A pregnant East Tennessee woman didn’t get essential medical care from a Sevierville hospital when she was discharged with an infection in her arm, possibly violating federal law, according to an Associated Press analysis.

The Emergency Medical Treatment and Labor Act, or EMTALA requires hospitals to stabilize anyone who comes in needing emergency care, but near-total abortion bans — like the ones in place in Tennessee and 13 other states — can complicate that for doctors treating pregnant people, especially.

Although the bans tends to have exceptions to save the pregnant person’s life, critics say it’s unclear how life-threatening a condition needs to be before doctors can legally carry out the procedure. Doctors have to weigh the risk of imprisonment when deciding a course of action, and critics say that can lead them to delay or refuse care. There have also been legal concerns about providing care for miscarriages or ectopic pregnancies — a potentially fatal condition that occurs when an embryo implants outside the uterus, often in the fallopian tube.

Abortion access supporters, physician associations and gynecological trade groups have argued abortion bans have made it more dangerous for pregnant patients to seek care — even if they don’t require emergency abortions or aren’t having a miscarriage.

The Associated Press analysis of federal hospital investigations found more than 100 pregnant people in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022.

Reporters compiled investigations by the U.S. Centers for Medicare and Medicaid Services. In addition to funding the health coverage programs for low-income people, that agency acts as a regulator over medical providers. Any facility that accepts Medicare and Medicaid patients have to adhere to the agency’s rules, undergo CMS inspections, and can be subject to CMS investigations if patients file a complaint.

A case in Tennessee

A pregnant patient — whose name is redacted — went to LeConte Medical Center in April of 2023, according to the complaint.

The patient had a port in her arm for a feeding tube — a common treatment for pregnancy-related vomiting.

She showed up to the E.R. at about 11 p.m., according to the complaint. The investigation states the patient believed her arm was infected, and she might be developing sepsis — a condition that can be fatal.

It took about eight hours for the patient to get a basic medical screening, the report states. She wasn’t examined for sepsis, her port site wasn’t examined for infection, and the staff didn’t do a wellbeing check on the fetus.

The patient was discharged — not transferred — the next afternoon. She took herself to another ER, where she found out she did have an infection. She was hospitalized for a week.

The hospital didn’t immediately respond to a request for comment.

Confusion among doctors 

The U.S. Supreme Court could have clarified protections for doctors in EMTALA earlier this year, but punted.

That case hinged on Idaho’s abortion ban. Like many other states, that law says physicians can perform abortions to save a patient’s life, but not to protect the patient from serious injury or harm. One often-used example: some pregnancy complications can cause infertility, and patients might prefer to undergo an abortion to maintain future fertility.

The federal government filed a lawsuit, arguing that EMTALA preempts Idaho’s law in cases where a patients’ life isn’t at risk, but an abortion is necessary to protect their health. The Supreme Court issued a decision in June saying it wouldn’t weigh in on the issue.

There have been legal challenges across the country that argue abortion bans cause doctors to delay or refuse care. Not all of them focus on EMTALA.

In Tennessee last year, a group of abortion access supporters, doctors and patients filed a challenge to the state’s ban.

The lawsuit argues the state’s emergency exceptions “are too narrow and unclear for physicians to provide life-saving care without fear of criminal liability.” It also criticizes the law because it has no exceptions for fetal abnormalities — cases where the fetus wouldn’t survive.

There was a hearing in April, but the state supreme court hasn’t yet issued a decision.