New Jersey needs a panel of experts with subpoena power to provide additional scrutiny of pregnancy-related deaths and to help healthcare providers identify the most effective strategies for improving maternal care.
That’s the position of two Democratic state senators who have introduced legislation to create a Maternal Mortality Review Commission that would review and investigate maternal deaths, or those in which a woman dies from factors related to pregnancy or childbirth. The commission, which would operate under the state Department of Health, would also report its findings to state officials and lawmakers, and recommend to hospitals and other providers strategies to reduce these negative outcomes.
Sen. Joseph Vitale (D-Middlesex), the longtime health committee chairman, and Sen. M. Teresa Ruiz (D-Essex), who introduced the legislation, specifically noted a six-month investigation by NPR and ProPublica that found the United States has the worst maternal death rate in the so-called developed world — nearly three times the rate in England and Germany, the nations with the next highest rates — and the rates in this country have been rising for decades.
The investigation, which featured the story of a Monmouth County neonatal nurse who died after giving birth in 2011, also found that a lack of consistent protocols allows “treatable complications to become lethal,” the senators noted. According to the federal Centers for Disease Control and Prevention, pregnancy-related deaths have jumped from 7.9 per 100,000 births in 1987 to 15.9 in 2013.
“The maternal mortality rate in this country is remarkably high compared to other developed nations, and reports indicate that many of these deaths are preventable,” Vitale said yesterday.
NJ ranked 35th among the states
New Jersey’s health department already operates a Maternal Mortality Review Program, which tracks and reviews these deaths and periodically reports on its findings. The group has reviewed more than 700 cases since 1999.
According to its most recent report, covering 2009 to 2013, the maternal death rate for white women went from 10.2 to 12.8 per 100,000 births; among black women, it started at 48.8, dropped to 25.7 in 2011, and had climbed back to 46.5 by 2013. At the time it was published, the report notes New Jersey ranked 35th among the states for the number of pregnancy-related deaths.
New Jersey also tracks other maternal health indicators, including infant mortality, which has declined since 2000 and remains below the national average. (A separate commission investigates all child and infant deaths.) The state has struggled to bring down the number of babies with low-birth weight and reduce the C-section rate; low-birth weight babies can suffer long-term health consequences and struggle academically, and C-sections involve major surgery with potential implications for mother and baby.
Concerns about maternal health were the focus of an NJ Spotlight roundtable in October at which providers and public policy experts discussed these challenges and the financial costs and long-term health implications that result from issues like low birth weight. They also shared strategies for better engaging expectant moms and connecting them with proper care.
Vitale said the state could do more to address these concerns. “There has to be a greater emphasis on the health of mothers and in providing proper information and care at every stage of pregnancy,” he said. “That means implementing a process for reporting and investigating cases but also standardizing protocols in health care facilities for addressing the factors that are leading to pregnancy-related deaths.”
Commission would have wide-ranging powers
The bill, (S-3452), introduced late last week, calls for the creation of a 31-member commission made up of key state health and human services officials, the state medical examiner, and a variety of provider and patient representatives including the New Jersey Hospital Association, the New Jersey Medical Society, leaders of regional maternal health coalitions, and city health officials from Trenton, Newark, and Camden. It would also include OB/GYNs, a variety of nurses, a health administrator and several citizens with patient advocacy experience.
The commission would be empowered to review all existing reports on maternal deaths and conduct its own investigations, interview witnesses, hold public hearings and issue subpoenas. It would report its findings and the trends it uncovered to state health officials, lawmakers and the governor’s office each year, and share these discoveries with the hospitals and providers involved.
In addition, within three months of its first meeting, the group should develop a confidential but mandatory reporting process for maternal deaths; hospitals and birthing facilities would be required to inform the DOH of any pregnancy-related mortality, but without the names attached. The bill also calls for a voluntary reporting system open to members of the public.
The bill also calls for the commission to work with the DOH and professional groups to develop an educational protocol to help providers reduce death and other poor maternal health outcomes. The program, which would be updated every few years, would be incorporated into the requirements of various licensing boards.
The proposal would go beyond previous bills that have sought to improve the transparency of maternal health indicators and expand access to data about trends in care. Assemblywoman Valerie Vainieri Huttle (D-Bergen), who chairs the human services panel, has championed a measure that would create a “Maternity Report Card” to help the public better understand maternal health outcomes and focus attention on the high rate of C-sections.
“It is unacceptable that maternal death rates have risen in the United States despite vast improvements in medical science and technology,” Ruiz said. “As a nation we have to address this issue, but we have a responsibility in New Jersey to improve outcomes for mothers by embarking on an aggressive campaign to address maternal care. This commission is key to that process.”