Direct-entry Midwives

C.R.S. tit. 12, art. 225
in effect

C.R.S. § 12-225-101 Scope of article - exemptions - legislative declaration

12-225-101. Scope of article - exemptions - legislative declaration. (1) (a) This article 225 applies only to direct-entry midwives and does not apply to those persons who are otherwise licensed by the state of Colorado under this title 12 if the practice of midwifery is within the scope of that licensure. (b) (I) A person who is a certified nurse-midwife authorized pursuant to section 12-255-111, a certified midwife authorized pursuant to section 12-255-111.5, or a physician as provided in article 240 of this title 12 shall not simultaneously be so licensed and also be registered under this article 225. A physician, certified nurse-midwife, or certified midwife who holds a license in good standing may relinquish the license and subsequently be registered under this article 225. (II) A direct-entry midwife shall not represent oneself as a nurse-midwife, certified nurse-midwife, or certified midwife. (III) The fact that a direct-entry midwife may hold a practical or professional nursing license does not expand the scope of practice of the direct-entry midwife. (IV) The fact that a practical or professional nurse may be registered as a direct-entry midwife does not expand the scope of practice of the nurse. (c) It is the intent of the general assembly that health care be provided pursuant to this article 225 as an alternative to traditional licensed health care and not for the purpose of enabling providers of traditional licensed health care to circumvent the regulatory oversight to which they are otherwise subject under any other part or article of this title 12. (2) Nothing in this article 225 shall be construed to prohibit, or to require registration under this article 225, with regard to: (a) The gratuitous rendering of services in an emergency; (b) The rendering of services by a physician licensed pursuant to article 240 of this title 12 or otherwise legally authorized to practice in this state; (c) The rendering of services by certified nurse-midwives or certified midwives properly licensed and practicing in accordance with part 1 of article 255 of this title 12; or (d) The practice by persons licensed or registered under any law of this state, in accordance with that law, to practice a limited field of the healing arts not specifically designated in this section.

C.R.S. § 12-225-102 Applicability of common provisions

12-225-102. Applicability of common provisions. Articles 1, 20, and 30 of this title 12 apply, according to their terms, to this article 225.

C.R.S. § 12-225-103 Definitions

12-225-103. Definitions. As used in this article 225, unless the context otherwise requires: (1) "Birth center" means a freestanding facility licensed by the department of public health and environment that: (a) Is not a hospital, attached to a hospital, or located in a hospital; (b) Provides prenatal, labor, delivery, and postpartum care to low-risk pregnant persons and newborns; and (c) Provides care during delivery and immediately after delivery that is generally less than twenty-four hours in duration. (1.5) "Client" means a pregnant woman for whom a direct-entry midwife performs services. For purposes of perinatal or postpartum care, "client" includes the woman's newborn. (2) "Direct-entry midwife" means a person who practices direct-entry midwifery. (3) "Direct-entry midwifery" or "practice of direct-entry midwifery" means the advising, attending, or assisting of a woman during pregnancy, labor and natural childbirth at home or at a birth center, and the postpartum period in accordance with this article 225. (4) "Natural childbirth" means the birth of a child without the use of instruments, surgical procedures, or prescription drugs other than those for which the direct-entry midwife has specific authority under this article 225 to obtain and administer. (5) "Perinatal" means the period from the twenty-eighth week of pregnancy through seven days after birth. (6) "Postpartum period" means the period of six weeks after birth.

