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A 29-page report released Thursday says hospital leaders and lawyers are letting doctors fend for themselves with minimal guidance as doctors avoid the risk of criminal prosecution in states where abortion is banned. At times, he maintains a “conspicuous and deliberate silence.” By Ron Wyden, Chairman of the Senate Finance Committee. This misdirection is leading to delays in emergency care for patients facing pregnancy complications, the report concluded.
The Oregon Democratic Party launched an investigation in September in response to a ProPublica report on preventable maternal deaths in states that ban abortion. Wyden requested documentation from eight hospitals to ensure they are complying with federal laws that require them to keep or transport emergency patients. His committee has authority over regulatory agencies that enforce the law. The report is also based on roundtable discussions with doctors in states that restrict abortion access.
The resulting committee staff report provides new insight into the chaotic and dysfunctional state of hospitals in states where abortion is prohibited, and helps hospitals consider reforms and It provides new opportunities to provide proactive and transparent guidance to patients and physicians.
The report said anonymous doctors testified that hospital lawyers “refused” them to meet with them for months, making it “almost impossible” to contact them in “life-or-death” situations, and that legal The government reportedly provided little assistance beyond “reversing the flow”. Report. The doctors explained how other doctors passed on false and potentially harmful information, that patients could not legally choose their own treatment, and that doctors He said he cannot legally treat ectopic pregnancies, a potentially fatal complication in which the embryo develops.
“Doctors are playing lawyers, and lawyers are playing doctors,” Wyden said in an interview. As a result, “women can get hurt, suffer and die. We are sounding this alarm to ensure that women are better protected and know what their rights are.” I am thinking of doing so.”
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The Biden administration has told hospital officials that under the federal Emergency Medical Labor Act, known as EMTALA, they have a responsibility to stabilize patients who come to emergency rooms, even if the procedure involves a conflicting abortion procedure. said. Along with state abortion laws. If this is not possible, the patient must be transferred to an available hospital in accordance with administrative guidance. Some states fought this. In Texas, a court ruled that government guidance could not override the state’s abortion ban, and the Supreme Court rejected the appeal.
Information about how to address legal conflicts between the ban and federal law is typically not documented by hospitals and, in some cases, provided only on a “need-to-know” basis, the study found. It turns out. The Idaho doctor said the nurses, who were not included in the same email as the doctor, did not believe they could treat the patient and that the doctor would “find the second or third best option.” It is up to them to do so, he added. An emergency medicine doctor who once worked in Texas said he encountered obstetricians and gynecologists who were too scared to help. Another colleague said he “just wants to get the patients out of the hospital” because he is concerned about the professional and personal risks of their treatment.
The report described each of the five preventable deaths that ProPublica reported as examples of the deadly consequences of abortion bans. Additionally, patients in crisis are increasingly being denied care. Doctors shared examples such as:
The Idaho patient’s placenta “separated” from the side of her uterus, causing heavy bleeding. The bleeding patient was sent home from the emergency room four or five times. The doctor said he believed the hospital was legally allowed to stabilize the patient only at the moment he was “on the verge of bleeding.” Another patient in Idaho, who was 19 weeks pregnant, had cramps and spotting, but was sent home at the direction of a maternal-fetal medicine specialist until she was “referred to as an emergency.” The patient’s membranes broke at 21 weeks and the fetus was not viable. Doctors refused to remove the fetus until the heartbeat had stopped, sent her home and then, upon their return, required her to wait more than six hours before agreeing to induce labor. ProPublica wrote about a similar case in Texas where a woman died from a deadly infection after waiting 40 hours for her unborn baby’s heartbeat to stop.
Wyden was able to obtain documents and answers from the hospital that are rarely provided to the public. In December, ProPublica requested miscarriage treatment protocols from 50 Texas hospitals, which account for about half of the state’s births, according to state hospital discharge data. Almost all of them refused. Researchers attempted a similar study in Oklahoma last year after trying to force hospitals to share treatment policies for pregnancy complications under the state’s ban, according to an investigation by Physicians for Human Rights. He said he encountered resistance.
