JCARR Hears Testimony on Nursing Board Doula Rules, Continued Opposition to DEW Gifted Rule
The chair Ohio’s state-convened Doula Advisory Group pushed
back Monday on Ohio Board of Nursing rules that interpret HB101’s (Bird) near-unanimous
provisions signed in January and effective since only April. Chairwoman Marie
McCausland told the Joint Committee on Agency Rule Review (JCARR) that agency- versus
state-certified doulas under Rule 4723-24 could be left out of the workforce and
are getting little help from the nursing board at a critical time for
Medicaid-funded maternity care.
JCARR Director Ian Dollenmayer announced Friday that he was
expecting McCausland, a certified post-partum doula and certified lactation consultant,
for oral testimony. Noting several committee members had co-sponsored or voted
for the multi-subject bill and/or standalone predecessors, she cited the
following language in newly approved Ohio Administrative Code 4723-24-01(D):
“‘Certified doula’ means an individual who holds a
certificate to practice issued or renewed by the board under section 4723.89 of
the Revised Code.”
She said the definition would appear to exclude doulas
licensed with certifying agencies including Doulas of North America (DONA) and
Childbirth and Postpartum Professional Association (CAPPA), even though the
nursing board apparently recognizes the validity of agency-certified doulas by
listing the advisory group’s five members -- none state-certified -- as
“certified doulas,” McCausland observed.
“I have asked if there is a recommendation by the Board of
Nursing for what agency-certified doulas should call themselves post Oct. 3,
and we have been told there is no recommendation,” she said, citing R.C.
Section 4723.89(B): “Beginning on Oct. 3, 2024, a person shall not use or
assume the title ‘certified doula’ unless the person holds a certificate issued
under this section by the Board of Nursing.”
At the same time, said McCausland, nursing board staff told
the advisory group last week that the board “doesn’t plan to actually protect
this title … and sanction individuals” beginning in October.
Adding to the confusion, the advisory group has learned that
legal counsel to the board will ask members to dispatch their legislative
liaison to push for a statutory fix. Putting her concerns into context, she
said Ohio will need around 3,000 doulas for Medicaid recipients and likely must
grow its workforce to do so.
“In Ohio, over 67,000 births were covered by Medicaid in
2020, which was approximately 53 percent of
Ohio births,” the advisory chair said. “If these rules go
into effect as written, I foresee continued loss of life, continued
cost-of-care burdens, and a loss in the doula workforce as agency-certified
doulas leave the state to avoid fines for representing themselves as ‘certified
doulas.’”
In sum, she called for the following amendment to Rule
4723-24-01(D):
“‘Certified Doula’ means an individual who holds a
certificate to practice issued or renewed by the board under section 4723.89 of
the Revised Code, not to be confused with the agency certifications provided
by a doula certification organization.”
Citing a second concern, she said disciplinary powers in
O.A.C. 4723-24-07 comprise the largest section of doula rules even though they
weren’t addressed by HB101.
“Much of the public comment regarded the disciplinary
section and folks were especially concerned with the potential for racial bias
given the need for culturally competent doulas to address the disparities for
Black mothers in maternal mortality and infant mortality and [who] would be
disciplined by the Board of Nursing, which currently has zero Black individuals,”
said McCausland.
“Doulas are rightfully concerned, and the Board of Nursing
is neither addressing these comments in changes to the rules or even in public
meetings where they could assuage these concerns with commitments to addressing
any potential bias, having doulas part of the disciplinary process, or even
committing to adhere to the same standards of racial bias training being
requested of our doulas in the state,” she concluded.
Speaking for the committee, Rep. Jamie Callender (R-Concord)
noted that JCARR cannot address statutory scruples, though he said members’
nodding heads during her remarks demonstrated their sentiments.
“We are limited to the law as it is, not as we wish it were,”
he said. “We appreciate your effort. It was not in vain. We have a grasp of
what the issue is, and we do not disagree with the concerns you have.”
JCARR also received written-only testimony from Executive
Director Abbie Sigmon of the Ohio Association for Gifted Children (OAGC). She reprised
her concerns with Ohio Department of Education and Workforce (DEW) Rule
3301-51-15 from the committee’s July meeting, after which Ohio Administrative
Code language was refiled. (See The Hannah Report, 7/22/24.)
“There are 225,000 identified gifted students in Ohio [but]
fewer than 940 gifted intervention specialists (GIS) and fewer than 1,150
gifted staff -- including educational service center (ESC) staff,” said Sigmon,
a workforce she called “deeply unsatisfactory” and a contributor to “daily
burnout, struggles and exhaustion.”
She said the refiled rule of Aug. 21 removed professional
development hours for general education teachers backed by OAGC and the Ohio
Education Association (OEA).
“Even with the support of both of those associations, DEW
replaced that language, citing a desire to remain less authoritative. This is a
frustrating step backwards in ensuring gifted students are recognized,
differentiated, and taught according to their needs,” said Sigmon.
In addition, she said OAGC continues to oppose removal of corrective
plans following a state audit that were included in the original draft rule. She
said parents and others should be allowed to file gifted education complaints
and ask DEW to investigate alleged violations of R.C. 3324 or Rule 3301-51-15.
Districts could then respond to allegations, and the department could proceed
with any corrective action, she said.
At the same time, Sigmon thanked DEW for amending the rule
with “letters of no services,” which she also addressed in July.
“Ohio mandates the identification of gifted students, but
the service of gifted students is not mandated,” she observed. “No services
letters are a powerful tool that would provide parents and guardians of gifted
children ongoing updates on gifted services.”
Sigmon thanked Rep. Mike Skindell (D-Lakewood) for standing
up for parents and guardians of gifted students. He responded by thanking DEW
and OAGC and said the General Assembly will need to address her concerns.
McCausland and Sigmon’s testimony can be found at www.hannah.com>Important
Documents and Notices>Library.