Feds rarely punish hospitals for turning away pregnant patients

As the pregnant woman's contractions rolled in every two minutes, staff at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, dispatched an ambulance to send her elsewhere.

Just two minutes later, she gave birth to a 6-pound baby girl in the cab of the ambulance down the road from the 900-bed hospital.

The incident, government investigators concluded last year, was a violation of a federal law that requires emergency rooms to stabilize patients in medical distress before discharging or transferring them.

Yet, Our Lady of the Lake has never been been penalized for that incident or any of its other violations of the law. Few emergency rooms ever are.

Just a dozen hospitals have been fined for refusing to treat patients — pregnant or not — over the past two years, an Associated Press analysis of civil monetary penalties issued by the U.S. Health and Human Services Office of Inspector General found. It took years for the government to decide those penalties.

Not one of the more than 100 emergency rooms that mistreated or turned away pregnant women since 2022, when the Biden administration pledged to toughen enforcement of the law, has been fined.

“What little we know about the investigations have yielded very rare results,” said Sara Rosenbaum, a George Washington University health law and policy professor.

At Our Lady of the Lake, which did not provide comment for this article, inspectors determined the emergency room’s staff members violated the federal mandate seven times since 2017, when they refused a needed 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, federal records show.

Other emergency rooms denied care to pregnant women, sometimes leaving them to miscarry in bathrooms, deliver babies in cars or develop risky infections. Some repeatedly flouted the mandate without consequence, including one Tennessee emergency room with such long wait times that a pregnant woman had to be hospitalized for a week after an 8-hour wait and a man with chest pain collapsed in the lobby, then died.

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

“Because the consequences are so real, we have seen hospitals work with us almost every single time,” HHS Secretary Xavier Becerra said in a statement to the AP. “We have been and will continue to be forward leaning here, communicating our intent directly and very seriously to hospital executives and provider associations which is, in part, why we have seen such good cooperation.”

After the Supreme Court overturned the nationwide right to an abortion, the Biden administration turned to a longstanding federal law, the Emergency Medical Treatment and Active Labor Act, in a frantic effort to ensure abortion access for women in dire medical circumstances. The White House has argued that to comply with the law, hospitals must provide emergency abortions for pregnant women who need them to save their lives or reproductive organs, despite state abortion bans.

Asked about the AP’s findings on Friday, White House press secretary Karine Jean-Pierre put blame on former President Donald Trump for appointing three Supreme Court justices who ruled to upend U.S. abortion rights.

The Biden administration has sent letters to hospitals repeatedly reminding them of that law and the penalties — up to $129,232 per violation or loss of Medicare funding — for flouting it.

It also has rolled out a new website making it easier for patients to file a complaint if they are rejected, and it promised to expediate those investigations.

Last year, for example, HHS announced that two facilities — Freeman Health System in Joplin, Missouri, and University of Kansas Health System in Kansas City, Kansas — ran afoul of the federal law after refusing an emergency abortion to Mylissa Farmer.

Doctors at both hospitals told the 41-year old Missouri woman that her baby had no chance of surviving after her water broke at 17 weeks but because a fetal heartbeat was still detectable, her condition needed to worsen before they’d be willing to terminate her pregnancy.

Neither hospital has been fined.

“It would be welcomed if the federal government took a stronger enforcement role in those cases.” said Alison Tanner, an attorney for National Women’s Law Center who represents Farmer. “We have a maternal health crisis in this country and in states with bans on abortion care, it is far worse and more dangerous."

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

The government’s most recent fines against hospitals that turned away pregnant patients were cases from years ago.

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

After a complaint against a hospital is filed, a state surveyor investigates the hospital. A physician and the federal government review the findings to determine whether or not a patient received inadequate treatment. If an emergency room violated the federal law, the Centers for Medicare and Medicaid Services may refer the case to the HHS inspector general to consider penalties.

Those investigations are “slow, insufficiently staffed, with a lot of pushback tolerated from hospitals,” Rosenbaum, an expert on the law, said.

Emergency rooms were supposed to stop turning away patients in medical crisis decades ago, when Congress passed bipartisan legislation designed to prohibit patient dumping that then-Republican President Ronald Reagan signed in 1986.

The law requires facilities that accept Medicare funding to provide a medical screening exam to anyone who shows up at or near their door and offer stabilizing treatment, if needed. Emergency rooms without the resources or staff to properly treat that patient are required to arrange a medical transfer to another hospital, after they’ve confirmed the facility can accept the patient.

The law, Sen. David Durenberger promised nearly 40 years ago as he rallied for its passage, would be a warning to private hospitals that had been dumping pregnant patients and gunshot victims on the doorsteps of public hospitals.

