice, and thus are not appropriate to the scope of practice afforded
a documented midwife in Texas. The board should not regulate an ACNM-accredited
training program for certified midwives due to these differences. No change
was made as a result of this comment.
Comment: Concerning §831.31(e)(6), a commentor stated that course
approval by reciprocity should also be available for a course currently accredited
by the ACNM's Division of Accreditation if the amendment would allow midwives
who have met all other requirements to practice in Texas. The commentor stated
that if certified midwives who have completed ACNM-accredited education programs
outside of Texas would remain ineligible for documentation by the board, other
sections of the rules should be amended to permit this change.
Response: The board intended to exempt courses, such as those certified
by MEAC, which already meet or exceed the board's requirements for approval.
The board disagrees with the proposed revision because the ACNM Core Competencies
and Standards of Practice are very different from the MANA Core Competencies
and Standards of Practice, and thus are not appropriate to the scope of practice
afforded a documented midwife in Texas. The board therefore declines to approve
ACNM-accredited CM training programs located in or out of state by reciprocity.
No change was made as a result of this comment.
Comment: Concerning §831.31(f)(1)(A)(iv), one commentor asked why
an applicant for comprehensive exam approval should be required to provide
references to the MANA Core Competencies included in the exam.
Response: Requiring references to the MANA Core Competencies allows the
board's Education Committee to better evaluate any exam submitted for approval.
The content of the exam will be more clearly correlated to the content of
approved basic midwifery education courses in Texas.
Comment: Concerning §831.31(f)(1)(A)(iv), one commentor suggested
that approval of comprehensive examinations based on the ACNM Core Competencies
should also be permitted.
Response: The board disagrees because the ACNM Core Competencies and Standards
of Practice are very different from the MANA Core Competencies and Standards
of Practice, and thus are not appropriate to the scope of practice afforded
a documented midwife in Texas. The board therefore declines to approve exams
based on the ACNM Core Competencies due to these differences. No change was
made as a result of this comment.
Comment: Concerning §831.101 in general, one commentor stated that
the section should be amended to permit administration of oxygen to the mother
via nasal cannula at 3-4 liters/minute.
Response: The board disagrees because administration of oxygen to a mother
or infant in distress is more efficient by mask than by nasal cannula. No
change was made as a result of this comment.
Comment: Concerning §831.101 in general, one commentor stated that
the section should be amended to permit administration of oxygen to the mother
only when the mother is positioned on her left side.
Response: The board disagrees. The commentor provided no reason for the
proposed amendment, and the board generally considers this degree of specificity
unnecessary. No change was made as a result of this comment.
Comment: Concerning §831.101 in general, several commenters stated
that in order to administer oxygen in accordance with the guidelines suggested
in these rules, midwives must procure not only oxygen but also the supplies
necessary to administer it. The commenters added that some suppliers have
refused to sell supplies to midwives, citing a lack of specific authority.
Response: The board agrees that Subchapter D should be amended to clarify
midwives' authority to purchase and possess supplies for the administration
of oxygen. New §831.101(d) has been added which authorizes midwives to
purchase the equipment and supplies listed in the American Heart Association
Cardiopulmonary Resuscitation Guidelines and the American Academy of Pediatrics
Neonatal Resuscitation Guidelines for the administration of oxygen.
Comment: Concerning §831.101(c)(1), several commentors stated that
the section should be amended to permit administration of oxygen to the mother
for "comfort", for a "tired mom", or "to calm the mother".
Response: The board disagrees. Midwives who choose to administer oxygen
to a mother in labor should do so only while assessing for consultation, possible
transfer, or transport. No change was made as a result of this comment.
Comment: Concerning §831.101(c)(2)(A), several commentors stated that
the section is unclear, inconsistent with American Academy of Pediatrics certification
in Neonatal Resuscitation guidelines, and should be amended accordingly. Specific
comments included the assertion that the flow should be 8 liters/minute for
a full-term newborn; that the guidelines suggest administration of 5 liters/minute
rather than 1-2 liters/minute when resuscitating a newborn; that oxygen should
be available to "pink up" the baby; and that "while monitoring in accordance
with the standards" should be added to this section. One commentor stated
that the rules should exactly reflect the language used in the Neonatal Resuscitation
course to be amended as follows: "to the newborn via free-flow oxygen by mask
or oxygen tubing using a cupped hand over the baby's face at a rate of 5 liters,
concurrent with American Academy of Pediatrics certification in Neonatal Resuscitation
guidelines;...".
Response: The board agrees and has amended §831.101(c)(2) accordingly.
Comment: Concerning §831.101(c)(2)(A), one commentor stated that the
section should be amended to specify administration of postpartum oxygen to
the newborn via infant or newborn mask.
Response: The board acknowledges the clarification, but the broader scope
of the amendment to §831.101(c)(2) makes this change unnecessary.
Comment: Concerning §831.161(c)(1)(B), one commentor expressed concerns
about confidentiality if the Complaint Review Committee includes persons who
are not members of the Midwifery Board. Two other commentors expressed concerns
about liability issues, and another commentor questioned the necessity of
paying travel expenses for so many committee members.
Response: The board agrees and has amended the section to address these
concerns.
Comment: Concerning §831.161 in general, one commentor stated that
a statute of limitations on complaints should be added to the subchapter.
