January 24, 2002 - Introduced by Senators Robson, Moen, Moore, Roessler,
Rosenzweig, Wirch, Burke, Erpenbach, Breske
and Darling, cosponsored by
Representatives Underheim, Krawczyk, Lippert, Miller, Olsen, Bies,
Skindrud, Townsend, Albers
and Gard. Referred to Committee on Health,
Utilities, Veterans and Military Affairs.
SB397,1,5 1An Act to renumber and amend 441.15 (1) and 441.15 (3) (a); to amend 253.13
2(1), 441.15 (2) (intro.), 441.15 (2) (a), 441.15 (2) (b), 441.15 (3) (b) and 441.15 (4);
3and to create 441.15 (1) (a), 441.15 (2) (c), 441.15 (3) (a) 3. and 441.15 (5) of the
4statutes; relating to: the practice of nurse-midwifery, providing an exemption
5from emergency rule procedures, and granting rule-making authority.
Analysis by the Legislative Reference Bureau
Under current law, no person may practice as a nurse-midwife unless he or she
is issued a license by the board of nursing (board). "Nurse-midwifery" is defined as:
1) managing the care of a woman in normal childbirth; 2) providing prenatal,
intrapartal, postpartal, and nonsurgical contraceptive methods; and 3) caring for a
mother and newborn. Current law also requires a nurse-midwife to practice in a
health care facility approved by the board and under the general supervision of a
physician with training in obstetrics. Also, there must be a formal written
agreement between the nurse-midwife and supervising physician. In addition, if a
nurse-midwife discovers evidence of a complication that jeopardizes the health or
life of a mother or newborn, a nurse-midwife must immediately refer the patient to
the supervising physician or, if he or she is not available, to another physician.
This bill creates a new definition of "nurse-midwifery." Under the bill,
"nurse-midwifery" means the management of women's health care, pregnancy,
childbirth, postpartum care for newborns, family planning, and gynecological
services consistent with the standards of practice of the American College of

Nurse-Midwives and the education, training, and experience of the nurse-midwife.
As under current law, the bill prohibits a person from acting as a nurse-midwife
without a license issued by the board. In addition, as under current law, a
nurse-midwife must practice in an approved health care facility.
In addition, under the bill, a nurse-midwife must practice in collaboration with
a physician, not under a physician's general supervision. Also, the bill requires the
physician's training in obstetrics to be postgraduate training. The bill defines
"collaboration" as a process that involves two or more health care professionals
working together and, when necessary, in each other's presence. Additionally,
"collaboration" is defined as a process in which each health care professional
contributes his or her expertise to provide more comprehensive care than one health
care professional alone can offer. The bill also requires a written agreement between
the collaborating physician and nurse-midwife. Also, if a nurse-midwife discovers
evidence of a complication, the nurse-midwife must consult with the collaborating
physician or the physician's designee, or make a referral as specified in the written
agreement.
Finally, the bill requires the board to consult with the commissioner of
insurance and promulgate rules establishing the minimum amount of malpractice
liability insurance that a nurse-midwife must have in effect. The rules must include
requirements and procedures for waiving the rules for any period of time for which
the commissioner of insurance determines that such insurance is not reasonably
available. The following are not required to have the insurance: 1) federal, state,
county, city, village, and town employees who practice nurse-midwifery within the
scope of their employment; 2) certain health center employees who are immune from
liability under federal law; 3) employees who are covered by their employers'
insurance in at least the minimum amount required under the rules; and 4) persons
who do not provide care for patients. If applicable, an applicant for a license or for
renewal of a license must submit proof of the insurance to the board.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB397, s. 1 1Section 1. 253.13 (1) of the statutes is amended to read:
SB397,3,32 253.13 (1) Blood tests. The attending physician or nurse certified licensed
3under s. 441.15 shall cause every infant born in each hospital or maternity home,
4prior to its discharge therefrom, to be subjected to blood tests for congenital and
5metabolic disorders, as specified in rules promulgated by the department. If the
6infant is born elsewhere than in a hospital or maternity home, the attending

1physician, nurse certified licensed under s. 441.15 or birth attendant who attended
2the birth shall cause the infant, within one week of birth, to be subjected to these
3blood tests.
SB397, s. 2 4Section 2. 441.15 (1) of the statutes is renumbered 441.15 (1) (intro.) and
5amended to read:
SB397,3,66 441.15 (1) (intro.) In this section, "the practice:
SB397,3,13 7(b) "Practice of nurse-midwifery" means the management of care of a woman
8in normal childbirth and the provision of prenatal, intrapartal, postpartal and
9nonsurgical contraceptive methods and care for the mother and the newborn

