Hospital investigated for allegedly refusing an emergency abortion after patient's water ruptured

Hospital investigated for allegedly refusing an emergency abortion after patient's water ruptured

The federal government has launched its first confirmed investigation into an alleged denial of an abortion to a woman experiencing a medical emergency.

In late October, the Missouri Department of Health and Senior Services opened an investigation at Freeman Hospital in Joplin, Missouri, under the Federal Emergency Medical Treatment and Labor Act, department spokeswoman Lisa Cox told KHN. It was authorized by the federal Centers for Medicare & Medicaid Services, which contracts with state agencies to conduct EMTALA surveys.

The case involves a woman whose water broke early in her pregnancy, but the hospital refused to let doctors perform an abortion. She eventually sought medical help out of state.

The Biden administration in July had reminds hospitals and doctors In the 13 states that have banned the most abortions, federal law requires them to provide life- or health-saving medical services - including abortion if necessary - to patients who experience emergency complications during pregnancy.

The Missouri investigation is significant because EMTALA is one of the government's strongest tools to ensure that patients with pregnancy complications receive the abortions they need after the Supreme Court ruled in June to strike down the constitutional right to abortion. The EMTALA Act of 1986 requires hospitals and physicians to provide screening and stabilizing treatment in emergency situations.

The Political guidelines for July from the Department of Health and Human Services emphasized that EMTALA supersedes all state laws banning abortions and that hospitals and doctors who do not comply with the federal mandate could face civil penalties and termination of the Medicare and Medicaid programs.

HHS cited several emergency pregnancy situations in which abortion may be necessary to prevent permanent injury or death, such as: which can lead to serious infections and threaten their lives.

Other EMTALA investigations of hospitals and doctors who allegedly denied medically necessary emergency abortions have been initiated in Texas but have not been publicly reported, said Greer Donley, an associate law professor at the University of Pittsburgh who studies abortion issues.

CMS does not disclose EMTALA investigations until they are complete and results and penalties are finalized, and states generally do not disclose them either. But patients or hospital staff could speak up, particularly about issues like abortion, if they strongly object to the alleged denial of services.

The Missouri investigation involves the case of Mylissa Farmer, 41, who went to Freeman Hospital on Aug. 2 after her water broke nearly 18 weeks into her pregnancy, followed by bleeding and cramping. Doctors there reportedly recommended terminating the pregnancy because it was not viable, Farmer had lost amniotic fluid and she was at risk of serious infection. Your case is described in detail in one October 19 article in the Springfield News-Leader, which Farmer said was accurate in a brief interview with KHN. Farmer confirmed that she was contacted and interviewed about the EMTALA investigation in October.

According to the newspaper article, Farmer's doctors, after consulting with Freeman Hospital's legal department, told her that they could not offer her the standard procedure for terminating the pregnancy - dilation and evacuation - because of Missouri's law banning all abortions, which went into effect on June 24.

This position was different than what Farmer said doctors told her. “My doctors said it was an emergency and I felt it was an emergency,” she told KHN.

Although the law provides for an exception Due to “medical emergencies,” the hospital’s doctors and lawyers reportedly determined that her case did not fall under this exception. Providers found violating the law may be prosecuted for a Class B felony and have their professional license revoked. The burden of proof that the abortion was performed due to a medical emergency lies with the health care provider.

Abortion opponents argue that most state anti-abortion laws contain reasonable exceptions for the health and life of the pregnant woman. But doctors and hospital lawyers say the exceptions are vaguely worded and what really matters is how prosecutors in these conservative states interpret them.

Doctors say they need flexibility in making decisions when an emergency requires an abortion and that having politicians and lawyers looking over their shoulders is dangerous. “This is medicine, not law, and it is very complicated,” said Dr. Kim Puterbaugh, a Cleveland ob-gyn and past president of the Society of OB/GYN Hospitalists. Setting arbitrary blood pressure or bleeding limits to determine whether a pregnancy is in distress "is ridiculous. There are too many variables."

Democratic lawmakers in Missouri have pushed the governor, attorney general and state health officials for a clearer definition of the medical emergency exemption.

Farmer and her boyfriend, who both wanted a child, called several hospitals in Kansas and Illinois to see if she could give birth safely, but were repeatedly told the pregnancy was not viable and her health was at risk. She eventually got an appointment at the Hope Clinic for Women across the state line in Granite City, Illinois, where she went into labor and received a pregnancy termination procedure on August 6.

Freeman Hospital officials did not respond to repeated requests for comment.

“Missouri law puts physicians and providers between a rock and a hard place,” he said Genevieve Scott, senior counsel at the Center for Reproductive Rights in New York. "It creates an extreme deterrent to providing care in medical emergencies given the risk that providers will be prosecuted and lose their livelihoods. This clearly threatens the health and life of every pregnant person in the state."

The Missouri investigation could provoke a new legal showdown between the Biden administration and Republican elected officials who support strict abortion bans. The government is already embroiled in litigation in Texas and Idaho over July guidance on EMTALA.

A Texas federal judge issued a interim injunction in August said the guidance was “unauthorized” and went beyond EMTALA by requiring abortions in emergency situations. Federal officials have filed an appeal. But a federal judge from Idaho agreed with the administration's position and Idaho officials have asked him to reconsider his decision.

Experts question whether such litigation will block enforcement of EMTALA in abortion-related situations like the Missouri case. The investigation into the actions of Freeman Hospital and its doctors will examine only whether they complied with the requirements of federal law, not state law, he said Katie Keith, an associate research professor in the Institute for Health Policy at Georgetown University. Still, she added, the hospital could cite Missouri's anti-abortion law as a defense and set up a court fight down the line.

So is Farmer's case play a role in the U.S. Senate race in Missouri between Republican Attorney General Eric Schmitt and Democratic candidate Trudy Busch Valentine, a nurse. Farmer appeared in a television ad for Busch Valentine in which he criticized Schmitt for issuing a proclamation on June 24 enacting Missouri's anti-abortion law. “My doctors in Missouri were not allowed to give me the care I needed, all because of the mandate given by Eric Schmitt,” Farmer said in the complaint. “Eric Schmitt is not interested in women like me.”

According to local news reports, Schmitt's campaign lawyers sent letters to the television stations that aired the ad demanding that it be taken off the air. They claimed it was inaccurate to state that women could go to prison for having an abortion and failed to mention that there was an exception to protect the patient's health.

Cases similar to Farmer's are likely to occur every day in states that have banned abortions, and more EMTALA investigations will be launched, warned Sarah Rosenbaum, professor of health law and policy at George Washington University. This puts hospitals and doctors in an agonizing position, she added. CMS has said it will initiate investigations based on credible information, including news reports.

An EMTALA investigation "is one of the worst things that can happen to you," she said, speaking of providers, "because it puts a label on you that you denied the woman what she needed to survive when it was clear the baby was lost."

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