ERs in limbo after Supreme Court ruling on emergency abortion care

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The Supreme Court has ruled that abortions for life-saving care in Idaho is legal, at least for now.

This means that hospitals and emergency room physicians don't have to second guess whether the care they're providing is criminal, but the SCOTUS decision also kicked the can down the road by not ruling on the merits of the case.

On June 27, in a 6-3 decision SCOTUS dismissed two consolidated cases, Moyle vs. United States and Idaho vs. United States. Both addressed access to abortions in emergency circumstances. The Justices' dismissal upholds a lower court order blocking Idaho from enforcing its abortion ban in emergency medical situations. 

The case pitted state law in Idaho against a federal law called the Emergency Medical Treatment and Labor Act. EMTALA mandates that physicians give stabilizing care for patients in the ER. 

American Medical Association President-elect Dr. Bobby Mukkamala said: "The AMA is relieved the dismissal of an Idaho case by the U.S. Supreme Court has reinstated a pause on parts of the state's near-total abortion ban and restored access to emergency abortions in Idaho under federal law. However, today's decision failed to confirm that patients in every state are entitled to prompt, complete, and unbiased emergency healthcare that is medically and scientifically sound and provided in compliance with the country's Emergency Medical Treatment and Labor Act (EMTALA)." 

Because the court did not rule on the substance of the case, it could hear this very case or another one like it from other states in future terms, Mukkamala said.

WHY THIS MATTERS

On July 2, Health and Human Services Secretary Xavier Becerra and the Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure sent a letter to hospitals reaffirming commitment to EMTALA.

However, HHS said its interpretation of EMTALA -- both as to when an abortion is required and EMTALA's effect on state laws governing abortion -- is currently enjoined within the state of Texas and subject to further litigation. HHS has sought the Supreme Court's review of that injunction, and its petition for review remains pending. 

Physicians for Reproductive Health President and CEO Dr. Jamila Perritt said: "Today's Supreme Court's decision to allow the lower court's injunction of Idaho's law to remain in place while litigation continues is a relief, albeit temporary. While it is devastating that the Supreme Court declined to end this uncertainty, this decision will ensure that for now abortion care can be provided in the case of life-threatening emergencies and will save countless lives."

The Supreme Court ruling upholds the relationship between doctor and patient in the most dire of circumstances, according to an ER physician writing in the Scientific American.

The ER physician said she takes care of pregnant people during most of her shifts in the emergency department. 

"What the highest court has preserved is my ability to fully care for people in cases like this: a pregnant person with a life-threatening infection that may cause what's known as a septic abortion, a uterine lining so riddled with infection that the only way to save that person is through a hysterectomy," she said in the report.

THE LARGER TREND

Idaho law imposes criminal penalties on doctors who perform abortions. Because of the risk of prosecution under the law, obstetricians in Idaho have facilitated emergency airlifts so that patients can access medical care in other states without restrictive bans, according to Health Care in Motion.

The American College of Emergency Physicians said it is hopeful that future court decisions clearly and emphatically reaffirm the broad patient protections that already exist in federal law under the Emergency Medical Treatment and Labor Act, a bedrock principle of emergency care. 

ACAP said in one of its briefs that it submitted to the court: "The devastating impact of delaying necessary care is not hypothetical, and neither are the consequences for pregnant patients. … EMTALA does not allow physicians to withhold specific treatments for nonmedical reasons. Rather, if a treatment is 'required to stabilize the medical condition,' it must be made available to the patient -- full stop."

Dr. Bruce Siegel, president and CEO of America's Essential Hospitals, said: "We are pleased the U.S. Supreme Court reinstated a lower court's ruling that affirms the obligation of healthcare providers, under federal law, to provide stabilizing care to patients with life-threatening conditions. Today's decision, for now, safeguards the health of pregnant patients and respects the sanctity of the physician-patient relationship and medical judgment of providers."
 
 

Email the writer: SMorse@himss.org