Supreme Court rules on Idaho emergency abortion case

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The U.S. Supreme Court decision allowing emergency abortion care in Idaho may offer temporary relief for hospitals and doctors, but it leaves large questions unresolved.

The high court released its ruling Thursday, a day after the opinion briefly appeared on its website, as first reported by Bloomberg Law. Under the ruling, Idaho hospitals receiving federal funding can provide abortions in emergencies where the patient is facing serious harm.

But the ruling allows litigation in the Idaho case to continue, and doesn’t set precedent as legal battles continue.

As Justice Ketanji Brown Jackson notes in her comments on the ruling, the opinion doesn’t clarify that states can’t act in violation of the Emergency Medical Treatment and Labor Act, the federal law known as EMTALA. She also pointed to a federal appeals court siding with the state of Texas, finding that federal law doesn’t supersede the state’s abortion law.

“This Court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it,” Jackson wrote. “And for as long as we refuse to declare what the law requires, pregnant patients in Idaho, Texas, and elsewhere will be paying the price.”

Safeguards, for now

For the time being, Idaho doctors and hospitals can offer emergency abortion care if patients face serious health risks.

Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, said he is “pleased the U.S. Supreme Court reinstated a lower court’s ruling that affirms the obligation of health care providers, under federal law, to provide stabilizing care to patients with life-threatening conditions.”

“Today’s decision, for now, safeguards the health of pregnant patients and respects the sanctity of the physician-patient relationship and medical judgment of providers,” Siegel said in a statement. “We call on states and the courts to reject misguided and dangerous restrictions that would undermine lifesaving emergency services for entire communities.”

Hospitals have been anticipating the ruling in a case that has commanded national attention. Litigation will continue in Idaho and elsewhere, as will confusion for some providers, in all likelihood.

Chad Golder, general counsel of the American Hospital Association, said Thursday that the Supreme Court ruling offers some temporary help to Idaho’s hospital, but hospitals are still waiting for stronger protections for providers.

“While we are pleased that the Supreme Court’s decision to dismiss these cases as improvidently granted will restore the temporary stay on Idaho’s law, we are disappointed that physicians, nurses, and other clinicians across the country still do not have needed clarity,” Golder said in a statement.

“Caregivers must be able to exercise their professional judgment about a patient’s care as federal law requires under the Emergency Medical Treatment and Active Labor Act (EMTALA) without the fear of criminal prosecution,” Golder said. “We continue to urge courts to protect clinicians as they seek to provide emergency care to their patients.”

Stella Dantas, MD, president of the American College of Obstetricians and Gynecologists, said Thursday that she hoped for a more definitive ruling from the Supreme Court.

“We are relieved that the U.S. Supreme Court has reached a decision that will temporarily allow for stabilizing emergency abortion care to continue in the state of Idaho,” Dantas said in a statement Thursday.

“However, we are truly disappointed that this decision affords no long-term clarity of the law for doctors, no comfort or peace of mind for pregnant people living under abortion bans across the country, and no real protection for the provision of evidence-based essential health care or for those who provide that care,” Dantas said. “Unfortunately, litigation in this case will continue-and with it will come serious concern for the future of abortion access and for the health and safety of the patients we treat.”

Doctors have left Idaho

The Supreme Court ruled two years ago that abortion is not a constitutional right, leaving the issue to the states. Since the high court’s decision, 21 states have enacted laws restricting abortion.

Over the past two years, doctors and hospitals have struggled to determine what care they can deliver. The Biden administration has consistently argued that the federal law requires hospitals to treat those patients, even in states that have laws barring most abortions.

Idaho’s law represents a wide-ranging ban in abortions, with exceptions only to save the life of the mother and in cases of rape and incest. Idaho’s law also imposes stiff penalties for violators, including a minimum of two years in prison and a maximum sentence of five years.

Some doctors have left Idaho over the past two years, Dantas says.

“In Idaho, for example, nearly one-quarter of the state’s obstetrician–gynecologists have relocated in the last two years, leaving roughly half of Idaho’s counties without an obstetrician–gynecologist,” Dantas said in a statement earlier this week. “With two of Idaho’s hospitals also closing their labor and delivery units, many patients now have to travel significantly longer distances for everything from preventive gynecologic care to childbirth.”

Destiny Lopez, acting co-CEO of the Guttmacher Institute, which advocates for reproductive writes, describes the ruling as “the bare minimum.”

“The Court should have been clear in affirming that the Emergency Medical Treatment and Labor Act (EMTALA) protects abortion in emergency situations in all states,” Lopez said in a statement.

‘Not a victory’

In arguing the case before the Supreme Court in April, U.S. Solicitor General Elizabeth B. Prelogar pointed out what she identified as key shortcomings in Idaho’s law and said the federal law should supersede the state’s law.

“In Idaho, doctors have to shut their eyes to everything except death, whereas, under EMTALA, you're supposed to be thinking about things like, is she about to lose her fertility? Is her uterus going to become incredibly scarred because of the bleeding? Is she about to undergo the possibility of kidney failure? So I think that that is one critical distinction,” Prelogar told the justices in April.

Justice Jackson wrote that doctors in Idaho will still have to make decisions on providing emergency care in a highly charged environment, with uncertainty on the bigger legal questions. She wrote that it is “not a victory for pregnant patients in Idaho. It is delay.”

“While this Court dawdles and the country waits, pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires,” Jackson wrote.