Wyoming Administrative Rules 036 — Midwifery, Board of

335 Midwifery, Board of

Chapter 1 General Provisions

Wyo. Code R. 036.0001.1.07182018 General Provisions

STATE OF WYOMING

CHAPTER 1

GENERAL PROVISIONS

Section 1. Authority. The Board is authorized under the Act, specifically Wyoming Statute 33-46-103, the WAPA, W.S. 16-3-103(j), and W.S. 33-1-302(a) to promulgate rules.

Section 2. Definitions.

(a) "Act" means the Midwifery Practice Act.

(b) "Antepartum" means occurring or existing during pregnancy.

(c) "ARC" means Application Review Committee.

(d) "CPM" means Certified Professional Midwife.

(e) "IBM" means Investigative Board Member.

(f) "Intrapartum" means occurring during labor and delivery.

(g) "MEAC" means the Midwifery Education Accreditation Council.

(h) "NACPM" means the National Association of Certified Professional Midwives.

(i) "NARM" means the North American Registry of Midwives.

(j) "Postpartum" means occurring in approximately the six (6) week period after childbirth.

(k) "WAPA" means Wyoming Administrative Procedure Act, W.S. 16-3-101 through -115.

Section 3. Board Office. The Board Office is located at 2001 Capitol Ave., Room 104, Cheyenne, Wyoming.

Section 4. Annual Regular Board Meeting. The Board shall have a regular meeting annually on the second Thursday of June at the Board Office beginning at 10:00 a.m.

(a) The Board shall meet as necessary at the time and place designated by the Board president.

Section 5. Change of Name, Address, or Telephone Number. Each applicant and licensee shall notify the Board in writing of any change to their legal name, home address, business address, e-mail address, or telephone number within thirty (30) days of the change.

Section 6. Requests for Roster of Licensees. The roster of current licensees shall be updated at least annually and made available electronically at no charge.

Section 7. Reference by Incorporation.

(a) Each rule and code incorporated by reference is further identified as follows:

(i) Chapter 2 - Uniform Rules for Contested Case Practice and Procedure, adopted by the Office of Administrative Hearings and effective on August 20, 2017, found at: http://midwifery.wyo.gov/.

(ii) Chapter 2 - Uniform Procedures, Fees, Costs, and Charges for Inspection, Copying, and Producing Public Records, adopted by the Department of Administration and Information and effective on September 6, 2016, found at http://midwifery.wyo.gov/.

(iii) Chapter 7 - Philosophy and Principles of Practice and Scope of Practice, adopted by the NACPM revised 2004, found at: http://midwifery.wyo.gov/.

(b) For these rules incorporated by reference:

(i) The Board has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (a) of this section; and

(iii) The incorporated rules are maintained at the Board Office and are available for public inspection and copying at cost at the same location.

History

• Effective 2018-07-18

Chapter 3 Requirements for Licensure and Application

Wyo. Code R. 036.0001.3.10132016 Requirements for Licensure and Application

STATE OF WYOMING

CHAPTER 3

REQUIREMENTS FOR LICENSURE AND APPLICATION

Section 1. Requirements for all applicants. Applicant shall ensure that the Board receives all documentation necessary to prove to the Board's satisfaction that the applicant meets all the requirements for licensure herein. Every applicant shall provide:

(a) Completed application and fee;

(b) Evidence they have not been convicted of a crime which in the judgment of the board renders the person unfit to practice midwifery;

(c) Fingerprints and other information necessary for a criminal history record background check;

(d) Have current certification as a CPM by the NARM; and

(e) Applicant may be required to appear for a personal interview with the Board if the ARC deems an interview appropriate in general, or in a specific case.

Section 2: Application Processing.

(a) Applications shall be deemed "complete" when all necessary documentation has been received by the Board office, including fee;

(b) Applications shall expire one year after submission. If an application expires, an applicant shall submit a new application, including payment of fee; and

(c) ARC shall review every application.

Section 3. License by Education.

(a) Eligibility. An applicant may seek licensure through education if the applicant has graduated from a midwifery education program accredited by MEAC or a similar successor organization.

