WASHINGTON (AP) — A woman miscarried in the bathroom lobby of a Texas emergency room after the front desk staff refused to admit her. Another woman discovered her unborn child had no heartbeat at a Florida hospital, a 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 was unable to offer an ultrasound. The baby later died.
Complaints that pregnant women were turned away from US emergency rooms increased in 2021 after US Supreme Court knocked down Roe v. Wade, federal documents obtained by the Associated Press reveal.
The cases raise alarms about the state of emergency care during pregnancy in the US, especially in states that have enacted strict rules abortion laws and created confusion around the treatment doctors can provide.
“It’s shocking, it’s absolutely shocking,” said Amelia Huntsberger, an OB/GYN in Oregon. “It’s appalling that someone would show up at an emergency room and not receive care – that’s inconceivable.”
It happened despite federal orders 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 on Wednesday that could weaken these protections. The Biden administration has sued Idaho over its ban on abortion even in medical emergencies, arguing that it conflicts with 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 facing pregnancy-related emergencies, must have access to emergency medical care required by the Emergency Medical Treatment and Labor Act.”
PREGNANCY CARE AFTER ROE
Pregnant patients “have become emergency department radioactive” in states with extreme abortion restrictions, said Sara Rosenbaum, a professor of health law and policy at George Washington University.
“They are so afraid of a pregnant patient that the emergency team doesn’t even look. They just want these people to disappear,” Rosenbaum said.
Let’s look at what happened to a woman who was nine months pregnant and having contractions when she arrived at Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s abortion ruling. The doctor on duty refused to treat her.
“The doctor came to the triage desk and told the patient that we did not have obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to the documents. “The nursing team informed the doctor that we could do tests to check for the presence of amniotic fluid. However, the doctor strongly recommended that the patient be taken to a Waco hospital.”
Investigators from the Centers for Medicare and Medicaid Services concluded that Falls Community Hospital broke the law.
Reached by phone, a hospital administrator declined to comment on the incident.
The investigation was one of dozens the AP obtained from a Freedom of Information Act request filed in February 2023 that sought all pregnancy-related EMTALA complaints from the previous year. A year after the request was filed, the federal government agreed to release only a few complaints and investigative documents filed in just 19 states. The names of patients, doctors and medical staff were removed from the documents.
Federal investigators looked at just over a dozen pregnancy-related complaints in those states during the months leading up to the U.S. Supreme Court’s pivotal 2022 abortion ruling. But more than two dozen complaints about emergency pregnancy care were filed in the months after the decision was revealed. It is unknown how many complaints were filed last year, as the records request only asked for complaints from 2022 and the information is not otherwise publicly available.
The documents did not detail what happened to the patient removed from Falls Community Hospital.
‘SHE’S BLEEDING A LOT’
Other pregnancies ended in catastrophe, the documents show.
At Sacred Heart Emergency Center in Houston, front desk staff refused to admit a woman after her husband asked for help delivering her baby in September. She miscarried in a bathroom in the emergency room lobby while her husband called 911 for help.
“She is bleeding a lot and had a miscarriage,” her husband told rescuers in 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 a hospital, appeared confused by the staff’s refusal to help the woman, according to transcripts of the 911 calls.
A first responder told federal investigators that when an employee at Sacred Heart Emergency Center was asked about the gestational age of the fetus, the employee responded, “No, we can’t say, she’s not our patient. That’s why you’re here.”
A manager at Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding 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 the AP.
Sacred Heart Emergency’s website says it no longer accepts Medicare, a change that was made some time after the woman’s miscarriage, according to publicly available files on the center’s website.
Meanwhile, staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman complaining of stomach pain that an ultrasound would not be possible. The team did not tell her how risky it could be for her to leave without being stabilized, according to federal investigators. On the way to another hospital, 45 minutes away, the woman gave birth to a baby in a car who did not survive.
Person Memorial Hospital reported the incident themselves. A spokeswoman said the hospital continues to “provide ongoing education to our employees and vendors to ensure compliance.”
In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman enter the screening area because she had brought a child with her. When the patient returned the next day, the medical team was unable to locate a fetal heartbeat. The center declined to comment on the case.
WHAT IS THE PENALTY?
Emergency departments are subject to heavy 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 is unclear what fines could be imposed on more than a dozen hospitals that the Biden administration says did not adequately treat pregnant patients in 2022.
It can take years for fines to be collected in these cases. The Health and Human Services agency, which enforces the law, declined to share whether the hospitals were referred to the agency’s Office of Inspector General for sanctions.
For Huntsberger, an obstetrician and gynecologist, EMTALA was one of the few ways she felt protected treating pregnant patients in Idaho, despite the state’s abortion ban. 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 a major deterrent that stops hospitals from abandoning patients, she said. Many would not be able to keep their doors open if they lost their Medicare funding.
She’s waiting to see how HHS penalizes two hospitals in Missouri and Kansas that HHS announced last year that it was investigating after a pregnant woman, who was in premature labor at 17 weeks, was denied an abortion.
“Many of these situations go unreported, but even those that are – like the cases in the Midwest – are investigated, but nothing really comes of it,” Huntsberger said. “People will continue to provide substandard care or no care at all. The only way to change is things like this.”
NEXT TO EMTALA
President Joe Biden and the top US health official, Xavier Becerra, have publicly vowed vigilance in law enforcement.
Even though states have enacted strict abortion laws, the White House has argued that if hospitals receive Medicare funding, they must provide stabilizing care, including abortions.
In a statement to the AP, Becerra called it “the nation’s fundamental law that protects Americans’ right to life- and health-saving emergency medical care.”
“And doctors, not politicians, should determine what constitutes emergency care,” he added.
Idaho law does not allow abortion if the mother’s health is at risk. But the state attorney general argued that the abortion ban is “consistent” with federal law, which requires emergency services to protect the unborn child in medical emergencies.
“The Biden administration has no business rewriting federal law to nullify 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 give its opinion. The case could have implications in other states like Arizona, which is reinstating an 1864 law which prohibits all abortions, with exceptions only if the mother’s life is at risk.
EMTALA was initially introduced decades ago because private hospitals dumped patients at city or state hospitals, often because they were uninsured, said Alexa Kolbi-Molinas of the American Civil Liberties Union.
Some hospitals also refused to treat pregnant women when they did not have an established relationship with the doctors on staff. If the court overturns or weakens those protections, it could result in more hospitals turning away patients without fear of penalties from the federal government, she said.
“The government knows there is a problem and is investigating and doing something about it,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do this.”
