By: Walle H.B. No. 1133

A BILL TO BE ENTITLED

AN ACT

relating to the creation of a review board to study maternal mortality and severe maternal morbidity.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle B, Title 2, Health and Safety Code, is amended by adding Chapter 34 to read as follows:

CHAPTER 34. MATERNAL MORTALITY AND MORBIDITY REVIEW BOARD

Sec. 34.001. DEFINITIONS. In this chapter:

(1) "Commissioner" means the commissioner of state health services.

(2) "Department" means the Department of State Health Services.

(3) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(4) "Institution of higher education" has the meaning assigned by Section 61.003, Education Code.

(5) "Intrapartum care" has the meaning assigned by Section 32.002.

(6) "Maternal morbidity" means a pregnancy-related health condition occurring during pregnancy, labor, or delivery or within one year of delivery or end of pregnancy.

(7) "Patient" means the woman who while pregnant or within one year of delivery or end of pregnancy suffers death or maternal morbidity.

(8) "Perinatal care" has the meaning assigned by Section 32.002.

(9) "Pregnancy-related death" means the death of a woman while pregnant or within one year of delivery or end of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

(10) "Review board" means the Maternal Mortality and Morbidity Review Board.

(11) "Severe maternal morbidity" means maternal morbidity that constituted a life-threatening condition.

Sec. 34.002. MATERNAL MORTALITY AND MORBIDITY REVIEW BOARD. (a) The review board is a multidisciplinary advisory committee composed of the following 15 members:

(1) 13 members appointed by the commissioner as follows:

(A) four obstetricians, at least one of whom is a maternal fetal medicine specialist;

(B) one midwife;

(C) one registered nurse;

(D) one physician specializing in family practice;

(E) one mental health professional;

(F) one pathologist;

(G) one epidemiologist, biostatistician, or researcher of pregnancy-related deaths;

(H) one social worker or social service provider;

(I) one community advocate in a relevant field; and

(J) one medical examiner or coroner responsible for recording deaths;

(2) a representative of the department's family and community health programs; and

(3) the state epidemiologist for the department or the epidemiologist's designee.

(b) In appointing members to the review board, the commissioner shall:

(1) include members:

(A) working in and representing communities that:

(i) are diverse with regard to race, ethnicity, immigration status, and English proficiency; and

(ii) are severely affected by pregnancy-related deaths and severe maternal morbidity and by a lack of access to relevant perinatal and intrapartum care services; and

(B) from differing geographic regions in the state, including both rural and urban areas; and

(2) ensure that the composition of the board reflects the racial, ethnic, and linguistic diversity of this state.

(c) The commissioner shall appoint from among the review board members a presiding officer.

(d) A member of the review board is not entitled to compensation but is entitled to reimbursement for travel or other expenses incurred by the member while conducting the business of the review board, as provided by the General Appropriations Act. Reimbursement for a review board member's travel or other expenses shall be paid from funds appropriated to the department.

Sec. 34.003. TERMS; VACANCY. (a) Review board members appointed by the commissioner serve staggered six-year terms, with the terms of four or five members, as appropriate, expiring February 1 of each odd-numbered year.

(b) A review board member may serve more than one term.

(c) A vacancy on the review board shall be filled for the unexpired term in the same manner as the original appointment.

Sec. 34.004. MEETINGS. (a) The review board shall meet at least quarterly. The review board may meet at other times at the call of the commissioner.

(b) Meetings of the review board are closed to the public and are not subject to Chapter 551, Government Code.

Sec. 34.005. DUTIES OF REVIEW BOARD. (a) The review board shall:

(1) study and review pregnancy-related deaths and cases of severe maternal morbidity; and

(2) create recommendations for the prevention of pregnancy-related deaths and severe maternal morbidity.

(b) The review board shall develop standard procedures and criteria for the comprehensive, multidisciplinary review of pregnancy-related deaths and cases of severe maternal morbidity.

