WOMEN'S HEALTH
Division during the past 22 years has been erratic because the
Maternal Child Heath Division has forgotten the maternal part
of the partnership. The directors have all been pediatricians or
neonatologists. An attempt to improve the relationship was accom-
plished about 10 to 15 years ago by Steve Davis, MD, a pediatrician
who actually had OB/GYNs come into the division at Frankfort
for consultations and lectures. This was discontinued when Ruth
Shepard, MD, a neonatologist, became division director and was
followed by open hostility by Henrietta Bade, MD, neonatologist
who essentially ignored the MMRC activities.
This was manifested by the following:
(1) The Maternal Child Health Division refused to send any
death certificates for the year 2012 despite reminders that
the committee was not receiving any death certificates to
review. After a year of regular reminders and correspon-
dence, ‘Maternal Child’ sent 1,500 death certificates for
review at one time.
(2) In the year 2017-2018, MCH Health sent two death cer-
tificates for review despite telling the committee they had
at least 40 maternal deaths to be reviewed. No reasons for
withholding the death certificates were given.
(3) As of March 2018, the committee had knowledge of four
maternal deaths in Jefferson County, however, MCH re-
fused to send death certificates so review could be done,
even when the exact date of the death had occurred was
known.
(4) The committee had requested from MCH up-to-date in-
formation from the Kentucky Attorney General’s office
which would be included with the death certificates sent
to reviewers to assist in gaining entry to hospital records.
This information had been requested yearly for three years
without a response from MCH.
(5) The committee requested information from the Kentucky
Attorney General’s Office through MCH regarding discov-
erability of information and legal immunity for serving on
the committee without response from MCH.
(6) The renewal contract sent to the MMRC for fiscal year
2018-2019 contained expanded features (which I will
discuss). It was sent to MCH from the Center for Dis-
ease Control (CDC) to investigate the increasing rate of
maternal deaths in the US. The MCH’s proposal was to
take the criteria for neonatal and fetal death reviews and
apply them to maternal mortality reviews. These changes
were never discussed with the MMRC, and it is difficult
to understand the use of the neonatal-fetal death reviews
and determine how they apply to maternal death reviews.
The Kentucky General Assembly amended KRS211.680 to
KRS 211-686 and KRS72.029 for the purpose to review the
number of child and Maternal Fatalities (“Maternal” added:
Isn’t that what the MMRC has been doing for 46 years?).
The expanded features highlighted the formation of a
multidisciplinary review group according to CDC guide-
lines. It is to include OB/GYN, anesthesiology, patholo-
gy, mental health, nursing, medical examiners, coroners,
epidemiologists, adult and child protective services, law
enforcement, WIC, HANDS, social services, Department
for Community Based Services and clergy. My question
is how this bureaucratic expanded committee is going to
improve the efforts and results of the MMRC? This com-
mittee will meet twice or more times a year. How do you
get professional people to serve on a committee that is
proposed and operated by MCH which ignores maternal
problems and is dysfunctional at best? The proposal was
sent to the MMRC by a non-physician!
(7) Additionally, the MCH proposal wants to include drug
overdose deaths, homicides, suicides and motor vehicle
accidents (MVA) in their reviews for which there is no
medical data available. These four categories make up
approximately 50 percent of the maternal deaths.
(8) To reiterate: the members of the MMRC receive no com-
pensation except travel expenses to review maternal deaths.
I have never received any compensation as Chair of the
MMRC for 22 years. The committee proceedings are car-
ried out in strict confidentiality and I do not know of any
instance where confidentiality has been breached.
The MMRC, which has effectively reviewed maternal deaths for
42 years, has been killed by a hostile MCH which is now directed
by the CDC to use a model that has been poorly accepted and has
not been discussed with the MMRC. There is no evidence that you
can use neonatal-fetal review criteria for maternal death reviews.
National ACOG is starting to push this but the model is flawed,
and they will be spinning their wheels for years trying to come
up with meaningful data. Meanwhile, maternal deaths will not be
appropriately reviewed, and thus the opportunity to learn from and
understand the loss of these women will be lost for current and
future physicians for women.
Dr. Gall practices obstetrics, gynecology and women’s health as part
of the University of Louisville Physicians Group.
OCTOBER 2018
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