The Texas House Public Health Committee heard testimony on two bills aimed at revising the state’s process for reviewing maternal deaths on Monday.
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House Bill 1847 would allow officials who review maternal death cases for the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) access to unredacted health information, while HB 663 would establish a maternal mortality and morbidity registry to assist with data collection. Both bills remain in committee under consideration.
In September, the Texas Department of State Health Services (DSHS) informed the MMMRC that its report on maternal deaths would be delayed until the summer of 2023 due to a lag in processing data.
While the DSHS and MMMRC eventually released the 2022 joint biennial report in December after public calls for its disclosure, the bill’s sponsors say additional reforms are needed to improve the timeliness and thoroughness of MMMRC’s review.
“[MMMRC’s] work has been instrumental in addressing the state’s maternal mortality rate,” said HB 1847 sponsor Rep. Donna Howard (D-Austin). “It has led to important policy changes that have improved the maternal healthcare in our communities. The purpose of requiring the report [to be] released by Sept. 1st is to allow the legislature time to review, draft, and file legislation related to the recommendations made within the report …
So in order to ensure timely analysis in the future, HB 1847 would allow nurses to review unredacted materials related to maternal mortality and morbidity cases in the course of preparing the review committee’s report and would accelerate the process of extracting data from maternal death cases.”
The joint report on maternal health and safety initiatives outlined the need for process improvement strategies for maternal mortality review protocols to improve case review capacity and quality.
“HB 663 establishes a workgroup comprised of health experts aiming to establish a secure maternal mortality and morbidity registry under the DSHS with the goal of improving the quality of maternal care,” said sponsor Rep. Shawn Thierry (D-Houston). “The purpose will be to record information submitted by participant healthcare providers on the status of maternal patients over varying periods. This will include metrics such as the frequency and characteristics of the mother’s postpartum period.”
Thierry said the workgroup would be tasked with establishing best practices related to the registry, including data submission and sharing.
Of the 140 deaths from 2019 that were reviewed in the joint report, 58 of the 64 pregnancy-related deaths were deemed “preventable.” A majority of maternal deaths were associated with one of six underlying causes: obstetric hemorrhage, mental health conditions, non-cerebral thrombotic embolism, cardiovascular conditions, injury, and infection.
The severe maternal morbidity (SMM) rate was disproportionately higher for Black women than other racial groups at 117.3 deaths per 10,000 hospital deliveries. This is more than double the rate for white women (56.3 deaths per 10,000 deliveries).
Obstetric hemorrhage was the leading cause of SMM among all Texas women. While rates of hemorrhage-related deaths decreased for every population tracked, that rate rose among Black women.
Maternal health advocates called on lawmakers to address the state’s rising SMM rates.
“The state of Texas can no longer shrug our shoulders and look the other way—not when the most recent data confirms that 90% of pregnancy-related deaths are preventable,” said Reverend Taylor Fuerst of First United Methodist Church of Austin, testifying on behalf of the bills. “As an organizational leader, as a pastor, and as a practicing disciple of Jesus, I know that change happens in the areas where we pay the most attention.
We have to pay more attention here and we have to clear the obstacles to make way for more data, better data, and more efficient data so that we are better equipped to address these preventable deaths. We believe that [these bills] will take another step in the right direction.”