BILL NUMBER: AB 508	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 20, 2016
	AMENDED IN ASSEMBLY  JANUARY 21, 2016
	AMENDED IN ASSEMBLY  JANUARY 13, 2016
	AMENDED IN ASSEMBLY  JANUARY 4, 2016

INTRODUCED BY   Assembly Member Cristina Garcia
   (Coauthor: Assembly Member Burke)

                        FEBRUARY 23, 2015

   An act to add Section 123237 to the Health and Safety Code,
relating to public health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 508, as amended, Cristina Garcia. Public health: maternal
health.
   Existing law establishes the State Department of Public Health and
sets forth its powers and duties, as specified. Existing law
requires the department to maintain a program of maternal, child, and
adolescent health. 
   This bill would require the department to prepare and submit to
the Legislature an annual report on maternal mortality and morbidity
in California, including an analysis of maternal deaths and severe
maternal morbidity. The bill would also require the department, in
order to develop accurate reports in a resource-efficient manner, to
consider existing resources, including, among others, opportunities
for partnerships with other entities and use of physician volunteers.
 
   This bill would establish a maternal mortality review panel to
conduct ongoing comprehensive, multidisciplinary reviews of maternal
deaths and severe maternal morbidity in California to identify
factors associated with the deaths and make recommendations for
system changes to improve health care services for women in this
state. The bill would also make information, documents, proceedings,
records, and opinions created, collected, or maintained by the
maternity mortality review panel or the State Department of Public
Health in support of the maternal mortality review panel confidential
and not subject to public inspection, discovery, or introduction
into evidence in any civil action. The bill would also prohibit any
person in attendance at a meeting of the maternal mortality review
panel or who participates in the creation, collection, or maintenance
of the panel's information, documents, proceedings, records, or
opinions to testify in any civil action as to the content of those
proceedings or the panel's information, documents, records, or
opinions. The bill would require the State Department of Public
Health to review department available data to identify maternal
deaths and would mandate health care providers, health care
facilities, clinics, laboratories, medical examiners, coroners,
professionals, and facilities licensed by the State Department of
Public Health to provide documents, as specified, upon request of the
department. The bill also requires the State Department of Public
Health to prepare and submit to the Legislature a biennial report on
maternal mortality in California based on the data collected. 

   Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.  
   This bill would make legislative findings to that effect. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    The Legislature finds and declares all
of the following:  
   (a) Between 2002 and 2006, the rates of maternal deaths and severe
complications doubled in both California and the United States. For
every maternal death, there are approximately 100 cases of severe
complications as defined by the federal Centers for Disease Control
and Prevention. Severe complications occur in nearly 2 percent of all
California births.  
   (b) Not only are these deaths and severe complications devastating
for those affected families, but the cost to the state and private
payers is significant. The University of California at Los Angeles
studied the costs for maternal hemorrhage and
preeclampsia/hypertension, the two leading causes of preventable
maternal mortality and 80 percent of severe maternal morbidity. The
study estimates that these conditions together cost Medi-Cal $200
million every year.  
   (c) Information and data regarding maternal mortality and
morbidity provides a clearer understanding as to the causes and can
be used for guidance in quality improvement projects needed to reduce
or eliminate deaths and severe complications.  
   (d) Analysis using certificates of death alone has proven to be an
incomplete and inadequate window into the underlying causes and
assessment of maternal deaths and needs to be supplemented with other
material, including coroner's reports and medical records. 

