BILL NUMBER: S4498A

SPONSOR: RIVERA
 
TITLE OF BILL:  An act to amend the public health law, in relation to
the establishment of obstetric hemorrhage protocols; and providing for
the repeal of certain provisions upon the expiration thereof

 
PURPOSE:

Requires that hospitals adopt, implement, periodically update and submit
to the department standard protocols for management of obstetric hemor-
rhage.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill amends section 2803-n of the public health to
direct the Commissioner of Health in conjunction with clinical experts
to develop or identify management protocols and strategies related to
obstetric hemorrhages to be utilized by hospitals. Hospitals would be
directed to adopt, implement, and regularly update their protocols
related to obstetric hemorrhages, including a response plan for emergen-
              

cy transfers to facilities that can provide a higher level of care. The
Commissioner of Health would be directed to produce a biannual report to
the Legislature on the protocols and strategies developed and imple-
mented by this bill.

Section 2 of the bill sets forth the effective date.

 
JUSTIFICATION:

The United States has the largest maternal death rate among the world's
developed nations, with 26.4 deaths per 100,000 births. While other
countries have been improving, U.S. rates continue to worsen.  It is
estimated that over half of the 700 annual maternal deaths could have
been prevented by better care. In 2017, the American College of Obstet-
ricians and Gynecologists recommended all hospitals put in place "organ-
ized, systematic processes ... to help coordinate the response and
management of postpartum hemorrhage," the leading cause of maternal
mortality worldwide. According to the Department of Health, 97% of all
cases of obstetric hemorrhages occur at a hospital and are highly
preventable.

New York currently ranks 30th out of 50 states in its maternal death
rate. The rate of maternal mortalities in New York has risen from 15.4
per 100,000 live births in 2001-2003 to 19.6 per 100,000 in 2014-2016.
Between 2012-2014, hemorrhage accounted for 16% of maternal deaths. The
issue is compounded by significant racial and ethnic disparities, with
black women nearly 3.4 times more likely to die during pregnancy and
childbirth compared to white women.

One of the few states tackling this deadly issue head on is California.
Through their Material Quality Care Collaborative, which established an
obstetric hemorrhage toolkit, hospital best practices, and statewide
outreach, they were able to reduce severe maternal morbidity by 20.8%
over a two-year span. Despite the professional guidance and the wide-
spread knowledge that the California program has saved lives, many
hospitals still lack the proper protocols and training to properly iden-
tify and treat obstetric hemorrhage.

Hospitals in New York have begun working with the Department of Health
and the American College of Obstetricians and Gynecologist to do hands-
on simulation and to reinforce best practices on accurately quantifying
blood loss to reduce hemorrhage related deaths. While such voluntary
efforts are a positive step, more is needed to ensure every woman in the
state is provided the appropriate standard of care regardless of hospi-
tal. Formal guidance from the Department of Health, along with the
adoption of standard protocols in all hospitals will ensure hospitals
statewide are practicing proper care for obstetric hemorrhages. Recog-
nizing the need for similar protocols to address the increase in sepsis
deaths in our state, we were successful in reducing hospital mortality
rates. Using this model, we will see similar outcomes for maternal
mortality rates. This legislation, combined with legislation the Senate
passed establishing the Maternal Mortality Review Board, New York will
move into the modern era where women will not have to worry about making
it out of the delivery room.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect six months after enactment