New Mexico Register / Volume XXXIII,
Issue 21 / November 8, 2022
TITLE 7 HEALTH
CHAPTER 4 DISEASE CONTROL (EPIDEMIOLOGY)
PART 8 MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY
REVIEW
7.4.8.1 ISSUING AGENCY:
Department of Health, Public Health Division,
Family Health Bureau.
[7.4.8.1 - N, NMAC, 11/08/2022]
7.4.8.2 SCOPE:
These regulations shall apply to the New
Mexico maternal mortality review committee; any department staff or contractors
engaged in supporting committee activities; and any public or private entity
from whom information may be requested to conduct maternal mortality and
morbidity reviews. These regulations supersede any other
regulations previously promulgated by the department related to the operations
of the New Mexico maternal mortality review committee.
[7.4.8.2 - N, NMAC, 11/08/2022]
7.4.8.3 STATUTORY AUTHORITY: The regulations set
forth herein are promulgated by the secretary of the department of health by
the authority of Subsection F of Section 9-7-6 NMSA 1978 and implement the
Public Health Act, Section 24-1-3 NMSA 1978, as amended, and the Maternal
Mortality and Morbidly Prevention Act Section 24-32-1 to 24-32-5, NMSA 1978.
[7.4.8.3 - N, NMAC, 11/08/2022]
7.4.8.4 DURATION:
Permanent.
[7.4.8.4 - N, NMAC, 11/08/2022]
7.4.8.5 EFFECTIVE DATE:
November 8, 2022, unless a later date is
cited at the end of a section.
[7.4.8.5- N, NMAC, 11/08/2022]
7.4.8.6 OBJECTIVE:
These regulations are promulgated
pursuant to statute to define and support the maternal mortality review
committee, the purpose of which is to comprehensively review and analyze deaths
that occur during pregnancy, childbirth and the year
postpartum; to identify remediable problems contributing to maternal mortality;
to develop recommended interventions to prevent these deaths; and disseminate
findings. The committee shall also
review aggregate data related to severe maternal morbidity to look for opportunities
for improvement in care that could lead to improved maternal outcomes and fewer
deaths. Given the persistent and
significant disparities in maternal morbidity and mortality experienced by
people of color in New Mexico and the United States overall, the committee will
apply lenses of racial justice, diverse representation and health equity across
its functions including staffing, committee membership and leadership, case
review and analysis.
[7.4.8.6 - N, NMAC, 11/08/2022]
7.4.8.7 DEFINITIONS: As used in these
regulations:
A. Definitions
beginning with “A”:
(1) “Abstractor" means
an individual who is trained to comprehensively gather pertinent information
from a variety of available sources in order to
accurately capture the events of a person’s life leading up to and including
their death in the form of a case summary for committee review. All abstractors will possess a
professional background in maternal health and the requisite training, provided
or endorsed by the department, to approach cases with a health equity lens. Given the critical role of the abstractor in identifying
the defining details leading to a death, including factors such as racism, bias
and discrimination, the department shall undertake deliberate, demonstrable
efforts to engage abstractors who possess lived experience as members of
communities of color disproportionately impacted by maternal mortality who are
able to apply an anti-racist lens to the abstracting process.
(2) “Act” means the Maternal Mortality and Morbidity Prevention Act.
(3) “Administrative co-chair” means the chief medical officer, or another representative
of the department and who is appointed by the secretary to serve as co-chair of
the committee for administrative matters. The administrative co-chair shall be equipped
with the measurable skills, training or lived experience to incorporate the
racial, ethnic and linguistic diversity of New Mexico
into this leadership role.
(4) "Aggregate data" means health care data that exclude any individually
identifiable health information, including patient and health care provider
identification.
B. Definitions beginning with “B”: “BVRHS” means the department of health bureau of vital records and
health statistics.
C. Definitions beginning with “C”:
(1) “Case-related material” means any de-identified information that relates to or
summarizes an incident of maternal mortality or severe maternal morbidity.
(2) “Case summary”
means a de-identified summary of an incident of maternal mortality.
(3) “CDC” means the
U.S. centers for disease control and prevention.
