They are also hoping that the federal government will proactively investigate without waiting for complaints from individuals whenever appropriate emergency medical care might have been withheld because of the new laws. The New York Times reported in July that a 35-year-old woman in the Dallas–Fort Worth area was denied a dilation and evacuation procedure for her first-trimester miscarriage, despite severe pain and bleeding. The hospital reportedly sent her home with advice to return if she was bleeding heavily. The hospital did not respond to a request for comment for this article.
“If a hospital has a policy saying that when the correct medical procedure for a woman in the emergency department is abortion but physicians can’t do that, that’s a violation of EMTALA that CMS should find actionable,” said Thomas Barker, a former general counsel for the Centers for Medicare & Medicaid Services who advises hospitals on EMTALA compliance issues.
In another potential EMTALA case, Valerie Williams, MD, reported that, after Louisiana implemented its near-total ban on abortion with criminal penalties, her hospital in the New Orleans area blocked her from performing a dilation and evacuation procedure on a pregnant patient whose water broke at 16 weeks. The patient was forced to go through a painful, hours-long labor to deliver a nonviable fetus, with heavy loss of blood.
“This was the first time in my 15-year career that I could not give a patient the care they needed,” Dr. Williams wrote in a court affidavit as part of a case seeking to block the state’s abortion law. “This is a travesty.”
But CMS often relies on state agencies to investigate alleged EMTALA violations. That raises questions about how seriously those investigations will be conducted in states where officials have embraced strict limits on any medical services they deem abortion related.
In July, the Texas Medical Association warned that hospitals are pressing doctors to send pregnant patients with complications home, to wait until they expel the fetus – known as expectant management – rather than treating them at the hospital to remove the fetal remains, according to The Dallas Morning News. In a letter to the Texas Medical Board, the medical association said delayed or denied care risks patients’ future reproductive ability and poses a serious risk to their immediate health.
A study published in the American Journal of Obstetrics and Gynecology found that, after Texas implemented its tight abortion restrictions in September, patients with pregnancy complications experienced much worse outcomes than similar patients in states without abortion bans. Of those treated with expectant management at two major Dallas hospitals, 57% suffered serious complications such as bleeding and infection, compared with 33% who chose immediate pregnancy termination in other states.
Ob.gyns. and emergency physicians say they expect to be on the phone frequently with lawyers to get advice on complying with state antiabortion laws while they are seeing pregnant patients with emergency and near-emergency complications.
“This will endanger women’s lives, no question about it,” Dr. Puterbaugh said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.