EMTALA covers abortion in Idaho hospitals, judge rules

A federal judge temporarily blocked a portion of an Idaho law that would criminalize medical professionals who performed abortions in medical emergencies. 

U.S. District Judge B. Lynn Winmill ruled Aug. 24 the state law, set to take effect Aug. 25, violates the Emergency Medical Treatment and Labor Act. The federal law, enacted in 1986, requires that Medicare hospitals provide all patients appropriate emergency care — including medical screening, examination, stabilizing treatment and transfer, if necessary — irrespective of any state laws or mandates that apply to specific procedures.

HHS directed hospitals in July that if a hospital is in a state that prohibits abortion by law and does not make exceptions for the health or life of a pregnant person, EMTALA preempts that state law. 

Idaho's abortion law was set to criminalize the performance of most abortions except for limited scenarios, including those where abortion is necessary to prevent the death of a pregnant woman. The U.S. Justice Department filed a lawsuit Aug. 2 to block the state law, alleging it violates EMTALA. The government says EMTALA's definition of emergency medical care is broader than treatment to avoid death — it also covers treatment for conditions that place a patient's health in serious jeopardy or risk impairment to bodily functions or any body organ. 

"The doctor believes her EMTALA obligations require her to offer that abortion right now. But she also knows that all abortions are banned in Idaho. She thus finds herself on the horns of a dilemma," the judge wrote in his opinion. "Which law should she violate?"

By upholding EMTALA over the state's law, the judge's ruling still leaves room for Idaho to have a strict abortion law in place — but medical professionals cannot be punished for performing emergency abortions that are medically necessary to preserve patients' health and life.

"It's not about the bygone constitutional right to an abortion," the judge's 39-page ruling states. "This Court is not grappling with that larger, more profound question. Rather, the Court is called upon to address a far more modest issue — whether Idaho's criminal abortion statute conflicts with a small but important corner of federal legislation. It does."

The decision conflicts with one delivered the day prior, in which a federal judge in Texas preliminarily halted enforcement of HHS' guidance in Texas, leaving healthcare professionals in the state's Medicare-funded hospitals to defer to state law over federal EMTALA for abortion in medical emergencies. 

Abortion is banned in Texas because of a law from before Roe v. Wade that is being enforced. The ban makes no exceptions for rape or incest. The state's trigger law, set to take effect Aug. 25, will increase the penalties for those involved in an illegal abortion — putting physicians who perform the procedure at risk of facing life in prison and fines no less than $100,000 for each violation.

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