CHAPTER 33 - MIDWIFERY JOINT COMMITTE

 

SECTION .0100 MIDWIFERY JOINT COMMITTE

 

21 NCAC 33 .0101 ADMINISTRATIVE BODY AND DEFINITIONS

(a) The responsibility for administering the provisions of G.S. 90, Article 10A, shall be assumed by an administrative body, the Midwifery Joint Committee, hereinafter referred to as the "Committee." The certified nurse midwife shall hereinafter be referred to as "midwife."

(b) Definitions:

(1) "Primary Supervising Physician" means the licensed physician who, by signing the certified nurse-midwife application, shall be held accountable for the on-going supervision, consultation, collaboration, and evaluation of the medical acts performed by the certified nurse-midwife, as defined in the site specific written clinical practice guidelines. A physician in a graduate medical education program, whether fully licensed or holding only a resident's training license, shall not be named as a primary supervising physician. A physician in a graduate medical education program who is also practicing in a non-training situation may supervise a certified nurse-midwife in the non-training situation if he or she is fully licensed.

(2) "Back-up Primary Supervising Physician" means the licensed physician who, by signing an agreement with the certified nurse-midwife and the primary supervising physician or physicians shall be held accountable for the supervision, consultation, collaboration and evaluation of medical acts by the certified-nurse midwife in accordance with the site specific written clinical practice guidelines when the Primary Supervising Physician is not available. The signed and dated agreements for each back-up primary supervising physician or physicians shall be maintained at each practice site. A physician in a graduate medical education program, whether fully licensed or holding only a resident's training license, shall not be named as a back-up primary supervising physician. A physician in a graduate medical education program who is also practicing in a non-training situation may be a back-up primary supervising physician to a certified nurse-midwife in the non-training situation if he or she is fully licensed and has signed an agreement with the certified nurse-midwife and the primary supervising physician.

(3) "Obstetrics" means a branch of medical science that deals with birth and with its antecedents and sequels, including prenatal, intrapartum, postpartum, newborn, gynecology, and otherwise unspecified primary health services for women.

 

History Note: Authority G.S. 90‑178.4;

Eff. February 1, 1984;

Amended Eff. July 1, 2000; October 1, 1988;

Readopted Eff. November 1, 2018.

 

21 NCAC 33 .0102 FEES

(a) The fee for a new application and initial approval shall be one hundred dollars ($100.00).

(b) The fee for annual renewal shall be fifty dollars ($50.00).

(c) The fee for reinstatement for a lapsed approval shall be five dollars ($5.00).

 

History Note: Authority G.S. 90‑178.4(b);

Eff. February 1, 1984;

Amended Eff. July 1, 2000;

Readopted Eff. November 1, 2018.

 

21 NCAC 33 .0103 APPLICATION

(a) The application to obtain approval to practice as a midwife is electronically available from the Committee on the North Carolina Board of Nursing website, www.ncbon.com.

(b) The application shall require information on the applicant's education, evidence of the applicant's certification by the American College of Nurse Midwives, identification of the physician or physicians who will supervise the applicant, and the sites where the applicant intends to practice midwifery.

 

History Note: Authority G.S. 90‑178.4(b); 90‑178.5;

Eff. February 1, 1984;

Amended Eff. March 1, 2017; January 1, 1989;

Readopted Eff. November 1, 2018.

 

21 NCAC 33 .0104 PHYSICIAN SUPERVISION

The applicant shall furnish the committee evidence that the applicant will perform the acts authorized by the Midwifery Practice Act under the supervision of a physician who is actively engaged in the practice of obstetrics in North Carolina. Such evidence shall include a description of the nature and extent of such supervision and a delineation of the procedures to be adopted and followed by each applicant and the supervising physician responsible for the acts of said applicant for rendering health care services at the sites at which such services will be provided. Such evidence shall include:

(1) mutually agreed upon written clinical practice guidelines that define the individual and shared responsibilities of the midwife and the supervising physician or physicians in the delivery of health care services;

(2) mutually agreed upon written clinical practice guidelines for ongoing communication that provide for and define appropriate consultation between the supervising physician or physicians and the midwife;

(3) periodic and joint evaluation of services rendered, such as chart review, case review, patient evaluation, and review of outcome statistics; and

(4) periodic and joint review and updating of the written medical clinical practice guidelines.

 

History Note: Authority G.S. 90‑178.4(b);

Eff. February 1, 1984;

Amended Eff. July 1, 2000; October 1, 1988; April 1, 1985;

Readopted Eff. November 1, 2018.

 

21 ncac 33 .0105 DUE PROCESS

(a) Denial, revocation, or suspension of an approval to practice midwifery shall be governed by G.S. 90-178.6 and this Chapter. The applicant aggrieved by a decision of the Committee shall be entitled to a hearing pursuant to the provisions of G.S. 150B, Article 3A.

(b) Complaints.

(1) A complaint regarding a violation of the Midwifery Practice Act or Rules shall be submitted in writing and document:

(A) the name of the certified nurse-midwife or other person involved;

(B) a description of the alleged behavior or incident; and

(C) the name, mailing address, and phone number of the person filing the complaint.

(2) The complaint shall be delivered to the Committee administrative office by mail, private carrier, facsimile, electronic mail, or in person.

