Idaho’s strict abortion ban faces scrutiny in federal appeals court hearing

PASADENA, California (AP) — A federal appeals court is expected to hear arguments Tuesday afternoon over whether Idaho should be prohibited from enforcing a strict abortion ban during medical emergencies when a pregnant patient’s life or health is at risk.

The state law makes it a felony to perform an abortion unless the procedure is necessary to prevent the death of the patient. President Biden’s administration sued Idaho two years ago, contending the law violates a federal rule called the Emergency Medical Treatment and Labor Act, or EMTALA, because it prevents doctors from performing abortions that save their patients from serious infections, organ loss or other major medical issues.

The U.S. Supreme Court heard the case earlier this year, but bounced it back to the lower court on a procedural issue, leaving unanswered questions about the legality of the state abortion ban.

Dr. Jessica Evans-Wall, an emergency room physician in Boise, Idaho, hopes the 9th Circuit ruling will provide some clarity for her and other Idaho physicians.

“For a lot of us in emergency care, it’s not just about reproductive health or those rare but really important life-threatening situations when someone would need an emergency abortion. It’s about EMTALA as a whole,” Evans-Wall said Tuesday morning. The federal law was created to ensure that hospitals couldn’t refuse to treat emergency patients just because they are uninsured or for other reasons, she noted.

“That feels really precious and important in emergency situations, because we want to take care of anyone who walks through the door, for any reason, at any time,” Evans-Wall said. “If we say the state law overrides the EMTALA statute, what does that do for the strength of EMTALA protections moving forward?”

Idaho officials have argued in court filings that the state abortion ban doesn’t violate EMTALA. Instead, they say the fetus or embryo should be considered a patient with protections under EMTALA as well. They also argue that doctors have enough wiggle room under the law to use their best judgment about when to treat pregnant people with life-threatening medical conditions.

“Taking EMTALA for what it actually says, there is no direct conflict with Idaho’s Defense of Life Act,” attorneys representing the Idaho Legislature wrote in court filings earlier this month. “Nothing in EMTALA requires physicians to violate state law. And nothing in Idaho law — whether in EMTALA-covered circumstances or beyond — denies medical care to pregnant women.”

About 50,000 people in the U.S. develop life-threatening complications during pregnancy each year. Those complications can include major blood loss, sepsis, or the loss of reproductive organs. In rare cases, doctors might need to terminate a pregnancy to protect the health of the pregnant person, especially in cases where there is no chance for a fetus to survive.

“We’re only involved when there’s an emergency, when a patient’s life or health is affected,” said Evans-Wall. “I think it sometimes comes across like, ‘Oh, we’re choosing the pregnant person over the pregnancy,’ but the truth is if that pregnant person is having serious complications where their life or health is at risk then the viability of that pregnancy is not there. It’s not a choice that we’re making saying we’re going to prioritize the pregnant person over that pregnancy. Because of the medical circumstances, that choice has already been made.”

Still, some state abortion bans have made medical decisions that once seemed clear feel particularly fraught for emergency room physicians. Complaints that pregnant patients were turned away from U.S. emergency rooms spiked in 2022 after the U.S. Supreme Court overturned Roe v. Wade.

“These harms are not hypothetical,” Idaho’s largest hospital system, St. Luke’s Health System, wrote in a friend-of-the-court brief in October. “In all of 2023, before Idaho’s law went into effect, only one pregnant patient presenting to St. Luke’s with a medical emergency was airlifted out of state for care. Yet in the few months when Idaho’s new abortion law was in effect, six pregnant St. Luke’s patients with medical emergencies were transferred out of state for termination of their pregnancy.”

One of those patients had severe preeclampsia — a condition that causes dangerously high blood pressure that can be fatal if untreated — and the others had premature rupture of their membranes, putting them at risk of life-threatening infections, St. Luke’s said.

“The stakes could not be higher,” ACLU Reproductive Freedom Project Deputy Director Alexa Kolbi-Molinas said Monday. She noted recent news reports in Texas about women who died after being denied appropriate treatments for incomplete miscarriages. “The reality is, exceptions don’t work. They don’t actually protect the health and rights of pregnant people regardless of what is written on the page, and that is just the reality when you threaten physicians with criminal penalties.”