2746. The board shall issue a certificate to practice
nurse-midwifery to any person who qualifies under this article and is
licensed pursuant to the provisions of this chapter.
2746.1. Every applicant for a certificate to practice
nurse-midwifery shall comply with all the provisions of this article
in addition to the provisions of this chapter.
2746.2. Each applicant shall show by evidence satisfactory to the
board that he has met the educational standards established by the
board or has at least the equivalent thereof. The board is authorized
to appoint a committee of qualified physicians and nurses,
including, but not limited to, obstetricians and nurse-midwives, to
develop the necessary standards relating to educational requirements,
ratios of nurse-midwives to supervising physicians, and associated
matters.
2746.3. Midwife's certificates issued by the Medical Board of
California prior to the effective date of this article shall be
renewable only by such board.
2746.4. Nothing in this article shall be construed to prevent the
practice of midwifery by a person possessing a midwife's certificate
issued by the Medical Board of California on the effective date of
this article.
2746.5. (a) The certificate to practice nurse-midwifery authorizes
the holder, under the supervision of a licensed physician and
surgeon, to attend cases of normal childbirth and to provide
prenatal, intrapartum, and postpartum care, including family-planning
care, for the mother, and immediate care for the newborn.
(b) As used in this chapter, the practice of nurse-midwifery
constitutes the furthering or undertaking by any certified person,
under the supervision of a licensed physician and surgeon who has
current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal. All
complications shall be referred to a physician immediately. The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.
(c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
(d) A certified nurse-midwife is not authorized to practice
medicine and surgery by the provisions of this chapter.
(e) Any regulations promulgated by a state department that affect
the scope of practice of a certified nurse-midwife shall be developed
in consultation with the board.
2746.51. (a) Neither this chapter nor any other provision of law
shall be construed to prohibit a certified nurse-midwife from
furnishing or ordering drugs or devices, including controlled
substances classified in Schedule II, III, IV, or V under the
California Uniform Controlled Substances Act (Division 10 (commencing
with Section 11000) of the Health and Safety Code), when all of the
following apply:
(1) The drugs or devices are furnished or ordered incidentally to
the provision of any of the following:
(A) Family planning services, as defined in Section 14503 of the
Welfare and Institutions Code.
(B) Routine health care or perinatal care, as defined in
subdivision (d) of Section 123485 of the Health and Safety Code.
(C) Care rendered, consistent with the certified nurse-midwife's
educational preparation or for which clinical competency has been
established and maintained, to persons within a facility specified in
subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the
Health and Safety Code, a clinic as specified in Section 1204 of the
Health and Safety Code, a general acute care hospital as defined in
subdivision (a) of Section 1250 of the Health and Safety Code, a
licensed birth center as defined in Section 1204.3 of the Health and
Safety Code, or a special hospital specified as a maternity hospital
in subdivision (f) of Section 1250 of the Health and Safety Code.
(2) The drugs or devices are furnished or ordered by a certified
nurse-midwife in accordance with standardized procedures or
protocols. For purposes of this section, standardized procedure means
a document, including protocols, developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee. The standardized
procedure covering the furnishing or ordering of drugs or devices
shall specify all of the following:
(A) Which certified nurse-midwife may furnish or order drugs or
devices.
(B) Which drugs or devices may be furnished or ordered and under
what circumstances.
(C) The extent of physician and surgeon supervision.
(D) The method of periodic review of the certified nurse-midwife's
competence, including peer review, and review of the provisions of
the standardized procedure.
(3) If Schedule II or III controlled substances, as defined in
Sections 11055 and 11056 of the Health and Safety Code, are furnished
or ordered by a certified nurse-midwife, the controlled substances
shall be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician and
surgeon. For Schedule II controlled substance protocols, the
provision for furnishing the Schedule II controlled substance shall
address the diagnosis of the illness, injury, or condition for which
the Schedule II controlled substance is to be furnished.
(4) The furnishing or ordering of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision. For
purposes of this section, no physician and surgeon shall supervise
more than four certified nurse-midwives at one time. Physician and
surgeon supervision shall not be construed to require the physical
presence of the physician, but does include all of the following:
(A) Collaboration on the development of the standardized procedure
or protocol.
