Legislature(2003 - 2004)
02/10/2003 03:15 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 71-EXTEND BOARD OF MIDWIVES CHAIR ANDERSON announced the first order of business was a hearing on HOUSE BILL NO. 71, "An Act extending the termination date of the Board of Certified Direct-Entry Midwives." Number 0077 REPRESENTATIVE BRUCE WEYHRAUCH, Alaska State Legislature, speaking as chair of the House State Affairs Standing Committee, sponsor of HB 71, explained that this legislation that extends the Board of Certified Direct-Entry Midwives through June 30, 2007. He said the continuation of this board was handled in a stand-alone bill because the profession is significantly different from other health professions. The fiscal note is zero. Fees from midwife licensing cover the administrative costs of the board. REPRESENTATIVE WEYHRAUCH explained his personal experience with the midwife profession. His three children were born at home with the assistance of midwives. Representative Weyhrauch's wife selected this birthing option after researching what midwives offer. Each time, the midwife carefully examined Mrs. Weyhrauch, monitored her pregnancy, and evaluated her for risks such as twins and Caesarian section birth. Both the Weyhrauchs took prenatal classes from the midwife and the hospital and developed contingency plans for emergencies. He described these services, when conservatively handled, as a great asset both in rural and urban Alaska. The board gives the state oversight over who's practicing when, where, and how. Number 0445 REPRESENTATIVE CRAWFORD noted that two of his three children were born with the assistance of midwives, and he supports this profession. He asked whether midwives would rather be separate from related professionals and bear all the administrative cost themselves or be combined with another board in order to keep the cost of their licenses lower. REPRESENTATIVE WEYHRAUCH suggested that a member of the midwife board could better answer that question. Number 0575 PAT DAVIDSON, Legislative Auditor, Division of Legislative Audit, Alaska State Legislature responded to a question from Representative Guttenberg about the legislative audit of the Board of Certified Direct-Entry Midwives. The audit [Control No. 08-20016-02] recommended a four-year extension of the board's termination date. In a similar sunset audit four years ago, the agency was concerned that the high cost of the licensing fee was presenting a barrier to entry into the profession. In this audit, staff found that those fees have dropped, but the board is collecting sufficient fees to cover their expenses. This audit did not examine whether the midwives should consider joining another board. In answer to a question from Representative Crawford, she noted that the biennial fee is currently $950, down from $1,550 two years ago. Ms. Davidson, in response to a comment by Representative Rokeberg, noted that the Board of Certified Direct-Entry Midwives received a clean audit. Number 0675 KAYE KANNE, President, Midwives Association of Alaska; Executive Director, Juneau Family Birth Center, told members that she has practiced as a midwife in Juneau for 19 years. She testified in support in HB 71. She said the Board of Certified Direct-Entry Midwives board has done an excellent job of writing and implementing regulations. She noted that she was a member of the board from its inception in 1992 through 1999 and was its chair for four of those years. The board strives for high standards for CDMs [certified direct-entry midwives], and as a result, she testified, midwives in Alaska are professional, well trained, and provide safe, excellent care for women and families. MS. KANNE referred to data from the Office of Vital Statistics, Division of Public Health, Department of Health and Social Services, on the percentage of births in Alaska attended by certified direct-entry midwives. She said they delivered almost 10 percent of the babies born in Alaska last year. The percentage is even higher in some parts of the state, for example, almost 25 percent in the Matanuska-Susitna Borough. Alaska's figures are higher than the nationwide average, where midwives attend approximately 5 percent of the births. MS. KANNE opined that Alaska has one of the best midwifery laws in the United States. Many other states look to Alaska as an example when passing midwifery legislation. Some 21 states have licensing for direct-entry midwives and 8 more have legislation pending. Number 0830 MS. KANNE answered Representative Rokeberg's questions from the Legislative Audit report about why only 7 out of 30 apprentices are still active. She described supervising apprentices during her 20-year career. The long hours, low pay, and huge responsibility discourage many students. She has supervised two apprenticeships who finished their training and became licensed. There's no requirement for a university degree in Alaska; Alaska's direct-entry midwifery laws are based on the apprenticeship model. There are several nationally credited programs that instructors use when they supervise midwife trainees; Ms. Kanne explained that she uses the National College of Midwifery out of New Mexico, which is a degree program. Number 0928 REPRESENTATIVE ROKEBERG noted his concern about high licensure costs. He cited a recent disciplinary action by the board, the cost of which must be covered by the midwife licensing fee. He expressed concern that the fee would rise again. He noted it was a key issue when the board was created because of its potential barrier to entry; the amount of the licensing fee is always a consideration in licensing an occupation. MS. KANNE replied that the licensing fee was $1,300 for the most recent renewal of December 31, so it has risen from $950, probably because of the investigation. As the president of the Midwives Association of Alaska, she reported that members feel it is very important to have an independent board, and they do not want to be merged with any other board. Members are willing to pay the higher licensing fees, she said. They are continuing to recruit midwives in the state. The Juneau Family Birth Center and other nonprofit birth centers in Alaska pay their midwives' licensing fees. They try to assure that no one is prohibited from practicing because of the licensing fees. Number 1085 MS. KANNE, in response to questions from Representative Rokeberg about whether midwives can afford the fees, said midwifery services pay for themselves and the midwives' salaries. She said the total fees for a childbirth at the Juneau Family Birth Center range from $3,000 to $5,000, which is about half the cost of a normal delivery at the hospital. Number 1127 REPRESENTATIVE LYNN asked if midwife services are covered by insurance. He asked about the process, and timeframe, and the cost of getting licensed as a certified direct-entry midwife. MS. KANNE answered that midwife training in Alaska uses an apprenticeship model. Students must finish an academic program approved by the national accreditation program for midwives and must finish clinical requirements under state law. Most apprentices take three to four years because they must assist at 60 births. The cost of apprenticeship varies around the state. At the Juneau birth center, for example, students pay $200 a month and work at the center. Number 1240 REPRESENTATIVE GUTTENBERG asked about the protocols to transfer a patient from a midwife to a doctor in case of complications. MS. KANNE replied that certified direct-entry midwives are independent practitioners who do not practice under the supervision of physicians. State law recommends - but does not require - that patients see a physician for a complete physical exam. She said she believes midwives and medical professionals in Juneau and around the state have good working relationships. Alaska law clearly defines what midwives can and cannot do. REPRESENTATIVE GUTTENBERG asked whether there has been a situation in which someone used a midwife instead of using a physician. MS. KANNE replied no, not to her knowledge. Number 1360 MS. KANNE, in response to a question from Representative Lynn about whether midwives administer pain medication during childbirth, answered that no, midwives use natural techniques such as massage and water to create a situation in which pain medication isn't necessary. MS. KANNE answered a question from Representative Gatto about whether men are allowed to become midwives. She said that yes they are, although there are none that she knows of practicing in Alaska. Number 1388 RICK URION, Director, Division of Occupational Licensing, Department of Community & Economic Development, said the Board of Certified Direct-Entry Midwives functions well and within its budget. He urged the committee to pass HB 71. Number 1430 DANA BROWN, Chair, Board of Certified Direct-Entry Midwives; Executive Director, Alaska Family Health and Birth Center, testified in favor of extending the board. She said the board has been doing its work of maintaining high standards of care for the public's safety. The midwives are able and willing to pay the licensing fees required to maintain a separate board. Number 1504 REPRESENTATIVE GATTO moved to report HB 71 out of committee with individual recommendations and the attached fiscal note. There being no objection, HB 72 was reported from the House Labor and Commerce Standing Committee.
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