RELATING TO VITAL STATISTICS.

SB2856

THE SENATE

S.B. NO.

2856

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to vital statistics
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

����
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:

_____________________________

Report Title:

Vital
Statistics; Fetal Death; Certificate of Fetal Death; Registration; Filing and
Preparation; Permits

Description:

Amends
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.

The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.