| 1 | A bill to be entitled |
| 2 | An act relating to infant mortality; providing legislative |
| 3 | intent relating to the black infant health practice |
| 4 | initiative; providing definitions; providing objectives; |
| 5 | providing for administration of the initiative; requiring |
| 6 | a local community to develop a team to serve as a part of |
| 7 | a statewide practice collaborative; requiring healthy |
| 8 | start coalitions to conduct case reviews; requiring |
| 9 | certain public universities or colleges to provide |
| 10 | technical assistance, to assist in determining certain |
| 11 | criteria, and to present findings and make |
| 12 | recommendations; requiring the Department of Health to |
| 13 | distribute funding to the coalitions; providing duties of |
| 14 | each participating coalition; requiring the department to |
| 15 | award grants; requiring the department to conduct an |
| 16 | annual evaluation of the initiative; requiring each |
| 17 | coalition to submit a report to the Governor, the |
| 18 | Legislature, and the department; providing immunity from |
| 19 | liability to participating coalitions; requiring the |
| 20 | department to adopt rules; providing a timeframe for |
| 21 | reviewing cases; providing an appropriation; providing an |
| 22 | effective date. |
| 23 |
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| 24 | WHEREAS, the Legislature recognizes that pregnancy, birth, |
| 25 | and infant health outcomes are internationally recognized as |
| 26 | measures of health for a community, as these outcomes are |
| 27 | indicators of population sustenance, growth, and quality of |
| 28 | life, and |
| 29 | WHEREAS, the Legislature also recognizes that infant |
| 30 | mortality disproportionately affects African-American infants, |
| 31 | as the resident infant mortality rate in 2005 for nonwhites is |
| 32 | 12.5 per 1,000 live births, which is more than double the infant |
| 33 | mortality rate for whites, which is 5.3 per 1,000 live births, |
| 34 | and |
| 35 | WHEREAS, the Legislature recognizes that a continued effort |
| 36 | to identify the causes of racial disparities in infant mortality |
| 37 | benefits all citizens of Florida, NOW, THEREFORE, |
| 38 |
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| 39 | Be It Enacted by the Legislature of the State of Florida: |
| 40 |
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| 41 | Section 1. Black infant health practice initiative.-- |
| 42 | (1) LEGISLATIVE INTENT.--It is the intent of the |
| 43 | Legislature to create a black infant health practice initiative. |
| 44 | The initiative shall include reviews of infant mortality in |
| 45 | select counties in this state in order to identify factors in |
| 46 | the health and social services systems contributing to higher |
| 47 | mortality rates among African-American infants. It is also the |
| 48 | intent of the Legislature that the initiative produce |
| 49 | recommendations on how to address the factors identified by the |
| 50 | reviews as contributing to these higher infant mortality rates. |
| 51 | (2) DEFINITIONS.--As used in this section, the term: |
| 52 | (a) "Coalition" means a federal or local healthy start |
| 53 | coalition or consortium. |
| 54 | (b) "Department" means the Department of Health. |
| 55 | (c) "FIMR" means a fetal and infant mortality review |
| 56 | committee. |
| 57 | (d) "Infant mortality" means the death of a live-born |
| 58 | infant within 364 days after the infant's birth. |
| 59 | (e) "Infant mortality rate" means the number of infant |
| 60 | deaths per 1,000 annual live births. |
| 61 | (3) OBJECTIVES.--The objectives of the initiative include: |
| 62 | (a) Determining the significant social, economic, |
| 63 | cultural, safety, and health system factors that are associated |
| 64 | with racial disparities in infant mortality rates through a |
| 65 | practice collaborative approach using perinatal periods of risk |
| 66 | and modified fetal infant mortality reviews. |
| 67 | (b) Developing a series of interventions and policies that |
| 68 | address these factors to improve the service systems and |
| 69 | community resources. |
| 70 | (c) Participating in the implementation of community-based |
| 71 | interventions and policies that address racial disparities in |
| 72 | infant mortality rates. |
| 73 | (d) Assessing the progress of interventions. |
| 74 | (4) ADMINISTRATION.--The black infant health practice |
| 75 | initiative shall be administered through a collaboration among |
| 76 | the department, federal and state healthy start coalitions, and |
| 77 | public universities or colleges having expertise in public |
| 78 | health. A local community shall develop an interdisciplinary |
| 79 | team to serve as part of a statewide practice collaborative. |
| 80 | Both perinatal periods of risk and fetal infant mortality |
| 81 | reviews may be used. A case review shall be conducted by each |
| 82 | participating healthy start coalition using professional in- |
| 83 | house staff or through contracts with an outside professional. |
| 84 | Public universities or colleges having expertise in public |