(B) Approval of the standardized procedure or protocol.
(C) Availability by telephonic contact at the time of patient
examination by the certified nurse-midwife.
(b) (1) The furnishing or ordering of drugs or devices by a
certified nurse-midwife is conditional on the issuance by the board
of a number to the applicant who has successfully completed the
requirements of paragraph (2). The number shall be included on all
transmittals of orders for drugs or devices by the certified
nurse-midwife. The board shall maintain a list of the certified
nurse-midwives that it has certified pursuant to this paragraph and
the number it has issued to each one. The board shall make the list
available to the California State Board of Pharmacy upon its request.
Every certified nurse-midwife who is authorized pursuant to this
section to furnish or issue a drug order for a controlled substance
shall register with the United States Drug Enforcement
Administration.
(2) The board has certified in accordance with paragraph (1) that
the certified nurse-midwife has satisfactorily completed at least six
months of physician and surgeon supervised experience in the
furnishing or ordering of drugs or devices and a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this paragraph.
(3) A copy of the standardized procedure or protocol relating to
the furnishing or ordering of controlled substances by a certified
nurse-midwife shall be provided upon request to any licensed
pharmacist who is uncertain of the authority of the certified
nurse-midwife to perform these functions.
(4) Certified nurse-midwives who are certified by the board and
hold an active furnishing number, who are currently authorized
through standardized procedures or protocols to furnish Schedule II
controlled substances, and who are registered with the United States
Drug Enforcement Agency shall provide documentation of continuing
education specific to the use of Schedule II controlled substances in
settings other than a hospital based on standards developed by the
board.
(c) Drugs or devices furnished or ordered by a certified
nurse-midwife may include Schedule II controlled substances under the
California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) under
the following conditions:
(1) The drugs and devices are furnished or ordered in accordance
with requirements referenced in paragraphs (2) to (4), inclusive, of
subdivision (a) and in paragraphs (1) to (3), inclusive, of
subdivision (b).
(2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
(d) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure or
protocol. Use of the term "furnishing" in this section shall include
the following:
(1) The ordering of a drug or device in accordance with the
standardized procedure or protocol.
(2) Transmitting an order of a supervising physician and surgeon.
(e) "Drug order" or "order" for purposes of this section means an
order for medication or for a drug or device that is dispensed to or
for an ultimate user, issued by a certified nurse-midwife as an
individual practitioner, within the meaning of Section 1306.03 of
Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a drug order issued pursuant to this
section shall be treated in the same manner as a prescription of the
supervising physician; (2) all references to "prescription" in this
code and the Health and Safety Code shall include drug orders issued
by certified nurse-midwives; and (3) the signature of a certified
nurse-midwife on a drug order issued in accordance with this section
shall be deemed to be the signature of a prescriber for purposes of
this code and the Health and Safety Code.
2746.52. Notwithstanding Section 2746.5, the certificate to
practice nurse-midwifery authorizes the holder to perform and repair
episiotomies, and to repair first-degree and second-degree
lacerations of the perineum, in a licensed acute care hospital, as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, and a licensed alternate birth center, as defined in paragraph
(4) of subdivision (b) of Section 1204 of the Health and Safety Code,
but only if all of the following conditions are met:
(a) The supervising physician and surgeon and any backup physician
and surgeon is credentialed to perform obstetrical care in the
facility.
(b) The episiotomies are performed pursuant to protocols developed
and approved by all of the following:
(1) The supervising physician and surgeon.
(2) The certified nurse-midwife.
(3) The director of the obstetrics department or the director of
the family practice department, or both, if a physician and surgeon
in the obstetrics department or the family practice department is a
supervising physician and surgeon, or an equivalent person if there
is no specifically identified obstetrics department or family
practice department.
(4) The interdisciplinary practices committee, if applicable.
(5) The facility administrator or his or her designee.
(c) The protocols, and the procedures which shall be developed
pursuant to the protocols, shall relate to the performance and repair
of episiotomies and the repair of first-degree and second-degree
lacerations of the perineum, and shall do all of the following:
(1) Ensure that all complications are referred to a physician and
surgeon immediately.
