CMS Report: Multiple hospital failures, not pro-life law, led to delayed ectopic pregnancy care

Following an inquiry, the Centers for Medicare and Medicaid Services (CMS) found that a Texas hospital violated the law when it failed to properly treat a woman who was experiencing an ectopic pregnancy.

Though the media has blamed Texas’ pro-life law for the lack of care provided, the CMS report confirms that the hospital failed to follow protocol, leading to a misdiagnosis and failure to provide appropriate care to the patient.

KEY TAKEAWAYS:

• Failure to follow hospital protocol: CMS investigated the case of Kyleigh Thurman, a woman who blamed Texas’ pro-life law for delayed treatment of an ectopic pregnancy in 2023, and found that multiple instances of failure to follow hospital protocol were the cause.

• Failure to properly screen: CMS determined that hospital personnel failed to properly screen Thurman “for known risks associated with presenting signs, symptoms, and test results” for conditions such as ectopic pregnancy.

• Misdiagnosis: These failures led to a misdiagnosis of miscarriage, and Thurman ended up requiring surgical removal of a fallopian tube when her ectopic pregnancy ruptured.

THE DETAILS:

CMS launched an investigation into how Ascension Seton Williamson Hospital handled Kyleigh Thurman’s ectopic pregnancy in February 2023. It reviewed the Emergency Medical Treatment and Active Labor Act (EMTALA) and “Medical Screening Examination” (MSE), the process required “to reach with reasonable clinical confidence the point at which it can be determined whether an Emergency Medical Condition exists.” It is an ongoing evaluation that includes all services available to the emergency department and supporting medical teams.

CMS also reviewed the bylaws for medical staff, the rules for medical staff consultations, the clinical management tool “Positive Pregnancy Test with No Visible Intrauterine Pregnancy (IUP),” and Thurman’s medical records.

According to the CMS report, on February 21, 2023, Thurman arrived at the emergency department of Ascension Seton Williamson with vaginal bleeding and abdominal cramping in early pregnancy. She was evaluated using an ultrasound for an ectopic pregnancy. The ultrasound showed “no evidence of intrauterine pregnancy” and a “rounded structure in the right adnexa” — the area next to but outside of the uterus where the ovary and fallopian tube are located. These two findings should have meant that Thurman was seen by an OB/GYN.

According to the report, hospital policy states:

• Patients with a “positive pregnancy test with no visible intrauterine pregnancy” and “adnexal mass seen on ultrasound” should be evaluated by an OB/GYN in the emergency department or should be admitted to be seen by an OB/GYN.

• The ER doctor can consult with an OB/GYN over the phone but only if the patient does not have an adnexal mass on the ultrasound, has no adnexal tenderness on examination, has no palpable adnexal mass on examination, and has no cervical motion tenderness.

CMS concluded:

• Thurman’s record does not show that she was examined for adnexal tenderness, palpable adnexal mass, or cervical motion tenderness, and there was no indication as to why these evaluations did not take place.

• Despite having an adnexal mass on the ultrasound, Thurman’s medical record did not note that the on-call OB/GYN evaluated her as required by hospital policy.

• Her “case [was] discussed with OB who states that she is stable for discharge home” (emphasis added). (She was not examined by an OB/GYN based on signs of ectopic pregnancy in person — against hospital policy.)

• “This failure meant that the hospital did not appropriately screen (Thurman) for known risks associated with presenting signs, symptoms, and test results, including those which would constitute an EMC [emergency medical condition], such as, but not limited to, ectopic pregnancy” (emphases added).

Thurman was discharged on February 22. Her paperwork stated that “there is no definite ectopic pregnancy noted on ultrasound. There is also no IUP.” Thurman was diagnosed with a miscarriage and was told to follow up with her primary care physician in two to four days.

Medical records show that she ended up needing surgery to remove her right fallopian tube and an evaluation of internal bleeding in her abdominal cavity for a ruptured ectopic pregnancy.

Summing up, CMS noted (emphases added):

The hospital’s failure to provide an appropriate medical screening examination, within the capability of the hospital’s emergency department (including but not limited to the ancillary services of the on-call obstetrical physician) and consistent with the hospital’s screening process, placed the patient at risk for deterioration of her health and wellbeing as a result of an untreated medical condition.

THE BACKSTORY:

Thurman previously said that she initially went to Ascension Seton Williamson Hospital based on the advice of her OB/GYN, who was concerned about an ectopic pregnancy. But doctors discharged Thurman and told her to “let nature take its course.”

She returned “days later” with continued bleeding and claimed she was “denied care even though her OB/GYN had concluded she had an ectopic pregnancy, and an attending hospital physician concluded her symptoms were those of an ectopic pregnancy.”

She filed a complaint, stating that it wasn’t until her OB/GYN “pleaded to hospital staff that she be given care that the hospital provided the necessary care.” At this point, too much time had passed for Thurman to receive an injection of methotrexate, a drug that stops the embryo from continuing to grow, and it ultimately dissolves.

By the time doctors acted, her fallopian tube had ruptured, her life was at risk, and she required surgery to remove the fallopian tube.

In her complaint, she blamed Texas’ pro-life law and the overturning of Roe v. Wade for the delay in care that she received. However, it is clear from the CMS findings that it was not the state’s pro-life law that led to her improper care.

THE BOTTOM LINE:

A misdiagnosis of miscarriage due to a failure to properly evaluate Thurman based on hospital protocol is at the root of Thurman’s mistreatment. This is not because of the pro-life law, which specifically states that treatment for an ectopic pregnancy is not an abortion and such treatment is not prohibited or restricted in Texas.

In fact, in Thurman’s complaint, it states, “Moreover, although Texas law bans nearly all abortions, Texas law explicitly allows termination of ectopic pregnancies.”

Sec. 171.205 of Texas’ heartbeat law states that it does not apply “if a physician believes a medical emergency exists” and Texas’ Health and Safety Code states, “An act is not an abortion if the act is done with the intent to… remove an ectopic pregnancy.”