S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8833
 
                           I N  A S S E M B L Y
 
                             January 18, 2024
                                ___________
 
 Introduced  by M. of A. FORREST -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the public health law, in relation to  requiring  hospi-
   tals  and other facilities that provide perinatal care to implement an
   evidence-based implicit bias program, to providing  expectant  mothers
   with  written  information  regarding  certain  patient rights, and to
   including information related to pregnancy on death certificates
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Article 25 of the public health law is amended by adding a
 new title 9 to read as follows:
                                  TITLE IX
             NEW YORK DIGNITY IN PREGNANCY AND CHILDBIRTH ACT
 SECTION 2599-E. SHORT TITLE.
         2599-F. LEGISLATIVE FINDINGS.
         2599-G. DEFINITIONS.
         2599-H. IMPLICIT BIAS PROGRAM.
         2599-I. DATA COLLECTION.
   § 2599-E. SHORT TITLE. THIS TITLE SHALL BE KNOWN AND MAY BE  CITED  AS
 THE "NEW YORK DIGNITY IN PREGNANCY AND CHILDBIRTH ACT".
   §  2599-F. LEGISLATIVE FINDINGS. 1. EVERY PERSON SHOULD BE ENTITLED TO
 DIGNITY AND RESPECT DURING AND AFTER PREGNANCY AND CHILDBIRTH.  PATIENTS
 SHOULD  RECEIVE THE BEST CARE POSSIBLE REGARDLESS OF THEIR RACE, GENDER,
 AGE, CLASS, SEXUAL ORIENTATION, GENDER  IDENTITY,  DISABILITY,  LANGUAGE
 PROFICIENCY,  NATIONALITY,  IMMIGRATION  STATUS,  GENDER  EXPRESSION, OR
 RELIGION.
   2.  WHILE MATERNAL HEALTH CONTINUES TO MAKE  GREAT  STRIDES  GLOBALLY,
 THE  UNITED STATES IS ONE OF THE ONLY NATIONS IN THE WORLD THAT HAS SEEN
 AN INCREASE IN MATERNAL MORTALITY OVER THE PAST SEVERAL DECADES.  TODAY,
 THE  UNITED STATES HAS THE HIGHEST MATERNAL MORTALITY RATE IN THE DEVEL-
 OPED  WORLD.    ACCORDING  TO  THE  CENTERS  FOR  DISEASE  CONTROL   AND
 PREVENTION,  MORE  THAN  ONE  THOUSAND TWO HUNDRED WOMEN DIE OF MATERNAL
 CASES EACH YEAR, AND ANOTHER FIFTY THOUSAND SUFFER FROM  SEVERE  COMPLI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13847-02-3
              

 A. 8833                             2
 
 CATIONS.    NATIONALLY  IT  IS  ESTIMATED  THAT SIXTY PERCENT (I.E., THE
 MAJORITY) OF PREGNANCY-RELATED DEATHS ARE PREVENTABLE.
   3.  FOR WOMEN OF COLOR, PARTICULARLY BLACK WOMEN, THE MATERNAL MORTAL-
 ITY RATE REMAINS THREE TO FOUR TIMES HIGHER THAN CAUCASIAN WOMEN. IN NEW
 YORK, THE MORTALITY RATE FOR BLACK WOMEN PER ONE HUNDRED THOUSAND BIRTHS
 IS 51.6, WHEREAS FOR CAUCASIAN WOMEN IT IS 15.9. NEW YORK HAS A  RESPON-
 SIBILITY  TO  DECREASE  THE  NUMBER OF PREVENTABLE PREGNANCY- AND CHILD-
 BIRTH-RELATED DEATHS.
   4. ACCESS TO PRENATAL CARE, SOCIOECONOMIC STATUS, AND GENERAL PHYSICAL
 HEALTH DO NOT FULLY EXPLAIN THE DISPARITY SEEN IN BLACK WOMEN'S MATERNAL
 MORTALITY AND MORBIDITY RATES. THERE IS A GROWING BODY OF EVIDENCE  THAT
 BLACK  WOMEN ARE OFTEN TREATED UNFAIRLY AND UNEQUALLY IN THE HEALTH CARE
 SYSTEM.