C.R.S. § 12-225-104 Requirement for registration with the division - annual fee - grounds for revocation

12-225-104. Requirement for registration with the division - annual fee - grounds for revocation. (1) Every direct-entry midwife shall register with the division by applying to the director in the form and manner the director requires. The application shall include the information specified in section 12-225-105. (2) Any changes in the information required by subsection (1) of this section shall be reported within thirty days after the change to the division in the form and manner required by the director. (3) Every applicant for registration shall pay a registration fee to be established by the director in the manner authorized by section 12-20-105. Registrations issued pursuant to this article 225 are subject to the renewal, expiration, reinstatement, and delinquency fee provisions specified in section 12-20-202 (1) and (2). Any person whose registration has expired shall be subject to the penalties provided in this article 225 or section 12-20-202 (1). (4) To qualify to register, a direct-entry midwife must have successfully completed an examination evaluated and approved by the director as an appropriate test to measure competency in the practice of direct-entry midwifery, which examination must have been developed by a person or entity other than the director or the division and the acquisition of which shall require no expenditure of state funds. The national registry examination administered by the Midwives Alliance of North America, or its successor, must be among those evaluated by the director. The director is authorized to approve any existing test meeting all the criteria set forth in this subsection (4). In addition to successfully completing the examination, a direct-entry midwife is qualified to register if the person has: (a) Attained the age of nineteen years; (b) Earned at least a high school diploma or the equivalent; (c) Successfully completed training approved by the director in: (I) The provision of care during labor and delivery and during the antepartum and postpartum periods; (II) Parenting education for prepared childbirth; (III) Aseptic techniques and universal precautions; (IV) Management of birth and immediate care of the mother and the newborn; (V) Recognition of early signs of possible abnormalities; (VI) Recognition and management of emergency situations; (VII) Special requirements for home birth; (VIII) Recognition of communicable diseases affecting the pregnancy, birth, newborn, and postpartum periods; and (IX) Recognition of the signs and symptoms of increased risk of medical, obstetric, or neonatal complications or problems as set forth in section 12-225-106 (3); (d) Acquired practical experience including, at a minimum, experience with the conduct of at least one hundred prenatal examinations on no fewer than thirty different women and observation of at least thirty births; (e) Participated as a birth attendant, including rendering care from the prenatal period through the postpartum period, in connection with at least thirty births; and (f) Filed documentation with the director that the direct-entry midwife is currently certified by the American Heart Association or the American Red Cross to perform adult and infant cardiopulmonary resuscitation ("CPR"). (5) Effective July 1, 2003, in order to be deemed qualified to register, a direct-entry midwife must have graduated from an accredited midwifery educational program or obtained a substantially equivalent education approved by the director. The educational requirement does not apply to direct-entry midwives who have registered with the division before July 1, 2003. (6) For purposes of registration under this article 225, no credential, licensure, or certification issued by any other state meets the requirements of this article 225, and therefore there is no reciprocity with other states.

C.R.S. § 12-225-105 Mandatory disclosure of information to clients

12-225-105. Mandatory disclosure of information to clients. (1) Every direct-entry midwife shall provide the following information in writing to each client during the initial client contact: (a) The name, business address, and business phone number of the direct-entry midwife; (b) A listing of the direct-entry midwife's education, experience, degrees, membership in any professional organization whose membership includes not less than one-third of all registrants, certificates or credentials related to direct-entry midwifery awarded by any such organization, and the length of time and number of contact hours required to obtain the degrees, certificates, or credentials; (c) A statement indicating whether or not the direct-entry midwife is covered under a policy of liability insurance for the practice of direct-entry midwifery; (d) A listing of any license, certificate, or registration in the health-care field previously or currently held by the direct-entry midwife and suspended or revoked by any local, state, or national health-care agency; (e) A statement that the practice of direct-entry midwifery is regulated by the department. The statement must provide the address and telephone number of the office of midwifery registration in the division and shall state that violation of this article 225 may result in revocation of registration and of the authority to practice direct-entry midwifery in Colorado. (f) A copy of the emergency plan as provided in section 12-225-106 (6); (g) A statement indicating whether or not the direct-entry midwife will administer vitamin K to the client's newborn infant and, if not, a list of qualified health-care practitioners who can provide that service; and (h) A statement indicating whether or not the direct-entry midwife will administer Rho(D) immune globulin to the client if she is determined to be Rh-negative and, if not, a list of qualified health-care practitioners who can provide that service. (2) Any changes in the information required by subsection (1) of this section shall be reflected in the mandatory disclosure within five days after the change.

