THE TEXAS TRIBUNE – For the last year, members of Texas’ maternal mortality review committee have been increasingly vocal about the ways state law limits their ability to analyze maternal deaths and near-misses. Now, it’s time to see whether legislators will heed these calls for change.
So far, bills have been filed that would allow the committee to review abortion-related deaths, lift some of the redaction requirements that delay the review of cases, and allow Texas to rejoin the federal maternal death tracking system. Almost all of these bills have been filed by Democrats, who hope the bipartisan attention on maternal health may allow some modest tweaks to pass both chambers.
“Texas says it’s a pro-life state. I don’t think we’ll be able to wave a magic wand and totally eradicate maternal mortality,” said Houston Rep. Lauren Ashley Simmons, a Democrat. “But as much as we can ensure we’re taking this seriously and tracking these numbers, that’s a low bar that I hope and think we can clear this session.”
Maternal deaths, and the committee that reviews them, have been in the spotlight since Texas banned nearly all abortions. At least three women have died and countless others have come forward with stories of medical care delayed or denied due to confusion or fear of the strict laws, which come with up to life in prison for performing a prohibited abortion.
The work of reviewing maternal deaths has come under increasing conservative scrutiny in some states. In Georgia, the governor removed the entire board from their posts over confidentiality issues after ProPublica reported on an abortion-related death, and Idaho disbanded its committee in 2023. Lawmakers later restored the board.
At a committee meeting Friday, Houston OB/GYN Dr. Carla Ortique, who chairs the group, spoke generally about the need for doctors to be allowed to practice medicine without fear of criminalization. She called on lawmakers, hospitals and professional associations to “support doctors in making the best decisions possible along with their patients.”
Several Democrats have filed bills to amend or clarify the near-total abortion ban, and Lt. Gov. Dan Patrick has said he’s open to the idea. But no Republicans have filed a bill or signed onto any of those already filed.
Ortique said doctors need to remember their oath to “first, do no harm.” She described treating a molar pregnancy, which cannot produce a viable fetus and can endanger a patient’s life if allowed to go on.
“What would you have done in 2021 in that situation?” she said, referring to before abortion was banned. “Would you have acted in the best interest of the patient? Or would you have been concerned about what your life might look like were you to be prosecuted for doing something that would be in your patients best interest?”
The push to review abortion-related deaths
For a decade, the Department of State Health Services has been excluding deaths related to “voluntary or therapeutic termination of pregnancy” from the pile given to the committee to review. This exclusion was written into the original statute, but members of the committee only became aware of it last year.
“Each maternal death, each life that is lost, has value,” chair Dr. Carla Ortique said at a meeting in September. “We can’t make comments about what caused an increase in maternal death in our state if we’re not really reviewing all of them.”
Sen. Tan Parker, a Republican from Flower Mound, has filed Senate Bill 1831, which would require the committee to review deaths related to voluntary termination of pregnancy, but continue to exclude deaths related to therapeutic abortions. Texas law only allows so-called therapeutic abortions, to save the life or bodily function of the pregnant patient, although many Texans are finding ways to terminate their pregnancies outside of the law. Parker did not respond to a request for comment.
San Antonio Democrat Sen. José Menéndez has filed a bill that would take a different approach by requiring the committee to review deaths and near-misses related to “miscarriage or threatened miscarriage or attributable to lack of access to therapeutic termination of pregnancy.”
He said his bill is carefully worded to avoid setting off alarm bells among his Republican colleagues who are hesitant to pass anything seen as amending or loosening the abortion laws.
“They’re so adamant about not having abortions, but we’re just thinking that you can’t have people dying,” he said. “That’s what this is trying to address.”
Two bills have been filed by Democrats that would require the committee to review pregnancy-related deaths, regardless of the outcome of the pregnancy. HB 3121, filed by Fort Worth Rep. Nicole Collier, and Simmons, HB 1989, would both also allow a larger swath of deaths to be reviewed to determine whether they would qualify as pregnancy-related deaths.
These bills would allow family members and health care providers to confidentially report deaths to the committee for review, would allow committee members to be reimbursed for some costs related to their work and would create a workgroup to assess the feasibility of creating a public-facing maternal health data registry.
