83R16510 JSC-F
By: Walle, S. Davis of Harris H.B. No. 1085
Substitute the following for H.B. No. 1085:
By: Naishtat C.S.H.B. No. 1085
A BILL TO BE ENTITLED
AN ACT
relating to the creation of a task force 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 TASK FORCE
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) "Health care provider" means an individual or
facility licensed, certified, or otherwise authorized to
administer health care, for profit or otherwise, in the ordinary
course of business or professional practice, including a physician
or a hospital or birthing center.
(5) "Institution of higher education" has the meaning
assigned by Section 61.003, Education Code.
(6) "Intrapartum care" has the meaning assigned by
Section 32.002.
(7) "Life-threatening condition" means a condition
from which the likelihood of death is probable unless the course of
the condition is interrupted.
(8) "Maternal morbidity" means a pregnancy-related
health condition occurring during pregnancy, labor, or delivery or
within one year of delivery or end of pregnancy.
(9) "Patient" means the woman who while pregnant or
within one year of delivery or end of pregnancy suffers death or
severe maternal morbidity.
(10) "Perinatal care" has the meaning assigned by
Section 32.002.
(11) "Physician" means a person licensed to practice
medicine in this state under Subtitle B, Title 3, Occupations Code.
(12) "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.
(13) "Severe maternal morbidity" means maternal
morbidity that constitutes a life-threatening condition.
(14) "Task force" means the Maternal Mortality and
Morbidity Task Force.
Sec. 34.002. MATERNAL MORTALITY AND MORBIDITY TASK FORCE.
(a) The Maternal Mortality and Morbidity Task Force is administered
by the department.
(b) The task force is a multidisciplinary advisory
committee within the department and is composed of the following 15
members:
(1) 13 members appointed by the commissioner as
follows:
(A) four physicians specializing in obstetrics,
at least one of whom is a maternal fetal medicine specialist;
(B) one certified nurse-midwife;
(C) one registered nurse;
(D) one physician specializing in family
practice;
(E) one physician specializing in psychiatry;
(F) one physician specializing in pathology;
(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.
(c) In appointing members to the task force, the
commissioner shall:
(1) include members:
(A) working in and representing communities that
are diverse with regard to race, ethnicity, immigration status, and
English proficiency; and
(B) from differing geographic regions in the
state, including both rural and urban areas;
(2) endeavor to include members who are working in and
representing communities that are affected by pregnancy-related
deaths and severe maternal morbidity and by a lack of access to
relevant perinatal and intrapartum care services; and
(3) ensure that the composition of the task force
reflects the racial, ethnic, and linguistic diversity of this
state.
(d) The commissioner shall appoint from among the task force
members a presiding officer.
(e) A member of the task force appointed under Subsection
(b)(1) is not entitled to compensation for service on the task force
or reimbursement for travel or other expenses incurred by the
member while conducting the business of the task force.
(f) In carrying out its duties, the task force may use
technology, including teleconferencing or videoconferencing, to
eliminate travel expenses.
Sec. 34.003. TERMS; VACANCY. (a) Task force 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 task force member may serve more than one term.
(c) A vacancy on the task force shall be filled for the
unexpired term in the same manner as the original appointment.
Sec. 34.004. MEETINGS. (a) The task force shall meet at
least quarterly. The task force may meet at other times at the call
of the commissioner.
(b) Meetings of the task force are closed to the public and
are not subject to Chapter 551, Government Code.
Sec. 34.005. DUTIES OF TASK FORCE. The task force shall:
(1) study and review:
(A) cases of pregnancy-related deaths; and
(B) trends in severe maternal morbidity;
(2) determine the feasibility of the task force
studying cases of severe maternal morbidity; and
(3) make recommendations to help reduce the incidence
of pregnancy-related deaths and severe maternal morbidity in this
state.
Sec. 34.006. CONSULTATIONS AND AGREEMENTS WITH OUTSIDE
PARTIES. (a) The department and task force may consult with any
relevant experts and stakeholders, including:
(1) anesthesiologists;
(2) intensivists or critical care physicians;
(3) nutritionists;
(4) substance abuse treatment specialists;
(5) hospital staff or employees;
(6) representatives of the state Medicaid program;
(7) paramedics or other emergency medical response
personnel;
(8) hospital-based risk management specialists;
(9) representatives of local health departments and
public health districts in this state;
(10) public health experts;
(11) government representatives or officials; and
(12) law enforcement officials.
