Hospitals are rarely punished for turning away pregnant patients

As the pregnant woman’s contractions were occurring every two minutes, staff at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, dispatched an ambulance to take 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.

Government investigators concluded last year that the incident constituted a violation of a federal law which requires emergency services to stabilize patients in medical distress before releasing or transferring them.

Yet Notre-Dame du Lac has never been penalized for this incident or any other violation of the law. Few emergency services are.

In the past two years, only about a dozen hospitals have been fined for refusing to treat patients, pregnant or not, according to an Associated Press analysis. civil monetary penalties The sanctions were issued by the U.S. Office of Inspector General of Health and Human Services. It took the government years to decide on these sanctions.

Not one of the most 100 emergency rooms Those who have mistreated or turned away pregnant women since 2022, when the Biden administration pledged to toughen enforcement, have been fined.

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

At Notre Dame du Lac, which did not provide comment for this article, inspectors determined that emergency room staffers violated the federal mandate seven times since 2017, when they denied necessary surgery to a Medicaid patient with a broken spine, left a suicidal teenager unattended in the lobby and failed to examine another pregnant woman before sending her to another hospital, according to federal documents.

Other emergency services refused to treat pregnant women, sometimes leaving them to miscarry. bathrooms, giving birth in the car or develop dangerous infections. Some have repeatedly flouted 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 chest pains collapsed in the lobby and died.

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

“Because the consequences are real, we have 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 forward-looking, communicating our intent directly and very seriously to hospital leaders and provider associations, which is part of why we have seen such good cooperation.”

After the Supreme Court struck down the nation’s right to abortion, the Biden administration turned to a longstanding federal law, the Emergency Medical Treatment and Active Labor Act, in a frantic effort to ensure access to abortion for women in dire 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 this law and penalties—up to $129,232 per violation or loss of Medicare funding—for any violation thereof.

The government has also deployed a new website make it easier for patients to file complaints if their claims are denied and has promised to speed up those investigations. Last year, for example, HHS announced that two installations — 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 her baby had no chance of surviving after her water broke at 17 weeks, but because of state abortion bans, her condition would have to worsen before they would terminate her pregnancy.

Neither hospital was sanctioned.

“It would be welcome if the federal government took a stronger role in these cases,” said Alison Tanner, a lawyer with the National Women’s Law Center who represents Farmer. “We have a maternal health crisis in this country, and in states that ban abortion, the situation is much worse and much more dangerous.”

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

The most recent government fines on hospitals that turned away pregnant patients date back years.

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

After a complaint is filed against a hospital, a state investigator investigates the hospital. A doctor and the federal government review the findings to determine whether a patient received inadequate treatment. If an emergency department violated federal law, the Centers for Medicare and Medicaid Services may refer the case to the HHS inspector general for consideration of sanctions.

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

Emergency departments were supposed to stop turning away patients in medical crises decades ago, when Congress passed a bipartisan law banning patient abandonment, signed by then-Republican President Ronald Reagan in 1986.

The law requires facilities that accept Medicare funding to provide a medical screening to anyone who comes to or near their door and to offer stabilizing treatment, if needed. Emergency departments that do not have the resources or staff to adequately treat the patient are required to arrange for medical transfer to another hospital, after confirming that the facility can accept the patient.

The law, Sen. David Durenberger promised nearly 40 years ago when he campaigned for its passage, would be a warning to private hospitals that were abandoning pregnant patients and gunshot victims at the doors of public hospitals.

“This amendment is about sending a clear signal to the hospital community,” he told Congress. “All Americans, regardless of wealth or status, should know that a hospital will provide the services it can when they are truly in need.”

But ten years ago, a report published by the United States Commission on Civil Rights The agency concluded that there was “insufficient regulatory oversight of the law” and that hospitals were not adequately training their staff to follow the mandate and did not have the funding to comply. ___ Associated Press writer Kevin S. Vineys contributed to this report.