Add Art 25 Title 9 §§2599-e - 2599-i, amd §§2803-n & 4141, Pub Health L
Establishes the New York dignity in pregnancy and childbirth act to require hospitals and other facilities that provide perinatal care to implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities; requires hospitals to provide expectant mothers with written information regarding certain patient rights; requires information related to pregnancy, if known, to be included on death certificates.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8833
SPONSOR: Forrest TITLE OF BILL:
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
PURPOSE OR GENERAL IDEA OF BILL:
To require healthcare facilities that provide perinatal care to imple-
ment evidence-based implicit bias programs and to inform patients of
their rights to reduce the instances of maternal mortality for Black
mothers and their babies.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 adds a new title to article 25 of the public health law titled
"New York Dignity in Pregnancy and Childbirth Act".
Section 2 adds two new subdivisions to section 2803-n of the public
health law requiring hospitals to inform expectant mothers of their
rights, to provide information about how to file complaints if those
rights are violated, to provide information regarding the hospital's
policies and procedures for contacting next of kin, and to provide
information related to seeking legal counsel.
Section 3 adds a new paragraph to subdivision 4 of section 4141 of the
public health law requiring certificates of death to include information
about pregnancy status at the time of death.
Section 4 sets the effective date.
JUSTIFICATION:
Every person is entitled to dignity and respect during and after preg-
nancy 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. For women of color, particularly
Black women, the maternal mortality rate remains three to four times
higher than the rate for 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 responsibility to
decrease the number of preventable pregnancy- and childbirth-related
deaths. Studies have repeatedly highlighted the existence of these
disparities, with Black women and their babies, in particular, facing
significantly higher risks of complications and mortality. Despite
controlling for socioeconomic status, access to care, and overall
health, these disparities persist, indicating that systemic issues such
as implicit bias play a role in shaping these outcomes.
Implicit racial bias training is crucial for pregnancy and childbirth
workers due to its potential to significantly decrease racial and ethnic
disparities in maternal and infant health outcomes. Implicit biases are
unconscious attitudes or stereotypes that affect our understanding,
actions, and decisions. In the context of healthcare, these biases can
influence the quality of care that a provider delivers. For example, a
provider might unintentionally under-assess a patient's pain or dismiss
their concerns based on their racial or ethnic identity. This could lead
to delayed diagnoses, inappropriate treatment plans, and overall lower
quality of care. For pregnant women, these biases can translate into
higher rates of severe maternal morbidity and mortality.
By requiring hospitals and other facilities that provide perinatal care
to implement evidence-based implicit bias training programs, healthcare
providers can become aware of their unconscious biases and learn strate-
gies to mitigate their impact. This can foster more open communication
with patients, leading to improved patient satisfaction and trust. In
the long term, addressing these biases can contribute to health equity,
ensuring that every woman-regardless of her racial or ethnic back-
ground-receives high-quality, respectful care during pregnancy and
childbirth. In turn, this can help reduce the stark disparities in
maternal and infant health outcomes currently seen.
PRIOR LEGISLATIVE HISTORY:
None
FISCAL IMPLICATIONS:
TBD
EFFECTIVE DATE:
Immediately
STATE OF NEW YORK
________________________________________________________________________
8833
IN ASSEMBLY
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:
1 Section 1. Article 25 of the public health law is amended by adding a
2 new title 9 to read as follows:
3 TITLE IX
4 NEW YORK DIGNITY IN PREGNANCY AND CHILDBIRTH ACT
5 Section 2599-e. Short title.
6 2599-f. Legislative findings.
7 2599-g. Definitions.
8 2599-h. Implicit bias program.
9 2599-i. Data collection.
10 § 2599-e. Short title. This title shall be known and may be cited as
11 the "New York dignity in pregnancy and childbirth act".
12 § 2599-f. Legislative findings. 1. Every person should be entitled to
13 dignity and respect during and after pregnancy and childbirth. Patients
14 should receive the best care possible regardless of their race, gender,
15 age, class, sexual orientation, gender identity, disability, language
16 proficiency, nationality, immigration status, gender expression, or
17 religion.
18 2. While maternal health continues to make great strides globally,
19 the United States is one of the only nations in the world that has seen
20 an increase in maternal mortality over the past several decades. Today,
21 the United States has the highest maternal mortality rate in the devel-
22 oped world. According to the Centers for Disease Control and
23 Prevention, more than one thousand two hundred women die of maternal
24 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
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1 cations. Nationally it is estimated that sixty percent (i.e., the
2 majority) of pregnancy-related deaths are preventable.
