As I study the latest Louisiana midwifery rules and regulations, for the test which will satisfy the third sanction that the LSBME has bestowed upon me i.e. “Ms. Macaluso shall demonstrate her understanding of the Board’s rules and regulations regarding Midwife practice in this state, in a manner determined by the Board,” I wonder how in the world did these updated rules get promulgated?
Read rules here:
https://www.lsbme.la.gov/sites/default/files/documents/Rules/Individual%20Rules/Midwife%20Dec%202016.pdf
*side note, I wanted to demonstrate my understanding of the Board’s rules in either an interpretive dance or a book report, but apparently those suggestions were shot down in favor of a boring test. The Board obviously lacks humor. LOL But seeing that the LSBME has spent tens of thousands of dollars on computer software and equipment in the past few years, its not surprising that they want to use that technology. Oh, wait…I am still waiting for my test “to be put online” according to my compliance officer. That was in October. They must’ve been taken advantage of if they paid that much and can’t email a test to me or put it online, but that is a whole other post.
Back to the rules….Is anyone paying attention? Did anyone read these new rules? They are that insane. There are so many examples, but I’ll start with the one in Chapter 23 under statute 2315 (Effect of Application) B. By submission of an application for licensing to the board, an applicant shall be deemed to have given his or her consent to submit to physical or mental examinations if, when and in the manner so directed by the board and to waive all objections as to the admissibility or disclosure of findings, reports, or recommendations pertaining thereto on the grounds of privileges provided by law. The expense of any such examination shall be borne by the applicant.
Let me tell you what that says in plain English: THE LSBME CAN REQUIRE MIDWIFE APPLICANTS TO HAVE A MENTAL AND PHYSICAL EXAM AND THE APPLICANT HAS TO PAY FOR THE EXAM. HOLY BLEEP!
The LSBME is calling midwife applicants crazy! While I have to admit I felt this whole witch hunt has been nothing short of crazy since the beginning, I never imagined these unbelievable rules would grow out of the Board’s unbridled lack of oversight. It is like a runaway train with no stop in sight. So one has to ask oneself—self, why would the Board institute such a rule? A rule which will undoubtedly frighten potential midwifery applicants, especially ones with any preexisting conditions. I mean, the Board does not describe what it will do with that information, so how will applicants know if their heart murmur or Hashimotos or depression will affect their application process? How does this rule not discriminate against applicants with preexisting conditions? How is this not antitrust? This seems like a rule ripe with restrictive capabilities to practice ones trade. And as someone who has been denied a license in another state, let me tell you how hard that makes getting a job or other licenses (again, another post). So, potential applicants will think they are going to start this new profession as a midwife in Louisiana, take all the classes, do all the training, take all the tests, pay the application fees, pay for a mental evaluation and may still get denied? Yes, yes, I know its a privilege to have a license, but this is ridiculous. Not only will it scare away potential applicants, but why would I want the medical board to have my medical records? That is invasive and wrong. And do you think the Board won’t implement that rule? hahahahahahahahahahahahahahahahahahahahahahahahahahahahaahahYes, yes they will use it. How do I know this? Oh, because my first sanction is ordering me to get a mental/physical evaluation. No big deal right? Seems legit as they should make sure healthcare providers are relatively sane and healthy enough to do their jobs, but there is a catch. There is always a catch. Do you think they will allow you to go to just any doctor for this evaluation? I highly doubt it. Why am I so skeptical you say? Oh, it might stem from the fact that I have to go to a “physician or group of physicians who have been pre-approved in writing by the Board and be deemed competent to resume the practice of midwifery.” Ms. Mouton, the ex-executive director of the cartel, err I mean LSBME, so graciously offered me a list of five drug and alcohol rehabs to choose from to get my evaluation, but Ms. Mouton apparently does not know that a person cannot just go get an evaluation for no reason. The rehabs will not evaluate someone without a demonstrable problem. I know that seems obvious right? Not for the corrupt medical board as they don’t care about doing anything legal. Physician Health Programs (PHP) (like the drug and alcohol facilities list provided by Ms. Mouton) and medical boards make strange bedfellows until you realize they are both benefiting. The medical boards provide a steady stream of victims, err customers, err patients at the tune of $5-10,000 and four days of your life followed by “recommendations” for treatment which might mean several tens of thousands of dollars and months spent in a facility for absolutely no reason at all. There are many reports of the corruption surrounding PHPs and licensing boards. It was not until the admissions counselor at PineGrove in Mississippi reached out to my compliance officer that suddenly I was a perfect candidate for an extensive psych evaluation, even though after previously reading my court documents she had stated that I needed something their facility couldn’t provide. Sounds fishy because it is!