10women's health care, pregnancy, childbirth, postpartum care for newborns, family
11planning, and gynecological services consistent with the standards of practice of the
12American College of Nurse-Midwives and the education, training, and experience
13of the nurse-midwife
.
SB397, s. 3 14Section 3. 441.15 (1) (a) of the statutes is created to read:
SB397,3,1815 441.15 (1) (a) "Collaboration" means a process that involves 2 or more health
16care professionals working together and, when necessary, in each other's presence,
17and in which each health care professional contributes his or her expertise to provide
18more comprehensive care than one health care professional alone can offer.
SB397, s. 4 19Section 4. 441.15 (2) (intro.) of the statutes is amended to read:
SB397,3,2120 441.15 (2) (intro.) No person may engage in the practice of nurse-midwifery
21unless each of the following conditions is satisfied:
SB397, s. 5 22Section 5. 441.15 (2) (a) of the statutes is amended to read:
SB397,3,2423 441.15 (2) (a) Without a certificate issued The person is issued a license by the
24board under sub. (3) (a).
SB397, s. 6 25Section 6. 441.15 (2) (b) of the statutes is amended to read:
SB397,4,4
1441.15 (2) (b) Unless such The practice occurs in a health care facility approved
2by the board by rule under sub. (3) (c), under the general supervision of in
3collaboration with
a physician with postgraduate training in obstetrics, and
4pursuant to a formal written agreement with that physician.
SB397, s. 7 5Section 7. 441.15 (2) (c) of the statutes is created to read:
SB397,4,86 441.15 (2) (c) Except as provided in sub. (5) (a), the person has in effect the
7malpractice liability insurance required under the rules promulgated under sub. (5)
8(b).
SB397, s. 8 9Section 8. 441.15 (3) (a) of the statutes is renumbered 441.15 (3) (a) (intro.)
10and amended to read:
SB397,4,1411 441.15 (3) (a) (intro.) The board shall grant a license to engage in the practice
12of nurse-midwifery to any person licensed as a registered nurse under this
13subchapter or in a party state, as defined in s. 441.50 (2) (j), who meets does all of the
14following:
SB397,4,17 151. Submits evidence satisfactory to the board that he or she meets the
16educational and training prerequisites established by the board for the practice of
17nurse-midwifery and who pays.
SB397,4,18 182. Pays the fee specified under s. 440.05 (1).
SB397, s. 9 19Section 9. 441.15 (3) (a) 3. of the statutes is created to read:
SB397,4,2220 441.15 (3) (a) 3. If applicable, submits evidence satisfactory to the board that
21he or she has in effect the malpractice liability insurance required under the rules
22promulgated under sub. (5) (b).
SB397, s. 10 23Section 10. 441.15 (3) (b) of the statutes is amended to read:
SB397,5,624 441.15 (3) (b) On or before the applicable renewal date specified under s. 440.08
25(2) (a), a person issued a certificate license under par. (a) and practicing

1nurse-midwifery shall submit to the board on furnished blanks a statement giving
2his or her name, residence, and other information as that the board requires by rule,
3with the applicable renewal fee specified under s. 440.08 (2) (a). If applicable, the
4person shall also submit evidence satisfactory to the board that he or she has in effect
5the malpractice liability insurance required under the rules promulgated under sub.
6(5) (b).
SB397, s. 11 7Section 11. 441.15 (4) of the statutes is amended to read:
SB397,5,138 441.15 (4) A nurse-midwife who discovers evidence that any aspect of care
9involves any complication which jeopardizes the health or life of the a newborn or
10mother shall immediately refer the patient to the supervising consult with the
11collaborating
physician under sub. (2) (b) or, if that physician is unavailable, to
12another physician
or the physician's designee, or make a referral as specified in a
13written agreement under sub. (2) (b)
.
SB397, s. 12 14Section 12. 441.15 (5) of the statutes is created to read:
SB397,5,1815 441.15 (5) (a) Except for any of the following, no person may practice
16nurse-midwifery unless he or she has in effect malpractice liability insurance in an
17amount that is at least the minimum amount specified in rules promulgated under
18par. (b):
SB397,5,2019 1. A federal, state, county, city, village, or town employee who practices
20nurse-midwifery within the scope of his or her employment.
SB397,5,2221 2. A person who is considered to be an employee of the federal public health
22service under 42 USC 233 (g).
SB397,5,2523 3. A person whose employer has in effect malpractice liability insurance that
24provides coverage for the person in an amount that is at least the minimum amount
25specified in the rules.
SB397,6,1
14. A person who does not provide care for patients.
SB397,6,72 (b) In consultation with the commissioner of insurance, the board shall
3promulgate rules establishing the minimum amount of malpractice liability
4insurance that is required for a person to practice nurse-midwifery. The rules shall
5include requirements and procedures for waiving the rules for any period of time for
6which the commissioner of insurance determines that such insurance is not
7reasonably available.
SB397, s. 13 8Section 13. Nonstatutory provisions.
SB397,6,159 (1) Using the procedure under section 227.24 of the statutes, the board of
10nursing may promulgate the rules required under section 441.15 (5) (b) of the
11statutes, as created by this act, for the period before permanent rules become
12effective, but not to exceed the period authorized under section 227.24 (1) (c) and (2)
13of the statutes. Notwithstanding section 227.24 (1) (a) and (2) (b) of the statutes, the
14board of nursing need not provide evidence of the necessity of preservation of the
15public peace, health, safety, or welfare in promulgating rules under this subsection.
SB397, s. 14 16Section 14. Effective date.
SB397,6,1817 (1) This act takes effect on the first day of the 7th month beginning after
18publication.
SB397,6,1919 (End)
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