BILL ANALYSIS Ó
AB 508
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Date of Hearing: January 21, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
508 (Cristina Garcia) - As Amended January 13, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires the California Department of Public Health
(CDPH) to annually publish a report on maternal mortality and
morbidity, and specifies factors the department must analyze.
It also requires the department to support efforts of
private-public collaboration to collect and analyze data and
complete the report.
AB 508
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FISCAL EFFECT:
1)In absence of another fund source, there would be significant
GF costs to the Maternal, Child, and Adolescent Health
division of CDPH to complete this annual study, likely in the
range of several hundred thousand dollars to the low millions
annually. The low end of the range would assume use of
publicly available data and a lower level of analytical depth,
while the high end would assume significant costs for novel
data collection and higher analytical complexity. The bill is
fairly broad in its requirements, so the robustness and cost
of implementation would depend on administrative and
legislative decisions about resource availability for this
purpose.
2)CDPH would also likely incur, on a one-time basis, some level
of infrastructure capacity enhancement in order to process and
store data. For example, new databases, automated processes
or new computer hardware may be required. The level of
one-time costs would increase commensurate with the complexity
of the effort as described above. Higher one-time costs- for
example, to automate certain processes- could also potentially
reduce ongoing personnel costs, depending on the approach
chosen.
3)Depending on the availability and approval of federal Title V
funds for this purpose, federal funds could potentially be
used instead of GF. Approximately $39 million in federal
Title V funds are available to California annually. Funding
decisions are based partially on a federally required needs
assessment, and these monies currently fund other maternal,
child, and adolescent health priorities, including $8 million
for state operations and $31 million for local assistance
annually.
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COMMENTS:
1)Purpose. According to the author, although California's trends
are among the best in the country, maternal mortality and
morbidity remain unacceptably high. The author points to past
successes in reducing maternal mortality by CDPH's attention
to the issue, analysis of data, and collaborative
problem-solving with the health care delivery system. The
author believes the annual report required by this bill will
assist the state to further reduce dangerous complications
from pregnancy and childbirth.
2)Background. The CDPH administers the California
Pregnancy-Associated Mortality Review (CA-PAMR) in
collaboration with private sector efforts. CA-PAMR reviews
information related to maternal deaths and translates findings
into quality improvement projects.
The department regularly reports trends in maternal mortality,
but no longer conducts case review of each maternal death.
The most recent report notes a sustained decline in maternal
mortality from 2008 until 2013, while national rates rose.
The national rate is nearly three times California's rate,
although health disparities persist in the state. Notably,
African-American women in California are three to four times
more likely to die from maternal causes than whites.
CDPH efforts appear to focus on mortality, not morbidity.
According to the World Health Organization (WHO), maternal
death (mortality) is defined as "the death of a woman while
pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from
any cause related to or aggravated by pregnancy or its
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management but not from accidental or incidental causes.
"Pregnancy-related death" is also used in this field to
indicate the same, but it refers to death while pregnant or
within one year of the termination of pregnancy.
In addition to maternal mortality, this bill requires study of
morbidity, including study of all instances of complications
from pregnancy. Pregnancy-related complications and maternal
morbidity are fairly broad terms. The WHO Maternal Morbidity
Working Group defines maternal morbidity as "any health
condition attributed to, and/or aggravated by, pregnancy and
childbirth that has a negative impact on the woman's
wellbeing." The Center for Disease Control and Prevention
(CDC) idenifies "severe maternal morbidity" through delivery
hospitalization data and medical codes that indicate a
potentially life-threatening maternal condition or
complication. Severe postpartum hemorrhage is an example of
severe maternal morbidity. The CDC lists the following as
potential pregnancy complications: obesity and weight gain,
high blood pressure, gestational diabetes, mental health
conditions, anemia, and urinary tract infections.
3)Staff Comment. There is surely merit in analyzing various
pregnancy complications and all types of maternal morbidity
for their potential effects on women's health, but if the
intent is to concentrate resources on the conditions with the
greatest potential for harm or loss of life, the author may
wish to consider narrowing the bill somewhat. For example,
the bill could be narrowed to require study of severe maternal
morbidity instead of maternal morbidity and pregnancy
complications generally. Another alternative is to require
study of factors contributing to pregnancy-related deaths as
defined above, instead of all complications. Yet another
option would be to require a baseline study that includes
review of all complications, but require an annual or biennial
study to focus on those complications with the greatest
potential for severe health outcomes. Narrowing the bill
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could provide more direction to the department about what is
most important to study, as well as reduce costs.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081