   5. IMPLICIT BIAS IS A DRIVER OF HEALTH DISPARITIES IN  COMMUNITIES  OF
 COLOR. AT PRESENT, HEALTH CARE PROVIDERS IN NEW YORK ARE NOT REQUIRED TO
 UNDERGO  ANY IMPLICIT BIAS TESTING OR TRAINING. NOR DOES THERE EXIST ANY
 SYSTEM TO TRACK THE NUMBER OF INCIDENTS  WHERE  IMPLICIT  PREJUDICE  AND
 IMPLICIT  STEREOTYPES  HAVE  LED  TO  NEGATIVE BIRTH AND MATERNAL HEALTH
 OUTCOMES.
   6. IT IS THE INTENT OF  THE  LEGISLATURE  TO  REDUCE  THE  EFFECTS  OF
 IMPLICIT  BIAS  IN PREGNANCY, CHILDBIRTH, AND POSTNATAL CARE SO THAT ALL
 PEOPLE ARE TREATED WITH DIGNITY AND RESPECT BY THEIR HEALTH CARE PROVID-
 ERS.
   § 2599-G. DEFINITIONS. FOR THE PURPOSES OF THIS TITLE,  THE  FOLLOWING
 TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   1.  "PREGNANCY-RELATED  DEATH" MEANS THE DEATH OF A PERSON WHILE PREG-
 NANT OR WITHIN THREE HUNDRED SIXTY-FIVE DAYS OF THE END OF A  PREGNANCY,
 IRRESPECTIVE  OF  THE  DURATION OR SITE OF THE PREGNANCY, FROM ANY CAUSE
 RELATED TO, OR AGGRAVATED BY, THE PREGNANCY OR ITS MANAGEMENT,  BUT  NOT
 FROM ACCIDENTAL OR INCIDENTAL CAUSES.
   2.  "IMPLICIT  BIAS" MEANS A BIAS IN JUDGMENT OR BEHAVIOR THAT RESULTS
 FROM  SUBTLE  COGNITIVE  PROCESSES,  INCLUDING  IMPLICIT  PREJUDICE  AND
 IMPLICIT  STEREOTYPES  THAT  OFTEN  OPERATE  AT  A LEVEL BELOW CONSCIOUS
 AWARENESS AND WITHOUT INTENTIONAL CONTROL.
   3. "IMPLICIT PREJUDICE" MEANS PREJUDICIAL NEGATIVE FEELINGS OR BELIEFS
 ABOUT A GROUP THAT A PERSON HOLDS WITHOUT BEING AWARE OF THEM.
   4. "IMPLICIT STEREOTYPES" MEAN THE UNCONSCIOUS ATTRIBUTIONS OF PARTIC-
 ULAR QUALITIES TO A MEMBER OF A CERTAIN SOCIAL  GROUP.  IMPLICIT  STERE-
 OTYPES  ARE  INFLUENCED  BY  EXPERIENCE AND ARE BASED ON LEARNED ASSOCI-
 ATIONS BETWEEN VARIOUS QUALITIES AND SOCIAL CATEGORIES,  INCLUDING  RACE
 OR GENDER.
   5.  "PERINATAL  CARE"  MEANS  THE  PROVISION OF CARE DURING PREGNANCY,
 LABOR, DELIVERY, AND POSTPARTUM AND NEONATAL PERIODS.
   § 2599-H. IMPLICIT BIAS PROGRAM. 1. A HOSPITAL OR OTHER FACILITY  THAT
 PROVIDES  PERINATAL CARE SHALL IMPLEMENT AN EVIDENCE-BASED IMPLICIT BIAS
 PROGRAM FOR ALL HEALTH CARE PROVIDERS INVOLVED IN THE PERINATAL CARE  OF
 PATIENTS WITHIN THOSE FACILITIES.
