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Legislative exchange
The Wall Street Journal featured the article "Health Care Battle: Doctors Sue Hospitals for Staff Privileges as Competition Rises" on September 29, 1981. The article dealt primarily with the case of cardiothoracic surgeon John Robinson who lost a sixyear antitrust suit against Pittsburgh's Allegheny General Hospital which had denied him staff privileges. The article also included a subparagraph "Gains by Midwives" which interviewed Mark Kleiman, director of Nashville's Consumer Coalition for Health, which is backing CNMs Victoria Henderson and Susan Sizemore's legal battle for hospital privileges. (See M a y / J u n e 1981 Legislative Exchange.) A similar antitrust lawsuit is underway in Ohio. Dr. Peter Howison and Maria Eversole, C.N.M. filed a $I million suit against Grady Memorial Hospital of Columbus in June 1981 after the hospital suspended Dr. Howison's privileges when Ms. Eversole attended a precipitous delivery at the hospital. Ms. Eversole had been denied delivery privileges in April 1981 by the Executive Committee of the Medical Staff at Grady, but was permitted to support laboring women of the practice as their private duty nurse in the hospitars Birthing Room; Dr. Howison, however, would have to actually deliver the baby. Howison and Eversole abided by the hospital regulation until May 23, 1981 when Dr. Howison did not make it to the hospital in time for a precipitous labor and Ms. Eversole, being the most competent individual in attendance,
delivered the baby. The hospital revoked Dr. Howison's privileges. The first hearing of the suit was held in U.S. District Court on July 1, 1981 before Judge Duncan who ruled that the hospital had not followed its bylaws and that Dr. Howison had to be reinstated. The plaintiffs law firm of Spater, Gittes, and Terzian is now engaged in discovery and further court action is not expected until March 1982. As a result of the case, Grady Hospital in the meantime has changed its bylaws to prohibit a CNM from being eligible for privileges and no longer allows private duty nurses in the Birthing Room. Maria Eversole is the only CNM in clinical practice in Columbus, Ohio. Contributions to her legal fund are greatly appreciated. They can be sent to her c/o The Community Family Health Center, 3037 Indianola Avenue, Columbus, OH 43202.
In Massachusetts, the efforts to expand nurse-midwifery practice outside of hospitals continues. CNMs in the state thought the battle was won when their legislation, which included a provision allowing practice within birth centers licensed by the Public Health Department, passed both houses of the state's assembly in early summer 1981. Governor Edward J. King, however, vetoed the legislation in July using language that was verbatim from the Massachusetts Medical Society's opposition letter. The Massachusetts Medical Society claimed
Journal of Nurse-Midwifery • Vol. 27, No. 1, January/February 1982 Copyright © 1982 by the American CoUege of Nurse-Midwives
that the bill would "seriously and adversely affect health care" in the state and that "if routine delivery is performed out of the hospital setting as the bill would allow, and even seem to demand, there would be an incalculable increase in involvement with unanticipated catastrophe." Then in September 1981, the Massachusetts Senate overwhelmingly overrode the Governor's veto. As of October, CNMs in the state were hopeful that the House would also override the veto before the legislative session ends.
CNMs in New York State have been asked to help develop the class in the class action lawsuit Pat and Jonathan Moscow v. Blue Cross and Blue Shield of Greater New York, after a computer search done with faulty coding by Blue Cross came up with only 16 subscribers who were denied reimbursement of midwifery services. Rather than subjecting Blue Cross to another computer run which they claimed would cost $2.2 million, Judge Michael Dontzin of the New York County Supreme Court suggested in August 1981 that the plaintiffs turn to the registry of CNMs maintained by the State Department of Public Health. The Judge noted that "although the cooperation of these nursemidwives would be necessary, it would be in their best professional interests to assist the plaintiffs in reaching their former clients. This could be accomplished without sacrificing the confidentiality that attends
41 0091-2182/82/010041 +2502.75
such a relationship." Judge Dontzin then denied the plaintiff's motion for class certification but without prejudice to a new effort at discovery. The standard downstate Blue Cross-Blue Shield contract in New York refers to "licensed practitioners" who qualify for reimbursement of services. The law firm Weisen and Gurfein, which is representing the Moscows in the case, are arguing that CNMs are licensed practitioners and therefore should be eligible for reimbursement. The law firm has undertaken the case on a contingency fee basis; that is, no legal fees are collected unless they win a favorable decision. Mark Weisen, one of the firm's founding partners, became interested in the plight of Blue Cross subscribers who want a maternity care alternative because of his experience in medical malpractice suits that resulted from induced labor and heavy medication.
New Hampshire's new law for the "regulation, development and iraprovement of lay-midwifery," Chapter 326-D, became effective on August 15, 1981. The law provides for
42
an advisory committee, composed of an obstetrician, pediatrician, certified nurse-midwife, two lay-midwives who have each attended at least 50 births, and a public member who delivered a baby with a lay-midwife, to assist the Director of Public Health Services in determining qualifications, educational programs, practice guidelines, and certification for lay-midwives.
Midwifery became legal in Kansas for the first time in May 1980 when Advanced Nurse-Practitioner Regulations went into effect. The regulations referred to four categories of advanced nurse-practitioners: CNMs, nurse-practitioners, nurse-anesthetists, and clinical nurse specialists. The Kansas Medical Society did not approve of the regulations, however, and is suing the Kansas State Board of Nursing. The Medical Society claims that the regulations are unconstitutional because their authorizing legislation does not authorize the Board of Nursing to define scope of practice and because the regulations allow the independent practice of medicine without MD direction. A similar lawsuit has been filed by
the Louisiana State Medical Society against nurse-practitioner regulations that took effect in that state in March 1981.
