Refusal To Participate in Maternal Deaths Review Shows City Has Not Learned from Brooklyn Death
by The Opportunity Agenda, Wed Aug 06, 2008 at 06:27:25 AM EDT
The public recently witnessed the lack of basic care that people are subjected to at Kings County Hospital Center in Brooklyn, New York. A woman was left for dead in the middle of the hospital's psychiatric ward waiting room as staff did nothing but walk away. The evidence in the New York Civil Liberties Union's lawsuit against the city proved that this was not an isolated incident (it just happened to be one of the only ones caught on tape). Unfortunately, New York City's government is not learning from this catastrophe and taking sufficient steps forward to examine their hospitals - Women's eNews is reporting that the city is refusing to participate in a state review of maternal deaths and racial disparities, despite the fact that New York City has the highest number of maternal deaths and one of the largest populations of African-American patients in the country.
The New York City Health and Hospitals Corporation (the same agency that is named in the NYCLU lawsuit as the agency that is responsible for the negligence at Kings County Hospital Center), has refused to participate in the review the Safe Motherhood Initiative is conducting. Pamela McDonnell, a spokesperson for Health and Hospitals Corporation (HHC) said:
We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives.
However, one of the main points in the NYCLU's complaint was that the city had insufficient monitoring and oversight measures at its hospitals - it was this lack of oversight that led to last month's death at Kings County, and it could be part of the cause of numerous maternal deaths at city hospitals.
New York's American College of Obstetricians and Gynecologists, in conjunction with the New York State Department of Health, launched the Safe Motherhood Initiative in 2001. The Initiative was established to conduct reviews that facilitate responses to pregnancy-related deaths and eliminate racial disparities in maternal mortality in New York State. However, HHC's refusal to participate will lead to a great deal of information, particularly information on racial disparities among pregnant women in the hospitals, being left out of the review.
The first Safe Motherhood Initiative review that came out in 2005 interpreted 33 deaths over the course of 2 years - it found that 60% of those women who died were African American. The review examined the deaths of these women in detail and sought to determine what the cause of the racial disparity was. According to Women's eNews:
In 2004, black women were nearly four times as likely to die in childbirth as white women nationwide, and had a maternal death rate of 34.7 per 100,000 live births compared to 9.3 deaths per 100,000 live births for white women...
Designed to discover and interpret major risk factors, [director of New York's American College of Obstetricians and Gynecologists Donna] Montalto's State Maternal Mortality Review surveys--among many data--the deceased woman's occupation, primary language, education, insurance coverage, prenatal care, method of delivery and history of sexually transmitted diseases. It asks if the pregnancy was intended or unintended. It might also help explain why African American women represent a disproportionate amount of maternal deaths.
The Opportunity Agenda's report on New York City's health care system, Dangerous and Unlawful: Why Our Health Care System Is Failing New York Communities and How To Fix It, showed the unequal and inadequate access to health care that many communities, particularly communities of color, are faced with. This lack of access and poor quality was most evident in the absence of primary care for many New Yorkers. Incidentally, the last Safe Motherhood Initiative review found that inadequate prenatal care was one of the main causes of the racial disparity in maternal deaths in New York State. Prenatal care is something that many women get through their gynecologist as part of their primary care; thus, the lack of decent primary care can lead to many women in communities of color having at-risk pregnancies.
The problems in the city's health care system was exemplified by last month's disaster at Kings County Hospital. It is to the detriment of all New Yorkers that HHC is refusing to participate in the Safe Motherhood Initiative's review - it is crucial that we address health disparities and find real solutions to the problems in the state's health care system, but the city has to play a role in doing this. HHC says its mission is:
To extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity and respect.
The death of Esmin Green last month showed that HHC is not succeeding in its mission. Its decision not to participate in the Safe Motherhood Initiative review is another one that could lead to an unnecessary, preventable death at a city hospital. The city needs to work to address these problems - until it does, our communities will suffer.