(b) In gathering information, the department and task force
may consult with representatives of any relevant state professional
associations and organizations, including:
(1) District XI of the American Congress of
Obstetricians and Gynecologists;
(2) the Texas Association of Obstetricians and
Gynecologists;
(3) the Texas Nurses Association;
(4) the Texas Section of the Association of Women's
Health, Obstetric and Neonatal Nurses;
(5) the Texas Academy of Family Physicians;
(6) the Texas Pediatric Society;
(7) the Consortium of Texas Certified Nurse-Midwives;
(8) the Association of Texas Midwives;
(9) the Texas Hospital Association;
(10) the Texas Medical Association; and
(11) the Texas Public Health Association.
(c) In consulting with individuals or organizations under
Subsection (a) or (b), a member of the task force or employee of the
department may not disclose any identifying information of a
patient or health care provider.
(d) The department on behalf of the task force may enter
into agreements with institutions of higher education or other
organizations consistent with the duties of the department or task
force under this chapter.
Sec. 34.007. SELECTION AND REVIEW OF CASES. (a) The
department shall determine a statistically significant number of
cases of pregnancy-related deaths for review. The department shall
randomly select cases for the task force to review under this
subsection to reflect a cross-section of pregnancy-related deaths
in this state.
(b) The department shall analyze aggregate data of severe
maternal morbidity in this state to identify any trends.
(c) If feasible, the department may select cases of severe
maternal morbidity for review. In selecting cases under this
subsection, the department shall randomly select cases for the task
force to review to reflect trends identified under Subsection (b).
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 task force to review the case. The department
shall provide the information to the task force.
(b) The information provided to the task force may not
include identifying information of a patient or health care
provider, including:
(1) the name, address, or date of birth of the patient
or a member of the patient's family; or
(2) the name or specific location of a health care
provider that treated the patient.
(c) On the request of the department, a hospital, birthing
center, 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, if the
patient is deceased, without the authorization of the patient's
family.
(d) A person who provides information to the department
under this section is not subject to an administrative, civil, or
criminal action for damages or other relief for providing the
information.
Sec. 34.009. CONFIDENTIALITY; PRIVILEGE. (a) Any
information pertaining to a pregnancy-related death or severe
maternal morbidity is confidential for purposes of this chapter.
(b) Confidential information that is acquired by the
department and that includes identifying information of an
individual or health care provider is privileged and may not be
disclosed to any person. 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) Task force 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 task force 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 task force 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;
(3) does not include any information that could be
used to identify a patient or the patient's family; and
(4) does not identify a health care provider.
(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 task force 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. Task force 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 administrative, civil, or criminal
proceeding against a patient, a member of the family of a patient,
or a health care provider.
Sec. 34.011. IMMUNITY. (a) A member of the task force or a
person employed by or acting in an advisory capacity to the task
force and who provides information, counsel, or services to the
task force is not liable for damages for an action taken within the
scope of the functions of the task force.
(b) Subsection (a) does not apply if the person acts with
malice or without the reasonable belief that the action is
warranted by the facts known to the person.
(c) This section does not provide immunity to a person
described by Subsection (a) for a violation of a state or federal
law or rule relating to the privacy of health information or 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. 34.012. 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 task force in performing
functions under this chapter.
(b) The information in the database may not include
identifying information, including:
(1) the name of a patient; or
(2) the name or specific location of a health care
provider that treated a patient.
(c) The database may be accessed only by the department and
the task force 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 task force under this chapter.
(b) The department may accept gifts and grants from any
source to fund the duties of the department and the task force under
this chapter.
Sec. 34.015. REPORTS. (a) Not later than September 1 of
each even-numbered year, the task force and the department shall
submit a joint report on the findings of the task force 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 task force's
recommendations under Section 34.005(a)(3).
(c) The department shall disseminate the report to the state
professional associations and organizations listed in Section
34.006(b) and make the report publicly available 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. (a)
Notwithstanding Chapter 108 or any other law, the department may
have access to the following information that may include the
identity of a patient to fulfill its duties under this chapter:
(1) birth records;
(2) fetal death records;
(3) maternal death records; and
(4) hospital and birthing center discharge data.
(b) The department may not disclose the information
described by Subsection (a) to the task force or any other person.
Sec. 34.018. SUNSET PROVISION. The task force is subject to
Chapter 325, Government Code (Texas Sunset Act). Unless continued
in existence as provided by that chapter, the task force is
abolished and this chapter expires September 1, 2019.
SECTION 2. (a) Not later than September 1, 2014, 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 Task Force 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 Task Force 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, 2016.
(c) Not later than December 1, 2013, the commissioner of
state health services shall appoint the members of the Maternal
Mortality and Morbidity Task Force in accordance with Section
34.002(b)(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, 2015, four members
to serve terms expiring February 1, 2017, and four members to serve
terms expiring February 1, 2019.
SECTION 3. This Act takes effect September 1, 2013.