Friday, March 03, 2017

Some rural ERs still turn away women in labor, despite federal law requiring treatment

Jewish Hospital in Shelbyville, Ky.
was cited for turning away a woman in labor
Over the last five years at least 20 rural hospitals have been found in violation of the federal Emergency Medical Treatment and Labor Act (EMTALA) requiring "every U.S. hospital with an emergency room to treat patients who arrive in labor, caring for them at least until the delivery of the placenta after a baby is born," Julie Lasson reports for Pro Publica. "In several cases, women suffered serious complications after being turned away, or were misdiagnosed at facilities that lacked specialists in obstetrics."

"Some ERs not only denied treatment to women in labor, they also would not help them transfer elsewhere, records show," Lasson writes. "A woman turned away by Monroe County Hospital in Forsyth, Ga., ended up calling 911 from outside the dialysis center across the street. Another woman, told there were no staff gynecologists at a Hartford, Ky. hospital, called an ambulance from a grocery store parking lot."

"EMTALA was passed primarily to ensure that emergency rooms couldn't refuse patients because they couldn't pay for services," Lasson writes. "Prompted by a catastrophic case in which a pregnant woman was turned away from two California hospitals that believed she had no insurance, the provisions outlined in EMTALA specific to labor reflected that a growing number of hospitals, especially in rural areas, had begun eliminating obstetrics departments because of high costs and a lack of doctors."

study by The Walsh Center for Rural Health Analysis found that the number of non-metro hospitals lacking hospital-based obstetric services was 44 percent in 2002, up from 24 percent in 1985, Lasson writes. "A study by the University of Minnesota Rural Health Research Center found that 7 percent of hospitals in nine states with large rural populations closed their obstetrics units between 2010 and 2014."

While some of the cited hospitals have made changes, not all have, Lasson writes. "Government inspectors cited East Texas Medical Center Carthage in Carthage, Texas, for a July 2012 incident in which a staffer told a woman in labor that the hospital didn’t have obstetric services or an obstetrician, and didn’t know where ambulances were stationed to transfer her elsewhere. She and her husband tried to drive themselves to another hospital, but their car broke down, the inspection report said." The baby died. "As part of their investigation, inspectors turned up an email from one Carthage staff member to another, noting this was not the first time the medical center had turned away an emergency delivery."

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