Medical Emergencies & Access to Abortion Care

The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals that receive Medicare funds to treat and stabilize anyone who presents with an emergency medical condition, regardless of their ability to pay. If the hospital is not equipped to provide treatment, it must arrange a transfer. The U.S. Department of Health and Human Services (HHS) underscored that EMTALA requires hospitals to offer abortion care to stabilize a pregnant person in an emergent situation and reaffirmed this position in a letter to health care providers. Nevertheless, in states that have banned access to abortion care, some are testing, and even violating, this federal protection. SMFM has been providing expert input in court filings supporting efforts to protect clinicians’ ability to provide necessary and life-saving health care to patients experiencing obstetric emergencies. Learn more about this work below.

SMFM members with questions regarding EMTALA should consult with counsel or contact the Abortion Defense Network, a coalition of attorneys and legal organizations that can provide legal advice, resources, and assistance in evaluating a range of legal issues for providers in a post-Roe landscape.

SMFM JUDICIAL ADVOCACY

Idaho: In March 2022, Idaho passed a near total ban on abortion care. The federal government sued the state to block enforcement of the ban, citing the conflict with EMTALA. In August 2022, SMFM joined the American College of Obstetricians and Gynecologists (ACOG), the American College of Emergency Physicians (ACEP), and several other medical societies to file an amicus brief in support of the federal government detailing the life-saving nature of abortion care. A federal judge temporarily blocked a portion of the Idaho law that would criminalize clinicians who perform abortions in medical emergencies. The Ninth Circuit will hear argument on January 23, 2024.

Texas: In July 2022, Texas filed a lawsuit against HHS asserting that the HHS EMTALA guidance did not provide a basis for the federal government to compel clinicians to offer abortion care. In response, SMFM joined ACOG, ACEP, and the American Medical Association to file an amicus brief explaining the importance of the federal law requiring clinicians to provide stabilizing medical care, including abortion care, to patients experiencing medical emergencies. In August 2022, a federal judge agreed with the State of Texas, temporarily blocking the HHS EMTALA guidance. HHS appealed the ruling, and again, SMFM joined partner organizations in filing an amicus brief detailing how Texas and the lower court misunderstood EMTALA and the realities of emergency medical care. In January 2024, the Fifth Circuit held that EMTALA did not conflict with Texas' abortion ban. HHS now has until April 1, 2024 to ask the Supreme Court to take the case. 

FEDERAL AGENCY ACTIVITIES

In 2022, HHS issued guidance and a letter from Secretary Becerra reaffirming that EMTALA requires clinicians to offer necessary stabilizing care for patients suffering emergency medical conditions, including abortion care.

An investigation led by the Centers for Medicare and Medicaid Services (CMS) found that hospitals in Missouri and Kansas violated EMTALA for failing to provide emergency abortion care to a patient following preterm premature rupture of membranes (PPROM). HHS can penalize both hospitals and individual clinicians who are found to have violated EMTALA. Following the investigation, Secretary Becerra issued an open letter to hospitals and health care providers reinforcing EMTALA obligations under federal law.  

SMFM’s support for reproductive rights and freedom is unwavering. Learn more about our efforts to protect and expand access to abortion care, review clinical resources, and see how you can get involved at SMFM.org/repro. Questions? Contact RHProject@smfm.org.