HB1858

SECTION 1. The legislature finds that according to National Vital Statistic System data, Native Hawaiians and other Pacific Islanders have one of the highest rates of fetal death in the United States. Studies have shown that parents who experience a fetal death can experience lasting psychological trauma, with sixty to seventy per cent of grieving mothers reporting clinically significant depression one year after their baby's death. For some parents, these mental health struggles are lifelong. Furthermore, psychological trauma associated with fetal death has been shown to have societal effects such as reduced earnings from employment or an inability to return to paid employment.

The legislature further finds that the State lacks the comprehensive, reliable data needed to understand and address the causes behind the disparity in rates of fetal death among Native Hawaiians and Pacific Islanders. Amending existing law will address inconsistencies in reporting requirements, improve clarity and feasibility of reporting, and improve the quality of fetal death data in Hawaii, which will in turn enable health care providers to implement interventions to prevent and decrease the rate of fetal death in the State's communities.

The legislature notes that existing law combines fetal death reporting requirements with general death reporting requirements, which creates ambiguity, operational burdens, and privacy concerns. Existing law also mandates submission of a report of fetal death to be submitted for every fetal death, including first-trimester miscarriages. This requirement is unrealistic, as these miscarriages can occur at home and will never result in a complete or accurate dataset. Amendments are therefore needed to align Hawaii's reporting requirements with the majority of the United States and federal Centers for Disease Control and Prevention recommendations by implementing a minimum gestational age threshold for fetal death reporting. Furthermore, making fetal death reporting optional in certain specific circumstances will decrease the administrative burden on the department of health and also support families who experience a fetal death and would like this report to assist in their healing process.

The legislature additionally finds that the current timeframe to report a fetal death is only three days. Extending this time frame is necessary so that health care providers have sufficient time to comprehensively determine the cause of a fetal death. This in turn will ensure that health care providers are able to ascertain what is driving the high rates of fetal death in the State. Amendments to existing law are also necessary to clarify when a permit is required to dispose of fetal remains, as this will improve consistency with fetal death reporting requirements and ensure required reports of fetal death are to the department of health upon disposition of fetal remains.

The legislature finds that improving the quality of fetal death data in Hawaii will ultimately enable targeted prevention and education efforts to reduce the State's fetal death rates and the societal impacts that result from families who experience this tragic loss.

Accordingly, the purpose of this Act is to amend the various requirements in the event of a fetal death, including registration of certain fetal deaths, filing and preparation of a certificate of fetal death, and issuance of a permit for removal, burial, or other disposition

SECTION 2. Chapter 338, Hawaii Revised Statutes, is amended by adding five new sections to be appropriately designated and to read as follows:

"§338-A Compulsory registration of certain fetal deaths. (a) A certificate of fetal death in the case of fetuses of twenty weeks gestation or more, calculated from the date the last normal menstrual period began to the date of delivery or best ultrasound measurement if last menstrual period is unknown, or, if gestational age is unknown, fetuses of at least three hundred fifty grams in weight, shall be filed with the department in Honolulu or with the local agent of the department in the district in which the fetal death occurred within fourteen days after the date of fetal death. In these instances, a certificate of fetal death shall be filed before interment or other disposition of the body.

(b) A certificate of fetal death shall not be required for a fetal death in the case of fetuses of less than twenty weeks gestation; fetuses less than three hundred fifty grams of weight, if gestational age is unknown; or fetuses from an intentionally terminated pregnancy performed in accordance with section 453-16 or 457-8.7.

§338-B Filing and preparation of certificate of fetal death. (a) The person in charge of the disposition of the body shall file with the department in Honolulu or with the local agent of the department in the district in which the fetal death occurred a certificate of fetal death within fourteen days after the date of fetal death; provided that neither the certificate nor its filing shall be required for a fetal death in the case of fetuses of less than twenty weeks gestation; fetuses less than three hundred fifty grams of weight, if gestational age is unknown; or fetuses from an intentionally terminated pregnancy performed in accordance with section 453-16 or 457-8.7.

(b) In preparing a certificate of fetal death, the person in charge of the disposition of the body shall:

(1) Obtain, and enter on the certificate, personal data and other information as required by the department pertaining to the deceased from the person best qualified to provide this information; and

(2) Present the certificate of fetal death to the physician, physician assistant, or advanced practice registered nurse, who shall certify the fetal death and furnished medical data pertaining to the fetal death.