(4) “Chief medical
officer” means the chief medical officer of the department.
(5) “Clinical
co-chair" means a committee member with maternal child health clinical
or paraprofessional training nominated and approved by a two-thirds vote of the
committee and approved by the department to serve in this position for a term
that aligns with the overall duration of their membership on the committee
unless the member chooses to step down from the co-chair role prior to the end
of their membership term. The clinical co-chair shall be equipped with the
measurable skills, training or lived experience to incorporate the racial, ethnic and linguistic diversity of New Mexico into this
leadership role.
(6) “Committee”
means the maternal mortality review committee.
(7) "Committee member"
means a person who has been appointed to sit as a member of the committee and
who participates in committee business and votes on committee matters.
(8) “Community co-chair” means a
committee member nominated and approved by a two-thirds vote of the committee
to a term that aligns with the overall duration of their membership on the committee
unless the member chooses to step down from the co-chair role prior to the end
of their membership term. The community
co-chair shall possess lived experience as a community member able to represent
the regional, racial, linguistic, and ethnic diversity of New Mexico’s
communities disproportionately impacted by maternal mortality in this
leadership role.
(9) “Contributing
factors” are the circumstances, events, exposures, procedures, or products
identified by the committee as having contributed to an incident or group of
incidents resulting in maternal mortality or severe maternal morbidity which
may include systemic racism or inequities.
(10) “Coordinator”
means the operational staff member designated by the department to manage the
day-to-day operations of the committee.
(11) "Critical
income" means income lost as a result of
uncompensated work time used to attend a committee meeting.
D. Definitions beginning with “D”:
(1) “Data set” means a collection of de-identified information collected
or created by or under the direction of DOH epidemiologists.
(2) “De-identified data” means
information that has been purged of all personally identifying information
including, but not limited to, names; any geographic subdivision smaller than a
state including street address, city, county, precinct, zip code, and their
equivalent geocodes; all elements of dates except the year of an incident,
including birth date, admission dates, discharge dates, and dates of death;
telephone numbers, fax numbers electronic mail addresses; social security
numbers; health plan beneficiary numbers; certificate and license numbers;
vehicle identifiers and serial numbers, including license plate numbers; device
identifiers and serial numbers; web universal resource locators (URLs);
internet protocol address numbers; biometric identifiers, including finger and
voice prints; full face photographic images and any comparable images; and any
other unique identifying number characteristic, or code.
(3) “Department” or “DOH” means the New Mexico department
of health.
(4) “DOH epidemiologist”
means the operational staff responsible for creating, interpreting, and
analyzing data sets and for supporting committee efforts to develop and
disseminate data-driven recommendations.
E. Definitions
beginning with “E”:
(1) “Executive committee” means a subcommittee of the committee consisting of the
co-chairs and additional committee members that provides leadership and
guidance to the committee and operational staff to effectuate the objective of
the committee.
(2) “Expertise” means special skill,
knowledge, or judgement that results from training, practice or lived
experience.
F. Definitions beginning with “F”: [RESERVED]
G. Definitions beginning with “G”: [RESERVED]
H. Definitions beginning with “H”:
(1) "Health care provider" means an individual licensed, certified
or otherwise authorized to provide health care services in the ordinary course
of business in the state; or a health facility that the department licenses.
(2) “Health equity” means the attainment of the highest
level of health for all people through focused and ongoing efforts to address
avoidable inequalities, historic and contemporary injustices, and the
elimination of health and healthcare disparities.
(3) “HIDD database” means the hospital inpatient discharge database or state
inpatient database.
I. Definitions beginning with “I”:
(1) “IAD” means: Indian
affairs department of the state.
(2) “Identifiable information” means any information that may be used to determine the
identity of an individual directly or indirectly involved in an incident of
maternal mortality or severe maternal morbidity.
J. Definitions beginning with “J”: [RESERVED]
K. Definitions beginning with “K”: [RESERVED]
L. Definitions beginning with “L”:
(1) "Law enforcement agency" means a law enforcement agency of the state, an Indian
nation, tribe or pueblo or a political subdivision of the state.
