What to know about the federal law at the center of the latest Supreme Court abortion case

What to know about the federal law at the center of the latest Supreme Court abortion case

One of the latest 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.

The issue is whether the law requires hospital emergency rooms to provide abortion facilities in urgent circumstances in which continuing the pregnancy would threaten a woman’s health. But, like many arguments related to abortion, it could have broader implications. Some legal experts say it could potentially determine how restrictive state abortion laws are allowed to be and whether states can bar emergency rooms from providing other types of medical care, such as gender-affirming treatment.

The Biden administration is in the midst of a legal battle with the states of Texas and Idaho over the law. The Supreme Court has agreed to hear the Idaho case.

Enacted by Congress in 1986, EMTALA (pronounced em-TAHL-uh) requires hospitals across the country to guarantee a standard of emergency care to all patients, regardless of whether they have insurance or can pay. The law, which was passed to address concerns that hospitals were failing to diagnose, treat or transfer patients properly, applies to any hospital that receives Medicare funding and has Have an emergency department – ​​most hospitals in the United States.

Specifically, the law states that if a patient goes to the emergency room with an “emergent medical condition”, hospitals must either provide treatment to stabilize the patient or transfer the patient to a medical facility that can Can do. Hospitals that violate the law may face consequences including fines and exclusion from further Medicare funding.

The law does not mention abortion or name specific treatments for any emergency medical condition. It simply requires that hospitals use an accepted medical approach for each patient. But soon after the Supreme Court Overturned Biden administration releases national right to abortion in June 2022 memorandum That said, EMTALA applies in cases where an abortion is necessary to stabilize a patient.

The memo states, “If a physician believes that a pregnant patient presenting to the emergency department is experiencing an emergency medical condition as defined by EMTALA, and abortion is the stable treatment necessary to resolve that condition, The physician must provide that treatment.” “When a state law prohibits abortion and does not include an exception for the life of the pregnant person—or stretches the exception more narrowly than EMTALA’s emergency medical condition definition—that state law is pre-emptive.”

The attorneys general of Idaho and Texas have said that their states’ abortion restrictions do not violate EMTALA, which they say requires emergency departments to stabilize both a pregnant woman and the “unborn child.”

“The federal government has been wrong from day one,” said Idaho Attorney General Raul Labrador. a statement About the Supreme Court’s decision to hear a case related to his state. “Federal law does not supersede Idaho’s Life Saving Act. In fact, the goal of EMTALA and Idaho’s law is the same: to save the lives of all women and their unborn children.”

Last year, The first case after Roe v. Wade was overturnedfederal government One hospital was reported in Missouri and the other in Kansas. When he denied an abortion to Mylisa Farmer, whose waters broke at 17 weeks gestation, less than halfway through her pregnancy, he did not provide “essential stable care” as required by EMTALA. At each hospital, doctors told Ms. Farmer that the fetus would not survive because her amniotic fluid had been destroyed and that if her pregnancy was not terminated, she could develop serious infections and even lose her uterus. Could. But because the fetus still had cardiac activity, doctors would not terminate the pregnancy.

Ms. Farmer had to travel to Illinois for an abortion. The National Women’s Law Center filed complaints against two hospitals with the Centers for Medicare and Medicaid Services, known as CMS found agency The hospitals “violated EMTALA protections that were designed to protect patients like her” and asked for a plan of improvement.

In September, the Center for Reproductive Rights filed an EMTALA complaint on behalf of Jackie Stanton, an Oklahoma woman 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 deteriorate. Will be threatened.

However, after investigating the matter, CMS issued a letter saying it “did not confirm a violation” of EMTALA. Although the agency did not provide a reason, Ms. Staton’s medical records provided to The New York Times suggest that her experience in the Oklahoma health system may not fit the exact pattern of EMTALA violations.

In the records, one hospital in the system indicated that its emergency department had stabilized her and transferred her to other hospitals in the system, where she was admitted for a day and treated by a maternal-fetal medicine doctor. it was done. The doctor wrote that while the fetus’s prospects were serious and Ms. Staton was experiencing bleeding and nausea, Oklahoma law would permit an abortion only if “there is an immediate threat to the mother’s life.”

The doctor said, “Therefore, we are unable to offer termination” and added that “termination can be performed in a different state where the procedure is legal.” Ms. Staton traveled 180 miles to get an abortion at a clinic in Kansas.

Texas sued the federal Department of Health and Human Services in July 2022, arguing that the agency’s memorandum regarding EMTALA would “force abortions” into the state’s hospitals, in violation of the state’s ban. A federal district court ruled for Texas. Biden administration appealed. In January 2024, the US Court of Appeals for the Fifth Circuit District court decision upheldThat makes it currently impossible 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. Justice Department filed suit Claims in August 2022 that the state’s abortion ban violated EMTALA because it only makes exceptions for abortions “necessary to prevent the death of a pregnant woman” but do not address threats to a woman’s health. Not for.

“Even in extreme circumstances, those who may qualify for the Idaho law’s limited ‘necessary to prevent the death of a pregnant woman’ affirmative defense,” the federal government’s lawsuit says, some providers face criminal prosecution. Care may be withheld based on a well-founded fear of running. ,

Shortly after the lawsuit was filed, a federal district judge issued an order a preliminary injunction Partially blocking the state’s ban. Last fall, a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit in San Francisco blocked a lower court’s decision and reinstated the abortion ban, saying the Idaho Supreme Court struck down the ban to give doctors more authority. Flexibility in deciding when abortion is needed to save women’s lives. But in December, an 11-member panel of the appeals court temporarily blocked the law pending an appeal.

Idaho asked the Supreme Court to intervene, and High Court has reinstated the ban on abortion And said she would hear arguments in the case in April.

abby vansickle Contributed to the reporting.

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