CHAPTER 203. MIDWIVES

OCCUPATIONS CODE

TITLE 3. HEALTH PROFESSIONS

SUBTITLE C. OTHER PROFESSIONS PERFORMING MEDICAL PROCEDURES

CHAPTER 203. MIDWIVES

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 203.001. SHORT TITLE. This chapter may be cited as the

Texas Midwifery Act.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.002. DEFINITIONS. In this chapter:

(1) Repealed by Acts 2005, 79th Leg., Ch. 1240, Sec. 56(1), eff.

September 1, 2005.

(2) "Certified nurse-midwife" means a person who is:

(A) a registered nurse under Chapter 301;

(B) recognized as an advanced nurse practitioner by the Texas

Board of Nursing; and

(C) certified by the American College of Nurse-Midwives.

(3) "Commissioner" means the commissioner of state health

services.

(4) "Department" means the Department of State Health Services.

(4-a) "Executive commissioner" means the executive commissioner

of the Health and Human Services Commission.

(5) "Local health department" means a department of health

created by the governing body of a municipality or a county under

Section 121.031, Health and Safety Code.

(6) "Midwife" means a person who practices midwifery and has met

the licensing requirements established by this chapter and

midwifery board rules.

(7) "Midwifery" means the practice of:

(A) providing the necessary supervision, care, and advice to a

woman during normal pregnancy, labor, and the postpartum period;

(B) conducting a normal delivery of a child; and

(C) providing normal newborn care.

(8) "Newborn" means an infant from birth through the first six

weeks of life.

(9) "Normal" means, as applied to pregnancy, labor, delivery,

the postpartum period, and the newborn period, and as defined by

midwifery board rule, circumstances under which a midwife has

determined that a client is at a low risk of developing

complications.

(10) "Postpartum period" means the first six weeks after a woman

has given birth.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 1, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

1240, Sec. 56(1), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

889, Sec. 35, eff. September 1, 2007.

Sec. 203.003. FINDINGS. The legislature finds:

(1) a parent has the responsibility and right to give birth

where and with whom the parent chooses;

(2) childbirth is a natural process of the human body and not a

disease; and

(3) midwifery has been practiced in this state since the days of

the Republic.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.004. APPLICABILITY. This chapter does not apply to:

(1) a certified nurse-midwife, a physician, or another health

care professional licensed by the state and operating within the

scope of the person's license;

(2) a natural childbirth trainer; or

(3) a person other than a midwife who assists childbirth in an

emergency.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.005. EFFECT ON LOCAL ORDINANCES. This chapter does not

prohibit a municipality from adopting a local ordinance or rule

to regulate the practice of midwifery in the municipality if the

ordinance or rule is compatible with and at least as strict as

this chapter and midwifery board rules.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 2, eff. September 1, 2005.

Sec. 203.006. APPLICATION OF SUNSET ACT. The midwifery board is

subject to Chapter 325, Government Code (Texas Sunset Act).

Unless continued in existence as provided by that chapter, the

midwifery board is abolished and this chapter expires September

1, 2017.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 3, eff. September 1, 2005.

SUBCHAPTER B. MIDWIFERY BOARD

Sec. 203.051. MIDWIFERY BOARD. The commissioner shall appoint a

midwifery board that reports directly to the commissioner.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 4, eff. September 1, 2005.

Sec. 203.052. APPOINTMENT OF MIDWIFERY BOARD. (a) The

midwifery board consists of nine members appointed as follows:

(1) five licensed midwife members each of whom has at least

three years' experience in the practice of midwifery;

(2) one physician member who is certified by a national

professional organization of physicians that certifies

obstetricians and gynecologists;

(3) one physician member who is certified by a national

professional organization of physicians that certifies family

practitioners or pediatricians; and

(4) two members who represent the public and who are not

practicing or trained in a health care profession, one of whom is

a parent with at least one child born with the assistance of a

midwife.

(b) Appointments to the midwifery board shall be made without

regard to the race, color, disability, sex, religion, age, or

national origin of the appointee.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 5, eff. September 1, 2005.

Sec. 203.053. ELIGIBILITY OF PUBLIC MEMBERS. A person is not

eligible for appointment as a public member of the midwifery

board if the person or the person's spouse:

(1) is registered, certified, or licensed by an occupational

regulatory agency in the field of midwifery;

(2) is employed by or participates in the management of a

business entity or other organization regulated by the midwifery

board or receiving funds from the midwifery board;

(3) owns or controls, directly or indirectly, more than a 10

percent interest in a business entity or other organization

regulated by or receiving funds from the midwifery board; or

(4) uses or receives a substantial amount of tangible goods,

services, or funds from the midwifery board, other than

compensation or reimbursement authorized by law for midwifery

board membership, attendance, or expenses.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.054. MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a) In

this section, "Texas trade association" means a cooperative and

voluntarily joined statewide association of business or

professional competitors in this state designed to assist its

members and its industry or profession in dealing with mutual

business or professional problems and in promoting their common

interest.

(b) A person may not be a midwifery board member, an employee of

the midwifery board, or a department employee employed in a "bona

fide executive, administrative, or professional capacity," as

that phrase is used for purposes of establishing an exemption to

the overtime provisions of the federal Fair Labor Standards Act

of 1938 (29 U.S.C. Section 201 et seq.) if:

(1) the person is an officer, employee, or paid consultant of a

Texas trade association in the field of health care; or

(2) the person's spouse is an officer, manager, or paid

consultant of a Texas trade association in the field of health

care.

(c) A person may not be a midwifery board member or act as the

general counsel to the midwifery board or the department if the

person is required to register as a lobbyist under Chapter 305,

Government Code, because of the person's activities for

compensation on behalf of a profession related to the operation

of the midwifery board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 6, eff. September 1, 2005.

