The Supreme Court will hear arguments in an Idaho case centered on abortion rights.
Catie Dull/NPR
hide caption
toggle caption
Catie Dull/NPR
The Supreme Court will hear arguments in an Idaho case centered on abortion rights.
Catie Dull/NPR
The Supreme Court hears a new abortion case Wednesday. This tests whether a state can prevent a pregnant woman from receiving what her doctors consider essential medical treatment, including termination of pregnancy, if her health, but not her life, is in serious danger.
In 1986, Congress passed the Emergency Medical Treatment and Labor Act, or EMTALA. The law provides that hospitals receiving Medicare and Medicaid payments from the federal government – and most hospitals do – must provide stabilization care to any patient whose life or health is seriously threatened. If the hospital cannot provide care, it is responsible for providing safe transportation to another hospital that can.
This was all well and good until the 2022 Supreme Court Dobbs decision, which annulled Roe v. Wade and returned the issue of abortion to the states. Since then, a handful of states have passed laws that prohibit providing standard emergency treatment that includes termination of pregnancy if the woman’s health, but not her life, is in imminent danger.
The facts of the case
Wednesday’s test case comes from Idaho, where the law banning abortion is strict enough that the state’s main hospital system declares its patients to be at risk.
“There are patients who have very serious conditions that could lead to loss of reproductive organs, that could lead to permanent disability, and that could potentially be life-threatening, but are not life-threatening at this time- there,” explains lawyer Lindsey Harrison. She represents St. Luke’s Health System, Idaho’s only nonprofit community hospital system, which operates nine emergency departments in the state.
“For the doctors at St. Luke’s hospitals… there is a conflict between what federal law says they should do, which would allow them to preserve patients’ organs… and what Idaho says they should do. allows you to do, which is nothing, until the patient is informed life is in danger,” says Harrison.
The result is that patients often have to be transferred by ambulance or helicopter out of state, and that takes time, especially during Idaho’s harsh winters. “This delay in itself can cause a lot of harm to the patient,” she adds.
The state of Idaho maintains that it effectively protects women, including allowing termination of pregnancies when medically necessary. But after the Supreme Court’s 2022 abortion ruling, the state enacted a law that made it a crime for doctors to terminate a pregnancy except to save the mother’s life.
Arguments
John Bursch, one of the lawyers representing Idaho on the Supreme Court, is accusing the Biden administration of issuing new guidance on how to apply federal pregnancy-related emergencies law.
“What’s different about EMTALA is that it’s based on Medicare law, and Medicare law is based on state law,” Bursch says. “It states that hospitals must ensure that their staff meets applicable standards required by state or local laws.” He is adamant that “EMTALA does not enforce a national standard of care.”
The federal government, backed by the American College of Emergency Physicians and the American Hospital Association, counters that EMTALA’s sole purpose was to establish a national basis for emergency care and ensure that uninsured patients would not be refused.
“EMTALA would make no sense if state laws could simply write exceptions to the emergency stabilization requirement,” says Alexa Kolbi-Molinas, deputy director of the ACLU’s Reproductive Freedom Project. “That’s why this argument that Idaho has the right to exclude certain conditions or treatments from EMTALA is simply incorrect.”
Kolbi-Molinas maintains that the Biden administration’s new directives to hospitals after the Dobbs decision That’s the kind of advice the Centers for Medicare and Medicaid Services regularly distributes to remind hospitals of their obligations under the federal Emergency Care Act.
Bursch disputes this. “EMTALA does not require any specific medical standard. It has that foundation of state law. And state law requires that you preserve life whenever possible.”
He notes that EMTALA refers to four different places in the unborn child’s life, but if it is not possible to save both mother and child, “then Idaho law on defense of life says to protect the life of the mother, and she is unequivocal about it. that.”
However, unless there is a life or death situation, Idaho does not currently allow saving a mother’s health, even though inaction could leave the woman with lifelong health consequences. This can mean that “if you wait too long, until a patient is on the brink of death, it may simply be too late,” according to the ACLU’s Kolbi-Molinas.
The Biden administration argues that because Idaho law only allows abortion “to prevent the death of the pregnant woman,” it is in direct conflict with EMTALA, which allows termination of pregnancy to prevent “serious harm to women’s health”.
A conflict within the law?
Under the Constitution, in the event of a conflict between state law and federal law, federal law prevails over state law.
Idaho, however, asserts that there is no conflict with EMTALA because the law is part of the Medicare law, which defers to state regulation of doctors and nurses. Essentially, the state claims that when the Supreme Court referred the issue of abortion to the states, Idaho was free to draw the line as it did, banning abortions except to save the life of the mother.
St. Luke’s, in its brief to the Supreme Court, says it’s not always easy to draw that line, putting doctors and nurses at risk of criminal prosecution and license suspension. As a result, according to the hospital system, doctors and nurses are fleeing the state, creating obstetric shortages so “disastrous” that hospitals are simply closing their labor and delivery departments and even their neonatal intensive care programs. .
The prospects for such a change are not promising. Two lower courts initially blocked Idaho’s abortion law on the grounds that it conflicted with EMTALA. But in January, the Supreme Court granted Idaho’s request and allowed the law to take effect while the court considers the case. This action is a preliminary indication that a majority of the justices are inclined to agree with Idaho.
NPR News
