Prenatal Care

Five of the eight managed care organizations providing health care for Maryland's poor failed to meet required standards, according to a study released yesterday.As a result, the state will withhold $640,000 in payments to the companies until their performance improves, said Maryland Department of Health and Mental Hygiene Secretary Georges C. Benjamin."These fines are in the range to get people's attention," Benjamin said. "I would like to see them improve."The report was the first independent evaluation of the state's HealthChoice program since it began in 1997.

Worried by a sharp increase in infant mortality in the Baltimore area, state health officials are reviewing the deaths of babies who suffered from congenital anomalies, infections and heart disease.The 18 percent jump in deaths from 1996 to 1997 runs against the trend in the past several years, in which infant mortality rates in the city, the state and the nation have dropped. While physicians know the medical reasons for the deaths, they want to determine the circumstances and what medical care was provided.

Gov. Parris N. Glendening outlined his vision of a better future for Maryland children yesterday and pledged a tougher fight for his "Thriving by Three" program in the next legislative session.In a 20-minute pep talk at a two-day summit on child well-being at Morgan State University, the governor said one of his goals was to make sure that the state's children were "well-educated and healthy -- physically, mentally and morally headed in the right direction."Glendening's program, aimed at providing quality health care for children up to age 3, would offer prenatal care to mothers and assistance for children.

The governor of Maryland is downright bullish on spending taxpayer dollars for professional football franchises -- $200 million for a Browns stadium in Baltimore, another $73 million in corporate welfare for Jack Kent Cooke and his new stadium in Prince George's County."

A HOST OF experts will gather tomorrow in College Park to consider what we Americans can learn from the French. Not about haute cuisine or even haute couture, this conference will focus on a subject much closer to home.The French-American Foundation, a private group committed to enhancing ties between the two countries, took a look at our problems with infant and maternal health and at the French success in this area and decided that this was an issue ripe for exploration.Given this country's affluence, it puzzles other nations why we tolerate stigmas more common to the Third World high infant mortality, lack of consistent prenatal care for every pregnant woman and, as one result, lots of babies born so small their survival depends on advanced and expensive neo-natal intensive care.

A FEW YEARS AGO the federal government took an unusually bold risk on a social issue.It decided to get serious about reducing the nation's shamefully high infant-mortality rate and set a goal for reducing it. The Healthy Start program was charged with reducing infant deaths by 50 percent over five years.Building on local health initiatives, Baltimore applied to be one of the nation's 15 Healthy Start demonstration cities. The proposal was successful, winning for the city millions of dollars in federal .. funds -- and, equally important, accountability for actually making a difference in infant health in the city's targeted areas.

Maryland's infant mortality rate, for many years among the worst in the nation, fell 11 percent last year to a record low.The state Department of Health and Mental Hygiene, which released new figures yesterday, credited programs that have discouraged teen-age pregnancy, ushered low-income women into prenatal care, and raised awareness of sudden infant death syndrome."

WASHINGTON -- A university hospital has been accused of testing women for drug use without their consent, and collecting confidential information from them to turn over to the police without their knowledge when the women came to the hospital for prenatal care.In a charge filed yesterday with the National Institutes of Health, the hospital was also accused of conducting illegal human experimentation.The drug-testing program at the hospital, the Medical University of South Carolina, in Charleston, is intended to force drug-addicted women who are pregnant to stop using drugs by threatening them with jail if they fail to cooperate with the hospital's regimen of prenatal visits and to attend a drug-treatment program.

Tawana Davis has no doubt about what would happen if the Annapolis City Council goes along with Mayor Alfred A. Hopkins' proposal to eliminate bus transportation on Sundays and limit routes into the county."

Vice President Al Gore launched a partnership yesterday between Baltimore and the U.S. Agency for International Development designed to apply here the agency's expertise in helping people mired in poverty.Speaking at a conference titled "Lessons Without Borders," at Morgan State University, the vice president referred to the efforts of the tens of thousands of health workers, literacy teachers and small business advisers sent abroad since 1961 to focus America's attention on the plight of the Third World.

The recent, tragic medevac helicopter accident that claimed four lives has focused the attention of Marylanders on our emergency medical services system. While there may be disagreement about the decision to make that particular medevac flight, every Marylander can agree that the goal of EMS should be to provide the best and most appropriate care to every patient. To achieve that goal, we need to look at EMS as one cog within a much larger health care system. Each year in Maryland, there are about 5,000 helicopter flights, 500,000 ambulance runs and 2.3 million emergency room visits.

