Investigation concludes Freeman violated federal law by denying emergency abortion care

May 1—Freeman Health System in Joplin is one of two hospitals that violated federal law last year in denying an abortion to a patient who needed emergency care, a federal investigation has found.

The investigation by the Centers for Medicare & Medicaid Services found that Freeman and a hospital in the Kansas City area erred when they turned away Mylissa Farmer, who was experiencing premature labor at approximately 18 weeks of pregnancy, rather than providing her with emergency abortion care.

That's a violation, the investigation concluded, of the federal Emergency Medical Treatment and Active Labor Act, or EMTALA, which requires that patients receive the emergency medical care they need, even if it conflicts with state law. Abortion has been effectively banned in Missouri since last summer, when the U.S. Supreme Court overturned the abortion protections that had been guaranteed by the 1973 case Roe v. Wade.

"What happened to our client Mylissa was not only horrific — CMS has just made crystal clear that it was illegal, regardless of where she lived or that state's laws. 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," said Michelle Banker, director of reproductive rights and health litigation at the National Women's Law Center, and one of the lead attorneys representing Farmer, in a statement. "Other hospitals should take heed — there are consequences for denying people emergency abortion care."

The National Women's Law Center said Farmer, who at the time was living in Joplin, last August began experiencing preterm premature rupture of membranes, a condition that, at 18 weeks of pregnancy, put her at risk of severe blood loss, sepsis or death. When she sought care at Freeman and then the University of Kansas Hospital in Kansas City, Kansas, a state where abortion remains legal until 22 weeks of pregnancy, she was denied an abortion at both locations, the law center said.

Still in labor and severe pain, Farmer ultimately drove with her boyfriend to Illinois, where she received treatment days later, the law center said.

Attorneys with the law center say that doctors had concluded that Farmer's pregnancy was no longer viable and that she was at risk of a serious infection, hemorrhaging or death. But the hospitals' legal teams overrode the physicians' concerns, the attorneys wrote in a complaint filed with CMS in November of last year. That action, they argued, violated Farmer's rights to receive emergency medical care under EMTALA.

That federal law trumps state laws, like Missouri's, that ban abortion, the nation's top health official reiterated in a statement to The Associated Press.

"Fortunately, this patient survived," Health and Human Services Secretary Xavier Becerra said. "But she never should have gone through the terrifying ordeal she experienced in the first place. 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."

Farmer said in a statement that she is "pleased" with the outcome of CMS' investigation.

"But pregnant people across the country continue to be denied care and face increased risk of complications or death, and it must stop," she said in the statement. "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."

Globe efforts to obtain comment from Freeman officials were unsuccessful Monday.

Farmer's care at University of Kansas Hospital followed hospital policy, Jill Chadwick, the media relations director for the hospital system, told The Associated Press 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."

CMS has not announced any fines or other penalties against the two hospitals in its investigation, but it did send them notices warning that they were in violation of the law and asking them to correct the problems that led to Farmer being turned away. Federal Medicare investigators will follow up with the hospitals before closing the case.

The law center also earlier this year filed a complaint on Farmer's behalf with the Department of Health and Human Services Office for Civil Rights, arguing that multiple hospitals discriminated against her on the basis of her sex by denying her necessary care to save her health and life, as well as sex discrimination charges with the Missouri Commission on Human Rights and the Kansas Human Rights Commission.

The Associated Press contributed to this report.