(2) Ensure immediate care of patients who are in need of care
beyond the scope of practice of the certified nurse midwife, or
emergency care for times when the supervising physician and surgeon
is not on the premises.
(3) Establish the number of certified nurse-midwives that a
supervising physician and surgeon may supervise.
2746.7. An applicant for certification pursuant to this article
shall submit a written application in the form prescribed by the
board, accompanied by the fee prescribed by Section 2815.5.
2746.8. Each certificate issued pursuant to this article shall be
renewable biennially, and each person holding a certificate under
this article shall apply for a renewal of his certificate and pay the
biennial renewal fee required by Section 2815.5 every two years on
or before the last day of the month following the month in which his
birthday occurs, beginning with the second birthday following the
date on which the certificate was issued, whereupon the board shall
renew the certificate.
Each such certificate not renewed in accordance with this section
shall expire but may within a period of eight years thereafter be
reinstated upon payment of the biennial renewal fee and penalty fee
required by Section 2815.5 and upon submission of such proof of the
applicant's qualifications as may be required by the board, except
that during such eight-year period no examination shall be required
as a condition for the reinstatement of any such expired certificate
which has lapsed solely by reason of nonpayment of the renewal fee.
After the expiration of such eight-year period the board may require
as a condition of reinstatement that the applicant pass such
examination as it deems necessary to determine his present fitness to
resume the practice of nurse-midwifery.
2746. The board shall issue a certificate to practice
nurse-midwifery to any person who qualifies under this article and is
licensed pursuant to the provisions of this chapter.
2746.1. Every applicant for a certificate to practice
nurse-midwifery shall comply with all the provisions of this article
in addition to the provisions of this chapter.
2746.2. Each applicant shall show by evidence satisfactory to the
board that he has met the educational standards established by the
board or has at least the equivalent thereof. The board is authorized
to appoint a committee of qualified physicians and nurses,
including, but not limited to, obstetricians and nurse-midwives, to
develop the necessary standards relating to educational requirements,
ratios of nurse-midwives to supervising physicians, and associated
matters.
2746.3. Midwife's certificates issued by the Medical Board of
California prior to the effective date of this article shall be
renewable only by such board.
2746.4. Nothing in this article shall be construed to prevent the
practice of midwifery by a person possessing a midwife's certificate
issued by the Medical Board of California on the effective date of
this article.
2746.5. (a) The certificate to practice nurse-midwifery authorizes
the holder, under the supervision of a licensed physician and
surgeon, to attend cases of normal childbirth and to provide
prenatal, intrapartum, and postpartum care, including family-planning
care, for the mother, and immediate care for the newborn.
(b) As used in this chapter, the practice of nurse-midwifery
constitutes the furthering or undertaking by any certified person,
under the supervision of a licensed physician and surgeon who has
current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal. All
complications shall be referred to a physician immediately. The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.
(c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
(d) A certified nurse-midwife is not authorized to practice
medicine and surgery by the provisions of this chapter.
(e) Any regulations promulgated by a state department that affect
the scope of practice of a certified nurse-midwife shall be developed
in consultation with the board.
2746.51. (a) Neither this chapter nor any other provision of law
shall be construed to prohibit a certified nurse-midwife from
furnishing or ordering drugs or devices, including controlled
substances classified in Schedule II, III, IV, or V under the
California Uniform Controlled Substances Act (Division 10 (commencing
with Section 11000) of the Health and Safety Code), when all of the
following apply:
(1) The drugs or devices are furnished or ordered incidentally to
the provision of any of the following:
(A) Family planning services, as defined in Section 14503 of the
Welfare and Institutions Code.
(B) Routine health care or perinatal care, as defined in
subdivision (d) of Section 123485 of the Health and Safety Code.
(C) Care rendered, consistent with the certified nurse-midwife's
educational preparation or for which clinical competency has been
established and maintained, to persons within a facility specified in
subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the
Health and Safety Code, a clinic as specified in Section 1204 of the
Health and Safety Code, a general acute care hospital as defined in
subdivision (a) of Section 1250 of the Health and Safety Code, a
licensed birth center as defined in Section 1204.3 of the Health and
Safety Code, or a special hospital specified as a maternity hospital
in subdivision (f) of Section 1250 of the Health and Safety Code.
