By AMANDA SEITZ (Associated Press)
In 2022, complaints increased about pregnant women being turned away from U.S. emergency rooms, following the overturning of Roe v. Wade, federal documents obtained by The Associated Press show. These cases raise concerns about the state of emergency pregnancy care in the U.S., particularly in states with strict laws that have caused confusion about the treatment doctors can provide.
There has been a spike in complaints that U.S. emergency rooms turned away pregnant women in 2022 after the U.S. Supreme Court overturned Roe v. Wade, according to federal documents obtained by The Associated Press. overturned Roe v. Wade, federal documents obtained by The Associated Press reveal.
The cases raise alarms about the state of emergency pregnancy care in the U.S., especially in states that enacted strict abortion laws and sparked confusion around the treatment doctors can provide.
“It is shocking, it’s absolutely shocking,” said Amelia Huntsberger, an OB/GYN in Oregon. “It is appalling that someone would show up to an emergency room and not receive care — this is inconceivable.”
It’s happened despite federal mandates that the women be treated.
Federal law requires emergency rooms to treat or stabilize patients who are in active labor and provide a medical transfer to another hospital if they don’t 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 has sued Idaho over its abortion ban, even in medical emergencies, arguing it conflicts with the 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 who are 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 “become radioactive to emergency departments” in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor.
“They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Rosenbaum said.
Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her.
“The physician 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 documents. “The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital.”
Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law.
When contacted by phone, a manager at the hospital refused to give any comments about the incident.
The inquiry was one of many obtained by the AP through a Freedom of Information Act application submitted in February 2023, which requested all EMTALA complaints related to pregnancy from the previous year. A year after the application was filed, the federal government agreed to release only certain complaints and investigation documents from just 19 states. The documents had the names of patients, doctors, and medical staff removed.
Federal investigators examined just over a dozen pregnancy-related complaints in those states during the months leading up to the U.S. Supreme Court’s significant ruling on abortion in 2022. However, more than two dozen complaints about emergency pregnancy care were made in the months following the decision. It is unclear how many complaints were filed last year as the records only requested 2022 complaints and the information is not publicly available otherwise.
The documents did not provide details on what happened to the patient who was turned away from Falls Community Hospital.
‘SHE IS BLEEDING A LOT’
Other pregnancies ended tragically, according to the documents.
At Sacred Heart Emergency Center in Houston, reception staff declined to admit a woman after her husband requested assistance with her delivery in September. She suffered a miscarriage in the emergency room lobby restroom while her husband called 911 for help.
“She is bleeding a lot and had a miscarriage,” the husband told first responders in his call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we are not their client.”
Emergency responders, who arrived 20 minutes later and transported the woman to a hospital, seemed puzzled by the staff’s refusal to help the woman, according to 911 call transcripts.
One first responder informed federal investigators that when a Sacred Heart Emergency Center employee was asked about the fetus's gestational age, the employee responded: “No, we can’t tell you, she is not our patient. That’s why you are here.”
A manager for Sacred Heart Emergency Center declined to give any comments. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law mandates that these facilities must treat or stabilize patients, according to a spokeswoman for the Texas Health and Human Services agency.
Sacred Heart Emergency’s website states that it has stopped accepting Medicare, a change that occurred sometime after the woman miscarried, according to publicly available archives of the center’s website.
Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, informed a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff neglected to inform her of the risks associated with leaving without being stabilized, according to federal investigators. While on the way to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.
Person Memorial Hospital admitted to the incident. A spokesperson stated that the hospital continues to provide ongoing education for their staff and providers to ensure compliance.
In Melbourne, Florida, a guard at Holmes Regional Medical Center denied entry to a pregnant woman at the triage area because she had brought a child. When the patient returned the next day, medical staff were unable to find a fetal heartbeat. The center chose not to comment on the situation.
WHAT’S THE PENALTY?
Emergency rooms may face significant fines if they refuse to admit patients, fail to stabilize them, or transfer them to another hospital for treatment. Violations can also jeopardize hospitals’ Medicare funding.
But it’s unclear what penalties might be imposed on more than a dozen hospitals that the Biden administration says did not properly treat pregnant patients in 2022.
It can take years for fines to be imposed in these cases. The Health and Human Services agency, which enforces the law, declined to share if the hospitals have been referred to the agency’s Office of Inspector General for penalties.
For Huntsberger, the OB-GYN, EMTALA was one of the few ways she felt protected to treat 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 strong deterrent that prevents hospitals from turning away patients, she said. Many couldn’t keep their doors open if they lost Medicare funding.
She has been waiting to see how HHS penalizes two hospitals in Missouri and Kansas that HHS announced last year it was investigating after a pregnant woman, who was in preterm labor at 17 weeks, was denied an abortion.
“A lot of these situations are not reported, but even the ones that are — like the cases out of the Midwest — they’re investigated but nothing really comes of it,” Huntsberger said. “People are just going to keep providing substandard care or not providing care. The only way that changes is things like this.”
NEXT UP FOR EMTALA
President Joe Biden and top U.S. health official Xavier Becerra have both publicly vowed vigilance in enforcing the law.
Even as states have enacted strict abortion laws, the White House has argued that if hospitals receive Medicare funds they must provide stabilizing care, including abortions.
In a statement to THE AP, Becerra called it the “nation’s bedrock law protecting Americans’ right to life- and health-saving emergency medical care.
“And doctors, not politicians, should determine what constitutes emergency care,” he added.
Idaho’s law does not allow abortions if a mother’s health is at risk. But the state’s attorney general has argued that its abortion ban is “consistent” with federal law, which calls for emergency rooms to protect an unborn child in medical emergencies.
“The Biden administration has no business rewriting federal law to override Idaho’s law and force doctors to perform abortions,” Idaho Attorney General Raúl Labrador said in a statement earlier this year.
Now, the highest court will consider the situation. The situation may affect other states such as Arizona, which is bringing back a law from 1864 that prohibits all abortions, allowing an exception only if the mother’s life is in danger.
EMTALA was first introduced many years ago because private hospitals would transfer 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 declined to see pregnant women when they did not have an established relationship with physicians on staff. If the court invalidates or reduces those protections, it could lead to more hospitals rejecting patients without worrying about punishment from the federal government, she said.
“The government knows there’s an issue and is investigating and taking action about that,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do that.”
