Last August 2, Mylissa Farmer’s water broke. It was much too early. At Freeman Hospital, in Joplin, her obstetrician told her that she had lost all her amniotic fluid. The news was devastating: The child she had carried for more than 17 weeks — already with a name picked out — would not survive.
“They informed me that our daughter was no longer going to survive, and that my life was in danger,” Farmer told St. Louis on the Air on Friday.
But what happened next would turn Farmer’s personal tragedy into the cause of an unprecedented federal investigation. Farmer recalled that a doctor discussed options, and that ruptures of her membranes called for a delivery — what in effect would be an abortion, since the fetus was no longer viable.
“Normally, they would be able to intervene,” Farmer said. “But because Missouri law was not clear, they recommended that I leave the state to get care.”
Farmer’s account is corroborated in a “statement of deficiency” issued to Freeman Hospital in April by the Centers for Medicare and Medicaid Services, the federal agency which administers the government health care programs.
The statement, whose existence was first revealed last week by reporting from the Associated Press, concluded that the hospital violated the Emergency Medical Treatment and Labor Act, or EMTALA. The law prohibits hospitals that accept Medicaid from refusing to provide emergency medical service. It is the first time that a hospital had triggered an EMTALA investigation by denying an emergency abortion.
According to the statement of deficiency, hospital staff at Freeman diagnosed Farmer with a preterm premature rupture of the membranes. She was told the hospital could not perform a delivery “while (the) fetus has a heartbeat, even though the fetus is not viable.”
Another staff member, identified in the statement as a Maternal Fetal Medicine Specialist, told Farmer “the chances of continuing to carry the fetus to gestational age, with potential survival, were extremely low.”
Farmer’s worries about bleeding and her ruptured membranes were also documented in the statement of deficiency. At Freeman, a staffer told her there were options for “medically intervening to aid the process of her inevitable miscarriage,” but when she requested that intervention, the staffer told her that current Missouri law “supersedes our medical judgment… we cannot intervene in the setting of a pregnancy with positive fetal heart motion unless there is a 'medical emergency.’”
The response both baffled and terrified Farmer. “That's when the fear really began to set in. Being denied care, and my life is in danger — the longer we wait, it really just set fear in my heart.”
Missouri’s abortion ban, enacted almost immediately after the U.S. Supreme Court overturned Roe v. Wade last June, bans the procedure when a “fetal heartbeat” can be detected. It includes an exception for a “medical emergency,” but medical professionals say the law’s definition of an emergency is vague. The law leaves doctors with the choice of either telling patients to wait until their conditions further deteriorate, or risk criminal charges by performing an abortion.
For Farmer, there was no doubt she was experiencing a medical emergency. After leaving the hospital on August 2, she returned to Freeman, only to be given the same answer. After that, she was turned away by the The University of Kansas Health System in Kansas City, Kansas, where doctors affirmed that her condition was serious. Even so, she was told, they couldn’t give her an abortion.
Farmer didn’t have time to wait. After two days of trying to get care in Joplin and Kansas, she was finally able to book an appointment for an abortion in Granite City, Illinois, a 300-mile journey from her home.
For Farmer, the five-hour drive was torturous. The pain was hitting her in waves.
“We realized that I was actually in labor,” she recalled. “By the time we got to the clinic… the doctor said, ‘You're ready right now, and we can perform the procedure right now.’”
More than nine months later, the two hospitals that denied Farmer an abortion, Freeman Hospital in Joplin and the The University of Kansas Health System have been found by federal investigators to have “failed to stabilize” Farmer. The hospitals were “determined to be in non-compliance” with the federal law that requires them to provide emergency medical treatment.
The Centers for Medicare and Medicaid Services have not announced any fines or other penalties against the two hospitals. In a May 1 statement, Health and Human Services Secretary Xavier Becerra addressed the violations and Farmer’s case, saying, “Fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place.”
Today, Farmer is no longer a Missouri resident. She also can no longer have children.
“Two months after, I did get a tubal ligation,” she told St. Louis on the Air, “because it was just too risky to try again in the state.”
“It's crucial to understand that this can happen to anyone,” she added. “This can happen to your wife, your daughter, your sister. Pregnancy can be a beautiful journey. But it can also become a medical nightmare in Missouri.”
“St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is produced by Miya Norfleet, Emily Woodbury, Danny Wicentowski, Elaine Cha and Alex Heuer. The audio engineer is Aaron Doerr. Send questions and comments about this story to talk@stlpr.org.
