Abortion ruling leaves pregnant patients and doctors uncertain about high-risk care

A month after Kelsie Norris-De La Cruz was turned away from a Texas hospital due to a life-threatening pregnancy complication, the 25-year-old college student learned about a federal law that could have protected her during the episode scariest medical treatment of his life. life.

Just knowing the Emergency Medical Care and Labor Act, known as the EMTALA made her feel empowered, Norris-De La Cruz said: The federal government required doctors and hospitals to perform abortions in emergency situations like hers, even in states where abortion is illegal. If she had another high-risk pregnancy, she hoped she could invoke federal law to demand treatment.

“EMTALA, EMTALA, EMTALA,” she imagined saying to the doctor who refused in February to terminate her ectopic pregnancy, a very dangerous condition in which the fetus implants outside the uterus. “If you don’t help me, I might report you.”

Norris-De La Cruz was shocked to learn Thursday that the Supreme Court, while allowing emergency abortions to resume in Idaho for now, had stopped short of broadly affirming EMTALA protections for abortion care, leaving patients facing pregnancy complications in limbo, not knowing what kind of care to expect at hospitals in states with strict antiabortion laws.

If judges had outright protected emergency abortions, she said, “I would have felt like I had a tool…power over my own body and my own life.” »

“I’m on birth control right now and I’m still terrified.”

The June 27 ruling allows emergency abortions in Idaho to stabilize patients while litigation continues. Health journalist Dan Diamond explains. (Video: Drea Cornejo/The Washington Post)

The Supreme Court’s decision offers temporary relief to doctors in Idaho, the state at the center of the legal challenge. But the justices chose not to address the broader question of whether the four-decade-old EMTALA requires medical providers nationwide to provide abortions when a doctor deems it necessary to stabilize a pregnant woman. The Biden administration has invoked that position repeatedly since 2021, as abortion opponents have worked to overturn it. Roe v. Wade and its national protections against abortion, which fell in 2022, and subsequently pushed for state restrictions.

The case returns to the U.S. Court of Appeals for the 9th Circuit, where litigation will continue. In a call with reporters, Idaho Attorney General Raúl R. Labrador (R) said he hoped the 9th Circuit judges would interpret “the Supreme Court’s tea leaves and (understand) that … the excesses of the Biden administration have to stop.”

The Supreme Court’s decision — first revealed Wednesday, after the court accidentally released a near-final version of its decision — leaves the nation’s abortion landscape unstable.

Doctors and hospitals across the South and Midwest still struggle to determine which pregnancy complications they can legally treat under the limited medical exceptions included in abortion bans. Federal officials remain engaged in a battle with state leaders over whether state abortion bans or federal emergency care laws take precedence; abortion advocates are bracing for months of additional litigation over EMTALA and whether it requires providers who receive Medicare funds to follow the federal interpretation of the law.

And women in Texas, including Norris-De La Cruz, still lack guaranteed federal protection for emergency abortions. A state lawsuit has blocked the Biden administration’s EMTALA guidelines from being invoked in Texas since 2022.

“This is not a victory, it’s a delay,” said Nisha Verma, an obstetrician/gynecologist who works at a large Georgia hospital and frequently treats women with high-risk pregnancy complications. “With all this back and forth, we can’t just practice medicine. … We have to analyze what the court says, which leaves us with even more uncertainty.”

Georgia’s six-week abortion ban includes exceptions for medical emergencies and “medically futile” pregnancies – but, Verma said, implementing the Those exceptions vary widely from state to state. While Verma’s institution tries to provide clear guidance on what pregnancy conditions doctors can treat, she said, many of her colleagues at other Georgia hospitals have to make these decisions for themselves, knowing that a bad choice could lead to a felony conviction.

She hoped the Supreme Court would send a clear and resounding message that doctors are still capable of providing stabilizing care in an emergency.

Instead, she said, they must wait.