The senator requested documentation from eight hospitals across the country that had reports that emergency care for pregnancy complications was delayed or denied. She called for “state abortion laws and emergency reproductive health policies, processes, and procedures.” All eight responded and shared hundreds of pages of documents and responses, which the committee published with its report. The document provides a rare detailed look into the operations of private healthcare systems, giving hospital doctors and ethics committees new insight into what other companies are doing to comply with the law. There is a possibility of giving.
The responses revealed that many hospitals relied on guidance created before the abortion ban existed, the report said. In most cases, doctors were given basic EMTALA guidance that did not address how to address new abortion restrictions and were told to contact legal or ethics attorneys if they had questions. Only two hospitals have developed proactive guidance to help providers respond to the new situation, and two have explicitly discussed the conflict between abortion bans and EMTALA and how to address it. There was only one. It was not always clear whether these instructions were created prior to media reports about the denial of care.
Missouri’s Freeman Health System was cited by federal investigators for violating EMTALA after doctors told a patient whose water broke at nearly 18 weeks pregnant that they could not induce labor because of the state’s new abortion law. It turned out that it did. The company has robust protocols in place, including intake flow diagrams for pregnant patients and informed consent documentation advising patients with high-risk pregnancy complications that constitute an “emergency medical condition” under EMTALA. was submitted to the committee. The Missouri hospital system is the only one of its eight hospitals to say it provides full civil and criminal defenses to providers sued under the state’s abortion law, according to the report. It was.
Also under investigation was the Georgia hospital system that treated Amber Thurman, a 28-year-old single mother who faced a deadly infection from a rare complication after taking abortion pills. Doctors at Piedmont Henry Hospital discussed but did not offer a procedure to remove her uterus in time, according to a report from the state Maternal Mortality Review Board. The commission concluded that her death was preventable.
Piedmont told Wyden it formed a task force after the state’s abortion ban went into effect. The hospital consults with providers of educational materials about the conflicts that abortion bans can cause, including the American College of Obstetricians and Gynecologists’ statement “Decision Tree” on exceptions to abortion bans and guidance on complying with the law’s documentation requirements. He said that he provided it. (ProPublica reported in September that the task force provided education in the months after Thurman’s death.)
Piedmont Hospital, Freeman Hospital and five other hospitals mentioned in the report did not respond to requests for comment. Dr. R. Cliff Moore, chief medical officer and maternal-fetal physician at Women’s Hospital of Louisiana, said that when the diagnosis of early miscarriage is unclear, doctors “wait for additional information as long as the patient’s condition is stable.” Ta.
“The policy, assessment, treatment and care for early miscarriage at Women’s Hospital remains unchanged,” he said.
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To protect emergency reproductive health care, the report called for reestablishing access to abortion across the country and for the federal government to enforce EMTALA “to the fullest extent of the law.”
But Wyden acknowledges this is an unlikely scenario, as Republicans will control all branches of government in the next Congress.
“It is increasingly important that hospitals and health care provider organizations work together to ensure patients get the care they need,” he said. “It means making clear that patients have a federal legal right to emergency treatment, no matter where they live, and they don’t have to be on the brink of death to receive it.”
The report makes four recommendations:
The report called for hospitals and hospital associations to work together to provide training, guidance and resources to doctors to ensure they can provide emergency pregnancy care in abortion-ban states. The report said professional medical organizations should “issue guidance and publicize standards that clearly define appropriate clinical care in obstetric emergencies.” The law encouraged hospitals to help doctors, from obstetricians and gynecologists to family physicians, obtain certification to prescribe mifepristone, which is part of a two-pill abortion pill regimen. The report said doctors should advise patients about their rights under EMTALA and how to report violations.
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