Sec. 203.055. TERMS. Members of the midwifery board serve for

staggered terms of six years. The terms of three members expire

on January 31 of each odd-numbered year.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.056. OFFICERS. The commissioner shall designate a

public member of the midwifery board as the presiding officer of

the midwifery board to serve in that capacity at the pleasure of

the commissioner. The midwifery board shall elect one of the

other members of the midwifery board as vice presiding officer.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 7, eff. September 1, 2005.

Sec. 203.057. GROUNDS FOR REMOVAL. (a) It is a ground for

removal from the midwifery board that a member:

(1) does not have at the time of taking office the

qualifications required by Section 203.052;

(2) does not maintain during service on the midwifery board the

qualifications required by Section 203.052;

(3) is ineligible for membership under Section 203.053 or

203.054;

(4) cannot, because of illness or disability, discharge the

member's duties for a substantial part of the member's term; or

(5) is absent from more than half of the regularly scheduled

midwifery board meetings that the member is eligible to attend

during a calendar year without an excuse approved by a majority

vote of the midwifery board.

(b) The validity of an action of the midwifery board is not

affected by the fact that it is taken when a ground for removal

of a midwifery board member exists.

(c) If the program coordinator has knowledge that a potential

ground for removal exists, the program coordinator shall notify

the presiding officer of the midwifery board of the potential

ground. The presiding officer shall then notify the commissioner

that a potential ground for removal exists. If the potential

ground for removal involves the presiding officer, the program

coordinator shall notify the next highest ranking member of the

midwifery board, who shall then notify the commissioner that a

potential ground for removal exists.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 8, eff. September 1, 2005.

Sec. 203.058. REIMBURSEMENT. A midwifery board member may

receive reimbursement for travel expenses as provided by the

General Appropriations Act.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 9, eff. September 1, 2005.

Sec. 203.059. MEETINGS. (a) The midwifery board shall meet at

least semiannually.

(b) The midwifery board shall meet at other times at the call of

the midwifery board or the commissioner.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 10, eff. September 1, 2005.

Sec. 203.060. TRAINING. (a) A person who is appointed to and

qualifies for office as a member of the midwifery board may not

vote, deliberate, or be counted as a member in attendance at a

meeting of the midwifery board until the person completes a

training program that complies with this section.

(b) The training program must provide the person with

information regarding:

(1) this chapter and the programs, functions, rules, and budget

of the midwifery board;

(2) the results of the most recent formal audit of the midwifery

board;

(3) the requirements of laws relating to open meetings, public

information, administrative procedure, and conflicts of interest;

and

(4) any applicable ethics policies adopted by the midwifery

board or the Texas Ethics Commission.

(c) A person appointed to the midwifery board is entitled to

reimbursement, as provided by the General Appropriations Act, for

the travel expenses incurred in attending the training program

regardless of whether the attendance at the program occurs before

or after the person qualifies for office.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 11, eff. September 1, 2005.

SUBCHAPTER C. PROGRAM COORDINATOR AND PERSONNEL

Sec. 203.101. PROGRAM COORDINATOR. The department shall, after

consultation with the midwifery board, employ a coordinator for

the midwifery program and the staff necessary to administer the

program.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 12, eff. September 1, 2005.

Sec. 203.102. DUTIES OF PROGRAM COORDINATOR. The program

coordinator shall supervise the staff in the performance of

administrative duties, including:

(1) keeping the minutes of midwifery board meetings; and

(2) maintaining:

(A) records about basic midwifery education courses and

continuing midwifery education courses;

(B) a roster of midwives licensed under Section 203.251; and

(C) a record of each person who is licensed under this chapter.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 13, eff. September 1, 2005.

Sec. 203.103. DIVISION OF RESPONSIBILITIES. The midwifery board

shall develop and implement policies that clearly define the

respective responsibilities of the midwifery board and the staff

of the midwifery board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.104. EQUAL EMPLOYMENT OPPORTUNITY POLICY; REPORT. (a)

The program coordinator or the program coordinator's designee

shall prepare and maintain a written policy statement to ensure

implementation of an equal employment opportunity program under

which all personnel transactions are made without regard to race,

color, disability, sex, religion, age, or national origin. The

policy statement must include:

(1) personnel policies, including policies related to

recruitment, evaluation, selection, application, training, and

promotion of personnel that are in compliance with Chapter 21,

Labor Code;

(2) a comprehensive analysis of the midwifery board workforce

that meets federal and state guidelines;

(3) procedures by which a determination can be made of

significant underuse in the midwifery board workforce of all

persons for whom federal or state guidelines encourage a more

equitable balance; and

(4) reasonable methods to appropriately address those areas of

underuse.

(b) A policy statement prepared under Subsection (a) must:

(1) cover an annual period;

(2) be updated annually;

(3) be reviewed by the Commission on Human Rights for compliance

with Subsection (a)(1); and

(4) be filed with the governor.