(b) Application Requirements. The applicant shall provide the Board with evidence of successful completion of Board approved courses in the treatment of respiratory distress in newborns, pharmacology, the treatment of shock, intravenous therapy, and suturing specific to midwives as follows:

(i) Treatment of respiratory distress in newborns- current certification in neonatal resuscitation obtained through completion of American Heart Association approved cardiopulmonary resuscitation courses and American Academy of Pediatrics approved neonatal resuscitation courses;

(ii) Pharmacology specific to midwives-training obtained through completion of MEAC approved courses, or other courses sponsored by or approved by the Board which cover all drugs listed in the formulary;

(iii) Treatment of shock-training obtained through completion of MEAC approved courses or other courses approved by the Board;

(iv) Intravenous therapy-training obtained through completion of MEAC approved courses or other courses approved by the Board; and

(v) Suturing specific to midwives-training obtained through completion of MEAC approved courses or other courses approved by the Board.

Section 4. License by Endorsement.

(a) Eligibility: An applicant may seek licensure through endorsement if they hold a license in good standing to engage in the practice of midwifery under the laws of another state provided:

(i) The applicant is currently licensed or certified by any state with requirements at least as stringent as Wyoming; and

(ii) The applicant has not been sanctioned in another state without resolution satisfactory to the Board.

Section 5. License by Practical Experience.

(a) Eligibility. An applicant may seek licensure through experience if the applicant does not have an education through a MEAC accredited school nor a license in a state that has substantially similar rules to Wyoming but has 5 years practical experience and has met the following requirements for that 5 year period:

(i) The experience shall be within the 5 years immediately preceding the application;

(ii) Have attended 55 out-of-hospital births within that 5 year period;

(iii) Have held a CPM for all 5 of those years;

(iv) Practiced within the standards of the Board Rules; and

(v) Applicant shall interview with the Board.

Section 6. Provisional License. The Board may issue a provisional license to:

(a) Any person eligible for licensure, to allow the applicant to practice under the supervision of another midwife, a person licensed under the Medical Practice Act or a certified nurse midwife until the board has the opportunity to act on the person's application for licensure. However, this paragraph shall not apply to any person whose license or certificate is under revocation, suspension, investigation or disciplinary restriction in another state;

(i) A provisional license issued under this paragraph is valid until action is taken on the application.

(b) Pursuant to WS 33-46-103 (f)(ii) an applicant shall seek a provisional license while undertaking their practicum.

(i) Practicum is defined as when the supervisor signs off on any clinical requirement necessary under the student's educational program

(ii) A provisional license issued under this paragraph is valid for two (2) years.

(c) Any person licensed or certified in another state with requirements at least as stringent as this state to practice for thirty (30) days to provide education and instruction in midwifery or to act as a locum tenens for a midwife licensed under this act.

(i) A provisional license is not required in order to provide classroom instruction or continuing education that does not involve participation at a birth.

Section 7. Issuance of License. Initial licenses shall expire 2 years from the date of issuance and every 2 years after initial licensure.

History

• Effective 2016-10-13

Chapter 5 Fees

Wyo. Code R. 036.0001.5.10132016 Fees

STATE OF WYOMING

CHAPTER 5

FEES

Section 1. Fees. This fee schedule is adopted by the Board pursuant to W.S. 33-1-201. Fees are established as follows:

(a) Application Fee: $1200.00

(b) Provisional License Fee:

(i) Pending Application Processing $200.00

(ii) Undertaking Practicum $400.00

(iii) Education/Instruction/Locum Tenens $200.00 per provisional

(c) Renewal Fee: $1200.00

(d) Reinstatement Fee: $1200.00

(e) Re-Licensure Fee $1800.00

(f) Per Delivery Fee: $50.00 per delivery

(g) Non-sufficient Funds Fee: $30.00

(h) Verification Fee: $30.00

(j) Copy Fee: $.50 per page

(k) Duplicate Wall Certificate Fee: $20.00

(l) Duplicate Pocket Card: $10.00

Section 2. Refunds. All fees collected by the Board are non-refundable.

History

• Effective 2016-10-13

Chapter 6 Renewals

Wyo. Code R. 036.0001.6.10132016 Renewals

STATE OF WYOMING

CHAPTER 6

RENEWAL

Section 1. Biennial Renewal.