   2. AN IMPLICIT BIAS PROGRAM IMPLEMENTED PURSUANT TO SUBDIVISION ONE OF
 THIS SECTION SHALL INCLUDE ALL OF THE FOLLOWING:
   (A)  IDENTIFICATION  OF  PREVIOUS  OR  CURRENT  UNCONSCIOUS BIASES AND
 MISINFORMATION;
   (B) IDENTIFICATION OF PERSONAL, INTERPERSONAL,  INSTITUTIONAL,  STRUC-
 TURAL, AND CULTURAL BARRIERS TO INCLUSION;
   (C) CORRECTIVE MEASURES TO DECREASE IMPLICIT BIAS AT INTERPERSONAL AND
 INSTITUTIONAL  LEVELS, INCLUDING ONGOING POLICIES AND PRACTICES FOR THAT
 PURPOSE;
 A. 8833                             3
 
   (D) INFORMATION ON THE EFFECTS, INCLUDING, BUT NOT LIMITED TO, ONGOING
 PERSONAL  EFFECTS,  OF  HISTORICAL  AND   CONTEMPORARY   EXCLUSION   AND
 OPPRESSION OF MINORITY COMMUNITIES;
   (E)  INFORMATION  ABOUT  CULTURAL  IDENTITY  ACROSS  RACIAL  OR ETHNIC
 GROUPS;
   (F) INFORMATION ABOUT COMMUNICATING MORE  EFFECTIVELY  ACROSS  IDENTI-
 TIES, INCLUDING RACIAL, ETHNIC, RELIGIOUS, AND GENDER IDENTITIES;
   (G) DISCUSSION ON POWER DYNAMICS AND ORGANIZATIONAL DECISION MAKING;
   (H)  DISCUSSION  ON HEALTH INEQUITIES WITHIN THE PERINATAL CARE FIELD,
 INCLUDING INFORMATION ON HOW IMPLICIT BIAS IMPACTS MATERNAL  AND  INFANT
 HEALTH OUTCOMES;
   (I)  PERSPECTIVES OF DIVERSE, LOCAL CONSTITUENCY GROUPS AND EXPERTS ON
 PARTICULAR RACIAL, IDENTITY, CULTURAL, AND PROVIDER-COMMUNITY  RELATIONS
 ISSUES IN THE COMMUNITY; AND
   (J) INFORMATION ON REPRODUCTIVE JUSTICE.
   3.  A  HEALTH CARE PROVIDER INVOLVED IN THE PERINATAL CARE OF PATIENTS
 IN A HOSPITAL OR OTHER  FACILITY  THAT  PROVIDES  PERINATAL  CARE  SHALL
 COMPLETE  INITIAL  TRAINING  THROUGH THE IMPLICIT BIAS PROGRAM AS IMPLE-
 MENTED PURSUANT TO SUBDIVISION TWO OF THIS SECTION. UPON  COMPLETION  OF
 THE  INITIAL  TRAINING, A HEALTH CARE PROVIDER SHALL COMPLETE ADDITIONAL
 TRAINING THROUGH THE IMPLICIT BIAS PROGRAM EVERY TWO  YEARS  THEREAFTER,
 OR  ON  A  MORE  FREQUENT  BASIS  IF DEEMED NECESSARY BY THE HOSPITAL OR
 FACILITY, IN ORDER TO KEEP CURRENT WITH CHANGING RACIAL,  IDENTITY,  AND
 CULTURAL  TRENDS  AND  BEST  PRACTICES  IN  DECREASING INTERPERSONAL AND
 INSTITUTIONAL IMPLICIT BIAS.
   4. A HOSPITAL OR OTHER FACILITY THAT  PROVIDES  PERINATAL  CARE  SHALL
 PROVIDE  A  CERTIFICATE OF TRAINING COMPLETION BY A HEALTH CARE PROVIDER
 INVOLVED IN THE PERINATAL CARE OF PATIENTS TO ANOTHER  FACILITY  OR  THE
 PROVIDER  WHO ATTENDED THE TRAINING UPON REQUEST. A HOSPITAL OR FACILITY
 MAY ACCEPT A CERTIFICATE OF TRAINING COMPLETION FROM ANOTHER HOSPITAL OR
 OTHER FACILITY THAT PROVIDES PERINATAL  CARE  TO  SATISFY  THE  TRAINING
 REQUIRED  OF  HEALTH  CARE  PROVIDERS  INVOLVED IN THE PERINATAL CARE OF
 PATIENTS PURSUANT TO SUBDIVISION THREE OF THIS  SECTION  FROM  A  HEALTH
 CARE PROVIDER WHO WORKS IN MORE THAN ONE FACILITY.
