Alabama State Board of Midwifery Emergency Board Meeting Minutes
April 8, 2020
The Alabama State Board of Midwifery held an Emergency Board meeting via video conference,
(https://www.gotomeet.me/ASBM/04082020) on Wednesday, April 8, 2020. Present remotely were 1) Mr. Chris Megginson (member), 2) Ms. Christine Litas (member), 3) Ms. Marietta Nero (member), 4) Ms. Tori Dennis (member), 5) Ms. Noel Leithart (member), and 6) Ms. Stacey Bufkin (member, Chair). Ms. Stephanie Armstead (member) was absent. Dr. Sharon Porterfield Miller, administrative assistant to the Board and Ms. Bettie Carmack, attorney to the Board were also present remotely.
The members of the public remotely present were: Laura Reeder LM, Chloe Raum LM, Rebekah Myrick LM, Lauren Collins LM, Jo Crawford LM, Rachel Clark CNM, Bethany Quillen. Also present remotely were Stephen McCormick, representing Alabama Hospital Association, and Matt Hart, representing the Alabama Board of Medical Examiners.
Christine Litas (CPM) was sworn in as a new member of the board by Dr. Porterfield Miller.
The Emergency Board meeting had been advertised on the Secretary of State’s website, in accordance with the Alabama Open Meetings Act. Being a quorum of board members present. Dr. Porterfield Miller, Administrative Assistant, called the meeting to order at 3:15 PM and introduced Chris Megginson as the host of the teleconference.
State of Emergency Letter
Mr. Megginson began the meeting asking for discussion in response to Governor Kay Ivey and Dr. Scott Harris regarding the lack of mention of Licensed Midwives in the State’s letter concerning the COVID-19 crisis. Mr. Megginson had drafted a letter in response. Ms. Leithart made a motion that the letter to the Governor and State Health Officer be accepted and sent to both parties. Ms. Dennis seconded the motion. An oral vote was taken. All in favor. None opposed. The letter will be sent to both parties, the Governor and the State Health Officer.
Ms. Leithart reminded the public that this was a Board meeting, not a Town Hall meeting, and that comments from the public could be typed into the “comment” box for the teleconference and would be addressed in a timely manner.
Ms. Bufkin, proposed two rules in response to the COVID-19 Emergency that would affect the practice of Licensed Midwives. After initial discussion, Ms. Bufkin made a motion to go into Executive Session for one hour to discuss the legal ramifications of the two proposed rules. 1) Emergency Expedited License Standards Related to COVID-19 State of Emergency (582-X-2-.13ER), and 2) Emergency Rule Pertaining to Time Sensitive Situations (582-X-3-.11ER). This motion was seconded by Ms. Leithart, and certified by the attorney, Ms. Carmack. Roll Call vote regarding executive session: Mr. Megginson aye, Ms. Dennis aye, Ms. Leithart aye, Ms. Nero aye, Ms. Litas aye, Ms. Bufkin aye. Motion carried. The meeting adjourned at 3:51 to go into Executive Session. Return to General Session at 4:47. Due to technical difficulties during executive session, Mr. Megginson made a motion to return to Executive Session for 30 minutes. It was seconded by Ms. Dennis. Roll Call vote regarding returning to executive session: Mr. Megginson aye, Ms. Dennis aye, Ms. Leithart aye, Ms. Nero aye, Ms. Litas aye, Ms. Bufkin aye. Motion carried. Roll Call vote to return to general session: Mr. Megginson aye, Ms. Dennis aye, Ms. Leithart aye, Ms. Nero aye, Ms. Litas aye, Ms. Bufkin aye. Motion carried. General session reopened at 5:32.
Emergency Rule 582-X-2-.13ER (Emergency Expedited License Standards Related to COVID-19 State of Emergency)
Ms. Bufkin introduced an emergency rule that would encourage more applicants for licensure to alleviate the increased demand for Licensed Midwives as women are choosing to avoid medical facilities during COVID-19. He made a motion to adopt Emergency Rule 582-X-2-.13ER (Emergency Expedited License Standards Related to COVID-19 State of Emergency) It was seconded by Marietta Nero, an oral vote was taken. All in favor, none opposed. The Emergency Rule 582-X-2-.13ER passed. The emergency rule will waive the application and license fees for initial applicants.
Emergency Rule 582-X-3-.11ER Emergency Rule Pertaining to Time Sensitive Situations
Mr Megginson introduced an emergency rule to allow the Licensed Midwives to possess and administer time sensitive medications during the COVID-19 crisis. A motion was made by Ms Leithart to adopt Emergency Rule 582-X-3-.11ER Emergency Rule Pertaining to Time Sensitive Situations. It was seconded by Ms. Bufkin. Oral vote was taken. All in favor and none opposed. The Emergency Rule 582-X-2-.11ER passed.