(a) Licenses may be renewed every two (2) years by providing the Board with the following:

(i) Complete application for renewal;

(ii) Payment of the renewal fee;

(iii) Verification of having maintained CPM certification from NARM; and

(iv) Verification of current Infant Child and Adult CPR and NRP certificate.

(b) Approximately sixty (60) days prior to the renewal date the Board may send a renewal notice to the licensee's last address of record.

(c) Renewal applications shall not be accepted more than one hundred twenty (120) days prior to the expiration date.

(d) Renewal applications received by the Board which are postmarked after the expiration date, or after the next business day in cases when the expiration date falls on a weekend or holiday, will not be accepted by the Board, and the license shall expire.

(e) Failure to receive a notice for renewal from the Board shall not excuse a licensee from the requirement for renewal under the Act and these rules.

Section 2. Relicensure.

(a) Eligibility. An applicant may seek relicensure if the applicant has been licensed in Wyoming and either failed to timely renew or is seeking to return to active clinical practice.

(b) Application Requirements. Applicant shall:

(i) Submit a completed relicensure application and payment of fee;

(ii) Current CPM certification from NARM

Section 3. Reinstatement of Licensure.

(a) Eligibility. An applicant may seek reinstatement of their license if that license has been revoked, surrendered, suspended, conditioned, restricted, or otherwise disciplined.

(b) Application Reinstatement Requirements. The applicant shall:

(c) Submit a completed reinstatement application and payment of fee;

(i) Submit evidence of complying with the requirements of a previous Board order;

(ii) Submit evidence that the applicant has corrected the conduct that formed the basis of the discipline of applicant's license and the applicant is able to safely, skillfully and competently practice; and Submit evidence demonstrating just cause for reinstatement.

(d) Hearing. Applicant shall appear before the Board.

History

• Effective 2016-10-13

Chapter 7 Professional Responsibility

Wyo. Code R. 036.0001.7.10262021 § 1 Scope and Practice Standards

A licensed midwife shall adhere to the following scope and practice standards when providing antepartum, intrapartum, postpartum, and newborn care.

(a) The Board hereby incorporates by reference the following uniform rules outlining the scope and practice standards:

(i) Philosophy and Principles of Practice and Scope of Practice, adopted by the NACPM revised 2004, found at: http://nacpm.org/about-cpms/professional-standards/

(ii) For these rules incorporated by reference:

(A) The Board has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(B) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (a) of this section; and

(C) The incorporated rule is maintained at Board Office and is available for public inspection and copying at cost at the same location.

(b) Conditions for Which a Licensed Midwife May Not Provide Care. A licensed midwife shall not provide care to a client with any of the disorders, diagnoses, conditions or symptoms listed in Wyoming Statute 33-46-103(j)(i)(A).

(c) Conditions for Which a Licensed Midwife May Not Provide Care Without Physician Involvement. Before providing care to a client with any of the disorders, diagnoses, conditions or symptoms listed in W.S. 33-46-103(j)(i)(B), the licensed midwife shall notify the client in writing that the client shall obtain the described physician care as a condition to the client's eligibility to obtain maternity care from the licensed midwife. The licensed midwife shall, additionally, obtain the client's signed acknowledgement that the client has received the written notice. A licensed midwife must also follow the requirements in this section if the client has any of the following:

(i) HIV positive; or

(ii) Anemic with documented hemoglobin at less than ten (10) at thirty seven (37) weeks.

(d) Follow the Conditions for Which a Licensed Midwife Shall Recommend Physician Involvement as referenced in the Act. Before providing care for a client with a history of any of the disorders, diagnoses, conditions or symptoms listed in W.S. 33-46-103(j)(i)(C), a licensed midwife shall provide written notice to the client that the client is advised to see a licensed physician during the client's pregnancy. Additionally, the licensed midwife shall obtain the client's signed acknowledgement that the client has received the written notice.

