Establishes state and New York city maternal mortality review boards and the maternal mortality and morbidity advisory council for the purpose of reviewing maternal deaths and maternal morbidity and developing and disseminating findings, recommendations, and best practices to contribute to the prevention of maternal mortality and morbidity.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3276 REVISED MEMO 03/19/2019
SPONSOR: Joyner
 
TITLE OF BILL: An act to amend the public health law, in relation to
maternal mortality review boards and the maternal mortality and morbidi-
ty advisory council
 
PURPOSE OF BILL:
This legislation establishes the Maternal Mortality Review Board for the
purposes of reviewing maternal mortality and morbidity. The Board shall
assess the cause of death and factors leading, to death and preventabil-
ity for each maternal death reviewed, and to develop strategies for
reducing the risk of maternal mortality.
 
SUMMARY OF PROVISIONS:
The legislation adds a new Section 2509 to the Public Health Law which
establishes the Maternal Mortality Review Board for purposes of assess-
ing the cause of death and factors. leading to death and preventability
for each maternal death reviewed, and to develop strategies for.reducing
the risk of maternal mortality.
Section 2509, Subsection (b) authorizes the commissioner to enter into
an agreement with the City of New York providing that the functions of
the state board relating to maternal deaths and severe morbidity occur-
ring in the City shall be conducted by the city board, and requires the
city board to provide the state board with the results of its reviews,
relevant information in the possession of the city board, and the recom-
mendations of the city board. The department and the state board to
provide information and assistance to the city board for the performance
. of its functions.
Section 2509 Subsection 2 includes definitions of various terms.
Section 2509 Subsection 3 establishes the number of members comprising
the board, the terms office for the board members, the requirements for
a quorum of the board, and establishes a diversity requirement for the
members of the board. Among the requirements; the board shall include
health care professionals or other experts who serve and are represen-
tative of the diversity of the women and mothers in medically under-
served areas of the state or areas of the state with disproportionately
high occurrences of maternal mortality or morbidity Meetings of the
state board will be held at least twice a year, but may be held more
frequently as deemed necessary, subject to the request of the depart-
ment. Members of the state and city boards shall be indemnified and
membership on a board shall not disqualify any person from holding
public office or employment.
Section 2509 Subsection 4 authorizes the commissioner and the city
commissioner, as the case may be, to receive such information that will
help the department to properly carry out its functions, powers, and
duties. This information may include voluntary information, including
oral or written statements, relating to a maternal death and case of
severe maternal morbidity, from any family member or other interested
party (including the patient in the case of in a case of severe maternal
morbidity) relating to any case that may come before the board. Before
transmitting any information to the board, the commissioner or city
commissioner shall remove all personal identifying information of the
woman, health care practitioner or practitioners or anyone else individ-
ually named in such information, as well as the hospital or facility
that treated the woman, and any other information such as geographic
location that may inadvertently identify the woman, practitioner or
facility.
Section 2509 Subsection 5 each board shall make and report findings to
the commissioner and city commissioner, as the case may be, regarding
the causa of death, factors leading to death, and preventability of each
maternal death case, and each case of severe matern- al morbidity
reviewed by the board, and shall provide such findings and recommenda-
tions, including best practices and strategies for reducing the risk of
maternal mortality to the advisory council. Each board shall develop
recommendations to the state or city commissioner, as the case may be,
for areas of focus, including issues of severe maternal morbidity and
issues of racial, economic or other disparities in maternal outcomes.
Section 2509 Subsection 6 provides that the commissioner and the city
commissioner and the state and city boards shall each keep confidential
any information collected or received under this section that includes
personal identifying information of the woman, health care practitioner
or practitioners or anyone else individually named in such information,
as well as the hospital or facility that treated the woman, and any
other information such as geographic location that may inadvertently
identify the woman, practitioner or facility, and shall use the informa-
tion provided or received under this section solely for the purposes of
improvement of the quality of health care of women and to prevent mater-
nal mortality and morbidity. This subdivision shall not preclude the
transmitting of information to the board that is reasonably necessary to
enable the board to perform an appropriate review under this section.
All information and records received, meetings conducted, reports and
records made and maintained and all books and papers obtained by the
board shall be confidential and shall not be made open or available,
including under article six of the public officers law, and shall be
limited to board members as well as those authorized by the state or
city commissioner. Such information shall not be discoverable or admis-
sible as evidence in any action in any court or before any other tribu-
nal, board, agency or person.
Section 2509 Subsection 7 provides that the commissioner and the city
commissioner, within their respective legal authority, may use the
recommendations and findings of the boards to develop guidance and other
actions relating to best practices, and shall disseminate information
relating to that guidance and other actions to appropriate health care
providers.
