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Experts say the court’s failure to definitively act puts pregnant women, hospitals, doctors and public health nationwide at risk
Last week the Supreme Court ruled that, at least temporarily, the Emergency Medical Treatment and Labor Act’s basic guarantee of hospital emergency care will once again go back into effect for pregnant women in Idaho. Its decision thus bars state officials from criminally prosecuting hospitals and physicians under Idaho law for complying with the requirements of a federal law that requires emergency care not only when death is imminent but when a patient’s health is threatened. At the same time, the Court refused to consider the actual merits of the case and sent the dispute back to the appeals court for a full hearing.
“The Emergency Medical Treatment Act imposes a direct duty on all Medicare participating hospitals to stabilize patients facing medical emergencies that threaten their health,” said Lynn R. Goldman, Dean of the Milken Institute School of Public Health at the George Washington University. “The Supreme Court’s failure to definitively act in this case leaves pregnant women in Idaho and other abortion-banning states at risk of delays in treatment or no treatment at all. The result could be death or severe long lasting health consequences.”
EMTALA, the federal law at issue here, was enacted by Congress in 1986 to ensure universal immediate access to emergency hospital care for all people. Because the Court punted on the question of whether EMTALA actually bars criminal laws such as the one enacted by Idaho, the protection the decision reinstates applies only in Idaho and not in other states, such as Texas, that bar hospital care for pregnancy emergencies unless life itself is endangered. In these states, hospitals and physicians risk prosecution simply for complying with EMTALA, whose duty of care is tied to a health endangerment standard. This standard is crucial to the proper care of pregnancy emergencies that, while not implicating death, nonetheless could leave women with lifelong injuries including the inability to bear children. Such emergencies, which compel abortion as the stabilizing treatment, are exceedingly rare and, as several Justices noted, overwhelmingly arise in the very early stages of pregnancy.
“The Court’s decision maintains the status quo, but they missed an opportunity to rule on the merits of the case and reinforce the importance of EMTALA to clearly affirm the right of all people, including pregnant women, to receive necessary emergency medical treatment,” said Georges C. Benjamin, Executive Director of the American Public Health Association. “To protect everyone’s health, medical professionals need to know they won’t be prosecuted for providing necessary care. Failing to resolve this legal uncertainty puts the life and health of women at risk.”
Today’s opinion sides with the Biden Administration on the question of immediately reinstating EMTALA protections for Idaho women but leaves the deeper issue of the legality of Idaho’s law for another day.
How the case ultimately gets resolved carries implications that go well beyond pregnancy emergencies, since a final decision in Idaho’s favor ultimately could open the door to other state laws criminalizing most emergency care for disfavored populations or conditions, according to an amicus brief filed in the case by the American Public Health Association, the Robert Wood Johnson Foundation, the American Medical Women’s Association, the Network for Public Health Law as well as 133 deans and scholars in public health and health policy.
The brief can be accessed online. You can also view all the briefs in the case. The amici are represented by attorneys Thomas Barker (counsel of record) and Andrew London, Jack C. Smith, and Alexander Somodevilla at Foley Hoag LLP.
The deans and scholars who signed the brief did so in their individual capacities. The views expressed are their own and do not represent their affiliated institutions, organizations or employer.
Additional information about the Supreme Court ruling can be found in a July 1 Health Affairs Forefront piece by Sara Rosenbaum titled, “Moyle Review ‘Improvidently Granted,’ But Justices’ Positions on EMTALA, Emergency Abortions on Display.”
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