Federal investigation finds 2 hospitals that denied emergency abortion broke federal law

The Centers for Medicare and Medicaid Services is investigating two hospitals that violated federal law by refusing to provide emergency abortion care to a woman who was experiencing life-threatening pregnancy complications, the agency announced Monday.

The federal investigation's findings, revealed in documents obtained by The Associated Press, are a warning to hospitals across the nation facing several new state laws that ban or severely restrict abortions. After the overturn of Roe V. Wade last year, a guidance was issued on a federal law that mandates providers continue offering emergency abortion care.

Health and Human Services Secretary Xavier Becerra said Monday that the two hospitals were in violation of the Emergency Medical Treatment and Labor Act, or EMTALA, the federal law that ensures public access to emergency services regardless of conflicting state laws.

"Fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place," Becerra said in a 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 EMTALA enforcement and federal investigation, the first of its kind since the overruling of Roe V. Wade, is in response to a complaint filed in November 2022 by the National Women’s Law Center on behalf of Mylissa Farmer with the CMS.

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Pregnant woman denied abortion despite risk of death

Farmer was denied care by two different hospitals — Freeman Health System in Joplin, Missouri, and University of Kansas Health System in Kansas City, Kansas, — in August 2022 when her water broke early at 17 weeks of pregnancy.

Doctors at both hospitals told Farmer that her fetus would not survive and that since her amniotic fluid had emptied, she was also at risk of a serious infection or losing her uterus. But doctors said they would not provide emergency abortion care because a fetal heartbeat was still detectable.

Farmer, who still struggles emotionally with the experience, had to travel to an abortion clinic in Illinois.

"It was dehumanizing. It was terrifying. It was horrible not to get the care to save your life," Farmer, who lives in Joplin, Missouri, said. "I felt like I was responsible to do something, to say something, to not have this happen again to another woman. It was bad enough to be so powerless."

Farmer's care at the University of Kansas followed hospital policy, Jill Chadwick, the media relations director for the hospital system, said in a statement.

"It met the standard of care based upon the facts known at the time, and complied with all applicable law," Chadwick said in an email. "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."

But at the time when Farmer visited the hospital, abortions in Kansas were still legal up to 22 weeks. And while abortions in Missouri are banned, there are exceptions for medical emergencies.

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CMS to ensure federal law compliance

Across the country, pregnant people have reported being turned away from hospitals for abortions, despite doctors telling them that this puts them at further risk for infection or even death.

The Biden administration has urged health care providers to not turn away patients in those situations, even if state law bans abortions. The federal government can investigate hospitals that receive Medicare and Medicaid money — which encompasses most facilities in the United States — for violations of EMTALA.

But doctors across the United States, especially those in the nearly 20 states who have banned or limited abortion care, have reported uncertainty or fears in providing the care to pregnant women. Some states have enacted criminal and civil penalties for those who provide abortion care.

The CMS also announced Monday that Becerra had sent a letter to hospital and provider associations across the United States "reminding them that it is a health care provider’s professional and legal duty to offer necessary stabilizing medical treatment to a patient who presents to a covered emergency department and is found to have an emergency medical condition (or, if appropriate, to transfer them)."

The CMS said it will ensure that hospitals are in compliance with the federal law and that EMTALA’s guarantees are protected.

“I am pleased with this decision, but pregnant people across the country continue to be denied care and face increased risk of complications or death, and it must stop,” Farmer said in a statement with the National Women’s Law Center. “I was already dealing with unimaginable loss and the hospitals made things so much harder. 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.”

Contributing: The Associated Press

This article originally appeared on USA TODAY: Hospitals under federal investigation for denying abortion care