Can states prevent hospitals from providing emergency abortion care to patients experiencing serious pregnancy complications?
That’s the question before the Supreme Court, which will rule before the end of the term on whether Idaho’s near-total abortion ban can override the Emergency Medical Care and Active Labor Act (EMTALA), the federal law requiring Medicare-funded hospitals. to provide stabilization care—including abortion—to all patients in the emergency department.
After Idaho’s abortion ban took effect in August 2022, the Justice Department sued on the grounds that EMTALA, which was enacted in 1986, preempts state law. The case moved from the lower courts to the Supreme Court allowed Idaho to enforce the ban on Jan. 5 and put the case (which has been consolidated with Moyle v. United States) in its case.
Idaho’s ban, one of the strictest in the nation, allows abortions only in cases of rape or incest, ectopic or infant pregnancy, or in “prevent the death of the pregnant woman.” Doctors face criminal charges and the possibility of losing their license to perform abortions in other cases, and there are no exceptions to preserve the health of the pregnant woman or an organ system, such as the reproductive system.
“The way the law is written, in our good faith medical judgment, there has to be a threat to the life of the mother,” said Dr. Caitlin J. Gustafson, a family medicine obstetrician and president of the Idaho Coalition for Safe Health. However, “emergencies are not cut and dry, black and white. We don’t wait for people to be on the brink of death until we intervene,” Gustafson added.
Idaho’s ban has put health care providers in an untenable position, as they are trained to prevent disasters, said Dr. Rory Cole, a fourth-year medical student at Idaho who is about to begin a residency in family medicine.
If a pregnant woman goes to the hospital with a serious health condition, such as placental abruption, that puts her at great risk of infection, sepsis and bleeding, and “the treatment of choice would be an abortion,” said Dr. Jim Souza, chief medical officer at the U.S. Health System. St. Luke in Boise, he said at an ACLU news conference in April. This is especially true if the pregnancy is premature and the fetus is pre-viable, meaning there is virtually no chance of survival.
“This is not a rare occurrence in our health care system,” Souza said, adding that it was happening more than once a week last year. But because of Idaho’s ban, there’s now a lot of second-guessing and questions: “Is she sick enough, is she bleeding enough, is she septic enough that I can have this abortion and not risk going to jail and losing my license? ” This type of situation has resulted in some pregnant patients being airlifted to nearby states after their medical team determined that the patient’s condition did not meet the threshold for the ban.
Amid the U.S. maternal mortality crisis, Idaho ranks in the tenth percentile for maternal pregnancy outcomes, according to an Idaho Physician Well-Being Action partnership. report. The report also found that since the abortion ban was passed, the state has also lost nearly a quarter of its obstetricians and more than half of its high-risk obstetricians. The loss has led to the closing of three hospital-based midwifery programs in the state and half the counties no longer have an obstetrician intern, making Idaho an “unsafe place” for pregnant women, said Sabrina Talukder, director of the Women’s Initiative at the Center for American Progress. .
“If the Supreme Court rules in favor of the Idaho state legislature, it’s essentially giving mothers a death sentence,” Talukder said.
A ruling in Idaho’s favor means that EMTALA will no longer protect emergency abortion care, affecting every EMTALA-certified hospital in the United States, even if abortion is legal in a state.
It would also create “a precedent that pregnant women are excluded from this urgent care benefit protection,” said Dr. Alexandria Wells, an OB-GYN in Washington state and a contributor to Physicians for Reproductive Health. “It would make pregnancy more dangerous across the United States because there are emergencies that happen when you’re pregnant, and it shouldn’t be up to the politician to determine what that emergency is or what the treatment for that emergency is.”
Even health care providers in states where abortion is legal worry about their ability to continue providing evidence-based care.
“I imagine if I have a patient who has an ectopic pregnancy or is at risk of miscarriage and needs medication to end a pregnancy that’s already at term, I don’t know if I can go ahead and just deal with it,” said Dr. Polly Wiltz, resident second year in emergency medicine at a community hospital in East Cleveland, Ohio.
In that case, Wiltz said, a legal team would need to be consulted, which leads to a delay in care.
“This will create a huge mess for doctors because you will be afraid to take care of these patients and risk losing your license,” he said. “But then you put people at risk of dying.”
Even with EMTALA protections, doctors practicing in the 14 states with total abortion bans had to deviate from the usual standard of care to comply with the bans, according to Report 2023 from promoting new standards in reproductive health. This included sending patients home from hospital who had premature antenatal rupture of membranes and telling them to return when labor started or when they showed signs of infection. prior to the ban, the standard of care would have been to immediately offer the option of dilation and evacuation.
Blocking or criminalizing access to abortion sends the message that “it’s okay to discriminate against people who need an abortion,” said Dr. DeShawn Taylor, founder and CEO of the Desert Star Institute for Family Planning in Phoenix. “It’s appalling how abortion is the only type of health care where people get a pass for patient neglect.”
The ripple effect from the harm caused by abortion bans could include increases in obstetric and reproductive health care deserts across the country, where there is a shortage of obstetric care similar to what is already happening in Idaho and other states with extreme abortion bans .
Kwajelyn Jackson, executive director of the Feminist Women’s Health Center in Atlanta, has concerns about the long-term effects of a potential EMTALA debacle on the workforce.
Jackson said the possibility of criminal charges “may influence someone not to practice in the South or the Midwest,” or where they are receiving medical training or completing their residency, not to mention medical school in general.
“I really believe that over the next several years, we’re going to see a shortage of reproductive health care providers in states that have made it so clear that they’re willing to undermine the expertise of doctors,” Jackson said.