C.R.S. § 12-225-106 Prohibited acts - practice standards - informed consent - emergency plan - risk assessment - referral - rules

12-225-106. Prohibited acts - practice standards - informed consent - emergency plan - risk assessment - referral - rules. (1) A direct-entry midwife shall not dispense or administer any medication or drugs except in accordance with section 12-225-107. (2) A direct-entry midwife shall not perform any operative or surgical procedure; except that a direct-entry midwife may perform sutures of perineal tears in accordance with section 12-225-107. (3) A direct-entry midwife shall not provide care to a pregnant woman who, according to generally accepted medical standards, exhibits signs or symptoms of increased risk of medical or obstetric or neonatal complications or problems during the completion of her pregnancy, labor, delivery, or the postpartum period. Those conditions include but are not limited to signs or symptoms of diabetes, multiple gestation, hypertensive disorder, or abnormal presentation of the fetus. (4) A direct-entry midwife shall not provide care to a pregnant woman who, according to generally accepted medical standards, exhibits signs or symptoms of increased risk that her child may develop complications or problems during the first six weeks of life. (5) (a) A direct-entry midwife shall keep appropriate records of midwifery-related activity, including but not limited to the following: (I) The direct-entry midwife shall complete and file a birth certificate for every delivery in accordance with section 25-2-112. (II) The direct-entry midwife shall complete and maintain appropriate client records for every client. (III) Before accepting a client for care, the direct-entry midwife shall obtain the client's informed consent, which shall be evidenced by a written statement in a form prescribed by the director and signed by both the direct-entry midwife and the client. The form shall certify that full disclosure has been made and acknowledged by the client as to each of the following items, with the client's acknowledgment evidenced by a separate signature or initials adjacent to each item in addition to the client's signature at the end of the form: (A) The direct-entry midwife's educational background and training; (B) The nature and scope of the care to be given, including the possibility of and procedure for transport of the client to a hospital and transferral of care prenatally; (C) A description of the available alternatives to direct-entry midwifery care, including a statement that the client understands the client is not retaining a certified nurse midwife, a nurse midwife, or a certified midwife; (D) A description of the risks of birth, including those that are different from those of hospital birth and those conditions that may arise during delivery; (E) A statement indicating whether or not the direct-entry midwife is covered under a policy of liability insurance for the practice of direct-entry midwifery; and (F) A statement informing the client that, if subsequent care is required resulting from the acts or omissions of the direct-entry midwife, any physician, nurse, certified midwife, prehospital emergency personnel, and health-care institution rendering subsequent care will be held only to a standard of gross negligence or willful and wanton conduct. for the practice of direct-entry midwifery; and (F) A statement informing the client that, if subsequent care is required resulting from the acts or omissions of the direct-entry midwife, any physician, nurse, certified midwife, prehospital emergency personnel, and health-care institution rendering subsequent care will be held only to a standard of gross negligence or willful and wanton conduct. (IV) (A) Until the liability insurance required pursuant to section 12-225-112 (2) is available, each direct-entry midwife shall, before accepting a client for care, provide the client with a disclosure statement indicating that the direct-entry midwife does not have liability insurance. To comply with this section, the direct-entry midwife shall ensure that the disclosure statement is printed in at least twelve-point bold-faced type and shall read the statement to the client in a language the client understands. Each client shall sign the disclosure statement acknowledging that the client understands the