“This amendment is to send a clear signal to the hospital community,” he said on the floor of Congress. “That all Americans, regardless of wealth or status, should know that a hospital will provide what services it can when they are truly in distress.”

FILE - Mylissa Farmer stands for a portrait at her home in Joplin, Mo., on Sept. 28, 2022. (Nathan Papes/The Springfield News-Leader via AP, File)

NEW YORK (AP) — U.S. stock indexes remained stuck in place on Tuesday as Wall Street made few big moves ahead of what’s expected to be the first cut to interest rates in more than four years.

The S&P 500 edged up by 1.49, or less than 0.1%, to 5,634.58. It remains 0.6% below its all-time closing high set in July, and it briefly rose above that mark during the morning.

The Dow Jones Industrial Average slipped 15.90 points, or less than 0.1%, to 41,606.18 from its own record set the day before, while the Nasdaq composite edged up by 35.93, or 0.2%, to 17,628.06.

Intel helped drive the market with a gain of 2.7% following a series of announcements, including an expansion of its partnership with Amazon Web Services to produce custom chips. Intel also detailed plans to build its foundry business.

That helped offset a 2.2% drop for Philip Morris International, which said it expects to record a loss of $220 million against its third-quarter results because of the sale of its Vectura Group inhaled-therapeutics subsidiary.

The calm movements for the U.S. stock market overall were a sharp departure from prior weeks, during which the S&P 500 briefly fell nearly 10% below its all-time high. At the time, global markets were reeling on worries that a slowing U.S. economy could fall into a recession, along with some technical factors that forced hedge funds around the world to back out of a popular trade all at once.

Since then, excitement has built about an announcement scheduled for Wednesday afternoon from the Federal Reserve. The unanimous expectation on Wall Street is that the Fed will cut the federal funds rate, which has been sitting in a range of 5.25% to 5.50% for more than a year.

Lower rates would make things easier for the economy, which has already begun to slow because it’s become so expensive to borrow money for everything from houses to cars to corporate debt. The Fed has been keeping its main interest rate at a two-decade high in hopes of grinding down on the economy enough to stifle high inflation.

Now that inflation is down substantially from its peak two summers ago, the Fed believes it can shift its focus more toward protecting the job market and economy. The only question is how much the Fed will cut rates by, and that is a delicate balancing act.

While lowering rates gives a boost to the overall economy and to financial markets, it can also give inflation more fuel. Some critics say the Fed is already moving too late to help the economy, while others warn of inflation staying stubbornly higher than it has in the past.

The general expectation on Wall Street is for the Fed to deliver a larger-than-usual cut of half of a percentage point on Wednesday, according to data from CME Group. But it’s not a certainty. Traders are still betting on a 35% probability for a traditional-sized move of a quarter of a percentage point,

Economic reports released Tuesday did little to change those expectations. One said U.S. shoppers spent more at retailers last month than expected. That’s an encouraging signal indicating strength for the heart of the U.S. economy, but details underneath the surface may have been more discouraging. After ignoring automobiles and fuel, sales at U.S. retailers last month were a touch weaker than economists expected.

“This data isn’t going to decide the issue for the Fed, one way or the other,” Chris Larkin, managing director, trading and investing, at E-Trade from Morgan Stanley, said about the size of Wednesday’s rate cut.

A separate report that came later in the morning said U.S. industrial production returned to growth in August and was stronger than economists expected.

In the bond market, the 10-year Treasury yield rose to 3.64% from 3.62% late Monday. The two-year yield, which more closely tracks expectations for the Fed’s actions, rose to 3.59% from 3.56%.

In stock markets abroad, Japan’s Nikkei 225 fell 1% after the value the Japanese yen ticked higher against the U.S. dollar.

The yen has been rising on expectations the Bank of Japan will continue to head in the opposite direction of the Federal Reserve and keep raising interest rates. A stronger yen can hurt the profits of Japan’s big exporters.

Stock indexes rose modestly across much of Europe, while markets were closed in mainland China and South Korea.

AP Business Writers Matt Ott and Elaine Kurtenbach contributed.

The New York Stock Exchange, with a banner for American Eagle Outfitters, is shown on Tuesday, Sept. 17, 2024, in New York. (AP Photo/Peter Morgan)

FILE - The American flag hangs from the front of the New York Stock Exchange on Sept. 10, 2024, in New York. (AP Photo/Peter Morgan, File)

FILE - A person stands in front of an electronic stock board showing Japan's Nikkei index at a securities firm in Tokyo, on May 28, 2024. (AP Photo/Eugene Hoshiko, File)

FILE - People walk in front of Tokyo Stock Exchange building in Tokyo, on May 28, 2024. (AP Photo/Eugene Hoshiko, File)