Emergency rooms across in some state refused to treat pregnant women, leaving one to miscarry in a lobby restroom
By AMANDA SEITZ | Associated Press
WASHINGTON — A woman suffered a miscarriage in the bathroom lobby of a Texas emergency room as reception staff refused to admit her. Another woman learned her fetus no longer had a heartbeat at a Florida hospital the day after a security guard turned her away from the facility. And in North Carolina, a woman gave birth in a car after the emergency room couldn’t offer an ultrasound. The baby later died.
Complaints that pregnant women were turned away from US emergency rooms increased in 2022 after the US Supreme Court overturned Roe v. Wade, federal documents obtained by The Associated Press show.
These cases raise alarms about the state of emergency pregnancy care in the United States, particularly in states that have enacted strict abortion laws and caused confusion about what treatments doctors can provide.
“It’s shocking, it’s absolutely shocking,” said Amelia Huntsberger, an obstetrician-gynecologist in Oregon. “It’s appalling that someone would show up to the emergency room and not receive care – it’s unconscionable. »
This happened despite federal mandates that women be treated.
Federal law requires emergency rooms to treat or stabilize patients in active labor and provide medical transfer to another hospital if they do not have the staff or resources to treat them. Medical facilities must comply with the law if they accept Medicare funding.
The Supreme Court will hear arguments Wednesday that could weaken those protections. The Biden administration sued Idaho over its ban on abortion, even in medical emergencies, arguing that it contradicted federal law.
“No woman should be denied the care she needs,” Jennifer Klein, director of the White House Gender Policy Council, said in a statement. “All patients, including women experiencing pregnancy-related emergencies, should have access to emergency medical care required under the Emergency Medical Treatment and Labor Act. »
PREGNANCY CARE AFTER ROE
Pregnant patients have “gone radioactive in emergency rooms” in states with extreme abortion restrictions, said Sara Rosenbaum, a professor of health law and policy at George Washington University.
“They’re so afraid of a pregnant patient that emergency doctors don’t even look. They just want these people gone,” Rosenbaum said.
Consider what happened to a woman who was nine months pregnant and having labors when she arrived at Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on the ‘abortion. The doctor on duty refused to see her.
“The doctor showed up at the triage office and told the patient we had no obstetrical services or capabilities,” hospital staff told federal investigators in interviews, according to documents. “The nursing staff informed the doctor that we could test him for the presence of amniotic fluid. However, the doctor categorically recommended that the patient go to a hospital in Waco.
Investigators from the Centers for Medicare and Medicaid Services concluded that Falls Community Hospital violated the law.
Reached by telephone, a hospital administrator declined to comment on the incident.
The investigation was one of dozens the AP obtained following a Freedom of Information Act request filed in February 2023 that targeted all pregnancy-related EMTALA complaints from the previous year. A year after submitting the request, the federal government agreed to release only certain complaints and investigative documents filed in just 19 states. The names of patients, doctors and medical staff were redacted from the documents.
Federal investigators examined just over a dozen pregnancy-related complaints in those states in the months leading up to the U.S. Supreme Court’s pivotal ruling on abortion in 2022. But more than two Dozens of complaints about emergency pregnancy care were filed in the months following the ruling. was revealed. It’s unclear how many complaints were filed last year because the records request only asked for 2,022 complaints and the information would not otherwise be publicly available.
The documents did not detail what happened to the patient turned away from Falls Community Hospital.
“SHE BLEEDS A LOT”
Other pregnancies ended in disaster, the documents show.
At Houston’s Sacred Heart emergency center, front desk staff refused to check a woman in after her husband asked them to help give birth in September. She miscarried in the emergency room bathroom while her husband called 911 for help.
“She is bleeding a lot and had a miscarriage,” the husband told first responders during his call, which was transcribed from Spanish into federal documents. “I’m here at the hospital but they told us they can’t help us because we’re not their customers. »
Emergency crews, who arrived 20 minutes later and transferred the woman to the hospital, appeared confused by staff’s refusal to help the woman, according to transcripts of the 911 calls.
