Individuals working to establish a maternal mortality review committee (MMRC) should be aware of what protections their state statutes do and do not offer. If a state’s laws and protections are not adequate, efforts should be made to have appropriate laws or regulations enacted. It requires time and effort to develop and advocate for clear authority and protections; however, strong authority and protections strengthen the review process and minimize challenges.
The necessary legal framework for an MMRC covers three issues— confidentiality, immunity, and access to records. Confidentiality refers to the legal protection of the information collected as part of the review process as well as the results of any discussions or findings from disclosure, either as part of discovery or used as part of any court proceedings. Immunity protects members of the committee process as well as any witnesses or others providing information from personal liability based on activities during the review process. Finally, legal access to medical records provides the material that can be critical to understanding the events that occurred leading up to the death. In this era of concern over liability, strong confidentiality protection can help assuage the concerns of providers and institutions about sharing materials.
MMRCs are comprised of multidisciplinary experts, and are different from peer review committees. The latter, based at the local level, usually in institutions, have as their charge the evaluation of the qualifications of individuals, and have the authority to take punitive action, such as the revoking of staff privileges. MMRCs review cases that usually consist of anonymous data, their goal being not to find individual fault but rather to find ways to improve care within the system.i
Since legal protections vary by state, committee administrators should research their state’s statutes prior to establishing an MMRC to learn the extent of its protections and the statutory requirements for the structure and conduct of committee work. Administrators should also periodically review the status of proposed or passed legislation to understand its implications for the committee’s authority. After the MMRC is established, the committee should consult legal counsel should any questions or concerns arise. All communications with the committee members should include information about statutes and protections.
MMRCs need the authority to collect medical and other records related to each maternal death that they identify or choose to review. Maternal death case abstractors should be able to collect vital records (e.g. birth and death certificates), hospitalization and prenatal care records, and autopsy reports. Additionally, committees may wish to secure other useful resources, such as police reports and interviews with family members. Clearly specifying via legislation the authority of the committee to collect these records, and pointing to that authority during records requests, can facilitate compliance with the request and mitigate any concerns by the record providers.
i Berg, C.J. (2012). From identification and review to action: maternal mortality review in the United States. Seminars in Perinatology, 36 (1), 7-13.
Efforts to establish or strengthen a maternal mortality review committee (MMRC) should include a review of what protections and authorities are already in place. This document shows key components to consider and sample language for each component.