(c) The governor shall deliver a biennial report to the

legislature based on the information received under Subsection

(b). The report may be made separately or as a part of another

biennial report made to the legislature.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

SUBCHAPTER D. POWERS AND DUTIES OF MIDWIFERY BOARD, EXECUTIVE

COMMISSIONER, AND DEPARTMENT

Sec. 203.151. RULEMAKING AUTHORITY OF MIDWIFERY BOARD. (a)

Subject to the approval of the executive commissioner, the

midwifery board shall:

(1) adopt substantive and procedural rules necessary for the

licensing of midwives;

(2) adopt rules prescribing the standards for the practice of

midwifery in this state, including standards for:

(A) the delineation of findings that preclude a woman or newborn

from being classified as having a normal pregnancy, labor,

delivery, postpartum period, or newborn period; and

(B) administration of oxygen by a midwife to a mother or

newborn;

(3) adopt rules prescribing:

(A) the type of courses and number of hours required to meet the

basic midwifery education course and continuing midwifery

education course requirements; and

(B) minimum standards for the approval and revocation of

approval of:

(i) basic midwifery education courses and continuing midwifery

education courses; and

(ii) instructors or facilities used in basic midwifery education

courses and continuing midwifery education courses;

(4) adopt rules prescribing a procedure for reporting and

processing complaints relating to the practice of midwifery in

this state;

(5) adopt and implement substantive and procedural rules as

necessary to discipline midwives determined to be in violation of

this chapter or otherwise a threat to the public health and

safety;

(6) adopt rules as necessary to establish eligibility for

reciprocity for initial licensing under this chapter; and

(7) adopt other rules necessary to implement a duty imposed on

the executive commissioner or the department under this chapter.

(b) The rules adopted under Subsection (a)(5) must include rules

relating to:

(1) warnings provided to midwives for a violation of this

chapter or rules adopted under this chapter;

(2) agreed orders for additional education by midwives;

(3) recommendations or requirements for medical or psychological

treatment, including treatment related to substance abuse by a

midwife; and

(4) restrictions on the practice of a midwife, including

practice limitations and the suspension and revocation of a

license, and placement of a midwife on probation.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 15, eff. September 1, 2005.

Sec. 203.1515. RULES ON CONSEQUENCES OF CRIMINAL CONVICTION.

(a) Subject to the approval of the executive commissioner, the

midwifery board shall adopt rules necessary to comply with

Chapter 53.

(b) In its proposed rules under this section, the midwifery

board shall list the specific offenses for which a conviction

would constitute grounds for the midwifery board to take action

under Section 53.021.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 16, eff. September 1, 2005.

Sec. 203.152. FEES. (a) Subject to the approval of the

executive commissioner, the midwifery board by rule shall

establish reasonable and necessary fees that, in the aggregate,

produce sufficient revenue to cover the costs of administering

this chapter.

(b) The midwifery board may not set a fee for an amount less

than the amount of that fee on September 1, 1993.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 17, eff. September 1, 2005.

Sec. 203.153. MANUALS. (a) Subject to the approval of the

department, the midwifery board shall issue basic information

manuals for the practice of midwifery. The midwifery board shall

approve the basic information manuals and instructor manuals that

may be used in basic midwifery education courses.

(b) The department shall provide the manuals to each licensed

midwife and to any other person on request.

(c) A basic information manual must include information about:

(1) the knowledge necessary to practice as a midwife;

(2) the basic education and continuing education requirements

for a midwife;

(3) the legal requirements and procedures relating to midwifery;

(4) the standards of practice as a midwife; and

(5) other information or procedures required by the midwifery

board or the department.

(d) The department may charge a fee for each manual not to

exceed $10. The department shall make the manual available in

English and Spanish.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 18, eff. September 1, 2005.

Sec. 203.154. ANNUAL REPORT; REPORTS ON MIDWIFERY. (a) The

department shall file annually with the governor and the

presiding officer of each house of the legislature a complete and

detailed written report accounting for all funds received and

distributed by the midwifery board during the preceding fiscal

year.

(b) The report under Subsection (a) must be in the form and

reported in the time provided by the General Appropriations Act.

(c) The midwifery board shall prepare and publish reports on the

practice of midwifery in this state, including statistical

reporting of infant fetal morbidity and mortality.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 19, eff. September 1, 2005.

Sec. 203.155. COMPLAINT PROCEDURE AND INVESTIGATION. (a) The

midwifery board shall adopt rules concerning the investigation of

a complaint filed with the midwifery board.

(b) The rules adopted under Subsection (a) must:

(1) distinguish among categories of complaints;

(2) ensure that a person who files a complaint has an

opportunity to explain the allegations made in the complaint; and

(3) provide for the release of any relevant midwifery or medical

record to the midwifery board, without the necessity of consent

by the midwife's client, as necessary to conduct an investigation

of a complaint.

(c) The midwifery board by rule shall:

(1) adopt a form to standardize information concerning

complaints made to the midwifery board; and

(2) prescribe information to be provided to a person when the

person files a complaint with the midwifery board.

(d) The midwifery board shall provide reasonable assistance to a

person who wishes to file a complaint with the midwifery board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.156. DUTIES OF MIDWIFERY BOARD AND DEPARTMENT. (a)

Repealed by Acts 2005, 79th Leg., Ch. 1240, Sec. 56(2), eff.

September 1, 2005.

(b) The department, with the recommendation of the midwifery

board, shall:

(1) implement rules governing:

(A) basic midwifery education courses and continuing midwifery

education courses; and

(B) approval of instructors or facilities used in offering basic

midwifery education courses and continuing midwifery education

courses;

(2) prepare and distribute basic midwifery information and

instructor manuals; and

(3) enter into agreements necessary to carry out this chapter.

(c) The department shall:

(1) establish a program for licensure as a midwife as prescribed

by midwifery board rules;

(2) pay the salaries of the program coordinator and any

additional staff the department determines to be necessary; and

(3) provide office space and supplies for the program

coordinator and other staff.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 20, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

1240, Sec. 21, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

1240, Sec. 56(2), eff. September 1, 2005.

Sec. 203.157. ROSTER; NOTICE TO COUNTY OFFICIALS. (a) The

department shall maintain a roster of each person licensed as a

midwife in this state.

