Midwives Penalties and Sanctions

Texas Occupations Code, Chapter 203
16 Texas Administrative Code, Chapter 115

Class A:

Penalty: $100 to $1,000

Disclosure Violations

Violation Statutes
Provided an informed choice and disclosure statement that included inaccurate information or failed to include all required information 203.351(b-c)
Failed to provide a disclosure of legal requirements in both English and Spanish when required 203.351(d); 115.121
Failed to disclose to a prospective or actual client the procedure for reporting complaints to the Department 203.351(e); 115.121(3)

Advertising Violations

Violation Statutes
Implied in any way that the licensed midwife was registered or certified when the midwife was not registered or certified 203.402(1)
Advertised or represented the midwife was a physician or graduate of medical school when not licensed by the Texas Medical Board 203.402(2)
Made a false, misleading or deceptive statement in an advertisement or identifying statement 203.402(3)
Used the term that implied the midwife was licensed as a registered or vocational nurse when not authorized to do so 203.402(4)
Failure of a certified midwife to include a statement that the midwife is certified by the North American Registry of Midwives when using the term “certified” as an identifier or advertisement 203.403(a)
Used an identification statement or advertisement that implied the midwife was certified by a governmental entity 203.403(b)

Counseling and Education Violations

Violation Statutes
Failed to encourage a client to seek prenatal care 203.352(1)
Failed to provide prenatal health education counseling when appropriate 115.114(a)
Failed to provide postpartum health education or counseling 115.116(b)(4)
Failed to provide newborn care education or counseling 115.117(b)(2)

Class B:

Penalty: $300 to $2,000

Records Violations

Violation Statutes
Failed to grant a client access to their records within thirty days of the request 115.100(c)(2)
Failed to provide a mechanism for sending health record copies upon referral or transfer to other levels of care 115.100(c)(3)

Disclosure Violations

Violation Statutes
Failed to provide a prospective client an informed choice and disclosure statement 203.351
Failed to provide a prospective client with the limitations of skills and practices of a midwife 203.351(a)
Failed to provide clients with the scope of midwifery services or the clients rights and responsibilities 115.100(a)(1)
Failed to provide clients with information about other providers and services when requested 115.100(a)(3)

Standard of Care – Referral Violations

Violation Statutes
Failed to recommend referral when a prenatal condition existed that required a recommendation be made 115.114(b)
Failed to recommend referral when a postpartum condition existed that required a recommendation be made 115.116(c)
Failed to recommend referral when a newborn had a condition in the immediate postpartum period requiring a recommendation be made 115.117(c)
Failed to recommend referral when a newborn had a condition after the immediate postpartum period requiring a recommendation be made 115.117(e)

Documentation Violations

Violation Statutes
Failed to systematically collect or analyze client care data 115.100(d)(1)
Failed to review or act to resolve problems that had been identified 115.100(d)(2-3)
Terminated midwifery care without documenting the termination of care in midwifery records 115.112(2)(D)
Failed to properly and accurately collect, assess, or document maternal prenatal care data 115.114(a)
Failed to document a recommendation for referral when a prenatal condition existed that required a recommendation be made 115.114(b)
Failed to document a recommendation for referral when a postpartum condition existed that required a recommendation be made 115.116(c)
Failed to document a recommendation for referral when a newborn had a condition in the immediate postpartum period requiring a recommendation be made 115.117(c)
Failed to document a recommendation for referral when a newborn had a condition after the immediate postpartum period requiring a recommendation be made 115.117(e)
Failed to document indications for the administration of oxygen in a client’s chart 115.118(c)(3)
Failed to obtain a written exemption from treatment from a parent who refused the administration of eye prophylaxis to a newborn 115.119(b)
Failed to obtain a newborn screening test objection form from a parent who refused to allow newborn screening tests 115.120(d)

