I am an emergency physician. My job is to save lives. Destroying the Emergency Medical Treatment and Active Labor Act (EMTALA) would make that job impossible.
EMTALA, which Congress passed in 1986, ensures that doctors like me cannot turn anyone away from the emergency room until we know it is safe to do so. More specifically, it ensures that anyone who visits a hospital that receives Medicare funding is checked and medically stabilized, regardless of their ability to pay.
Pregnancy complications, such as an ectopic pregnancy or a septic miscarriage, can be life-threatening. They may require procedures (such as dilation and evacuation or D&E) or medication that anti-choice groups claim should be illegal. States with increasingly restrictive abortion laws are fighting over what can and cannot be done without violating EMTALA. If the pregnant woman’s life is in danger, providers are legally required to perform these procedures to stabilize her.
The Supreme Court will hear oral arguments today in the Idaho case that holds that these life-saving procedures are only necessary when a pregnant woman is on the brink of death — and not before. In the ER, we know that stabilization therapy includes abortion. Idaho wants to argue that it doesn’t.
Without EMTALA, patients’ lives are at risk
I work in Illinois, which has statewide legal protections for abortion care. Our neighboring states of Indiana and Wisconsin do not. Indiana, in fact, has some of the most restrictive abortion laws. I have treated too many patients who live in Indiana and have had to cross state lines to get the basic care they need. Many of these pregnant women experience miscarriages while travel. Many pregnant women in Idaho or other restrictive states do not have the luxury of proximity to safe care. They are at risk.
Meeting with fellow ERs from states like Idaho showed that ER providers have rebounded since the Supreme Court’s reversal Roe v. Wade in 2022. The laws that dictate what we can and cannot do to help our patients seem to change daily. Every legal challenge to new laws makes our place in this changed world even more confusing. But EMTALA made sure that we rely on providers to do the right thing, which is to save the lives of our patients who are at risk. We meet so we can plan – what can they do? What is legal right now? What training can we give fellow ER providers to help their patients in crisis?
OB-GYNs are already leaving states with increasingly restrictive abortion laws. This scares me.
Simply put, pregnancy can be dangerous. In the ER, we are trained to recognize and treat life-threatening emergencies related to pregnancy. We stabilize so that an OB-GYN can perform procedures or administer medications that are necessary to save lives. I have resuscitated too many women whose hearts have stopped beating because they were bleeding so much internally from ectopic pregnancies. I have watched a young woman bleed out from an active miscarriage that could only be saved in surgery, keeping her alive until the specialist arrived.
Idaho’s controversial abortion ban currently allows exceptions for ectopic pregnancies. However, if EMTALA no longer applies in these cases, our patients are no longer protected. The case claims that abortion care can only be performed when absolutely necessary — and not a minute before.
I’ve faced these situations, and this moment hangs on a knife’s edge. Women can go from stable and bleeding to unstable or dead in a matter of minutes. Uninformed anti-choice lawmakers with no medical knowledge create these laws. They haven’t seen what I’ve seen. Protecting only ectopic pregnancy and ignoring other life-threatening pregnancy risks is short-sighted and, frankly, dangerous.
We are watching reproductive health care collapse around us, leaving patients stranded and in very real crises. The danger is not only from the lack of access to the necessary medical stabilization, but also from leaving pregnant women without anyone to treat them afterwards.
The EMTALA decision will have ripple effects
OB-GYNs are already fleeing the states with increasingly restrictive abortion laws. This scares me. I will try to stabilize anyone who walks in my door, but I am not a surgeon or gynecologist. I can’t operate, so I rely on those who can. My ER colleagues in Idaho and Texas are feeling desperate. What do we do if we can’t provide our patients with the care they need?
This decision could also have a domino effect in further destroying EMTALA—it would change health care for everyone, no matter what state they live in. regardless of ability to pay or citizenship (among other factors). It’s not hard to imagine hospital systems turning away undocumented immigrants or those without health insurance after EMTALA. The hospitals I work in are in underserved communities, and many of them struggle to get payments from ineligible patients. If a hospital is no longer required to stabilize these patients, who is? My hospitals are caught up in the opioid epidemic, and many patients I see are uninsured and uninsured, being transported for life-threatening overdoses. If they can’t pay and are no longer protected by EMTALA, what happens to them?
I will be watching the Supreme Court closely as the arguments unfold and the justices ultimately issue a decision. I will hope for the best but prepare for the worst. In the meantime, I’ll go to work—both in and out of the hospital—to give patients the health care and lifesaving treatment they need and deserve.