A first responder told federal investigators that when a staff member at the Sacred Heart Emergency Center was asked about the gestational age of the fetus, the staff member responded, “No, we can’t tell you.” I mean, she’s not our patient. That’s why you’re here.
An official at the Sacré-Cœur emergency center declined to comment. The facility is licensed in Texas as a free-standing emergency room, meaning it is not physically connected to a hospital. State law requires these facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to AP.
Sacred Heart Emergency’s website says it no longer accepts Medicare, a change that was made sometime after the woman’s miscarriage, according to publicly available records on the center’s website.
Meanwhile, staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who complained of stomach pain, that they would not be able to give her a checkup. ultrasound. Staff did not tell her how risky it might be for her to leave without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.
Person Memorial Hospital self-reported the incident. A spokeswoman said the hospital continues to “provide ongoing training to our staff and providers to ensure compliance.”
In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman into the triage area because she had brought a child with her. When the patient returned the next day, medical staff could not locate a fetal heartbeat. The center declined to comment on the matter.
WHAT IS THE PENALTY?
Emergency departments face hefty fines when they turn away patients, fail to stabilize them or transfer them to another hospital for treatment. Violations can also put hospitals’ Medicare funding at risk.
But it’s unclear what fines could be imposed on more than a dozen hospitals that the Biden administration says failed to properly treat pregnant patients in 2022.
It can take years before fines are imposed in these cases. The Health and Human Services agency, which enforces the law, declined to say whether the hospitals had been referred to the agency’s Office of Inspector General for sanctions.
For Huntsberger, the OB-GYN, EMTALA was one of the few ways she felt protected treating pregnant patients in Idaho, despite the state’s ban on abortion. She left Idaho last year to practice in Oregon because of the ban.
The threat of fines or loss of Medicare funding for violating EMTALA is an important deterrent that prevents hospitals from dumping patients, she said. Many wouldn’t be able to keep their doors open if they lost Medicare funding.
She was waiting to see how HHS would penalize two hospitals in Missouri and Kansas that HHS announced last year it was investigating after a pregnant woman, in preterm labor at 17 weeks, was denied an abortion .
“A lot of these situations go unreported, but even the ones that are — like the cases in the Midwest — are investigated but nothing really comes of it,” Huntsberger said. “People are just going to continue to provide substandard care or no care at all. The only way that changes is things like that.
NEXT FOR EMTALA
President Joe Biden and top U.S. health official Xavier Becerra have both publicly pledged vigilance in enforcing the law.
Even though states have passed strict abortion laws, the White House has argued that if hospitals receive Medicare funds, they must provide stabilization care, including abortions.
In a statement to the AP, Becerra called it “the nation’s fundamental law protecting Americans’ right to emergency medical care that saves their lives and health.”
“And doctors, not politicians, should determine what constitutes emergency care,” he added.
Idaho law does not allow abortions if the mother’s health is in danger. But the state’s attorney general argued that its abortion ban was “consistent” with federal law, which requires emergency rooms to protect the unborn child in a medical emergency.
“The Biden administration does not have to rewrite federal law to override Idaho law and force doctors to perform abortions,” Idaho Attorney General Raúl Labrador said in a statement earlier This year.
Now the Supreme Court will rule. The case could have implications in other states like Arizona, which is reinstating an 1864 law banning all abortions, with an exception only if the mother’s life is in danger.
EMTALA was initially introduced several decades ago because private hospitals were abandoning their patients to county or state hospitals, often because they didn’t have insurance, said Alexa Kolbi-Molinas of the American Civil Liberties Union.
Some hospitals also refused to see pregnant women when they did not have an established relationship with the doctors on their staff. If the court strikes down or weakens those protections, it could lead more hospitals to turn away patients without fear of sanctions from the federal government, she said.
“The government knows there is a problem, it investigates and does something,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do this. »
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