This
rule was filed as 7 NMAC 4.5.
TITLE
7 HEALTH
CHAPTER
4 DISEASE CONTROL (EPIDEMIOLOGY)
PART
5 MATERNAL, FETAL, INFANT
AND CHILD DEATH REVIEW
7.4.5.1 ISSUING
AGENCY: New Mexico Department of
Health, Public Health Division, Family Health Bureau
[01/01/98;
Recompiled 10/31/01]
7.4.5.2 SCOPE: These regulations shall apply to the
operations of the New Mexico maternal mortality review team, fetal and infant
mortality review team, child fatality review team and any other team which
is deemed necessary by the department and their policies and procedures,
confidentiality provisions, management of records, dissemination of findings
and recommendations; and to the public and private entities from whom data,
information or records are requested for the purpose of mortality or fatality
review.
[01/01/98;
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7.4.5.3 STATUTORY AUTHORITY:
A. The regulation set forth herein is promulgated
by the secretary of the department of health by authority of the Department of
Health Act, Section 9-7-6.E. NMSA 1978 and the Public Health Act, Section
24-1-3 NMSA 1978, specifically Section 24-1-3. C. NMSA 1978, which states: "The
department has authority to: investigate, control and abate the causes of
disease, especially epidemics, sources of mortality and other conditions of
public health; and Section 24-1-3. F. NMSA 1978, which states: "The
department has authority to: establish programs and adopt regulations to
prevent infant mortality, birth defects and morbidity; and Section 24-1-3.
H. NMSA 1978, which states: "The department has authority to: provide
educational programs and disseminate information on public health." The administration and enforcement of these
regulations is the responsibility of the public health division of the
department.
B. Related statutes and regulations: New Mexico law
provides for other statutes and regulations that support or limit the statutory
authority of the department to regulate the review of maternal, fetal, infant
or child deaths.
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7.4.5.4 DURATION: Permanent
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7.4.5.5 EFFECTIVE DATE: January 1, 1998, unless a later date is
cited at the end of a section or paragraph.
[01/01/98;
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[Compiler’s
note: The words or paragraph, above, are no longer applicable. Later dates are now cited only at the end of
sections, in the history notes appearing in brackets.]
7.4.5.6 OBJECTIVE: The purpose of the retrospective case review
of death in the maternal, fetal, infant and child population in New Mexico by a
multidisciplinary team of experts is to reduce future rates of such deaths by
identification of prevention factors, risk reduction factors and/or systems
failure factors and the dissemination of such information to policy makers,
providers, communities and to the public.
[01/01/98;
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7.4.5.7 DEFINITIONS:
A. "AAP" means the American
academy of pediatrics
B. "ACOG" means the American
college of obstetricians and gynecologists.
C. "CYFD" means the New Mexico
children, youth and families department.
D. "Child fatality review" or
"CFR" means a review that includes all reported deaths of children
due to
fatal injury or other undetermined cause from birth through 24 years of age, or
a specific age range as determined appropriate by a special panel.
E. "Community based review"
means the review that takes place in the community where the death occurs, is
staffed by Team members approved by the department and may involve follow-back
interview with informed consent to surviving family, providers of care or other
relevant persons.
F. "Coordinator" means the
person designated by the department to administer and manage the day to day
operations of the review teams.
G. "Confidentiality" means the
protection of the privacy of the decedent, the decedent's family, and any
information pertaining to the fatality.
H. "Department" or
"DOH" means the New Mexico department of health.
I. "Department designee for MCH
death review" means the department staff person, usually an
epidemiologist, authorized to receive information regarding deaths that fit the
criteria for MMR, FIMR and CFR.
J. "Death investigation"
means the investigation of a death by appropriate authorities for the purpose
of establishing the manner and cause of death.
K. "Expert" means a person by whose
training and present work-related activities or professional licensure has the
requisite knowledge to review case information and contribute to an assessment
of prevention factors, risk reduction factors and/or systems failure factors. The expert is bound by confidentiality
policies and statute, and must be recognized by the department.
L. "Fetal and infant mortality
review" or "FIMR" means a review including all reported deaths
of fetuses (death prior to the complete expulsion or extraction from the mother
of a product of human conception, fetus and placenta, irrespective of the
duration of pregnancy), and infants (any death at any time from birth through
one year).
M. "MCH" means public health
practice concerned with maternal and child health.
N. "Maternal mortality review"
or "MMR" means the review of all reported deaths of the following:
pregnant women who die from any cause during pregnancy, or who die within one
calendar year of pregnancy termination.