Response: The board agrees and has added new §831.161(d)(2)(C).
Comment: Concerning §831.161 in general, one commentor stated that
Subchapter E should be amended to include a time limit on maintenance of complaint
files.
Response: The board disagrees. Complaint files are "state records" under
Government Code, §441.180(11) and therefore may be destroyed by the department
only in accordance with Government Code, §441.187. The board may not
adopt rules which authorize a shorter retention period than that specified
by the department's approved records retention schedule, and has chosen not
to adopt rules specifying a longer retention period. No change was made as
a result of this comment.
Comment: Concerning §831.161(f)(1)(C), one commentor stated that inclusion
of "an alleged violation of the Act and/or rules involving a potential for
deception, fraud, or injury to clients or the public" as a complaint category
was too vague, because a midwife might be held liable without evidence of
actual harm done.
Response: The board disagrees. The Midwifery Program must be able to investigate
and act upon complaints alleging violation of the Act and/or rules even if
no person has actually suffered harm as a result of the violation. No change
was made as a result of this comment.
Comment: Concerning §831.161(g)(3), two commentors suggested that
Afailure to receive informed consent@ should be added to the section as a
specific example of failure to practice midwifery in a manner consistent with
public health and safety. One commentor proposed the following specific language:
Afailure to give signed informed consent as to conditions in a client's care
which is (sic) defined as 'out of the range of normal' , or potentially 'high-risk',
according to Texas Standards of Practice.@
Response: The board disagrees, because §831.51(b)(2), Midwifery Practice
Standards and Principles, already guarantees the client's right to make an
informed choice. No change was made as a result of this comment.
Comment: Concerning §831.161(g)(3)(B)(ii), several commentors stated
that the term "abandonment" should be defined with more specificity. Some
commentors asked how a midwife should discontinue providing midwifery care
to a client "immediately before labor" so as to avoid disciplinary action
under this section. Other commentors questioned how a midwife could avoid
potential disciplinary sanctions for violation of either §831.51, concerning
the Midwifery Practice Standards and Principles, or §831.161(g)(3)(B)(ii),
concerning abandonment, when confronted with a client in labor who refuses
the midwife's attempts to transfer care to another health care provider as
required by the standards.
Response: Texas courts define abandonment in reference to a physician's
professional responsibilities as the physician's unilateral severance of the
professional relationship between the physician and patient without reasonable
notice at a time when there still exists the necessity of medical attention.
The board accepts this definition as appropriate for midwifery practice, but
disagrees that specific examples or practice guidance concerning avoidance
of client abandonment by midwives should be included in this rule. If more
specific guidance concerning a midwife's responsibilities concerning a client
in labor who refuses the midwife's attempts to transfer care to another health
care provider are necessary, amendment of §831.51 rather than this section
would be appropriate. No change was made as a result of this comment.
Comment: Concerning §831.161(i)(2)(A), one commentor stated that the
third sentence, concerning holding a settlement conference whether or not
the midwife is present, is confusing because a settlement conference would
only be conducted with the midwife present.
Response: The board agrees and has deleted the sentence. The comments on
the proposed rules received by the Midwifery Board during the comment period
were submitted by individual midwives, by midwifery associations, by the Midwifery
Board, by Midwives Alliance of North America (MANA), by the North American
Registry of Midwives (NARM), by American College of Nurse-Midwives (ACNM)
and by department staff. The commentors were neither for nor against the rules
in their entirety; however, they raised questions, offered comments for clarification
purposes, and suggested clarifying language concerning specific provisions
in the rules.
Subchapter B. Documentation
22 TAC §831.11
The new section is adopted under the Texas Midwifery Act,
Texas Civil Statutes, Article 4512i, §8A(b), which provides the board
with the authority to adopt rules concerning the practice of midwifery, subject
to the approval of the Texas Board of Health.
§831.11. Annual Documentation.
(a)
Purpose. This section details requirements for the annual
documentation and redocumentation after revocation, suspension, or the surrender
of documentation of midwives in Texas.
(b)
Provisions. This section establishes:
(1)
requirements and procedures for initial documentation;
(2)
requirements and procedures for annual redocumentation;
(3)
conditions for denial, revocation, suspension, or
surrender of documentation;
(4)
guidelines for reissuance of documentation after
revocation, suspension, or surrender of documentation;
(5)
guidelines for documentation of persons with criminal
convictions; and
(6)
a state midwifery roster.
(c)
Applicability. In order for an individual to legally practice
midwifery in Texas, she/he must be currently documented with the Midwifery
Program. Documentation shall be valid for a period of one year, except for
initial documentation. A midwife's initial documentation shall be valid from
the date issued until March 1 of the current or following year, whichever
occurs first.