The Emergency Rules will be filed with the Legislative Services Agency and will be placed on the Board website. Ms. Bufkin asked that the Midwives Alliance of North America’s (MANA) statement regarding the COVID-19 situation also be placed on the website for information.
Newborn Screening Card
Ms. Dennis motioned for Ms. Leithart and Ms. Bufkin to work with Ms. Carmack to draft a petition for an opinion from the Attorney General concerning the issuance of Newborn Screening Cards to the Licensed Midwives during the COVID-19 crisis. It was seconded by Ms. Nero.
An oral vote was taken. All in favor and none opposed. The motion passed.
Discussion ensued about the requirement that a Licensed Midwife accompany her client to the hospital in the case of a transport. Reports have circulated that hospitals will not allow extraneous people to be in attendance with a patient. Ms. Dennis commented that the LM can bring the woman to the door with a copy of all records and transfer care at the door. Ms. Carmacksuggested that the Licensed Midwives talk to individual hospitals concerning transfers.
Ms. Bufkin made a motion, seconded by Ms. Dennis that a letter be composed by Ms Nero and Ms Litas and emailed to all Licensed Midwives, acknowledging them as essential workers to travel during the COVID-19 Crisis. An oral vote was taken. All in favor. None opposed. Ms. Nero and Ms. Litas will compose the email. It will be sent out by the Administrative Assistant by Friday to the Licensed Midwives.
Comments/Concerns from the Public
- Matt Hart, Alabama Board of Medical Examiners, made the statement that rules should be read and commented on before the board votes on them.
- Chloe Raum, Midwife Representative, read the statement below:
“Public comments to ASBM Emergency Meeting 04/08/2020”
To the attention of the Alabama State Board of Midwifery:
Alabama Code Section 34-19-16 states,”(i) A licensed midwife shall instruct the client regarding the requirements of
administration of newborn health screening ordered by the Department of Public Health pursuant to Section 22-20-3.
Alabama Code Section 22-20-3 states, in subsection “(a) It shall be the duty of the administrative officer or other persons in charge of each institution caring for infants 28 days or less of age, or the physician attending a newborn child or the person attending a newborn child that was not attended by a physician to cause to have administered to every such infant or child in his care a reliable test for hypothyroidism and a reliable test for phenylketonuria (PKU), such as the Guthrie test, or any other test considered equally reliable by the State Board of Health and a reliable test for sickle cell anemia, sickle cell trait, and /or abnormal hemoglobin and such other tests relating to mental retardation or other heritable diseases and conditions as are designated by the Board of Health..”
The Alabama Dept. of Public Health amended their administrative rules Chapter 420-10-1-0.4 (6) on July 19, 2018 to
specifically exclude Licensed Midwives from causing the administration of newborn screenings. Instead they state that
LMs must refer all newborns to a licensed physician within 24 hours of age to perform the bloodspot specimen test,
the newborn hearing screening tests, and pulse oximetry test.
- The ADPH rules are in direct contradiction of the public health statute in AL Code Section 22-20-3.
- This exclusion marks Alabama as the only state where licensed midwives are not providing the newborn
bloodspot screening for newborns.
- This exclusion is not in the interest of the health of babies. Every Alabama baby deserves to have a timely
screening for metabolic disorders.
- There are two issues surrounding newborn screenings:
- Clients who already have a physician for their baby are not able to
obtain screening in a timely fashion. This was a problem prior to the current
pandemic and is exacerbated at this time.
- A client who delivered her baby at home on April 6 was forced to leave home
today with a 36-hour old baby to visit her pediatrician to obtain the newborn
bloodspot screening. Upon arrival, she discovered that his office does not
routinely carry the tests, and he was unable to provide screening. He asked
to return in two weeks to be screened at that time.
- Another recent client delivered her baby in the early hours of a Saturday
morning. She was unable to secure an appointment for her baby to be seen
for over four days.
- It is impossible for babies to be screened if the family is not able to secure
the care of a licensed physician. Many physicians will not accept new patients if the parents
do not comply with their policies regarding newborn healthcare. Physicians are often uncomfortable
with the choice to birth outside of a hospital, and unwilling to care for families that delay or decline
vaccinations. Although Alabama allows for religious exemptions to vaccinations, these families
struggle to find care providers. Without access to care, there is no ability to obtain newborn
screening at any point. Unattached patients have no physician to which a licensed midwife can refer them, thus rendering it impossible for midwives to comply with ADPH’s rule.
A motion was made by Ms Leithart to adjourn the meeting. It was seconded by Ms Dennis. The motion passed unanimously. Ms. Bufkin adjourned the meeting at 6:49pm.
Sharon Porterfield Miller
Dr. Sharon Porterfield Miller