WASHINGTON – A woman suffered a miscarriage in the lobby bathroom of a Texas emergency room because the front desk staff refused to admit her. Another woman learned her fetus had no heartbeat at a Florida hospital the day after a security guard kicked her out of the facility. And in North Carolina, a woman gave birth in a car after the emergency room was unable to offer her an ultrasound. The baby later died.

Complaints that pregnant women were turned away from US emergency rooms rose in 2022 after the US Supreme Court overturned Roe v. Wade, federal documents obtained by The Associated Press reveal.

The cases raise alarm about the state of emergency in pregnancy care in the United States, especially in states that have enacted strict abortion laws and created confusion about the treatment doctors can provide.

“It’s shocking, it’s absolutely shocking,” said Amelia Huntsberger, an OB-GYN in Oregon. “It is appalling that someone would show up at an emergency room and not receive care; this is unconscionable.”

This happened despite federal mandates that women receive treatment.

Federal law requires emergency rooms to treat or stabilize patients who are in active labor and provide medical transfer to another hospital if they do not have the staff or resources to treat them. Medical centers must follow the law if they accept Medicare funds.

The Supreme Court on Wednesday will hear arguments that could weaken those protections. The Biden administration has sued Idaho over its ban on abortion, even in medical emergencies, arguing it conflicts with federal law.

“No woman should be denied the care she needs,” Jennifer Klein, director of the White House Gender Policy Council, said in a statement. “All patients, including women experiencing pregnancy-related emergencies, should have access to emergency medical care required under the Emergency Medical Treatment and Labor Act.”

PREGNANCY CARE AFTER ROE

Pregnant patients have “become radioactive in emergency departments” in states with extreme restrictions on abortion, said Sara Rosenbaum, a professor of health law and policy at George Washington University.

“They are so afraid of a pregnant patient that the emergency room staff doesn’t even look. They just want these people to leave,” Rosenbaum said.

Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court ruling on abortion. The doctor on duty refused to see her.

“The doctor came to the triage desk and told the patient that we had no obstetric services or capabilities,” hospital staff told federal investigators during interviews, according to the documents. “The nursing staff informed the doctor that we could test him for the presence of amniotic fluid. However, the doctor strongly recommended that the patient drive to a Waco hospital.”

Investigators from the Centers for Medicare and Medicaid Services concluded that Falls Community Hospital violated the law.

Reached by phone, a hospital administrator declined to comment on the incident.

The investigation was one of dozens the AP obtained from a Freedom of Information Act request filed in February 2023 that sought all EMTALA complaints related to pregnancies from the previous year. A year after filing, the federal government agreed to release only some complaints and investigative documents filed in just 19 states. The names of patients, doctors and medical staff were redacted from the documents.

Federal investigators examined just over a dozen pregnancy-related complaints in those states in the months before the U.S. Supreme Court’s pivotal ruling on abortion in 2022. But in the months after the decision, more than two dozen complaints about emergency care during pregnancy. was unveiled. It is unknown how many complaints were filed last year, as the records request only asked for complaints from 2022 and the information is not publicly available otherwise.

The documents do not detail what happened to the patient rejected from Falls Community Hospital.

‘HE’S BLEEDING A LOT’

Other pregnancies ended in catastrophe, documents show.

At Sacred Heart Emergency Center in Houston, front desk staff refused to check in a woman after her husband asked for help delivering their baby in September. She miscarried in the emergency room lobby bathroom while her husband called 911 for help.

“She is bleeding a lot and had a miscarriage,” the husband told first responders in their call, which was transcribed from Spanish in federal documents. “I’m here at the hospital but they told us they can’t help us because we’re not their clients.”

Emergency crews, who arrived 20 minutes later and transported the woman to a hospital, appeared confused by the staff’s refusal to help the woman, according to transcripts of the 911 calls.

A first responder told federal investigators that when a staff member at Sacred Heart Emergency Center was asked about the gestational age of the fetus, the staff member responded: “No, we can’t tell her, she’s not our patient. That’s why you’re here.”

A manager at Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a free-standing emergency room, meaning it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokeswoman for the Texas Health and Human Services agency said in an email to the AP.

Sacred Heart Emergency’s website says it no longer accepts Medicare, a change that was made some time after the woman had an abortion, according to publicly available files on the center’s website.

Meanwhile, staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who complained of stomach pain, that they would not be able to perform an ultrasound. According to federal investigators, her staff did not tell her how risky it could be for her to leave without being stabilized. While she was headed to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive.

Person Memorial Hospital reported the incident itself. A spokeswoman said the hospital continues to “provide ongoing education to our staff and providers to ensure compliance.”

In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman into the triage area because she had brought a child with her. When the patient returned the next day, medical staff could not locate the fetus’s heartbeat. The center declined to comment on the case.

WHAT IS THE PENALTY?

Emergency rooms are subject to hefty fines when they turn away patients, fail to stabilize them, or transfer them to another hospital for treatment. Violations can also put hospitals’ Medicare funding at risk.

But it is unclear what fines could be imposed on more than a dozen hospitals that the Biden administration says did not adequately treat pregnant patients in 2022.

In these cases, it can take years before fines are imposed. The Health and Human Services agency, which enforces the law, declined to share whether hospitals have been referred to the agency’s Office of Inspector General for sanctions.

For Huntsberger, the OB-GYN, EMTALA was one of the few ways she felt protected in treating pregnant patients in Idaho, despite the state’s abortion ban. He left Idaho last year to practice in Oregon because of the ban.

The threat of fines or loss of Medicare funds for violating EMTALA is a strong deterrent that prevents hospitals from abandoning patients, he said. Many would not be able to keep their doors open if they lost Medicare funding.

You’ve been waiting to see how HHS penalizes two hospitals in Missouri and Kansas that HHS announced last year it was investigating after a pregnant woman, who was in preterm labor at 17 weeks, was denied an abortion .

“A lot of these situations are not reported, but even the ones that are, like the Midwest cases, are investigated, but nothing really comes of it,” Huntsberger said. “People will just continue to provide poor care or not provide care at all. The only way that changes is with things like this.”

NEXT FOR EMTALA

President Joe Biden and top U.S. health official Xavier Becerra have publicly vowed to be vigilant about law enforcement.

Even as states have enacted strict abortion laws, the White House has argued that if hospitals receive Medicare funds they must provide stabilizing care, including abortions.

In a statement to the AP, Becerra called it “the nation’s fundamental law that protects Americans’ right to life- and health-saving emergency medical care.”

“And doctors, not politicians, should determine what constitutes emergency care,” he added.

Idaho law does not allow abortions if the mother’s health is at risk. But the state attorney general has argued that its abortion ban is “consistent” with federal law, which requires emergency rooms to protect the fetus in medical emergencies.

“The Biden administration does not need to rewrite federal law to overturn Idaho’s law and force doctors to perform abortions,” Idaho Attorney General Raul Labrador said in a statement earlier this year.

Now, the Supreme Court will intervene. The case could have implications in other states such as Arizona, which is reinstating an 1864 law that bans all abortions, with an exception only if the mother’s life is at risk.

EMTALA was initially introduced decades ago because private hospitals left patients in county or state hospitals, often because they didn’t have insurance, said Alexa Kolbi-Molinas of the American Civil Liberties Union.

Some hospitals also refused to care for pregnant women when they did not have an established relationship with staff doctors. If the court strikes down or weakens those protections, it could result in more hospitals turning away patients without fear of sanctions from the federal government, she said.

“The government knows there is a problem, they are investigating and they are doing something about it,” Kolbi-Molinas said. “Without EMTALA, they wouldn’t be able to do that.”