Lawmakers Regulate Midwives, Pot Dispensaries, Community Health Workers; Launch Healthcare Study

The Oregon Legislature passed a flurry of bills on Saturday as it worked to end the 2013 session. Direct-entry midwives and marijuana dispensaries will be licensed and regulated. Traditional health workers get their own commission, and Oregon will solicit private funds to study universal healthcare, including single-payer insurance.
The Lund Report

July 8, 2013 — The Legislature cleared through dozens of bills on Saturday, including a study of universal healthcare and the regulation of midwives, marijuana dispensaries and traditional health workers as lawmakers moved to close the session.

Midwife Regulation

The Senate passed House Bill 2997, which requires direct-entry midwives to become licensed and prohibits them from advertising their services or using life-saving drugs unless they become licensed. The legislation exempts midwives from licensing requirements if they are part of a traditional religious or immigrant community. That bill is now headed to the governor’s desk for his signature.

Rep. Alissa Keny-Guyer, D-Portland, who shepherded the bill in the House, had hired certified nurse-midwifes for the delivery of her babies, including one at home.

But despite a strong 29-1 vote, the tenor of the debate in the Senate toward the practice of midwifery faced a more critical reception, led by the chamber’s two physicians — Sen. Elizabeth Steiner Hayward, D-Portland and Sen. Alan Bates, D-Medford.

“Home delivery can be safe in the hands of the right professional in the right circumstances,” Steiner Hayward said, before noting that she did not support the profession of direct-entry midwifery. However, she agreed to support the bill because mandatory licensing was an improvement over current law, where licensing is voluntary.

“Direct-entry midwifery is really a questionable practice,” Bates said, alluding to cases in recent years where babies have died in the care of unlicensed midwives that were likely preventable. “The statistics for the past year and a half are horrible.”

However, Alan Tressider, the lobbyist for the Oregon Midwifery Council, told The Lund Report that not enough data had been collected and any conclusions Bates made were anecdotal.

The bill had earlier passed the House unanimously, but one senator opposed the regulation. Sen. Larry George, R-Sherwood said he and his wife had chosen to use doulas and midwives with their children, and the state had no business trying to restrict the practice.

“That’s a personal decision,” George told The Lund Report. “People are smart enough to know if they want a licensed or unlicensed midwife.”

The new licensing requirements do not affect certified nurse midwives, who are already monitored by the Board of Nursing and can deliver babies in hospitals, at birth centers or in people’s homes.

Direct-entry midwives enter the practice of delivering babies directly without learning another healthcare trade. They learn their skills from a midwifery school or apprenticeship from another midwife.

“It’s very important that we have people who are trained and licensed in this service,” said Sen. Rod Monroe, D-Portland.

Monroe told his colleagues that his aunt, an experienced midwife, delivered him at home after bad weather and road closures prevented his mother from reaching the hospital.

Sen. Laurie Monnes Anderson, a Gresham Democrat and retired nurse, spoke favorably of midwifery, noting its widespread use in other parts of the world and the high cost of giving birth in the United States.

Universal Healthcare Study

The universal healthcare study passed the Senate in a strong bipartisan 20-10 vote after Rep. Michael Dembrow, D-Portland, reached across the aisle to convince his fellow lawmakers and made the bill a top priority. Four Republicans, including Sen. Jeff Kruse of Roseburg, joined all Democrats in support.

House Bill 3260 calls for a privately funded comprehensive study of healthcare financing in Oregon, analyzing at least four systems, including a single-payer system. Before the Senate voted, no one mentioned the words single payer.

“Everybody wants an unbiased, objective outcome,” said Sen. Elizabeth Steiner Hayward, D-Portland, noting that the Oregon Health Authority will help ensure the outcome, preventing interference between those who help finance the study and the researchers who analyze the data.

“The old ways of doing things don’t work anymore,” she added, mentioning the out-of-control healthcare costs in America and the dysfunctional fee-for-service payment methodology.

HB 3260 had five Republican supporters when it passed the House a week earlier.

Marijuana Dispensaries

The House re-passed House Bill 3460, which regulates dispensaries for the distribution of medical marijuana. The Senate passed the bill on Wednesday, but included amendments to deal with concerns raised by the district attorneys’ association.

Under the changes, those who run marijuana dispensaries must pass national background checks, not just be screened for Oregon felonies. Language that protected employees of marijuana dispensaries from prosecution was also removed.

About 200 unauthorized marijuana dispensaries operate in Oregon, according to Geoff Sugerman, a chief supporter of HB 3460. The Oregon Health Authority will be tasked with certifying those dispensaries and others, starting next March.

Without the legal protections, the dispensaries will remain in the same legal gray area as they currently do, leaving them vulnerable to prosecution from local authorities. Marijuana remains illegal for nearly all purposes under federal law.

“The point is that we do have a medical marijuana law now,” said Rep. Mitch Greenlick, D-Portland, supporting the final passage of HB 3460. The dispensary bill had bipartisan support in the Senate, but squeaked by on a 31-28 vote in the House with total Republican opposition. “This gives people with marijuana cards safe access to the marijuana.”

Traditional Health Workers

The House also passed House Bill 3407, which sets up a 19-member commission to monitor and set standards for traditional health workers. The vote was 52-7 with a handful of Republicans in opposition.

“The current law requires that the members of coordinated care organizations have access to traditional health workers,” said Rep. Joe Gallegos, D-Hillsboro, the bill’s chief sponsor.

Traditional health workers include community health workers, peer wellness specialists, birth attendants and healthcare navigators, but up until now the guidelines to register and recruit these workers has been the purview of an informal steering committee.

HB 3407 formalizes that Oregon Health Authority steering committee and sets a framework in which a majority of its members must be traditional healthcare workers. The agency has referred to them as “non-traditional” health workers, which advocates of HB 3407 have found objective.

The bill passed the House Health Committee in April with little opposition, but since all commissions require the commitment of government employees, they must pass the budget committee, and Sen. Bates had delayed its passage.

Bates told The Lund Report that he was concerned that having a commission of 19 members would be too unruly to be productive, but agreed to support the bill to honor the work and wishes of advocates such as the Latino Health Coalition.

Linda Roman of the Latino Health Coalition told The Lund Report that the current steering committee can have up to 25 members, and the commission was drawn so that each of the different types of healthcare workers could be represented.

On Sunday, the Senate passed HB 3407, and the House re-passed the midwife bill to approve a clerical amendment. Those bills, along with the marijuana dispensary bill and universal healthcare study bill, now head to Gov. Kitzhaber.

Image for this story by Christopher Dazey (CC BY-NC-ND 2.0) via Flickr.

Christopher David Gray can be reached at chris@thelundreport.org.

This story has been updated from an earlier version.

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