(2) “Lead abstractor” means the clinical co-chair or operational staff member
designated to coordinate the activities of any operational staff engaged as
abstractors. This person also prepares
case summaries for committee review and enters committee decisions into the
MMRIA database.
M. Definitions beginning with “M”:
(1) "Maternal mortality" means the death of a pregnant person or a birthing person
within one year postpartum.
(2) “Maternal mortality review” or “MMR” means
the review of all reported deaths of individuals who die of any cause during
pregnancy or within one year of the end of pregnancy.
(3) "Medical record" means the written or graphic documentation, sound recording
or electronic record relating to medical, behavioral health and health care
services that a patient receives from a health care provider or under the
direction of a physician or another licensed health care provider. "Medical record" includes diagnostic
documentation, including an x-ray, electrocardiogram, and electroencephalogram;
other test results; data entered into a prescription
drug monitoring program; and an autopsy report.
(4) “MMRIA” means the CDC maternal mortality review information
application or any successor application.
N. Definitions beginning with “N”: [RESERVED]
O. Definitions beginning with “O”:
(1) “OAAA” means the office of African American affairs of the state.
(2) “OMI” means the office of the medical investigator.
(3) "Operational staff" means staff or contractors of the department assigned or
contracted to support the work of the committee or its executive committee.
P. Definitions beginning with “P”:
(1) “PHD” means the public health division of the department.
(2) “Pregnancy-associated death”
means a death during or within one year of pregnancy, regardless of the
cause. If the definition is updated by
the CDC, that definition shall be the applicable definition for these rules.
(3) “Pregnancy-related
death” means a death during or within one year of pregnancy, from a
pregnancy complication, a chain of events initiated by pregnancy, or the
aggravation of an unrelated condition by the physiologic effects of pregnancy. If the definition is updated by the CDC, that
definition shall be the applicable definition for these rules.
Q. Definitions beginning with “Q”: "Qualified invited guest" means a person approved by the co-chairs and invited
by the committee to attend a committee meeting to provide technical expertise
to the committee, to enhance training in maternal health, to provide insight on
maternal mortality or severe maternal morbidity review in other jurisdictions
or to provide operational support to the committee.
R. Definitions beginning with “R”: [RESERVED]
S. Definitions beginning with “S”:
(1) “Secretary”
means the secretary of the department of health or designee.
(2) “Severe maternal morbidity” means unexpected outcomes of labor and delivery that result
in significant short- or long-term consequences to a person's health as
identified by hospitalizations using administrative hospital discharge data and
the world health organization's international classification of diseases diagnosis
and procedure codes.
T. Definitions beginning with “T”: “Trauma” means individual and communal trauma, defined as the experiences
inflicted upon people and communities impacting their physical, mental and
emotional well-being. This unresolved
impact leads to a perceived and experienced lack of safety and a recurring
experience of stress that impacts the physical and mental bodies of the victim
and at times their families and communities intergenerationally. Trauma is linked to acts of violence,
including micro-aggressions, systemic inequity and the
feeling that oneself, one’s family or community are not fully safe or capable
of being safe as a result of the traumatic incident(s).
U. Definitions beginning with “U”: [RESERVED]
V. Definitions beginning with “V”: [RESERVED]
W. Definitions beginning with “W”: [RESERVED]
X. Definitions beginning with “X”: [RESERVED]
Y. Definitions beginning with “Y”: [RESERVED]
Z. Definitions beginning with “Z”: [RESERVED]
[7.4.8.7 - N, NMAC, 11/08/2022]
7.4.8.8 PROGRAM ADMINISTRATION: The committee’s activities
shall be administered by the department using a health equity framework across
all functions including staffing, committee membership and leadership, and case
review and analysis in order to assure that the values
of cultural awareness, racial justice, and equity are infused throughout these
functions. The department shall
designate a committee coordinator in an employed or contracted position and
hire contractors and employ operational staff to support the work of the
committee. The co-chairs may
designate an executive committee to conduct business as outlined herein.
