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West Virginia Legislative Interims: DHHR official says lack of agency notification may have impacted prevention and treatment plan development

State’s infant mortality rate and abortion laws discussed

By Autumn Shelton, West Virginia Press Association

BERKELEY SPRINGS, W.Va – Due to a delay in properly reporting specific death-related information to the state’s governing bodies, there is a possibility that West Virginians have been missing out on prevention and treatment care.

During Monday’s legislative interim meeting of the Joint Committee of Health, held at Cacapon Resort State Park, Matt Izzo, administrative director of the Office of the Chief Medical Examiner (OCME), Department of Health and Human Resources (DHHR), said state code requires that four separate advisory panels under the Fatality and Mortality Review Team (FMRT) provide annual death-related reports to members of both the Legislative Oversight Commission on Health and Human Resources Accountability and to the governor’s office. 

However, according to Izzo, those reporting requirements have been unmet for years. 

For background information, he explained that the FMRT was created in 2013 to provide oversight, review and assessment of all deaths, under certain categories, that occur in West Virginia. The four panel advisory team includes the Unintentional Pharmaceutical Drug Overdose Review Panel (UPDORP), the Infant and Maternal Mortality Review Panel (IMMRP), the Domestic Violence Fatality Review Panel (DVFRP), and the Child Fatality Review Panel (CFRP). 

He said that panel reports had previously been submitted as individual reports published on either agency or legislative websites. 

“Since notification of this deficiency, the DHHR, BPH (Bureau of Public Health), OCME and the FMRT have taken the appropriate steps to consolidate the reports that include each of the legacy reports that were not properly submitted previously,” he assured. “Procedures have been implemented to ensure code compliance in the future.” 

In response to questioning from Sen. Jack David Woodrum, R-Summers, about whether or not this inappropriate reporting could have affected life-saving policy making, Izzo stated, “I believe there could have been recommendations in the previous panels that could have made a difference in perhaps looking at prevention and treatment.”

When asked by Del. Amy Summers, R-Taylor, about why this happened, Izzo responded that “it was a failure on my part to understand that they needed to be consolidated. It was a failure of some of the actual FMRT meetings to occur. It was quite a few shortcomings on our side that contributed to us not meeting the requirement.” 

He said that the team had good communication with various boards and law enforcement agencies during their monthly meetings, and that in the event of a child’s death, the OCME would subpoena appropriate agencies to determine an exact cause of death if possible, but the information wasn’t “consolidated and pushed up the way it should be.”  

In order to meet reporting requirements for 2022, Izzo then discussed current findings. 

He said that, currently, the CFRP is reviewing 324 cases, the DVFP is reviewing 342 cases, UPDORP is reviewing 2,910 cases, and the IMMRP is reviewing 798 infant and maternal death cases. 

“There have been a significant number of cases for each of the panels to review for the past several years,” Izzo stated, noting there is a backlog of cases due the pandemic. 

He continued that from 2015-2018, 41.6 percent of the state’s child fatalities were determined to be accidental, 9.3 percent were homicides, 9.3 percent were suicides, 1.9 percent were from natural causes and 37.9 percent were undetermined. 

Additionally, he said that between 2015-2017, 59.6 percent of domestic violence related fatalities were determined to be suicides and 32.7 percent were homicides. The remaining causes were accidental, natural and undetermined.

Izzo noted that in the past 21 years, overdose related deaths in West Virginia have increased by 615 percent, with Fentanyl, a synthetic opioid, being the largest contributor. 

“One of the most significant public health epidemics in all of our lifetimes is occurring right now in West Virginia,” Izzo stated. “No matter what perspective or viewpoint that is used to assess substance abuse disorder, or what label is used to describe it, we are losing more West Virginians to overdose deaths than any other non-natural cause of death.” 

Dr. David Didden, physician director for the Office of Maternal, Child and Family Health, then presented IMMRP death-related panel findings. 

From 2014-2019, the pregnancy-related maternal mortality rate was 14 deaths per 100,000 live births, Didden explained. Most of the deaths were determined to be accidental, which includes overdoses. 

The infant mortality rate in West Virginia in 2015 was 7.02 deaths per 100,000 live births compared to the national average of 5.9 deaths per 100,000 live births, he said. 

Del. Mike Pushkin, D-Kanawha, citing a recent report from West Virginia University, stated that he would like to have more information regarding infant mortality rates by race. 

“The first line of the report states that black infants die at almost twice the rate of white infants in West Virginia,” Pushkin said. “I think it’s important for us to have that information if we are going to address, in the state with one of the highest (infant) mortality rates, a subset that has an even higher mortality rate.” 

“There is no physiological explanation for that disparity,” Didden replied. “So, we need to dig down into the details to help sort out why that disparity is occurring.” 

Sen. Hannah Geffert, D-Berkeley, added that OB-GYN professionals will not come to the state to provide services because they are “in fear” about what the state’s legislative body might do to those who provide abortions. 

“I don’t know why people assume this is going to happen,” Geffert said. “Be we can’t get anybody to apply to those jobs. I would think that would have a healthy outcome with the outcome of births.” 

Also during the meeting, Dr. Angela Cherry, of the West Virginia Perinatal Partnership Advisory Council, provided additional information concerning the state’s maternal and infant mortality rates. 

With the loss of the birthing center at St. Mary’s Medical Center in Huntington, the state will only have 20 birthing hospitals, Cherry explained. 

“This causes obstetrical deserts throughout the state,” she said. “Women are having to travel far to get to hospitals that are doing deliveries.” 

Compared to other states, West Virginia has the fourth highest rate for preterm births, the tenth highest rate for low birth weight (5 lbs. 3 oz. or lower), the tenth highest rate for very low birth weight (3 lbs. 5 oz. or lower), the 8th highest infant mortality rate and twentieth highest maternal mortality rate, she said. 

The majority of maternal deaths, 42 percent, were the result of a drug overdose, she noted.

“Minorities have increased rates of low birth weight infants and also preterm deliveries,” she stated, adding that the infant mortality rate is “significantly higher” in the black/non-hispanic community. 

Fortunately, she said there has been a decrease in Neonatal Abstinence Syndrome due to programs that address maternal substance abuse disorders. 

In response to a question from Del. Heather Tully, R-Nicholas, regarding the increase in low birth weight rates at non-tertiary hospitals in 2020, Cherry stated she suspects this was due to low bed availability as a result of the pandemic. 

“We know that once a mom delivers outside of a tertiary care center, they have worse outcomes,” Cherry concluded.