HHS Secretary Xavier Becerra Statement on EMTALA Enforcement

The Centers for Medicare & Medicaid Services (CMS) announced two investigations of hospitals that did not offer necessary stabilizing care to an individual experiencing an emergency medical condition, in violation of the Emergency Medical Treatment and Labor Act (EMTALA). U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra released the following statement:

“As we have made explicitly clear: we will use the full extent of our legal authority, consistent with orders from the courts, to enforce protections for individuals who seek emergency care – including when that care is an abortion. HHS has announced investigations into two hospitals that did not offer necessary stabilizing care to an individual experiencing an emergency medical condition. During her visits to two different hospitals, the patient was not offered the care that her doctors determined was necessary to stabilize those emergency medical conditions — not because of the clinical judgment of her providers, but because the hospital policies would not allow an abortion to be performed.  

“Fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place. We want her, and every patient out there like her, to know that we will do everything we can to protect their lives and health, and to investigate and enforce the law to the fullest extent of our legal authority, in accordance with orders from the courts. The Biden-Harris Administration is committed to patient safety and protecting people’s access to the health care they need. Today, we send a reminder to hospitals participating in Medicare: you are obligated under EMTALA to offer stabilizing care to patients who need emergency care, and we will not hesitate to enforce your obligations under the law.”

Secretary Becerra also sent a letter to hospital and provider associations across the country today reminding them that it is a health care provider’s professional and legal duty to offer necessary stabilizing medical treatment to a patient who presents to a covered emergency department and is found to have an emergency medical condition (or, if appropriate, to transfer them).

CMS will make sure that the hospitals come into compliance with federal law so that EMTALA’s guarantees are protected and take additional action as appropriate. 

Last year, HHS issued guidance  ¹and a letter from Secretary Becerra  to reaffirm that EMTALA requires providers to offer necessary stabilizing care for patients suffering emergency medical conditions, which might include abortion care in certain situations.

Read the Secretary’s full letter to hospital and provider associations below:

Dear Hospital and Provider Associations:

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), took action to protect individuals’ access to emergency healthcare—including any necessary stabilizing treatment, which may include abortion care, or appropriate transfer for an emergency medical condition.

As healthcare providers on the front lines, the care you provide is critical for patients experiencing emergency medical conditions. Recent news reports have highlighted the troubling experiences of many pregnant women presenting to hospital emergency departments with emergency medical conditions and not being offered necessary stabilizing treatment or being turned away, which may be due to uncertainty regarding whether facility administrators may allow providers to follow their reasonable medical judgment in caring for pregnancy-related emergencies as a result of the legal status of abortion care and related obstetric services in their states.

Today, CMS announced two investigations of hospitals that did not offer necessary stabilizing treatment to an individual experiencing an emergency medical condition. At nearly 18 weeks of pregnancy, the patient experienced a preterm premature rupture of membranes (PPROM), and as a result was advised that her pregnancy was no longer viable. 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. This was a violation of the EMTALA protections that were designed to protect patients like her.

As the Secretary of HHS, I am committed to working with you to ensure that everyone who presents to a covered emergency department experiencing an emergency medical condition is offered the care they need. As you know, it is a healthcare provider’s professional and legal duty to offer necessary stabilizing medical treatment to a patient who presents to the emergency department and is found to have an emergency medical condition (or, if appropriate, to transfer them). 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.

I hope this information offers clarity on the protections afforded by EMTALA to patients. I deeply appreciate the care that frontline clinicians provide to patients every day across the country. We stand ready to continue to help make sure you have the clarity you need regarding the federal laws that affect your clinical decisions in emergency medical situations.

Endnotes

¹  The U.S. District Court for the Northern District of Texas issued an injunction prohibiting certain applications of the EMTALA Guidance issued on July 11, 2022 and Secretary Becerra’s accompanying July 11, 2022 letter.  Texas v. Becerra, No.5:22-cv-185H (N.D. Tex.).  HHS is complying with the court’s injunction, which states that: (1) The defendants may not enforce the Guidance and Letter’s interpretation that Texas abortion laws are preempted by EMTALA; and (2) The defendants may not enforce the Guidance and Letter’s interpretation of EMTALA—both as to when an abortion is required and EMTALA’s effect on state laws governing abortion—within the State of Texas or against  members of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) and the Christian Medical and Dental Association (CMDA).  HHS currently is appealing that ruling.