It is interesting to note that the LSBME has included this rule into most of the healthcare professions it oversees. So, doctors could be subject to this requirement of having an evaluation too. However, I could not find the rule associated with clinical laboratory personnel, acupuncturists, and X-ray techs. See list of professions below:
In a letter to the British Medical Journal, Dr. Manion states: “A compulsory forensic psychiatric evaluation of a physician is, by all understandings, a form of involuntary mental commitment whose unlawful use is banned by the Fourth Amendment to the US Constitution prohibiting unlawful search and seizure by a government agency. Without rigorous oversight, a PHP can get away with utilizing what one court euphemistically referenced as “relaxed diagnostic criteria.” The extreme danger of crafting one’s own illness criteria sets, not to mention – especially in the context of refusal of provision of their report – falsely adding non-existent symptoms to embellish a case history to support a diagnosis and achieve desired outcomes (e.g. to appear to justify costly referral to a PHP preferred program), ought to alarm every physician.” https://www.bmj.com/content/353/bmj.i3568/rapid-responses
When Ms. Mouton was taken off her thrown at the LSBME and Dr. Cresswell stepped into her small stilettos, he, not surprisingly said, well of course you do not have to go to a drug and alcohol center as there is no basis for it in your case. Yeah, no shit. Dr. Cresswell suggested I find a doctor in my neck of the woods to conduct the evaluation. So, just go find a physician, right? There are 17,000 of them in Louisiana according to the 2018 census from the National Federation of Medical Boards. http://www.fsmb.org/advocacy/news-releases/fsmb-releases-2018-u.s.-medical-regulatory-trends-and-actions-report/
Well, it seems that in order to call a doctor and ask if you can have an evaluation by said doctor, one must have a diagnosis or something that needs testing. Ok, so ask the Board what they want tested. Go ahead. Ask. Oh, they won’t tell you what you need to have tested? Shocking. It is so shocking that the Board would create a sanction that is illegal. There is no legal basis for me to get a mental/physical evaluation. In fact, they will have to make something up in order for me to ethically have a mental evaluation. Yes, they will have to lie or the could remove that sanction as it really is not legal. But no, instead of looking like the incompetent fools they are, the Board would rather tell me to go find a doctor, then I am supposed to tell the doctor to call the board and ask what needs to be tested. UHHHHH. That is so shady.
I have been waiting and asking repeatedly for over a year to have the LSBME tell me what needs to be mentally evaluated as I cannot go get this sanction accomplished without more information or lies, whatever is considered ethical to the LSBME. The LSBME has caused me great stress and prohibited me from working. Oh, and let’s not forget, because I cannot get a job because my suspension comes up in a background check, I cannot afford health insurance to get my cancer removed. I will continue to wait patiently and suffer knowing that my cancer may be spreading and affecting my health.
The Board is purposefully obstructing justice. I believe that is called maleficence, but I am not an attorney. Is it truly that shocking that the Board would obstruct justice like this? No. The LSBME continues to violate ethics, harm midwifery by placing burdensome and egregious requirements on its applicants, which will undoubtedly limit choices for consumers in the state of Louisiana and continue its disgusting deathcare spiral killing mothers along the way. Killing mothers, you say? Isn’t that a little harsh? No, no it isn’t. There is a maternity crisis in Louisiana and throughout the US. https://adams.house.gov/media-center/press-releases/congresswoman-adams-introduces-bill-address-maternal-mortality-racial
We do not have enough providers to give safe and effective maternity care. The South lags behind the rest of the country in maternal mortality especially for women of color. In fact, women of color in Louisiana are dying at a rate of 73/100,000 compared to 27/100,000 of white women. HOLY BLEEP. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/LA
Read that again– for every one white woman who dies in Louisiana almost three black women die. UHHHHHH. Something tells me doctors and hospitals are doing something wrong, very wrong. How do you know its doctors providing bad care? Because there are 17,000 of them in Louisiana compared to the 20 midwives practicing and licensed midwives do not work in hospitals. Doctors are killing women, not midwives. The LSBME needs to focus its investigations inward to truly achieve its mission statement of protecting the citizens of Louisiana. https://www.cnn.com/videos/health/2017/11/13/mother-birth-america-louisiana-orig.cnn
The limiting of safe out of hospital providers by the competition needs to end. We need to be making more midwives not less. According to one study, Louisiana ranks as the worst place to have a baby because hospitals are not following safety measures. “The report also breaks down a state-by-state ranking of maternal harms and deaths. In Louisiana, the state with the highest maternal death rate, there were 58.1 deaths per 100,000 births over the course of the study period from 2012 to 2016.” https://www.cbsnews.com/news/best-and-worst-states-to-give-birth-usa-today-investigation/
Tell me again how out of hospital midwives are incompetent and dangerous. I’ll wait. Oh, you have no statistics to back up that claim? It is because midwives are beyond safe. We provide one-on-one care and are able to assess women constantly because of our philosophy and model of care. Sure it takes time and is cost prohibitive for the provider, but cost effective for insurance companies and Medicaid, and you know what–our women and babies are alive, happy, and grateful at the end of the day. And you know what is better than money—safety, lives, and an investment in future generations. If healthcare providers got into the healthcare field to help make a positive change in lives then it would be seem intuitive to promote midwives on the basis of evidence-based care alone. https://mana.org/blog/home-birth-safety-outcomes
The LSBME needs to follow the spirit of the law in order to rehabilitate its licensees and promote the welfare and health of its citizens by encouraging more midwives, if that is truly its intentions, and not harass, extort, and financially drain them out of existence. No one should be above the law especially a board who creates the very laws they are violating. And it would behoove them to adopt some ethics while they are at it.
My Journey as a Licensed Midwife in Louisiana 