U.S. Court of Appeals for the Fifth Circuit Rules in Texas v. Becerra
On January 2, 2024, the U.S. Court of Appeals for the Fifth Circuit ruled in Texas’ favor—delivering a blow to women in need of essential, medically necessary health care. In related news, the U.S. Supreme Court on January 5, 2024 granted a request from Idaho and the state’s Republican-controlled legislature to temporarily put on hold an earlier ruling by a federal district court finding that EMTALA preempts Idaho’s near total abortion ban and requires certain hospitals to provide emergency abortions if that care is needed to stabilize pregnant women in an emergency. The Court will hear arguments in that case in April.
BACKGROUND – UNITED STATES V. STATE OF IDAHO
For nearly four decades, EMTALA has provided the foundation for the emergency care safety net and has been supported by lawmakers of diverse ideological perspectives. The American public trusts physicians to provide emergency care consistent with EMTALA and medical guidelines. Despite this, a range of state efforts would criminalize doctors who provide abortion even in such emergency circumstances, leaving physicians and their patients in an untenable and unsafe position.
The Biden Administration challenged one such effort – Idaho’s abortion ban – in federal court, arguing that its lack of a health exception unlawfully conflicts with federal protections under EMTALA.
On August 15, 2022, 10 of the nation’s leading professional organizations of physicians and public health experts, including the leading professional societies of emergency physicians and obstetrician-gynecologists, submitted a brief in the U.S. District Court for the District of Idaho in support of the U.S. Department of Justice’s challenge. The brief underscores the law’s clear conflict with EMTALA. The case is United States v. State of Idaho.
The brief explains some of the contexts in which the conflict with federal law arises. For example, the brief describes “contexts where a patient’s pregnancy is presenting urgent risks to the pregnant patient’s life or health but where the Idaho Law would prevent medically indicated care that includes terminating the pregnancy. Read the release here.
On August 26, 2022 a federal court in Idaho enjoined Idaho’s abortion law to the extent it conflicts with the Emergency Medical Treatment & Active Labor Act (EMTALA). The court agreed with the medical community that “Idaho’s criminal abortion law will undoubtedly deter physicians from providing abortions in some emergency situations,” subjecting “women in medical crisis to periods of serious physical and emotional trauma as they wait to get nearer and nearer to death.”
In September of 2023, the U.S. Ninth Circuit Court of Appeals granted the Idaho Legislature’s appeal. On September 29, 2023, a panel of three Trump-appointed judges stayed the injunction of Idaho’s abortion law as it applies to emergency care. On October 10, 2023, the Ninth Circuit agreed to reconsider the case.
BACKGROUND – STATE OF TEXAS V. BECERRA
In the weeks following the Dobbs decision, the U.S. Department of Health and Human Services (HHS) issued a guidance statement reminding hospitals and their medical providers that when abortion is necessary to stabilize a patient’s medical emergency, EMTALA requires that it be offered.
The guidance was immediately attacked by Texas Attorney General Ken Paxton and two interest groups, who filed suit in federal court in Texas to invalidate the guidance.
On August 17, 2022, ten of the nation’s leading professional organizations of physicians and public health experts, including the professional societies of emergency physicians and obstetrician-gynecologists, submitted a brief in support of the HHS EMTALA guidance. This brief explains how Texas’s challenge misunderstands both federal law and the on-the-ground practice of emergency medicine. It affirms that forcing physicians to decide between obeying state law and obeying EMTALA would harm physicians and the public interest and urges the court to reject Texas’s motion to enjoin the guidance. The case is State of Texas v. Becerra. Read the release here.
On August 25, 2022 a federal court in Texas endorsed Governor Ken Paxton’s attack on EMTALA, preliminarily enjoining the Biden administration’s guidance interpreting the law in Texas. The u.S. Department of Justice appealed that decision in October of 2022.
On May 8, 2023, a similar coalition of the nation’s leading professional organizations of physicians and public health experts, including the professional societies of emergency physicians and obstetrician-gynecologists, submitted a brief in support of the Biden administration in the U.S. Court of Appeals for the Fifth Circuit.