(d)
Initial documentation. An individual may apply for documentation
as a midwife at any time during the year by submitting the following to the
Midwifery Program:
(1)
a completed documentation application form;
(2)
proof of:
(A)
satisfactory completion of a mandatory basic midwifery
education course approved by the Midwifery Board and the North American Registry
of Midwives (NARM) exam or any other comprehensive exam approved by the Midwifery
Board; or
(B)
certified professional midwife (CPM) certification by
NARM and satisfactory completion of a continuing education course covering
the current Texas Midwifery Basic Information and Instructors Manual;
(3)
proof of current cardiopulmonary resuscitation
(CPR) certification for health care providers by the American Heart Association
(formerly a C certificate) or equivalent certification for the professional
rescuer from the Red Cross;
(4)
proof of current certification for neonatal resuscitation,
§§1-4, from the American Academy of Pediatrics, effective March
1, 1999;
(5)
proof of satisfactory completion of training in the
collection of newborn screening specimens or an established relationship with
another qualified and appropriately credentialed health care provider who
has agreed to collect newborn screening specimens on behalf of the applicant;
and
(6)
a nonrefundable $200 application fee (payable by
cashiers check or money order only). The fee for any application for initial
documentation received after September 1 shall be $100 plus $10 per month
or part thereof remaining in the documentation period.
(e)
Annual redocumentation. Documented midwives must apply
for redocumentation in January each year. Documentation expires March 1. The
Midwifery Program will send renewal applications to all documented midwives
in December of each year. However, each midwife is solely responsible for
compliance with the requirements for redocumentation, and nonreceipt of the
renewal application mailed by the Midwifery Program shall not constitute an
acceptable excuse for failure to comply. A midwife's application for redocumentation
must include the following:
(1)
a completed redocumentation application form;
(2)
proof of completion of at least ten contact hours
of approved continuing midwifery education since March 1 of the previous year;
(3)
proof of current CPR certification for health care
providers by the American Heart Association (formerly a C certificate) or
equivalent certification for the professional rescuer from the Red Cross;
(4)
proof of current certification for neonatal resuscitation,
§§1-4, from the American Academy of Pediatrics, effective March
1, 1999; and
(5)
a nonrefundable $200 application fee (payable by
cashiers check or money order only).
(f)
Late redocumentation. A midwife who fails to apply for
redocumentation by March 1 of a year in which the midwife is currently documented,
as evidenced by a valid U.S. Postal Service or recognized commercial carrier
postmark, may apply for late redocumentation on or before March 31 of that
year. Applications for late redocumentation must include the following:
(1)
each of the items listed in subsection (e) of this section;
and
(2)
an additional nonrefundable $75 late filing fee (payable
by cashiers check or money order only).
(g)
Redocumentation after interim of less than four years.
A midwife originally documented in Texas on or after January 1, 1995, who
since that time has not been documented for a period of less than four years
may redocument by:
(1)
providing proof of having completed 20 contact hours of
approved midwifery continuing education, including a continuing education
course covering the current Texas Midwifery Basic Information and Instructor
Manual, during the 12 months preceding the application for redocumentation;
(2)
paying the annual documentation fee plus a processing
fee of $100; and
(3)
meeting the initial documentation requirements in
subsections (d)(1) and (d)(3)-(5) of this section.
(h)
Redocumentation after interim of more than four years.
A midwife documented in Texas on or after January 1, 1995, who has not been
documented for a period of more than four years may redocument by:
(1)
providing proof of having completed at least 40 contact
hours of approved continuing midwifery education within the year preceding
the application, which shall be based upon a review of:
(A)
the current Texas Midwifery Basic Information and Instructor
Manual; and
(B)
the current Midwives Alliance of North America (MANA)
Core Competencies and Standards of Practice;
(2)
paying the annual documentation fee plus a processing
fee of $100; and
(3)
meeting the initial documentation requirements in
subsections (d)(1) and (d)(3)-(5) of this section.
(i)
Grounds for denial of application for documentation or
redocumentation and for disciplinary action. The Midwifery Board may deny
an application for initial documentation or redocumentation and may take disciplinary
action against any person based upon proof of the following:
(1)
violation of the Act or rules adopted under the Act;
(2)
submission of false or misleading information to
the Midwifery Board, the board, or the department;
(3)
conviction of a felony or a misdemeanor involving
moral turpitude;
(4)
intemperate use of alcohol or drugs while engaged
in the practice of midwifery;
(5)
unprofessional or dishonorable conduct that may reasonably
be determined to deceive or defraud the public;
(6)
inability to practice midwifery with reasonable skill
and safety because of illness, disability, or psychological impairment;
(7)
judgment by a court of competent jurisdiction that
the individual is mentally impaired;
(8)
disciplinary action taken by another jurisdiction
affecting the applicant's legal authority to practice midwifery;
(9)
submission of a birth or death certificate known
by the individual to be false or fraudulent, or other noncompliance with Health
and Safety Code, Chapter 191, or 25 TAC, Chapter 181 (relating to Vital Statistics);
(10)
noncompliance with Health and Safety Code, Chapter
244, or 25 TAC, Chapter 137 (relating to Birthing Centers);
(11)
failure to practice midwifery in a manner consistent
with the public health and safety; or
(12)
demonstrated lack of personal or professional character
in the practice of midwifery.
(j)
Surrender of documentation.
(1)
A midwife may surrender his or her documentation prior
to its expiration for the current period by mailing the original documentation
acknowledgment letter back to the Midwifery Program together with a signed
statement of his or her intent to surrender same.
(2)
Surrender of documentation by a midwife after receipt
of notification from the Midwifery Program that a complaint against the midwife
is being investigated shall not deprive the Midwifery Board of jurisdiction
in any disciplinary action which may result from said investigation.
