Idaho’s Abortion Ban Clears Hurdle in US Emergency Care Case

A federal law regulating hospitals’ emergency care doesn’t relate to abortion and can’t be used to thwart the will of Idahoans who have “elected to protect fetal life,” a federal appeals court said.

The US Court of Appeals for the Ninth Circuit’s Thursday ruling will allow Idaho to enforce its near-total abortion ban even though the threat of criminal prosecution and licensing sanctions allegedly might lead doctors to refuse to provide medically necessary emergency care.

The decision means the US can’t use the federal Emergency Medical Treatment and Active Labor Act to force states to allow abortions in emergency situations, or to ensure that people who may need abortions in emergencies can get them.

While the Ninth Circuit’s stay of a lower court’s injunction applies only for the duration of the appeal, it would be unusual for the court to reach a different result after arguments on the merits.

‘Pushes the Statute’

EMTALA expressly says that it doesn’t preempt state law except when there’s a direct conflict, the Ninth Circuit said. There’s no such conflict here, it said.

Reading EMTALA to require abortions “pushes the statute far beyond its original purpose, and therefore is not a ground to disrupt Idaho’s historic police powers,” the court said.

The federal law was intended to prevent hospitals that receive federal money from dumping emergency patients on the basis of their inability to pay, the court said. It doesn’t set specific standards of care or dictate which procedures must be offered, it said.

The provision doesn’t require abortions and, in any event, would require an abortion that’s prohibited by Idaho law, the court said. It only places a duty on hospitals to stabilize a patient’s medical condition before transferring or discharging them,it said.

Abortion could be a form of stabilizing treatment, the court said. But the federal law doesn’t require hospitals to provide any form of treatment that possibly could stabilize a patient’s condition, it said.

It’s not impossible to comply with both the state and federal laws, the court also said. Idaho’s law has a narrow exception that applies when a doctor determines, using good faith medical judgment based on known facts at the time, that “the abortion was necessary to prevent the death of the pregnant woman.”

The US had argued that the exception was ambiguous and still might interfere with a doctor’s decision, the court said. But the Idaho Supreme Court clarified the exception, and said it “means what it says,” the Ninth Circuit said.

Any ambiguity identified by the US or the district judge no longer exists, the court said. When a doctor decides that an abortion is necessary to save the pregnant person’s life, the abortion isn’t punishable under Idaho law, it said.

This is one of two cases testing the interplay between EMTALA and state abortion bans. Judge B. Lynn Winmill, of the US District Court for the District of Idaho, agreed with the US that there’s a conflict between the state and federal laws.

A federal district judge in Texas, however, accused the Biden administration of trying to impose its own views on abortion on states that had been given the go-ahead to regulate or ban the procedure by the US Supreme Court in June 2022. That decision is being reviewed by the US Court of Appeals for the Fifth Circuit, which has set oral arguments for Nov. 7.

The Justice Department represents the US. The Idaho Attorney General’s Office represents the state.

The case is United States v. Idaho, 9th Cir., No. 23-35440, 9/28/23.