   5.  NOTWITHSTANDING  SUBDIVISIONS  ONE,  TWO,  THREE  AND FOUR OF THIS
 SECTION, IF A HEALTH CARE PROVIDER INVOLVED IN  THE  PERINATAL  CARE  OF
 PATIENTS  IS  NOT  DIRECTLY  EMPLOYED  BY  A  HOSPITAL  OR FACILITY THAT
 PROVIDES PERINATAL CARE, THE HOSPITAL OR FACILITY WHERE THE HEALTH  CARE
 PROVIDER  PROVIDES SUCH CARE SHALL OFFER IMPLICIT BIAS TRAINING PURSUANT
 TO THIS SECTION TO SUCH HEALTH CARE PROVIDER.
   6. THE COMMISSIONER SHALL MONITOR IMPLEMENTATION OF  THIS  SECTION  BY
 FACILITIES  THAT  PROVIDE  PERINATAL  CARE  AND MAY INSPECT RECORDS FROM
 IMPLICIT BIAS TRAINING PROGRAMS OR REQUIRE SUCH HOSPITALS OR  FACILITIES
 TO  REPORT  TO  THE  COMMISSIONER ON THE IMPLICIT BIAS TRAINING PROGRAM,
 INCLUDING CONTINUING EDUCATION CURRICULA USED AND COURSES OFFERED PURSU-
 ANT TO THIS SECTION. INITIAL TRAINING PROVIDED PURSUANT TO THIS  SECTION
 SHALL BE MADE AVAILABLE TO HEALTH CARE PROVIDERS INVOLVED IN THE PERINA-
 TAL CARE WITHIN ONE YEAR OF THE EFFECTIVE DATE OF THIS TITLE.
   §  2599-I.  DATA  COLLECTION.  1.  THE  DEPARTMENT SHALL TRACK DATA ON
 SEVERE MATERNAL MORBIDITY, INCLUDING, BUT NOT LIMITED  TO,  ALL  OF  THE
 FOLLOWING HEALTH CONDITIONS:
   (A) OBSTETRIC HEMORRHAGE;
   (B) HYPERTENSION;
   (C) PREECLAMPSIA AND ECLAMPSIA;
   (D) VENOUS THROMBOEMBOLISM;
   (E) SEPSIS;
 A. 8833                             4
 
   (F) CEREBROVASCULAR ACCIDENT; AND
   (G) AMNIOTIC FLUID EMBOLISM.
   2.  THE DATA ON SEVERE MATERNAL MORBIDITY COLLECTED PURSUANT TO SUBDI-
 VISION ONE OF THIS SECTION SHALL BE PUBLISHED AT LEAST  ONCE  EVERY  TWO
 YEARS AFTER BOTH OF THE FOLLOWING HAVE OCCURRED:
   (A)  THE  DATA HAS BEEN AGGREGATED BY STATE REGIONS, AS DEFINED BY THE
 DEPARTMENT, TO ENSURE DATA REFLECTS HOW REGIONALIZED CARE SYSTEMS ARE OR
 SHOULD BE COLLABORATING TO IMPROVE MATERNAL HEALTH  OUTCOMES,  OR  OTHER
 SMALLER REGIONAL SORTING BASED ON STANDARD STATISTICAL METHODS FOR ACCU-
 RATE DISSEMINATION OF PUBLIC HEALTH DATA WITHOUT RISKING A CONFIDENTIAL-
 ITY OR OTHER DISCLOSURE BREACH; AND
   (B) THE DATA HAS BEEN DISAGGREGATED BY RACIAL AND ETHNIC IDENTITY.
   3.  THE  DEPARTMENT  SHALL  TRACK  DATA  ON  PREGNANCY-RELATED DEATHS,
 INCLUDING, BUT NOT LIMITED TO, ALL OF THE CONDITIONS LISTED IN  SUBDIVI-
 SION  ONE OF THIS SECTION, INDIRECT OBSTETRIC DEATHS, AND OTHER MATERNAL
 DISORDERS PREDOMINANTLY RELATED TO PREGNANCY AND COMPLICATIONS  PREDOMI-
 NANTLY RELATED TO THE PUERPERIUM.
