§ 25-52-105 — Access to health records related to maternal mortalities

(1) (a)
Except as otherwise provided by law, the committee may access medical records
related to maternal deaths upon request at any time up to seven years after the last
treatment of a patient.

(b) A health-care provider or a health-care facility licensed or certified
pursuant to article 3 of this title 25 shall provide medical records to the department
concerning each maternal mortality for access by the members of the committee.

(c) Upon request of the department, a law enforcement officer shall provide
a police report, and a coroner shall provide records of the coroner and medical
examiner investigations, that involve a maternal death to the committee.

(d) A health-care provider, pharmacist, health-care facility, law enforcement
officer, or coroner is not civilly or criminally liable for the release of medical records
when making a good-faith effort to comply with this subsection (1).

(2) (a) The discussions in committee meetings or meetings of an ad hoc panel
formed pursuant to section 25-52-104 (3) concerning details of a maternal death
that could identify an individual involved are confidential and are not subject to
section 24-6-402.

(b) The committee meeting notes, statements, medical records, reports,
communications, and memoranda obtained by the committee that contain
information that could identify an individual involved in a maternal death are
confidential and are not subject to the Colorado Open Records Act, part 2 of
article 72 of title 24.

(c) Members of the committee are not subject to subpoena in any civil,
criminal, or administrative proceeding regarding the information presented in or
opinions formed as a result of a meeting or communication of the committee;
except that this subsection (2)(c) does not prevent a member of the committee from
testifying regarding information or opinions obtained independently of the
committee or that are public information.

(d) Notes, statements, medical records, reports, communications, and
memoranda that are confidential pursuant to subsections (2)(a) and (2)(b) of this
section are not:

(I) Subject to subpoena, discovery, or introduction into evidence in any civil,
criminal, or administrative proceeding, unless the subpoena is directed to a source
that is separate and apart from the committee. Nothing in this section limits or
restricts the right to discover or use in a civil, criminal, or administrative proceeding
notes, statements, medical records, reports, communications, or memoranda that
are available from another source separate and apart from the committee and that
arise entirely independent of the committee's activities.

(II) Admissible as evidence in any action in any court or before any tribunal,
board, agency, or person and shall not be exhibited or disclosed in any way by any
person unless the information was obtained from another source that is separate
and apart from the committee, except as may be necessary to further the duties of
the committee or in response to an alleged violation of a confidentiality agreement
pursuant to subsection (2)(e) of this section.

(e) Each committee member shall sign a confidentiality agreement that
requires the member's adherence to subsections (2)(a) and (2)(b) of this section. A
member who knowingly violates the confidentiality agreement commits a petty
offense.

Source: L. 2019: Entire article added, (HB 19-1122), ch. 196, p. 2143, � 1,
effective May 16. L. 2021: (2)(e) amended, (SB 21-271), ch. 462, p. 3240, � 480,
effective March 1, 2022.

Cross references: For the penalty for a petty offense, see � 18-1.3-503.

25-52-106. Duty to comply with state and federal laws relating to health
information. The committee and the department shall comply with all applicable
state and federal laws and rules relating to the transmission of health information.

Source: L. 2019: Entire article added, (HB 19-1122), ch. 196, p. 2144, � 1,
effective May 16.

25-52-106.5. Perinatal health quality improvement program - perinatal
health quality improvement engagement program - perinatal quality
collaborative duties - data collection - reporting - legislative declaration -
definitions. (1) The general assembly finds and declares that:

(a) Disparities in maternal and infant health-care access, delivery, and
outcomes in Colorado persist, such that birthing people who are American
Indian/Alaska Native are nearly three times more likely to die during pregnancy or
within one year postpartum than the overall population of those giving birth in
Colorado;

(b) Birthing people who are Black are nearly two times more likely to die
during pregnancy or within one year postpartum than the overall population of
those giving birth in Colorado;

(c) Birthing people living in frontier counties are more likely to die from
pregnancy-related causes than those living in urban counties, and people insured
through the medical assistance program are more likely to die during pregnancy or
within one year postpartum than those with private insurance;

(d) Discrimination contributed to half of all pregnancy-associated deaths in
Colorado, and ninety percent of all deaths were deemed preventable by the
Colorado maternal mortality review committee;

(e) In 2022, the United States' infant mortality rate increased for the first
time in two decades. Infants born to Black and Native American birthing people are
two times more likely to die compared with their white and Hispanic counterparts.

(f) The committee and the maternal health task force established by the
department recommend statewide, universal participation in quality improvement
initiatives led by the perinatal quality collaborative and the adoption of Alliance for
Innovation on Maternal Health patient safety bundles;

(g) The National Governors Association, through its maternal and infant
health initiative, similarly recommends the adoption of patient safety bundles and
increased funding for state maternal mortality review committees and perinatal
quality collaboratives;

(h) Ninety-six percent of births in Colorado occur in hospitals, and there is a
need to provide practical support to hospitals, especially frontier and rural
hospitals, for the implementation of clinical quality improvement initiatives; and

(i) Participation in state perinatal quality collaboratives has been shown to
improve maternal and infant health outcomes through improved access to, and the
timeliness of, treatment and through reduced serious pregnancy complications.

(2) As used in this section, unless the context otherwise requires:

(a) Engagement program means the perinatal health quality improvement
engagement program created in subsection (5) of this section.

(b) Hospital means a hospital licensed or certified pursuant to section 25-1.5-103 that provides nonemergent perinatal care services.

(c) Quality improvement program means the hospital perinatal health
quality improvement program created in subsection (4) of this section.