Plan of Care Violations

Violation Statutes
Failed to develop and implement a prenatal plan of care or modify the plan of care as necessary 115.114(a)
Failed to develop and implement a postpartum plan of care or modify the plan of care as necessary 115.116(b)(2-3)
Failed to establish a plan of care for a newborn prior to delivery of the newborn 115.117(a)
Newborn care plan did not contain all required information or was not documented in the midwifery record 115.117(a)(1-3)

Prohibited Practices

Violation Statutes
Failed to administer or cause to be administered the necessary and approved eye prophylaxis to an infant 203.353; 115.119(a)
Failed to cause the newborn screening tests to be performed on the blood specimens taken from a newborn 203.354(a)
Collected blood specimens for newborn screening tests when not approved to do so 203.354(b)
Failed to accurately perform newborn screening tests or referral of a newborn for testing and document that referral 203.354(c); 115.120(a)
Performed newborn screening tests without being appropriately trained or approved 203.354(c); 115.120(a)
Failed to use universal precautions for infection control 115.100(b)(2)
Terminated midwifery care without making an attempt to tell the client in person and in the presence of witnesses 115.112(2)(B)
Terminated midwifery care without providing referrals 115.112(2)(C)
Administered oxygen when the mother or newborn did not have a condition that allowed for that action 115.118(c)(1)

Class C:

Penalty: $750 to $3,500

Standard of Care

Violation Statutes
Failed to provide clients with information about other providers and services when the care required was not within the scope of midwifery 115.100(a)(3)
Failed to conduct a complete prenatal physical exam and appropriate laboratory testing 115.114(a)
Failed, upon arriving for labor and delivery, to obtain a history of the client, perform a physical exam or collect laboratory specimens 115.115(a)
Failed to assess the mother during the immediate postpartum period for a minimum of two hours after her condition was stable 115.116(a)
Failed to observe the newborn for a minimum of two hours after he or she was stable with no signs of distress 115.117(b)(3)

Documentation Violations

Violation Statutes
Failed to document that a recommendation for transfer was made when a prenatal condition existed that required that recommendation 115.114(c)
Failed to document the initiation of an emergency transfer when a condition existed during labor or delivery that required the transfer 115.115(e)
Failed to collect, assess or document a history of the client, perform a physical exam or collect laboratory specimens during postpartum care 115.116(b)(1)
Failed to document the initiation of an emergency transfer and the care given when a postpartum condition existed that required the transfer 115.116(d)
Failed to collect, assess or document newborn care data, perform a physical exam or obtain laboratory specimens for the infant during the postpartum period 115.117(b)(1)
Failed to document the initiation of an emergency transfer and the care given when a newborn had a condition in the first six hours of life requiring the transfer 115.117(d)
Failed to document the initiation of an immediate transfer when a newborn had a condition after the first six hours of life requiring the transfer 115.117(f)

Unlicensed Activity

Violation Statutes
Practiced midwifery with an expired license 203.251; 115.2(a)
Retired midwife returned to active practice of midwifery without receiving approval from the Department first 115.16(b)(3)

Prohibited Practices

Violation Statutes
Administered an unauthorized prescription drug to a client 203.401(2)
Used a mechanical device or medicine to advance or retard labor or delivery 203.401(5)
Deceived or defrauded the public by engaging in unprofessional or dishonorable conduct 203.404(a)(5); 115.70(1)(E)
Violated the Texas Birthing Center Licensing Act 203.404(a)(9); 115.70(1)(J)
Midwife had a disciplinary action taken by another jurisdiction that affects the midwife’s authority to practice midwifery 203.404(b); 115.70(1)(H)
Failed to demonstrate personal or professional character in the practice of midwifery 115.70(1)(M)
Failed to practice in accordance with the Midwives Alliance of North America’s Core Competencies for Basic Midwifery Practice 115.100(a)(4)
Failed to provide care in a safe and clean environment 115.100(b)
Failed to maintain the confidentiality of client records 115.100(c)(4)
Terminated care of a client or refused midwifery care of a client when not specifically allowed, no emergency situation existed and the midwife did not formally terminate the relationship 115.112(1)
Terminated midwifery care without providing 30 days written notice or failed to continue midwifery care during those 30 days 115.112(2)(A)