   4. THE DATA ON PREGNANCY-RELATED DEATHS COLLECTED PURSUANT TO SUBDIVI-
 SIONS  ONE  AND  THREE  OF THIS SECTION SHALL BE PUBLISHED AT LEAST ONCE
 EVERY THREE YEARS AFTER BOTH OF THE FOLLOWING HAVE OCCURRED:
   (A) THE DATA HAS BEEN AGGREGATED BY STATE REGIONS, AS DEFINED  BY  THE
 DEPARTMENT, TO ENSURE DATA REFLECTS HOW REGIONALIZED CARE SYSTEMS ARE OR
 SHOULD  BE  COLLABORATING  TO IMPROVE MATERNAL HEALTH OUTCOMES, OR OTHER
 SMALLER REGIONAL SORTING BASED ON STANDARD STATISTICAL METHODS FOR ACCU-
 RATE DISSEMINATION OF PUBLIC HEALTH DATA WITHOUT RISKING A CONFIDENTIAL-
 ITY OR OTHER DISCLOSURE BREACH; AND
   (B) THE DATA HAS BEEN DISAGGREGATED BY RACIAL AND ETHNIC IDENTITY.
   § 2. Section 2803-n of the public health law is amended by adding  two
 new subdivisions 5 and 6 to read as follows:
   5.  EACH  HOSPITAL SHALL PROVIDE EACH EXPECTANT MOTHER, UPON ADMISSION
 OR AS SOON THEREAFTER AS  REASONABLY  PRACTICABLE,  WRITTEN  INFORMATION
 REGARDING THE PATIENT'S RIGHT TO THE FOLLOWING:
   (A)  TO  BE  INFORMED OF CONTINUING HEALTH CARE REQUIREMENTS FOLLOWING
 DISCHARGE FROM THE HOSPITAL;
   (B) TO AUTHORIZE THAT A FRIEND OR FAMILY MEMBER MAY BE PROVIDED INFOR-
 MATION ABOUT THE PATIENT'S CONTINUING HEALTH CARE REQUIREMENTS FOLLOWING
 DISCHARGE FROM THE HOSPITAL;
   (C) TO PARTICIPATE ACTIVELY IN DECISIONS REGARDING  MEDICAL  CARE.  TO
 THE  EXTENT  PERMITTED  BY LAW, PARTICIPATION SHALL INCLUDE THE RIGHT TO
 REFUSE TREATMENT;
   (D) APPROPRIATE PAIN ASSESSMENT AND TREATMENT;
   (E) TO BE FREE FROM DISCRIMINATION ON THE BASIS OF RACE, COLOR,  RELI-
 GION,  ANCESTRY, NATIONAL ORIGIN, DISABILITY, MEDICAL CONDITION, GENETIC
 INFORMATION,  MARITAL  STATUS,  SEX,  GENDER,  GENDER  IDENTITY,  GENDER
 EXPRESSION,  SEXUAL ORIENTATION, CITIZENSHIP, PRIMARY LANGUAGE, OR IMMI-
 GRATION STATUS; AND
   (F) TO FILE A COMPLAINT WITH THE DEPARTMENT OF HEALTH AND THE  MEDICAL
 BOARD OF NEW YORK AND INFORMATION ON HOW TO FILE THE COMPLAINT.
   6.  EACH  HOSPITAL SHALL PROVIDE EACH EXPECTANT MOTHER, UPON ADMISSION
 OR AS SOON THEREAFTER AS  REASONABLY  PRACTICABLE,  WRITTEN  INFORMATION
 REGARDING THE HOSPITAL'S POLICIES AND PROCEDURES FOR CONTACTING NEXT  OF
 KIN REGARDING PREGNANCY-RELATED DEATHS, AND HOW TO SEEK LEGAL COUNSEL IN
 THE EVENT OF ANY PREGNANCY-RELATED DEATHS OR INJURIES.
   § 3. Subdivision 4 of section 4141 of the public health law is amended
 by adding a new paragraph (e) to read as follows:
 A. 8833                             5
 
   (E)  THE  MEDICAL  CERTIFICATE  SHALL  INCLUDE  INFORMATION INDICATING
 WHETHER THE DECEDENT WAS PREGNANT AT THE TIME OF DEATH, OR WITHIN A YEAR
 PRIOR TO THE DEATH, IF KNOWN, AS DETERMINED BY OBSERVATION, AUTOPSY,  OR
 REVIEW OF THE MEDICAL RECORD. THIS PARAGRAPH SHALL NOT BE INTERPRETED TO
 REQUIRE THE PERFORMANCE OF A PREGNANCY TEST ON A DECEDENT, OR TO REQUIRE
 A REVIEW OF MEDICAL RECORDS IN ORDER TO DETERMINE PREGNANCY.
   § 4. This act shall take effect immediately.