(e) Conditions for Which a Licensed Midwife Shall Facilitate Hospital Transfer as referenced in the Act. A licensed midwife shall facilitate the immediate transfer of a client to a hospital for emergency care if the client has any of the following disorders, diagnoses, conditions or symptoms listed in W. S. 33-46-103(j)(i)(D) or any of the following:

(i) Maternal fever in labor of more than 100.4 degrees Fahrenheit, in the absence of environmental factors;

(ii) Suggestion of fetal jeopardy, such as any abnormal bleeding (with or without abdominal pain), evidence of placental abruption, thick meconium, or abnormal fetal heart tones with non-reassuring patterns where birth is not imminent;

(iii) Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first, unless birth is imminent or;

(iv) Rupture of membranes:

(A) longer than eighteen (18) hours without a documented negative Group B Streptococcus (GBS) screen and without intravenous (IV) antibiotic treatment;

(B) longer than twenty-four (24) hours without a documented negative GBS screen and with IV antibiotic treatment from the onset of labor or rupture of membranes, whichever occurs first;

(C) longer than twenty-four (24) hours with a documented negative GBS screen and without IV antibiotic treatment; or

(D) longer than thirty-six (36) hours with a documented negative GBS screen and IV antibiotic treatment.

(f) Plan for Emergency Transfer and Transport. When facilitating a transfer, the licensee shall notify the hospital when the transfer is initiated, accompany the client to the hospital if feasible, or communicate by telephone with the hospital if the licensed midwife is unable to be present. The licensed midwife shall also ensure that the transfer of care is accompanied by the client's medical record, which include:

(i) The client's name, address, and next of kin contact information;

(ii) A list of diagnosed medical conditions;

(iii) A list of prescription or over the counter medications regularly taken;

(iv) A history of previous allergic reactions to medications; and

(v) If feasible, the licensed midwife's assessment of the client's current medical condition and description of the care provided by the licensed midwife before transfer.

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 3 Record Keeping

Each client record shall be retained for a minimum of ten (10) years after the birth during which time reasonable efforts are to be made to advise clients of closure of practice or change in record location.

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 4 Written Informed Consent

The licensee shall provide to the client written informed consent documents in accordance with W.S. 33-46-103(j)(ii).

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 5 Medication Formulary

During the practice of midwifery a licensed midwife may obtain and administer the following drugs described in the midwifery formula, according to the protocol outlined in Appendix A, describing the indication for use, dosage, route of administration and duration of treatment:

(a) Oxygen;

(b) Oxytocin as a postpartum antihemorrhagic agent;

(c) Misoprostol as a postpartum antihemorrhagic agent;

(d) Methylergonovine (Methergine) as a postpartum antihemorrhagic agent;

(e) Injectable local anesthetic for the repair of lacerations which are no more extensive than second degree;

(f) Antibiotics for group B streptococcus prophylaxis consistent with the guidelines set forth in Prevention of Perinatal Group B Streptococcal Disease, published by the Centers for Disease Control and Prevention and for prolonged rupture of membranes;

(g) Epinephrine administered via a metered dose auto-injector;

(h) Intravenous fluids for stabilization of the woman;

(i) Rho(D) immune globulin;

(j) Phylloquinone (Vitamin K1);

(k) Eye prophylactics for the baby;

(l) Sterile H2O Papules; and

(m) Terbutaline.

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 6 Obtaining, Storing, and Disposing of Formulary Drugs

A licensee shall adhere to the following protocol for obtaining, storing, and disposing of formulary drugs during the practice of midwifery.

(a) Obtaining Formulary Drugs. A licensee shall obtain formulary drugs as allowed by law, including, without limitation, from:

(i) A person or entity that is licensed as a Wholesale Distributor by the Wyoming State Board of Pharmacy; or

(ii) A retail pharmacy, in minimal quantities for office use.

(b) Storing Formulary Drugs. A licensed midwife shall store all formulary drugs in secure areas suitable for preventing unauthorized access and for ensuring a proper environment for the preservation of the drugs. However, licensed midwives may carry formulary drugs to the home setting while providing care within the course and scope of the practice of midwifery. The licensed midwife shall promptly return the formulary drugs to the secure area when the licensed midwife has finished using them for patient care.