effect of its provisions. The direct-entry midwife shall also sign the disclosure statement and provide a copy of the signed disclosure statement to the client. (B) In addition to the information required in subsection (5)(a)(IV)(A) of this section, the direct-entry midwife shall include the following statement in the disclosure statement and shall display the statement prominently and deliver the statement orally to the client before the client signs the disclosure statement: "Signing this disclosure statement does not constitute a waiver of any right (insert client's name) has to seek damages or redress from the undersigned direct-entry midwife for any act of negligence or any injury (insert client's name) may sustain in the course of care administered by the undersigned direct-entry midwife." (b) As used in this subsection (5), "full disclosure" includes reading the informed consent form to the client, in a language understood by the client, and answering any relevant questions. (6) A direct-entry midwife shall prepare a plan, in the form and manner required by the director, for emergency situations. The plan must include procedures to be followed in situations in which the time required for transportation to the nearest facility capable of providing appropriate treatment exceeds limits established by the director by rule. A copy of the plan shall be given to each client as part of the informed consent required by subsection (5) of this section. (7) A direct-entry midwife shall prepare and transmit appropriate specimens for newborn screening in accordance with section 25-4-1004 and shall refer every newborn child for evaluation, within seven days after birth, to a licensed health-care provider with expertise in pediatric care. (8) A direct-entry midwife shall ensure that appropriate laboratory testing, as determined by the director, is completed for each client. (9) (a) A direct-entry midwife shall provide eye prophylactic therapy to all newborn children in the direct-entry midwife's care in accordance with section 25-4-301. n seven days after birth, to a licensed health-care provider with expertise in pediatric care. (8) A direct-entry midwife shall ensure that appropriate laboratory testing, as determined by the director, is completed for each client. (9) (a) A direct-entry midwife shall provide eye prophylactic therapy to all newborn children in the direct-entry midwife's care in accordance with section 25-4-301. (b) A direct-entry midwife shall inform the parents of all newborn children in the direct-entry midwife's care of the importance of critical congenital heart defect screening using pulse oximetry in accordance with section 25-4-1004.3. If a direct-entry midwife is not properly trained in the use of pulse oximetry or does not have the use of or own a pulse oximeter, the direct-entry midwife shall refer the parents to a health-care provider who can perform the screening. If a direct-entry midwife is properly trained in the use of pulse oximetry and has the use of or owns a pulse oximeter, the direct-entry midwife shall perform the critical congenital heart defect screening on newborn children in the direct-entry midwife's care in accordance with section 25-4-1004.3. (10) A direct-entry midwife shall be knowledgeable and skilled in aseptic procedures and the use of universal precautions and shall use them with every client. (11) To assure that proper risk assessment is completed and that clients who are inappropriate for direct-entry midwifery are referred to other health-care providers, the director shall establish, by rule, a risk assessment procedure to be followed by a direct-entry midwife for each client and standards for appropriate referral. The assessment shall be a part of each client's record as required in subsection (5)(a)(II) of this section. (12) Repealed. (13) A registered direct-entry midwife may purchase, possess, carry, and administer oxygen. The department shall promulgate rules concerning minimum training requirements for direct-entry midwives with respect to the safe administration of oxygen. Each registrant shall complete the minimum training requirements and submit proof of having completed the requirements to the director before administering oxygen to any client. (14) A registrant shall not practice beyond the scope of the registrant's education and training.