Section 2509 Subsection 8 establishes an Advisory Council that may
review the findings of the boards, develop recommendations on policies,
best practices, and strategies to prevent maternal mortality and morbid-
ity, hold public hearings on those matters, make findings and issue
reports, including an annual report, on such matters, and request and
shall receive the assistance of the commissioner, the city commissioner,
and the boards in carrying out its functions. The advisory council shall
consist of at least 20 members, to be determined by the commissioner.
The commissioner and the city commissioner shall each appoint half of
the members of the council. The commissioner shall appoint the chair of
the council. The members of the council shall be comprised of multidis-
ciplinary experts and lay persons knowledgeable in the field of maternal
mortality, women's health and public health and shall include members
who serve and are representative of the diversity of the women and moth-
ers in medically underserved areas of the state or areas of the state
with disproportionately high occurrences of maternal mortality or
morbidity.
This bill does not restrict the otherwise lawful use or transmission by
the commissioner or city commissioner of information that is provided to
or required to be provided to the commissioner or city commissioner
other than by this bill.
 
JUSTIFICATION:
New York currently ranks 30th out of 50 states in its maternal death
rate. The issue is compounded by significant racial and ethnic dispari-
ties with black women nearly four times more likely to die during preg-
nancy and childbirth compared to white women. Moreover, severe maternal
morbidity, serious life-threatening complications of delivery, is even
more pervasive. The state must invest in mothers through creation of a
maternal mortality review board to create new strategies for the
prevention of maternal mortality and morbidity.
Development of the maternal mortality review board will provide a deeper
understanding of the causes and circumstances surrounding each maternal
death. Through convening of a multidisciplinary, diverse group of clin-
ical experts, the maternal mortality review board will facilitate a
comprehensive, confidential review of maternal deaths and develop
actionable recommendations for the prevention of future deaths.
 
PRIOR LEGISLATIVE HISTORY:
06/15/18 Amend and recommit to Codes,
06/05/18 Reported referred to Codes,
05/30/18 Amend and recommit to Health,
04/16/18 Referred to Health
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
3276
2019-2020 Regular Sessions
IN ASSEMBLY
January 29, 2019
___________
Introduced by M. of A. JOYNER, GOTTFRIED, JEAN-PIERRE, L. ROSENTHAL,
THIELE, OTIS, BRONSON, HUNTER, ABINANTI, HEVESI, FAHY, ENGLEBRIGHT,
SIMON, BICHOTTE, SEAWRIGHT, BARRON, TAYLOR, ARROYO, GALEF,
PEOPLES-STOKES, RA, FERNANDEZ, RIVERA, WRIGHT, DICKENS, D'URSO,
JAFFEE, LAVINE, SOLAGES, BARRETT, EPSTEIN, DAVILA, LIFTON, NIOU,
ROZIC, MONTESANO, COOK, GLICK, MOSLEY, ORTIZ, STERN -- read once and
referred to the Committee on Health
AN ACT to amend the public health law, in relation to maternal mortality
review boards and the maternal mortality and morbidity advisory coun-
cil
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Legislative findings and intent. The legislature finds that
2 maternal mortality and morbidity is a serious public health concern and
3 has a serious family and societal impact. New York state has among the
4 highest maternal mortality rates in the country and racial disparities
5 remain significant. The U.S. Centers for Disease Control and Prevention
6 has determined that a regular process for professional, multi-discipli-
7 nary, confidential review of all maternal deaths can help identify the
8 causes of maternal mortality, and those findings can lead to clinical
9 and social change that can help prevent maternal mortality. The same is
10 true for severe maternal morbidity. Confidentiality is important to
11 ensure that full information is made available in the review process to
12 maximize protection of maternal health.
13 Section 3 of article 17 of the state constitution states: "The
14 protection and promotion of the health of the inhabitants of the state
15 are matters of public concern and provision therefor shall be made by
16 the state and by such of its subdivisions and in such manner, and by
17 such means as the legislature shall from time to time determine." The
18 legislature finds that the creation of a state maternal mortality review
19 board, and recognition and protection of a city of New York maternal
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00490-02-9
A. 3276 2
1 mortality review board, are a matter of state concern and an important
2 exercise of the legislature's constitutional mandate to protect the
3 public health.
4 § 2. The public health law is amended by adding a new section 2509 to
5 read as follows:
6 § 2509. Maternal mortality review board. 1. (a) There is hereby estab-
7 lished in the department the maternal mortality review board for the
8 purpose of reviewing maternal deaths and maternal morbidity and develop-
9 ing and disseminating findings, recommendations, and best practices to
10 contribute to the prevention of maternal mortality and morbidity. The
11 board shall assess the cause of death, factors leading to death and
12 preventability for each maternal death reviewed and, in the discretion
13 of the board, cases of severe maternal morbidity, and shall develop and
14 disseminate strategies for reducing the risk of maternal mortality and
15 morbidity, including risk resulting from racial, economic, or other
16 disparities. The commissioner may delegate the authority to conduct
17 maternal mortality reviews.
