Georgia removes all members of Maternal Mortality Committee after ProPublica obtained internal details about two deaths

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Georgia authorities have dismissed all members of the state committee tasked with investigating the deaths of pregnant women. The move came in response to ProPublica receiving internal reports detailing two deaths.

ProPublica published a report in September about the deaths of Amber Thurman and Candi Miller, which the state maternal mortality review committee investigated. determined to be preventable. These were the first reported female cases. died without access to care restricted by the state’s abortion banand they created an outpouring of anger against the deadly consequences of such laws. The women’s stories have become a central debate in the presidential campaign and ballot initiatives on abortion access in 10 states.

State Department of Public Health commissioner Dr. “Confidential information provided to the Maternal Mortality Review Committee was inappropriately shared with outside parties,” Kathleen Toomey said. He wrote in a letter dated November 8 and addressed the members of the commission. “Although this disclosure was investigated, the investigation could not reveal which person(s) disclosed the confidential information.

“Therefore, the current MMRC will be disbanded immediately and all member seats will be filled through a new application process.”

A health department spokesman declined to comment on the committee’s dismissal decision, saying the letter the department provided to ProPublica “speaks for itself.” Georgia Gov. Brian Kemp’s office also declined to comment, referring questions to the health department.

Under Georgian law, the work of the maternal mortality review committee is confidential and members are required to sign confidentiality agreements. These members see only summaries of medical records stripped of personal details, and their findings on individual cases are not supposed to be shared with the public, not even hospitals or family members of deceased women.

The health ministry’s letter states that new steps may be taken to hide the board’s deliberations from the public. The letter said officials may change “other procedures to better ensure confidentiality of entry committee members, committee oversight, and the MMRC organizational structure.”

Maternal mortality review committees exist in every state. They are tasked with examining deaths of women during pregnancy or up to a year later and determining whether they could have been prevented.

Georgia had 32 permanent members from a variety of backgrounds, including obstetricians, cardiologists, mental health providers, medical examiners, health policy experts, and community advocates. These are volunteer positions that pay a small fee.

Their job is to collect data and make recommendations and publish them in reports to combat systemic problems that can help reduce deaths. The Georgia committee’s latest report found that 101 of 113 pregnancy-related deaths from 2018 to 2020 had at least some chance of being prevented. Their recommendations have led to changes in hospital care to improve response to emergencies during labor and birth and new programs to increase access to psychiatric treatment.

The health ministry’s letter states that “the change to the current committee will not cause a delay in the MMRC’s responsibilities.” But at least one other state experienced a delay as a result of its committee reshaping. Idaho allowed its maternal mortality review committee legislation to expire in July 2023, effectively disbanding the committee after lobbyist groups attacked members who recommended the state expand Medicaid for postpartum women. Earlier this year, the Idaho Legislature reestablished the committee, but the new members were not announced until Nov. 15. There is currently a delay of more than a year in the review process.

Reproductive rights advocates say Georgia’s decision to dismiss and restructure the committee could have a chilling effect on its work and potentially deter its members from further investigating the circumstances surrounding the deaths of pregnant women if it is politically sensitive.

“They did what they had to do. That’s why we need them,” said Monica Simpson, executive director of SisterSong, one of the groups challenging Georgia’s abortion ban in court. “My concern with this sudden disbandment is, what are we going to lose in terms of time and data in the process?”

One of the goals of the maternal mortality review committee is to look holistically at the circumstances of death to identify root causes that could help other women in the future.

In the case of Candi MillerThe most glaring detail in a state medical examiner’s report on her death was the discovery of a lethal combination of painkillers, including fentanyl, in her system. He attributed the cause of death to drug poisoning.

But the Georgia committee looked at the facts of the death for a different purpose: to consider the broader context. The case summary Miller prepared for the committee, drawn from hospital records and the coroner’s report, included that Miller had multiple health problems that could be worsened by pregnancy, had ordered abortion pills from abroad, and had undisposed fetal tissue. This showed that the abortion was not completely completed. It was also stated that her family told the coroner that she did not see a doctor “due to current legislation regarding pregnancy and abortion”.

The committee found that her death was “preventable” and blamed it on the state’s abortion ban.

“We felt that the fact that he felt like he had to make these decisions and that he didn’t have enough options here in Georgia definitely impacted his situation,” one committee member told ProPublica in September. “It certainly responds to this legislation.”

For Miller’s family, the committee’s findings were painful but welcome. “This seems like important information to share with your family,” said Miller’s sister, Turiya Tomlin-Randall, who was unaware of the committee’s work until ProPublica contacted her.

He also said it was saddening to hear that committee members had been partially dismissed as a result of his sister’s case becoming public. “I don’t understand how this is possible,” he said.

The commission also investigated Amber Thurman caseHe died just a month after Georgia’s six-week abortion law went into effect. The coroner’s report stated that Thurman died of “sepsis” and that “products of conception were retained” and that a home abortion was followed by dilation and curettage, or D&C and hysterectomy.

When committee members received a summary of her hospital stay, they saw a timeline with additional factors: The hospital was 20 hours late in providing the D&C, a routine procedure to clear fetal tissue from the uterus, that Thurman needed due to rare complications. It developed after taking abortion medication. The state had recently added criminal penalties for performing a D&C, with a few exceptions. The summary showed doctors discussed providing a D&C twice, but by the time they performed the procedure it was too late. Committee members found there was a “great chance” Thurman’s death could have been prevented if she had received the D&C sooner.

Doctors and a nurse involved in Thurman’s care did not respond to ProPublica’s questions about the September story. The hospital also did not respond to multiple requests for comment.

Thurman’s family also told ProPublica they want information about her death released.

Some experts say that keeping the reports of maternal deaths investigation committees confidential is important for the committee to serve its purpose. These were created not to assign blame to others, but instead to create a space for clinicians to investigate common causes of maternal health failures. But others say the lack of transparency may serve to hide the biggest breakdown in maternal health care in half a century.

“We know that the reports coming out of this committee have been anonymized and synthesized to provide a 50,000-foot view,” said Kwajelyn Jackson, executive director of the Feminist Women’s Health Center, which provides abortion care in Atlanta. “But my concern is that in an effort to protect the state, there will be less information available to people who can change their actions, their protocols, their strategies, their behaviors to make a difference in their maternal relationships.” health outcomes.”

Two states reshuffled their committees: Idaho after members made a recommendation to expand Medicaid that Republicans opposed, and Texas after a member publicly criticized the state.

In 2022, Texas committeewoman Nakeenya Wilson, a community advocate, spoke out against the state’s decision to delay the release of its report through the election year. The following year, the Legislature passed a bill creating a second community advocate position in committee, redefining the position and allowing Wilson to reapply. He was not reappointed. Instead, the state filled one of the vacancies with a prominent anti-abortion activist.

Georgia’s decision to dismiss the committee could cause greater damage, Wilson said.

“What message is given to families who lost their loved ones?” he said. “There will be even less liability to make sure this doesn’t happen again.”

Ziva Branstetter, Kavitha Surana, Cassandra Jaramillo and Anna Barry-Jester contributed reporting. Doris Burke contributed to the research.

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