C.R.S. § 12-225-107 Limited use of certain medications - limited use of sutures - limited administration of intravenous fluids - emergency medical procedures - rules

12-225-107. Limited use of certain medications - limited use of sutures - limited administration of intravenous fluids - emergency medical procedures - rules. (1) A registrant may obtain prescription medications to treat conditions specified in this section from a registered prescription drug outlet, registered manufacturer, or registered wholesaler. An entity that provides a prescription medication to a registrant in accordance with this section, and who relies in good faith upon the registration information provided by the registrant, is not subject to liability for providing the medication. (2) Except as otherwise provided in subsection (3) of this section, a registrant may obtain and administer: (a) Vitamin K to newborns by intramuscular injection; (b) Rho(D) immune globulin to Rh-negative mothers by intramuscular injection; (c) Postpartum antihemorrhagic drugs to mothers; (d) Eye prophylaxis; (e) Local anesthetics, as specified by the director by rule, to use in accordance with subsection (6) of this section; and (f) Group B streptococcus (GBS) prophylaxis, subject to the limitations in subsection (7) of this section. (3) (a) If a client refuses a medication listed in subsection (2)(a) or (2)(b) of this section, the registrant shall provide the client with an informed consent form containing a detailed statement of the benefits of the medication and the risks of refusal, and shall retain a copy of the form acknowledged and signed by the client. (b) If a client experiences uncontrollable postpartum hemorrhage and refuses treatment with antihemorrhagic drugs, the registrant shall immediately initiate the transportation of the client in accordance with the emergency plan. (4) A registrant shall, as part of the emergency medical plan required by section 12-225-106 (6), inform the client that: (a) If she experiences uncontrollable postpartum hemorrhage, the registrant is required by Colorado law to initiate emergency medical treatment, which may include the administration of an antihemorrhagic drug by the registrant to mitigate the postpartum hemorrhaging while initiating the immediate transportation of the client in accordance with the emergency plan. (b) If she experiences postpartum hemorrhage, the registrant is prepared and equipped to administer intravenous fluids to restore volume lost due to excessive bleeding. (5) The director shall promulgate rules to implement this section. In promulgating the rules, the director shall seek the advice of knowledgeable medical professionals to set standards for education, training, and administration that reflect current generally accepted professional standards for the safe and effective use of the medications, methods of administration, and procedures described in this section, including a requirement that, to administer intravenous fluids, the registrant complete an intravenous therapy course or program approved by the director. The director shall establish a preferred drug list that displays the medications that a registrant can obtain. (6) (a) Subject to subsection (6)(b) of this section, a registrant may perform sutures of first-degree and second-degree perineal tears, as defined by the director by rule, on a client and may administer local anesthetics to the client in connection with suturing perineal tears. irector. The director shall establish a preferred drug list that displays the medications that a registrant can obtain. (6) (a) Subject to subsection (6)(b) of this section, a registrant may perform sutures of first-degree and second-degree perineal tears, as defined by the director by rule, on a client and may administer local anesthetics to the client in connection with suturing perineal tears. (b) In order to perform sutures of first-degree and second-degree perineal tears, the registrant shall apply to the director, in the form and manner required by the director, and pay any application fee the director may impose, for an authorization to perform sutures of first-degree and second-degree perineal tears. As part of the application, the registrant shall demonstrate to the director that the registrant has received education and training approved by the director on suturing of perineal tears within the year immediately preceding the date of the application or within such other time the director, by rule, determines to be appropriate. The director may grant the authorization to the registrant only if the registrant has complied with the education and training requirement specified in this subsection (6)(b). (7) A registered direct-entry midwife who was initially registered prior to January 1, 2000, must apply to the director and pay any applicable fees before obtaining or administering group B streptococcus (GBS) prophylaxis as part of the registrant's practice of direct-entry midwifery. The director shall verify the qualifications of a registrant applying pursuant to this subsection (7) before granting the registrant the authority to obtain and administer group B streptococcus (GBS) prophylaxis. (8) A registrant who is granted authority to act pursuant to this section is not required to apply for renewal of the authority or pay any renewal fees pertaining to the authority granted in this section.

C.R.S. § 12-225-108 Director - powers and duties - rules

12-225-108. Director - powers and duties - rules. (1) In addition to any other powers and duties conferred on the director by law, the director has the following powers and duties: (a) To adopt rules pursuant to section 12-20-204; (b) To establish the fees for registration and renewal of registration in the manner authorized by section 12-20-105; (c) To prepare or adopt suitable education standards for applicants and to adopt a registration examination; (d) To accept applications for registration that meet the requirements set forth in this article 225, and to collect the annual registration fees authorized by this article 225; (e) To seek an injunction in accordance with section 12-20-406 to enjoin any person from committing an act prohibited by this article 225; (f) To summarily suspend a registration upon the failure of the registrant to comply with any condition of a stipulation or order imposed by the director until the registrant complies with the condition, unless compliance is beyond the control of the registrant; (g) To develop policies and protocols, by rule, for direct-entry midwives in training that reflect the requirements of the North American Registry of Midwives, or its successor organization; (h) To order the physical or mental examination of a direct-entry midwife if the director has reasonable cause to believe that the direct-entry midwife is subject to a physical or mental disability that renders the direct-entry midwife unable to treat patients with reasonable skill and safety or that may endanger a patient's health or safety. The director may order a physical or mental examination regardless of whether there is injury to a patient.