(3)
The Midwifery Board may enter any disciplinary order
authorized by the Act or this subchapter to resolve a complaint against a
midwife who has surrendered his or her documentation after receipt of notification
from the Midwifery Program that a complaint is being investigated.
(k)
Redocumentation after disciplinary action or surrender.
(1)
A person whose documentation to practice midwifery in
this state has been revoked or suspended by the Midwifery Board or who has
surrendered his or her documentation after having received notice that the
Midwifery Program is investigating a complaint may not apply for reissuance
of documentation until the applicant has complied with all requirements imposed
by the Midwifery Board in connection with the revocation, suspension, or surrender.
If the Midwifery Board denies the application for reissuance of documentation,
an applicant may request a hearing under 25 TAC §§1.51-1.55 (relating
to Fair Hearing Procedures). The decision of the hearing examiner shall be
final.
(2)
The Midwifery Board may reissue documentation to
a midwife who surrendered his or her documentation while an investigation
or disciplinary action was pending only if the Midwifery Board finds that:
(A)
the applicant is competent to resume practice; and
(B)
the Midwifery Program has no evidence of current or continuing
violations by the applicant of the Act or this subchapter.
(l)
Documentation of persons with criminal conviction.
(1)
The Midwifery Board may refuse to issue documentation
to any individual who has been initially convicted of a felony or a misdemeanor
involving moral turpitude, or whose probation imposed pursuant to such conviction
has been revoked by the court.
(2)
The Midwifery Board shall consider the following
factors:
(A)
the nature and seriousness of the crime or the reason
the applicant's probation was revoked;
(B)
any relationship between the crime and the practice of
midwifery;
(C)
whether documentation might offer the applicant an opportunity
to engage in the same or similar criminal activity as that for which the applicant
was previously convicted; and
(D)
the relationship of the crime to the ability, capacity,
or fitness required to perform the duties and discharge the responsibilities
of midwifery.
(3)
the Midwifery Board, in determining the present
fitness of a person who has been convicted of a felony or a misdemeanor involving
moral turpitude, shall consider:
(A)
the age of the applicant when the crime was committed;
(B)
the amount of time that has elapsed since the applicant's
conviction;
(C)
the applicant's conduct and work history prior to and
following the conviction;
(D)
evidence of the applicant's progress toward rehabilitation
while incarcerated, on probation, or following release; and
(E)
other evidence of the person's present fitness, including
letters of recommendation from:
(i)
prosecutorial, law enforcement, probation, and correctional
officers;
(ii)
the sheriff or chief of police in the community where
the applicant resides; and
(iii)
other persons.
(m)
Midwifery roster. The Midwifery Program shall maintain
a roster of all individuals currently documented to practice midwifery in
the state. A copy of the roster shall be provided to each county clerk and
local registrar of births on request. The Midwifery Program shall provide
information on new and/or late documentees to individual county clerks and
local registrars of births during the course of a year as needed.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April
26, 1999.
TRD-9902439
Edna Dougherty
Chairperson
Texas Midwifery Board
Effective date: May 16, 1999
Proposal publication date: January 1, 1999
For further information, please call: (512) 458-7236
22 TAC §831.31
The new section is adopted under the Texas Midwifery Act,
Texas Civil Statutes, Article 4512i, §8A(b), which provides the board
with the authority to adopt rules concerning the practice of midwifery, subject
to the approval of the Texas Board of Health.
§831.31. Education.
(a)
Purpose. This section defines requirements for mandatory
basic midwifery education and continuing midwifery education.
(b)
Provisions. This section establishes:
(1)
an education committee;
(2)
standards for mandatory basic midwifery education;
(3)
standards for mandatory continuing midwifery education;
(4)
procedures for midwifery education course approval,
denial, and revocation of approval;
(5)
procedures for midwifery comprehensive exam approval,
denial, and revocation of approval;
(6)
procedures for appeals of denials of course and comprehensive
exam approval applications and revocations of approval; and
(7)
procedures for investigation and disposition of complaints
concerning education courses and comprehensive exams.
(c)
Applicability. All persons subject to the Act must comply
with §831.11 of this title (relating to Annual Documentation), including
the educational requirements for both initial documentation and redocumentation.
(d)
Education committee.
(1)
The Chairperson of the Midwifery Board shall appoint an
education committee for one year terms, with the approval of the Midwifery
Board, to consider all issues related to mandatory basic and continuing midwifery
education. The Education Committee shall review all applications submitted
by the Midwifery Program staff for approval of mandatory basic midwifery education
courses or comprehensive exams, as well as complaints concerning approved
courses or exams. The Education Committee will consist of the following persons:
(A)
members of the Midwifery Board:
(i)
two midwives, one of whom shall serve as chairperson;
(ii)
a physician or the certified nurse midwife; and
(iii)
a public interest member; and
(B)
a documented midwife who is not a member of the Midwifery
Board.
(2)
The Midwifery Board chairperson may convene
ad hoc working groups consisting of committee members, documented midwives,
and other interested individuals, as necessary.
(3)
Except for informal settlement conferences, all other
meetings and proceedings of the Education Committee shall be open to the public.
(e)
Basic Education.
(1)
The Midwifery Program staff shall consider for approval
only courses which have a course supervisor/administrator and site in Texas.