States which have not ratified the Equal Rights Amendment
Nevada Utah Arizona Oklahoma Illinois Missouri North Carolina Virginia Arkansas Louisiana Mississippi Alabama Georgia Florida South Carolina Anyone wishing to contribute information or short articles on legislative or regulatory actions affecting CNMs on the state or federal level should contact Nancy Kraus, C.N.M., 277 West 10th Street, New York, NY 10014.
Journal of Nurse-Midwlfery • Vol. 27, No. I, January/February 1982
delivered the baby. The hospital revoked Dr. Howison's privileges. The first hearing of the suit was held in U.S. District Court on July 1, 1981 before Judge Duncan who ruled that the hospital had not followed its bylaws and that Dr. Howison had to be reinstated. The plaintiffs law firm of Spater, Gittes, and Terzian is now engaged in discovery and further court action is not expected until March 1982. As a result of the case, Grady Hospital in the meantime has changed its bylaws to prohibit a CNM from being eligible for privileges and no longer allows private duty nurses in the Birthing Room. Maria Eversole is the only CNM in clinical practice in Columbus, Ohio. Contributions to her legal fund are greatly appreciated. They can be sent to her c/o The Community Family Health Center, 3037 Indianola Avenue, Columbus, OH 43202.
In Massachusetts, the efforts to expand nurse-midwifery practice outside of hospitals continues. CNMs in the state thought the battle was won when their legislation, which included a provision allowing practice within birth centers licensed by the Public Health Department, passed both houses of the state's assembly in early summer 1981. Governor Edward J. King, however, vetoed the legislation in July using language that was verbatim from the Massachusetts Medical Society's opposition letter. The Massachusetts Medical Society claimed
Journal of Nurse-Midwifery • Vol. 27, No. 1, January/February 1982 Copyright © 1982 by the American CoUege of Nurse-Midwives
that the bill would "seriously and adversely affect health care" in the state and that "if routine delivery is performed out of the hospital setting as the bill would allow, and even seem to demand, there would be an incalculable increase in involvement with unanticipated catastrophe." Then in September 1981, the Massachusetts Senate overwhelmingly overrode the Governor's veto. As of October, CNMs in the state were hopeful that the House would also override the veto before the legislative session ends.
CNMs in New York State have been asked to help develop the class in the class action lawsuit Pat and Jonathan Moscow v. Blue Cross and Blue Shield of Greater New York, after a computer search done with faulty coding by Blue Cross came up with only 16 subscribers who were denied reimbursement of midwifery services. Rather than subjecting Blue Cross to another computer run which they claimed would cost $2.2 million, Judge Michael Dontzin of the New York County Supreme Court suggested in August 1981 that the plaintiffs turn to the registry of CNMs maintained by the State Department of Public Health. The Judge noted that "although the cooperation of these nursemidwives would be necessary, it would be in their best professional interests to assist the plaintiffs in reaching their former clients. This could be accomplished without sacrificing the confidentiality that attends
41 0091-2182/82/010041 +2502.75
such a relationship." Judge Dontzin then denied the plaintiff's motion for class certification but without prejudice to a new effort at discovery. The standard downstate Blue Cross-Blue Shield contract in New York refers to "licensed practitioners" who qualify for reimbursement of services. The law firm Weisen and Gurfein, which is representing the Moscows in the case, are arguing that CNMs are licensed practitioners and therefore should be eligible for reimbursement. The law firm has undertaken the case on a contingency fee basis; that is, no legal fees are collected unless they win a favorable decision. Mark Weisen, one of the firm's founding partners, became interested in the plight of Blue Cross subscribers who want a maternity care alternative because of his experience in medical malpractice suits that resulted from induced labor and heavy medication.
New Hampshire's new law for the "regulation, development and iraprovement of lay-midwifery," Chapter 326-D, became effective on August 15, 1981. The law provides for
42
an advisory committee, composed of an obstetrician, pediatrician, certified nurse-midwife, two lay-midwives who have each attended at least 50 births, and a public member who delivered a baby with a lay-midwife, to assist the Director of Public Health Services in determining qualifications, educational programs, practice guidelines, and certification for lay-midwives.
Midwifery became legal in Kansas for the first time in May 1980 when Advanced Nurse-Practitioner Regulations went into effect. The regulations referred to four categories of advanced nurse-practitioners: CNMs, nurse-practitioners, nurse-anesthetists, and clinical nurse specialists. The Kansas Medical Society did not approve of the regulations, however, and is suing the Kansas State Board of Nursing. The Medical Society claims that the regulations are unconstitutional because their authorizing legislation does not authorize the Board of Nursing to define scope of practice and because the regulations allow the independent practice of medicine without MD direction. A similar lawsuit has been filed by
the Louisiana State Medical Society against nurse-practitioner regulations that took effect in that state in March 1981.
States which have not ratified the Equal Rights Amendment
Nevada Utah Arizona Oklahoma Illinois Missouri North Carolina Virginia Arkansas Louisiana Mississippi Alabama Georgia Florida South Carolina Anyone wishing to contribute information or short articles on legislative or regulatory actions affecting CNMs on the state or federal level should contact Nancy Kraus, C.N.M., 277 West 10th Street, New York, NY 10014.
Journal of Nurse-Midwlfery • Vol. 27, No. I, January/February 1982