Supreme Court tests Idaho abortion ban against federal EMTALA

The case is a showdown between the Biden administration and states that introduced abortion limits after the end of Roe v. Wade. A new abortion ban in Idaho is at the center of the debate.

WASHINGTON − A woman who was 18 weeks pregnant arrived at an Idaho emergency room in distress.

Her condition – hourglass membranes – was so dire that a miscarriage was inevitable.

Doctors feared they would run afoul of Idaho’s abortion restrictions if they provided the treatment that is standard in these situations: offering an abortion because the risk of infection was high and the fetus would not survive.

The patient was unable to travel to another state; she would probably miscarry and possibly bleed to death during the journey.

So she waited.

Several days later, the woman found herself in the emergency room where, after delivering a stillborn baby, she was hospitalized to prevent a rapidly developing infection from spreading.

Doctors with the Idaho Coalition for Safe Healthcare shared this case — and others — in a filing with the Supreme Court ahead of Wednesday’s oral arguments on whether a federal law requiring hospitals to provide emergency treatment overrides abortion restrictions of the state.

“These bans have destroyed the safe health care system we established for our pregnant patients,” said Dr. Caitlin Gustafson, an Idaho physician who spoke at a news conference hosted by the National Women’s Law Center, which also filed a request. shortly before the judge.

Idaho officials say the ban reflects the will of the state’s residents. They accuse the Biden administration of unlawfully trying to override it.

“The administration’s radical interpretation of federal law is nothing more than a reckless disregard for Idaho’s right to protect life,” Idaho Attorney General Raúl Labrador said in a statement.

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Confrontation between Biden and states with abortion bans

The consolidated cases, Idaho v. United States and Moyle v. United States, are a showdown between the Biden administration and states that implemented strict abortion limits after the Supreme Court erased the right to abortion in 2022.

It is the Supreme Court’s first chance to rule on state laws restricting abortion that have taken effect since the Dobbs v. Jackson Women’s Health Organization ruling.

And it comes a month after the court heard a challenge to a commonly used abortion drug and as the abortion issue continues to reshape electoral politics, including in Arizona, where a near-total ban from 1864 is back in play.

The federal law in question, passed in 1986 to prevent hospitals from turning away patients if they couldn’t pay, is one of the few tools President Joe Biden had to respond to the overturning of Roe v. Wade.

Biden directed the U.S. Department of Health and Human Services to clarify that doctors must perform emergency abortions when necessary to prevent death or serious illness. The law applies to any hospital that receives federal funding, such as through Medicare.

“It’s outrageous and dangerous,” Biden said of doctors who delayed emergency care because they needed to consult with an attorney about whether the care is allowed under state law.

Lower courts are divided

Texas quickly sued the government.

Weeks later, the Biden administration sued Idaho, claiming its near-total abortion ban directly violated the federal Emergency Medical Treatment and Labor Act (EMTALA). Doctors who violate Idaho law while trying to comply with federal law can be jailed and lose their medical licenses.

The issue has divided the lower courts.

The Louisiana-based 5th Circuit Court of Appeals sided with Texas, ruling in January that the government cannot use EMTALA to require Texas hospitals to perform emergency abortions.

Conversely, a federal district judge in Idaho said the state could not enforce the part of its ban that applied to emergency care when a patient’s health was at risk. That decision was overruled by three Trump-appointed judges on the California-based 9^e Circuit Court of Appeals – to be later reversed by the full circuit.

In January, the Supreme Court agreed to hear the case and allowed Idaho to fully implement its law in the meantime.

Organ failure, uncontrollable bleeding and permanent reproductive damage

How the justices decide the case could potentially affect abortion restrictions in more than two dozen states. Even if a ban includes medical exceptions, opponents of the ban say the exceptions may be too vague to provide the certainty patients and doctors need.

In contrast, the Biden administration says federal law is clear that hospitals receiving federal funding must provide “necessary stabilizing treatment” when the mother’s health is at risk — and not just when she is on the brink of death. Consequences of inactivity can include infection, organ failure, uncontrollable bleeding and permanent damage to the reproductive system.

Idaho states that the federal requirement applies only to treatments “available” at a hospital, and that abortion is not available in Idaho under most circumstances.

“In short, EMTALA leaves the issue of specific treatments for stabilizing care to state law,” the state wrote in its main brief, ahead of its oral arguments. Twenty-two states have told the court that they support Idaho’s position.

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Federal law makes no mention of abortion

Idaho also states that while federal law never specifically mentions abortion, it does provide explicit protections for “unborn children.” For example, the law’s definition of a medical emergency includes a condition that seriously endangers the “health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child).”

The Biden administration and their supporters counter that Congress added that language to make clear that hospitals must provide care to an unborn child even if the woman’s own health is not at risk.

“That language was added to expand, not restrict, access to care for pregnant people,” said Katie O’Connor, director of federal abortion policy at the National Woman’s Law Center.

‘Is she bleeding enough? Is she septic enough’

Complaints of pregnant women being turned away from hospitals increased after Dobbs, according to an investigation by The Associated Press.

Most medical providers see pregnant patients during virtually every shift, according to the major medical associations that support the government, including the American College of Obstetricians and Gynecologists.

While not all pregnancy complications require immediate intervention, many complications are dangerous.

Cases of rupture of membranes too early in pregnancy for the fetus to survive occurred an average of just over once a week at St. Luke’s Health System in Idaho last year. Such situations place a patient at high risk of infection, sepsis and bleeding.

Before the ban went into effect in Idaho, doctors acted as quickly as possible to preserve a woman’s health and her future reproductive potential, said Dr. Jim Souza, the hospital’s chief physician.

“There has been a lot of doubt and hand-wringing since then,” he said. ‘Is she sick? Is she bleeding enough? Is she septic enough to have this abortion and not risk going to jail and losing my license?

When Idaho’s law was suspended last year due to emergency medical conditions, only one pregnant patient was transported out of state for care. But after the Supreme Court gave the law full effect in January, Souza said six emergency patients were transferred to other states where they could receive abortions.

Doctors leave Idaho

Doctors are also leaving Idaho, where there was already a shortage of doctors. Two hospitals have closed their labor and delivery services.

“It’s not hard to see why,” Gustafson said. “Because how many doctors are actually willing to subject themselves to the risk of jail time and civil fines for doing their job?”

But state officials defending the ban told the Supreme Court that if they sided with the Biden administration, doctors would become “essentially unregulated, with their own medical judgment superseding all state laws that regulated the practice of medicine.”

“Dobbs’ entire purpose was to give the states their authority to regulate abortion,” Labrador and the other state attorneys wrote in their closing letter. “Yet the administration is attempting to thwart Idaho’s exercise of self-government on this important issue.”