RD138 - Workgroup Study: Fetal and Infant Mortality Review Team (FIMRT) HB1950 of 2021 – December 2021

Executive Summary:

From 2015-2020 there were a total of 5,182 fetal deaths in Virginia. Using data from the Virginia Office of Health Statistics, the rate of fetal death in Virginia in 2019 was 7.6 fetal deaths per every 1,000 live births (Statistical Reports and Tables, 2021), which is the lowest it has been since 2015. From 2016-2020 there were a total of 2,723 infant deaths in Virginia. The Centers for Disease Control estimates the infant mortality rate in Virginia to be 5.8 infant deaths per 1,000 live births as of 2019 (Centers for Disease Control, 2021), with similar rates over a 5 year time span. Despite lower numbers of fetal deaths and stable rates of infant deaths, Virginia continues to struggle to decrease mortality in these populations. According to the Centers for Disease Control, Virginia falls in the lower 50 percent when compared to other states and has been there for some time. Previous efforts aimed at reducing fetal and infant death have fallen short and resulted in the ending of fetal and infant death review through Regional Perinatal Councils in 2012.

Acknowledging the need to address fetal and infant death in the state of Virginia, the 2021 House Committee on Health, Welfare and Institutions requested the Virginia Department of Health’s Office of the Chief Medical Examiner (OCME) convene a work group to (1) study the feasibility and execution of a Fetal and Infant Mortality Review Team (FIMRT); and (2) address the following items, as able: 1. Methods for collecting information about fetal and infant death in the Commonwealth; 2. The definition of a fetal death for the purpose of review; 3. Criteria for the selection of deaths for review; 4. Criteria for the selection of deaths for which additional voluntary qualitative interviews will be conducted; 5. Procedures for maintaining confidentiality; and 6. A five-year implementation plan. Using a thematic approach, the workgroup identified three plausible review team options for Virginia. These included: (1) Using existing child and maternal mortality statuary provisions as the framework for a fetal and infant mortality review team and implementing a team that mirrors the other teams in the state; (2) Implementing a large scale, multi-region, state program; or (3) Implementing a team to review fetal deaths and natural infant deaths that do not fall under the Child Fatality Review Team. Both Option 1 and Option 3 are similar, but the distinguishing factors between them are that Option 3 would avoid duplicating the review of cases that are already reviewed under existing child fatality statute. Currently only non-natural deaths are reviewed under current child fatality statute, as natural deaths are deaths that do not fall under the jurisdiction of the OCME thus are not include in the child fatality review process. This would meet a greater need and provide a more direct focus that could aid in reducing fetal and infant deaths in Virginia.

After careful study, review, and discussion the workgroup decided that implementing Option 3, a team that reviews fetal deaths and natural infant deaths would address the needs of Virginia and complement the work that is already being done by the other review teams. This report highlights the need, background, discussion, and results of the workgroup and also identifies the necessary steps needed in order to move forward with this much needed fatality review team.