Change of Law: Hospital Action Required
To: Chief Nursing Officers, Chief Medical Officers, Legal Counsel and Government Affairs staff
From: Lauren McDonald, Policy Director, Health Access, LaurenM@wsha.org | (206) 277-1821
Zosia Stanley, Associate General Counsel, ZosiaS@wsha.org | (206) 216-2511
Subject: New Requirements for Maternal Mortality Reviews Effective July 28, 2019
Purpose
This bulletin is to inform hospitals of new requirements to notify their local coroner or medical examiner regarding maternal deaths that occur on or after July 28, 2019.
Under Senate Bill 5425, hospitals and licensed birth centers must make “a reasonable and good faith effort” to report all maternal deaths that occur during pregnancy or within forty-two days of the end of pregnancy. The deaths must be reported to the local coroner or medical examiner within thirty-six hours.
WSHA supported this bill and worked with the Department of Health to ensure hospitals could comply with the new requirements.
Applicability/Scope
The new requirements to report maternal deaths to a facility’s local coroner or medical examiner apply to all hospitals and licensed birth centers in the state of Washington.
Hospitals must report maternal deaths including death of a woman occurring any time during pregnancy and up to forty-two days following the end of a pregnancy.
Recommendation
- Review this bulletin and develop a policy regarding the actions practitioners will be required to take to make a “reasonable and good faith effort” to determine whether the patient was pregnant at the time of death, or whether the patient had a pregnancy that ended within forty-two days of the patient’s death. The term “reasonable and good faith effort” is not defined in the law. See more information below for examples of actions you may want to consider including in your hospital’s policy.
- Determine your facility’s policy for documenting the efforts taken to determine whether a patient death occurred during pregnancy or whether the patient had a pregnancy that ended within forty-two days of the patient’s death.
- Determine your facility’s policy for who will notify the local coroner or medical examiner of any maternal deaths, and how the notification will take place.
Overview
The goal of this legislation is to allow the Maternal Mortality Review Panel to have better real-time access to information regarding maternal deaths and assess opportunities for prevention. Washington state’s Maternal Mortality Review Panel was established in 2016 to conduct comprehensive reviews of maternal deaths in Washington State, for the purposes of identifying causes of maternal deaths and recommending system changes to improve healthcare services for women. When this panel was established, the Department of Health (DOH) was given the authority to review available data to identify maternal deaths, and to request information regarding specific maternal deaths such as medical records and autopsy reports from hospitals and other health care facilities.
In 2019, the legislature amended this law to include a new requirement for hospitals and licensed birth centers to proactively provide information to the local coroner or medical examiner regarding maternal deaths, so that an investigation can be performed (such as an autopsy), and data can be submitted to the Panel for review.
The language in Section 1 of the bill reads:
(9)”For the purposes of the maternal mortality review, hospitals and licensed birth centers must make a reasonable and good faith effort to report all deaths that occur during pregnancy or within forty-two days of the end of pregnancy to the local coroner or medical examiner:
(a) These deaths must be reported within thirty-six hours after death.
(b) Local coroners or medical examiners to whom the death was reported must conduct a death investigation, with autopsy strongly recommended.
(c) Autopsies must follow the guidelines for performance of an autopsy published by the department of health.
(d) Reimbursement of these autopsies must be at one hundred percent to the counties for autopsy services.”
To satisfy the “reasonable and good faith effort” requirement, hospitals might consider including checking the medical record for any evidence of a pregnancy within the specified timeframe in their policy for providers. Hospitals may also want to include within their policies how practitioners will document what efforts were made to determine whether a patient death meets this definition in the medical record, in addition to who is responsible for notifying the local coroner or medical examiner within the 36-hour required timeframe and the method of notification.
The Maternal Mortality Review Panel will submit a report to DOH and the legislature every three years beginning on October 1, 2019 on maternal deaths and recommendations for quality improvements. WSHA is recognized as an entity that the Panel can share information with periodically to help inform quality improvement efforts.
WSHA’s 2019 New Law Implementation Guide
Please visit WSHA’s 2019 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
Background and References
- Senate Bill 5425
- Department of Health website for the Maternal Mortality Review Panel, including past reports
