House of Representatives
Office of Program Research
Health Care & Wellness Committee
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.
Brief Description: Concerning maternal mortality reviews.
Sponsors: Representatives Macri, Harris, Robinson, Graham, Riccelli, Stonier, Jinkins, Appleton, Cody, Reeves, Pollet, Leavitt, Ormsby and Ortiz-Self; by request of Department of Health.
Hearing Date: 2/1/19
Staff: Kim Weidenaar (786-7120).
Maternal Mortality Review Panel.
In 2016 the Maternal Mortality Review Panel (Panel) was established to conduct comprehensive, multidisciplinary reviews of maternal deaths in Washington, identify factors associated with these deaths, and make recommendations for system changes to improve health care services for women. The terms "maternal mortality" and "maternal death" mean the death of a woman while pregnant or within one year following delivery or the end of a pregnancy, whether or not the death is related to or aggravated by the pregnancy.
The Panel is appointed by the Secretary of Health (Secretary) and may include an obstetrician, a physician specializing in maternal fetal medicine, a neonatologist, a licensed midwife, a Department of Health (Department) representative who works in the field of maternal and child health, a Department epidemiologist with experience analyzing prenatal data, a pathologist, and a representative of community mental health centers. The Panel and Secretary may retain identifiable data regarding facilities where maternal deaths occur or from where the patient was transferred and geographic data on each case for the sole purposes of trending and analysis over time. The Department must review available data to identify maternal deaths. The Department may access additional data to assist in determining whether a maternal death was related to or aggravated by the pregnancy and whether the maternal death was preventable. The additional data include information related to specific maternal deaths such as medical records, autopsy reports, medical examiner reports, coroner reports, and social services records and information from health care providers, health care facilities, clinics, laboratories, and medical examiners, coroners, health professions and facilities, local health jurisdictions, the Health Care Authority and its licensees and providers, and the Department of Social and Health Services and its licensees and providers.
The Panel must submit biennial reports to the Secretary and legislative health care committees beginning July 1, 2017. The reports must include a description of the maternal deaths reviewed by the panel in the prior two years, including aggregated statistics and causes, and evidence-based system changes and possible legislation to improve maternal outcomes and reduce preventable deaths in Washington. The report must be distributed to relevant stakeholder groups for performance improvement. Persons who attend panel meetings or prepare materials for the Panel may not testify in civil or criminal actions about the panel's proceedings or information, documents, records, or opinions, unless the testimony relates to their personal knowledge acquired independently of the panel. Panel members and persons providing information to the panel are immune from civil damages.
Information, documents, proceedings, records, and opinions related to the panel are confidential and exempt from public inspection and copying. Such materials are also exempt from discovery or introduction into evidence in civil or criminal actions.
Generally the cost of an autopsy is borne by the county in which the autopsy is performed. However, there are instances in which some costs may be reimbursed by the death investigations account or by the Department of Labor and Industries (L&I) when an autopsy was requested by the L&I.
Summary of Bill:
The Maternal Mortality Review Panel (Panel) must include at least one tribal representative, and may include at the discretion of the Department of Health (Department): Women's medical, nursing, and service providers' perinatal medical, nursing, and service providers; obstetric medical, nursing, and service providers; newborn or pediatric medical, nursing, and service providers; birthing hospital or licensed birth center representative; coroners, medical examiners, or pathologists; behavioral health or service providers; state agency representatives; community representatives; in addition to the representative from the Department who works in maternal and child health and a Department epidemiologist with experience analyzing perinatal data.
"Maternal mortality" or "maternal death" is defined as a death of a women while pregnant or within one year of the end of a pregnancy from any cause.
The Panel and the Department may retain identifiable information regarding facilities where maternal deaths occur, or facilities from which the patient was transferred, and geographic information on each case for the purposes of quality improvement efforts, in addition to determining trends and performing analysis over time.
The Department may access additional data related to maternal deaths for the purposes of coordinating quality improvement efforts in addition to determining whether a maternal death was related to or aggravated by a pregnancy or if it was preventable. The Department is authorized to also access data related to specific maternal deaths from the Department of Children, Youth, and Families and its licensees and providers.
The Panel must submit a report to the Secretary and legislative health care committees by October 1, 2019, and then every three years thereafter.
The Department may release data or findings with indirect identifiers to the Centers for Disease Control and Prevention, regional maternal mortality review efforts, local health jurisdictions of Washington, or other entities at the Department's discretion if provided through a signed written data-sharing agreement. The agreement must:
include a description of the proposed purpose of the request, the scientific justification, the type of data needed, and the purpose for which the data will be used;
include the methods to be used to protect the confidentiality and security of the data;
prohibit redisclosure of any identifiers unless there is express permission from the Department;
prohibit the recipient of the data from attempting to identify persons whose information is included in the data set;
state that ownership of data provided remains with the Department; and
require the recipient of the data to include appropriate citations when the data is used in research reports, publications, or findings.
The Department may deny a request for data or findings that do not meet these requirements.
Hospitals and license birth centers must make a reasonable and good faith effort to report within 36 hours of death, all deaths that occur during pregnancy or within 42 days of the end of pregnancy to the local coroner or medical examiner. Coroners or medical examiners notified of a maternal death must conduct a death investigation and an autopsy is strongly recommended. Autopsies performed must follow the Department's guidelines for performance of an autopsy and must be reimbursed at 100 percent to the counties for autopsy services.
The authority to disclose mental health information and records without an authorization is amended to include the Secretary of Health for purposes of the panel.
The provision expiring the panel on June 30, 2020, is repealed.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.