(2) The drugs or devices are furnished or ordered by a certified
nurse-midwife in accordance with standardized procedures or
protocols. For purposes of this section, standardized procedure means
a document, including protocols, developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee. The standardized
procedure covering the furnishing or ordering of drugs or devices
shall specify all of the following:
(A) Which certified nurse-midwife may furnish or order drugs or
devices.
(B) Which drugs or devices may be furnished or ordered and under
what circumstances.
(C) The extent of physician and surgeon supervision.
(D) The method of periodic review of the certified nurse-midwife's
competence, including peer review, and review of the provisions of
the standardized procedure.
(3) If Schedule II or III controlled substances, as defined in
Sections 11055 and 11056 of the Health and Safety Code, are furnished
or ordered by a certified nurse-midwife, the controlled substances
shall be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician and
surgeon. For Schedule II controlled substance protocols, the
provision for furnishing the Schedule II controlled substance shall
address the diagnosis of the illness, injury, or condition for which
the Schedule II controlled substance is to be furnished.
(4) The furnishing or ordering of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision. For
purposes of this section, no physician and surgeon shall supervise
more than four certified nurse-midwives at one time. Physician and
surgeon supervision shall not be construed to require the physical
presence of the physician, but does include all of the following:
(A) Collaboration on the development of the standardized procedure
or protocol.
(B) Approval of the standardized procedure or protocol.
(C) Availability by telephonic contact at the time of patient
examination by the certified nurse-midwife.
(b) (1) The furnishing or ordering of drugs or devices by a
certified nurse-midwife is conditional on the issuance by the board
of a number to the applicant who has successfully completed the
requirements of paragraph (2). The number shall be included on all
transmittals of orders for drugs or devices by the certified
nurse-midwife. The board shall maintain a list of the certified
nurse-midwives that it has certified pursuant to this paragraph and
the number it has issued to each one. The board shall make the list
available to the California State Board of Pharmacy upon its request.
Every certified nurse-midwife who is authorized pursuant to this
section to furnish or issue a drug order for a controlled substance
shall register with the United States Drug Enforcement
Administration.
(2) The board has certified in accordance with paragraph (1) that
the certified nurse-midwife has satisfactorily completed at least six
months of physician and surgeon supervised experience in the
furnishing or ordering of drugs or devices and a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this paragraph.
(3) A copy of the standardized procedure or protocol relating to
the furnishing or ordering of controlled substances by a certified
nurse-midwife shall be provided upon request to any licensed
pharmacist who is uncertain of the authority of the certified
nurse-midwife to perform these functions.
(4) Certified nurse-midwives who are certified by the board and
hold an active furnishing number, who are currently authorized
through standardized procedures or protocols to furnish Schedule II
controlled substances, and who are registered with the United States
Drug Enforcement Agency shall provide documentation of continuing
education specific to the use of Schedule II controlled substances in
settings other than a hospital based on standards developed by the
board.
(c) Drugs or devices furnished or ordered by a certified
nurse-midwife may include Schedule II controlled substances under the
California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) under
the following conditions:
(1) The drugs and devices are furnished or ordered in accordance
with requirements referenced in paragraphs (2) to (4), inclusive, of
subdivision (a) and in paragraphs (1) to (3), inclusive, of
subdivision (b).
(2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
(d) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure or
protocol. Use of the term "furnishing" in this section shall include
the following:
(1) The ordering of a drug or device in accordance with the
standardized procedure or protocol.
(2) Transmitting an order of a supervising physician and surgeon.
(e) "Drug order" or "order" for purposes of this section means an
order for medication or for a drug or device that is dispensed to or
for an ultimate user, issued by a certified nurse-midwife as an
individual practitioner, within the meaning of Section 1306.03 of
Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a drug order issued pursuant to this
section shall be treated in the same manner as a prescription of the
supervising physician; (2) all references to "prescription" in this
code and the Health and Safety Code shall include drug orders issued
by certified nurse-midwives; and (3) the signature of a certified
nurse-midwife on a drug order issued in accordance with this section
shall be deemed to be the signature of a prescriber for purposes of
this code and the Health and Safety Code.