(b) The roster shall contain for each person the information

required on the licensure form under this chapter and other

information the department determines necessary to accurately

identify each licensed midwife. The information is public

information as defined by Chapter 552, Government Code.

(c) The department shall provide each county clerk and each

local registrar of births in a county with the name of each

midwife practicing in the county.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 22, eff. September 1, 2005.

Sec. 203.158. RULES RESTRICTING ADVERTISING OR COMPETITIVE

BIDDING. (a) The midwifery board may not propose rules

restricting advertising or competitive bidding by a licensed

midwife except to prohibit false, misleading, or deceptive

practices.

(b) The midwifery board may not include in its proposed rules to

prohibit false, misleading, or deceptive practices by a licensed

midwife a rule that:

(1) restricts the licensed midwife's use of any advertising

medium;

(2) restricts the licensed midwife's personal appearance or use

of the licensed midwife's voice in an advertisement;

(3) relates to the size or duration of an advertisement by the

licensed midwife; or

(4) restricts the licensed midwife's advertisement under a trade

name.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 23, eff. September 1, 2005.

Sec. 203.159. BOARD COMMITTEES. (a) The midwifery board may

appoint committees to assist the midwifery board with its

functions under this chapter.

(b) Only a member of the midwifery board may serve as a member

of a midwifery board committee.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 23, eff. September 1, 2005.

Sec. 203.160. USE OF TECHNOLOGY. Subject to the approval of the

executive commissioner, the midwifery board shall implement a

policy requiring the midwifery board to use appropriate

technological solutions to improve the midwifery board's ability

to perform its functions. The policy must ensure that the public

is able to interact with the midwifery board on the Internet.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 23, eff. September 1, 2005.

Sec. 203.161. NEGOTIATED RULEMAKING AND ALTERNATIVE DISPUTE

RESOLUTION POLICY. (a) Subject to the approval of the executive

commissioner, the midwifery board shall develop and implement a

policy to encourage the use of:

(1) negotiated rulemaking procedures under Chapter 2008,

Government Code, for the adoption of midwifery board rules; and

(2) appropriate alternative dispute resolution procedures under

Chapter 2009, Government Code, to assist in the resolution of

internal and external disputes under the midwifery board's

jurisdiction.

(b) The midwifery board's procedures relating to alternative

dispute resolution must conform, to the extent possible, to any

model guidelines issued by the State Office of Administrative

Hearings for the use of alternative dispute resolution by state

agencies.

(c) The department shall designate a trained person to:

(1) coordinate the implementation of the policy adopted under

Subsection (a);

(2) serve as a resource for any training needed to implement the

procedures for negotiated rulemaking or alternative dispute

resolution; and

(3) collect data concerning the effectiveness of those

procedures, as implemented by the midwifery board.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 23, eff. September 1, 2005.

SUBCHAPTER E. PUBLIC INTEREST INFORMATION AND COMPLAINT

PROCEDURES

Sec. 203.201. PUBLIC INTEREST INFORMATION. (a) The midwifery

board shall prepare information of public interest describing the

functions of the midwifery board and the procedures by which

complaints are filed with and resolved by the midwifery board.

(b) The midwifery board shall make the information available to

the public and appropriate state agencies.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.202. COMPLAINTS. (a) The midwifery board by rule

shall establish methods by which consumers and service recipients

are notified of the name, mailing address, and telephone number

of the midwifery board for the purpose of directing complaints to

the midwifery board. The midwifery board may provide for that

notice:

(1) on each registration form, application, or disclosure and

informed consent form of a person regulated by the midwifery

board;

(2) on a sign prominently displayed in the place of business of

each person regulated by the midwifery board; or

(3) in a bill for service provided by a person regulated by the

midwifery board.

(b) The midwifery board shall list with its regular telephone

number the toll-free telephone number established under other

state law that may be called to present a complaint about a

health professional.

(c) The midwifery board shall maintain a system to promptly and

efficiently act on complaints filed with the midwifery board.

The midwifery board shall maintain:

(1) information about the parties to the complaint and the

subject matter of the complaint;

(2) a summary of the results of the review or investigation of

the complaint; and

(3) information about the disposition of the complaint.

(d) The midwifery board shall make information available

describing its procedures for complaint investigation and

resolution.

(e) The midwifery board shall periodically notify the parties of

the status of the complaint until final disposition of the

complaint.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 24, eff. September 1, 2005.

Sec. 203.2021. COMPLAINT COMMITTEE. The midwifery board shall

appoint at least one public member of the midwifery board to any

midwifery board committee established to review a complaint filed

with the midwifery board or review an enforcement action against

a licensed midwife related to a complaint filed with the

midwifery board.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 25, eff. September 1, 2005.

Sec. 203.203. PUBLIC PARTICIPATION. (a) The midwifery board

shall develop and implement policies that provide the public with

a reasonable opportunity to appear before the midwifery board and

to speak on any issue under the midwifery board's jurisdiction.

(b) The midwifery board shall prepare and maintain a written

plan that describes how a person who does not speak English may

be provided reasonable access to the midwifery board's programs.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

SUBCHAPTER F. LICENSURE REQUIREMENTS

Sec. 203.251. LICENSE REQUIRED. (a) A person may not practice

midwifery unless the person holds a license issued under this

chapter.

(b) The department shall provide a license to each person who

fulfills the licensing requirements.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 27, eff. September 1, 2005.

Sec. 203.252. QUALIFICATIONS FOR INITIAL LICENSE. (a) A person

qualifies to become a licensed midwife under this chapter if the

person provides the program coordinator with documentary evidence

that the person has:

(1) satisfied each requirement for basic midwifery education;

and

(2) passed the comprehensive midwifery examination and

jurisprudence examination required by this chapter.