[7.4.8.8 - N, NMAC, 11/08/2022]
7.4.8.9 EXECUTIVE COMMITTEE: If called, the
executive committee must include and reflect the ethnic, geographic, and
disciplinary make-up of the committee, state and the communities
disproportionately impacted by maternal mortality and morbidity.
A. The
formation of an executive committee must be endorsed by a vote of a two-thirds
majority of the current membership.
B. An executive committee shall consist
of co-chairs of the committee and up to three additional committee members nominated
and approved by a two-thirds majority of the current membership to effectuate
the objectives of the committee. No less
than one appointee from either IAD or OAAA will be offered the opportunity to
serve on the executive committee. Appointment
to the executive committee will be for the duration of the term of membership,
or until the member elects to step down from the executive committee, whichever
is sooner.
C. Operational staff and qualified
invited guests may participate in executive committee deliberations in an
advisory capacity as directed by the executive committee, but
they are not part of the committee membership.
D. If called, the executive committee
shall:
(1) meet at the
call of the co-chairs;
(2) monitor and
support the activities of the full committee;
(3) establish
policy and procedure and provide guidance to operational staff on implementation;
and
(4) make
final decisions regarding data analysis, data dissemination and evaluation
based on findings and recommendations from the full committee.
[7.4.8.9 - N, NMAC, 11/08/2022]
7.4.8.10 MEMBERSHIP:
A. Members
will be formally appointed by the administrative co-chair. The administrative co-chair may consult with
the clinical and community co-chairs, and if called, the executive committee
to confirm appointments.
B. The
committee shall be composed of no more than 30 members, not including the
co-chairs, provided that at least, four of those members shall include:
(1) two members
nominated by the secretary of Indian affairs; and
(2) two members
nominated by the director of the office of African American affairs.
C. Additional
members will be recruited through an open call:
(1) Operational
staff will post a call for members along with an application form on the
department’s website and advertise the call broadly in collaboration with OAAA,
IAD, and community-based organizations whose work focuses on health equity
within the communities most impacted by maternal mortality and morbidity.
(2) Operational
staff will receive applications and conduct an initial analysis using a scoring
matrix to evaluate applications that prioritizes applicants who are working in
and representing communities that are most impacted per the state maternal
mortality ratio so that the composition of the committee reflects:
(a) the racial, ethnic, and linguistic
diversity of the state;
(b) the differing geographic regions
within the state, including rural and urban areas;
(c) tribal areas and communities; and
(d) communities that are most impacted by
pregnancy-related deaths, severe maternal morbidity, or a lack of access to
relevant perinatal and intrapartum care services.
(3) Consideration
will also be given to assure that core disciplines and organizations
representing needed expertise in maternal health and safety, as identified by
the committee, are represented.
D. Upon
closure of an open call, operational staff will present a completed scoring
matrix for all applicants to the co-chairs for consideration.
E. Membership
is voluntary.
F. Members may
be reimbursed for expenses related to meeting attendance.
(1) Members who
must forsake critical income to attend meetings may, with the approval of the
department, be reimbursed for loss of that income in an amount not to exceed three
hundred dollars ($300.00) per meeting, whether virtual or in person.
(2) Members
required to travel in excess of 50 miles for an
in-person meeting may, with the approval of the department, receive per diem
and mileage for attending that meeting pursuant to the Per Diem and Mileage
Act.
(3) Operational
staff will advise all members of the opportunity to receive these types of
reimbursement, provide forms needed to complete enrollment according to
departmental policy, and provide any assistance members need to complete and
submit forms.
(4) Members may
not initiate a request for critical income or travel reimbursement for meetings
that occurred in a previous fiscal year.
G. Members are appointed for
a three-year term, with no consecutive terms. Terms served by committee members may be
staggered to assure continuity of effort.
H. Each member
shall receive training on trauma and the impacts of trauma, including secondary
trauma, trauma of racism and trauma of maternal mortality and morbidity
presented by a trainer who is a member of communities that are most impacted by
pregnancy-related deaths, severe maternal morbidity, or a lack of access to
unbiased, affordable and culturally congruent perinatal
and intrapartum care services.