   (e) The federal Centers for Disease Control and Prevention (CDC),
the American Congress of Obstetricians and Gynecologists (ACOG), and
the Maternal Child Health Bureau (HRSA-MCHB) all strongly encourage
every state to form and support a multi-disciplinary committee to
annually review maternal deaths in as timely a manner as possible.
The CDC reports that 33 states have instituted maternal mortality
committees.  
   (f) California's over 500,000 annual births represent fully
one-eighth of all United States births (and maternal deaths). Reviews
of these cases represent an important resource for state and
national efforts to better understand and reverse the rising rates of
maternal mortality and morbidity.  
   (g) Data from prior California maternal mortality reviews have
been particularly useful for launching statewide improvement projects
to reduce maternal deaths led by the State Department of Public
Health and the California Maternal Quality Care Collaborative. This
act shall establish an ongoing multi-disciplinary panel for maternal
mortality and severe morbidity reviews, including reports to the
Legislature. 
   SEC. 2.    Section 123237 is added to the  
Health and Safety Code   , to read:  
   123237.  (a) For the purposes of this section, "maternal mortality"
or "maternal death" means a death of a woman while pregnant or
within 42 days of delivering or following the end of a pregnancy when
the woman's death is from medical causes, including suicide, and is
related to or aggravated by the pregnancy. Cases meeting these
criteria are currently estimated to total between 70 and 90 cases
each year. Additional deaths occurring between 42 days and 1 year
following delivery may be included in these reviews if resources and
time permit. "Severe maternal morbidity" means major maternal
complications, as defined by the federal Centers for Disease Control
and Prevention, occurring during birth or within 42 days of delivery.

   (b) A maternal mortality review panel is established to conduct
ongoing comprehensive, multidisciplinary reviews of maternal deaths
and severe maternal morbidity in California to identify factors
associated with the deaths and make recommendations for system
changes to improve health care services for women in this state. A
maternity care provider shall chair the panel. Members of the panel
shall be appointed by the director, must serve without compensation,
and may include, as a minimum:
   (1) An obstetrician.
   (2) A physician specializing in maternal fetal medicine.
   (3) A neonatologist.
   (4) A certified nurse-midwife.
   (5) A labor and delivery nurse.
   (6) An anesthesiologist.
   (7) A representative from the department who works in the field of
maternal and child health.
   (8) An epidemiologist with experience analyzing perinatal data.
   (9) Other professionals determined by the department and the
committee chair to address specific case review topics by the
committee.
   (c) The maternal mortality review panel shall conduct
multidisciplinary reviews of maternal mortality and severe morbidity
in California. The panel may not call witnesses or take testimony
from any individual involved in the investigation of a maternal death
or enforce any public health standard or criminal law, or otherwise
participate, in any legal proceeding relating to a maternal death.
   (d) (1) Information, documents, proceedings, records, and opinions
created, collected, or maintained by the maternity mortality review
panel or the department in support of the maternal mortality review
panel are confidential and are not subject to public inspection or
discovery or introduction into evidence in any civil action.
   (2) Any person who attends a meeting of the maternal mortality
review panel or who participates in the creation, collection, or
maintenance of the panel's information, documents, proceedings,
records, or opinions shall not testify in any civil action as to the
content of those proceedings, or the panel's information, documents,
records, or opinions. This paragraph does not prevent a member of the
panel from testifying in a civil action concerning facts that form
the basis for the panel's proceedings of which the panel member has
personal knowledge acquired independently of the panel or that is
public information.
   (3) Any person who, in substantial good faith, participates as a
member of the maternal mortality review panel or provides information
to further the purposes of the maternal mortality review panel may
not be subject to an action for civil damages or other relief as a
result of the activity or its consequences.
   (4) All meetings, proceedings, and deliberations of the maternal
mortality review panel may, at the discretion of the maternal
mortality review panel, be confidential and may be conducted in
executive session.
   (5) The maternal mortality review panel and the director may
retain identifiable information regarding facilities where maternal
deaths occur, or from which the patient was transferred, and
geographic information on each case solely for the purposes of
trending and analysis over time. All individually identifiable
information shall be removed before any case is reviewed by the
panel.