Class D:

Violation Statutes
$1,500 to $4,500 and/or a one year probated suspension up to Revocation

Standard of Care - Transfer Violations

Violation Statutes
Failed to initiate emergency care and immediate transfer of care in an emergency situation 115.113
Failed to follow health care professional’s instructions during an emergency situation 115.113
Failed to continue emergency care while transporting a client by personal vehicle or when calling 911 and reporting the need for immediate transfer 115.113(1)(2)
Failed to recommend and complete transfer when a prenatal condition existed that required a recommendation be made 115.114(c)
Failed to initiate immediate transfer when a condition existed during labor or delivery that required a transfer be initiated 115.115(e)
Failed to initiate immediate transfer when a postpartum condition existed that required a transfer be initiated 115.116(d)
Failed to initiate or continue emergency postpartum care when necessary during an emergency transfer 115.116(d)
Failed to initiate or continue emergency care to a newborn in the immediate postpartum period when necessary during a transfer 115.117(d)
Failed to initiate an immediate transfer when a newborn had a condition in the immediate postpartum period requiring a transfer be made 115.117(d)
Failed to initiate an immediate transfer when a newborn had a condition after the immediate postpartum period requiring a transfer be made 115.117(f)

Standard of Care

Violation Statutes
Used forceps or a surgical instrument for a procedure other than cutting the umbilical cord or emergency first aid during delivery 203.401(3)
Removed the placenta by invasive techniques 203.401(4)
Failed to practice midwifery in a manner consistent with public health and safety 203.404(a)(10); 115.70(1)(K)
Failed to assess a client on an ongoing basis for factors that might preclude a client from midwifery care 115.100(a)(2)
Failed to carry and use resuscitation equipment when needed 115.100(b)(1)
Failed to evaluate a client’s prenatal condition on an ongoing basis 115.114(a)
Failed to properly monitor a client’s progress in labor 115.115(b)
Assisted with a childbirth that was not normal, outside of 37 to 42 weeks, with abnormalities or signs or symptoms of complications 115.115(c)
Applied fundal pressure on an abdomen or uterus during the first or second stage of labor 115.115(d)(1)
Administered oxytocin, ergot, or prostaglandins prior to or during the first or second stage of labor 115.115(d)(2)
Failed to properly assess the mother during the immediate postpartum period 115.116(a)
Failed to evaluate a client’s postpartum condition 115.116(b)(3)

Prohibited Practices

Violation Statutes
Used alcohol or drugs intemperately while engaged in the practice of midwifery 203.404(a)(4); 115.70(1)(D)

Records Violations

Violation Statutes
Failed to provide all relevant midwifery records and medical records to the Department 115.70(1)(L); 115.122
Failed to surrender a license to the Department when ordered 115.75(a)
Failed to maintain timely, legible, complete and accurate records 115.100(c); 115.100(c)(1);
Failed to maintain records for the mother for a minimum of five years 115.100(c)(5)(A)
Failed to maintain records for the infant until the age of majority 115.100(c)(5)(B)

Class E:

Penalty: $5,000 and/or Revocation

Unlicensed Activity

Violation Statutes
Practiced midwifery without a license 203.251; 115.2(a)

Prohibited Practices

Violation Statutes
Violated a previous order of Commission or Executive Director 51.353(a); 203.306; 115.70(2)
Failed to pay a refund to a consumer when ordered to do so by the Department 203.406(a)
Made a false statement or record on a birth certificate 203.401(6)
Submitted false or misleading information to the Department 203.404(a)(2); 115.70(1)(B)
Submitted a birth or death certificate the midwife knew to be false or fraudulent 203.404(a)(8); 115.70(1)(I)
Violated a cease and desist order of the Department 203.505(b)
Falsified information on a license application 115.13
Obtained or attempted to obtain a license by fraud or false representations 115.13 60.23(a)(1)
Violated examination security requirements 60.52(a)
Failed to pay the Department for a dishonored payment 60.82