This matter came on regularly for hearing before
Jaime Rene' Roman, Administrative Law Judge, Medical Quality Hearing Panel, Office of
Administrative Hearings, in Sacramento, California, on August 16 - 20, 1999.
Complainant was represented by Mara Faust, Deputy Attorney General, Health Quality
Enforcement Section, Department of Justice, State of California.
Respondent Alison Osborn, L.M. ("Respondent"), appeared by, with and through her
counsel of record, Nossaman, Guthner, Knox & Elliott, LLP, Attorneys at Law, by John
T. Kennedy,Esq.
During the proceeding, Complainant moved to dismiss the Fourth Cause of Action in the
Accusation for want of proof. There being no objection, the motion was granted.
Subsequently, Complainant moved to file a First Amended Accusation, adding an additional
cause of action; the motion, over objection, was granted.
Evidence was received and the matter deemed submitted on August 20, 1999.
Synopsis
of August 1999 Judicial Ruling
Medical Board of California vs.
Licensed Midwife Alison Osborn
The
Administrative Judge ruled that:
1) midwifery
was a separate and distinct discipline from that of the practice of medicine
2) midwifery
standards of practice were unique from that of medicine’s
3) it was
inappropriate for midwifery practice or its practitioners to be judged by
medical doctors imposing medically-based standards.
"[m]idwifery presumes that childbirth is a
healthy and normal event."
Midwifery involves "socially oriented preventive care, which
incorporates prenatal care and a concern for the social and emotional
aspects of pregnancy and birth in order to meet the individual needs of each
woman."' "Decision
making is collaborative. "
In regard to physician supervision the Judge acknowledged
that the medical community of obstetricians was “hostile to licensed
midwives”, that “As a consequence of such hostility” midwives were
“unable to gain supervision by a physician and surgeon”.
He states that “evidence presented this tribunal further
establishes that, with the exception of one licensed midwife who is also a
licensed physician assistant, no California licensed midwife, despite
efforts for supervision, possesses a supervising physician....
Nevertheless, the evidence further established that Respondent uses at least
one physician for collaborative consult, collaborative assistance, and
emergent issues.”
(emphasis added)
Judge Roman went on to say that the midwife “presented
competent and credible evidence in the form of witnesses and documents”
that “She avidly seeks, along with other midwives, to be part and
parcel of the healthcare team that serves the residents of California.”
“Were this tribunal to employ the medical model on
licensed midwifery, as Complainant (MBC)
urges, no home births could be competently assisted. Mindful that
licensed midwives, with only one exception presented before this tribunal,
possess no hospital privileges, the legislation would function to permit lay
persons to possess a license that would not be functional anywhere within
the State of California. This tribunal declines Complainant's offer.”
(emphasis added)
“In an effort to practice their art, virtually all
of California's 109 licensed midwives, including Respondent, have, with the
cooperation of physicians sympathetic to their plight and who seek to expand
the options available to patients, developed a relationship that involves
collegial referral and assistance, collaboration, and emergent assistance
without direct or accountable physician and surgeon supervision of
licensed midwives. In an effort to promote the efficacy of the Act, this
tribunal concludes, at this time, that a licensed midwife who possesses a
relationship with a California physician and surgeon as referenced herein
has feasibly and reasonably satisfied the ambit of the Act”.
Accordingly, cause does not exist to revoke or suspend
the license of Respondent pursuant to Business and Professions Code
section 2519(e), in conjunction with sections 2507(a) and 2507(b), for unprofessional
conduct arising from lack of supervision.