Support Task Force to Study Childbirth Related Deaths

Testimony by Lisa M. Hollier, MD, MPH, FACOG

House Committee on Public Health
House Bill 1085 by Rep. Armando Walle
March 27, 2013

Madam Chairman, thank you for the opportunity to provide testimony today.  I speak on behalf of the Texas Medical Association (TMA) and the Texas District of the American Congress of Obstetricians and Gynecologists (ACOG), organizations together representing more than 47,000 physicians dedicated to improving health in Texas.

The pregnancy-associated mortality ratio in Texas has been rising since 1996. In fact, it has quadrupled over that time period. By 2010, the statewide maternal mortality ratio was 25 per 100,000 live births.  This is higher than the national average of 19 deaths per 100,000 live births and more than twice as high as the Healthy People 2020 Goal of 11.4 deaths per 100,000 live births. Rates of maternal death are worse in some urban areas such as Harris County where I practice.  Maternal mortality is one of the most striking of health disparities.  African-American women in Texas are at least three times more likely to die from pregnancy complications than are Caucasian women.  I have witnessed first-hand the burden of these deaths on families and on our society in economic, social, and personal terms.

Current leading causes of maternal death in Texas include high blood pressure or preeclampsia, blood clots, bleeding, and heart disease. Many of these deaths are believed to be preventable — as many as 50 percent in some scientific studies.

Maternal deaths are just the tip of the iceberg:  Many more women suffer severe complications like kidney failure, shock, and heart attack.  Like the rising rate of maternal death, the rate of severe complications also is rising. As a high-risk pregnancy specialist, working predominantly with Medicaid patients, I have cared for many women with life-threatening complications.  I remember one patient in particular who lost her baby, suffered cardiac arrest, was saved, and spent weeks in the intensive care unit, and then six months on dialysis until her kidneys recovered. Preventing just one hospitalization like hers would result in huge savings to our state Medicaid system.

The multidisciplinary task force as outlined will examine the circumstances of a mother’s death and complications.  By reviewing a large number of cases across multiple health systems, the task force has the ability to identify gaps in services and systems to prevent future deaths and complications; then synthesize and disseminate findings and recommendations. By clearly identifying preventable causes of death and complications, we can better direct resources to improve health for women while reducing health care costs — the best of both worlds.

For these reasons, the TMA and the Texas District of ACOG strongly support the committee substitute for House Bill 1085 by Rep. Armando Walle. As physicians, our life’s work is dedicated to improving the outcomes of pregnancy for women and their children. This bill, Madam Chairman, represents a small investment in the future.  This bill will give us the tools and the infrastructure we need to create a significant return on our investment – improvement in the lives of all Texans.  

Thank you for your time today.

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