Hospitals are rarely punished for turning away pregnant patients

As the pregnant woman’s contractions registered every two minutes, staff at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, sent an ambulance to send her elsewhere.

Just two minutes later, she gave birth to a 6-pound baby girl in the ambulance cab down the road from the 900-bed hospital.

The incident, government investigators concluded last year, was a violation of aa federal law which requires emergency rooms to stabilize patients in medical distress before discharging or transferring them.

However, Our Lady of the Lake was never sanctioned for that incident or any of the other violations of the law. Few emergency rooms ever are.

Just a dozen hospitals have been fined for refusing to treat patients — pregnant or not — in the past two years, an Associated Press analysis found. civil monetary penalties issued by the US Office of Health and Human Services of the Inspector General found. It took years for the government to decide on those penalties.

None of the more than 100 emergency rooms who mistreated or turned away pregnant women since 2022, when the Biden administration pledged to strengthen enforcement, has been fined.

“What little we do know about investigations has yielded very rare results,” said Sara Rosenbaum, a professor of health law and policy at George Washington University.

At Our Lady of the Lake, which did not provide comment for this article, inspectors determined that emergency room staff members violated the federal mandate seven times since 2017 when they denied a necessary spine surgery to a Medicaid patient broken, they left a suicide. teenager unsupervised in the lobby and failed to examine another pregnant woman before sending her to another hospital, federal records show.

Other emergency rooms have refused care to pregnant women, sometimes letting them miscarry bathrooms, deliver babies in cars or develop dangerous infections. Some have repeatedly violated the mandate without consequence, including a Tennessee emergency room with wait times so long that a pregnant woman had to be hospitalized for a week after an 8-hour wait and a man with pain in chest collapsed in the hall, then died.

HHS does not seek fines from hospitals that violate the law, except in unusual cases where they refuse to improve their practices, agency officials said.

“Because the consequences are so real, we’ve seen hospitals work with us almost every time,” HHS Secretary Xavier Becerra said in a statement to the AP. “We have been and will continue to be inclined here, communicating our intent directly and very seriously to hospital executives and provider associations, which is, in part, why we’ve seen such good cooperation.”

After the Supreme Court struck down abortion rights nationwide, the Biden administration turned to a longstanding federal law, the Emergency Medical Treatment and Active Work Act, in a frantic effort to ensure access to abortion for women in unpleasant medical circumstances. The White House has argued that to comply with the law, hospitals must provide emergency abortions to pregnant women who need them to save their lives or reproductive organs, despite state abortion bans.

HHS sent letters to hospitals reminding them repeatedly of that law and the penalties—up to $129,232 per violation or loss of Medicare funding—for violating it.

The government also launched a new website making it easier for patients to file a complaint if they’re rejected, and promised to speed up those investigations. Last year, for example, HHS announced that two facilities – Freeman Health System in Joplin, Missouri and the University of Kansas Health System in Kansas City, Kansas – violated federal law after denying Mylissa Farmer an emergency abortion.

Doctors at both hospitals told the 41-year-old Missouri woman that her baby had no chance of survival after her water broke at 17 weeks, but because the fetal heartbeat was still detectable, her condition had to to get worse before they are willing to stop it. task.

No hospital was fined.

“It would be welcome if the federal government had a stronger law enforcement role in these cases.” said Alison Tanner, an attorney with the National Women’s Law Center, which is representing Farmer. “We have a maternal health crisis in this country, and in states with bans on abortion care, it’s much worse and more dangerous.”

Tanner said the HHS Office of Inspector General, which is responsible for issuing fines for violations of the law, is investigating Farmer’s case. The office declined to comment on pending cases.

The most recent government fines against hospitals that turned away pregnant patients were years ago.

A Tennessee Hospital agreed to pay a $100,000 fine in a 2018 case involving a pregnant patient who was discharged and gave birth in a car at 42 weeks’ gestation. A hospital in Kentucky was fined $90,000 for refusing to help a patient with an ectopic pregnancy in 2021.

After a complaint is filed against a hospital, a state inspector investigates the hospital. A doctor and the federal government review the findings to determine whether or not a patient received inappropriate treatment. If an emergency room has violated federal law, the Centers for Medicare and Medicaid Services can refer the case to the HHS inspector general to consider sanctions.

These investigations are “slow, understaffed, with many denials tolerated by hospitals,” said Rosenbaum, the legal expert.

Emergency rooms should have stopped turning away patients in the medical crisis decades ago, when Congress passed bipartisan legislation to ban dumping patients that then-Republican President Ronald Reagan signed into law in 1986.

The law requires facilities that accept Medicare funding to provide a medical screening exam to anyone who shows up at or near their door and provide stabilization treatment if needed. Emergency rooms without the resources or staff to properly treat that patient must arrange for a medical transfer to another hospital after confirming that the facility can accept the patient.

The law, Sen. David Durenberger promised nearly 40 years ago as he rallied for its passage, would be a warning to private hospitals that had been dumping pregnant patients and gunshot victims at the doors of public hospitals.

“This amendment is to send a clear signal to the hospital community,” he told the congressional hearing. “That all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in need.”

But a decade ago, a report published by the US Commission on Civil Rights concluded that there was “insufficient regulatory oversight of the law” and that hospitals were not properly training staff to follow their mandate, nor were they adequately funded to comply with it. ___ Associated Press Editor Kevin S. Vineys contributed to this report.