Florida Senate - 2020                                    SB 1764
       By Senator Flores
       39-00727A-20                                          20201764__
    1                        A bill to be entitled                      
    2         An act relating to childbirth; amending s. 382.008,
    3         F.S.; requiring a certificate for fetal death to
    4         include certain information if the death occurred in
    5         association with a planned out-of-hospital birth;
    6         amending s. 382.013, F.S.; requiring a certificate of
    7         live birth to list the intended place of birth;
    8         requiring the certificate to list certain information
    9         if the mother or newborn was transferred to a
   10         hospital, an intensive care unit, or a similar
   11         facility during certain times; amending s. 456.0495,
   12         F.S.; revising the definition of the term “adverse
   13         incident”; requiring certain health care practitioners
   14         to submit adverse incident reports to the Department
   15         of Health within a specified timeframe under certain
   16         circumstances; requiring the department to investigate
   17         adverse incident reports involving unlicensed
   18         individuals and take appropriate action; creating a
   19         review panel within the department, in consultation
   20         with certain regulatory boards; providing for the
   21         membership, meetings, and duties of the panel;
   22         requiring the panel to submit annual reports to the
   23         department, the Board of Medicine, the Board of
   24         Osteopathic Medicine, the Board of Nursing, and the
   25         Council of Licensed Midwifery by a specified date;
   26         requiring the department to collect and analyze
   27         certain data relating to adverse incidents in planned
   28         out-of-hospital births; requiring the department to
   29         submit annual reports on its findings and
   30         recommendations to the Governor and the Legislature by
   31         a specified date and publish the report on its
   32         website; requiring the department to deidentify
   33         information in such report; creating s. 456.0496,
   34         F.S.; providing continuing education requirements for
   35         and duties of licensed health care practitioners
   36         providing out-of-hospital births; requiring the
   37         department to adopt rules for such education
   38         requirements; requiring a patient informed consent
   39         form for out-of-hospital births to include specified
   40         information; providing for violations and penalties;
   41         providing grounds for disciplinary action; providing
   42         an effective date.
   44  Be It Enacted by the Legislature of the State of Florida:
   46         Section 1. Subsection (1) of section 382.008, Florida
   47  Statutes, is amended to read:
   48         382.008 Death, fetal death, and nonviable birth
   49  registration.—
   50         (1) A certificate for each death and fetal death which
   51  occurs in this state shall be filed electronically on the
   52  department electronic death registration system or on a form
   53  prescribed by the department with the department or local
   54  registrar of the district in which the death occurred within 5
   55  days after such death and prior to final disposition, and shall
   56  be registered by the department if it has been completed and
   57  filed in accordance with this chapter or adopted rules. The
   58  certificate shall include the decedent’s social security number,
   59  if available. In addition, each certificate of death or fetal
   60  death:
   61         (a) If requested by the informant, shall include aliases or
   62  “also known as” (AKA) names of a decedent in addition to the
   63  decedent’s name of record. Aliases shall be entered on the face
   64  of the death certificate in the space provided for name if there
   65  is sufficient space;
   66         (b) If the place of death is unknown, shall be registered
   67  in the registration district in which the dead body or fetus is
   68  found within 5 days after such occurrence; and
   69         (c) If death occurs in a moving conveyance, shall be
   70  registered in the registration district in which the dead body
   71  was first removed from such conveyance; and
   72         (d) If the fetal death occurred in association with a
   73  planned out-of-hospital birth, including a fetal death that
   74  occurs out-of-hospital or during a transfer or admission to a
   75  hospital, an intensive care unit, or a similar facility, shall
   76  include the name, title, and professional license number of each
   77  physician, certified nurse midwife, or midwife who treated the
   78  mother or fetus during the pregnancy, labor, or delivery, or
   79  immediately thereafter. If an individual who treated the mother
   80  or fetus is not appropriately licensed in this state but
   81  represented himself or herself as such, the certificate of fetal
   82  death must also include the name of the unlicensed individual
   83  and any title or professional license number the individual used
   84  to represent himself or herself as appropriately licensed in
   85  this state, with a clear notation that the individual is not
   86  appropriately licensed as such.
   87         Section 2. Subsection (6) is added to section 382.013,
   88  Florida Statutes, to read:
   89         382.013 Birth registration.—A certificate for each live
   90  birth that occurs in this state shall be filed within 5 days
   91  after such birth with the local registrar of the district in
   92  which the birth occurred and shall be registered by the local
   93  registrar if the certificate has been completed and filed in
   94  accordance with this chapter and adopted rules. The information
   95  regarding registered births shall be used for comparison with
   96  information in the state case registry, as defined in chapter
   97  61.
   98         (6) INTENDED PLACE OF BIRTH.—A certificate of live birth
   99  must include the intended place of birth. If the mother or
  100  newborn was transferred to a hospital, an intensive care unit,
  101  or a similar facility at any point during labor or delivery, or
  102  within 72 hours of delivery, the certificate must also include
  103  the name and address of the transferring location and the name,
  104  title, and professional license number of each physician,
  105  certified nurse midwife, or midwife who treated the mother or
  106  newborn during the pregnancy, labor, or delivery, or immediately
  107  thereafter. If an individual who treated the mother or fetus
  108  prior to such transfer is not appropriately licensed in this
  109  state but represented himself or herself as such, the
  110  certificate of live birth must also include the name of the
  111  unlicensed individual and any title or professional license
  112  number the individual used to represent himself or herself as
  113  appropriately licensed in this state, with a clear notation that
  114  the individual is not appropriately licensed as such.
  115         Section 3. Section 456.0495, Florida Statutes, is amended
  116  to read:
  117         456.0495 Reporting adverse incidents occurring in planned
  118  out-of-hospital births.—
  119         (1) For purposes of this section, the term “adverse
  120  incident” means an event over which a physician licensed under
  121  chapter 458 or chapter 459, a nurse midwife certified under part
  122  I of chapter 464, or a midwife licensed under chapter 467 could
  123  exercise control and which is associated with an attempted or
  124  completed planned out-of-hospital birth, and results in one or
  125  more of the following injuries or conditions:
  126         (a) A maternal death that occurs during delivery or within
  127  42 days after delivery;
  128         (b) The transfer of a maternal patient to a hospital
  129  intensive care unit;
  130         (c) A maternal patient experiencing hemorrhagic shock or
  131  requiring a transfusion of more than 4 units of blood or blood
  132  products;
  133         (d) A fetal or newborn death, including a stillbirth,
  134  associated with an obstetrical delivery;
  135         (e) A transfer of a newborn to a neonatal intensive care
  136  unit due to a traumatic physical or neurological birth injury,
  137  including any degree of a brachial plexus injury;
  138         (f) A transfer of a newborn to a neonatal intensive care
  139  unit within the first 72 hours after birth if the newborn
  140  remains in such unit for more than 72 hours; or
  141         (g)Any transfer of a maternal patient or newborn from an
  142  out-of-hospital birth setting to a hospital during the prenatal,
  143  intrapartal, or postpartal period, as those periods are defined
  144  in s. 467.003, that results in fetal or maternal morbidity or
  145  mortality; or
  146         (h)(g) Any other injury as determined by department rule.
  147         (2) Beginning July 1, 2018, A physician licensed under
  148  chapter 458 or chapter 459, a nurse midwife certified under part
  149  I of chapter 464, or a midwife licensed under chapter 467 who
  150  performs an attempted or completed planned out-of-hospital birth
  151  must report an adverse incident, along with a medical summary of
  152  events, to the department within 15 days after the adverse
  153  incident occurs. A health care practitioner required to report
  154  adverse incidents under this section who is aware of an adverse
  155  incident related to an out-of-hospital birth attempted or
  156  completed by an individual who was not appropriately licensed in
  157  this state but who represented himself or herself as licensed
  158  must report such adverse incident, including all related
  159  information of which the health care practitioner has knowledge,
  160  to the department within 15 days after becoming aware of such
  161  adverse incident.
  162         (3) The department shall review each incident report and
  163  determine whether the incident involves conduct by a health care
  164  practitioner which is subject to disciplinary action under s.
  165  456.073. Disciplinary action, if any, must be taken by the
  166  appropriate regulatory board or by the department if no such
  167  board exists. If the department receives an adverse incident
  168  report involving conduct by an unlicensed individual, the
  169  department shall investigate the individual for unlicensed
  170  activity and take appropriate action under s. 456.065.
  171         (4)A review panel is created within the department, in
  172  consultation with the Board of Medicine, the Board of
  173  Osteopathic Medicine, the Board of Nursing, and the Council of
  174  Licensed Midwifery, to review reported adverse incidents
  175  involving a planned out-of-hospital birth.