O. "Multidisciplinary team"
means a team of experts comprising, but not limited to, the disciplines
essential to death review, such as medicine, nursing, social work, law
enforcement, mental health, public health, education, domestic violence, and
child advocacy.
P. "OMI" means the New Mexico
office of medical investigator.
Q. "PHD" means the public
health division of the department.
R. "Prevention factors" means
the circumstances, events, exposures or products that are identified by the
death review team as potential contributors to the death and about which
providers, communities and/or the public need to be informed and/or educated
for the prevention of future such death(s).
S. "Retrospective case review"
means the gathering of case information and analysis of information after the
manner and cause of death have been registered with vital records and health
statistics. Retrospective case review
is not a death investigation process.
It is a public health function concerned with assessment, prevention,
risk reduction and/or systems improvements.
T. "Risk reduction factors"
means the circumstances, events, exposures or products that are identified by
the death review team as potential contributors to the death and about which
providers, communities and/or the public need to be informed and/or educated
for the prevention of future such death(s).
U. "Secretary" means the
secretary of the department or his/her designee.
V. "Special panel" means a
group convened on a permanent or temporary basis for the MMR, FIMR or CFR Team,
to review an aggregation of deaths by selected categories to increase the power
of analysis and interpretation by reviewing several cases of a similar manner
or cause of death.
W. "State level review" means
the process whereby statewide quantitative and qualitative data, gathered
either at the state level or by a local community death review team, are
analyzed and used for development of public policy, public health
recommendations, and/or implementation of prevention measures.
X. "System failure factors"
means the community-based circumstances, events, resources including the lack
thereof, and provider policies that are identified by the death review team as
potential contributors to the death and about which providers, communities
and/or the public need to be informed and or educated for the prevention of
future such death(s).
Y. "Team" means one of the
state or community level MMR, FIMR or CFR teams.
Z. "UNM" means the university
of New Mexico.
AA. "VRHS/NM" means the department
entity responsible for vital records and health statistics in New Mexico.
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7.4.5.8 PROGRAM ADMINISTRATION: MMR, FIMR, and CFR are administered by the
public health division in the department in collaboration with the OMI of
UNM. MMR, FIMR and CFR are coordinated by
the MCH death review coordinator in the office of MCH epidemiology.
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7.4.5.9 EXECUTIVE OVERSIGHT BOARD: An executive oversight board will comprise
department representatives designated by the secretary including but not
limited to the office of the DOH chief medical officer, office of general
counsel, offices of the PHD director, VRHS/NM, family health, MCH epidemiology;
and a designated representative of OMI, ACOG and CYFD.
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7.4.5.10 MEMBERSHIP: The members of maternal mortality review
team, the fetal and Infant mortality review team and child fatality review team
will be state or local experts in their field and appointed by the department. Members are selected to achieve a culturally
diverse, multidisciplinary team that may include but is not limited to
representatives of the following disciplines: medicine and selected
subspecialties, nursing, nurse-midwifery, forensic medicine, mental health,
social work, specialists in child abuse and neglect, public health
epidemiology, law enforcement, the judiciary, prosecution, traffic safety,
education, child advocacy, grief intervention and support, domestic violence,
health education, survivor or parent support groups. Membership will include representation from federal (military and
Indian), state and local entities.
Membership is voluntary and team members or special panel members shall
not be remunerated by the department.
A. State level teams are organized for
MMR, FIMR and CFR and are responsible for initial and/or final review of all
cases, aggregate analysis of statewide data, and the identification and
preparation of reports or other documents to address statewide and or local
systems improvements, prevention, and risk reduction factors. State level teams are responsible for
training, support and consultation to community level teams.
B. Community level teams shall be
organized with training and support of state level teams, and shall abide by state
level regulations, protocols and policies.
The formation of community level teams shall be contingent upon
available resources including consultation by specialists in appropriate
disciplines. The purpose of a community
team is to bring case review to the local level where identification of
problems and development of interventions for systems improvements, risk
reduction or prevention can take place
C. Special panels: Special ad hoc panels
may be organized in response to any identified profile or cluster of fatalities
that are identified by a team and the department, the OMI, or other appropriate
entities as approved by the executive committee.
