A blue-ribbon panel of experts next week will hand Mayor Marion Barry its recommendations -- some of them costly and politically sensitive -- for reducing Washington's high infant death rate.
Among those measures are stiffer training requirements for hospital staff who care for babies, a citywide system to transport sick infants, mobile clinics for pregnant women, and a broader role for nurse-midwives, according to Dr. Frederick Green, chairman of the Mayor's Blue Ribbon commissionon Infant Mortality.
In February 1979 the seven-member commission began studyng the city's infant mortality rate -- the highest of any city in the country in 1977, the most recent year for which cities have been ranked.
Washington in 1977 had 27.3 deaths per 1,000 births. The rate has fallen somewhat since then, in 1979 there were 21.5 deaths per 1,000 births. But the death rate, particularly for babies born to minorities, remains far above the national figure of 14 deaths per 1,000.
Hospitals and city officials already have adopted some of the measures urged in an interim report by the commission last year. Several, such as providing a transport system and expanding prenatal clinics, would strain the city's coffers. Others, such as building infant resuscitation training into hospital licensing requirements and sending inspectors into nurseries, are politically sensitive because they step on the toes of private hospitals.
It now will be up to the mayor and District of Columbia health officials to determine how much of the commission's advice becomes policy.
"We're not legislators," Greene said. "When we recommend things . . . it seems like there are 1 million bureaucratic reasons why things can't be done."
In an interview, Green discussed some of the substantive changes urged by the Commission and the opposition they may face:
Requiring resuscitation training for obstetric and nursery personnel. Experts estimated last year that a full-scale training program would cost $90,000. Children's Hospital and Columbia Hospital for Women have started programs voluntarily, but other District of Columbia hospitals are not required to send staff for training.
The commission's recommendation that new licensing rules include infant resuscitation training has been tentatively accepted by the hospital licensing agency within the Department of Human Services. The recomendation must be approved by DHS Commissioner James Buford.
A system to transport sick babies to intensive care nurseries. "That's one of the sticky ones," Green said, adding that the recommendation incited battles among hospitals over which nurseries were most qualified.
He said he frequently received calls from frantic doctors seeking to transfer sick infants from area hospitals. At present only Children's Hospital has a team that picks up such babies, and no hospital has vehicles equipped for the purpose, he said.
Expanding the role of midwives and nurse-practitioners in providing care to pregnant women. Green said a Nurse Practitioner Act was introduced last year in the D.C. City Council, but has not passed. The Commission decided that giving more reponsibility to nurses is necessary to improving prenatal care, but Green said the idea "has aroused the anxieties of some medical practitioners."
Requiring visits to hospital nurseries by outside experts to assess care and staff proficiency. Green said that at a meeting last year representatives of each hospital assured the commission they could provide immediate treatment to sick babies 24 hours a day, but there is resistance to regular monitoring by outsiders.
A spokeswoman at the D.C. Office of Communications said city officials could not comment on the commission's recommendations until they formally are presented to the mayor June 19.
Specialists in newborns at some local hospitals said they though increased public awarness of the high infant death rate already had resulted in better care for Washington's babies.
"I would expect that in this town, given the general concern, the cooperation (to make further gains) would be available," said Dr. Dorothy Starr, president of the D.C. Medical Society.