(2)
Mandatory basic midwifery education shall:
(A)
be offered to ensure that only trained individuals practice
midwifery in Texas;
(B)
be offered by any individual or organization meeting the
requirements for course approval established by this subsection;
(C)
include a didactic component which shall:
(i)
be based upon and completely cover the most current Core
Competencies and Standards of Practice of the Midwives Alliance of North America
(MANA) and the current Texas Midwifery Basic Information Manual;
(ii)
prepare the student to apply for certification by North
American Registry of Midwives (NARM); and
(iii)
include a minimum of 250 hours course work.
(D)
be supervised and conducted by a course supervisor/administrator
who shall:
(i)
be responsible for all aspects of the course; and
(ii)
have two years of experience in the independent practice
of midwifery, nurse-midwifery or obstetrics; and
(iii)
have been primary care giver for at least 75 births
including provision of prenatal, intrapartum, and postpartum care; and
(iv)
have met initial documentation requirements; or
(v)
be a Certified Professional Midwife (CPM); or
(vi)
be American College of Nurse Midwives (ACNM) certified;
or
(vii)
be a licensed physician in Texas actively engaged in
the practice of obstetrics.
(E)
include didactic curriculum instructors who:
(i)
have training and credentials for the course material
they will teach; and
(ii)
are approved by the course supervisor/administrator.
(F)
provide clinical experience/preceptorship of at least
one year in duration and equivalent to 1360 clinical contact hours which prepares
the student to become certified by NARM, including successful completion of
at least the following activities:
(i)
serving as an active participant in attending 20 births;
(ii)
serving as the primary midwife, under supervision, in
attending 20 additional births, at least 10 of which shall be out-of-hospital
births;
(iii)
serving as the primary midwife, under supervision, in
performing:
(I)
75 prenatal exams, including at least 20 initial history
and physical exams;
(II)
20 newborn exams; and
(III)
40 postpartum exams.
(G)
include preceptors who are approved by the course supervisor/administrator
and shall be:
(i)
documented midwives;
(ii)
certified professional midwives;
(iii)
certified nurse midwives; or
(iv)
physicians licensed in Texas and actively engaged in
the practice of obstetrics.
(3)
Individuals enrolled as students in an
approved midwifery course must possess:
(A)
a high school diploma or the equivalent; and
(B)
a current cardiopulmonary resuscitation (CPR) certificate
for health care providers from the American Heart Association (formerly a
C certificate) or an equivalent CPR certificate for the professional rescuer
from the Red Cross.
(4)
Course approval.
(A)
The course supervisor/administrator shall submit an application
form and a non-refundable initial application fee of $150 to the Midwifery
Program with the following supporting documentation:
(i)
course outline;
(ii)
course curriculum with specific content references to:
(I)
MANA Core Competencies;
(II)
NARM Written Test Specifications;
(III)
NARM Skills Assessment Test Specifications; and
(IV)
Texas Midwifery Basic Information Manual.
(iii)
identification of didactic and preceptorship teaching
sites;
(iv)
a financial statement or balance sheet (within the last
year) for the course supervisor/administrator or course owner and disclosure
of any bankruptcy within the last five years; and
(v)
written policies to include:
(I)
tuition schedule, other charges, and cancellation and
refund policy, including the right of any prospective student to cancel his/her
enrollment agreement within 72 hours after signing the agreement and receive
a full refund of any money which may have paid;
(II)
student attendance, progress, and grievance policies;
(III)
rules of operation and conduct of school personnel;
(IV)
requirements for state documentation;
(V)
disclosure of approval status of course;
(VI)
maintenance of student files; and
(VII)
reasonable access for non-English speakers and compliance
with Federal and state laws on accessibility.
(B)
Student files shall be maintained for a minimum of five
years and shall include:
(i)
evidence that the entrance requirements have been met;
(ii)
documentation demonstrating completion of didactic and
clinical course work; and
(iii)
copies of any financial agreements between the student
and the school.
(C)
The Midwifery Program staff and Education Committee chairperson
shall review each course application submitted for approval. If an application
for initial approval meets all of the requirements specified in this paragraph,
a one-year provisional approval will be granted. An on-site evaluation of
the course shall be scheduled. The evaluation shall be conducted by a member
of the Midwifery Program staff and a documented midwife within the provisional
year. The midwife member of the evaluation team shall be appointed by the
Chairperson of the Midwifery Board and shall not be the supervisor, didactic
instructor, or preceptor of another basic midwifery education course in the
same geographic area. The site visit will include the following:
(i)
an inspection of the course's facilities;
(ii)
a review of its teaching plan, protocols, and teaching
materials;
(iii)
a review of didactic and preceptorship instruction;
(iv)
interviews with staff and students; and
(v)
a review of student files.
(D)
A non-refundable fee of $400 shall be assessed for each
course approval site visit.
(E)
The review team's written report shall conclude with a
recommendation to the Education Committee for approval or denial of the course.
(F)
The Education Committee shall evaluate the application
and all other pertinent information, including any complaints received and
the on-site review team's report and recommendation.
(G)
The Midwifery Board shall consider the application and
the recommendations of the Education Committee and shall render a final decision
during the provisional year. The decisions of the Education Committee and
Midwifery Board shall be based upon the criteria specified in this subsection.