  176         (a)The panel shall be composed of one obstetrical medical
  177  physician, one obstetrical osteopathic physician, one certified
  178  nurse midwife, one paramedic, and one midwife, each of whom must
  179  have experience in out-of-hospital births and be appointed by
  180  the applicable board or council. The State Surgeon General or
  181  his or her designee shall serve as the chair and a nonvoting
  182  member of the panel. The panel shall meet quarterly and as often
  183  as necessary to perform its duties under this subsection and may
  184  conduct its meetings using any method of telecommunication.
  185  Panel members shall serve without compensation but may receive
  186  reimbursement for per diem and travel expenses as provided in s.
  187  112.061.
  188         (b)Based on its review of reported adverse incidents under
  189  this subsection, the panel shall collaborate with experts in
  190  data collection and public health to identify any patterns or
  191  trends linking certain adverse incidents to any licensed health
  192  care practitioner providing planned out-of-hospital births,
  193  identify causes for such patterns or trends, and make
  194  recommendations for changes to address causes for adverse
  195  incidents identified in the panel’s review.
  196         (c)By July 1 of each year, the panel shall report its
  197  collaborative findings and recommendations to the department,
  198  the Board of Medicine, the Board of Osteopathic Medicine, the
  199  Board of Nursing, and the Council of Licensed Midwifery.
  200         (5)(a)Using data collected from adverse incident reports
  201  submitted under this section, from certificates of live birth
  202  and certificates of fetal death filed with its Office of Vital
  203  Statistics, and from information submitted by licensed midwives
  204  to the Council of Licensed Midwifery, the department or its
  205  designee shall, at a minimum:
  206         1.Analyze data relating to the frequency and nature of
  207  adverse incidents in planned out-of-hospital births;
  208         2.Identify the rate of adverse incidents by the type of
  209  adverse incident and attending health care practitioners or
  210  unlicensed individuals;
  211         3.Identify any patterns or trends linking types of adverse
  212  incidents to attending health care practitioners or unlicensed
  213  individuals, and study causes for such patterns or trends;
  214         4.Compare the findings to any comparable research and data
  215  associated with out-of-hospital births available from other
  216  states; and
  217         5.Make recommendations for policy changes that may reduce
  218  the rate of adverse incidents in planned out-of-hospital births
  219  in this state.
  220         (b)By July 1 of each year, the department shall submit a
  221  report of its findings and any recommendations to the Governor,
  222  the President of the Senate, and the Speaker of the House of
  223  Representatives. The report shall also be published on the
  224  department’s website. All information in the report must be
  225  deidentified.
  226         (6)(4) The department shall adopt rules to implement this
  227  section and shall develop a form to be used for the reporting of
  228  adverse incidents.
  229         Section 4. Section 456.0496, Florida Statutes, is created
  230  to read:
  231         456.0496Out-of-hospital births; continuing education
  232  requirements; responsibilities; violations and penalties;
  233  grounds for discipline; enforcement.—
  235         (a) A licensed health care practitioner who provides out
  236  of-hospital births shall biennially satisfy the following
  237  continuing education hours as a condition for renewal of his or
  238  her license:
  239         1.Three hours of instruction on the risk of complications
  240  during pregnancy, labor, and delivery.
  241         2.Four hours of instruction on ethics and collaborative
  242  care, including informed consent, patient confidentiality,
  243  patient relationships, transportation from a home or birth
  244  center to a hospital, and malpractice and negligence.
  245         (b)The department shall prescribe by rule continuing
  246  education requirements as a condition for renewal of a license.
  247  The criteria for continuing education programs must be approved
  248  by the department. Any individual, institution, organization, or
  249  agency that is approved by the department to provide continuing
  250  education programs for the purpose of license renewal to a
  251  licensed health care practitioner providing out-of-hospital
  252  births must demonstrate that such programs comply with all of
  253  the following requirements:
  254         1.The programs have clinical relevance to practitioners
  255  providing out-of-hospital birth.
  256         2.The programs are at least 1 clock hour in duration.
  257         3.The programs have an organized structure with objectives
  258  and expected outcomes.
  259         4.Each presenter, instructor, or facilitator of a program
  260  is a recognized professional, such as a physician, nurse,
  261  certified nurse midwife, psychologist, or licensed midwife.
