By: Huffman, West S.B. No. 495
 
 
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 the 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 Subdivision
  (1), Subsection (b), Section 34.002, 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.