Georgia Dismissed All Members of Maternal Mortality Committee After ProPublica’s Report on Amber Thurman, Candi Miller Deaths — ProPublica

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

ProPublica reported in September the deaths of Amber Thurman and Candy Miller, which were reported by the state’s Maternal Mortality Panel determined that they could have been prevented. These were the first reported cases of women who died without access to care limited by the state’s abortion banand they caused a flood of indignation at the fatal consequences of such laws. The women’s stories have become a central theme in the presidential campaign and ballot initiatives related to access to abortion in 10 states.

“Confidential information provided to the Maternal Mortality Review Committee was improperly disclosed,” Dr. Kathleen Toomey, commissioner of the state Department of Public Health, wrote in a Nov. 8 letter to committee members. “Although this disclosure was investigated, the investigation was unable to identify who (persons) disclosed the sensitive information.

“Therefore, the current MMRC is being dissolved and all membership positions will be filled through a new application process.”

A spokesman for the health department declined to comment on the decision to disband the committee, saying the letter, which 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 Georgia law, the work of the Maternal Mortality Review Committee is confidential, and members must sign confidentiality agreements. These members see only brief summaries of medical records, stripped of personal information, and their findings on individual cases must not be released to the public – not even to hospitals or family members of the women who died.

The letter from the health department said new steps could be taken to prevent the council from discussing the matter with the public. The letter said officials may change “other procedures for committee members that better ensure confidentiality, committee oversight and MMRC’s organizational structure.”

Maternal Mortality Review Committees exist in every state. They are tasked with investigating deaths of women during or within a year of pregnancy and determining whether they could have been prevented.

Georgia had 32 permanent members from various walks of life, including obstetrician-gynecologists, cardiologists, psychiatric specialists, medical examiners, health policy experts, and public defenders. These are volunteer positions that pay a small fee.

Their job is to collect data and make recommendations aimed at tackling systemic problems that could help reduce deaths, and publish them in reports. The latest report by a Georgia committee found that of the 113 pregnancy-related deaths from 2018 to 2020, 101 were at least somewhat preventable. Her recommendations led to changes in inpatient care to improve emergency response during childbirth and to new programs to increase access to psychiatric care.

The letter from the health department said that “changes in the current committee will not cause any delay in the performance of the MMRC’s duties”. But at least one other state has felt left behind as a result of reforming its committee. In July 2023, legislation for Idaho’s Maternal Mortality Review Committee expired, effectively disbanding the committee after lobbying groups attacked members for recommending the state expand Medicaid for postpartum women. The Idaho Legislature re-established the committee earlier this year, but no new members were announced until Nov. 15. Currently, the review process is delayed for more than a year.

Reproductive rights advocates say Georgia’s decision to fire and restructure its committee could also have a chilling effect on the committee’s work, potentially dissuading its members from delving so deeply into the circumstances of pregnant women’s deaths when it could be 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. “With this sudden disbandment, my concern is what will we lose in the process in terms of time and data?”

One of the tasks of any maternal mortality review committee is to comprehensively analyze the circumstances of the death to identify underlying causes that may help other women in the future.

In the case of Candy Millerthe most notable detail in the state medical examiner’s report on her death was that she had a lethal combination of painkillers, including fentanyl, in her system. The cause of death was drug intoxication.

But the Georgia committee looked at the facts of the death for a different purpose: to consider the larger context. A summary of Miller’s case prepared for the committee, drawn from hospital records and a medical examiner’s report, included that Miller had several medical conditions that could be worsened by pregnancy, that she had ordered abortion pills from abroad, and that she had not had fetal tissue removed. , which showed that the abortion was not completely completed. It also said her family told the coroner she had not seen a doctor “due to current pregnancy and abortion legislation”.

The committee found that her death could have been “prevented” and blamed the state’s abortion ban.

“The fact that she felt she had to make these decisions, that she didn’t have an adequate choice here in Georgia, we felt that definitely affected her case,” one committee member told ProPublica in September. “She is fully responsive to this legislation.”

For Miller’s family, the committee’s findings were painful but welcome. “It sounds like this is important information that you would want to share with the family,” said Miller’s sister, Turia Tomlin-Randall, who was not aware of the committee’s work until contacted by ProPublica.

She also said it was very upsetting to hear that committee members were fired in part as a result of her sister’s case being made public. “I don’t understand how that’s possible,” she said.

The committee also investigated the case of A Amber Thurmanwho died just a month after Georgia’s six-week abortion law went into effect. The medical examiner’s report stated that Thurman died of “sepsis” and “retained products of conception” and that she had a dilation and curettage, or D&C, and hysterectomy after a home abortion.

When committee members received a summary of her hospital stay, they saw a timeline with additional factors: The hospital delayed a D&C — a routine procedure to remove fetal tissue from the uterus — for 20 hours, which Thurman needed for rare complications. It developed after taking abortion pills. Recently, the state has criminalized the performance of D&C, with few exceptions. The summary revealed that doctors had twice discussed providing a D&C, but by the time they performed the procedure, it was too late. Committee members found there was a “good chance” Thurman’s death could have been prevented if she had received a D&C earlier.

The doctors and nurse who cared for Thurman did not respond to ProPublica’s questions for the September story. The hospital also did not respond to multiple requests for comment.

Thurman’s family also told ProPublica that they wanted to release information about her death.

Some experts say that keeping the reports of maternal mortality committees confidential is important for the committee to fulfill its purpose. They are not designed to assign blame, but instead to create a space for clinicians to investigate the broad causes of maternal health disorders. But others say the lack of transparency could be hiding the biggest failure in maternal health care in half a century.

“We know that the reports coming out of this committee are anonymous and synthesized to provide a 50,000-foot view,” said Quajelyn Jackson, executive director of the Feminist Women’s Health Center in Atlanta, an abortion advocacy group. “But my concern is that in trying to protect the state, there will be less information available to people who could change their actions, change protocols, change strategies, change behaviors to change mothers’ lives. health outcomes”.

Two states made changes to 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 Nakinya Wilson, a public advocate, spoke out against the state’s decision to delay the release of its report in an election year. The next year, the Legislature passed legislation that created a second community advocate position on the committee, redefined the position and forced Wilson to reapply. She was not reassigned. Instead, the state filled one of the seats with a prominent anti-abortion activist.

Wilson said Georgia’s decision to dissolve its committee could cause more damage.

“What is the message to bereaved families?” she said. “There will be even less accountability to make sure it doesn’t happen again.”