The hospital was later investigated for denying allegations of emergency abortions

The federal government has launched the first confirmed investigation into the 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 into Freeman Hospital in Joplin, Missouri, under the federal Emergency Medical Treatment and Labor Act, department spokeswoman Lisa Cox told KHN. It is authorized by the federal Centers for Medicare and Medicaid Services, which contracts with state agencies to conduct EMTALA surveys.

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

In July, the Biden administration reminded hospitals and doctors in 13 states that have outlawed most abortions that federal law requires them to provide life- or health-saving medical services — including abortions if necessary — to patients experiencing emergency pregnancy complications.

The Missouri investigation is significant because EMTALA is one of the government’s most powerful tools to ensure that patients with pregnancy complications get the abortions they need after the Supreme Court’s June ruling removed the constitutional right to abortion. The 1986 EMTALA Act requires hospitals and physicians to provide screening and stable treatment in emergency situations.

A July policy guidance from the Department of Health and Human Services emphasized that EMTALA preempts any state law, except for abortion, and that hospitals and physicians who do not comply with the federal mandate could face civil penalties and termination from the Medicare and Medicaid programs.

HHS cites several emergency pregnancy situations where an abortion may be necessary to prevent permanent injury or death, such as an ectopic pregnancy, a severe blood pressure spike known as preeclampsia, and premature rupture of membranes that breaks a woman’s water before her pregnancy is viable, which is a serious infection. May be and endanger his life.

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

CMS does not release EMTALA investigations before they are complete and the findings and penalties are final, and states generally do not publicize them either. But patients or hospital staff members can speak up, especially on issues like abortion if they strongly object to the alleged denial of service.

The Missouri investigation involved the case of 41-year-old Mylisa Farmer, who went to Freeman Hospital on Aug. 2 after her water broke about 18 weeks into her pregnancy, followed by bleeding and cramping. Doctors there recommended terminating the pregnancy as it was not viable, the farmer had lost amniotic fluid and she faced the risk of serious infection. An Oct. 19 article in the Springfield News-Leader detailed his case, which Farmer, in a brief interview with KHN, said was correct. Farmer confirmed that he was contacted and questioned in October about the EMTALA investigation.

According to the newspaper article, Farmer’s doctors, after consulting with Freeman Hospital’s legal team, told her they could not offer her the standard procedure to terminate a pregnancy — dilation and transfer — because of Missouri’s law banning all abortions, which took effect June 24. .

That position was different from what the doctors had told him. “My doctors said it was an emergency, and I felt it was an emergency,” she told KHN

Although the law includes an exception for “medical emergency,” doctors and hospital lawyers reportedly determined her case did not qualify for that exception. Providers found to be in violation of the law can be prosecuted for a Class B felony, as well as having their license to practice revoked. The burden of proof is on providers to show that the abortion was performed due to a medical emergency.

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

Doctors say they need flexibility in deciding when to terminate a pregnancy in an emergency, and it is dangerous to have politicians and lawyers looking over their shoulders. “It’s medicine, not law, and it’s very complicated,” said Dr. Kim Puterbaugh, a Cleveland OB-GYN who is past president of the Society of OB/GYN Hospitalists. Arbitrary limits on blood pressure or bleeding when determining whether a pregnancy is “in difficulty” is ridiculous. There are too many variables.”

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

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

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

“The Missouri law puts doctors and providers between a rock and a hard place,” said Genevieve Scott, senior counsel at the Center for Reproductive Rights in New York. “This creates an extreme barrier to providing care in medical emergencies, putting providers at risk of prosecution and losing their livelihood. It clearly threatens the health and life of every pregnant person in the state.”

The Missouri investigation could spark a new legal showdown between the Biden administration and Republican state elected officials who favor stricter abortion bans. The administration is already locked in litigation over the July guidance on EMTALA in Texas and Idaho.

A federal judge in Texas issued a temporary restraining order in August that the guidelines were “unauthorized” and exceeded EMTALA to require abortions in emergency situations. Federal officials appealed. But an Idaho federal judge sided with the administration’s position, and Idaho officials asked him to reconsider his ruling.

Experts doubt whether such a case would prevent EMTALA from applying in abortion-related situations like the Missouri case. Katie Keith, an associate research professor at the Georgetown University Health Policy Institute, said the investigation into the actions of Freeman Hospital and its physicians will only examine whether they followed the requirements of federal law, not state law. Still, he added, the hospital could cite Missouri’s anti-abortion law as a defense, setting up a court fight down the line.

Farmer’s case is also playing a role in the US Senate race in Missouri between Republican Attorney General Eric Schmitt and Democratic nominee Trudy Bush Valentine, a nurse. Farmer Bush appeared in a Valentine’s TV ad criticizing Schmitt for issuing a proclamation on June 24 to enact Missouri’s anti-abortion trigger law. “My Missouri doctors are not allowed to give me the care I need, because of Eric Schmitt’s order,” the farmer said in the ad. “Eric Schmitt doesn’t care about women like me.”

According to local news reports, lawyers for Schmitt’s campaign sent letters to TV stations demanding they stop airing the ad. They claimed that women could go to prison for abortions and failed to mention that it included an exception to protect the patient’s health.

Sara Rosenbaum, a professor of health law and policy at George Washington University, warned that cases like Farmer’s are happening every day in states that have banned abortions, and that more EMTALA investigations will be launched. This puts hospitals and doctors in a painful spot, he adds. CMS said it would launch an investigation based on credible information, including news reports.

An EMTALA investigation is “one of the worst things that can happen to you,” he 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 that the child is lost.”

Related topics

Contact us Submit a story tip

Leave a Reply

Your email address will not be published.