Add Art 25 Title 9 §§2599-e - 2599-i, amd §§2803-n & 4141, Pub Health L
Establishes the New York dignity in pregnancy and childbirth act to require hospitals and other facilities that provide perinatal care to implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities; requires hospitals to provide expectant birthing parents with written information regarding certain patient rights; requires information related to pregnancy, if known, to be included on death certificates.
STATE OF NEW YORK
________________________________________________________________________
4018
2025-2026 Regular Sessions
IN ASSEMBLY
January 30, 2025
___________
Introduced by M. of A. FORREST, LEVENBERG, LUNSFORD, MAMDANI, GIBBS,
SHRESTHA, GONZALEZ-ROJAS, BICHOTTE HERMELYN, GALLAGHER -- read once
and referred to the Committee on Health
AN ACT to amend the public health law, in relation to requiring hospi-
tals and other facilities that provide perinatal care to implement an
evidence-based implicit bias program, to providing birthing parents
with written information regarding certain patient rights, and to
including information related to pregnancy on death certificates
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Article 25 of the public health law is amended by adding a
2 new title 9 to read as follows:
3 TITLE IX
4 NEW YORK DIGNITY IN PREGNANCY AND CHILDBIRTH ACT
5 Section 2599-e. Short title.
6 2599-f. Legislative findings.
7 2599-g. Definitions.
8 2599-h. Implicit bias program.
9 2599-i. Data collection.
10 § 2599-e. Short title. This title shall be known and may be cited as
11 the "New York dignity in pregnancy and childbirth act".
12 § 2599-f. Legislative findings. 1. Every person should be entitled to
13 dignity and respect during and after pregnancy and childbirth. Patients
14 should receive the best care possible regardless of their race, gender,
15 age, class, sexual orientation, gender identity, disability, language
16 proficiency, nationality, immigration status, gender expression, or
17 religion.
18 2. While maternal health continues to make great strides globally,
19 the United States is one of the only nations in the world that has seen
20 an increase in maternal mortality over the past several decades. Today,
21 the United States has the highest maternal mortality rate in the devel-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07167-01-5
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1 oped world. According to the Centers for Disease Control and
2 Prevention, more than one thousand two hundred birthing parents die of
3 maternal cases each year, and another fifty thousand suffer from severe
4 complications. Nationally it is estimated that sixty percent (i.e., the
5 majority) of pregnancy-related deaths are preventable.
6 3. For individuals of color, particularly Black individuals, the
7 maternal mortality rate remains three to four times higher than Cauca-
8 sian individuals. In New York, the mortality rate for Black individuals
9 per one hundred thousand births is 51.6, whereas for Caucasian individ-
10 uals it is 15.9. New York has a responsibility to decrease the number of
11 preventable pregnancy- and childbirth-related deaths.
12 4. Access to prenatal care, socioeconomic status, and general physical
13 health do not fully explain the racial disparity seen in maternal
14 mortality and morbidity rates. There is a growing body of evidence that
15 Black birthing parents are often treated unfairly and unequally in the
16 health care system.
17 5. Implicit bias is a driver of health disparities in communities of
18 color. At present, health care providers in New York are not required to
19 undergo any implicit bias testing or training. Nor does there exist any
20 system to track the number of incidents where implicit prejudice and
21 implicit stereotypes have led to negative birth and maternal health
22 outcomes.
23 6. It is the intent of the legislature to reduce the effects of
24 implicit bias in pregnancy, childbirth, and postnatal care so that all
25 people are treated with dignity and respect by their health care provid-
26 ers.
27 § 2599-g. Definitions. For the purposes of this title, the following
28 terms shall have the following meanings:
29 1. "Pregnancy-related death" means the death of a person while preg-
30 nant or within three hundred sixty-five days of the end of a pregnancy,
31 irrespective of the duration or site of the pregnancy, from any cause
32 related to, or aggravated by, the pregnancy or its management, but not
33 from accidental or incidental causes.
34 2. "Implicit bias" means a bias in judgment or behavior that results
35 from subtle cognitive processes, including implicit prejudice and
36 implicit stereotypes that often operate at a level below conscious
37 awareness and without intentional control.
38 3. "Implicit prejudice" means prejudicial negative feelings or beliefs
39 about a group that a person holds without being aware of them.
40 4. "Implicit stereotypes" mean the unconscious attributions of partic-
41 ular qualities to a member of a certain social group. Implicit stere-
42 otypes are influenced by experience and are based on learned associ-
43 ations between various qualities and social categories, including race
44 or gender.
45 5. "Perinatal care" means the provision of care during pregnancy,
46 labor, delivery, and postpartum and neonatal periods.
47 § 2599-h. Implicit bias program. 1. A hospital or other facility that
48 provides perinatal care shall implement an evidence-based implicit bias
49 program for all health care providers involved in the perinatal care of
50 patients within those facilities.
51 2. An implicit bias program implemented pursuant to subdivision one of
52 this section shall include all of the following:
53 (a) identification of previous or current unconscious biases and
54 misinformation;
55 (b) identification of personal, interpersonal, institutional, struc-
56 tural, and cultural barriers to inclusion;
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1 (c) corrective measures to decrease implicit bias at interpersonal and
2 institutional levels, including ongoing policies and practices for that
3 purpose;
4 (d) information on the effects, including, but not limited to, ongoing
5 personal effects, of historical and contemporary exclusion and
6 oppression of minority communities;
7 (e) information about cultural identity across racial or ethnic
8 groups;
9 (f) information about communicating more effectively across identi-
10 ties, including racial, ethnic, religious, and gender identities;
11 (g) discussion on power dynamics and organizational decision making;
12 (h) discussion on health inequities within the perinatal care field,
13 including information on how implicit bias impacts maternal and infant
14 health outcomes;
15 (i) perspectives of diverse, local constituency groups and experts on
16 particular racial, identity, cultural, and provider-community relations
17 issues in the community; and
18 (j) information on reproductive justice.
