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<regulation prefix="Regulation" num=".02" citation="COMAR 10.64.02.02" title_num="10" subtitle_num="64" chapter_num="02" heading="Ethical Responsibilities.">
  <paragraph num="A.">
    <text>A licensed direct-entry midwife shall:</text>
    <paragraph num="(1)">
      <text>Provide services with respect for human dignity and the uniqueness of a client unrestricted by consideration of social or economic status, religious affiliation, personal attributes, or the nature of health problems;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Safeguard a client's right to privacy by maintaining confidentiality of information;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Act to safeguard a client and the public if health care and safety are affected by the incompetent, unethical, or illegal practice of any individual;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Promptly report a breach of confidentiality or privacy;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Assume responsibility and accountability for one’s judgments and actions while providing direct-entry midwifery services;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Maintain competence in direct-entry midwifery;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Exercise informed judgment and use individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating direct-entry midwifery activities to others;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Inform the Board regarding unethical conduct by another licensed direct-entry midwife;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Provide information about fees upon request by a client;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Notify the Board in writing within 30 days if any license, certificate, permit, or registration granted by another state or territory for the practice of direct-entry midwifery or certified professional midwifery is restricted, suspended, revoked, or subjected to other disciplinary action by a licensing or certifying authority; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Make a client’s record available to the client upon request, complying with all applicable State and federal laws and regulations governing disclosure of medical records.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A licensed direct-entry midwife may not, when acting in the capacity or identity of a licensed direct-entry midwife:</text>
    <paragraph num="(1)">
      <text>Knowingly participate in or condone dishonesty, fraud, deceit, or misrepresentation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Engage or participate in an action that violates or diminishes the civil or legal rights of a client;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Perform new techniques and procedures without adequate education and practice;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Assume duties and responsibilities in the practice of direct-entry midwifery without adequate preparation or without maintaining competency;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Practice direct-entry midwifery if unfit to perform procedures or make decisions because of a physical or mental impairment including, but not limited to, a substance use disorder or the effects of prescription drugs;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>If engaged in research, coerce or pressure a subject to participate or continue to participate in the research;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Knowingly or willfully destroy, damage, alter, obliterate, or otherwise obscure a medical record or billing record or other information about a client to conceal the information from use as evidence in an administrative, civil, or criminal proceeding; or</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Abandon a client.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A licensed direct-entry midwife may not engage in behavior that dishonors the profession, whether or not acting in the capacity or identity of a licensed direct-entry midwife, including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Verbal abuse, including use of racial or ethnic slurs, directed toward a client, client 's family member, coworker, employer, Board staff member, or third party;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Physically abusing, threatening, or intimidating a client, client’s family member, coworker, employer, Board staff member, or third party;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Deceiving, defrauding, or stealing from a client, client’s family member, coworker, employer, or third party;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Diverting any medication or providing false or misleading information to an authorized prescriber or a pharmacist to obtain or attempt to obtain any medication;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Performing acts beyond the authorized scope of practice for which the individual is licensed;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Obtaining or copying any part of a client’s health record for purposes other than:</text>
      <paragraph num="(a)">
        <text>Providing health care to the client;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Conducting quality improvement activities;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Complying with legal requirements such as a subpoena; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Allowing a direct-entry midwifery student to use records for educational purposes if client identification has been redacted or disguised;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Using, possessing, supplying, administering, or attempting to use, possess, supply, or administer prescription drugs or controlled dangerous substances without valid medical indication;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Reporting to work under the influence of alcohol or a controlled dangerous substance or submitting a pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all controlled dangerous substances in the sample;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Reporting to work under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Using the power, influence, or knowledge inherent in or obtained during the direct-entry midwife-client relationship for the direct-entry midwife's personal gratification or benefit;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Engaging in unprofessional or immoral conduct;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Misrepresenting or concealing a material fact in obtaining a license, renewing a license, or reinstating a license; or</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A licensed direct-entry midwife may not engage in sexual misconduct. Sexual misconduct includes, but is not limited to:</text>
    <paragraph num="(1)">
      <text>Sexual behavior with a client in the context of a professional evaluation, treatment, procedure, or service to the client, regardless of the setting in which the professional service is rendered;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Sexual behavior with a client under the pretext of diagnostic or therapeutic intent or benefit;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Solicitation of a sexual relationship, whether consensual or nonconsensual, with a client;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Sexual advances toward, or the request of sexual favors from, a coworker, student, employer, client, or client's family member;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Discussion of nontherapeutic sexual matters while treating a client;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Taking photographs of a client for a sexual purpose;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Sexual harassment of a coworker, student, employer, client, or client's family member;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Sexual contact with an incompetent or unconscious client;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Intentionally exposing any of the direct-entry midwife's sexual body parts; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Intentionally exposing any of the client's sexual body parts for a nontherapeutic purpose.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Electronic devices, including but not limited to telephones, may not be used to record medical records or take pictures or videos of clients for purposes not directly related to client care without written client authorization.</text>
  </paragraph>
  <paragraph num="F.">
    <text>A licensed direct-entry midwife:</text>
    <paragraph num="(1)">
      <text>May not make use of electronic devices and social media to transmit or place any client information online for public viewing without written client authorization; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall adhere to the following principles for the use of electronic devices and social media:</text>
      <paragraph num="(a)">
        <text>Every licensed direct-entry midwife has an obligation to understand the nature, benefits, and consequences of the use of electronic devices and participating in social media networking;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Licensed direct-entry midwives are bound to observe ethically prescribed direct-entry midwife-client boundaries online as in any other setting;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Client information in electronic format shall be maintained in secured files;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A licensed direct-entry midwife has an obligation to report any electronically generated material that could harm a client's privacy rights; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The standards of professionalism are the same when using electronic devices and social media as in any other circumstance.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>