D. Maternal mortality review: The
organizational membership of MMR shall seek to include, but not be limited to,
representatives of the New Mexico section of ACOG; the New Mexico academy of
family practice; the New Mexico hospital and health service association; the
New Mexico association for women's health, obstetrics, and neonatal nursing;
the New Mexico department of health, public health division; the New Mexico
chapter of the American college of nurse midwives; the New Mexico vital records
and health statistics entity; the Indian health service; the New Mexico office
of the medical investigator; tertiary center perinatologists (institutions
designated as level III neonatal intensive care unit); and community
obstetricians and family practitioners.
E. Fetal and infant mortality review:
The organizational membership of FIMR shall seek to include but not be limited
to representatives from New Mexico units of the American academy of family
physicians; the American academy of pediatrics; the American anthropological
association; ACOG; the American college of nurse midwives; the New Mexico
hospital and health service association; the MCH Title V entity of the
department; the New Mexico vital records and health statistics entity; the
association of state and territorial health officials; the college of American
pathologists; the march of dimes birth defects foundation; the association for
women's health, obstetric and neonatal nurses; and the society of perinatal
obstetricians.
F. Child fatality review: The membership
of CFR
shall seek to include but not be limited to representatives of the following
organizations and interest areas: law enforcement; prosecution; the medical and
mental health communities; tribal governments; tribal social service agencies;
military bases; a domestic violence program; a grief intervention program; the
New Mexico traffic safety bureau; the New Mexico sudden infant death syndrome
program; a child advocacy group; the unit responsible for the investigation and
prevention of child abuse and neglect in CYFD; public health epidemiology, the
New Mexico vital records and health statistics entity; the MCH Title V entity
in the department; a representative from OMI; a representative of the New
Mexico not even one project, and a representative from the public school
system.
[01/01/98;
Recompiled 10/31/01]
7.4.5.11 CASE IDENTIFICATION: Deaths of New Mexico residents which are
registered with VRHS/NM will serve as the denominator or source file for MMR,
FIMR and CFR. Deaths of non-residents
which have occurred in New Mexico may not always be included.
A. MMR case identification: Deaths that
meet criteria for maternal mortality review will be reported by OMI to the
department designee on a monthly basis.
At the closing of the VRHS/NM file for a calendar year, all deaths
meeting criteria for MMR including a linked birth, death and fetal death file,
will be reported by VRHS/NM to the department designee.
B. FIMR case identification: Deaths that
meet criteria for fetal or infant mortality review will be reported by VRHS/NM
to the department designee on a monthly basis.
At the closing of the VRHS/NM file for a calendar year, all deaths
meeting criteria for FIMR will be reported by VRHS/NM to the department
designee.
C. CFR case identification: Deaths that
meet criteria for child fatality review will be reported by OMI to the department
designee on a monthly basis. At the
closing of the VRHS/NM file for a calendar year, all deaths meeting criteria
for child fatality review will be reported by VRHS/NM to the department
designee for MCH death review.
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7.4.5.12 DATA COLLECTION: The department designee shall receive case
identifiers from OMI and VRHS/NM and shall prepare the file for review by
ascertaining what supplementary records are needed for a comprehensive case
review. Case data and information are
then requested from the relevant sources.
A. Non-federal sources: Relevant sources
for FIMR, MMR, CFR review include but are not limited to: OMI records;
providers of medical, health, nutrition and mental heath care; emergency
department records; emergency transport records; hospital records; records of
applicable law enforcement agencies; other public safety service records such
as those maintained by fire departments; records of providers of social work
care including child protective services; day care records; school-based
records; motor vehicle crash reports.
B. Federal sources: Deaths meeting
criteria for MMR, FIMR and CFR which have occurred on military reserves or
Indian reservations will require collection of case information from relevant
federal agencies including but not limited to the federal bureau of
investigation (FBI); the bureau of Indian affairs (BIA), the Indian health
service (IHS), military and tribal police, and military and tribal social
services.
C. Forms: A standard form to request
information of private or public entities shall be used and which states the
authority of the department with the signature of the chief medical officer of
the department. The form shall be
prepared, signed and dated by the department designee or the coordinator.
D. Collection of information by
interview: Case review may include interviews with the decedent's family, care
providers, and other relevant persons.
These interviews will be conducted only with the informed consent of the
interviewee.
E. Partial collection of information: In
death review data collection where case information is sequestered, privileged,
or confidential, the department will request information as required on the
data form from appropriate agencies.
Such deaths may be deferred for review until such time as the case file
may be available for review.