(b) The initial license must be issued before the midwife begins

to practice midwifery and may be issued at any time during the

year.

(c) The term of the initial license begins on the date the

requirements are met and extends through December 31 of the year

in which the initial license is issued.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 28, eff. September 1, 2005.

Sec. 203.253. LICENSE APPLICATION. A person who practices

midwifery must apply to the department to be licensed as a

midwife. The application must:

(1) be accompanied by a nonrefundable application fee; and

(2) include information required by midwifery board rules.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 29, eff. September 1, 2005.

Sec. 203.254. BASIC MIDWIFERY EDUCATION. Subject to the

approval of the executive commissioner, the midwifery board shall

establish requirements for basic midwifery education.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 30, eff. September 1, 2005.

Sec. 203.255. EXAMINATION. (a) The midwifery board, with the

approval of the executive commissioner, shall:

(1) adopt a comprehensive midwifery examination for persons

regulated under this chapter that must be passed before the

initial license may be issued; and

(2) establish eligibility requirements for persons taking a

comprehensive midwifery examination.

(b) The midwifery board shall have an independent testing

professional validate any written portion of the examination.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 31, eff. September 1, 2005.

Sec. 203.2555. JURISPRUDENCE EXAMINATION. (a) The midwifery

board shall develop and administer at least twice each calendar

year a jurisprudence examination to determine an applicant's

knowledge of this chapter, midwifery board rules, and any other

applicable laws of this state affecting the applicant's midwifery

practice.

(b) Subject to the approval of the executive commissioner, the

midwifery board shall adopt rules to implement this section,

including rules related to the development and administration of

the examination, examination fees, guidelines for reexamination,

grading the examination, and providing notice of examination

results.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 32, eff. September 1, 2005.

Sec. 203.2556. EXAMINATION RESULTS. (a) The midwifery board

shall notify each examinee of the examination results not later

than the 30th day after the date on which the examination is

administered. If an examination is graded or reviewed by a

national testing service, the midwifery board shall notify each

examinee of the examination results not later than the 14th day

after the date the midwifery board receives the results from the

testing service.

(b) If the notice of the examination results graded or reviewed

by a national testing service will be delayed for more than 90

days after the examination date, the midwifery board shall notify

the examinee of the reason for the delay before the 90th day.

(c) The midwifery board may require a testing service to notify

an examinee of the examination results.

(d) If requested in writing by a person who fails an examination

administered under this chapter, the midwifery board shall

furnish the person with an analysis of the person's performance

on the examination.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 32, eff. September 1, 2005.

Sec. 203.256. TRAINING IN NEWBORN SCREENING AND BASIC LIFE

SUPPORT CARDIOPULMONARY RESUSCITATION. A person who practices

midwifery in this state must provide the program coordinator with

satisfactory evidence that the person:

(1) is trained to perform the newborn screening tests under

Section 203.354 or has made arrangements for the performance of

those tests; and

(2) holds:

(A) a current certificate issued by the American Heart

Association in basic life support cardiopulmonary resuscitation;

or

(B) another form of certification acceptable to the department

that demonstrates proficiency in basic life support

cardiopulmonary resuscitation for adults and children.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

SUBCHAPTER G. LICENSE RENEWAL

Sec. 203.301. APPLICATION FOR LICENSE RENEWAL. An applicant for

renewal of a license under this chapter must apply biennially as

provided in Section 203.253.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 34, eff. September 1, 2005.

Sec. 203.302. PROCEDURE FOR RENEWAL. (a) A licensed midwife is

responsible for renewing a license before the expiration date of

the license. A person whose license has expired may not engage

in activities that require a license until the license has been

renewed.

(b) A person may renew an unexpired license by paying the

required renewal fee to the midwifery board before the expiration

date of the license.

(c) A person whose license has been expired for 90 days or less

may renew the license by paying to the midwifery board a fee that

is equal to 1-1/4 times the amount of the renewal fee.

(d) If a person's license has been expired for more than 90 days

but less than one year, the person may renew the license by

paying to the midwifery board a fee that is equal to 1-1/2 times

the amount of the renewal fee.

(e) A person whose license has been expired for one year or more

may not renew the license. The person may obtain a new license

by submitting to reexamination and complying with the

requirements and procedures for obtaining an initial license.

(f) Not later than the 30th day before the date a person's

license is scheduled to expire, the midwifery board shall send

written notice of the impending expiration to the person at the

person's last known address according to the records of the

midwifery board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 35, eff. September 1, 2005.

Sec. 203.303. STAGGERED RENEWAL DATES. (a) The midwifery board

by rule may adopt a system under which licenses expire on various

dates during the year.

(b) For the year in which the license expiration date is

changed, license fees payable on the original expiration date

shall be prorated on a monthly basis so that each licensed

midwife pays only that portion of the license fee that is

allocable to the number of months during which the license is

valid.

(c) On renewal of the license on the new expiration date, the

total license renewal fee is payable.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 36, eff. September 1, 2005.

Sec. 203.304. CONTINUING MIDWIFERY EDUCATION. (a) Subject to

the approval of the executive commissioner, the midwifery board

shall establish requirements for continuing midwifery education,

including a minimum number of hours of continuing education

required to renew a license under this chapter.

(b) On renewal of the license, a midwife must provide the

program coordinator with evidence, acceptable under midwifery

board rules, of completion of continuing midwifery education as

prescribed by the midwifery board.

(c) The midwifery board by rule shall develop a process to

evaluate and approve continuing education courses.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 37, eff. September 1, 2005.

