New court order shields certain Idaho doctors from prosecution for emergency abortion care
Supporters hold signs in support of their doctors and abortion access at a rally on April 21, 2024, at the Idaho Statehouse in Boise. (Otto Kitsinger for States Newsroom)
Physicians at Idaho's largest health system will continue to be shielded from criminal prosecution for providing abortion care in an emergency after a federal court judge issued a new protection order Thursday in a lawsuit over the state's abortion ban.
The directive applies only to St. Luke's Health System and its medical providers as the sole plaintiff suing Idaho over restrictions hospital officials say conflict with the federal Emergency Medical Treatment and Labor Act, or EMTALA. That law requires any hospital that accepts Medicare funding to provide stabilizing treatment to patients who come to emergency rooms regardless of their ability to pay.
St. Luke's operates eight of the 39 hospitals in Idaho that accept Medicare funding, and it delivered more than 40% of the 22,000 babies born in the state in 2024.
U.S. District Judge B. Lynn Winmill, an appointee of former Democratic President Bill Clinton, cited the original intention of the law in his Thursday order. Republican President Ronald Reagan signed the law in response to 'patient dumping,' when hospitals would turn people away for being uninsured or covered by Medicaid.
'When EMTALA passed, these 'undesirable' patients were the indigent. Today, they are pregnant women,' Winmill wrote in Thursday's decision.
The U.S. Department of Justice, under the Biden administration, sued Idaho in 2022. The case reached the U.S. Supreme Court in April 2024, but justices decided they couldn't rule on it at that juncture and returned it to the lower courts for further argument. After Republican President Donald Trump's election victory, St. Luke's filed its own separate lawsuit against Idaho Attorney General Raúl Labrador because the hospital's leadership anticipated Trump's Justice Department would drop the case. The DOJ attorneys moved to dismiss the case on March 5, dissolving the previous injunction.
A health system is fighting Idaho's abortion ban. It's not its first controversial stance.
'Specifically, the attorney general, including his officers, employees, and agents, are prohibited from initiating any criminal prosecution against, attempting to suspend or revoke the professional license of, or seeking to impose any other form of liability on, St. Luke's or any of its medical providers based on their performance of conduct that is defined as an 'abortion' under Idaho Code, but that is necessary to 'stabilize' a patient presenting with an 'emergency medical condition' as required by EMTALA,' Winmill wrote.
Winmill said it was clear that without the injunction, St. Luke's and its patients would be harmed, because for three months in 2024 when the injunction was not in place, six patients were airlifted out of state if they needed to end their pregnancies to preserve their health. That situation only came up once in the entire year before.
The cases these situations apply to are rare, physicians have said, but the consequences can be severe if left untreated. The most common issue is when a pregnant patient's water breaks before the fetus is viable. That can quickly progress to an infection that can cause great damage to the kidneys and reproductive organs, jeopardizing a patient's ability to have children in the future.
Labrador's office asked Winmill to dismiss the case, arguing there is no conflict between Idaho's abortion law and EMTALA, and maintaining that the abortion ban protects 'both the mother and their unborn child.'
Earlier this month, Labrador's deputies argued at a hearing that case law from the Idaho Supreme Court's interpretation of the ban does not require an immanency of death, only a subjective, good faith medical judgment that the person's life is threatened. At the same time Deputy Attorney General David Myers told Winmill there is no medical situation in which it is necessary to perform an abortion as stabilizing care.
Winmill wrote in his decision that while that is true of their interpretation, there is still a conflict.
'The Defense of Life Act plainly requires that an abortion is 'necessary to prevent the death.' If 'imminent' is not the standard, how close must the woman be to death for the abortion to be 'necessary'?' he wrote. 'There is no way for physicians to know this, and the price of falling on the wrong side of the line is a felony conviction.'
EMTALA, he added, uses much less categorical language: 'such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result.'
North Idaho legislators bring bill to add health exceptions to state's abortion ban
The American College of Obstetricians and Gynecologists, a group of more than 60,000 physicians, issued a statement Friday celebrating the decision, saying it was a relief.
'OB-GYNs see every day that bans on abortion cannot exist in concert with EMTALA, because bans prevent clinicians from providing patients with the full range of emergency care that they might need,' said Molly Meegan, chief legal officer and general counsel for the organization, in the statement. 'ACOG is grateful that our members in Idaho now have the ability to provide evidence-based medical care to patients facing obstetric emergencies without fear of prosecution.'
Idaho's abortion ban applies to all stages of pregnancy and includes an exception to prevent the pregnant patient's death, but not to preserve their health. Physicians found in violation of the law are subject to two to five years in prison, the loss of their medical license, and civil penalties. Without a health exception, which the Idaho Legislature has failed to enact despite repeated pleas from doctors and other providers, doctors have said they cannot terminate a pregnancy to prevent someone from experiencing detrimental health effects without fear of prosecution. The health system also says it could lose Medicare funds for violating EMTALA and the laws have already been driving physicians to practice in other states.
The injunction will stay in place as the case proceeds, according to Winmill's order. The next hearing date has not yet been scheduled.
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