(H)
Each applicant shall be notified of the Midwifery Board's
decision in writing within 10 working days. If an application is denied, the
notification shall specify the reason(s) for denial.
(5)
Appeal of course denial. An appeal of a notification
of a denial must be submitted in writing to the Chairperson of the Midwifery
Board through the Midwifery Program within 21 working days of the applicant's
receipt of the notice. Upon receipt of the appeal, the appellant will be placed
on the agenda of the next scheduled meeting of the Midwifery Board, at which
time the appellant may appear and the Board shall render a decision on the
appeal.
(6)
Course reciprocity. A basic midwifery education course
which is currently accredited by the Midwifery Education Accreditation Council
(MEAC) shall be deemed approved under this subsection upon submission of evidence
of such accreditation.
(7)
Duration of course approval.
(A)
The Midwifery Board shall approve courses for a three-year
period.
(B)
Course approvals granted prior to December 31, 1996, shall
expire upon the adoption of these rules, and course supervisors/administrators
shall apply for initial approval within 60 days.
(C)
Course supervisors/administrators shall reapply for approval
six months prior to expiration.
(8)
Course changes. Any substantive change(s) in
the course or its content shall be submitted to the Midwifery Program staff
prior to the change(s) if known in advance or within 10 working days after
change(s). The Midwifery Program staff shall notify the Education Committee
Chairperson. The Midwifery Board may reconsider the status of any course which
has undergone substantive changes should the course no longer meet the requirements
in subsections (e)(1)-(2) of this section.
(9)
Revocation of course approval. The Midwifery Board
may revoke the approval of a course after notifying the course supervisor/administrator
of its intended action and the opportunity for an appeal, if the Midwifery
Board determines that:
(A)
the course no longer meets the standards established by
this subsection;
(B)
the course supervisor, instructor(s), or preceptor(s)
do not have the qualifications required by this subsection;
(C)
course approval was obtained by fraud or deceit;
(D)
the course supervisor has falsified course registration,
attendance, and/or completion records; or
(E)
continued approval of the course is not in the public
interest as defined by the Midwifery Board.
(10)
Fair hearing procedures. Notice and hearings
required under this subsection will be conducted according to and will be
governed by 25 TAC §§1.51-1.55 (relating to Fair Hearing Procedures),
except that final decisions on hearings shall be made by the Midwifery Board
rather than the commissioner.
(f)
Comprehensive exams.
(1)
Comprehensive exam approval.
(A)
Any approved education course or midwifery association
may submit an application form and a non-refundable initial application fee
of $150 to the Midwifery Program with the following supporting documentation:
(i)
copy of exam;
(ii)
copy of all exam information and preparation materials,
including sample test booklet(s);
(iii)
evidence that the written portion of the examination
has been validated by an independent professional, as required by the Act,
§11(b);
(iv)
references to the MANA Core Competencies included in
the exam;
(v)
identification of proposed test sites;
(vi)
a financial statement or balance sheet (within the last
year) for the course supervisor/administrator or course owner or midwifery
association and disclosure of any bankruptcy within the last five years; and
(vii)
written policies to include:
(I)
charge for exam administration, other charges, and cancellation
and refund policy;
(II)
confidentiality of individual exam scores;
(III)
administration and grading of exam;
(IV)
requirements for test sites and proctors;
(V)
disclosure of approval status of exam;
(VI)
complaint procedures;
(VII)
maintenance of exam files; and
(VIII)
reasonable access for non-English speakers and compliance
with Federal and state laws on accessibility.
(B)
Separate exam files for each administration of the exam
shall be maintained for a minimum of five years and shall include:
(i)
evidence of identity of all test takers, and of all proctors;
(ii)
documentation concerning exam administration procedures;
(iii)
copies of any financial agreements related to the administration
of the exam;
(iv)
copies of any complaints received;
(v)
copies of exam(s) administered; and
(vi)
originals of all scored exams.
(C)
The Midwifery Program staff and Education Committee chairperson
shall review each exam application submitted for approval. If an application
for approval meets all of the requirements specified in this paragraph, it
will be forwarded to the Education Committee within 60 days.
(D)
The Education Committee shall evaluate the application
and recommend either approval or denial of the application to the Midwifery
Board.
(E)
The Midwifery Board shall consider the application and
the recommendations of the Education Committee and shall render a final decision.
(F)
Each applicant shall be notified of the Midwifery Board's
decision in writing within 10 working days. If an application is denied, the
notification shall specify the reason(s) for denial.
(2)
Appeal of exam denial. An appeal of a notification
of a denial must be submitted in writing to the Chairperson of the Midwifery
Board within 21 working days of the applicant's receipt of the notice. The
appellant may appear at the next scheduled meeting of the Midwifery Board,
at which the Board shall render a decision on the appeal.
(3)
Duration of exam approval.
(A)
The Midwifery Board shall approve exams for a three-year
period;
(B)
Any revisions to the exam must be approved according to
the requirements of this subsection; and
(C)
Course supervisors/administrators or associations of midwifery
shall reapply for approval six months prior to expiration.
(4)
Exam changes/revisions. Any substantive change(s)
in, or revisions to, the exam, its administration, or any of the policies
associated with it, shall be submitted to the Midwifery Program staff prior
implementation of the change(s), along with a explanation for the proposed
change(s). The Midwifery Program staff shall notify the Education Committee
Chairperson. The Midwifery Board may reconsider the status of any exam in
which substantive changes have been made.