Sec. 203.305. REQUIRED ATTENDANCE AT SPECIFIC MIDWIFERY

EDUCATION COURSES. The midwifery board may assess the continuing

education needs of licensed midwives and may require licensed

midwives to attend continuing midwifery education courses

specified by the midwifery board.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 38, eff. September 1, 2005.

Sec. 203.306. GROUNDS FOR REFUSING RENEWAL. The midwifery board

may refuse to renew the license of a person who fails to pay an

administrative penalty imposed under Subchapter J, unless

enforcement of the penalty is stayed or a court has ordered that

the administrative penalty is not owed.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 39, eff. September 1, 2005.

SUBCHAPTER H. PRACTICE BY MIDWIFE

Sec. 203.351. INFORMED CHOICE AND DISCLOSURE REQUIREMENTS. (a)

A midwife shall disclose in oral and written form to a

prospective client the limitations of the skills and practices of

a midwife.

(b) The midwifery board shall prescribe the form of the informed

choice and disclosure statement required to be used by a midwife

under this chapter. The form must include:

(1) statistics of the midwife's experience as a midwife;

(2) the date the midwife's license expires;

(3) the date the midwife's cardiopulmonary resuscitation

certification expires;

(4) the midwife's compliance with continuing education

requirements;

(5) a description of medical backup arrangements; and

(6) the legal responsibilities of a midwife, including

statements concerning newborn blood screening, ophthalmia

neonatorum prevention, and prohibited acts under Sections

203.401-203.403.

(c) The informed choice statement must include a statement that

state law requires a newborn child to be tested for certain

heritable diseases and hypothyroidism. The midwife shall disclose

to a client whether the midwife is approved to collect blood

specimens to be used to perform the tests. If the midwife is not

approved to collect the blood specimens, the disclosure must

inform the client of the midwife's duty to refer the client to an

appropriate health care facility or physician for the collection

of the specimens.

(d) The disclosure of legal requirements required by this

section may not exceed 500 words and must be in English and

Spanish.

(e) A midwife shall disclose to a prospective or actual client

the procedure for reporting complaints to the department.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 40, eff. September 1, 2005.

Sec. 203.352. PRENATAL AND CERTAIN MEDICAL CARE ENCOURAGED. A

midwife shall encourage a client to seek:

(1) prenatal care; and

(2) medical care through consultation or referral, as specified

by midwifery board rules, if the midwife determines that the

pregnancy, labor, delivery, postpartum period, or newborn period

of a woman or newborn may not be classified as normal for

purposes of this chapter.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.353. PREVENTION OF OPHTHALMIA NEONATORUM. Unless the

newborn child is immediately transferred to a hospital because of

an emergency, a midwife who attends the birth of the child shall

comply with Section 81.091, Health and Safety Code.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.354. NEWBORN SCREENING. (a) Each midwife who attends

the birth of a child shall cause the newborn screening tests to

be performed on blood specimens taken from the child as required

by Chapter 33, Health and Safety Code.

(b) A midwife may collect blood specimens for the newborn

screening tests if the midwife has been approved by the

department to collect the specimen. Subject to the approval of

the executive commissioner, the midwifery board shall adopt rules

establishing the standards for approval. The standards must

recognize completion of a course of instruction that includes the

blood specimen collection procedure or verification by

appropriately trained health care providers that the midwife has

been instructed in the blood collection procedures.

(c) A midwife who is not approved to collect blood specimens for

newborn screening tests shall refer a client and her newborn to

an appropriate health care facility or physician for the

collection of the blood specimen and submission of the specimen

to the department.

(d) If the midwife has been approved by the department to

collect blood specimens under this section, the collection by the

midwife of blood specimens for the required newborn screening

tests does not constitute the practice of medicine as defined by

Subtitle B.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 41, eff. September 1, 2005.

Sec. 203.355. SUPPORT SERVICES. (a) In this section:

(1) "Clinical services" include prenatal, postpartum, child

health, and family planning services.

(2) "Local health unit" means a division of a municipal or

county government that provides limited public health services

under Section 121.004, Health and Safety Code.

(3) "Public health district" means a district created under

Subchapter E, Chapter 121, Health and Safety Code.

(b) The department and a local health department, a public

health district, or a local health unit shall provide clinical

and laboratory support services to a pregnant woman or a newborn

who is a client of a midwife if the midwife is required to

provide the services under this chapter.

(c) The laboratory services must include the performance of the

standard serological tests for syphilis and the collection of

blood specimens for newborn screening tests for phenylketonuria,

hypothyroidism, and other heritable diseases as required by law.

(d) The provider may charge a reasonable fee for the services. A

person may not be denied the services because of inability to

pay.

(e) If available, appropriately trained personnel from local

health departments, public health districts, and local health

units shall instruct licensed midwives in the approved techniques

for collecting blood specimens to be used to perform newborn

screening tests.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 42, eff. September 1, 2005.

Sec. 203.356. IMMUNITY. (a) A physician, a registered nurse,

or other person who, on the order of a physician, instructs a

midwife in the approved techniques for collecting blood specimens

to be used for newborn screening tests is immune from liability

arising out of the failure or refusal of the midwife to:

(1) collect the specimens in the approved manner; or

(2) submit the specimens to the department in a timely manner.

(b) A physician who issues an order directing or instructing a

midwife is immune from liability arising out of the failure or

refusal of the midwife to comply with the order if, before the

issuance of the order, the midwife provided the physician with

evidence satisfactory to the department of compliance with this

chapter.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 43, eff. September 1, 2005.