(c) Disposing of Formulary Drugs. A licensed midwife shall dispose of formulary drugs using means that are reasonably calculated to guard against unauthorized access and harmful excretion of the drugs into the environment. The means that may be used include, without limitation:

(i) Transferring the drugs to a reverse distributor who is registered to destroy drugs with the U.S. Drug Enforcement Agency;

(ii) Removing the drugs from their original containers, mixing them with an undesirable substance such as coffee grounds or kitty litter, putting them in impermeable, non-descript containers such as empty cans or sealable bags, and throwing the containers in the trash; or

(iii) Flushing the drugs down the toilet if the accompanying patient information instructs that it is safe to do so.

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 7 Newborn Care

(a) The licensee shall carry the equipment necessary for resuscitation of the newborn.

(b) Midwives shall transfer (immediately if indicated) any newborn showing the following signs to the nearest hospital or pediatric care provider:

(i) Ten (10) minute Apgar score of less than seven (7);

(ii) Signs of a medically significant anomaly;

(iii) Signs of respiratory distress including respiratory rate over eighty (80) per minute, poor color, grunting, nasal flaring and/or retractions that are not showing consistent improvement;

(iv) Need for oxygen for more than twenty (20) minutes, or after one (1) hour following the birth;

(v) Seizures;

(vi) Fontanel full and bulging;

(vii) Significant or suspected birth injury;

(viii) Cardiac irregularities including a heart rate that is consistently below eighty (80) beats per minute or greater than one hundred sixty (160) beats per minute; poor capillary refilling (greater than three (3) seconds);

(ix) Pale, cyanotic, gray color;

(x) Lethargy or poor muscle tone;

(xi) Temperature instability;

(xii) Jaundice at less than twenty-four (24) hours; or

(xiii) Loss of greater than ten (10) percent birth weight.

(c) All licensees shall comply with the Wyoming Department of Health's Newborn Screening requirements stated in W.S. 35-4-801.

(i) Informed consent of parents shall be obtained and if any parent or guardian of a child objects to a mandatory examination, the child is exempt from subsection (c).

(d) All licensees shall register births, stillbirths and deaths with the local registrar of the district in which the occurrence took place within ten (10) days after the birth pursuant to W.S. 35-1-401 through 431;

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 8 Medical Waste

Medical waste (items removed from a private residence) shall be disposed of according to the following protocol:

(a) Containers for Non-Sharp, Medical Waste. Medical waste, except for sharps, shall be placed in disposable containers/bags which are impervious to moisture and strong enough to preclude ripping, tearing or bursting under normal conditions of use. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid waste during storage, handling or transport. The containment system shall have a tight-fitting cover and be kept clean and in good repair. All bags used for containment of medical waste must be clearly identified by label or color, or both.

(b) Containers for Sharps. Sharps shall be placed in impervious, rigid, puncture-resistant containers immediately after use. Needles shall not be bent, clipped or broken by hand. Rigid containers of discarded sharps shall either be labeled or colored like the disposable bags used for other medical waste, or placed in such labeled or colored bags.

(c) Storage Duration. Medical waste may not be stored for more than seven (7) days, unless the storage temperature is below thirty-two (32) degrees Fahrenheit. Medical waste shall never be stored for more than ninety (90) days.

History

• Effective 2021-10-26

Wyo. Code R. 036.0001.7.10262021 § 9 Professional Standards

(a) Persons licensed by the Board shall:

(i) Use the term "Licensed Midwife" and/or the initials LM only after the applicant is granted licensure by the Board;

(ii) Practice in a manner that is in the best interest of the public and does not endanger the public health, safety or welfare;

(iii) Be able to justify all services rendered to clients as necessary for diagnostic or therapeutic purposes;

(iv) Practice only within the competency areas for which they are trained and experienced. The licensee shall be able to demonstrate to the Board competency, training, and/or expertise;

(v) Report to the board outcomes of all clients for which they have provided services at any point during labor or delivery within thirty (30) days after each birth;

(vi) Report to the Board known or suspected violations of the laws and regulations governing the practice of licensed professionals;

(vii) Maintain accurate documentation of all professional services rendered to a client in confidential files for each client and ensure that client records are kept in a secure, safe, retrievable and legible condition;

(A) The licensee shall make provisions for the retention and/or release of client records if the licensee is unable to do so. Such provision shall include the naming of a qualified person who will retain the client records and properly release the client records upon request.

