One of the newest battlegrounds in the abortion debate is a decades-old federal law called the Emergency Medical Treatment and Labor Act, known to doctors and health policymakers as EMTALA.
At issue is whether the law requires hospital emergency rooms to perform abortions in urgent circumstances, even when a woman's health is threatened by the continuation of her pregnancy. But, as with many abortion-related arguments, this one could have broader implications. Some legal experts say it could determine how restrictive state abortion laws can be and whether states can prevent emergency rooms from providing other types of medical care, such as gender-affirming treatments.
The Biden administration is in the midst of legal battles over the law with the states of Texas and Idaho. The Supreme Court agreed to hear the Idaho case.
What does the law do?
Enacted by Congress in 1986, EMTALA (pronounced em-TAHL-uh) requires hospitals nationwide to guarantee all patients a standard of emergency care, regardless of whether they have insurance or can pay. The law, which was passed to address concerns that hospitals were not properly screening, treating or transferring patients, applies to any hospital that receives Medicare funding and has an emergency department — most hospitals in the United States. Joined.
Specifically, the law says that if a patient goes to an emergency room with an “emergency medical condition,” hospitals must provide treatment to stabilize the patient or transfer the patient to a medical facility that can do so. Hospitals that violate the law can face consequences including fines and exclusion from further Medicare funding.
What does that have to do with abortion?
The law does not mention abortion or name specific treatments for any emergency medical condition. It only requires that hospitals use accepted medical approaches for each patient. But shortly after the Supreme Court struck down the nation's right to abortion in June 2022, the Biden administration issued a memo saying EMTALA applies in cases where abortion is necessary to stabilize a patient.
“If a physician believes that a pregnant patient presenting to an emergency department is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment.” , the memo said. “When a state law prohibits abortion and does not include an exception for the life of the pregnant person, or states the exception more narrowly than EMTALA's definition of an emergency medical condition, that state law takes precedence.”
The attorneys general of Idaho and Texas have said their states' abortion bans do not violate EMTALA, which they say requires emergency departments to stabilize both a pregnant woman and an “unborn child.”
“The federal government has been wrong from day one,” Idaho Attorney General Raul Labrador said in a statement about the Supreme Court's decision to hear the case involving his state. “Federal law does not preempt the Idaho Defense of Life Act. In fact, EMTALA and Idaho law share the same goal: saving the lives of all women and their unborn children.”
Has EMTALA been applied in cases where patients needed abortions?
Last year, in the first case since Roe v. Wade, the federal government told a hospital in Missouri and another in Kansas that they had not provided the “necessary stabilizing care” required by EMTALA when they denied an abortion to Mylissa Farmer, whose water broke at 17 weeks gestation, less than half of the pregnancy. At each hospital, doctors told Ms. Farmer that the fetus would not survive because she had lost her amniotic fluid and that if they did not abort her pregnancy, she could develop a serious infection and even lose her uterus. But since the fetus still had cardiac activity, the doctors did not want to abort the pregnancy.
Ms. Farmer ended up traveling to Illinois to have an abortion. The National Women's Law Center filed complaints against the two hospitals with the Centers for Medicare and Medicaid Services, known as CMS. The agency found that the hospitals “violated EMTALA protections that were designed to protect patients like her” and sought correction plans from them.
In September, the Center for Reproductive Rights filed a complaint in EMTALA on behalf of an Oklahoma woman, Jaci Statton, who was denied an abortion for a condition called partial molar pregnancy, in which the fetus is highly unlikely to survive. and the mother's health may be affected. be threatened
However, after investigating the case, CMS issued a letter saying it “did not confirm a violation” of EMTALA. While the agency did not give a reason, medical records Statton provided to The New York Times suggest that his experience at an Oklahoma health system may not have fit the exact pattern of an EMTALA violation.
In the records, one hospital in the system indicated that its emergency service stabilized her and transferred her to another of the system's hospitals, where she remained admitted for a day and was cared for by a maternal-fetal doctor. The doctor wrote that although the outlook for the fetus was dire and Mrs. Statton was experiencing bleeding and nausea, Oklahoma law would allow an abortion only if there was “an immediate threat to the life of the mother.”
The doctor added, “therefore, we cannot offer a termination” and noted that “the termination can be performed in a different state where the procedure is legal.” Ms. Statton then traveled 180 miles to have an abortion at a clinic in Kansas.
What are the lawsuits in Texas and Idaho about?
Texas sued the federal Department of Health and Human Services in July 2022, arguing that the agency's memo on EMTALA would “force abortions” in the state's hospitals, violating the state ban. A federal district court ruled in favor of Texas. The Biden administration appealed. In January 2024, the U.S. Court of Appeals for the Fifth Circuit upheld the district court's ruling, making it impossible, for now, for the federal government to enforce EMTALA in Texas when doctors believe women need emergency abortions.
The Idaho case before the Supreme Court was brought by the Biden administration. The Justice Department filed a lawsuit in August 2022 alleging that the state's abortion ban violated EMTALA because it makes exceptions only for abortions “necessary to prevent the death of the pregnant woman,” but not to address health threats. of the woman.
“Even in extreme situations that could qualify for the limited affirmative 'necessary to prevent the death of the pregnant woman' defense of Idaho law,” the federal government's lawsuit said, “some providers could deny care based on a fear of founded on criminal proceedings”. .”
Shortly after the lawsuit was filed, a federal district judge issued a preliminary injunction partially blocking the state ban. Last fall, a three-judge panel of the 9th U.S. Circuit Court of Appeals in San Francisco stayed the lower court's ruling and reinstated the abortion ban, saying the Idaho Supreme Court had interpreted the ban to give doctors more flexibility to decide when abortions are needed to save women's lives. But in December, an 11-member appeals court panel temporarily blocked the law pending an appeal.
Idaho asked the Supreme Court to intervene, and the high court reinstated the abortion ban and said it would hear arguments in the case in April.
Abbie VanSickle contributed with reports.