§338-C Certificate of fetal death for miscarriages less than twenty weeks gestation or three hundred fifty grams. (a) The state registrar shall issue a certificate of fetal death to a parent of a miscarriage if:

(1) The parent requests, on a form prescribed by the state registrar, that the state registrar register and issue a certificate of fetal death for the miscarriage; and

(2) The parent files with the state registrar:

(A) A signed statement from a health care provider confirming the miscarriage; or

(B) An accurate copy of the parent's medical records related to the miscarriage.

(b) As used in this section, "miscarriage" means a product of human conception that:

(1) Is less than twenty weeks gestation, calculated from the date on which the mother's last normal menstrual period began to the date of delivery or early ultrasound, or if the gestational age is unknown, is less than three hundred fifty grams in weight;

(2) Is not born alive; and

(3) Is not due to an intentional termination performed in accordance with section 453-16 or 457-8.7.

§338-D Late determination of the cause of fetal death. (a) If the cause of fetal death cannot be determined within fourteen days, the certification of its cause may be filed after the prescribed period, but the attending physician, physician assistant, advanced practice registered nurse, or coroner's physician shall notify in writing the local agent of the department of the district in which the death occurred of the reason for late filing, so that a permit for the disposition of the body may be issued.

(b) As used in this section, "late" means more than fourteen days after the date of fetal death.

§338-E Permit for removal, burial, or other disposition of body due to fetal death. When a fetal death occurs, the body shall not be disposed of or removed from the registration district until a written permit has been issued by the local agent of the department, except that if:

(1) The fetal death is less than twenty weeks of gestation, or if the gestational age is unknown, the fetal death is less than three hundred fifty grams in weight; or

(2) The fetal death was due to an intentional termination performed in accordance with section 453-16 or 457-8.7,

no permit shall be required."

SECTION 3. Section 338-1, Hawaii Revised Statutes, is amended by adding three new definitions to be appropriately inserted and to read as follows:

""Advanced practice registered nurse" means a person licensed pursuant to section 457-8.5.

"Department" means the department of health.

"Physician assistant" means a person licensed to practice medicine under the supervision of a physician or an osteopathic physician, as required by section 453-5.3."

SECTION 4. Section 338-2, Hawaii Revised Statutes, is amended to read as follows:

"§338-2 Authority and duties of the department [~~of health~~]. The department [~~of health, herein referred to as the department,~~] shall:

(1) Establish a central bureau of public health statistics with suitable offices properly equipped for the safety and preservation of all its official records;

(2) Install a statewide system of public health statistics;

(3) [~~Make~~] Adopt and amend, after notice and hearing, necessary [~~regulations,~~] rules, give instructions and prescribe forms for collecting, transcribing, compiling, and preserving public health statistics; and

(4) Enforce this part and the [~~regulations made~~] rules adopted pursuant thereto."

SECTION 5. Section 338-8, Hawaii Revised Statutes, is amended to read as follows:

"§338-8 Compulsory registration of deaths [~~and fetal deaths~~]. [A] Except as provided in section 338-A, a certificate of every death [~~or fetal death~~] shall be filed with the department [~~of health~~] in Honolulu or with the local agent of the department [~~of health~~] in the district in which the death [~~or fetal death~~] occurred or a dead body was found within three days after the date of death [~~or fetal death occurred~~] or [~~the~~] date the dead body was found. In every instance, a certificate shall be filed [~~prior to~~] before interment or other disposition of the body."

SECTION 6. Section 338-9, Hawaii Revised Statutes, is amended to read as follows:

"§338-9 Filing and preparation of death [~~and fetal death~~] certificates. (a) [~~The~~] Except as provided in section 338-B, the person in charge of the disposition of the body shall file with the department [~~of health~~] in Honolulu or with the local agent of the department [~~of health~~] in the district in which the death [~~or fetal death~~] occurred, or a dead body was found, a certificate of death [~~or fetal death~~] within three days after the [~~occurrence, except that reports of intentional terminations of pregnancy performed in accordance with section 453-16 may be deferred for up to one month.~~] date of death or date the dead body was found.