(viii) Clearly state the person's licensure status by the use of a title or initials such as "licensed midwife" (LM) or a statement such as "licensed by the Wyoming Board of Midwifery" in any advertising, public directory or solicitation, including telephone directory listings;

(ix) Respond to all requests for information and all other correspondence from the Board;

(x) Not permit, condone or facilitate unlicensed practice or any activity which is a violation of the Act or these rules and regulations;

(xi) Not use vacuum extraction or forceps as an aid in the delivery of a newborn; and

(xii) Not perform abortions.

History

• Effective 2021-10-26

Chapter 8 Practice and Procedures for Disciplinary, Application and Licensure Matters

Wyo. Code R. 036.0001.8.07182018 Practice and Procedures for Disciplinary, Application and Licensure Matters

STATE OF WYOMING

CHAPTER 8

PRACTICE AND PROCEDURES

FOR DISCIPLINARY, APPLICATION, AND LICENSURE MATTERS

Section 1. Statement of Purpose. These rules are adopted to implement the Board's authority to:

(a) Conduct investigations, hearings, and proceedings concerning:

(i) Alleged violations of the Act or the Board Rules; or

(ii) Actions relating to an application for a licensure including granting or denying.

(b) Determine and administer appropriate disciplinary action against licensee.

Section 2. Grounds. In addition to the grounds outlined in Wyoming Statute 33-46-103, the Board may take action for unprofessional or unethical conduct.

(a) Unprofessional conduct shall include, but is not limited to:

(i) Suspension, revocation, denial, or other disciplinary action imposed upon a license held in another jurisdiction. A certified copy of the disciplinary order shall be conclusive evidence.;

(ii) Engaging in the practice of midwifery without a license issued by this Board;

(iii) Conviction of a felony. A certified copy of the conviction shall be conclusive evidence;

(iv) Conviction of a misdemeanor involving moral turpitude. A certified copy of the conviction shall be conclusive evidence;

(v) Renting or lending the license issued pursuant to this act to any person;

(vi) Gross incompetence or malpractice;

(vii) Mental incompetency;

(viii) Knowingly submitting false information to the Board;

(ix) Addiction or habitual intemperate use of alcohol, drugs and/or a controlled substance;

(x) Violation and conviction of a charge under W.S. 35-7-1001 et seq., the Wyoming Controlled Substance Act;

(xi) Sexual exploitation of a client, defined as; and

(A) Offering professional services for some form of sexual gratification; or

(B) Sexual contact with a client.

(xii) Willful violation of any provisions of the Act.

(b) Unethical conduct shall be a violation of any provision of the adopted Standards of Practice as set forth in these Rules.

Section 3. Application Review and Investigation Process.

(a) Application Review.

(i) Every application for a license issued by the Board shall be subject to investigation to determine whether the requirements set forth in the Act and Board Rules are satisfied.

(ii) If any application, including renewals, reveals any information which merits further investigation, the matter shall be assigned to the ARC.

(b) ARC Action. The ARC may:

(i) Recommend a license be issued or renewed;

(ii) Recommend a license be issued, renewed, relicensed, or reinstated subject to conditions, restrictions, or other disciplinary action;

(iii) Recommend a settlement agreement which may include the issuance of a license or renewal with the imposition of restrictions, conditions, reprimand or a combination thereof; or

(iv) Recommend denial of the application.

(c) Notice of Intent. The ARC shall notify the applicant of its intent to recommend denial. Such notification shall contain:

(i) A brief description of the facts or conduct that warrant the denial of licensure;

(ii) A statement of the nature of the actions which warrant the denial or other authorized action, the facts upon which the denial or other action is based, the specific statutory provisions or the specific Board Rules involved; and

(iii) Notice of the right to a hearing if a written request is received in the Board office within thirty (30) days of the date of mailing the letter of the denial.

(d) Applicant's Request for Hearing. If the ARC recommends denial of an application, the applicant may request a contested case hearing in writing within thirty (30) days of the mailing of the notification.