18 (b) The commissioner may enter into an agreement with the city of New
19 York providing:
20 (i) that the functions of the state board relating to maternal deaths
21 and severe maternal morbidity occurring within the city of New York
22 shall be conducted by the city board;
23 (ii) the city board shall provide to the state board the results of
24 its reviews, relevant information in the possession of the city board,
25 and the recommendations of the city board; and
26 (iii) the department and the state board shall provide information and
27 assistance to the city board for the performance of its functions.
28 (c) Nothing in this section shall prevent the city of New York from
29 establishing, without an agreement with the commissioner, a board relat-
30 ing to maternal deaths and severe maternal morbidity occurring within
31 the city of New York.
32 2. As used in this section, unless the context requires otherwise:
33 (a) "Advisory council" and "council" mean the advisory council on
34 maternal mortality and morbidity, established under this section.
35 (b) "Board" means a maternal mortality review board established by
36 this section, referred to in this section as the "state board", or a
37 board operating under this section established by the city of New York,
38 with or without an agreement with the commissioner, referred to in this
39 section as the "city board".
40 (c) "Maternal death" means the death of a woman during pregnancy or
41 within a year from the end of pregnancy.
42 (d) "Severe maternal morbidity" means unexpected outcomes of pregnan-
43 cy, labor, or delivery that result in significant short- or long-term
44 consequences to a woman's health.
45 (e) "City commissioner" means the commissioner of the New York city
46 department of health and mental hygiene.
47 3. (a) The members of the state board shall be comprised of multidis-
48 ciplinary experts in the field of maternal mortality, women's health and
49 public health, and shall include health care professionals or other
50 experts who serve and are representative of the diversity of the women
51 and mothers in medically underserved areas of the state or areas of the
52 state with disproportionately high occurrences of maternal mortality or
53 morbidity.
54 (b) The state board shall be composed of at least fifteen members, all
55 of whom shall be appointed by the commissioner.
A. 3276 3
1 (c) The terms of the state board members shall be three years. The
2 commissioner may choose to reappoint state board members to additional
3 three year terms.
4 (d) A majority of the appointed membership of the state board, no less
5 than three, shall constitute a quorum.
6 (e) When any member of the state board fails to attend three consec-
7 utive regular meetings, unless such absence is for good cause, that
8 membership may be deemed vacant for purposes of the appointment of a
9 successor.
10 (f) Meetings of the state board shall be held at least twice a year
11 but may be held more frequently as deemed necessary, subject to request
12 of the department.
13 (g) Members of the state and city boards shall be indemnified under
14 section seventeen of the public officers law or section fifty-k of the
15 general municipal law, as the case may be.
16 (h) Members of the state board shall not be compensated for their
17 participation on the board but shall receive reimbursement for their
18 ordinary and necessary expenses of participation.
19 (i) Membership on a board shall not disqualify any person from holding
20 any public office or employment.
21 4. (a) The commissioner and the city commissioner, as the case may be,
22 may request and shall receive upon request from any department, divi-
23 sion, board, bureau, commission, local health departments or other agen-
24 cy of the state or political subdivision thereof or any public authori-
25 ty, as well as hospitals established pursuant to article twenty-eight of
26 this chapter, birthing facilities, medical examiners, coroners and
27 coroner physicians and any other facility providing services associated
28 with maternal mortality, such information, including, but not limited
29 to, death records, medical records, autopsy reports, toxicology reports,
30 hospital discharge records, birth records and any other information that
31 will help the department under this section to properly carry out its
32 functions, powers and duties.
33 (b) The commissioner and the city commissioner shall receive and may
34 solicit voluntary information, including oral or written statements,
35 relating to any maternal death and case of severe maternal morbidity,
36 from any family member or other interested party (including the patient
37 in a case of severe maternal morbidity) relating to any case that may
38 come before the board. Oral statements received under this paragraph
39 shall be transcribed or summarized in writing. The commissioner and the
40 city commissioner shall transmit that information to the board consider-
41 ing the case.
42 (c) Before transmitting any information to the board, the commissioner
43 or the city commissioner shall remove all personal identifying informa-
44 tion of the woman, health care practitioner or practitioners or anyone
45 else individually named in such information, as well as the hospital or
46 facility that treated the woman, and any other information such as
47 geographic location that may inadvertently identify the woman, practi-
48 tioner or facility. This paragraph shall not preclude the transmitting
49 of information to the board that is reasonably necessary to enable the
50 board to perform an appropriate review under this section.