Sec. 203.357. ADDITIONAL INFORMATION REQUIRED. (a) The

midwifery board may require information in addition to that

required by Section 203.253 if it determines the additional

information is necessary and appropriate to ascertain the nature

and extent of midwifery in this state. The midwifery board may

not require information regarding any act that is prohibited

under this chapter.

(b) With the approval of the midwifery board, the department

shall prescribe forms for the additional information and shall

distribute those forms directly to each midwife. Each midwife

must complete and return the forms to the department as

requested.

(c) Information received under this section may not be made

public in a manner that discloses the identity of any person to

whom the information relates. The information is not public

information as defined by Chapter 552, Government Code.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

SUBCHAPTER I. PROHIBITED PRACTICES AND GROUNDS FOR DISCIPLINARY

ACTION

Sec. 203.401. PROHIBITED PRACTICES. A midwife may not:

(1) provide midwifery care in violation of midwifery board rule,

except in an emergency that poses an immediate threat to the life

of a woman or newborn;

(2) administer a prescription drug to a client other than:

(A) a drug administered under the supervision of a licensed

physician in accordance with state law;

(B) prophylaxis approved by the department to prevent ophthalmia

neonatorum; or

(C) oxygen administered in accordance with midwifery board rule;

(3) use forceps or a surgical instrument for a procedure other

than cutting the umbilical cord or providing emergency first aid

during delivery;

(4) remove placenta by invasive techniques;

(5) use a mechanical device or medicine to advance or retard

labor or delivery; or

(6) make on a birth certificate a false statement or false

record in violation of Section 195.003, Health and Safety Code.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 44, eff. September 1, 2005.

Sec. 203.402. PROHIBITED REPRESENTATION. A midwife may not:

(1) except as provided by Section 203.403, use in connection

with the midwife's name a title, abbreviation, or designation

tending to imply that the midwife is a "registered" or

"certified" midwife as opposed to one who is licensed under this

chapter;

(2) advertise or represent that the midwife is a physician or a

graduate of a medical school unless the midwife is licensed to

practice medicine by the Texas Medical Board;

(3) use advertising or an identification statement that is

false, misleading, or deceptive; or

(4) except as authorized by rules adopted by the Texas Board of

Nursing, use in combination with the term "midwife" the term

"nurse" or another title, initial, or designation that implies

that the midwife is licensed as a registered nurse or vocational

nurse.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by Acts 2003, 78th Leg., ch. 553, Sec. 2.015, eff. Feb.

1, 2004.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 45, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

889, Sec. 36, eff. September 1, 2007.

Sec. 203.403. PROHIBITED USE OF TITLE. (a) A midwife certified

by the North American Registry of Midwives who uses "certified"

as part of the midwife's title in an identification statement or

advertisement must include in the statement or advertisement a

statement that the midwife is certified by the North American

Registry of Midwives.

(b) A midwife may not use an identification statement or

advertisement that would lead a reasonable person to believe that

the midwife is certified by a governmental entity.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.404. GROUNDS FOR DISCIPLINARY ACTION. (a) The

midwifery board may discipline a licensed midwife, refuse to

renew a midwife's license, or refuse to issue a license to an

applicant if the person:

(1) violates this chapter or a rule adopted under this chapter;

(2) submits false or misleading information to the midwifery

board or the department;

(3) is convicted of a misdemeanor involving moral turpitude or a

felony;

(4) uses alcohol or drugs intemperately;

(5) engages in unprofessional or dishonorable conduct that may

reasonably be determined to deceive or defraud the public;

(6) is unable to practice midwifery with reasonable skill and

safety because of illness, disability, or psychological

impairment;

(7) is determined by a court judgment to be mentally impaired;

(8) submits a birth or death certificate known by the person to

be false or fraudulent or engages in another act that violates

Title 3, Health and Safety Code, or a rule adopted under that

title;

(9) violates Chapter 244, Health and Safety Code, or a rule

adopted under that chapter; or

(10) fails to practice midwifery in a manner consistent with the

public health and safety.

(b) The midwifery board may discipline a licensed midwife and

may refuse to issue a license to an applicant for a disciplinary

action taken by another jurisdiction that affects the person's

authority to practice midwifery, including a suspension, a

revocation, or another action.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 46, eff. September 1, 2005.

Sec. 203.405. EMERGENCY SUSPENSION. (a) The midwifery board or

a three-member committee of midwifery board members designated by

the midwifery board shall temporarily suspend the license of a

licensed midwife if the midwifery board or committee determines

from the evidence or information presented to it that continued

practice by the licensed midwife would constitute a continuing

and imminent threat to the public welfare.

(b) A license may be suspended under this section without notice

or hearing on the complaint if:

(1) action is taken to initiate proceedings for a hearing before

the State Office of Administrative Hearings simultaneously with

the temporary suspension; and

(2) a hearing is held as soon as practicable under this chapter

and Chapter 2001, Government Code.

(c) The State Office of Administrative Hearings shall hold a

preliminary hearing not later than the 14th day after the date of

the temporary suspension to determine if there is probable cause

to believe that a continuing and imminent threat to the public

welfare still exists. A final hearing on the matter shall be held

not later than the 61st day after the date of the temporary

suspension.

Added by Acts 2003, 78th Leg., ch. 326, Sec. 1, eff. Sept. 1,

2003.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 47, eff. September 1, 2005.

Sec. 203.406. REFUND. (a) Subject to Subsection (b), the

midwifery board may order a licensed midwife to pay a refund to a

consumer as provided in an agreement resulting from an informal

settlement conference instead of or in addition to imposing an

administrative penalty under this chapter.

(b) The amount of a refund ordered as provided in an agreement

resulting from an informal settlement conference may not exceed

the amount the consumer paid to the licensed midwife for a

service regulated by this chapter. The midwifery board may not

require payment of other damages or estimate harm in a refund

order.