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7.4.5.13 CONFIDENTIALITY OF RECORDS,
PROCEEDINGS AND FINDINGS: MMR, FIMR and CFR
involve the use of highly confidential case files which are protected by statute(s),
regulation(s), departmental protocol, and policy.
A. Confidentiality of Information from
VRHS/NM: Access to data constituting vital statistics as defined in the New
Mexico Vital Statistics Act, Section 24-14-1, et seq. NMSA 1978, shall be in
accordance with the Act and applicable department regulations.
B. Open records: All information and
records accessed or in the possession of the MMR team, FIMR team, CFR team, or
a special panel are confidential in accordance with the New Mexico Inspection
of Public Records Act, Sections 14-2-1, et seq. NMSA 1978 and applicable law.
C. Member confidentiality statement: All
members shall receive a training orientation regarding applicable statutes,
protocols, and the rules for confidentiality.
Each member is required to sign a confidentiality statement, the intent
of which is to protect the confidentiality and privacy of the decedent, the
decedent's family, and other individuals, agencies or providers cited in the
case file. The confidentiality
statement shall be signed by a team member prior to participation in case
review and signed annually thereafter on July 1st or the first review session
held for the state fiscal year. Experts
invited for a special panel are to sign the confidentiality statement prior to
participation in a case review.
D. Breach of confidentiality: Anyone who
breaches confidentiality shall be subject to legal liability including, but not
limited to, the provisions of the Vital Statistics Act at Sections 24-14-27
NMSA 1978 and 24-14-31 NMSA 1978.
E. Review team findings: The findings
and recommendations of the MMR, FIMR, and CFR teams with respect to prevention,
risk reduction or systems failures are the property of the department. They are based on retrospective case
review. The process by which findings
are derived is different from the understanding and judgment of a provider or
any other person present at the time of caring for the decedent prior to the
death. Findings and recommendations are
prevention-oriented rather than investigatory.
The opinions expressed are based upon an aggregate of information which
has been compiled from a variety of sources post-mortem, and which was not
available to any single provider at the time of death.
F. Closed meetings: Team meetings are
not subject to the Open Meetings Act, Sections 10-15-1 through 10-15-4 NMSA
1978. Records of the team shall be
confidential pursuant to the provisions of the Inspection of Public Records Act
and Section 24-1-20 NMSA 1978 of the Public Health Act. Individuals who are not members of the team
or special panel will not be allowed to be present at case reviews unless the
individual is approved by the presiding chair with the consent of the panel or
team, and that individual signs the confidentiality agreement.
G. Reports of findings: Statistical
studies and research reports based upon the confidential information may be
published, but they will not identify decedents, their families, or provide any
other information that can be extrapolated to ultimately identify these
individuals. Data will be published in
the aggregate.
H. Follow-up to at-risk circumstances: In
the event that a team or special panel finds that there are circumstances that
may place others at risk for injury or untoward exposure, the department on
behalf of the team or special
panel shall inform the appropriate federal, state and/or community entity in
accordance with procedures and protocols established by the department.
[01/01/98;
Recompiled 10/31/01]
7.4.5.14 SECURITY OF RECORDS:
A. Statistical information: Information
from forms completed by any of the teams or its special panels will be entered
without personal identifiers into a data base dedicated solely to MMR, FIMR and
CFR, and will be accessed only by the team coordinator, the department designee
for MCH death review, and the individual who is responsible for data base
management and data entry. Personal
identifiers include first, middle, and last name, and the street address of
decedent or other persons, including providers.
B. Administrative information: The
review forms with personal identifiers will be kept in a secure, locked
location which can be accessed only by the department designee for MCH death
review, the coordinator, and the individual responsible for data base management
and entry.
C. Management of case documentation
during review session: Team members are prohibited from leaving case reviews
with any identifiable written review information that is related to cases under
review, those cases which have been reviewed, and those cases which will be
reviewed. All materials held by anyone
other than the coordinator of the review team, the department designee for MCH
death review, an OMI representative, or the designee of any of the aforementioned
individuals will be collected and destroyed by the presiding chair of the team
reviewing the case.
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7.4.5.15 DISSEMINATION OF INFORMATION: Non-identified, aggregate data and
descriptive risk information will be disseminated by the MMR, FIMR or CFR team
in annual reports, epidemiological bulletins to providers, informational
releases to the public regarding preventable risk, and special reports to the
New Mexico legislature and other appropriate groups.
[01/01/98;
Recompiled 10/31/01]
HISTORY
OF 7.4.5 NMAC: [RESERVED]