Sec. 34.006. CONSULTATIONS AND AGREEMENTS WITH OUTSIDE PARTIES. (a) The department and review board may consult with:

(1) anesthesiologists;

(2) intensivists or critical care physicians;

(3) nutritionists;

(4) substance abuse treatment specialists;

(5) hospital administrators;

(6) representatives of the state Medicaid program;

(7) paramedics or other emergency medical response personnel;

(8) lawyers;

(9) risk management specialists;

(10) representatives of local health departments and public health districts in this state;

(11) policy makers;

(12) public health experts; and

(13) government representatives or officials.

(b) In gathering information, the department and the review board may consult with representatives of relevant state professional associations, including:

(1) District XI of the American Congress of Obstetricians and Gynecologists;

(2) the Texas Nurses Association;

(3) the Texas Section of the Association of Women's Health, Obstetric and Neonatal Nurses;

(4) the Texas Academy of Family Physicians;

(5) the Consortium of Texas Certified Nurse-Midwives;

(6) the Association of Texas Midwives;

(7) the Texas Hospital Association;

(8) the Texas Medical Association; and

(9) the Texas Public Health Association.

(c) The department on behalf of the review board may enter into agreements with institutions of higher education consistent with the duties of the department or review board under this chapter.

Sec. 34.007. IDENTIFICATION AND REVIEW OF CASES. The department shall identify cases of pregnancy-related deaths and severe maternal morbidity for review. The department shall determine the appropriate number of cases for the review board to review to reflect a cross-section of pregnancy-related deaths and severe maternal morbidity cases in this state.

Sec. 34.008. OBTAINING DE-IDENTIFIED INFORMATION FOR REVIEW. (a) On selecting a case of pregnancy-related death or severe maternal morbidity for review, the department shall, in accordance with this section, obtain information relevant to the case to enable the review board to review the case. The department shall provide the information to the review board.

(b) The information provided to the review board may not include identifying information, including:

(1) the name, address, or date of birth of the patient or a member of the patient's family;

(2) the name of a health care provider; or

(3) the name or specific location of a facility that treated the patient.

(c) On the request of the department, a health care provider or other custodian of the requested information shall provide the information to the department. The information shall be provided without the authorization of the patient or the patient's family if the patient is deceased.

(d) A health care provider or other person who provides information to the department under this section is not subject to a civil action for damages or other relief for providing the information. This subsection does not apply if the information provided was false and the health care provider or other person knew or had reason to know that the information was false.

Sec. 34.009. CONFIDENTIALITY; PRIVILEGE. (a) Information is confidential for purposes of this chapter if the disclosure of the information would compromise the privacy of the individual who is the subject of the information or the individual's family. Confidential information includes any information pertaining to the pregnancy-related death or severe maternal morbidity.

(b) Confidential information that is acquired by the department and that permits the identification of an individual or health care provider is privileged and may not be disclosed to any person except to the extent necessary to carry out the purposes of this chapter. Information that may not be disclosed under this subsection includes:

(1) the name and address of a patient or a member of the patient's family;

(2) any service received by the patient or a member of the patient's family;

(3) the social and economic condition of the patient or a member of the patient's family;

(4) medical, dental, and mental health care information related to the patient or a member of the patient's family, including diagnoses, conditions, diseases, or disability; and

(5) the identity of a health care provider that provided any services to the patient or a member of the patient's family.

(c) Review board work product or information obtained by the department under this chapter, including information contained in an electronic database established and maintained under Section 34.012, or any other document or record, is confidential. This subsection does not prevent the review board or department from releasing information described by Subsection (d) or (e) or from submitting the report required by Section 34.015.

(d) Information is not confidential under this section if the information is general information that cannot be connected with any specific individual, case, or health care provider, such as:

(1) total expenditures made for specified purposes;

(2) the number of families served by particular health care providers or agencies;

(3) aggregated data on social and economic conditions;

(4) medical data and information related to health care services that do not include any identifying information relating to a patient or the patient's family; and

(5) other statistical information.

(e) The review board may publish statistical studies and research reports based on information that is confidential under this section, provided that the information:

(1) is published in aggregate;

(2) does not identify a patient or the patient's family; and

(3) does not include any information that could be used to identify a patient or the patient's family.