(b) In preparing a certificate of death [~~or fetal death~~] under this section the person in charge of the disposition of the body shall:

(1) Obtain, and enter on the certificate [~~the~~], personal data and other information as required by the department pertaining to the deceased [~~person required by the department~~] from the person best qualified to [~~supply them;~~] provide this information;

(2) Present the certificate of death to the physician, physician assistant, or advanced practice registered nurse last in attendance upon the deceased, or to the coroner's physician, who shall [~~thereupon~~] certify the cause of death to the physician's, physician assistant's, or advanced practice registered nurse's best knowledge and belief[, or present the certificate of fetal death to the physician, physician assistant, advanced practice registered nurse, midwife, or other person in attendance at the fetal death, who shall certify the fetal death and such medical data pertaining thereto as can be furnished; provided that fetal deaths of less than twenty-four weeks or intentional terminations of pregnancy performed in accordance with section 453-16 may be certified by a nurse or other employee based upon the physician's records]; and

(3) Notify immediately the appropriate local agent, if the death occurred without medical attendance, or if the physician, physician assistant, or advanced practice registered nurse last in attendance fails to sign the death certificate. In such event, the local agent shall inform the local health officer[,] and refer the case to the local health officer for immediate investigation and certification of the cause of death [~~prior to~~] before issuing a permit for burial, or other disposition of the body. When the local health officer is not a physician or when there is no [~~such~~] local health officer, the local agent may complete the certificate on the basis of information received from relatives of the deceased or others having knowledge of the facts.

If the circumstances of the case suggest that the death [~~or fetal death~~] was caused by other than natural causes, the local agent shall refer the case to the coroner for investigation and certification.

(c) A death certificate under this section may be filed by the next of kin and accepted by the local agent without meeting the requirements set forth [~~above~~] in this section when there has been a judicial finding and declaration by a court of record that a person is dead; provided that the certificate [is] shall be in a form approved by the department and [~~has~~] shall have been certified by the clerk of court."

SECTION 7. Section 338-10, Hawaii Revised Statutes, is amended to read as follows:

"§338-10 Late determination of the cause of death. [If] (a) Except as provided in section 338-D, if the cause of death cannot be determined within three days, the certification of its cause may be filed after the prescribed period, but the attending physician, physician assistant, advanced practice registered nurse, or coroner's physician shall notify in writing the local agent of the department [~~of health~~] of the district in which the death occurred of the reason for late filing, [~~in order~~] so that a permit for the disposition of the body may be issued.

(b) As used in this section, "late" means more than three days after the date of death."

SECTION 8. Section 338-23, Hawaii Revised Statutes, is amended to read as follows:

"§338-23 Permit for removal, burial, or other disposition of body. [~~When~~] Except as provided in section 338-E, when a death [~~or fetal death~~] occurs or a dead body is found, the body shall not be disposed of or removed from the registration district until a written permit has been issued by the local agent of the department [~~of health, except that if the dead fetus is less than twenty-four weeks of gestation, no permit shall be required and~~], except that if the death occurred as a result of an accident or other casualty occurrence, the local agent of the department [~~of health~~] may orally authorize the dead [~~bodies~~] body to be removed from a registration district and airlifted or otherwise directly transported to the Honolulu registration district for the preparation and filing of the death [~~certificates~~] certificate and the issuance of a written [~~permits~~] permit for further disposition."

SECTION 9. Section 338-25, Hawaii Revised Statutes, is amended to read as follows:

"§338-25 Prerequisite for permit. No permit under section 338-23 or 338-E shall be issued until a certificate of death or certificate of fetal death, as far as it can be completed under the circumstances of the case, has been filed and until all the [~~regulations~~] rules of the department [~~of health~~] in respect to the issuance of [~~such~~] the permit have been complied with."

SECTION 10. Sections 338-3, 338-4, 338-5, 338-6, 338-7, 338-11, 338-11.5, 338-13, 338-14, 338-14.3, 338-14.5, 338-14.6, 338-15, 338-16, 338-17.7, 338-18, 338-19, 338-20, 338-20.5, 338-21, 338-24, 338-25.5, 338-28, and 338-29.5, Hawaii Revised Statutes, are amended by substituting the term "department", or similar term, wherever the term "department of health", or similar term, appears, as the context requires.

SECTION 11. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect on July 1, 2026.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1858
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII