BILL NUMBER: S4981

SPONSOR: BROUK
 
TITLE OF BILL:

An act to amend the public health law, in relation to treatment follow-
ing the confirmation of fetal or embryo death in utero; to amend the
public health law, in relation to requiring the commissioner of health
to establish a registry of facilities providing certain services and to
requiring hospitals to have healthcare providers on call to perform
certain procedures; and to amend the education law, in relation to
requiring training in certain procedures

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to ensure expected mothers who encounter
fetal deaths get the treatment they need, especially in the event of an
emergency.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. This act shall be known and may be cited as "Mickie's law."
              

Section 2. Amended to require healthcare providers to arrange for the
removal of dead fetus or embryo at the request of patient and is
medically approved.

Subdivision 1. Provider should remove dead fetus at the request of the
patient within 48 hours provided that it is medically advisable.

Subdivision 2. Provider must notify patient within 24 hours after iden-
tifying the results of fetus or embryo death and referring them to
another healthcare provider if not available to perform services.

Subdivision 3. Defines the term of healthcare provider for purposes of
this section.

Section 3. Section 2500 of the public health law is amended by adding a
new subdivision 5 that requires a registry of facilities that perform
surgical intervention procedures to remove the dead fetus or embryo.

Section 4. Section 2803-n of the public health law is amended by adding
a new subdivision 5 requiring obstetric care to have at least one
healthcare provider either present in the hospital or on call to remove
the dead fetus or embryo upon the expectant mother's request.

Section 5. The education law is amended by adding a new section 6524-a
that requires applicants obtaining a license to practice obstetrics,
gynecology or general surgery to receive training to perform dilation
and curettage and dilation and evacuation procedures.

Section 6. Sets forth the effective date.

 
JUSTIFICATION:

This bill has been named Mickie's Law in honor of the fetus loss of
parents who experienced challenges with medical support while visiting a
private out-of-state hospital for their routine check-up and were
informed of their fetus passing. The parents were told that a D&E proce-
dure was needed to remove the dead fetus. Due to religious beliefs of
the private hospital, the healthcare provider informed them that they
needed to visit a public hospital to have the procedure done. While
carrying the dead fetus, the parents searched for a hospital in New York
to quickly remove the fetus before approaching a window of time where
the decomposing fetus would create a toxic medical condition for the
expecting mother. Many of the public hospitals they spoke with indicated
that they had a scheduling conflict and were unable to perform the
procedure until the next 2 - 3 weeks. Although 2 weeks is within the
time frame that a mother can carry a dead fetus before it begins to
decompose, it can be traumatic for the parents to know that their baby
has died and is decaying in the womb. This type of mental distress can
become debilitating to the expecting mother which can cause additional
health challenges.  Fortunately, the parents were able to find a hospi-
tal that preformed the D&E procedure within 3 days after learning of his
passing. Many parents are not as fortunate in finding a facility or
provider to perform such procedure in a timely manner.

Challenges such as this have been known to be a contributing factor to
maternal mortality. In the United States, the alarming rate of maternal
mortality continues to increase; in 2020 23.8 deaths per 100,000 accord-
ing to the National Vital Statistics System. Even more alarming is the
rate of maternal mortality for Black women, who are three times more
likely than White women to die from a pregnancy-related cause. According
to the CDC, each year in the United States, about 700 expectant mothers
die during pregnancy or in the year after. Fetal mortality has slowly
decreased since 2019; however, according to a CDC study, Black women are
still the highest group to experience fetal death at 10.41 per 1,000
live births and fetal deaths.' Though the rate of Black women encounter-
ing these experiences have decreased from 2018 to 2019, rates are still
higher among mothers 40 to 44 years of age (9.06) and 45 years of age
and older (9.79), and lowest among mothers 30 to 34 years old (5.09)
which was reported by U.S News in 2021.

According to the American Medical Association Patient Rights Code of
Medical Ethics Opinion 1.1.3, patients have the right to make decisions
about the care the physician recommends and to have those decisions
respected. Patients also have the right to receive information from
their physicians and to have the opportunity to discuss the benefits,
risks, and costs of appropriate treatment alternatives, including the
risks, benefits and costs of forgoing treatment. It also states that
patients should be able to expect that their physicians will provide
guidance about what they consider the optimal course of action for the
patient based on the physician's objective professional judgment.

There are procedures that can remove a dead fetus. The first is a Dila-
tion and evacuation (D&E) which dilates the cervix and then evacuates
the fetus and the placenta from the uterus. The second is a Dilation and
curettage (D&C) which removes the tissue from inside of the uterus to
diagnose and treat certain uterine conditions - such as heavy bleeding -
or to clear the uterine lining after a miscarriage or abortion. Both
procedures are similar to that of an elective abortion. However, the
purpose is critically different. In 1973, the U.S. Supreme Court ruled
that the Constitution of the United States granted the right to have an
abortion. In 1992, the Supreme Court of the United States upheld the
right to have an abortion as established by the Roe v. Wade case in 1973
during the landmark case Planned Parenthood v. Casey, 505 U.S. 833.
After the Supreme Court's decision to overturn Roe v. Wade in 2022, it
has left many providers with questions. This is because any remains of a
fetus dead or viable is considered an abortion; however, women should
have the right to get the fetus removed. In the situation with a Texas
woman, she experienced a miscarriage and was denied medical intervention
due to a Texas anti-abortion law. In this cas e, the fetus was already
deceased in the womb thus, the procedure would not take a life away,
instead prevent possible health risks to the expectant mother. Although
we talk about abortions, we don't address dead fetus needing to be
aborted.

 
PRIOR LEGISLATIVE HISTORY:

2021-22: Referred to Rules.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become a law.

                                 
BILL NUMBER: S4981A

SPONSOR: BROUK
 
TITLE OF BILL:

An act to amend the public health law, in relation to requiring hospi-
tals to adopt, implement and periodically update standard protocols for
the management of fetal or embryo death in utero

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to ensure expected mothers who encounter
fetal deaths get the treatment they need, especially in the event of an
emergency.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. This act shall be known and may be cited as "Mickie's law."

Section 2. Amended to require healthcare providers to arrange for the
removal of dead fetus or embryo at the request of patient and is
medically approved.
              

Subdivision 1. Provider should remove dead fetus at the request of the
patient within 48 hours provided that it is medically advisable.

Subdivision 2. Provider must notify patient within 24 hours after iden-
tifying the results of fetus or embryo death and referring them to
another healthcare provider if not available to perform services.
Subdivision 3. Defines the term of healthcare provider for purposes of
this section.

Section 3. Section 2500 of the public health law is amended by adding a
new subdivision 5 that requires a registry of facilities that preform
surgical intervention procedure to remove the dead fetus or embryo.

Section 4. Section 2803-n of the public health law is amended by adding
a new subdivision 5 requiring obstetric care to have at least one
healthcare provider either present in the hospital or on call to remove
the dead fetus or embryo upon the expectant mother's request.

Section 5. The education law is amended by adding a new section 6524-a
that requires applicants obtaining a license to practice obstetrics,
gynecology or general surgery to receive training to preform dilation
and curettage and dilation and evacuation procedures.

Section 6. Sets forth the effective date.

 
JUSTIFICATION:

This bill has been named Mickie's Law in honor of the fetus loss of
parents who experienced challenges with medical support while visiting a
private out-of-state hospital for their routine check-up and were
informed of their fetus passing. The parents were told that a D&E proce-
dure was needed to remove the dead fetus. Due to religious beliefs of
the private hospital, the healthcare provider informed them that they
needed to visit a public hospital to have the procedure done. While
carrying the dead fetus, the parents searched for a hospital in New York
to quickly remove the fetus before approaching a window of time where
the decomposing fetus would create a toxic medical condition for the
expecting mother. Many of the public hospitals they spoke with indicated
that they had a scheduling conflict and were unable to perform the
procedure until the next 2 - 3 weeks. Although 2 weeks is within the
time frame that a mother can carry a dead fetus before it begins to
decompose, it can be traumatic for the parents to know that their baby
has died and is decaying in the womb. This type of mental distress can
become debilitating to the expecting mother which can cause additional
health challenges.  Fortunately, the parents were able to find a hospi-
tal that preformed the D&E procedure within 3 days after learning of his
passing. Many parents are not as fortunate in finding a facility or
provider to perform such procedure in a timely manner.

Challenges such as this have been known to be a contributing factor to
maternal mortality. In the United States, the alarming rate of maternal
mortality continues to increase; in 2020 23.8 deaths per 100,000 accord-
ing to the National Vital Statistics System. Even more alarming is the
rate of maternal mortality for Black women, who are three times more
likely than White women to die from a pregnancy-related cause. According
to the CDC, each year in the United States, about 700 expectant mothers
die during pregnancy or in the year after. Fetal mortality has slowly
decreased since 2019; however, according to a CDC study, Black women are
still the highest group to experience fetal death at 10.41 per 1,000
live births and fetal deaths.' Though the rate of Black women encounter-
ing these experiences have decreased from 2018 to 2019, rates are still
higher among mothers 40 to 44 years of age (9.06) and 45 years of age
and older (9.79), and lowest among mothers 30 to 34 years old
(5.09)which was reported by U.S News in 2021.

According to the American Medical Association Patient Rights Code of
Medical Ethics Opinion 1.1.3, patients have the right to make decisions-
about the care the physician recommends and to have those decisions
respected. Patients also have the right to receive information from
their physicians and to have opportunity to discuss the benefits, risks,
and costs of appropriate treatment alternatives, including the risks,
benefits and costs of forgoing treatment. It also states that patients
should be able to expect that their physicians will provide guidance
about what they consider the optimal course of action for the patient
based on the physician's objective professional judgment.

There are procedures that can remove a dead fetus. The first is a Dila-
tion and evacuation (D&E) which dilates the cervix and then evacuates
the fetus and the placenta from the uterus. The second is a Dilation and
curettage (D&C) which removes the tissue from inside of the uterus to
diagnose and treat certain uterine conditions - such as heavy bleeding
or to clear the uterine lining after a miscarriage or abortion. Both
procedures are similar to that of an elective abortion. However, the
purpose is critically different. In 1973, the U.S. Supreme Court ruled
that the Constitution of the United States granted the right to have an
abortion. In 1992, the Supreme Court of the United States upheld the
right to have an abortion as established by the Roe v. Wade case in 1973
during the landmark case Planned Parenthood v. Casey, 505 U.S. 833.
After the Supreme Court's decision to overturn Roe v. Wade in 2022, it
has left many providers with questions. This is because any remains of a
fetus dead or viable is considered an abortion; however, women should
have the right to get the fetus removed. In the situation with a Texas
woman, she experienced a miscarriage and was denied medical intervention
due to a Texas anti-abortion law. In this case, the fetus was already
deceased in the womb thus, the procedure would not take a life away,
instead prevent possible health risks to the expectant mother.  Although
we talk about abortions, we don't address dead fetus needing to be
aborted.

 
PRIOR LEGISLATIVE HISTORY:

S9581 of 2022 referred to rules. A10659 of 2022 referred to health.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall have
become a law.