To repeal sections 334.010, 334.190, 334.260 and 335.016, RSMo 1994, relating to midwives, and to enact in lieu thereof five new sections relating to the same subject.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI,

AS FOLLOWS:

Section A. Sections 334.010, 334.190, 334.260 and 335.016, RSMo 1994, are repealed and five new sections enacted in lieu thereof, to be known as sections 334.010, 334.190, 335.016, 335.300 and 335.305, to read as follows:

334.010. It shall be unlawful for any person not now a registered physician within the meaning of the law to practice medicine or surgery in any of its departments, or to profess to cure and attempt to treat the sick and others afflicted with bodily or mental infirmities[, or engage in the practice of midwifery] in this state, except as herein provided.

334.190. It is unlawful for any person [licensed] practicing as a midwife [only to engage in any other branch of medical practice or] to advertise [herself] as a doctor[, doctress] or physician or to use any letters before or after [her] such person's name on a sign or otherwise, indicating that [she] such person is authorized to or does engage in [any other branch of medical practice] the practice of medicine.

[334.260. On August 29, 1959, all persons licensed under the provisions of chapter 334, RSMo 1949, as midwives shall be deemed to be licensed as midwives under this chapter and subject to all the provisions of this chapter.]

335.016. As used in sections 335.011 to 335.096, unless the context clearly requires otherwise, the following words and terms shall have the meanings indicated:

(1) "Accredited", recognized by the board as meeting or maintaining state board of nursing standards for the educational preparation of professional or practical nurses;

(2) "Advanced practice nurse", a nurse who has had education beyond the basic nursing education and is certified by a nationally recognized professional organization as having a nursing specialty, or who meets criteria for advanced practice nurses established by the board of nursing. The board of nursing may promulgate rules specifying which professional nursing organization certifications are to be recognized as advanced practice nurses, and may set standards for education, training and experience required for those without such specialty certification to become advanced practice nurses;

(3) "Board" or "state board", the state board of nursing;

(4) "Certified nurse-midwife", is one licensed under the provisions of sections 335.011 to 335.096 to engage in the practice of professional nursing who holds a current certification by the national certifying body of the American College of Nurse-Midwives to engage in the practice of nurse- midwifery;

[(4)] (5) "Executive director", a qualified registered professional nurse employed by the board as executive secretary or otherwise to implement the provisions of the nursing practice act under its direction, who shall not be a member of the board;

[(5)] (6) "Inactive nurse", as defined in section 335.061;

[(6)] (7) A "licensed practical nurse" or "practical nurse" is one licensed under the provisions of sections 335.011 to 335.096 to engage in the practice of practical nursing;

[(7)] (8) "Licensure", the issuing of a license to practice professional or practical nursing to candidates who have met the specified requirements and the recording of the names of those persons as holders of a license to practice professional or practical nursing;

(9) "Nurse-midwifery", is the care and advice provided by a certified nurse-midwife for compensation in the absence of medical complications through the course of the normal cycle of gestation, including pregnancy and the intrapartum and postpartum periods. The practice of nurse-midwifery does not extend further than the scope of the practice of nursing as provided in this chapter;

[(8)] (10) "Practical nursing" is the performance for compensation of selected acts for the promotion of health and in the care of persons who are ill, injured, or experiencing alterations in normal health processes. Such performance requires substantial specialized skill, judgment and knowledge. All such nursing care shall be given under the direction of a person licensed in this state to prescribe medications and treatments or under the direction of a registered professional nurse;

[(9)] (11) "Professional nursing" is the performance for compensation of any act which requires substantial specialized education, judgment and skill based on knowledge and application of principles derived from the biological, physical, social and nursing sciences, including, but not limited to:

(a) Responsibility for the teaching of health care and the prevention of illness to the patient and his family; or

(b) Assessment, nursing diagnosis, nursing care, and counsel of persons who are ill, injured or experiencing alterations in normal health processes; or

(c) The administration of medications and treatments as prescribed by a person licensed in this state to prescribe such medications and treatments; or

(d) The coordination and assistance in the delivery of a plan of health care with all members of the health team; or

(e) The teaching and supervision of other persons in the performance of any of the foregoing;

[(10)] (12) A "registered professional nurse" or "registered nurse" is one licensed under the provisions of sections 335.011 to 335.096 to engage in the practice of professional nursing.

335.300. 1. No person shall use the title "certified nurse-midwife" or like terms or abbreviations unless such person is certified as defined in section 335.016.

2. Only certified nurse-midwives and physicians shall engage in the practice of midwifery.

3. Nothing in sections 334.010, 334.190, 335.016, 335.300 or 335.305 of this act shall be construed to prohibit gratuitous midwifery services. Sections 334.010, 334.190, 335.016, 335.300 or 335.305 of this act shall not be construed to interfere, in any way, with the practice of religion, nor shall these sections be held to apply to or regulate any type of treatment by prayer.

4. The delivery of emergency medical care to a pregnant woman by licensed or certified ambulance personnel acting in the course of their regular duties shall not be construed to be the practice of midwifery.

335.305. 1. Any health care professionals, or hospitals licensed pursuant to chapter 197, RSMo, rendering care or assistance in good faith and within the scope of their licenses to a patient receiving midwife services from a certified nurse-midwife, as defined in section 335.016, shall not be liable for civil damages, except damages occasioned by gross negligence or by willful or wanton acts or omissions in rendering such care or assistance.

2. No health care professional rendering care or assistance to the patient of a certified nurse-midwife shall be liable for any complications arising due to the failure of the certified nurse-midwife to provide adequate care prior to the referral to such health care professional.