I 
111TH CONGRESS 
1ST SESSION H. R. 3212 
To amend the Public Health Service Act to improve the health of children 
and reduce the occurrence of sudden unexpected infant death and to 
enhance public health activities related to stillbirth. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 14, 2009 
Mr. PALLONE introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve the 
health of children and reduce the occurrence of sudden 
unexpected infant death and to enhance public health 
activities related to stillbirth. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Stillbirth and SUID 
Prevention, Education, and Awareness Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) Every year, there are more than 25,000 
stillbirths in the United States. 
(2) Common diagnosable causes for stillbirth 
include genetic abnormalities, umbilical cord acci-
dents, infections, and placental problems. 
(3) A number of risk factors for stillbirth have 
been described in pregnant women such as maternal 
age, obesity, smoking, diabetes, and hypertension. 
(4) Because of advances in medical care over 
the last 30 years, much more is known about the 
causes of stillbirth. But for as many as 50 percent 
of stillbirths, the cause is never identified. 
(5) Sudden, Unexpected Infant Death (SUID) 
is the sudden death of an infant under 1 year of age 
that when first discovered did not have an obvious 
cause. These include those deaths that are later de-
termined to be from explained as well as unexplained 
causes. 
(6) In 2004, approximately 4,600 infants died 
suddenly and unexpectedly of no immediate obvious 
cause. Each year approximately 200 deaths of chil-
dren between the ages of 1 and 4 remain unex-
plained after a thorough case investigation is con-
ducted. 
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(7) The Sudden Infant Death Syndrome 
(SIDS) rate has been declining significantly since 
the early 1990s. However, research has found that 
the decline in SIDS since 1999 can be explained by 
increasing Sudden Unexpected Infant Death rates. 
(8) Many Sudden Unexpected Infant Deaths 
are not investigated and, even when they are, cause- 
of-death data are not collected and reported consist-
ently. 
(9) Inaccurate or inconsistent classification of 
cause and manner of death impedes prevention ef-
forts and complicates the ability to understand risk 
factors related to these deaths. 
(10) The National Child Death Review Case 
Reporting System collects comprehensive informa-
tion on the risk factors associated with SUID 
deaths. As of March 2009, 29 of the 49 States con-
ducting child death reviews are voluntarily submit-
ting data to this reporting system. 
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
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‘‘PART S—SUDDEN UNEXPECTED INFANT DEATH 
AND 
SUDDEN 
UNEXPLAINED 
DEATH 
IN 
CHILDHOOD 
‘‘SEC. 399HH. DEFINITION. 
‘‘In this part: 
‘‘(1) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Health Re-
sources and Services Administration. 
‘‘(2) DIRECTOR.—The term ‘Director’ means 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(3) STATE.—The term ‘State’ includes the 50 
States and the District of Columbia. 
‘‘(4) SUDDEN
UNEXPECTED
INFANT
DEATH; 
SUID.—The terms ‘sudden unexpected infant death’ 
and ‘SUID’ mean the sudden death of an infant 
under 1 year of age that when first discovered did 
not have an obvious cause. Such terms include those 
deaths that are later determined to be from ex-
plained as well as unexplained causes. 
‘‘(5) SUDDEN UNEXPLAINED DEATH IN CHILD-
HOOD; SUDC.—The terms ‘sudden unexplained death 
in childhood’ and ‘SUDC’ mean the sudden death of 
a child older than 1 year of age which remains unex-
plained after a thorough case investigation, including 
a review of the clinical history and circumstances of 
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death, and performance of a complete autopsy with 
appropriate ancillary testing. 
‘‘SEC. 399II. DEATH SCENE INVESTIGATION AND AUTOPSY. 
‘‘(a) INVESTIGATIONS.— 
‘‘(1) GRANTS.—The Secretary, acting through 
the Director, shall award grants to States to enable 
such States to improve the completion of comprehen-
sive death scene investigations for sudden unex-
pected infant death and sudden unexplained death in 
childhood. 