(c) Action on a Complaint. Action on a complaint shall consist of the following:

(1) The Committee shall receive and acknowledge complaints, open a file, and initiate complaint tracking.

(2) Complaints shall be screened to determine jurisdiction and the type of response appropriate for the complaint.

(3) Investigation:

(A) If the facts clearly indicate a Midwifery Practice Act violation, the Committee shall commence an investigation.

(B) A report of each investigation shall be prepared for the Committee's review.

(4) Formal and Informal Hearings:

(A) The Committee, after review of an investigative file and upon request by a licensee, shall schedule an informal meeting.

(B) If the matter cannot be resolved informally, then a formal hearing shall be held.

(C) No Committee member shall participate in more than one of the following steps in the enforcement process:

(i) investigation;

(ii) informal hearing; or

(iii) formal hearing.

(D) Members of the Committee shall not make ex-parte communication with parties to a hearing.

(5) Final Orders: No later than 60 days after a hearing, the Committee shall issue its final decision, in writing, specifying the date on which it shall take effect. The Committee shall serve one copy of the decision on each party to the hearing.

(6) Compliance: The Committee Chair shall cause a follow-up inquiry to determine that the orders of the Committee are being obeyed.

(d) Disciplinary Sanctions.

(1) The following types of disciplinary sanctions may, among others, be used by the Committee when a violation of G.S. 90-178.6(a) is found:

(A) Letter of reprimand;

(B) probation;

(C) suspension of approval;

(D) nonrenewal of approval;

(E) revocation of approval; and

(F) injunction.

(2) The Committee may request information from professional associations, professional review organizations (PROs), hospitals, clinics, or other institutions in which a certified nurse-midwife performs professional services.

(3) The Committee shall provide notice of sanction taken by it to other public entities as necessary to ensure that other state Boards and enforcement authorities receive the names of certified nurse midwives who have been disciplined.

 

History Note: Authority G.S. 90-178.6;

Eff. February 1, 1985;

Amended Eff. August 1, 2002; October 1, 1988;

Readopted Eff. November 1, 2018.

 

21 NCAC 33 .0106 NURSE MIDWIFE APPLICANT STATUS (repealed)

 

History Note: Authority G.S. 90‑178.2; 90‑178.5;

Eff. March 1, 1991;

RRC Objection Eff. May 18, 2000 due to lack of statutory authority;

RRC returned rule to agency on June 19, 2000;

Codifier of Rules removed rule from the NCAC Eff. June 19, 2000.

 

21 ncac 33 .0107 NURSE MIDWIFE APPLICANT STATUS

 

History Note: Authority G.S. 90-178.2; 90-178.3; 90-178.5; 90-171.83;

Eff. April 1, 2001;

Repealed Eff. March 1, 2017.

 

21 NCAC 33 .0108 SUSPENSION OF AUTHORITY TO EXPEND FUNDS

In the event the Midwifery Joint Committee's authority to expend funds is suspended pursuant to G.S. 93B-2(d), the Committee shall continue to issue and renew licenses and all fees tendered shall be placed in an escrow account maintained by the Committee for this purpose. Once the Committee's authority is restored, the funds shall be moved from the escrow account into the general operating account.

 

History Note: Authority G.S. 93B-2;

Eff. May 1, 2011;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.

 

21 NCAC 33 .0109 Termination of Approval to Practice

 

History Note: Authority G.S. 90-178.2; 90-178.3; 90-178.4; 90-178.5;

Emergency Adoption Eff. June 18, 2012;

Emergency Adoption expired August 31, 2012.

 

21 NCAC 33 .0110 REPORTING CRITERIA

(a) The Department of Health and Human Services ("Department") may report to the Committee information regarding the prescribing practices of those midwives ("prescribers") whose prescribing:

(1) falls within the top two percent of those prescribing 100 morphine milligram equivalents ("MME") per patient per day; or

(2) falls within the top two of those prescribing 100 MME's per patient per day in combination with any benzodiazepine and who are within the top one percent of all controlled substance prescribers by volume.

(b) In addition, the Department may report to the Committee information regarding midwives who have had two or more patient deaths in the preceding 12 months due to opioid poisoning where the prescribers authorized more than 30 tablets of an opioid to the decedent and the prescriptions were written within 60 days of the patient deaths.

(c) The Department may submit these reports to the Committee upon request and may include the information described in G.S. 90-113.73(b).

(d) The reports and communications between the Department and the Committee shall remain confidential pursuant to G.S. 90-113.74.

 

History Note: Authority G.S. 90-113.74; 90-178.4;

Eff. May 1, 2016;

Amended Eff. December 1, 2017;

Readopted Eff. November 1, 2018.

 

21 NCAC 33 .0111 CONTINUING EDUCATION (CE)

In order to maintain approval to practice midwifery, a midwife shall meet the requirements of the Certificate Maintenance Program of the American College of Nurse-Midwives, including continuing education requirements. Every midwife who prescribes controlled substances shall complete at least one hour of continuing education (CE) hours annually consisting of CE designated specifically to address controlled substances prescribing practices, signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management. Documentation of continuing education shall be maintained by the midwife for the previous five calendar years and made available upon request to the Committee.

 

History Note: Authority: G.S. 90-5.1; 90-14(a)(15); 90-178.5(2); S.L. 2015-241, s. 12F .16(b);

Eff. March 1, 2017;

Readopted Eff. November 1, 2018.