Legislation recently approved by the West Virginia Senate and House of Delegates is set to repeal state code guidelines mandating that healthcare professionals (HCPs) address ocular inflammation in newborns immediately following birth.
The move is facing backlash from one of the country’s top vision advocacy public health organizations and other medical professionals over concerns it could lead to an increase in infant blindness rates.
First, explain the current state law.
Between 1910 and 1940, West Virginia joined multiple state legislatures in passing statutes requiring physicians to administer prophylactic medication (such as erythromycin or ceftriaxone) in each eye of newborns to prevent potential infection that could cause serious eye damage and potential blindness.
- This infection: Ophthalmia neonatorum manifesting as pink eye (neonatal conjunctivitis) due to bacterial infection or a sexually transmitted disease (STD; such as gonorrhea or chlamydia) passed from the mother.
- This typically develops within a few days to several weeks following birth.
Talk more about this prevention method.
The process: HCPs apply an antibiotic eye ointment over a newborn’s eyes within 2 to 3 hours of birth.
- In West Virginia: First enacted in 1919 (and amended in 1981), current protocol requires an HCP to topically apply FDA-approved prophylactic (erythromycin eye ointment 0.5% being the most common) on an infant’s eyes within 24 hours of birth.
- Those who fail to comply with this may be subject to legal repercussions, such as a misdemeanor.
Outside the state: Nearly all U.S. states (32, as of 2006) currently mandate this method for newborns.
And outside the U.S.: Countries such as Brazil, France, Italy, Slovenia, Spain, and Turkey have similar mandates in place.
- Conversely: Australia, Belgium, Canada, Denmark, the United Kingdom, Norway, and Sweden no longer do.
And who are the supporters of this?
Both the U.S. Preventive Services Task Force and the American Association of Family Physicians have recommended automatic prophylaxis via eye ointment, with the AAFP noting it “found convincing evidence that applying this ointment to the eye is safe and effective.”
- And while the American Academy of Pediatrics (AAP) no longer recommends universal prophylaxis for infants (as of 2018), the AAP has stated that routine eye ointment is still appropriate for regions where gonorrhea is widespread and with low rates of prenatal screening and treatment.
See here for a rundown on research conducted over the last 30+ years evaluating the use of prophylactic eye ointments for preventing ophthalmia neonatorum.
Now explain this new legislation.
House Bill (H.B.) 3444 proposes a repeal of several sections of West Virginia guidelines to remove the legal framework that mandates “specific actions and protocol for addressing inflammation of the eyes in newborns.”
- This includes the use of prophylactic medications (erythromycin ointment) and non-compliance penalties.
- See here for a look at the seven revisions.
Just to be clear: It’s not banning HCPs from continuing to follow this standard, right?
That’s correct. H.B. 3444 would still permit medical professionals to apply the ointment to newborns’ eyes; however, they would no longer be legally obligated to do so.
For those supporting this: Del. Evan Worrell (R), a sponsor of the bill, told local news outlets that the decision for applying an eye ointment to newborns “should be between a provider and a patient and not punishable by a misdemeanor … as current code calls for.”
- Further: Worrell added that he doesn’t expect the current process for newborns to change at all—the intent is to just remove the code section.
And as Sen. Chris Rose (R), another supporter of the bill, was quoted: “This just gives parental rights [and] parental choice.”
Interesting. And there’s an issue with that?
According to those advocating against this—yes. The collective concern is that the removal of such a mandate could lead to an increased rate of infant blindness.
Prevent Blindness (PB), a public health advocacy organization for preserving sight via public services, education, advocacy, and community and patient engagement programs, urged West Virginia legislators to reject H.B. 3444.
In an April 15 statement, PB said that lawmakers are choosing to opt for “parental notification and choice for determining if a newborn receives the ointment.”
- The problem with this: H.B. 3444 doesn’t provide “a clear method to define or ensure that informed parental consent has occurred,” PB stated.
- And the potential repercussions: The organization emphasized “parental confusion and misinformation to the science that has driven this proven public health intervention”—not to mention potential blindness among infants left untreated.
Go on …
Also speaking out against the bill: West Virginia Sen. Joey Garcia (D) argued that these changes would be detrimental for women in rural counties across the state—in which prenatal care may not be readily accessible.
- Case in point: While ongoing state efforts are pushing to improve state-wide healthcare access, recent reports have noted that residents in these areas currently face limited access due to significant real times and a general shortage of medical providers and staff.
“Women may not be educated on the use of ointment to give informed consent during birth,” he told a local news outlet. “I don’t understand why we would risk our children being blind.”
So what’s next for this legislation?
Since the West Virginia Senate passed H.B. 3444 on April 10 (in a vote of 18-15)—after the House passed the bill on April 1 (96-1)—the next step is for a final vote before passing it on to Gov. Patrick Morrisey for signing.
- If signed, the revisions would take effect July 9.
*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.