A woman had a miscarriage in the lobby bathroom of a Texas emergency room when front desk staff refused to check her in. Another learned that her fetus no longer had a heartbeat at a Florida hospital the day after a security guard kicked her out of the facility. And in North Carolina, one more gave birth in a car after the emergency room was unable to offer her an ultrasound. The baby later died.
Complaints from pregnant women who were turned away in US emergency rooms increased in 2022 after the Supreme Court overturned Roe v. Wade, federal documents obtained by reveal.e
The cases raise alarms about the state of emergency in pregnancy care in the United States, especially in states that have enacted strict abortion laws and caused confusion about the treatment doctors can provide.
“It's shocking, it's absolutely shocking,” said Amelia Huntsberger, an OB-GYN in Oregon. “It is shocking that someone arrives at an emergency room and does not receive care; “This is inconceivable.”
This happened despite federal mandates that women must receive treatment.
Federal law requires emergency rooms to treat or stabilize patients who are in active labor and provide medical transfer to another hospital if they do not have the staff or resources to help them. Medical centers must follow the law if they accept Medicare funds.
The Supreme Court on Wednesday will hear arguments that could weaken those protections. The Biden Administration has sued Idaho over its ban on abortion, even in medical emergencies, arguing 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 experiencing pregnancy-related emergencies, must have access to the medical care required under the Emergency Medical Treatment and Labor Act (EMTALA).”
Pregnancy care after annulment of Roe vs. Wade
Pregnant patients have “become radioactive in emergency rooms” in states with extreme restrictions on abortion, 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 room staff doesn't even look. They just want these people to go away”Rosenbaum added.
In July 2022, just a week after the Supreme Court ruling on abortion, a nine-month pregnant woman with contractions arrived at Falls Community Hospital in Marlin, Texas. The doctor on duty refused to see her.
“The doctor came to the counter and told the patient that we had no obstetric services or capabilities,” hospital workers told federal investigators during interviews, according to the documents. “The nursing staff informed the doctor that we could test him for the presence of amniotic fluid. However, the doctor strongly recommended that the patient drive to a Waco hospital.”
Investigators from the Centers for Medicare and Medicaid Services concluded that Falls Community Hospital violated the law.
Reached by phone, a hospital administrator He declined to comment on the incident.
The investigation was one of dozens obtained from a Freedom of Information Act subpoena issued in February 2023, which sought all EMTALA complaints related to pregnancies from 2002. A year after filing the request, The federal government agreed to release some 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 in those after the decision, more than two were filed. dozens of complaints about emergency care during pregnancy. It is not known how many were raised last year, since the records request only requested 2022 and, on the other hand, the information was not publicly available.
The documents do not detail what happened to the patient rejected from Falls Community Hospital.
“He's bleeding a lot.”
Other pregnancies ended in catastrophe, documents show.
At Sacred Heart Emergency Center in Houston, front desk staff in September refused to check in a woman after her husband asked them for help delivering her baby. She miscarried in the emergency room lobby bathroom while her husband called 911.
“She is bleeding a lot and had a miscarriage,” the husband told emergency services in his call, which was transcribed from Spanish in federal documents. “I am here at the hospital but they told us that they cannot help us because we are not their clients.”
Emergency crews, who arrived 20 minutes later and transported 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 a medical center staff member was asked about the gestational age of the fetus, he responded: “No, we can't tell her, she is 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 free-standing emergency room, meaning it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to .
Sacred Heart Emergency's website says it no longer accepts Medicare, a change that was made some time after the woman had an abortion, according to records available on the 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 perform an ultrasound. According to federal investigators, she was not told how risky it could be for her to leave without being stabilized. While she was headed to another hospital 45 minutes away, she gave birth in a car to a baby who did not survive.
It was the hospital itself that reported the incident. A spokeswoman said the center continues to “provide ongoing education to our staff and providers to ensure compliance with their duties.”
In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman in because she had brought a child with her. When the patient returned the next day, medical staff could not locate the fetus's heartbeat. The hospital declined to comment on the case.
What is the penalty?
Emergency rooms are subject to hefty fines when they turn away patients, fail to stabilize them, or transfer them to another hospital for treatment. Violations can also jeopardize the facilities' Medicare funding.
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.
In these cases, it can take years before fines are imposed. The Health and Human Services Agency (HHS) declined to share whether hospitals have 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 abortion ban, which she left last year to work in Oregon because to the ban.
The threat of fines or loss of Medicare funds for violating EMTALA is a strong deterrent that prevents hospitals from abandoning patients, he added. Many would not be able to keep their doors open if they lost that money.
She has been waiting to see how HHS penalizes two hospitals in Missouri and Kansas that the agency announced last year it was investigating after a pregnant woman, who was in preterm labor at 17 weeks, was denied an abortion. .
“Many of these situations are not reported, but even the ones that are, like the cases in the Midwest, are investigated, but nothing really comes of it,” Huntsberger said. “There will simply continue to be poor or no care provided.”
What's next for EMTALA
President Joe Biden and top US health official Xavier Becerra have publicly promised Be attentive to law enforcement.
Even as 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 Associated Pres, Becerra called it “the nation's founding law that protects Americans' right to life-saving emergency medical care.”
“And doctors, not politicians, should determine what constitutes emergency care,” he added.
Idaho law allows abortion only if the life, not the health, of the mother is at risk. But the state attorney general has argued that its abortion ban is “consistent” with federal law, which requires emergency rooms to protect the fetus in medical emergencies.
“The Biden Administration does not have to rewrite federal law to overturn Idaho's law and force doctors to perform abortions,” Idaho Attorney General Raul Labrador added in a statement earlier this year.
Now, the Supreme Court will intervene. The case could have implications in other states such as Arizona, which is reinstating an 1864 law that bans all abortions, with an exception only if the mother's life is at risk.
EMTALA was initially introduced decades ago because private hospitals were dropping patients off at county or state facilities, often because they didn't have insurance, said Alexa Kolbi-Molinas of the American Civil Liberties Union.
Some hospitals also refused to care for pregnant women when they did not have an established relationship with staff doctors. If the court strikes down or weakens those protections, it could result in more hospitals turning away patients without fear of sanctions from the federal government, she said.
“The Government knows there is a problem, it is investigating and it is doing something about it,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do that.”
