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 the name EMTALA.
At issue is whether the law requires hospital emergency departments to perform abortions in emergency situations, including when a woman’s health is threatened by a continued pregnancy. But, as with many abortion-related arguments, this one could have broader implications. Some legal experts say this could potentially determine how restrictive state abortion laws can be and whether states can prevent emergency rooms from providing other types of medical care, such as life-affirming treatments. of the kind.
The Biden administration is in the middle 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?
Passed by Congress in 1986, EMTALA (pronounced em-TAHL-uh) requires hospitals nationwide to provide all patients with an emergency level of care, whether or not they have insurance or they can pay. The law, which was passed to address concerns that hospitals were failing to properly screen, treat or transfer patients, applies to any hospital that receives Medicare funding and has an emergency department – most hospitals in the United States.
Specifically, the law states that if a patient goes to the emergency room with an “emergency medical problem,” hospitals must either provide treatment to stabilize the patient or transfer the patient to a medical facility that can. Hospitals that violate the law may face consequences, including fines and exclusion from supplemental Medicare funding.
What does this have to do with abortion?
The law does not mention abortion or name specific treatments for any emergency medical conditions. It only requires that hospitals use accepted medical approaches for each patient. But shortly after the Supreme Court reversed the national right to abortion in June 2022, the Biden administration issued a memorandum saying that EMTALA applies in cases where abortion is necessary to stabilize a patient.
“If a physician believes that a pregnant patient presenting to the emergency room is suffering from an emergency medical problem as defined by EMTALA and that abortion is the stabilizing treatment necessary to resolve this problem, the physician must provide this treatment,” the note said. “When a state law prohibits abortion and does not include an exception for the life of the pregnant person – or defines the exception more narrowly than EMTALA’s definition of emergency medical conditions – this state law is preempted.”
The attorneys general of Idaho and Texas said their states’ abortion bans do not violate EMTALA, which they say requires emergency services to stabilize both a pregnant woman and a ” unborn child.”
“The federal government has been wrong since day one,” Idaho Attorney General Raúl Labrador said in a statement. statement about the Supreme Court’s decision to hear the case involving his state. “Federal law does not preempt Idaho’s Defense of Life Act. In fact, EMTALA and Idaho law share the same goal: to save the lives of all women and their children to be born.”
Has EMTALA been applied in cases where patients needed an abortion?
Last year, in the first case since Roe v. Wade was knocked downthe federal government told to a hospital in Missouri and another in Kansas that they failed to provide the “necessary stabilization care” required by EMTALA when they refused to abort Mylissa Farmer, whose water broke at 17 weeks gestation, less than halfway through of pregnancy. At each hospital, doctors told Ms. Farmer that the fetus would not survive because she had lost her amniotic fluid and that if her pregnancy was not terminated, she could develop a serious infection and even lose her uterus. But because the fetus still had cardiac activity, doctors did not terminate 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 hospitals in “violation of EMTALA protections designed to protect patients like her” and asked them for correction plans.
In September, the Center for Reproductive Rights filed a lawsuit against EMTALA on behalf of an Oklahoma woman, Jaci Statton, who was denied an abortion due to a condition called partial molar pregnancy, in where a fetus is very unlikely to survive and the health of the mother may be compromised. to be threatened.
However, after investigating the matter, CMS issued a letter asserting that it “did not confirm a violation” of EMTALA. Although the agency did not give a reason, medical records provided by Ms. Statton to the New York Times suggest that her experience at an Oklahoma health system may not fit the exact pattern of a violation of EMTALA.
In records, a system hospital said its emergency department stabilized her and transferred her to another system hospital, where she was admitted for a day and treated by a maternal-fetal medicine doctor. The doctor wrote that even though the outlook for the fetus was dire and Ms. Statton suffered bleeding and nausea, Oklahoma law would only allow an abortion if there was “an immediate threat to the life of the child.” the mother “.
The doctor added, “therefore, we are unable to offer termination” and noted that “termination may be pursued in another 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 memorandum regarding EMTALA would “force abortions” in the state’s hospitals, violating the state’s ban on abortion. ‘State. 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 decisionwhich makes it impossible, for now, for the federal government to enforce EMTALA in Texas when doctors believe women need an emergency abortion.
The Idaho case before the Supreme Court was initiated by the Biden administration. Department of Justice filed a complaint in August 2022, claiming the state’s ban on abortion violated EMTALA because it only provides exceptions for abortions “necessary to prevent the death of the pregnant woman” but not to address threats for a woman’s health.
“Even in dire situations that might benefit from Idaho law’s limited affirmative defense, ‘necessary to prevent the death of the pregnant woman,'” the federal government’s lawsuit says, “some providers might deny care by due to a well-founded fear of criminal prosecution. .”
Shortly after the suit was filed, a federal district judge issued a preliminary injunction partially blocking the state ban. In the latest setback, a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit in San Francisco issued the lower court’s ruling on upholding and reinstating the abortion ban, saying the court Idaho Supreme Court had interpreted the ban as giving doctors more freedom. flexibility in deciding when abortion is necessary 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 the High Court reinstated the ban on abortion and said he would hear arguments in the case in April.
Abbie Van Sickle reports contributed.