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Lawmakers weigh ‘advanced’ birth centers

The measure is drawing some bipartisan concern.

With a key senator saying hospitals can be “Petri dishes” for infections, lawmakers are considering a pair of bills that would increase the number of options for pregnant women who are seeking out-of-hospital deliveries.

Despite concerns about safety and potential effects of competition on hospitals, the Senate Health Policy Committee this week unanimously passed a measure (SB 448) by Chairwoman Gayle Harrell, a Stuart Republican, that would authorize “advanced birth centers” and allow them to offer certain women access to Caesarean deliveries and epidurals. The bill would allow the facilities to keep women for up to three days.

Harrell said when the state initially authorized birth centers, they were established for women who wanted “simple, uncomplicated, low-risk, natural births.”

Birth centers currently are precluded from offering women epidurals or from performing Caesarean sections, and babies generally are delivered by lay midwives or certified nurse midwives. Those restrictions have been limiting, Harrell said, adding that her bill “takes the next step” by increasing services that could be provided.

“This legislation takes the next step and brings birthing centers really up for a lot of women who would really like the opportunity of not delivering in a hospital setting, which can be Petri dishes for all kinds of infections,” Harrell said. “This gives women certainly the next option. A whole new level of experience.”

The bill is one of a number of measures filed for the upcoming legislative session that would increase the types of facilities competing with hospitals for patients. The House has pushed to lower health-care costs and, to that end, is considering bills that would allow ambulatory surgical centers to treat patients overnight and to establish what are known as recovery care centers.

While the Senate Health Policy Committee unanimously passed Harrell’s bill Monday, the proposal received bipartisan concern from committee members.

Sen. Aaron Bean, a Fernandina Beach Republican, said the advanced birth centers would operate like “mini-hospitals.” But Bean, who is chairman of the Senate Health and Human Services Appropriations Subcommittee, said he was concerned that, unlike hospitals, the centers would not would be required to provide charity care  to pregnant women in need.

“What requirements are there for those who aren’t on Medicaid and can’t pay?” asked Bean. “Is there any charity requirement that the birthing centers have to take care of anybody that comes up?”

Medicaid pays for about 54 percent of the births in Florida, according to state data. But the bill would not mandate that advanced birth centers accept Medicaid patients.

Harrell assured committee members that the centers “couldn’t afford not to take Medicaid.”

Sen. Janet Cruz, a Tampa Democrat, asked Harrell whether Medicaid managed-care plans could require pregnant women against their will to be treated at advanced birth centers.

But Harrell told Cruz that physicians and patients would make decisions about where labor and delivery would occur and that Medicaid managed-care plans would not decide. Harrell also told Cruz that only low-risk patients could be treated at advanced birth centers.

Nevertheless, Cruz had concerns.

“If a woman is afraid, I just want to make sure that she has the ability to go to a hospital,” she said.

Cruz also had filed an amendment that would have made advanced birth centers liable for injuries caused by a failure to exercise due care. The amendment also would have required advanced birth centers to maintain $250,000 in liability coverage. But Cruz withdrew the amendment.

Sen. Lori Berman, a Lantana Democrat, asked Harrell about pediatricians and whether they would be required to examine babies born at the centers. Harrell told her that the standards at advanced birth centers would be the same as those at existing birth centers.

“The difference is, though, now there will be anesthesia so you could have much more serious issues because of that,” Berman replied, pressing Harrell about whether there would be additional requirements beyond what is currently in place.

Harrell replied: “I am sure if they anticipated a problem, they would immediately call a pediatrician in.”

Harrell’s bill is slated to be heard next by the Senate Children, Families and Elder Affairs Committee. A House version (HB 383) has been filed by Rep. Colleen Burton, a Lakeland Republican.

The News Service of Florida provides journalists, lobbyists, government officials and other civic leaders with comprehensive, objective information about the activities of state government year-round.

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