Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom
WASHINGTON — A woman suffered a miscarriage in the restroom lobby of a Texas emergency room after front-desk staff refused to let her in. Another woman learned her fetus had no 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 was unable to provide an ultrasound. The baby later died.
Complaints that pregnant women were turned away from U.S. emergency departments increased in 2022 after the U.S. Supreme Court overturned Roe v. Wade, according to federal documents obtained by The Associated Press.
The cases raise alarms about the emergency of pregnancy care in the US, especially in states that have passed strict abortion laws and caused confusion about the treatment doctors can provide.
“It’s shocking, it’s absolutely shocking,” said Amelia Huntsberger, an obstetrician/gynecologist in Oregon. “It is terrible that someone shows up to the emergency room and does not receive care – this is unthinkable.”
It happened despite federal mandates that the women needed treatment.
Federal law requires emergency departments to treat or stabilize patients in active labor and provide a medical transfer to another hospital if they do not have the staff or resources to treat them. Medical institutions must comply with the law if they accept Medicare financing.
The Supreme Court will hear arguments Wednesday that could weaken these protections. The Biden administration has sued Idaho over its abortion ban, even in medical emergencies, arguing it violates 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.”
Pregnant patients have become “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 are so afraid of a pregnant patient that the emergency room doesn’t even look. They just want these people gone,” Rosenbaum said.
Consider what happened to a woman who was nine months pregnant and in labor when she arrived at Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court ruled 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, documents show. “The nursing staff told the doctor that we could test her for the presence of amniotic fluid. However, the doctor firmly advised the patient to drive to a Waco hospital.
Investigators from the Centers for Medicare and Medicaid Services concluded that Falls Community Hospital violated the law.
A hospital administrator, reached by phone, declined to comment on the incident.
The survey was one of dozens the AP obtained through 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 made, the federal government agreed to release only some complaints and investigative documents filed in just 19 states. The names of patients, doctors and medical staff were removed from the documents.
Federal investigators investigated just over a dozen pregnancy-related complaints in those states in the months leading up to the U.S. Supreme Court’s pivotal 2022 ruling on abortion. But more than two dozen emergency pregnancy care complaints were filed in the months after the decision. was revealed. It is not known how many complaints were filed last year because the file request only asked for complaints about 2022 and the information is otherwise not publicly available.
The documents did not detail what happened to the patient who was sent away from Falls Community Hospital.
Other pregnancies ended in disaster, the documents show.
At Sacred Heart Emergency Center in Houston, front desk staff refused to check a woman in after her husband asked for help delivering her baby in September. She miscarried in a bathroom toilet in the emergency room lobby while her husband called 911 for help.
“She is bleeding a lot and had a miscarriage,” the man 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’re not their client.”
Emergency responders, who arrived 20 minutes later and took the woman to a hospital, appeared confused by the staff’s refusal to help the woman, according to transcripts of the 911 calls.
One first responder told federal investigators that when a Sacred Heart Emergency Center employee was asked about the gestational age of the fetus, he responded, “No, we can’t tell you, 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 AP.
Sacred Heart Emergency’s website says it no longer accepts Medicare, a change made some time after the woman suffered a miscarriage, according to publicly available records from 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 an ultrasound. According to federal investigators, staff failed to tell her how risky it might be for her to leave without being stabilized. 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 educate our staff and providers to ensure compliance.”
In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to allow a pregnant woman into the triage room because she 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 case.
Emergency departments can face hefty fines if they turn away patients, fail to stabilize them, or transfer them to another hospital for treatment. Violations can also jeopardize hospitals’ Medicare funding.
But it is 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.
In these cases it can take years before fines are imposed. 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 sanctions.
For Huntsberger, the 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 keeps hospitals from dumping patients, she said. Many couldn’t keep their doors open if they lost Medicare funding.
She has been waiting to see HHS sanction two hospitals in Missouri and Kansas, which HHS announced last year it was investigating after a pregnant woman who went into premature labor at 17 weeks was denied an abortion.
“A lot of these situations are not reported, but even the ones that are — like the Midwestern cases — are being investigated, but nothing really comes of it,” Huntsberger said. “People simply continue to provide substandard care or do not provide care. The only way that changes is things like this.”
President Joe Biden and top U.S. health official Xavier Becerra have both publicly vowed vigilance in enforcing the law.
Even as states have passed 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 “basic 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 abortions if the mother’s health is at risk. But the state’s attorney general has argued that the abortion ban is “consistent” with federal law, which calls for emergency care to protect an unborn child in medical emergencies.
“The Biden administration has nothing to do with rewriting 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 pass judgment. The case could have ramifications in other states such as Arizona, which is reinstating an 1864 law banning all abortions except only when the mother’s life is in danger.
EMTALA was initially introduced decades ago because private hospitals were dumping patients into provincial 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 if they did not have an established relationship with the doctors on staff. If the court nullifies or weakens these protections, it could lead to more hospitals turning away patients without fear of punishment from the federal government, she said.
“The government knows there is a problem, is investigating and doing something about it,” Kolbi-Molinas said. “They wouldn’t be able to do that without EMTALA.”