  263  licensed health care practitioner providing out-of-hospital
  264  births shall do all of the following:
  265         (a)Upon acceptance of a patient into care, advise the
  266  patient of the clinical outcomes of births in low-risk patients
  267  during an out-of-hospital birth and any increased risks
  268  associated with an individual having a vaginal birth after
  269  having a caesarean section, a breech birth, or a multiple
  270  gestation pregnancy. The licensed health care practitioner
  271  providing out-of-hospital births shall further advise, but may
  272  not require, the patient to consult an obstetrician for more
  273  information related to such clinical outcomes and increased
  274  risks.
  275         (b)Prepare a written plan of action with the family to
  276  ensure continuity of medical care throughout labor and delivery
  277  and to provide for immediate medical care if an emergency
  278  arises. The family should have specific plans for medical care
  279  throughout the prenatal, intrapartal, and postpartal periods.
  280         (c)If a home birth is planned, instruct the patient and
  281  family regarding the preparation of the home and ensure
  282  availability of equipment and supplies needed for delivery and
  283  infant care.
  284         (d)Instruct the patient in personal hygiene and sanitary
  285  measures as they relate to pregnancy and in nutrition as it
  286  relates to prenatal care.
  287         (e)Maintain equipment and supplies required for providing
  288  care during the intrapartum and immediate postpartum periods in
  289  an out-of-hospital setting.
  290         (f)Upon initial contact with the patient during the
  291  intrapartal period, measure and record the vital signs of the
  292  mother and fetus to serve as a baseline during labor and
  293  delivery.
  294         (g)Transfer care of the patient to a hospital with
  295  obstetrical services in accordance with the written emergency
  296  plan if any of the following occurs or presents during labor or
  297  delivery or immediately thereafter:
  298         1.An unexpected nonvertex presentation of the fetus;
  299         2.Indication that the mother’s uterus has ruptured;
  300         3.Evidence of severe and persistent fetal or maternal
  301  distress;
  302         4.Pregnancy-induced hypertension;
  303         5.An umbilical cord prolapse;
  304         6.Active infectious disease process; or
  305         7.Any other severe emergent condition.
  306         (3)INFORMED CONSENT.—The department shall develop a
  307  uniform patient informed consent form to be used by the licensed
  308  health care practitioner providing out-of-hospital births to
  309  inform the patient of the health care practitioner’s
  310  qualifications and the nature and risk of the procedures to be
  311  performed by the health care practitioner and to obtain the
  312  patient’s consent for the provision of out-of-hospital birth
  313  services. The form must be signed by the patient and the health
  314  care practitioner providing out-of-hospital births, and a copy
  315  must be provided to the patient. The form shall include, at a
  316  minimum, all of the following:
  317         (a)A statement advising the patient of the clinical
  318  outcomes of births in low-risk patients during an out-of
  319  hospital birth and any increased risks associated with having a
  320  vaginal birth after having a caesarean section, a breech birth,
  321  or a multiple gestation pregnancy.
  322         (b)A detailed statement explaining to the patient hospital
  323  admitting privileges and the requirements to obtain and maintain
  324  such privileges.
  325         (c)Disclosure of each hospital and specific department, if
  326  any, where the health care practitioner providing out-of
  327  hospital births has been granted admitting privileges, including
  328  the scope and duration of the admitting privileges, the current
  329  contact information for the specific hospital or department that
  330  has granted the health care practitioner admitting privileges,
  331  and a copy of documentation from the hospital or department
  332  providing proof of such admitting privileges. A health care
  333  practitioner providing out-of-hospital births who does not have
  334  admitting privileges at any hospital must explicitly state that
  335  fact on the form.
  337         (a)A person who knowingly conceals or fraudulently
  338  misrepresents information or a requirement relating to the
  339  practice of out-of-hospital birth commits a felony of the third
  340  degree, punishable as provided in s. 775.082, s. 775.083, or s.
  341  775.084.
  342         (b)The fraudulent misrepresentation of a requirement
  343  relating to the practice of out-of-hospital birth is grounds for
  344  denial of a license or disciplinary action, as specified in s.
  345  456.072(2).
  347  ground for disciplinary action is a first-time violation of a
  348  practice act for unprofessional conduct, as used in ss.
  349  464.018(1)(h), 467.203(1)(f), 468.365(1)(f), and 478.52(1)(f),
  350  and no actual harm to the patient occurred, the board or
  351  department, as applicable, shall issue a citation in accordance
  352  with s. 456.077 and assess a penalty as determined by rule of
  353  the board or department.
  354         Section 5. This act shall take effect July 1, 2020.