   (e) The department shall review department available data to
identify maternal deaths. To aid in determining whether a maternal
death was related to or aggravated by the pregnancy, and whether it
was preventable, the department has the authority to do both of the
following:
   (1) Request and receive data for specific maternal deaths,
including, but not limited to, all medical records, autopsy reports,
medical examiner reports, coroner's reports, and social service
records.
   (2) Request and receive data, as described in paragraph (1), from
health care providers, health care facilities, clinics, laboratories,
medical examiners, coroners, professionals, and facilities licensed
by the department.
   (f) Upon request by the department, health care providers, health
care facilities, clinics, laboratories, medical examiners, coroners,
professionals, and facilities licensed by the department must provide
all medical records, autopsy reports, medical examiner reports,
coroner's reports, social services records, information, and other
data requested for specific maternal deaths as provided in this
subdivision to the department.
   (g) The panel shall also review severe maternal morbidity data
provided by either the department or the California Maternal Quality
Care Collaborative (CMQCC). This data shall be aggregated and
deidentified but indicate major causes of morbidity and time trends.
   (h) (1) Notwithstanding Section 10231.5 of the Government Code,
the department, as part of its work to advance and improve California
maternity care through data-driven quality improvement, shall
prepare and submit to the Legislature a biennial report on maternal
mortality in California based on the data collected. The report shall
protect the confidentiality of all decedents and other participants
involved in any incident. The report shall be distributed publically
to stimulate performance improvement. Interim results may be shared
with the CMQCC quality improvement programs. The report shall include
both the following:
   (A) A description of the maternal deaths reviewed by the panel
during the preceding twenty-four months, including statistics and
causes of maternal deaths presented in the aggregate. The report must
not disclose any identifying information of patients, decedents,
providers, and organizations involved.
   (B) Evidence-based system changes and policy recommendations to
improve maternal outcomes and reduce preventable maternal deaths in
California.
   (2) A report submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government Code.
   (i) The department may use Title V Block Grant Program funds to
support these efforts and may apply for additional federal government
and private foundation grants, as needed. The department may also
accept private, foundation, city, county, or federal monies to
implement this section. 
   SEC. 3.    The Legislature finds and declares that
Section 2 of this act, which adds Section 123237 of the Health and
Safety Code, imposes a limitation on the public's right of access to
the meetings of public bodies or the writings of public officials and
agencies within the meaning of Section 3 of Article I of the
California Constitution. Pursuant to that constitutional provision,
the Legislature makes the following findings to demonstrate the
interest protected by this limitation and the need for protecting
that interest:  
   In order to protect confidential information, documents,
proceedings, records, and opinions created, collected, or maintained
by the maternity mortality review panel or the department in support
of the maternity mortality review panel, it is necessary that this
act limit the public's right of access to that information. 

  SECTION 1.    Section 123237 is added to the
Health and Safety Code, to read:
   123237.  (a) Notwithstanding Section 10231.5 of the Government
Code, the State Department of Public Health, as part of its work to
advance and improve California maternity care through data-driven
quality improvement, shall prepare and submit to the Legislature an
annual report on maternal mortality and morbidity in California. The
report shall include, but not be limited to, all of the following:
   (1) An analysis of maternal deaths that includes both of the
following:
   (A) Case review of each death.
   (B) Analysis of patient demographics, contributing factors, and
underlying causes.
   (2) An analysis of all cases of severe maternal morbidity, as
defined by the federal Centers for Disease Control and Prevention,
for which data collection is practicable, including analysis of
patient demographics and underlying causes.
   (3) Suggestions for improvements in care to reduce maternal death
and severe maternal morbidity.
   (b) In order to develop accurate reports in a resource-efficient
manner, the department shall consider existing resources, including,
but not limited to, all of the following:
   (1) Existing data sources available to the department.
   (2) Opportunities for partnerships with entities engaged in
maternal care quality measurement or improvement.
   (3) Use of physician volunteers or committees.
   (c) A report submitted pursuant to subdivision (a) shall be
submitted in compliance with Section 9795 of the Government Code.