Added by Acts 2005, 79th Leg., Ch.

1240, Sec. 48, eff. September 1, 2005.

SUBCHAPTER J. ADMINISTRATIVE PENALTY

Sec. 203.451. IMPOSITION OF ADMINISTRATIVE PENALTY. The

midwifery board may impose an administrative penalty on a person

who violates this chapter or a rule adopted under this chapter.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.452. AMOUNT OF ADMINISTRATIVE PENALTY. (a) The amount

of the administrative penalty may not exceed $5,000 for each

violation. Each day a violation continues is a separate

violation.

(b) The amount shall be based on:

(1) the seriousness of the violation;

(2) the history of previous violations;

(3) the amount necessary to deter a future violation;

(4) efforts made to correct the violation; and

(5) any other matter that justice may require.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1240, Sec. 49, eff. September 1, 2005.

Sec. 203.453. NOTICE OF VIOLATION AND PENALTY. (a) If, after

investigation of a possible violation and the facts surrounding

that possible violation, the midwifery board or its designee

determines that a violation has occurred, the midwifery board or

its designee shall give written notice of the violation to the

person alleged to have committed the violation.

(b) The notice must:

(1) include a brief summary of the alleged violation;

(2) state the amount of the proposed administrative penalty; and

(3) inform the person of the person's right to a hearing on the

occurrence of the violation, the amount of the penalty, or both.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.454. PENALTY TO BE PAID OR HEARING REQUESTED. (a) Not

later than the 20th day after the date the person receives the

notice under Section 203.453, the person may:

(1) accept the midwifery board or its designee's determination

and the proposed administrative penalty; or

(2) make a written request for a hearing on that determination.

(b) If the person accepts the midwifery board or its designee's

determination, the midwifery board by order shall approve the

determination and require the person to pay the proposed penalty.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.455. HEARING. (a) If the person timely requests a

hearing, the midwifery board or its designee shall set a hearing

and give written notice of the hearing to the person. The

midwifery board or its designee may employ a hearings examiner

for this purpose.

(b) The hearings examiner shall make findings of fact and

conclusions of law and promptly issue to the midwifery board a

proposal for decision as to the occurrence of the violation and

the amount of the proposed administrative penalty.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.456. DECISION BY MIDWIFERY BOARD. (a) Based on the

findings of fact, conclusions of law, and proposal for decision,

the midwifery board by order may determine that:

(1) a violation has occurred and impose an administrative

penalty; or

(2) a violation did not occur.

(b) The midwifery board shall give notice of the midwifery

board's order to the person. The notice must include:

(1) separate statements of the findings of fact and conclusions

of law;

(2) the amount of any penalty assessed; and

(3) a statement of the right of the person to judicial review of

the midwifery board's order.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.457. OPTIONS FOLLOWING DECISION: PAY OR APPEAL. (a)

Not later than the 30th day after the date the midwifery board's

order becomes final, the person shall:

(1) pay the administrative penalty;

(2) pay the penalty and file a petition for judicial review

contesting the fact of the violation, the amount of the penalty,

or both; or

(3) without paying the penalty, file a petition for judicial

review contesting the fact of the violation, the amount of the

penalty, or both.

(b) Within the 30-day period, a person who acts under Subsection

(a)(3) may:

(1) stay enforcement of the penalty by:

(A) paying the penalty to the court for placement in an escrow

account; or

(B) giving to the court a supersedeas bond that is approved by

the court and that:

(i) is for the amount of the penalty; and

(ii) is effective until judicial review of the order is final;

or

(2) request the court to stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person

stating that the person is financially unable to pay the amount

of the penalty and is financially unable to give the supersedeas

bond; and

(B) giving a copy of the affidavit to the midwifery board by

certified mail.

(c) If the midwifery board receives a copy of an affidavit under

Subsection (b)(2), the midwifery board may file with the court a

contest to the affidavit not later than the fifth day after the

date the copy is received.

(d) The court shall hold a hearing on the facts alleged in the

affidavit as soon as practicable and shall stay the enforcement

of the penalty on finding that the alleged facts are true. The

person who files an affidavit has the burden of proving that the

person is financially unable to pay the penalty and to give a

supersedeas bond.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.458. COLLECTION OF PENALTY. (a) If the person on whom

the administrative penalty is imposed does not comply with

Section 203.457, the penalty may be collected.

(b) The midwifery board may assess reasonable expenses and costs

against a person in an administrative hearing if, as a result of

the hearing, an administrative penalty is assessed against the

person. The person shall pay expenses and costs assessed under

this subsection not later than the 30th day after the date the

order of the midwifery board requiring the payment of expenses

and costs is final. The midwifery board may refer the matter to

the attorney general for collection of the expenses and costs.

(c) If the attorney general brings an action against a person to

enforce an administrative penalty assessed under this chapter and

the person is found liable for an administrative penalty, the

attorney general may recover, on behalf of the attorney general,

the midwifery board, and the department, reasonable expenses and

costs.

(d) In this section, reasonable expenses and costs includes

expenses incurred by the department, the midwifery board, and the

attorney general in the investigation, initiation, or prosecution

of an action, including reasonable investigative costs, court

costs, attorney's fees, witness fees, and deposition expenses.

(e) Costs and expenses collected under this section shall be

deposited in the state treasury to the credit of a special

account that may be appropriated only to the department. Section

403.095, Government Code, does not apply to the account.

Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

Sec. 203.459. DETERMINATION BY COURT. (a) If a court sustains

the determination that a violation occurred, the court may uphold

or reduce the amount of the administrative penalty and order the

person to pay the fu