To Alma Roberts, Maryland's grim statistics on infant mortality affect more than babies. They serve as an indicator of the state's overall health. And she's alarmed. Maryland has struggled for a decade with infant death rates above the national average - it ranked 31st in 2005 statistics - and figures released last month showed the problem getting worse. In 2007, the infant mortality rate increased, and the racial disparity in infant deaths widened. Last year, 14 newborns died per 1,000 live births, and black infants were three times as likely as white infants to die within their first year.

Infant mortality remains very high in Maryland, especially for African-American infants, who are three times as likely to die as white infants, state health figures show. According to statistics released by the Maryland Department of Health and Mental Hygiene, infant deaths rose to 623 in 2007, which means eight newborns died for every 1,000 live births. Though the infant mortality rate varies somewhat. Maryland fares poorly when compared with other states - it ranked 31st, based on 2005 statistics, and the rate of infant deaths has gone up 5 percentage points since then.

Better access to care will count for kids I take a different message from the Annie E. Casey Foundation's Kids Count report than The Sun does ("A report on Maryland kids," editorial, June 12). Perhaps because I am a Johns Hopkins-trained obstetrician, I view things from the perspective of the fetus and newborn. And to paraphrase a political cliche, "It's the poverty, stupid." What I take from the report is that the fact that Maryland is a wealthy state does not ensure that the have-nots will have easy access to the kinds of preconception and prenatal care that will lessen the occurrence of low-birthweight babies.

The current decade hasn't been kind to Maryland's babies, with rising percentages born underweight or dying in infancy, according to a report by Advocates for Children & Youth. Meanwhile, declining percentages of women were entering prenatal care early in their pregnancies, according to the most recent data, depriving them of care needed to stave off bad outcomes. "It's a great concern that infant health is declining, given that Maryland already ranks so poorly in infant health nationally," Matthew Joseph, executive director of the nonprofit agency, said yesterday.

At Baltimore Washington Medical Center's outreach center, amid bottles, breast pumps and toys, seven pregnant women discussed what mothers-to-be think about quite a lot: food. In this case, however, the talk was not about cravings. The women were learning that what they eat and what they feed their babies affects their children's health. On other days, they might discuss the effects of secondhand smoke and alcohol on fetal development, the discomforts of pregnancy and labor and delivery.

The medical forms completed on behalf of Brayan Herrera said this: Without continued treatment for a rare blood disease, the 8-year-old Maryland boy could die. His treatment ended anyway. Brayan is a member of a relatively new class of Maryland residents: legal, newly arrived immigrant children stripped of state-assisted health care. Last year, Gov. Robert L. Ehrlich Jr., pointing to budget difficulties, cut the $5.5 million set aside for legal immigrant children who have been in the country less than five years and whose families have income below certain limits.

As various health care and immigrant advocacy groups pressed him repeatedly to restore a $7 million cut in state spending this year on subsidized health insurance for legal immigrant children and pregnant women, Gov. Robert L. Ehrlich Jr. steadfastly refused. With legislation introduced this week, state lawmakers may now be able to force him to allocate at least $7 million in future budgets to cover the health care benefits. Mr. Ehrlich says the budget cut was necessary to rein in spending on Medicaid and a state-funded insurance program for children.

"The consequences of state budget cuts and differing political priorities could have potentially dangerous consequences in Howard County, health officer Penny Borenstein told local state legislators last week. The Ehrlich administration decision to not extend Medicaid coverage to newly pregnant, legal immigrants after July 1 is likely to swamp the Howard County Health Department's clinic, Borenstein told the group. The administration in July cut the coverage for already pregnant immigrant women to save $1.5 million, but the governor reversed that action July 21 after the state surplus swelled to $1 billion.

Cutting care for immigrants is no bargain Thankfully, Maryland's legislators "get it" even if Gov. Robert L. Ehrlich Jr. doesn't ("Legislators warn of care cuts' impact," July 27). Mr. Ehrlich is allowing low-income, pregnant legal immigrants to continue to receive prenatal care if they were in the Medicaid program prior to July 1. Any other legal immigrant pregnant woman is out of luck. So is her baby (who will be a U.S. citizen), and so are any of her older children. The medical journals are filled with pages documenting the cost-effectiveness, the savings and the alleviation of suffering that prenatal care and well-child care (including immunizations)