[7.4.8.10 - N, NMAC, 11/08/2022]
7.4.8.11 CASE
IDENTIFICATION: “Maternal
mortality”: The coordinator and operational staff shall
work with BVRHS to identify any death constituting an incident of maternal
mortality within one year from the date of death. Criteria for case identification shall be
consistent with standard reporting requirements.
[7.4.8.11 - N, NMAC, 11/08/2022]
7.4.8.12 DATA
COLLECTION:
A. Duty to report: A
health care provider, the office of the state medical investigator, and BVRHS shall
notify the operational staff of any incident of maternal mortality within three
months of the incident. A report made to BVRHS made within these
timelines will be sufficient to satisfy this requirement.
B. Authority to collect information: Except as otherwise restricted or prohibited
by state or federal statute or regulation, designated operational staff may
access medical records and other information relating to an incident of
maternal mortality at any time within five years of the date of the incident.
C. Information gathering: Regarding any incident of maternal mortality
involving a New Mexico resident, information including reports, records and
data files shall be provided upon request to the designated operational staff
from health care providers, law enforcement agencies, BVRHS, and the office of
the state medical investigator. The
designated operational staff may also request information from other entities
with relevant information to a maternal mortality case review. Any committee member
engaged in case review may request that designated operational staff initiate
such a request for information from other entities.
D. Information collection process: Information and records requests will be
conducted in a confidential manner.
E. Collection of information by
interview: Individuals who are
operational staff of the department, may, with appropriate training,
conduct interviews with a deceased person’s family, care providers, and other
relevant persons. These interviews shall
be conducted according to an established protocol with the consent of the
interviewee.
F. Case
abstraction process: Information
and records obtained through a formal request initiated by operational staff
will be provided to an abstractor who is assigned to develop a case summary. An
abstractor enters information directly into the MMRIA database. It is the responsibility of the abstractor to
employ training, experience, and abstracting tools endorsed or provided by the
department or CDC in order to create a comprehensive,
accurate summary of the events of a person’s life leading up to and including
their death. This process must include
tools that have been developed to facilitate the identification of racism,
discrimination, and interpersonal and structural bias in health care or life course
events that may have been contributing factors to the death. An abstractor may consult the co-chairs or
other operational staff as needed to confirm interpretations of data and the
relevance of details for inclusion in a case summary.
G. Identification of race and ethnicity of the deceased: Race
and ethnicity of the deceased, as identified in available records, are noted in
otherwise de-identified case summaries in order to
allow the committee to consider factors such as the role of systemic racism and
inequities related to pregnancy-associated deaths.
[7.4.8.12 - N, NMAC, 11/08/2022]
7.4.8.13 COMMITTEE RESPONSIBILITIES:
A. The
committee shall meet at the call of the co-chairs.
B. A majority
of appointed committee members shall constitute a quorum.
C. The
affirmative vote of at least a majority of a quorum present and approval by the
co-chairs shall be necessary for any decisions pertaining directly to case
review to be taken by the committee. A
quorum shall not be achieved without at least one AID appointee and OAAA
appointee in attendance. Administrative
decisions not pertaining to case review may be voted on electronically outside
of the course of a committee meeting to allow all members ample opportunity to
cast a vote.
D. Operational
staff and qualified guests may participate in committee deliberations in an
advisory capacity as directed by the co-chairs of the committee.
E. Operational
staff and qualified invited guest presence at a committee meeting shall not
convey committee membership.
F. The
committee shall be responsible for the following:
(1) review each
incident of maternal mortality using a de-identified case summary prepared by
operational staff;
(2) review
aggregate data related to severe maternal morbidity;
(3) outline
trends and patterns and provide recommendations related to maternal mortality
and severe maternal morbidity in the state;
(4) serve as a
link with maternal mortality and morbidity review teams nationwide and
participate in national maternal mortality and morbidity review team
activities; and
(5) perform any
other functions as resources allow to enhance efforts to reduce and prevent
maternal mortality and severe maternal morbidity in the state.
