November 16, 2017
Two New Jersey lawmakers have introduced a bill to overhaul how the state examines deaths related to pregnancy and childbirth, proposing one of the most sweeping maternal mortality review processes in the country.
Under the legislation introduced last week, hospitals and clinicians would face new requirements to report maternal deaths to state regulators, families would play a much greater role in understanding what happened, and the findings would be used to push for adoption of life-saving treatment protocols and other concrete policies to protect mothers and babies.
State Sen. Joseph Vitale said the legislation, S3452, was inspired by a ProPublica and NPR report on the case of Lauren Bloomstein, a neonatal nurse who worked at Monmouth Medical Center in Long Branch, New Jersey — and who died there from childbirth complications in 2011.
The ProPublica-NPR piece, part of our Lost Mothers project on maternal deaths and near-misses, highlighted a number of systemic problems in the way hospitals throughout the U.S. handle obstetric emergencies and sometimes prioritize the health and safety of infants over the well-being of their mothers.
Other ProPublica pieces have described widespread inadequacies in how maternal deaths are monitored and investigated in New Jersey and elsewhere. The new bill would address many of those problems.
New Jersey’s record on maternal health has long been mixed — a 2010 report by Amnesty International ranked it 35th among the states for its rate of pregnancy-related deaths. According to the most recent data, black mothers in the state are five times likelier to die from maternal complications than white mothers are.
The state already has a maternal mortality review committee in place to analyze deaths that occur within a year of the end of pregnancy. But the panel has little authority, it doesn’t assess the preventability of deaths, and its sporadic reports have had little impact.
Under the new bill, a 31-member commission would scrutinize maternal deaths in much greater depth, trying to understand why a death occurred, whether it was preventable and how those lessons might be translated into systemwide reforms. The commission would have the authority to review all existing reports on maternal deaths as well as patient and hospital records. It could also conduct its own investigations, hold public hearings and issue subpoenas. It would be able to interview witnesses, including members of a woman’s family — something no other maternal mortality review committee in the U.S. currently does.
“You need that [perspective],” said Vitale, a Democrat from Middlesex County who is the longtime chair of the Senate health committee. The underlying causes of maternal deaths “are not always just clinical. That information [from family members of a deceased woman] can a matter a lot.” The goal is “to really drill down into these issues and see what can we do to improve care.”
The commission would also develop two mechanisms for reporting maternal deaths to the New Jersey Department of Health for further investigation —a mandatory process for health care providers and medical examiners and a voluntary process for relatives and other interested parties. Both would be confidential.
That pleases Larry Bloomstein, an orthopedic surgeon who watched his wife perish from a form of severe preeclampsia, or pregnancy-induced hypertension, six years ago. After Lauren’s death, Larry was frustrated to discover that many maternal deaths didn’t result in investigations or even autopsies. “The one thing I think is so important is that every maternal death gets the attention it deserves and that we try to review it and figure out what the error was and what could have been done to alter that,” he said.
The commission would report its findings to state health officials, lawmakers and the governor’s office once a year, as well as to the hospitals and providers involved. The findings would be used to identify and promote practices — for example, protocols to treat preeclampsia, hemorrhage and blood clots — that could save lives. The commission would also work with the health department to develop education and training programs for doctors, nurses and other practitioners.
All names and other identifying information would be kept confidential and none of the findings could be used in malpractice lawsuits or other litigation.
Under the bill, the Maternal Mortality Review Commission could also elect to investigate cases involving life-threatening complications (also known as severe maternal morbidity), using data and information from patient registries.
“It is unacceptable that maternal death rates have risen in the United States despite vast improvements in medical science and technology,” M. Teresa Ruiz, a Democrat from Essex County who cosponsored the bill, said earlier this week. “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.”
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