(A)
The Education Committee may request and consider any relevant
information, including exam files, when reconsidering course approval.
(B)
The Education Committee shall forward its recommendations
to the Midwifery Board.
(5)
Revocation of exam approval.
(A)
The Midwifery Board may revoke the approval of a exam
after notifying the course supervisor/administrator or course owner or midwifery
association of its intended action and the opportunity for an appeal, if the
Midwifery Board determines that:
(i)
the exam or the course/association who submitted it for
approval no longer meets the standards established by this subsection; or
(ii)
exam approval was obtained by fraud or deceit; or
(iii)
records required by this subsection have been falsified
or are incomplete; or
(iv)
exam files or other relevant information have been withheld
from the Midwifery Board or Education Committee despite a written request;
or
(v)
continued approval of the exam is not in the public interest
as defined by the Midwifery Board.
(B)
Each course supervisor/administrator or midwifery association
shall be notified of the Midwifery Board's decision in writing within ten
working days. If an application is denied, the notification shall specify
the reason(s) for denial.
(C)
Notice and hearings required under this subsection will
be conducted according to and will be governed by 25 TAC §§1.51-1.55
(relating to Fair Hearing Procedures), except that final hearing decisions
will be made by the Midwifery Board rather than the commissioner.
(6)
Complaints. If a complaint cannot be resolved
by the complaint process associated with the exam, the complainant may file
a complaint against the exam or the course supervisor/administrator or course
owner or midwifery association with the Education Committee in accordance
with the procedures in subsection (h) of this section.
(g)
Continuing education.
(1)
Mandatory continuing midwifery education courses support
the need for midwives practicing in Texas to maintain current knowledge and
skills.
(2)
Courses may be offered by any individual or organization
that meets the requirements for course approval established by this subsection.
(3)
Course curriculum must provide an educational experience
which:
(A)
covers new developments in the fields of midwifery or
related disciplines; or
(B)
reviews established knowledge in the fields of midwifery
or related disciplines; and
(C)
shall be presented in standard contact hour increments
for continuing health education; and
(D)
shall provide reasonable access for non-English speakers
and comply with Federal and state laws on accessibility.
(4)
Course coordinators and instructors.
(A)
Course coordinators shall obtain course approval, register
and certify participant attendance, and provide attendance certificates to
participants following the course.
(B)
Course instructors shall have training and credentials
appropriate for the course material they will teach.
(5)
Course approval. Continuing education courses
attended to fulfill annual documentation requirements shall be accepted when
the courses:
(A)
satisfy the requirements of subsection (g)(3)(A)-(C) of
this section; and
(B)
are accredited by one of the following accrediting bodies:
(i)
a professional midwifery association, nursing, social
work, or medicine;
(ii)
a college or university;
(iii)
a nursing, medical, or health care organization;
(iv)
a state board of nursing or medicine;
(v)
a department of health; or
(vi)
a hospital.
(h)
Complaint procedure, investigation, and disposition.
(1)
Purpose. This subsection defines the procedures for filing
complaints against approved courses or exams. It further defines valid causes
for discipline and procedures to be utilized by the Midwifery Program, the
Education Committee, and the Midwifery Board in processing, investigating,
and resolving complaints against approved courses or exams.
(2)
Provisions. This subsection establishes:
(A)
procedures for reporting violations and/or complaints;
(B)
procedures for investigating alleged violations and/or
complaints;
(C)
procedures for informal hearings;
(D)
procedures for sanctions; and
(E)
procedures for complaint disposition and appeals.
(3)
Education Committee. The Education Committee
shall consider all complaints filed against approved courses or exams and
shall make recommendations to the Midwifery Board.
(A)
The Midwifery Board Chairperson may convene ad hoc working
groups consisting of committee members, documented midwives, and other interested
individuals as necessary.
(B)
All meetings of the Education Committee in which a complaint
is being discussed shall be closed to the public. The Education Committee
shall schedule an informal conference to discuss the investigation and any
proposed recommendation. At no time shall the Education Committee or Midwifery
Board disclose the identity of the complainant, or the course or exam that
is the subject of the complaint.
(4)
Report of a complaint. Complaints may be accepted
by the Midwifery Program by telephone, in person, or in writing from any person
or agency alleging violations of this section.
(A)
The Midwifery Program staff shall mail a letter and complaint
form to the complainant within 10 working days of being notified of the complaint.
The complaint form shall request at least the following information:
(i)
the name, address, and telephone number of complainant
(optional);
(ii)
the name, address, and telephone number of course supervisor/administrator
or course owner or midwifery association that is the subject of the complaint;
(iii)
a complete statement of the complaint, including date(s),
time(s), and location(s) of event(s);
(iv)
the name, address, and telephone number of any witnesses;
and
(v)
a description of any other reporting, filing, or attempted
resolution of the complaint.
(B)
The complaint review process begins when the completed
complaint form is received by the Midwifery Program and assigned a case number,
and the subject of the complaint is determined to be a course or exam approved
under this section.
(C)
If the complaint form includes the complainant's name
and address, the complainant shall be notified in writing of the Midwifery
Program's receipt of the complaint form within 10 working days.