[7.4.8.13 - N, NMAC, 11/08/2022]
7.4.8.14 CASE REVIEW
PROCESS:
A. The
committee reviews prepared case summaries based on the information obtained
from reports, records, and data files related to an incident of maternal
mortality and entered into the MMRIA database by an
abstractor. The committee is responsible
for reviewing the summary, identifying contributing factors, making
a determination on preventability and pregnancy-relatedness, and
articulating recommendations. The lead
abstractor shall be responsible for documenting committee decisions regarding
case summaries in MMRIA within 30 days of committee review.
B. Any
committee member who is concerned that any essential information is being
missed by the decisions the abstractor makes in creating summaries may initiate
a request to the clinical co-chair or operational staff with the authority to
collect information that:
(1) an abstractor’s work be reviewed by
the clinical co-chair and designated operational staff; or
(2) an alternative abstractor be
assigned.
[7.4.8.14 - N, NMAC, 11/08/2022]
7.4.8.15 CONFIDENTIALITY OF RECORDS, PROCEEDINGS, AND
FINDINGS:
A. Any
material obtained pursuant to these rules, any committee proceedings, and
findings, including any materials created to facilitate committee proceedings
shall be maintained and disposed of in a confidential manner and in any manner
as required by law.
B. The
following shall be confidential and shall not be subject to the open meetings
act or the inspection of public records act or subject to any subpoena,
discovery request or introduction into evidence in a civil or criminal
proceeding:
(1) any
meeting, part of a meeting or activity of the committee or executive committee
where data or other information is to be discussed and that may result in
disclosure to the public of information protected by law; and
(2) except as may be necessary
in furtherance of the duties of the committee or in response to an alleged
violation of a confidentiality agreement entered, any information, record,
report, notes, memoranda, or other data that the department or committee
obtains pursuant to the Maternal Mortality and Morbidity Prevention Act.
C. Only the clinical
co-chair and operational staff will have access to medical records, law
enforcement reports and vital records data to support the work of the full
committee.
(1) The
coordinator or DOH epidemiologist may share de-identified, aggregate datasets with
the CDC and with state, regional, or tribal entities engaged in reducing
incidents of maternal mortality or severe maternal morbidity.
(2) Identifiable
information entered into MMRIA shall only be
accessible to the clinical co-chair, coordinator, DOH epidemiologists and
abstractors.
D. Before participating in
their first committee meeting, each member, operational staff, and any
qualified invited guest shall be required to review and sign a confidentiality
agreement covering the duration of their membership or service to the
committee. Signed confidentiality
agreements will be collected and retained by the coordinator.
E. A brief
reminder of the confidentiality clause and any other relevant process
directives will be presented at the beginning of each case review session.
F. For
in-person meetings, case-related materials may not be removed from meetings by
any member. At the conclusion of any meeting at which case-related material has
been distributed, the coordinator shall collect that material and destroy it.
G. For
virtual meetings, case summaries and decision forms shall be distributed
electronically via a secure encrypted program, and members shall be instructed
to delete the summaries from their inbox, hard-drive
or cloud-based storage at the conclusion of the meeting.
[7.4.8.15 - N, NMAC, 11/08/2022]
7.4.8.16 DISSEMINATION
OF INFORMATION; DEVELOPMENT OF RECOMMENDATIONS; ADVANCEMENT OF RECOMMENDATIONS:
A. Data dissemination: The committee shall compile reports using
aggregate data and de-identified information on an annual basis in an effort to further study the causes and problems
associated with maternal mortality and severe maternal morbidity. These reports shall be distributed to:
(1) the New Mexico legislature;
(2) the Indian affairs department;
(3) office on African American affairs;
(4) health care providers;
(5) community-based organizations working
in the interest of maternal and child health;
(6) other government agencies as
necessary; and
(7) other entities as necessary to reduce
maternal mortality rate in the state.
B. Committee
members and operational staff may also deliver presentations using aggregated,
de-identified information to support and promote the study of causes and
problems associated with maternal mortality and severe maternal morbidity.
[7.4.8.16 - N, NMAC, 11/08/2022]
HISTORY OF 7.4.8 NMAC: [RESERVED]