C.R.S. § 12-225-109 Disciplinary action authorized - grounds for discipline - injunctions - rules

12-225-109. Disciplinary action authorized - grounds for discipline - injunctions - rules. (1) If a direct-entry midwife has violated any of the provisions of section 12-225-104, 12-225-105, 12-225-106, or 12-225-112 (2), the director may take disciplinary or other action as authorized by section 12-20-404 or seek an injunction against a direct-entry midwife in accordance with section 12-20-406 to enjoin the direct-entry midwife from practicing midwifery or committing a violation specified in this subsection (1). (2) (a) The director may assess a civil penalty in the form of a fine, not to exceed five thousand dollars, for violation of a rule or order of the director or any other act or omission prohibited by this article 225. (b) The director shall adopt rules establishing a fine structure and the circumstances under which fines may be imposed. (3) The director may take disciplinary action as authorized by section 12-20-404 (1)(a), (1)(b), or (1)(d) for any of the following acts or omissions: (a) Any violation of section 12-225-104, 12-225-105, 12-225-106, or 12-225-112 (2) or an applicable provision of article 20 or 30 of this title 12; (b) Failing to provide any information required pursuant to, or to pay any fee assessed in accordance with, section 12-225-104 or providing false, deceptive, or misleading information to the division that the direct-entry midwife knew or should reasonably have known was false, deceptive, or misleading; (c) Failing to respond in an honest, materially responsive, and timely manner to a letter of complaint from the director; (d) Failing to comply with an order of the director, including an order placing conditions or restrictions on the registrant's practice; (e) Engaging in any act or omission that does not meet generally accepted standards of safe care for women and infants, whether or not actual injury to a client is established; (f) Abuse or habitual or excessive use of a habit-forming drug, a controlled substance as defined in section 18-18-102 (5), or alcohol; (g) Procuring or attempting to procure a registration in this or any other state or jurisdiction by fraud, deceit, misrepresentation, misleading omission, or material misstatement of fact; (h) Having had a license or registration to practice direct-entry midwifery or any other health-care profession or occupation suspended or revoked in any jurisdiction; (i) Violating any law or regulation governing the practice of direct-entry midwifery in another state or jurisdiction. A plea of nolo contendere or its equivalent accepted by any state agency of another state or jurisdiction may be considered to be the same as a finding of violation for purposes of a proceeding under this article 225. (j) Falsifying, failing to make essential entries in, or in a negligent manner making incorrect entries in client records; (k) Conviction of a felony or acceptance by a court of a plea of guilty or nolo contendere to a felony. A certified copy of the judgment of a court of competent jurisdiction of a conviction or plea shall be prima facie evidence of the conviction. (l) Aiding or knowingly permitting any person to violate any provision of this article 225 or an applicable provision of article 20 or 30 of this title 12; (m) Advertising through newspapers, magazines, circulars, direct mail, directories, radio, television, website, e-mail, text message, or otherwise that the registrant will perform any act prohibited by this article 225; or of the conviction. (l) Aiding or knowingly permitting any person to violate any provision of this article 225 or an applicable provision of article 20 or 30 of this title 12; (m) Advertising through newspapers, magazines, circulars, direct mail, directories, radio, television, website, e-mail, text message, or otherwise that the registrant will perform any act prohibited by this article 225; or (n) (I) Failing to notify the director, as required by section 12-30-108 (1), of a physical illness, physical condition, or behavioral, mental health, or substance use disorder that renders the registrant unable, or limits the registrant's ability, to practice direct-entry midwifery with reasonable skill and safety to the client; (II) Failing to act within the limitations created by a physical illness, physical condition, or behavioral, mental health, or substance use disorder that renders the registrant unable to practice direct-entry midwifery with reasonable skill and safety or that may endanger the health or safety of persons under the registrant's care; or (III) Failing to comply with the limitations agreed to under a confidential agreement entered pursuant to sections 12-30-108 and 12-225-111. (4) Any proceeding to deny, suspend, or revoke a registration or place a registrant on probation shall be conducted pursuant to sections 12-20-403, 24-4-104, and 24-4-105. Section 12-20-408 governs judicial review of any final decision of the director. (5) The director may accept as prima facie evidence of grounds for disciplinary action any disciplinary action taken against a registrant by another jurisdiction if the violation that prompted the disciplinary action would be grounds for disciplinary action under this article 225. (6) The person providing copies of records subpoenaed pursuant to section 12-20-403 (2) shall prepare the copies from the original record and shall delete the name of the patient or client, to be retained by the custodian of the records from which the copies were made, but shall identify the patient or client by a numbered code. Upon certification by the custodian that the copies are true and complete except for the patient's or client's name, the copies shall be deemed authentic, subject to the right to inspect the originals for the limited purpose of ascertaining the accuracy of the copies. No privilege of confidentiality exists with respect to the copies and no liability lies against the director or the custodian or the director's or custodian's authorized employees for furnishing or using the copies in accordance with this section. (7) The director may issue and send a letter of admonition to a registrant under the circumstances specified in and in accordance with section 12-20-404 (4). (8) The director may send a confidential letter of concern to a registrant under the circumstances specified in section 12-20-404 (5). (9) The director may issue cease-and-desist orders under the circumstances and in accordance with the procedures specified in section 12-20-405.

