On Might 1, 2023, the Facilities for Medicare and Medicaid Companies (“CMS”) introduced two investigations of hospitals that failed to supply mandatory stabilizing care to a pregnant particular person experiencing an emergency medical situation (“EMC”), in violation of the Emergency Medical Remedy and Labor Act (“EMTALA”). The U.S. Division of Well being and Human Companies (“HHS”) launched a public assertion and a letter to hospitals and supplier associations, emphasizing the obligations of Medicare-participating hospitals’ underneath EMTALA, together with stabilizing remedy, like abortion care, or an acceptable switch. These investigations signify the primary EMTALA enforcement motion associated to abortion emergency care because the U.S. Supreme Courtroom’s resolution in Dobbs v. Jackson Girls’s Well being Group (“Dobbs”).
The investigations relate to a pregnant affected person who had a untimely rupture of membranes at 18 weeks and was suggested that the being pregnant was not viable. The affected person’s suppliers at hospitals in Missouri and Kansas knowledgeable the affected person that, though her situation may quickly deteriorate, they may not present the care that will forestall critical an infection, hemorrhage, and potential loss of life, for causes which included that the fetal heartbeat was nonetheless detectable and that the hospitals’ insurance policies prohibited the remedy that will terminate the being pregnant, because it could possibly be thought-about a prohibited abortion underneath state regulation. The affected person was in the end required to journey to an abortion clinic in Illinois for remedy. The failure to supply mandatory stabilizing remedy for the affected person or prepare for an acceptable switch may represent a violation underneath EMTALA.
Within the context of being pregnant care, any particular person who presents to a devoted emergency division (together with labor and supply models) in labor or requesting examination of a medical situation, should obtain an acceptable medical screening examination (“MSE”). If the MSE reveals an EMC, the hospital is required to supply acceptable stabilizing remedy or correctly switch the affected person to a different hospital that is ready to present such remedy. EMCs involving pregnant sufferers could embrace ectopic pregnancies, problems of being pregnant loss, or emergent hypertensive problems.
As described in an earlier put up, EMTALA has garnered renewed consideration in gentle of the Dobbs resolution. Though sure states have responded to the ruling by implementing authorized restrictions on the supply of and entry to reproductive and abortion care, HHS reiterated its place that EMTALA’s obligations preempt any straight conflicting state regulation or mandate which may prohibit mandatory stabilizing remedy or that apply to particular procedures, together with abortion care.[i] Two federal courts in Texas and Idaho are at the moment contemplating the impact of EMTALA on state legal guidelines that limit abortion care, together with HHS’ enforcement authority, which can in the end result in one other U.S. Supreme Courtroom case regarding abortion.[ii]
Hospitals ought to rigorously consider their compliance with EMTALA, and hospitals and suppliers with questions or searching for counsel can contact any member of the Sheppard Mullin Healthcare staff for help.
[i] See CMS, QSO-22-22-Hospitals: Reinforcement of EMTALA Obligations particular to Sufferers who’re Pregnant or are Experiencing Being pregnant Loss (Aug. 25, 2022); Letter from the Secretary of Well being and Human Companies (Jul. 11, 2022).
[ii] See Texas v. Becerra, No. 5:22-CV-185-H (N.D. Tex. Aug. 23, 2022), and United States v. Idaho, No. 1:22-cv-00329-BLW (D. Idaho Aug. 24, 2022).