51 5. Each board:
52 (a) shall make and report findings and recommendations to the commis-
53 sioner or city commissioner, as the case may be, regarding the cause of
54 death, factors leading to death, and preventability of each maternal
55 death case, and each case of severe maternal morbidity reviewed by the
56 board, by reviewing relevant information for each case in the state or
A. 3276 4
1 the city of New York, as the case may be, and consulting with experts as
2 needed to evaluate the information for each death; and shall provide
3 such findings and recommendations, including best practices and strate-
4 gies for reducing the risk of maternal mortality and morbidity, to the
5 advisory council; provided that material provided to the advisory coun-
6 cil shall not include any information that would be confidential under
7 this section;
8 (b) shall develop recommendations to the commissioner or city commis-
9 sioner, as the case may be, for areas of focus, including issues of
10 severe maternal morbidity and issues of racial, economic or other
11 disparities in maternal outcomes;
12 (c) may, in addition to the findings and recommendations made under
13 this subdivision, and consistent with all applicable confidentiality
14 protections, bring any particular matter to the attention of the commis-
15 sioner or the city commissioner;
16 (d) shall issue a report on its findings and recommendations every two
17 years, and may also issue reports more frequently. The reports shall be
18 public documents; and
19 (e) may request and shall receive the assistance of the commissioner
20 and the city commissioner in carrying out its functions.
21 6. The commissioner and the city commissioner and the state and city
22 boards shall each keep confidential any information collected or
23 received under this section that includes personal identifying informa-
24 tion of the woman, health care practitioner or practitioners or anyone
25 else individually named in such information, as well as the hospital or
26 facility that treated the woman, and any other information such as
27 geographic location that may inadvertently identify the woman, practi-
28 tioner or facility, and shall use the information provided or received
29 under this section solely for the purposes of improvement of the quality
30 of health care of women and to prevent maternal mortality and morbidity.
31 This subdivision shall not preclude the transmitting of information to
32 the board that is reasonably necessary to enable the board to perform an
33 appropriate review under this section. All records received, meetings
34 conducted, reports and records made and maintained and all books and
35 papers obtained by the board shall be confidential and shall not be made
36 open or available, including under article six of the public officers
37 law, and shall be limited to board members as well as those authorized
38 by the commissioner or city commissioner. Such information shall not be
39 discoverable or admissible as evidence in any action in any court or
40 before any other tribunal, board, agency or person.
41 7. The commissioner and the city commissioner, within their respective
42 legal authority, may use the recommendations and findings of the boards
43 to develop guidance and other actions relating to best practices, and
44 shall disseminate information relating to that guidance and other
45 actions to appropriate health care providers.
46 8. (a) There is hereby established in the department an advisory coun-
47 cil on maternal mortality and morbidity.
48 (b) The advisory council:
49 (i) may review the findings of the boards;
50 (ii) may develop recommendations on policies, best practices, and
51 strategies to prevent maternal mortality and morbidity;
52 (iii) may hold public hearings on those matters;
53 (iv) may make findings and issue reports, including an annual report,
54 on such matters; and
55 (v) may request and shall receive the assistance of the commissioner,
56 the city commissioner, and the boards in carrying out its functions.
A. 3276 5
1 (c) The advisory council shall consist of at least twenty members, to
2 be determined by the commissioner. The commissioner and the city commis-
3 sioner shall each appoint half of the members of the council. The
4 commissioner shall appoint the chair of the council.
5 (d) The members of the council shall be comprised of multidisciplinary
6 experts and lay persons knowledgeable in the field of maternal mortal-
7 ity, women's health and public health and shall include members who
8 serve and are representative of the diversity of the women and mothers
9 in medically underserved areas of the state or areas of the state with
10 disproportionately high occurrences of maternal mortality or morbidity.
11 (e) The terms of the council members shall be three years. The
12 appointing official may choose to reappoint council members to addi-
13 tional three-year terms. Vacancies on the council shall be filled by
14 appointment by the appointing official. A majority of the appointed
15 membership of the council shall constitute a quorum. When any member of
16 the council fails to attend three consecutive regular meetings, unless
17 such absence is for good cause, that membership may be deemed vacant for
18 purposes of the appointment of a successor.
19 (f) Meetings of the council shall be held at least twice a year.
20 (g) Members of the council shall be indemnified under section seven-
21 teen of the public officers law. Members of the council shall not be
22 compensated for their participation on the council but shall receive
23 reimbursement for their ordinary and necessary expenses of partic-
24 ipation. Membership on the council shall not disqualify any person from
25 holding any public office or employment.
26 § 3. This act shall take effect immediately.