In Idaho, Biden officials challenged the state’s strict abortion ban shortly after Deer was overturned, arguing that the law should allow abortions in cases where the mother’s health is at risk. The affair went ping-pong Since then, courts have been presented with rulings and injunctions forcing doctors to reassess the circumstances under which they can legally provide abortions.

The Supreme Court’s ruling gave Idaho doctors a temporary reprieve, allowing them to once again provide abortions when a doctor determines a woman’s health is in danger.

When Sara Thomson, an obstetrician-gynecologist in Idaho, first heard about the first version of the decision posted online Wednesday, she only had time to glance at a headline about the decision. As soon as she saw him and realized that she would be able to perform emergency abortions again, she felt immense relief.

Her feelings changed later that day, she said, when she returned to learn more about the decision — and realized it was only temporary.

“Doctors generally thought, ‘Well, if the case goes to the Supreme Court, we’ll get a final decision,'” Thomson said. “I find it disappointing to know… that we are going to have to wait some more.”

The back-and-forth journey has been an extremely trying “roller coaster,” Thomson said — so turbulent, she added, that many Idaho obstetricians/gynecologists have recently chosen to leave the state.

The unrest has drawn Biden officials and reproductive rights groups to Idaho. Health and Human Services Secretary Xavier Becerra, the nation’s top health official, joined Thomson and other providers Wednesday in Boise, where he pledged to defend access to emergency abortions.

“Every person in the United States who is at risk of death…and needs to go to the emergency room, should be able to go to the emergency room. That’s always been our position,” Becerra said. “Whether the care a healthcare professional tells you you need to stabilize your health or save your life is an abortion or not. »

Biden officials pledged to continue their efforts to advance EMTALA and help women quickly file complaints over abortion denials. They also said the protracted fight over the urgent care law — which has yet to be resolved — underscores the stakes in a presidential election that pits Biden, who has worked to protect access to abortion, to Donald Trump, who appointed three of the judges who struck down the law. Roe deer.

More victories for the anti-abortion movement could be coming. Labrador, the Idaho attorney general, said Thursday he was encouraged by the opinions of Supreme Court justices, citing examples in which Justices Amy Coney Barrett and Samuel A. Alito Jr. sided with his state or said the Biden administration had made significant concessions.

“We are confident that we will ultimately win this case,” Labrador said. He also stressed that there are protections for performing an abortion in Idaho when a woman’s life is in danger.

“There’s a pro-abortion agenda that’s trying to confuse doctors and scare them about what our law says when it’s very clear,” Labrador said, adding that doctors shouldn’t be overly concerned about the threat of abortion lawsuits. “Because they’re constantly being sued for malpractice, they think they’re going to be sued all the time. … The standards for malpractice and criminal prosecution are very different.”

State and national leaders warn that recent Supreme Court decisions have left America with a patchwork system, with some states restricting abortion and others becoming destinations for women seeking the procedure.

Massachusetts Governor Maura Healey (D) took executive action Monday to preemptively protect access to emergency abortions in the state in the event the Supreme Court strikes down EMTALA.

“We’ve already seen women pushed to the brink of death because they’re not allowed to get emergency care that could save their lives,” Healey said in an interview Wednesday. “It’s really important that in states like Massachusetts, we’re very clear about our laws and that we protect patients and providers.”

Many patients say clarification is desperately needed, two years on Deer was repealed and replaced by a confusing mix of state-level abortion bans and often overlooked federal guidelines.

In February, Norris-De La Cruz finally received treatment for her ectopic pregnancy at another Texas hospital, after her best friend referred her to her own obstetrician/gynecologist. Norris-De La Cruz had emergency surgery after her pregnancy had already begun to rupture, according to medical records and an interview with her doctor.

Norris-De La Cruz said she thinks about this episode all the time.

“If fate hadn’t intervened, I would have died,” she said.

The Supreme Court’s decision made her think about all the other women who will find themselves in similar situations, she said, without any federal laws to protect them.

“I wonder when it will be enough,” she said. “They had the opportunity to save women and they choose not to.”

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