Section 4. Complaint Review and Disciplinary Investigation Process.

(a) Complaint Review. Every complaint submitted to the Board or initiated on behalf of the Board shall be investigated by a IBM.

(b) IBM Action. The IBM may:

(i) Recommend dismissal of a complaint;

(ii) Recommend issuance of an advisory letter;

(iii) Recommend a settlement agreement which may include voluntary surrender, suspension, imposition of restrictions or conditions, reprimand or other discipline;

(iv) Recommend disciplinary action against the licensee including revocation, suspension, reprimand, restrictions or conditions, or other discipline; or

(v) Recommend summary suspension.

(c) Summary Suspension. The Board may conduct an expedited hearing if the IBM believes that the licensee's continued practice presents a danger to the public health, safety or welfare and recommends summary suspension.

Section 5. Summary Suspension.

(a) Recommendation. If the IBM recommends summary suspension, the Board shall conduct an expedited proceeding to determine whether the licensee's continued practice presents a clear and imminent danger to public health, safety or welfare.

(b) Notice of Intent to Recommend Summary Suspension.

(i) The IBM shall notify the licensee of its intent to recommend summary suspension;

(ii) The Notice of Intent shall contain:

(A) Copy of the complaint; and

(B) Notice that an expedited summary suspension proceeding shall be set at the earliest opportunity a quorum of Board members may be assembled;

(c) Notice of Expedited Proceeding. Upon confirmation of the date and time of the expedited proceeding, the IBM shall notify the licensee in writing of the date and time of the proceeding.

Section 6. Petition and Complaint and Notice of Hearing.

(a) Petition and Complaint. Formal proceedings for disciplinary action against a licensee shall be commenced by serving a petition and complaint and notice of hearing by certified or regular mail at least thirty (30) days prior to the date set for hearing.

(b) Notice of Hearing. The notice of hearing shall contain:

(i) The name and last address of the licensee;

(ii) A statement in ordinary and concise language of the matters asserted, which shall contain the nature of the complaint filed with the Board, the facts upon which the complaint is based, the specific statutory provisions and the specific Board Rules that the licensee is alleged to have violated;

(iii) The time, place and nature of the hearing;

(iv) The legal authority and jurisdiction; and

(v) A statement indicating that failure to respond to the Petition within thirty (30) days shall result in a default judgment.

Section 7. Lawful Service. There shall be a presumption of lawful service of a petition and complaint, notice of hearing, or any other communication required by these Board Rules if sent to the last known address of the licensee or applicant by certified, regular mail, or electronic mail to the e-mail address indicated to be the preferred method of communication..

Section 8. Default. The Board may enter an order of default judgment based on the allegations contained in the petition and complaint in any case where the licensee or the licensee's representative has not answered the petition and complaint or appeared at a scheduled noticed hearing.

Section 9. Board Decision and Order.

(a) Board Action. The Board may resolve a complaint by:

(i) Approving the recommendations of the IBM or ARC; or

(ii) Conduct a contested case hearing. Following the hearing and deliberation of all evidence admitted at a contested case hearing, the Board may:

(A) Dismiss the complaint due to lack of clear and convincing evidence;

(B) Issue an advisory letter; or

(C) Impose discipline by revocation, suspension, reprimand, restriction, condition, non-renewal, or a combination thereof, for a violation of any provision of the Act or the Board Rules.

(b) Board Order. The Board shall issue a written decision and order. The decision and order shall be sent to the applicant, licensee, or their attorneys by certified or regular mail.

Section 10. Appeals to District Court.

(a) Appeals from decisions of the Board are governed by the WAPA and the Wyoming rules of Appellate Procedure.

(b) Costs of transcripts and any reasonable costs assessed by the Board regarding the record on appeal shall be borne by the party making the appeal.

History

• Effective 2018-07-18

Chapter 10 Drug Formulary

Wyo. Code R. 036.0001.10.07182018 Drug Formulary

STATE OF WYOMING

Chapter 10

Drug Formulary

A licensed midwife may use the drugs described in the midwifery formula according to the following protocol describing the indication for use, dosage, route of administration and duration of treatment:

History

• Effective 2018-07-18