The Supreme Court Will Decide if States Can Force Hospitals to Let Women Die

The Supreme Court will decide this term whether states can force doctors to turn away patients suffering serious, life-threatening medical complications, or if doctors will be allowed to provide standard medical care to those patients: abortions. The court announced last week it will hear arguments over the Emergency Medical Treatment and Active Labor Act, or EMTALA, in April.

EMTALA is a more than three-decade-old federal law that says hospitals that accept Medicare (most hospitals in this country) cannot turn away anyone with an emergency medical condition; they are required to provide stabilizing treatment to prevent that person from suffering serious medical complications. After Roe v. Wade was overruled in 2022, the Biden administration issued guidance clarifying that if a pregnant patient arrives at a hospital with an emergency condition that could only be stabilized with an abortion, the hospital is required to provide that care — regardless of state law.  

To the Supreme Court, Idaho has argued that states — not doctors, and not the federal government — should be permitted to decide what kind of emergency medical care women can receive. “The federal government cannot use EMTALA to override in the emergency room state laws about abortion any more than it can use it to override state law on organ transplants or marijuana use,” the state’s attorney general wrote in its petition to the high court. 

Lawyers for the Department of Justice sued the state of Idaho last year over the criminal abortion ban passed by the GOP-controlled legislature, which only allows for abortions to prevent a patient’s death — language one Idaho doctor said “is not useful to medical providers because this is not a dichotomous variable.” 

The Biden administration argued the Idaho law violates care requirements mandated by EMTALA, and a lower court agreed, blocking the law as it applied to medical emergencies. But on Jan. 5, the Supreme Court lifted the lower court injunction, reinstating the ban and sending the chilling message to Idaho doctors that they cannot offer the care they have been trained to provide to pregnant patients without fear of criminal prosecution. 

Nancy Northup, president of the Center for Reproductive Rights, called the Supreme Court’s intervention in the case “deeply troubling.”

“EMTALA is currently the only federal protection for patients who need emergency abortions. If the Supreme Court eviscerates that, there is no doubt that people will die,” Northup said in a statement.

At least one woman may have died already. This week, The New Yorker reported on what may be the first death tied to failure to provide such emergency medical treatment: Yeniifer Alvarez-Estrada Glick, who expired outside an emergency room in Luling, Texas, in the summer of 2022. Glick had been hospitalized multiple times for severe pregnancy complications, including hypertension and pulmonary edema that put her in intensive care. Medical records indicate Glick was never offered an abortion — treatment, four experts told The New Yorker, that “if offered and accepted, would probably have saved her life.”

As one doctor in the hospital chain to which Glick was repeatedly admitted told the magazine, “It’s very frustrating to have your hands tied because the patient who you need to save is not the one that’s protected by law.”

Declarations submitted by doctors in the Idaho case at the Supreme Court show the impossible position the state is placing doctors in. In his declaration, Dr. Stacey Seyb, an OB-GYN and maternal-fetal medicine specialist at St. Luke’s Regional Medical Center in Boise, points out that modern abortion care is one of the chief reasons why women don’t die from pregnancy complications nearly as often as they used to: 800 out of every 100,000 women died for those reasons a hundred years ago; today, that rate is 25 out of 100,000. 

“There are situations where pregnancy termination is the only medical intervention that can preserve a patient’s health or save their life,” Seyb explains. He cites as examples three recent patients he’s treated for pregnancy-related emergencies — cases he says he and his colleagues encounter “approximately a dozen times per year.”

The first patient was a 22-year-old who was 18 weeks pregnant and arrived at his hospital with a fever, tender uterus, and an elevated heart rate; an ultrasound revealed her water had broken many days earlier. Without treatment, an abortion, Sayeb says, “the chance of her progressing to severe sepsis and dying was very high.” If she happened to survive, she was at high risk of infertility or a hysterectomy. 

There was the case of a 35-year old with a partial molar pregnancy — a condition that causes the placenta to grow irregularly. She arrived with headache, vision problems, and severely high blood pressure. “The only medically acceptable action to preserve her life was the termination of the pregnancy. Not only was the pregnancy ultimately not viable due to the nature of the molar pregnancy, but removal of the placenta — i.e., delivery — was the only cure to reverse the severe preeclampsia.”

There was the 25-year old who arrived at the hospital 19 weeks pregnant and bleeding uncontrollably from her vagina. She’d lost so much blood that she was in “hypovolemic shock.” 

“If left untreated, the risks of life-threatening shock, even with blood replacement, were very high,” Seyb said. Doctors across the state have confronted similar cases: In his work as a high-risk pregnancy consultant, Seyb described receiving a call from a physician in another part of the state, asking to transfer a patient with the same symptoms. “He was qualified but was afraid of the potential ramifications of his actions if he proceeded with termination…. This is one example that providers do not have a clear guide as to what situations will place their livelihood in danger.”

A former colleague of Seyb’s at St. Luke’s, Kylie Cooper, also submitted a declaration in the case. Cooper began practicing maternal fetal medicine in Idaho because, she says, “it was clear that Idaho had a great need for high-risk obstetricians given the growing population and multitude of health conditions and pregnancy complications.” She has since left Idaho, out of fear that she could lose her medical license or be criminally prosecuted for providing standard medical care — a decision she called “unbearable.”

Cooper described three patients she treated between September 2021 and June 2022, when the Supreme Court delivered its decision overruling Roe v. Wade, eliminating the federal protection for abortion rights. Two separate cases involved women whose fetuses had been diagnosed with triploidy, a fatal chromosomal abnormality known to involve severe birth defects. It’s a fatal condition, and one that dramatically increases the risk that the mother will develop preeclampsia, as these patients, both 15 weeks, did — putting them at risk for stroke, seizure, pulmonary edema, liver or kidney failure, and other life-threatening complications.

In another instance, Cooper recalled treating an expectant mother, 20 weeks pregnant, who arrived with acute “right upper abdominal pain” — a telltale symptom of preeclampsia. “Her labs quickly deteriorated…. Her platelets were dropping so quickly she required a platelet transfusion; she had evidence of hemolysis and concern for liver injury based on rising liver enzymes and upper abdominal pain.”

In the case of all three women, Cooper writes, “the only medically acceptable action to preserve her health and life was termination of the pregnancy.”

Under Idaho’s law, providers say performing life-saving abortions in cases like these will now mean risking arrest.  

It’s not just Idaho arguing that state lawmakers, rather than doctors, should be allowed to decide what kind of emergency medical care women should be allowed to receive. Attorneys general from 20 additional states — including Texas, which is leading a separate crusade against EMTALA — filed an amicus brief at the Supreme Court declaring: “It cannot be that, by directing hospitals to stabilize indigent patients, EMTALA creates an affirmative right to demand whatever procedure an individual patient or doctor might wish, without regard to state medical regulations.” 

Texas Gov. Greg Abbott (R) was recently asked about his state’s ongoing EMTALA court case by a right-wing radio host. “The Biden administration tried to circumvent Texas’s abortion law, or the six-week, or whatever-it-is-law that we have here. And they tried to do so by forcing emergency rooms to perform abortions — you have to perform an abortion if somebody shows up and says they need one,” the host, Joe Pags, says. “This was a blanket push by Biden to try to say: You can have an abortion in Texas. We say so. Right?”

Abbott replied, “What the United States Supreme Court decided is that the abortion issue is one to be decided by states. And what that means is the federal government does not have a say.”