Hospitals in Joplin, KCK cited for denying emergency abortion to Missouri woman

Two hospitals — one in Joplin and another in Kansas City, Kansas — denied emergency care to a pregnant Missouri woman in violation of federal law because doctors and staff worried that doing so would violate state abortion restrictions.

Those findings were included in a report from the Centers for Medicare and Medicaid Services on care received by Mylissa Farmer of Joplin at Freeman Health in Joplin and University of Kansas Hospital. The report found numerous violations of the Emergency Medical Treatment and Labor Act, known as EMTALA, and the hospitals must show future compliance to avoid penalties that could include loss of the ability to accept Medicare and Medicaid clients.

The report on KU Hospital also found a patient died in the emergency department waiting room who complained of a dry cough after arriving. The hospital was cited for failing to properly screen the patient to determine appropriate treatment.

In a letter to hospitals on Monday, U.S. Secretary of Health and Human Services Xavier Becerra warned that state laws outlawing abortion do not exempt providers from providing all necessary care required by federal law.

“While many state laws have recently changed, it’s important to know that the federal EMTALA requirements have not changed, and continue to require that healthcare professionals offer treatment, including abortion care, that the provider reasonably determines is necessary to stabilize the patient’s emergency medical condition,” Becerra wrote.

Farmer first visited Freeman Health on Aug. 2, the deficiency report states, when her water broke after almost 18 weeks of pregnancy. She was told her pregnancy was no longer viable but that the hospital could not terminate it because it was not immediately life-threatening for her and Missouri law prohibits abortions if a fetal heartbeat is detectable.

About 12 hours later, she arrived at University of Kansas Hospital, the report on that hospital states. Doctors there refused to terminate her pregnancy because while Kansas law protects the right to abortion, the law governing the KU Hospital bars abortions on its property.

She visited Freeman Health again the next day, where she was kept overnight for observation and released without further treatment.

“The hospital’s noncompliance creates a reasonable expectation that an adverse outcome resulting in serious injury, harm, impairment, or death will occur to current or future individuals in similar situations if not immediately corrected,” the report states.

“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” Becerra wrote. “This was a violation of the EMTALA protections that were designed to protect patients like her.”

Farmer suffered what doctors call preterm premature rupture of membranes — her water broke, followed by vaginal bleeding, abdominal pressure and cramping, the Springfield News-Leader reported in an October article. Doctors told her she would be unlikely to carry the child to term, and doing so increased her chances of infection or other severe outcome.

She told the newspaper she called hospitals in Colorado and Illinois and had an abortion Aug. 5 at the Hope Clinic in Granite City, Ill.

Farmer appeared in an ad for Trudy Busch Valentine, the Democratic candidate for U.S. Senate, as she campaigned against then-Attorney General Eric Schmitt, a Republican who signed the proclamation putting Missouri’s abortion ban into effect. A subsequent investigation, initiated by CMS after the News-Leader story, made Democrats suspicious as they worried it was an effort to find something false about Farmer’s story.

Farmer filed complaints against Freeman Health and KU Hospital on Nov. 8, after the election. The reports delivered Monday combine the findings of the federally initiated investigation and the investigation of Farmer’s complaint, said Michelle Banker, attorney for Farmer and Director of Reproductive Rights and Health Litigation at the National Women’s Law Center.

“The bottom line is that the Biden-Harris administration took decisive action to protect the rights of pregnant patients who need emergency abortion care,” Banker said. “And what’s really critical here is that by enforcing EMTALA, the administration has made it loud and clear that no one should be refused emergency health care, including abortion care.”

The U.S. Supreme Court in June overturned the 1973 Roe v. Wade decision that found federal constitutional protections for abortion. Missouri was the first state to implement its “trigger law” that took effect when Schmitt signed a proclamation that the court ruling satisfied the conditions to make abortion illegal in the state.

Under that law, passed in 2019, abortions will only be permitted in cases of a medical emergency when “a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.”

The investigative report details the internal discussion at Freeman Health about the treatments that could be provided. A maternal fetal medicine specialist reported speaking with Farmer about the myriad of medical complications that could arise if the pregnancy was not terminated and that the “chance of fetal survival was zero at this gestational age.”

At the time of the discussion, Farmer was medically stable, with some vaginal bleeding that was not heavy.
“Therefore contrary to the most appropriate management based (sic) my medical opinion, due to the legal language of MO law, we are unable to offer induction of labor at this time,” the report quotes the specialist as saying.

Along with the complaint about EMTALA violations, Farmer has filed complaints with the Department of Health and Senior Services Office of Civil Rights against Freeman and KU Hospital as well as Labette Health in Parsons, Kansas, and Memorial Hospital in Belleville, Illinois, both of which declined to accept her for treatment.

She has also filed a complaint against Freeman with the Missouri Commission on Human Rights and against KU Hospital and Labette Health with the Kansas Commission on Human Rights.

Banker would not say what comes next for Farmer.

“We’re continuing to evaluate her legal options,” she said.

In a statement, KU Hospital defended its actions in Farmer’s case but said it would comply with CMS policies.

“The care provided to the patient was reviewed by the hospital and found to be in accordance with hospital policy,” spokeswoman Jill Chadwick wrote in an email to The Independent. “It met the standard of care based upon the facts known at the time, and complied with all applicable law. 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.”

Freeman Health could not be reached for comment.

The findings in the deficiency report are critical for women facing complicated pregnancies, Banker said. The situation Farmer faced is recurring in several states, she said.

“We continue to hear reports of patients who are miscarrying, who are facing life threatening pregnancy complications and being forced to wait until they’re on the brink of death before hospitals will let their doctors intervene,” Banker said. “And so this is not just an important first step in obtaining justice for Melissa, but also in ensuring that this never happens again, to any other pregnant person across the country, and that hospitals are very aware of their legal obligations.”