2746.52. Notwithstanding Section 2746.5, the certificate to
practice nurse-midwifery authorizes the holder to perform and repair
episiotomies, and to repair first-degree and second-degree
lacerations of the perineum, in a licensed acute care hospital, as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, and a licensed alternate birth center, as defined in paragraph
(4) of subdivision (b) of Section 1204 of the Health and Safety Code,
but only if all of the following conditions are met:
(a) The supervising physician and surgeon and any backup physician
and surgeon is credentialed to perform obstetrical care in the
facility.
(b) The episiotomies are performed pursuant to protocols developed
and approved by all of the following:
(1) The supervising physician and surgeon.
(2) The certified nurse-midwife.
(3) The director of the obstetrics department or the director of
the family practice department, or both, if a physician and surgeon
in the obstetrics department or the family practice department is a
supervising physician and surgeon, or an equivalent person if there
is no specifically identified obstetrics department or family
practice department.
(4) The interdisciplinary practices committee, if applicable.
(5) The facility administrator or his or her designee.
(c) The protocols, and the procedures which shall be developed
pursuant to the protocols, shall relate to the performance and repair
of episiotomies and the repair of first-degree and second-degree
lacerations of the perineum, and shall do all of the following:
(1) Ensure that all complications are referred to a physician and
surgeon immediately.
(2) Ensure immediate care of patients who are in need of care
beyond the scope of practice of the certified nurse midwife, or
emergency care for times when the supervising physician and surgeon
is not on the premises.
(3) Establish the number of certified nurse-midwives that a
supervising physician and surgeon may supervise.
2746.7. An applicant for certification pursuant to this article
shall submit a written application in the form prescribed by the
board, accompanied by the fee prescribed by Section 2815.5.
2746.8. Each certificate issued pursuant to this article shall be
renewable biennially, and each person holding a certificate under
this article shall apply for a renewal of his certificate and pay the
biennial renewal fee required by Section 2815.5 every two years on
or before the last day of the month following the month in which his
birthday occurs, beginning with the second birthday following the
date on which the certificate was issued, whereupon the board shall
renew the certificate.
Each such certificate not renewed in accordance with this section
shall expire but may within a period of eight years thereafter be
reinstated upon payment of the biennial renewal fee and penalty fee
required by Section 2815.5 and upon submission of such proof of the
applicant's qualifications as may be required by the board, except
that during such eight-year period no examination shall be required
as a condition for the reinstatement of any such expired certificate
which has lapsed solely by reason of nonpayment of the renewal fee.
After the expiration of such eight-year period the board may require
as a condition of reinstatement that the applicant pass such
examination as it deems necessary to determine his present fitness to
resume the practice of nurse-midwifery.
2746. The board shall issue a certificate to practice
nurse-midwifery to any person who qualifies under this article and is
licensed pursuant to the provisions of this chapter.
2746.1. Every applicant for a certificate to practice
nurse-midwifery shall comply with all the provisions of this article
in addition to the provisions of this chapter.
2746.2. Each applicant shall show by evidence satisfactory to the
board that he has met the educational standards established by the
board or has at least the equivalent thereof. The board is authorized
to appoint a committee of qualified physicians and nurses,
including, but not limited to, obstetricians and nurse-midwives, to
develop the necessary standards relating to educational requirements,
ratios of nurse-midwives to supervising physicians, and associated
matters.
2746.3. Midwife's certificates issued by the Medical Board of
California prior to the effective date of this article shall be
renewable only by such board.
2746.4. Nothing in this article shall be construed to prevent the
practice of midwifery by a person possessing a midwife's certificate
issued by the Medical Board of California on the effective date of
this article.
2746.5. (a) The certificate to practice nurse-midwifery authorizes
the holder, under the supervision of a licensed physician and
surgeon, to attend cases of normal childbirth and to provide
prenatal, intrapartum, and postpartum care, including family-planning
care, for the mother, and immediate care for the newborn.
(b) As used in this chapter, the practice of nurse-midwifery
constitutes the furthering or undertaking by any certified person,
under the supervision of a licensed physician and surgeon who has
current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal. All
complications shall be referred to a physician immediately. The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.