Simmons’ bill is called “Tomara’s Law,” after one of her sorority sisters who died soon after giving birth. She said repealing the near-total abortion bans will be key to improving maternal health outcomes.
“But until that happens, we need to have a better understanding about why people are not surviving childbirth,” she said. “We can’t get to the root of it if we’re not properly recording and keeping track of the data as it comes in.”
Improving confidentiality and timeliness
Texas is the only state that requires all medical records to be fully redacted of personal information before they are handed over to the maternal mortality committee for review, a time-intensive process that the committee says delays their work.
This is due to a quirk of state regulations that would require any nurse on the committee to report to the Board of Nursing any allegations of medical misconduct they come across in these cases. The committee is intended to be analytical, not disciplinary, so removing that requirement would be key to allowing these records to be reviewed in their unredacted form, members of the committee and some lawmakers say.
“This is not a review to determine misconduct,” said state Rep. Donna Howard, an Austin Democrat. “This is a review to determine trends of health care, morbidity and mortality. We need to remove this barrier.”
Howard filed a bill that removes the mandatory reporting requirement for nurses working as part of the committee, and reiterates the confidentiality of the committee’s work. A similar bill passed the House last session but stalled in the Senate.
Collier and Simmons’ bills would also remove that reporting requirement.
The committee’s most recent report, released in September 2024, looked at deaths from 2020. Last year, the committee announced it would skip over deaths from 2022 and 2023, the first years abortion was banned in Texas, to do a more timely review of cases from 2024.
This decision has sparked outrage from the public, which accused the committee of trying to cover up the impacts of Texas’ abortion bans. Houston Democrat Rep. Armando Walle has filed HB 2117, which would require the committee to annually review cases from the previous year.
At Friday’s meeting, committee vice chair Dr. Patrick Ramsey said the timeliness issue can’t be addressed until redaction requirements are removed.
“That’s one of the reasons that we’re behind, in some aspects, for reviewing cases,” he said. “The ability to reduce the need, or remove that need, for complete reduction would certainly be a major improvement for our ability to expedite review of cases.”
Ramsey, along with several other committee members, also reiterated their request to be allowed to interview family members and other stakeholders involved in a maternal death as part of their review process. This is currently impossible, as redactions remove any identifying details.
“Having attended some of the national meetings and also hearing from other states that have adopted key informant interviews as a best practice, it certainly does lend additional voice to that mother who has lost her life, and gives the reviewers an additional perspective that may have not come across in the actual case,” Dr. Sherri Onyiego, a Houston family physician, said at Friday’s meeting.
Changing the makeup of the committee
Last session, legislators revised the makeup of the committee, adding certain medical providers and splitting the community advocate position into two, one for rural areas and one for urban areas. The legislation also changed the description of that position.
As a result, Nakeenya Wilson, the former community advocate and a Black woman who had a near-death experience in childbirth, was removed in favor of two doctors. The doctor appointed to represent rural communities, Dr. Ingrid Skop, is an anti-abortion advocate who lives and works in San Antonio, the state’s second-largest city.
Committee leaders have been outspoken about restoring community voices, as is recommended by national best practices. At a meeting Friday, Ortique said that as a Black woman who grew up in a marginalized community, she could speak for those groups in some ways, but her privilege as a doctor prevents her from “truly being able to be a voice for that community.”
“Our statute mandates that we specifically look at the groups that are at most risk in our state, and report after report has recognized that Black women are the group of highest risk,” she said. “We need to have a community voice at this table that speaks to the experience of those who are at most risk, and I feel that’s very important.”
The only bill filed so far to address the makeup of the committee is HB 2140, filed by Simmons, which would add two spots for doulas.
Rejoining the federal tracking system
Lawmakers last session also allocated almost $6 million to build a maternal death tracking system while quietly removing Texas from the federal Maternal Mortality Review Information Application run by the Centers for Disease Control and Prevention.
HB 731, filed by Walle, would restore Texas to the federal system, which committee leaders have said is essential for tracking and improving maternal health outcomes in Texas and the nation. At a June meeting, Ortique spoke about attending a national conference and seeing the importance of data sharing between states, especially for a state that represents more than 10% of births in the country.
Walle’s bill has been referred to committee.
This article originally appeared in The Texas Tribune.
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