19 3. A health care provider involved in the perinatal care of patients
20 in a hospital or other facility that provides perinatal care shall
21 complete initial training through the implicit bias program as imple-
22 mented pursuant to subdivision two of this section. Upon completion of
23 the initial training, a health care provider shall complete additional
24 training through the implicit bias program every two years thereafter,
25 or on a more frequent basis if deemed necessary by the hospital or
26 facility, in order to keep current with changing racial, identity, and
27 cultural trends and best practices in decreasing interpersonal and
28 institutional implicit bias.
29 4. A hospital or other facility that provides perinatal care shall
30 provide a certificate of training completion by a health care provider
31 involved in the perinatal care of patients to another facility or the
32 provider who attended the training upon request. A hospital or facility
33 may accept a certificate of training completion from another hospital or
34 other facility that provides perinatal care to satisfy the training
35 required of health care providers involved in the perinatal care of
36 patients pursuant to subdivision three of this section from a health
37 care provider who works in more than one facility.
38 5. Notwithstanding subdivisions one, two, three and four of this
39 section, if a health care provider involved in the perinatal care of
40 patients is not directly employed by a hospital or facility that
41 provides perinatal care, the hospital or facility where the health care
42 provider provides such care shall offer implicit bias training pursuant
43 to this section to such health care provider.
44 6. The commissioner shall monitor implementation of this section by
45 facilities that provide perinatal care and may inspect records from
46 implicit bias training programs or require such hospitals or facilities
47 to report to the commissioner on the implicit bias training program,
48 including continuing education curricula used and courses offered pursu-
49 ant to this section. Initial training provided pursuant to this section
50 shall be made available to health care providers involved in the perina-
51 tal care within one year of the effective date of this title.
52 § 2599-i. Data collection. 1. The department shall track data on
53 severe maternal morbidity, including, but not limited to, all of the
54 following health conditions:
55 (a) obstetric hemorrhage;
56 (b) hypertension;
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1 (c) preeclampsia and eclampsia;
2 (d) venous thromboembolism;
3 (e) sepsis;
4 (f) cerebrovascular accident; and
5 (g) amniotic fluid embolism.
6 2. The data on severe maternal morbidity collected pursuant to subdi-
7 vision one of this section shall be published at least once every two
8 years after both of the following have occurred:
9 (a) the data has been aggregated by state regions, as defined by the
10 department, to ensure data reflects how regionalized care systems are or
11 should be collaborating to improve maternal health outcomes, or other
12 smaller regional sorting based on standard statistical methods for accu-
13 rate dissemination of public health data without risking a confidential-
14 ity or other disclosure breach; and
15 (b) the data has been disaggregated by racial and ethnic identity.
16 3. The department shall track data on pregnancy-related deaths,
17 including, but not limited to, all of the conditions listed in subdivi-
18 sion one of this section, indirect obstetric deaths, and other maternal
19 disorders predominantly related to pregnancy and complications predomi-
20 nantly related to the puerperium.
21 4. The data on pregnancy-related deaths collected pursuant to subdivi-
22 sions one and three of this section shall be published at least once
23 every three years after both of the following have occurred:
24 (a) the data has been aggregated by state regions, as defined by the
25 department, to ensure data reflects how regionalized care systems are or
26 should be collaborating to improve maternal health outcomes, or other
27 smaller regional sorting based on standard statistical methods for accu-
28 rate dissemination of public health data without risking a confidential-
29 ity or other disclosure breach; and
30 (b) the data has been disaggregated by racial and ethnic identity.
31 § 2. Section 2803-n of the public health law is amended by adding two
32 new subdivisions 5 and 6 to read as follows:
33 5. Each hospital shall provide each expectant birthing parent, upon
34 admission or as soon thereafter as reasonably practicable, written
35 information regarding the patient's right to the following:
36 (a) to be informed of continuing health care requirements following
37 discharge from the hospital;
38 (b) to authorize that a friend or family member may be provided infor-
39 mation about the patient's continuing health care requirements following
40 discharge from the hospital;
41 (c) to participate actively in decisions regarding medical care. To
42 the extent permitted by law, participation shall include the right to
43 refuse treatment;
44 (d) appropriate pain assessment and treatment;
45 (e) to be free from discrimination on the basis of race, color, reli-
46 gion, ancestry, national origin, disability, medical condition, genetic
47 information, marital status, sex, gender, gender identity, gender
48 expression, sexual orientation, citizenship, primary language, or immi-
49 gration status; and
50 (f) to file a complaint with the department of health and the medical
51 board of New York and information on how to file the complaint.
52 6. Each hospital shall provide each expectant birthing parent, upon
53 admission or as soon thereafter as reasonably practicable, written
54 information regarding the hospital's policies and procedures for
55 contacting next of kin regarding pregnancy-related deaths, and how to
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1 seek legal counsel in the event of any pregnancy-related deaths or inju-
2 ries.
3 § 3. Subdivision 4 of section 4141 of the public health law is amended
4 by adding a new paragraph (e) to read as follows:
5 (e) The medical certificate shall include information indicating
6 whether the decedent was pregnant at the time of death, or within a year
7 prior to the death, if known, as determined by observation, autopsy, or
8 review of the medical record. This paragraph shall not be interpreted to
9 require the performance of a pregnancy test on a decedent, or to require
10 a review of medical records in order to determine pregnancy.
11 § 4. This act shall take effect immediately.