(c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
(d) A certified nurse-midwife is not authorized to practice
medicine and surgery by the provisions of this chapter.
(e) Any regulations promulgated by a state department that affect
the scope of practice of a certified nurse-midwife shall be developed
in consultation with the board.
2746.51. (a) Neither this chapter nor any other provision of law
shall be construed to prohibit a certified nurse-midwife from
furnishing or ordering drugs or devices, including controlled
substances classified in Schedule II, III, IV, or V under the
California Uniform Controlled Substances Act (Division 10 (commencing
with Section 11000) of the Health and Safety Code), when all of the
following apply:
(1) The drugs or devices are furnished or ordered incidentally to
the provision of any of the following:
(A) Family planning services, as defined in Section 14503 of the
Welfare and Institutions Code.
(B) Routine health care or perinatal care, as defined in
subdivision (d) of Section 123485 of the Health and Safety Code.
(C) Care rendered, consistent with the certified nurse-midwife's
educational preparation or for which clinical competency has been
established and maintained, to persons within a facility specified in
subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the
Health and Safety Code, a clinic as specified in Section 1204 of the
Health and Safety Code, a general acute care hospital as defined in
subdivision (a) of Section 1250 of the Health and Safety Code, a
licensed birth center as defined in Section 1204.3 of the Health and
Safety Code, or a special hospital specified as a maternity hospital
in subdivision (f) of Section 1250 of the Health and Safety Code.
(2) The drugs or devices are furnished or ordered by a certified
nurse-midwife in accordance with standardized procedures or
protocols. For purposes of this section, standardized procedure means
a document, including protocols, developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee. The standardized
procedure covering the furnishing or ordering of drugs or devices
shall specify all of the following:
(A) Which certified nurse-midwife may furnish or order drugs or
devices.
(B) Which drugs or devices may be furnished or ordered and under
what circumstances.
(C) The extent of physician and surgeon supervision.
(D) The method of periodic review of the certified nurse-midwife's
competence, including peer review, and review of the provisions of
the standardized procedure.
(3) If Schedule II or III controlled substances, as defined in
Sections 11055 and 11056 of the Health and Safety Code, are furnished
or ordered by a certified nurse-midwife, the controlled substances
shall be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician and
surgeon. For Schedule II controlled substance protocols, the
provision for furnishing the Schedule II controlled substance shall
address the diagnosis of the illness, injury, or condition for which
the Schedule II controlled substance is to be furnished.
(4) The furnishing or ordering of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision. For
purposes of this section, no physician and surgeon shall supervise
more than four certified nurse-midwives at one time. Physician and
surgeon supervision shall not be construed to require the physical
presence of the physician, but does include all of the following:
(A) Collaboration on the development of the standardized procedure
or protocol.
(B) Approval of the standardized procedure or protocol.
(C) Availability by telephonic contact at the time of patient
examination by the certified nurse-midwife.
(b) (1) The furnishing or ordering of drugs or devices by a
certified nurse-midwife is conditional on the issuance by the board
of a number to the applicant who has successfully completed the
requirements of paragraph (2). The number shall be included on all
transmittals of orders for drugs or devices by the certified
nurse-midwife. The board shall maintain a list of the certified
nurse-midwives that it has certified pursuant to this paragraph and
the number it has issued to each one. The board shall make the list
available to the California State Board of Pharmacy upon its request.
Every certified nurse-midwife who is authorized pursuant to this
section to furnish or issue a drug order for a controlled substance
shall register with the United States Drug Enforcement
Administration.
(2) The board has certified in accordance with paragraph (1) that
the certified nurse-midwife has satisfactorily completed at least six
months of physician and surgeon supervised experience in the
furnishing or ordering of drugs or devices and a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this paragraph.
(3) A copy of the standardized procedure or protocol relating to
the furnishing or ordering of controlled substances by a certified
nurse-midwife shall be provided upon request to any licensed
pharmacist who is uncertain of the authority of the certified
nurse-midwife to perform these functions.
