HHS: Hospitals violated federal law by denying needed emergency abortion care

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Two hospitals violated federal law when did not offer needed emergency abortion care to a woman with life-threatening pregnancy complications last year, according to the U.S. Department of Health and Human Services.

The U.S. Centers for Medicare & Medicaid Services (CMS) announced two investigations of hospitals “that did not offer necessary stabilizing care to an individual experiencing an emergency medical condition,” violating the Emergency Medical Treatment and Labor Act (EMTALA).

The cases are the first of that kind since the U.S. Supreme Court overturned the landmark Roe v. Wade last year, according to the National Women’s Law Center (NWLC). U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra issued a statement and sent a letter to hospital and provider associations reinforcing their professional and legal duties to stabilize patients in emergency situations, or transfer them if appropriate.

“As we have made explicitly clear: We will use the full extent of our legal authority, consistent with orders from the courts, to enforce protections for individuals who seek emergency care – including when that care is an abortion,” HHS Secretary Xavier Becerra said in the statement.

The case

The federal documents did not name the complainant or hospitals involved, but the NWLC has published information about the case.

Starting Aug. 2, 2022, Mylissa Farmer of Missouri was almost 18 weeks pregnant when she had preterm premature rupture of membranes, an emergency complication creating risk of serious infection, hemorrhaging, or death. Farmer sought care at Freeman Hospital West in Joplin, Missouri, and the University of Kansas Health System (UKHS) in Kansas City, Kansas.

However, “the legal departments at these two hospitals overrode their doctors’ medical judgment and denied the emergency abortion care she needed,” according to NWLC.

Farmer consistently told staff at Freeman Hospital West “she desperately wanted to keep her daughter if she could, but she did not want to continue with a nonviable pregnancy that was putting her health and life at risk,” her HHS complaint said. Utimately she sought and found treatment at a clinic in Illinois on Aug. 5.

Farmer’s complaint described her fear and emotional distress over the situation. Her boyfriend lost his job due to the travel involved, she missed work, and her insurance did not cover the care she received in Illinois.

‘Hospitals made things harder’

Farmer and her legal team praised the HHS announcement.

“I am pleased with this decision,” Farmer said about the HHS action, “but pregnant people across the country continue to be denied care and face increased risk of complications or death, and it must stop.

“I was already dealing with unimaginable loss and the hospitals made things so much harder,” Farmer said in a statement published by NWLC. “I’m still struggling emotionally with what happened to me, but I am determined to keep fighting because no one should have to go through this.”

The circumstances were horrific and illegal, regardless of her residency and state laws, NWLC Director of Reproductive Rights and Health Litigation Michelle Banker said in a statement. Banker is one of the lead attorneys representing Farmer.

“This is an important step in getting Mylissa some justice for the harm she suffered, but no one should ever go through this in the first place,” Banker said. “Other hospitals should take heed—there are consequences for denying people emergency abortion care.”

Meeting standards of care

The University of Kansas Health System issued a statement regarding the HHS announcement and Farmer’s complaint.

“The care provided to the patient was reviewed by the hospital and found to be in accordance with hospital policy,” said the statement sent to Medical Economics by UKHS Media Relations Director Jill Chadwick. “It met the standard of care based upon the facts known at the time, and complied with all applicable law. There is a process with CMS for this complaint and we respect that process. The University of Kansas Health System follows federal and Kansas law in providing appropriate, stabilizing, and quality care to all of its patients, including obstetric patients.”

Freeman Health System’s media team was not available immediately for comment on May 3.

Voters speak out

Farmer’s conditions started the same day Kansas voters went to the polls to vote on a ballot measure that would have removed protections for abortion rights from the state constitution, and granted lawmakers the right to further restrict or ban abortion, according to an Associated Press report. Voters turned out in favor of abortion rights that day.

In her EMTALA complaint, Farmer mentioned that politically charged atmosphere as a factor when she sought treatment at the University of Kansas Health System. Currently Missouri has begun enforcing a trigger ban that prohibits abortion, while Illinois has comprehensive protections for abortion rights, according to the Center for Reproductive Rights.

HHS ruling

Becerra cited Farmer’s trips to hospitals seeking care and the conflict between the clinical judgment of her physicians and hospital policies against abortions.

“Fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place,” Becerra said in his statement. “We want her, and every patient out there like her, to know that we will do everything we can to protect their lives and health, and to investigate and enforce the law to the fullest extent of our legal authority, in accordance with orders from the courts."

The administration of President Joe Biden and Vice President Kamala Harris is committed to patient safety and protecting people’s access to the health care they need, Becerra said.

"Today, we send a reminder to hospitals participating in Medicare: You are obligated under EMTALA to offer stabilizing care to patients who need emergency care, and we will not hesitate to enforce your obligations under the law,” Becerra said in his statement.