C.R.S. § 12-225-110 Unauthorized practice - penalties

12-225-110. Unauthorized practice - penalties. Any person who practices or offers or attempts to practice direct-entry midwifery without an active registration issued under this article 225 is subject to penalties pursuant to section 12-20-407 (1)(a).

C.R.S. § 12-225-111 Confidential agreement to limit practice

12-225-111. Confidential agreement to limit practice. Section 12-30-108 concerning confidential agreements to limit practice applies to this article 225.

C.R.S. § 12-225-112 Assumption of risk - no vicarious liability - professional liability insurance required

12-225-112. Assumption of risk - no vicarious liability - professional liability insurance required. (1) It is the policy of this state that registrants are liable for their acts or omissions in the performance of the services that they provide, and that no licensed physician, nurse, certified midwife, prehospital emergency medical personnel, or health-care institution is liable for any act or omission resulting from the administration of services by any registrant. This subsection (1) does not relieve any physician, nurse, certified midwife, prehospital emergency personnel, or health-care institution from liability for any willful and wanton act or omission or any act or omission constituting gross negligence, or under circumstances where a registrant has a business or supervised relationship with the physician, nurse, certified midwife, prehospital emergency personnel, or health-care institution. A physician, nurse, certified midwife, prehospital emergency personnel, or health-care institution may provide consultation or education to the registrant without establishing a business or supervisory relationship, and is encouraged to accept referrals from registrants pursuant to this article 225. (2) If the director finds that liability insurance is available at an affordable price, registrants shall be required to carry liability insurance.

C.R.S. § 12-225-113 Confidential files

12-225-113. Confidential files. The director may keep confidential all files and information concerning an investigation authorized under this article 225 until the results of the investigation are provided to the director and either the complaint is dismissed or notice of hearing and charges are served upon the person subject to the investigation.

C.R.S. § 12-225-114 Repeal of article - subject to review

12-225-114. Repeal of article - subject to review. This article 225 is repealed, effective September 1, 2028. Before the repeal, the registering of direct-entry midwives by the division is scheduled for review in accordance with section 24-34-104.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-12.docxFetched: 10/6/2026

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