(5)
Records of complaints. The Midwifery Program
shall maintain an information file about each complaint. The information file
shall be kept current and shall contain, if applicable:
(A)
the written complaint;
(B)
a record of all persons contacted in relation to the complaint;
(C)
client records;
(D)
other requested records;
(E)
a summary of findings;
(F)
an explanation of the legal basis and the Midwifery Board's
reason for dismissing a complaint;
(G)
sanctions imposed; and
(H)
other relevant information.
(6)
Complaint investigation. The Midwifery Program
Director shall:
(A)
notify the course supervisor/administrator or course owner
or midwifery association of the Midwifery Program's receipt of the complaint
by certified mail;
(B)
request all relevant records necessary to conduct an investigation
of the complaint;
(C)
interview the complainant, the respondent, and any witnesses;
(D)
review and evaluate all information received;
(E)
forward the complaint to any other agencies or organizations
which may also have jurisdiction and/or refer the complainant to said agencies
or organizations;
(F)
present each complaint to the Education Committee; and
(G)
notify the course supervisor/administrator or course owner
or midwifery association by certified mail of the date and time of the Education
Committee at which the complaint will be presented, at least 30 days in advance.
(7)
Settlement conference. The Education Committee
chairperson or, in his/her absence, the vice-chairperson, will preside over
and conduct the conference.
(A)
On the day and time designated for the conference, the
chairperson/vice-chairperson shall:
(i)
state the purpose of and the legal authority for the conference;
and
(ii)
outline the procedure and order of presentation to be
followed.
(B)
Order of presentation. After making the necessary introductory
and explanatory remarks, the chairperson/vice-chairperson shall state the
case number and the nature of the complaint.
(i)
The Education Committee shall review all available evidence
from the investigation, including any statements from the complainant and
the course supervisor/administrator or course owner or midwifery association.
The Education Committee may question any person present regarding relevant
information. Whether or not the complainant or course supervisor/administrator
or course owner or midwifery association is present, the settlement conference
shall proceed with the information on hand.
(ii)
Evidence and statements shall be reviewed by the Education
Committee and one of the following recommendations made to the Midwifery Board:
(I)
close the complaint file due to insufficient evidence;
or
(II)
enter an agreed order.
(iii)
Complaints not resolved by settlement conference shall
be referred for a hearing.
(8)
Hearings.
(A)
All administrative hearings under this section shall be
conducted according to 25 TAC §§1.51-1.55 (relating to Fair Hearing
Procedures).
(B)
All proposals for decision shall be referred to the Midwifery
Board for final decision.
(9)
Guidelines for sanctions. The Midwifery Board/Education
Committee shall consider the following factors in imposing sanctions:
(A)
the severity of the offense;
(B)
the damage to the public or to the profession of midwifery;
(C)
the number of repetitions of the offense;
(D)
the length of time since date of offense;
(E)
the number of sanctions imposed upon the course supervisor/administrator
or course owner or midwifery association;
(F)
the length of time the course or exam has been offered;
(G)
the actual injury, financial or otherwise, suffered by
the student(s) or person(s) taking the exam;
(H)
any efforts at rehabilitation or remediation by the course
supervisor/administrator or course owner or midwifery association; and
(I)
any other mitigating or aggravating circumstances.
(10)
Penalties and Sanctions. If the Midwifery Board
finds that a course supervisor/administrator or course owner or midwifery
association has violated this subsection, it shall enter an order imposing
one or more of the following:
(A)
a written warning;
(B)
limitation or restriction of course or exam approval for
a specified time;
(C)
suspension of course or exam approval for a specified
time;
(D)
revocation of course or exam approval;
(E)
probation of any sanction imposed on the course supervisor/administrator
or course owner or midwifery association;
(F)
acceptance by the Midwifery Board of the voluntary surrender
of approval and without the opportunity for reinstatement unless the Midwifery
Board determines the course supervisor/administrator or course owner or midwifery
association is competent to resume offering the course or exam; or
(G)
imposition of conditions for approval that the course
supervisor/administrator or course owner or midwifery association must satisfy
before the Midwifery Board issues an unrestricted approval.
(11)
Failure to cooperate. Failure to provide records
requested by the Midwifery Program, without good cause shown, shall be grounds
for additional disciplinary action.
(12)
Disposition.
(A)
Agreed disposition.
(i)
The Midwifery Board may, unless precluded by law or this
section, make a disposition of any complaint by agreed order.
(ii)
An agreed disposition is considered a disciplinary order
for purposes of reporting under this chapter and of administrative hearings
and proceedings by state and federal regulatory agencies regarding the practice
and education of documented midwives. An agreed order is a public record.
In civil or criminal litigation, an agreed disposition is a settlement agreement
under Texas Rules of Civil Evidence, Rule 408, and Texas Rules of Criminal
Evidence, Rule 408.
(B)
Closed file. The Midwifery Board may close the complaint
file due to insufficient evidence.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of the Secretary of State on April
26, 1999.
TRD-9902440
Edna Dougherty
Chairperson
Texas Midwifery Board
Effective date: May 16, 1999
Proposal publication date: January 1, 1999
For further information, please call: (512) 458-7236
Subchapter C. Education
Subchapter D. Practice of Midwifery