| 85 | health shall provide technical assistance in developing a |
| 86 | standard research methodology based on the fetal and infant |
| 87 | mortality review method. Public universities or colleges having |
| 88 | expertise in public health shall assist each participating |
| 89 | coalition in determining the selection of comparison groups, |
| 90 | identifying data collection and housing issues, and presenting |
| 91 | findings and recommendations. A single methodology for the |
| 92 | reviews conducted through the initiative shall be used by each |
| 93 | participating coalition. The department shall distribute funding |
| 94 | to each coalition that participates in the initiative through |
| 95 | annual grants that are subject to specific appropriations by the |
| 96 | Legislature. |
| 97 | (5) FUNCTIONS OF THE INITIATIVE.--Each participating |
| 98 | coalition shall: |
| 99 | (a) Develop an interdisciplinary team to oversee the |
| 100 | process in its local community. |
| 101 | (b) Use perinatal periods of risk methodology when |
| 102 | appropriate to examine infant deaths in its community. |
| 103 | (c) Use a modified FIMR approach to examine infant deaths |
| 104 | in its community by: |
| 105 | 1. Creating a case review FIMR team that may include |
| 106 | obstetricians, neonatologists, perinatalogists, pathologists, |
| 107 | registered nurses, social workers, hospital and clinic |
| 108 | administrators, social service agencies, researchers, citizens |
| 109 | and consumers, and other experts considered necessary to conduct |
| 110 | a standardized review of infant mortality. |
| 111 | 2. Hiring or contracting with professional staff that may |
| 112 | include licensed nurses and social workers to abstract and |
| 113 | present individual case reviews that omit identifying |
| 114 | information regarding infant deaths compared to live births to |
| 115 | the case review team. |
| 116 | 3. Developing abstracts of sample infant mortalities and |
| 117 | comparative live births that omit identifying information and |
| 118 | that identify social, economic, cultural, safety, and health |
| 119 | system factors that are associated with racial disparities in |
| 120 | infant mortality rates. The number of abstracted cases that must |
| 121 | be conducted by each participating coalition shall be determined |
| 122 | by a standard research methodology developed in conjunction with |
| 123 | a public university or college having expertise in public |
| 124 | health. |
| 125 | 4. Presenting abstracts that omit identifying information |
| 126 | to its case review team at least quarterly for their review and |
| 127 | discussion. |
| 128 | (d) Develop findings and recommendations for interventions |
| 129 | and policy changes to reduce racial disparities in infant |
| 130 | mortality. |
| 131 | (6) GRANT AWARDS.--The department shall award annual |
| 132 | grants through a request-for-proposal process that is subject to |
| 133 | specific appropriations by the Legislature. The department shall |
| 134 | award five grants to coalitions representing urban counties and |
| 135 | five grants to coalitions representing rural counties. Priority |
| 136 | of grant awards shall be given to those coalitions representing |
| 137 | counties having a nonwhite infant mortality rate at least two |
| 138 | times greater than the white infant mortality rate and at least |
| 139 | 40 nonwhite infant deaths annually between 2003 and 2005 for |
| 140 | urban counties and five nonwhite infant deaths annually between |
| 141 | 2003 and 2005 for rural counties. |
| 142 | (7) EVALUATIONS AND REPORTS.--The department shall conduct |
| 143 | an annual evaluation of the implementation of the initiative |
| 144 | describing which areas are participating in the initiative, the |
| 145 | number of reviews conducted by each participating coalition, |
| 146 | grant balances, and recommendations for modifying the |
| 147 | initiative. A participating coalition shall produce a report on |
| 148 | its collective findings and recommendations by January 1, 2010, |
| 149 | to the Governor, the President of the Senate, the Speaker of the |
| 150 | House of Representatives, and the Secretary of Health. |
| 151 | (8) IMMUNITY.--Each participating coalition, its case |
| 152 | review team members, and professional staff are immune from |
| 153 | liability pursuant to s. 766.101, Florida Statutes. |
| 154 | (9) RULEMAKING.--The department shall adopt rules, |
| 155 | pursuant to ss. 120.536(1) and 120.54, Florida Statutes, |
| 156 | necessary to implement this section. |
| 157 | (10) IMPLEMENTATION TIMELINE.--The department shall |
| 158 | release a request for proposals in a manner that will allow each |
| 159 | participating coalition to begin reviewing cases no later than |
| 160 | January 1, 2008. |
| 161 | Section 2. The sum of $1 million is appropriated from the |
| 162 | General Revenue Fund to the Department of Health for the 2007- |
| 163 | 2008 fiscal year to implement the black infant health practice |
| 164 | initiative and to fund one full-time equivalent position to |
| 165 | carry out the provisions of this act. |
| 166 | Section 3. This act shall take effect July 1, 2007. |