(3) (a) The department shall contract with the perinatal quality collaborative
to:

(I) Track statewide implementation of the committee's recommendations to
prevent maternal mortality;

(II) Implement hospital quality improvement programs through perinatal care
settings to reduce preventable causes of maternal mortality and morbidity; and

(III) Address disparate care of and outcomes among American Indian/Alaska
Native and Black birthing populations, birthing people insured through the medical
assistance program, and birthing people living in rural and frontier counties.

(b) In implementing hospital quality improvement programs, the perinatal
quality collaborative shall provide quality improvement program support that may
include:

(I) Clinical quality improvement science education concerning best practices
and innovations to support optimal outcomes;

(II) Tailored interventions designed to address the needs of priority
populations;

(III) Individualized program implementation guidance and support;

(IV) Data reporting, analysis, and rapid response feedback for assistance in
monitoring the sustainability of implemented changes;

(V) Provider training in stigma, bias, and trauma-informed and respectful
care; and

(VI) Public recognition as a maternal and infant care quality champion.

(c) The department shall provide vital statistics data to the perinatal quality
collaborative for purposes of data analysis and reporting. The perinatal quality
collaborative shall develop a data-sharing agreement with the department to
identify specific vital statistics data that must be shared. The data-sharing
agreement must address the confidentiality of data to ensure that data sharing is
protected.

(4) Hospital perinatal health quality improvement program. A hospital shall:

(a) No later than July 1, 2025, and no later than July 1 each year thereafter,
submit to the perinatal quality collaborative, either directly or through a statewide
association of hospitals, a minimum data set of key drivers of disparities in perinatal
health care and health-care outcomes, maternal mortality and severe maternal
morbidity, and infant health care and health-care outcomes, including:

(I) Cesarean deliveries;

(II) Perinatal hypertension, sepsis, and cardiac conditions;

(III) Maternal and neonatal readmissions and length of stay;

(IV) Unexpected newborn complications;

(V) Perinatal mental health and substance use conditions;

(VI) Obstetric hemorrhage; and

(VII) Preterm birth; and

(b) Beginning December 15, 2025, participate annually in at least one
maternal or infant health quality improvement initiative, as determined by the
hospital, in collaboration with the perinatal quality collaborative pursuant to
subsection (3) of this section, with the goal of:

(I) Promoting evidence-based, culturally relevant, safe, equitable, high-quality care; and

(II) Preventing maternal and infant mortality and severe morbidity.

(5) Perinatal health quality improvement engagement program. (a) No
later than July 1, 2025, the department shall create a perinatal health quality
improvement engagement program that provides financial support to hospitals and
facilities that provide emergent labor and delivery or perinatal care services that do
not have sufficient resources to participate in one or more maternal or infant health
quality improvement initiatives pursuant to subsection (4) of this section.

(b) The department shall select hospitals and facilities that provide
emergent labor and delivery or perinatal care services to participate in the
engagement program and may contract with the perinatal quality collaborative to
administer the engagement program. In order to participate in the engagement
program, a hospital or facility must commit to work with the perinatal quality
collaborative on the maternal or infant health quality improvement initiatives
selected by the hospital or facility.

(c) The department shall prioritize financial support for hospitals and
facilities that:

(I) Are in rural and frontier areas of the state;

(II) Qualify for disproportionate share payments under the medical
assistance program; or

(III) Have lower-acuity maternal or neonatal levels of care designations.

(d) Hospitals and facilities receiving financial support pursuant to the
engagement program may use the financial support for quality improvement,
including dedicated staff time, training costs, travel, continuing education, and data
entry and technical assistance.

(6) Collaboration with the perinatal quality collaborative. (a) The
department shall contract with the perinatal quality collaborative to:

(I) Track statewide implementation of the committee's recommendations,
developed pursuant to section 25-52-104, to prevent maternal mortality; and

(II) No later than July 1, 2026, and no later than July 1 each year thereafter,
issue a report to the department concerning:

(A) Clinical quality improvement efforts to reduce disparities in perinatal
health outcomes and to prevent maternal and infant mortality and morbidity that
includes relevant, aggregate hospital maternal and infant health quality metrics
and that may be distributed to policymakers, health-care providers, hospitals and
other health facilities, public health professionals, and other interested persons to
assist the department in promoting data access and facilitating additional efforts to
reduce maternal and infant mortality and morbidity;

(B) Hospital participation in maternal and infant perinatal quality
improvement initiatives pursuant to subsection (4)(b) of this section;

(C) Implementation of the federal health resources and services
administration maternal and child health bureau's and American College of
Obstetricians and Gynecologists' alliance for innovation on maternal health patient
safety bundles and related performance metrics, including the status of addressing
drivers of perinatal health disparities and maternal and infant mortality and
morbidity as described in subsection (4)(a) of this section; and

(D) Areas of opportunity for ongoing improvement.

(b) In compliance with all applicable state and federal laws relating to the
publication of health information and legally binding data use agreements, the
perinatal quality collaborative and the department shall make an aggregated and
de-identified report prepared pursuant to subsection (6)(a)(II) of this section
publicly available on the department's website and on the website of the perinatal
quality collaborative.

(c) The perinatal quality collaborative shall consult with a statewide
association of hospitals and with diverse hospital leadership to support ongoing
hospital engagement in quality improvement and to advise practitioners in clinical
settings across the state on the advancement of best practices to reduce maternal
and infant mortality and morbidity.

(d) Data submitted pursuant to subsection (4)(a) of this section is considered
confidential and proprietary, contains trade secrets, or is not a public record
pursuant to part 2 of article 72 of title 24 and is only reportable in an aggregated
and de-identified manner.

Legislative History

Source: L. 2024: Entire section added, (SB 24-175), ch. 433, p. 3035, � 4, effective June 5.