‘‘(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), a State shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
‘‘(3) USE OF FUNDS.— 
‘‘(A) IN
GENERAL.—A State shall use 
amounts received under a grant under para-
graph (1) to improve the completion of com-
prehensive death scene investigations for sud-
den unexpected infant death and sudden unex-
plained death in childhood, including through 
the awarding of subgrants to local jurisdictions 
to be used to implement standard death scene 
investigation protocols for sudden unexpected 
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infant death and sudden unexplained death in 
childhood and conduct comprehensive and to 
conduct standardized autopsies. 
‘‘(B) 
PROTOCOLS.—A 
standard 
death 
scene protocol implemented under subparagraph 
(A) shall include the obtaining of information 
on current and past medical history of the in-
fant/child, the circumstances surrounding the 
death including any suspicious circumstances, 
the sleep position and sleep environment of the 
infant/child, and whether there were any acci-
dental or environmental factors associated with 
the death. The Director in consultation with 
medical examiners, coroners, death scene inves-
tigators, law enforcement, emergency medical 
technicians and paramedics, public health agen-
cies, and other individuals or groups determined 
necessary by the Director shall develop a stand-
ard death scene protocol for children from 1 to 
4 years of age using existing protocols devel-
oped for SUID. 
‘‘(b) AUTOPSIES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director, shall award grants to States 
to enable such States to increase the rate at which 
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comprehensive and standardized autopsies are per-
formed for sudden unexpected infant death and sud-
den unexplained death in childhood. 
‘‘(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), a State shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
‘‘(3) COMPREHENSIVE AUTOPSY.—For purposes 
of this subsection, a comprehensive autopsy shall in-
clude a full external and internal examination of all 
major organs and tissues including the brain, com-
plete radiographs, metabolic testing, and toxicology 
screening of the infant/child involved. 
‘‘(4) GUIDELINES.—The Director, in consulta-
tion with board certified forensic pathologists, med-
ical examiners, coroners, pediatric pathologists, pedi-
atric cardiologists, pediatric neuropathologists and 
geneticists, and other individuals and groups deter-
mined necessary by the Director shall develop na-
tional guidelines for a standard autopsy protocol for 
sudden unexpected infant death and sudden unex-
plained death in childhood. The Director shall en-
sure that the majority of such consultation is with 
board certified forensic pathologists, medical exam-
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iners, and coroners. The Director is encouraged to 
seek additional input from child abuse experts, be-
reavement specialists, parents, and public health 
agencies on non-medical aspects of the autopsy 
guidelines. In developing such protocol, the Director 
shall consider autopsy protocols used by State and 
local jurisdictions. 
‘‘(c) STUDY ON GENETIC TESTING.—The Director, 
in consultation with medical examiners, coroners, forensic 
pathologists, geneticists, researchers, public health offi-
cials, and other individuals and groups determined nec-
essary by the Director, shall commission a study to deter-
mine the benefits and appropriateness of genetic testing 
for infant and early childhood deaths that remain unex-
plained after a complete death scene investigation and 
comprehensive and standardized autopsy. Such study shall 
include recommendations on developing a standard pro-
tocol for use in determining when to utilize genetic testing 
and standard protocols for the collection and storage of 
specimens suitable for genetic testing. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated, such sums as may be 
necessary for each of fiscal years 2010 through 2014, to 
carry out this section. 
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‘‘(c) SURVEILLANCE
PROTOCOL.—The Secretary, 
acting through the Director of the Centers for Disease 
Control and Prevention, shall— 
‘‘(1) provide for the continued development and 
dissemination of a standard protocol for stillbirth 
data collection and surveillance, in consultation with 
representatives of health and advocacy organizations, 
State and local governments, and other interested 
entities determined appropriate by the Secretary; 
‘‘(2) monitor trends and identify potential risk 
factors for further study using existing sources of 
surveillance data and expanded sources of data from 
targeted surveillance efforts, and methods for the 
evaluation of stillbirth prevention efforts; and 
‘‘(3) develop and evaluate methods to link exist-
ing data to provide more complete information for 
research into the causes and conditions associated 
with stillbirth. 
‘‘(d) POSTMORTEM EVALUATION AND DATA COLLEC-
TION.—The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention and in con-
sultation with physicians, nurses, pathologists, geneticists, 
parents, and other groups determined necessary by the Di-
rector, shall develop guidelines for increasing the perform-
ance and data collection of postmortem stillbirth evalua-
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