MEMORANDUM IN SUPPORT
Referred to Senate Health Committee 01/21/2011
An ACT to amend the public health law, in relation to establishing a neurological impairment program to provide compensation of neurologically-impaired persons
The American Congress of Obstetricians and Gynecologists (ACOG) STRONGLY supports this legislation, which would create the Neurological Impairment Program of New York State (NIPNY) and provide all eligible children necessary financial and medical support throughout their lives.
Despite technological advances and sophisticated research conducted in the medical community, we still cannot predict whether or not a child will be born with a neurological impairment such as cerebral palsy (CP). In most cases, CP can be attributed to events occurring prior to the onset of labor, the majority of which, unfortunately, are not preventable. In fact, the incidence of CP has remained unchanged despite innovations in the field of obstetrics over the past 35 years such as fetal heart rate monitoring, the ability to safely enter the uterus for therapeutic purposes and extraordinarily sophisticated diagnoses of fetal anomalies. Obstetrical interventions during a woman’s labor are inconsequential when intrapartum events are beyond the control of any obstetrical caregiver. Despite this, incidents of CP are real and every effort must be made to accommodate a child’s needs – whether they be financially or medically compensatory.
The program created in this legislation would screen for eligibility and refer those individuals to a physician expert for an eligibility determination. This is a necessary step in providing services and compensation to those who need it the most. Further, physician experts would establish a list of conditions that meet the definition of impairment while also listing those which would be excluded from eligibility. These conditions would be reviewed annually.
The bill allows for all families with impaired children who meet the entry criteria for this program to receive financial assistance. This financial assistance would pay for currently uncovered medical costs for children with neurologic motor impairments.
S.2445 would finance a lifetime of care from birth for all eligible children with “substantial, non-progressive neurologic motor deficits not caused by genetic or metabolic conditions.” Time and again, ACOG has championed proposals such as this that would provide long-term care to children, above and beyond what any court of law could ever provide and in an expeditious fashion. It is imperative that children born with CP receive immediate care and that their families have the ability to access necessary case management services to assist in navigating the endless system of government public health programs.
The case management services established in S.2445 are based upon entrance into the program and include initial intake and screening, assessment and reassessment and the development and coordination of a case management plan by a qualified case management professional. Providing extensive case management services ensures continuity and comprehensiveness while providing a means to navigate an often confusing and complex array of programs and benefits. Case managers would be able to guide families and determine what types of assistance a neurologically impaired person may receive while ensuring that the maximum benefit is maintained.
Many families are faced with the financial challenge of raising a child with a neurologic impairment which can be enormous and daunting. Reasonable expenses for additional medical care, services and supplies, along with care by other professionals such as social workers, counselors and mental health professionals are vital to the continuing care of a child with a neurological impairment. Establishing a system by which adequate compensation is delivered through a streamlined mechanism, similar to worker’s compensation, is the most effective way to not only utilize programs New York State currently operates but to also provide care where care is needed. Oftentimes lawsuits can take years to settle and the end result is uncertain. Neurologically impaired children and their families are entitled to more than just a legal lottery and do not deserve to play the waiting game and wondering if their child will be fairly compensated for life.
ACOG has committed itself to adopting procedures that would increase patient safety in the profession of obstetrics and gynecology. ACOG firmly believes that reviews of the “standard of care” as outlined in S.2445 are important and necessary. This legislation establishes the New York State standard of care assessment program within NIPNY. Under this program, physicians and nurses would serve as assessors, reviewing cases within 30 days. This assessment will ultimately conclude with a determination of whether the standard of care was met by each of the health care providers who participated in the obstetrical care and neonatal management. Assessments will determine whether systems failures at the site of the delivery or neonatal care contributed adversely to the child’s outcome. This is a necessary first step in examining the type of care rendered during a delivery and educating physicians on how to improve quality and safety.
If the material in the Level I assessment is insufficient and it has been decided that the standard of care was not met, a Level II panel of assessors will commence and review previous findings within 30 days. If the standard of care has again not been met, the health care providers will be sent a report detailing the acts of negligence that have been identified. Further, if it is decided that systems failures contributed adversely to the child’s outcome, the senior leadership of the institution involved will be sent a report detailing the negligent offenses that have been identified. If this negligence contributed to the poor outcome, a report will be sent to the Office of Professional medical Conduct (OPMC) and the New York Patient Occurrence, Reporting and Tracking System (NYPORTS). This assessment process, on both levels, ensures that every aspect of the delivery is looked at closely and deters future sub-standard care.
Finally, S.2445 would substantially stabilize medical malpractice premiums for obstetrical care providers throughout New York by giving families a better option than entering a court of law to decide the fate of their child’s health. While a family’s first reaction may be to sue a physician, hospital or entire labor and delivery team for a bad outcome, these lawsuits are time consuming, emotional and fail to rely upon a system that can evaluate the quality of care rendered.
ACOG continues to support efforts that enhance patient safety and provide ample means for children with neurologic impairments to live healthy and fulfilling lives.
For these reasons, ACOG STRONGLY supports S.2445 and urges its passage.
January 25, 2011
The American Congress of Obstetricians and Gynecologists, District II (ACOG) represents the board certified obstetrician-gynecologists in the state who deliver health care to New York’s women. Our Albany office offers the New York State Legislature its resources as a scientific and educational organization dedicated to quality health care for women. If you have questions on this or any other state legislative proposal, please contact our office at 518-436-3461.