By J. David McSwane and Terri Langford
The Dallas Morning News
Originally published Sept. 28, 2016
The rate of pregnancy-related deaths among Texas women nearly doubled in recent years, a national study found this month, while a separate state-commissioned study found black women are especially vulnerable.
Researchers can’t say why maternal death rates are higher in Texas than any other state, and the reasons are likely to remain hidden.
That’s because the data and records that could provide answers to the maternal death quandary are being kept secret by the Department of State Health Services, which has refused to disclose even an inventory of what data it keeps.
It’s part of a broader trend, the slow erosion of the state’s open records law and withering access to information about how state government does business.
After the medical journal Obstetrics and Gynecology published its study on nationwide trends and the state health department released the report of its Maternal Mortality and Morbidity Task Force, The Dallas Morning News requested data related to those deaths through the Texas Public Information Act.
Such data, a so-called summary death index, once contained the names, locations and cause of death of every mortality reported to the department’s Vital Statistics division. It was once readily available to the public.
For instance, in 2010, the state’s death data was used to show how many Texas suicides involved military veterans.
But the department denied The News’ request for the maternity-death information, citing a 2011 opinion by then-Attorney General Greg Abbott which made secret the cause of death, dates of birth and last known address of the deceased. Though such records are readily available in many states, Abbott ruled that the information should be kept secret to prevent fraud.
Dr. Daniel Grossman, an OB-GYN with the Texas Policy Evaluation Project at the University of Texas at Austin, which examines the effects of abortion and health care legislation in Texas, called the denial of such information “troubling.”
“We have a public health issue, bordering on crisis,” he said, arguing that case studies of each death should be conducted to determine if the rise in maternal deaths correlates with cuts to women’s health programs or a lack of access to health insurance.
More broadly, he said, trends of race, income and access to health care could be factors. And studies published so far don’t answer these questions.
Although stricter requirements for women’s health clinics forced the closures of several from 2011 to 2015, researchers could not tie the mere shutdown of the clinics to the doubling of the maternal death rate in 2011-12.
“Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate with a 2-year period in a state with almost 400,000 annual births seems unlikely,” the researchers concluded.
Researchers called it a “national embarrassment” that the U.S. has not been able to provide a national maternal mortality rate to international data repositories. Had there been consistent data recording, “the unusual findings from Texas for 2011-14 would have been investigated much sooner and in greater detail.”
Still, the lead researcher, Marian MacDorman, told The News the study evaluated only broad trends and did not attempt to evaluate specific cases to determine why pregnancy-related deaths spiked in Texas.
A second study, by the state health department’s Maternal Mortality and Morbidity Task Force, was released in August. It, too, analyzed maternal death data for 2011 and 2012. During that time, the state task force found black women bore the “greatest risk for maternal death.”
Looking at deaths of 189 mothers who died within a year of giving birth, the task force found that nearly a third were black women. Only 11.4 percent of births in 2011 and 2012 were to black women.
Top causes of death for moms during that time period were cardiac events, drug overdoes and hypertension/eclampsia. Again, the study is not clear as to why this is the case in Texas.
Both studies took issue with the quality of death reporting in Texas and nationwide. In the state-sponsored study, one of the major findings was “data quality issues” which make it difficult for researchers to identify a maternal or obstetric death.
Those researchers were reliant on a small sample of records provided by the Texas health department, and those were heavily redacted, the report notes. Also, the task force noted that maternal deaths are not investigated consistently in Texas, making data analysis difficult.
The task force also found “a lack of standardization” in how maternal deaths are reported to either medical examiner offices or the local justices of the peace. And when maternal deaths are reported, there were several instances, the task force found, in which pertinent laboratory tests were not performed.
Rep. Armando Walle, a Houston Democrat and vice chairman of the House Government Transparency and Operation Committee, said the Legislature needs to revisit broad exemptions in the open records law that are getting in the way of fixing a public health issue.
“There seems to be a lot of women dying,” he said. “We need to know why they’re dying. You can’t make corrective action if we don’t know why these women are dying.”
Although that 2011 ruling says health officials can no longer release the complete data, which researchers could use to evaluate specific death cases, the department took additional steps to keep public information private.
The department denied a request for a copy of its data record layout, which is essentially a table of contents that shows what data it collected, and how it’s stored. It does not contain any sensitive information.
Asked why the department would want to keep secret the data it collects on Texans and how they die, spokesman Chris Van Deusen did not respond. He said in an email that the department had asked Attorney General Ken Paxton to rule on the matter.
In its letter, the department cites several exemptions, including a 1990 attorney general’s opinion that determined the open records law does not make public programming information and source code. But records experts agree that shouldn’t include a record layout.
“It just really pisses me off,” said Joe Larsen, a Texas open records expert and attorney with the law firm Sedgwick LLC.
“It’s ridiculous. We have a clear public health problem, and the people really need to know what in the world is going on here, and they’re stymied by this,” he said. “A record layout is not software. It’s not code. It’s not source code. Period. I liken it to the key of a map. It’s actually public information itself. It’s like a Dewey Decimal System, in a way.”
Larsen said agencies have been emboldened by a politicized attorney general’s office under both Abbott and his successor, Paxton. He also noted a “degradation” of the Texas Public Information Act under consistent Texas Supreme Court rulings limited public access to government records.
For instance, following a well-publicized contract scandal, the Legislature passed unprecedented reforms in 2015 that included heightened oversight and more documentation when government signs hundreds of millions in deals with private companies.
But at the same time, in the case of Boeing vs. Paxton, the state’s highest court ruled that the very records used to uncover that contract scandal — the contract itself — could be kept secret to protect the privacy of a person or company being paid by governmental bodies large and small.
Kelley Shannon, executive director of the Freedom of Information Foundation of Texas, said such issues will be part of the group’s priorities when lawmakers convene at the Capitol early next year.
“I don’t get why they first wouldn’t want basic information about maternal mortality released. Second, I don’t see why they wouldn’t want to release the record layout,” she said.
“It’s definitely not within keeping the spirit of the open records act.”