Delaware Section report

Dr. Kirsten M. SmithKirsten M. Smith, MD, section chair

The Delaware Section held its Third Annual Legislative Day in Dover on June 6. Sixteen physicians participated in the meetings at Legislative Hall. We spoke with Gov. Jack Markell, Lt. Gov. Matt Denn, State Sen. Patricia Blevins (D-Elsmere), State Sen. Bethany Hall-Long (D-Middletown), State Rep. Michael Barbieri (D-Newark), State Rep. Ruth Briggs King (R-Georgetown), State Rep. Joseph E. Miro (R-Pike Creek Valley), and State Rep. Melanie George Smith (D-Bear). During our meetings, we touched on a variety of topics, including state-funded programs for obesity, concerns about lay midwives practicing in Delaware, access to affordable contraception, Delaware’s high unintended pregnancy rate, abortion access, and the need for an easily accessible comprehensive site that details state resources and programs. 

We are working on follow-up meetings with Lt. Gov. Denn and State Rep. Smith to better understand the disproportionate use and access to intrauterine device contraception in Delaware; State Sen. Hall-Long and State Rep. Barbieri to discuss strategies for decreasing the teen pregnancy rate in Delaware; and State Sen. Blevins to discuss efforts to better market the state’s programs.

The section held an educational event in Dover that same evening titled “Obesity and its Effects on Women and Children.” The event attracted health care providers from the northern and southern parts of Delaware, including physicians, nurses, nurse managers, and clinical care coordinators. We had a great panel of speakers, with Sherry L. Blumenthal, MD, Pennsylvania Section chair, presenting on “The OBesity Project;” David Paul, MD, speaking about obesity’s effects on infant mortality; and Leah Woodall, MPA, addressing Delaware’s role in tackling obesity. In addition to the formal presentations, we provided information about the resources and programs available in the state for health care needs to attendees. 

Two bills that passed last year grant the State of Delaware power to regulate medical practice. One bill provides the Delaware Department of Health and Social Services (DHSS) with explicit authority to investigate and inspect unsanitary or unsafe conditions in facilities where invasive medical procedures are performed. It also gives DHSS the power to adopt regulations to strengthen oversight of facilities.

The other bill gives DHSS the authority to require accreditation for medical facilities that perform invasive medical procedures. It also allows DHSS to promulgate regulations for accreditation. The bill requires that DHSS work with stakeholders in the development of these regulations and outlines who those stakeholders should be.

Draft regulations have been developed in response to these bills. As the Delaware Section representative in the stakeholders’ group, I reviewed these drafts and provided comments.

The most recent stakeholders’ group meeting occurred on July 23. One of the most contentious issues has been how to define “invasive medical procedures.” The current definition is “any medical procedure, including dental and podiatric procedures, in which the accepted standard of care requires anesthesia, major conduction anesthesia, or sedation.” Essentially, offices that perform procedures under local anesthetics (but not major conduction anesthesia or sedation) will not be affected.

The issue of lay midwives practicing in the state has presented itself again, unfortunately with poor maternal and neonatal outcomes. Because lay midwives are not licensed, they do not fall under the purview of the Board of Medical Licensure. In the spring, two individuals were reviewed by DHSS, given an order to cease and desist, and assessed a penalty of $1,000. Legislation passed in July aligns the penalty for non-compliance with the non-nurse midwives law and regulations with the penalty for practicing medicine without a license. It imposes civil and/or criminal penalties for violations of existing law.

On July 29, a meeting was held at the Medical Society of Delaware to discuss ways to address current and future concerns related to lay midwives practicing in Delaware. The primary goal for all who participated was to optimize patient care and safety to decrease morbidity and mortality for mothers and infants. Many issues were discussed, but none were resolved. The meeting preceded another meeting with DHSS staff, direct-entry and lay midwives, and interested legislators. The Delaware Section will continue to work for safe and collaborative care for women and their infants.

The Delaware Child Death, Near Death, and Stillbirth Commission reviews individual cases of child deaths and maternal deaths within one year of pregnancy. Fetal and infant mortality review and maternal mortality review fall under this commission. It provides recommendations to alleviate practices or conditions that impact the mortality of children and pregnant women. The Delaware Section has been asked to review several current recommendations formulated by the commission. These recommendations were discussed at the Delaware Section Advisory Council Meeting on September 16, and a formal response will be submitted to the commission.