(4) Certified nurse-midwives who are certified by the board and
hold an active furnishing number, who are currently authorized
through standardized procedures or protocols to furnish Schedule II
controlled substances, and who are registered with the United States
Drug Enforcement Agency shall provide documentation of continuing
education specific to the use of Schedule II controlled substances in
settings other than a hospital based on standards developed by the
board.
(c) Drugs or devices furnished or ordered by a certified
nurse-midwife may include Schedule II controlled substances under the
California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) under
the following conditions:
(1) The drugs and devices are furnished or ordered in accordance
with requirements referenced in paragraphs (2) to (4), inclusive, of
subdivision (a) and in paragraphs (1) to (3), inclusive, of
subdivision (b).
(2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
(d) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure or
protocol. Use of the term "furnishing" in this section shall include
the following:
(1) The ordering of a drug or device in accordance with the
standardized procedure or protocol.
(2) Transmitting an order of a supervising physician and surgeon.
(e) "Drug order" or "order" for purposes of this section means an
order for medication or for a drug or device that is dispensed to or
for an ultimate user, issued by a certified nurse-midwife as an
individual practitioner, within the meaning of Section 1306.03 of
Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a drug order issued pursuant to this
section shall be treated in the same manner as a prescription of the
supervising physician; (2) all references to "prescription" in this
code and the Health and Safety Code shall include drug orders issued
by certified nurse-midwives; and (3) the signature of a certified
nurse-midwife on a drug order issued in accordance with this section
shall be deemed to be the signature of a prescriber for purposes of
this code and the Health and Safety Code.
2746.52. Notwithstanding Section 2746.5, the certificate to
practice nurse-midwifery authorizes the holder to perform and repair
episiotomies, and to repair first-degree and second-degree
lacerations of the perineum, in a licensed acute care hospital, as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, and a licensed alternate birth center, as defined in paragraph
(4) of subdivision (b) of Section 1204 of the Health and Safety Code,
but only if all of the following conditions are met:
(a) The supervising physician and surgeon and any backup physician
and surgeon is credentialed to perform obstetrical care in the
facility.
(b) The episiotomies are performed pursuant to protocols developed
and approved by all of the following:
(1) The supervising physician and surgeon.
(2) The certified nurse-midwife.
(3) The director of the obstetrics department or the director of
the family practice department, or both, if a physician and surgeon
in the obstetrics department or the family practice department is a
supervising physician and surgeon, or an equivalent person if there
is no specifically identified obstetrics department or family
practice department.
(4) The interdisciplinary practices committee, if applicable.
(5) The facility administrator or his or her designee.
(c) The protocols, and the procedures which shall be developed
pursuant to the protocols, shall relate to the performance and repair
of episiotomies and the repair of first-degree and second-degree
lacerations of the perineum, and shall do all of the following:
(1) Ensure that all complications are referred to a physician and
surgeon immediately.
(2) Ensure immediate care of patients who are in need of care
beyond the scope of practice of the certified nurse midwife, or
emergency care for times when the supervising physician and surgeon
is not on the premises.
(3) Establish the number of certified nurse-midwives that a
supervising physician and surgeon may supervise.
2746.7. An applicant for certification pursuant to this article
shall submit a written application in the form prescribed by the
board, accompanied by the fee prescribed by Section 2815.5.
2746.8. Each certificate issued pursuant to this article shall be
renewable biennially, and each person holding a certificate under
this article shall apply for a renewal of his certificate and pay the
biennial renewal fee required by Section 2815.5 every two years on
or before the last day of the month following the month in which his
birthday occurs, beginning with the second birthday following the
date on which the certificate was issued, whereupon the board shall
renew the certificate.
Each such certificate not renewed in accordance with this section
shall expire but may within a period of eight years thereafter be
reinstated upon payment of the biennial renewal fee and penalty fee
required by Section 2815.5 and upon submission of such proof of the
applicant's qualifications as may be required by the board, except
that during such eight-year period no examination shall be required
as a condition for the reinstatement of any such expired certificate
which has lapsed solely by reason of nonpayment of the renewal fee.
After the expiration of such eight-year period the board may require
as a condition of reinstatement that the applicant pass such
examination as it deems necessary to determine his present fitness to
resume the practice of nurse-midwifery.