(f) The department shall adopt and implement practices and procedures to ensure that information that is confidential under this section is not disclosed in violation of this section.

(g) Information that is confidential under this section is excepted from disclosure under Chapter 552, Government Code, as provided by Section 552.101 of that chapter.

(h) The review board and the department shall comply with all state and federal laws and rules relating to the transmission of health information, including the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) and rules adopted under that Act.

Sec. 34.010. SUBPOENA AND DISCOVERY. (a) Review board work product or information that is confidential under Section 34.009 is privileged, is not subject to subpoena or discovery, and may not be introduced into evidence in any civil or criminal proceeding against a patient, a member of the family of a patient, or a health care provider.

(b) A document or other information that is otherwise available from another source is not protected from subpoena, discovery, or introduction into evidence under Subsection (a) solely because the document or other information was presented during a meeting of the review board or because a record of the document or other information is maintained by the review board.

Sec. 34.012. DATABASE OF DE-IDENTIFIED INFORMATION. (a) The department may establish and maintain an electronic database to track cases of pregnancy-related deaths and severe maternal morbidity to assist the department and review board in performing functions under this chapter.

(b) The information in the database may not include identifying information, including:

(1) the name of a patient;

(2) the name of a health care provider; or

(3) the name or specific location of a facility that treated a patient.

(c) The database may be accessed only by the department and the review board for the purposes described in this chapter.

Sec. 34.013. INAPPLICABILITY OF CHAPTER. This chapter does not apply to disclosure of records pertaining to voluntary or therapeutic termination of pregnancy, and those records may not be collected, maintained, or disclosed under this chapter.

Sec. 34.014. FUNDING. (a) The department shall apply for and use any available federal money to fund the duties of the department and the review board under this chapter.

(b) The department may accept gifts and grants from any source to fund the duties of the department and the review board under this chapter.

Sec. 34.015. REPORTS. (a) Not later than September 1 of each even-numbered year, the review board and the department shall submit a joint report on the findings of the review board under this chapter to the governor, lieutenant governor, speaker of the house of representatives, and appropriate committees of the legislature.

(b) The report must include the review board's recommendations to help reduce the incidence of pregnancy-related deaths and severe maternal morbidity in this state, including:

(1) potential legislation or rules; and

(2) best practices for health care providers and facilities that provide perinatal or intrapartum care.

(c) The department may disseminate the report to the relevant state professional associations listed in Section 34.006(b) in paper or electronic form.

Sec. 34.016. RULES. The executive commissioner may adopt rules to implement this chapter.

Sec. 34.017. DEPARTMENT ACCESS TO INFORMATION. Notwithstanding Chapter 108 or any other law, the department may have access to the following information that may reveal the identity of a patient to fulfill its duties under this chapter:

(1) birth records; and

(2) hospital discharge data.

SECTION 2. (a) Not later than September 1, 2012, the Department of State Health Services shall submit a report to the governor, lieutenant governor, speaker of the house of representatives, and appropriate committees of the legislature outlining:

(1) the department's progress in establishing the Maternal Mortality and Morbidity Review Board required by Chapter 34, Health and Safety Code, as added by this Act; and

(2) any recommendations for legislation to assist the department in studying pregnancy-related deaths and severe maternal morbidity.

(b) The Department of State Health Services and the Maternal Mortality and Morbidity Review Board created by Chapter 34, Health and Safety Code, as added by this Act, are not required to submit the first report required by Section 34.015, Health and Safety Code, as added by this Act, before September 1, 2014.

(c) Not later than December 1, 2011, the commissioner of state health services shall appoint the members of the Maternal Mortality and Morbidity Review Board in accordance with Section 34.002(a)(1), Health and Safety Code, as added by this Act. In making the initial appointments, the commissioner shall designate five members to serve terms expiring February 1, 2013, four members to serve terms expiring February 1, 2015, and four members to serve terms expiring February 1, 2017.

SECTION 3. This Act takes effect September 1, 2011.