3 3. For women of color, particularly Black women, the maternal mortal-
4 ity rate remains three to four times higher than Caucasian women. In New
5 York, the mortality rate for Black women per one hundred thousand births
6 is 51.6, whereas for Caucasian women it is 15.9. New York has a respon-
7 sibility to decrease the number of preventable pregnancy- and child-
8 birth-related deaths.
9 4. Access to prenatal care, socioeconomic status, and general physical
10 health do not fully explain the disparity seen in Black women's maternal
11 mortality and morbidity rates. There is a growing body of evidence that
12 Black women are often treated unfairly and unequally in the health care
13 system.
14 5. Implicit bias is a driver of health disparities in communities of
15 color. At present, health care providers in New York are not required to
16 undergo any implicit bias testing or training. Nor does there exist any
17 system to track the number of incidents where implicit prejudice and
18 implicit stereotypes have led to negative birth and maternal health
19 outcomes.
20 6. It is the intent of the legislature to reduce the effects of
21 implicit bias in pregnancy, childbirth, and postnatal care so that all
22 people are treated with dignity and respect by their health care provid-
23 ers.
24 § 2599-g. Definitions. For the purposes of this title, the following
25 terms shall have the following meanings:
26 1. "Pregnancy-related death" means the death of a person while preg-
27 nant or within three hundred sixty-five days of the end of a pregnancy,
28 irrespective of the duration or site of the pregnancy, from any cause
29 related to, or aggravated by, the pregnancy or its management, but not
30 from accidental or incidental causes.
31 2. "Implicit bias" means a bias in judgment or behavior that results
32 from subtle cognitive processes, including implicit prejudice and
33 implicit stereotypes that often operate at a level below conscious
34 awareness and without intentional control.
35 3. "Implicit prejudice" means prejudicial negative feelings or beliefs
36 about a group that a person holds without being aware of them.
37 4. "Implicit stereotypes" mean the unconscious attributions of partic-
38 ular qualities to a member of a certain social group. Implicit stere-
39 otypes are influenced by experience and are based on learned associ-
40 ations between various qualities and social categories, including race
41 or gender.
42 5. "Perinatal care" means the provision of care during pregnancy,
43 labor, delivery, and postpartum and neonatal periods.
44 § 2599-h. Implicit bias program. 1. A hospital or other facility that
45 provides perinatal care shall implement an evidence-based implicit bias
46 program for all health care providers involved in the perinatal care of
47 patients within those facilities.
48 2. An implicit bias program implemented pursuant to subdivision one of
49 this section shall include all of the following:
50 (a) identification of previous or current unconscious biases and
51 misinformation;
52 (b) identification of personal, interpersonal, institutional, struc-
53 tural, and cultural barriers to inclusion;
54 (c) corrective measures to decrease implicit bias at interpersonal and
55 institutional levels, including ongoing policies and practices for that
56 purpose;
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1 (d) information on the effects, including, but not limited to, ongoing
2 personal effects, of historical and contemporary exclusion and
3 oppression of minority communities;
4 (e) information about cultural identity across racial or ethnic
5 groups;
6 (f) information about communicating more effectively across identi-
7 ties, including racial, ethnic, religious, and gender identities;
8 (g) discussion on power dynamics and organizational decision making;
9 (h) discussion on health inequities within the perinatal care field,
10 including information on how implicit bias impacts maternal and infant
11 health outcomes;
12 (i) perspectives of diverse, local constituency groups and experts on
13 particular racial, identity, cultural, and provider-community relations
14 issues in the community; and
15 (j) information on reproductive justice.
16 3. A health care provider involved in the perinatal care of patients
17 in a hospital or other facility that provides perinatal care shall
18 complete initial training through the implicit bias program as imple-
19 mented pursuant to subdivision two of this section. Upon completion of
20 the initial training, a health care provider shall complete additional
21 training through the implicit bias program every two years thereafter,
22 or on a more frequent basis if deemed necessary by the hospital or
23 facility, in order to keep current with changing racial, identity, and
24 cultural trends and best practices in decreasing interpersonal and
25 institutional implicit bias.
26 4. A hospital or other facility that provides perinatal care shall
27 provide a certificate of training completion by a health care provider
28 involved in the perinatal care of patients to another facility or the
29 provider who attended the training upon request. A hospital or facility
30 may accept a certificate of training completion from another hospital or
31 other facility that provides perinatal care to satisfy the training
32 required of health care providers involved in the perinatal care of
33 patients pursuant to subdivision three of this section from a health
34 care provider who works in more than one facility.
