Judge axes new law on midwifery

Thursday, August 9, 2007

JEFFERSON CITY, Mo. -- A judge struck down a new law Wednesday that would have allowed certain trained midwives to deliver babies in Missouri without facing the threat of criminal charges.

A Cole County judge declared the midwifery law unconstitutional because of the way it was passed by legislators. Circuit Judge Patricia Joyce ruled the midwifery language went beyond the title and original purpose of the health insurance bill to which it was secretly attached in the final weeks of the legislative session.

Joyce issued a permanent injunction barring the midwifery law from taking effect as scheduled Aug. 28. But she allowed the rest of the health insurance bill to stand.

A midwives association vowed to appeal to the state Supreme Court.

Midwives typically provide prenatal care and help deliver babies in mothers' homes.

Missouri is among 10 states and the District of Columbia that prohibit "direct-entry midwives" -- those who enter the profession directly without medical or nursing degrees, according to the North American Registry of Midwives. Violators of Missouri's existing anti-midwifery law can face up to seven years in prison.

The new law would have sidestepped those criminal penalties by allowing anyone with a "tocological certification" -- meaning in obstetrics -- from a particular private accreditation group to provide pregnancy-related services.

Doctors groups claim that allowing unlicensed midwives to practice medicine could jeopardize patients and put physicians who cooperate with them at risk of professional discipline. Midwives insist that their supervised home births can be just as safe as ones in hospitals. But the court decision hinged on technicalities rather than public safety arguments.

The lawsuit by various physician groups cited two constitutional provisions. One states: "No bill shall contain more than one subject, which shall be clearly expressed in its title." The other states: "No bill shall be so amended in its passage through either house as to change its original purpose."

The title of the bill that passed described it as "relating to health insurance."

"The midwife provision does not relate to health insurance," Joyce wrote in her decision.

The judge said the law failed on three constitutional standards: It went beyond the bill's title, caused the bill to contain multiple subjects and changed the original purpose of the bill, which had been related "to portability and accessibility of health insurance."

Supporters expressed disappointment at the court loss, but optimism for success on appeal.

"This is just kind of a bump along the way," said Mary Ueland, the legislative chairwoman for the Missouri Midwives Association, which intervened as a defendant against the lawsuit. "I feel like in the end the courts will find it to be constitutional and that midwifery does indeed relate to health insurance and to the original scope of the bill."

Sen. John Loudon, R-Chesterfield, who handled the legislation, echoed that assertion. Allowing certified midwives to legally practice in Missouri expands access to health care, which affects health insurance, Loudon said Wednesday.

Loudon used what the judge described as "obscure Greek references" to slip the controversial midwifery language -- unannounced and unnoticed -- into a revision of the health insurance bill. Only after the Senate and House each passed the bill with little discussion did most lawmakers realize what Loudon had done. As retribution, Senate President Pro Tem Michael Gibbons stripped Loudon of a committee chairmanship.

Loudon said he was forced to resort to sly tactics because the Missouri State Medical Association has refused to negotiate a compromise that could set up state standards for midwives.

The medical association claimed Wednesday that Loudon engaged in "legislative duplicity."

The ruling "invalidates an ill-conceived and poorly written law that would have dramatically lowered the standard of care for childbirth services," said Dr. Charles Van Way III, president of the medical association.

The bill to which the midwifery language was attached authorizes tax credits for people who buy their own health insurance and lets people keep their individual health insurance policies when they take a job with a small business that provides a group health plan.

Another prong of the law expands the eligibility and lowers the premiums for people to be covered by the Missouri Health Insurance Pool, which is tailored for those who cannot afford insurance, often because they have chronic health problems.

The bill is HB818.

Case is Missouri State Medical Association et al v. State of Missouri, 07AC-CC00567.

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