In Clinicians’ Own Words: How Abortion Bans Impede Emergency Medical Treatment for Pregnant Patients in Idaho

Fact-Finding Brief: Introduction

The Emergency Medical Treatment & Labor Act (EMTALA) was enacted by Congress in 1986 to ensure patients’ access to emergency services regardless of a person’s ability to pay.

EMTALA requires hospitals with emergency departments (EDs) to take a range of measures when presented with a person who comes to the department, including providing a medical screening examination if the individual requests one; “necessary stabilizing treatment for emergency medical conditions and labor within the hospital’s capability and capacity”; and, where necessary, “appropriate transfer of an unstabilized individual to another medical facility” if circumstances permit.

In June 2022 the U.S. Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization to overturn nearly 50 years of legal precedent recognizing the constitutionally protected right to an abortion. Following growing confusion post-Dobbs about whether emergency medical care could be provided in states with newly enforceable or enacted abortion bans, the U.S. Centers for Medicare and Medicaid Services issued guidance to affirm that, “Emergency medical conditions involving pregnant patients [under EMTALA] may include, but are not limited to, ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features.”

In addition, Health and Human Services Secretary Xavier Becerra sent a letter to health care providers to reiterate that EMTALA federal law preempts state law restricting access to abortion in emergency situations.

Federal courts have also been presented with cases considering whether EMTALA preempts state abortion bans that were passed in the wake of Dobbs. In January 2024, following separate but related lower court proceedings in both Texas and Idaho, the Supreme Court agreed to hear the case of Idaho v. United States, which aims to clarify whether EMTALA preempts state laws that prohibit abortions, including laws like Idaho’s Defense of Life Act. The Idaho Defense of Law Act criminalizes anyone who performs or assists in performing an abortion except to prevent the death of the pregnant woman, in cases of rape and incest when reporting to law enforcement in the first trimester, and in cases of ectopic and molar pregnancy. Violation of this law is considered a felony and subjects clinicians—including nurses, lab techs, or anesthesiologists involved—with a minimum of two years in prison; providers also face having their professional licenses suspended a minimum of six months for the first offense and then permanently revoked upon a subsequent offense The Supreme Court allowed Idaho’s law to go into effect after scheduling to hear the case, for the first time since August 2022 when it had been enjoined by a lower court after the Biden administration sued to block the law.

Following the Supreme Court’s decision to hear this case, Physicians for Human Rights (PHR) undertook fact-finding interviews from January through February of 2024 with nine physicians who either currently practice or formerly practiced in Idaho, or who practice in surrounding states. Of the latter group, these physicians have treated pregnant patients from Idaho who were transferred out of state because the Idaho facility where the patient initially sought care determined treatment was no longer allowable under the state’s abortion laws. The purpose of these interviews was to document whether and how Idaho’s abortion bans have impeded the provision of care required under EMTALA.

In speaking with PHR, clinicians described multiple cases in which Idaho’s abortion ban caused delays in pregnant patients receiving the recommended standard of care, including, in some cases, as a result of the necessity of being transferred to out-of-state facilities, which resulted in increased morbidity among these patients. Their experiences are recounted below.

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