35 5. Notwithstanding subdivisions one, two, three and four of this
36 section, if a health care provider involved in the perinatal care of
37 patients is not directly employed by a hospital or facility that
38 provides perinatal care, the hospital or facility where the health care
39 provider provides such care shall offer implicit bias training pursuant
40 to this section to such health care provider.
41 6. The commissioner shall monitor implementation of this section by
42 facilities that provide perinatal care and may inspect records from
43 implicit bias training programs or require such hospitals or facilities
44 to report to the commissioner on the implicit bias training program,
45 including continuing education curricula used and courses offered pursu-
46 ant to this section. Initial training provided pursuant to this section
47 shall be made available to health care providers involved in the perina-
48 tal care within one year of the effective date of this title.
49 § 2599-i. Data collection. 1. The department shall track data on
50 severe maternal morbidity, including, but not limited to, all of the
51 following health conditions:
52 (a) obstetric hemorrhage;
53 (b) hypertension;
54 (c) preeclampsia and eclampsia;
55 (d) venous thromboembolism;
56 (e) sepsis;
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1 (f) cerebrovascular accident; and
2 (g) amniotic fluid embolism.
3 2. The data on severe maternal morbidity collected pursuant to subdi-
4 vision one of this section shall be published at least once every two
5 years after both of the following have occurred:
6 (a) the data has been aggregated by state regions, as defined by the
7 department, to ensure data reflects how regionalized care systems are or
8 should be collaborating to improve maternal health outcomes, or other
9 smaller regional sorting based on standard statistical methods for accu-
10 rate dissemination of public health data without risking a confidential-
11 ity or other disclosure breach; and
12 (b) the data has been disaggregated by racial and ethnic identity.
13 3. The department shall track data on pregnancy-related deaths,
14 including, but not limited to, all of the conditions listed in subdivi-
15 sion one of this section, indirect obstetric deaths, and other maternal
16 disorders predominantly related to pregnancy and complications predomi-
17 nantly related to the puerperium.
18 4. The data on pregnancy-related deaths collected pursuant to subdivi-
19 sions one and three of this section shall be published at least once
20 every three years after both of the following have occurred:
21 (a) the data has been aggregated by state regions, as defined by the
22 department, to ensure data reflects how regionalized care systems are or
23 should be collaborating to improve maternal health outcomes, or other
24 smaller regional sorting based on standard statistical methods for accu-
25 rate dissemination of public health data without risking a confidential-
26 ity or other disclosure breach; and
27 (b) the data has been disaggregated by racial and ethnic identity.
28 § 2. Section 2803-n of the public health law is amended by adding two
29 new subdivisions 5 and 6 to read as follows:
30 5. Each hospital shall provide each expectant mother, upon admission
31 or as soon thereafter as reasonably practicable, written information
32 regarding the patient's right to the following:
33 (a) to be informed of continuing health care requirements following
34 discharge from the hospital;
35 (b) to authorize that a friend or family member may be provided infor-
36 mation about the patient's continuing health care requirements following
37 discharge from the hospital;
38 (c) to participate actively in decisions regarding medical care. To
39 the extent permitted by law, participation shall include the right to
40 refuse treatment;
41 (d) appropriate pain assessment and treatment;
42 (e) to be free from discrimination on the basis of race, color, reli-
43 gion, ancestry, national origin, disability, medical condition, genetic
44 information, marital status, sex, gender, gender identity, gender
45 expression, sexual orientation, citizenship, primary language, or immi-
46 gration status; and
47 (f) to file a complaint with the department of health and the medical
48 board of New York and information on how to file the complaint.
49 6. Each hospital shall provide each expectant mother, upon admission
50 or as soon thereafter as reasonably practicable, written information
51 regarding the hospital's policies and procedures for contacting next of
52 kin regarding pregnancy-related deaths, and how to seek legal counsel in
53 the event of any pregnancy-related deaths or injuries.
54 § 3. Subdivision 4 of section 4141 of the public health law is amended
55 by adding a new paragraph (e) to read as follows:
A. 8833 5
1 (e) The medical certificate shall include information indicating
2 whether the decedent was pregnant at the time of death, or within a year
3 prior to the death, if known, as determined by observation, autopsy, or
4 review of the medical record. This paragraph shall not be interpreted to
5 require the performance of a pregnancy test on a decedent, or to require
6 a review of medical records in order to determine pregnancy.
7 § 4. This act shall take effect immediately.
