Let Texas doctors provide crucial emergency care

Physician organizations warn that pregnant patients will suffer and potentially die, or experience life-long complications, if the US 5th Circuit Court of Appeals does not overturn a preliminary injunction preventing doctors from providing emergency care for abortion when they deem it medically necessary to stabilize a patient.

In the wake of Dobbs decision last year, the US District Court for the Northern District of Texas issued preliminary injunction temporarily blocking the federal government’s guidance that the Emergency Medical Treatment and Active Labor Act (EMTALA) protects physicians and other health professionals who provide abortion assistance in emergency situations to save the life or health of the patient.

A 2021 Texas law bans nearly all abortions after about six weeks of gestation and allows private parties to bring civil suits against anyone who performs or aids and abets an abortion.

In an amicus brief, the AMA, the American College of Emergency Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Public Health Association and the Society for Maternal-Fetal Medicine urge the court of appeal to vacate the preliminary injunction in the case, State of Texas et al. see Becerra et al.

The organizations explained how EMTALA has been understood and applied in emergency medicine since it was enacted in 1986 and described the role abortion care plays in providing the stabilizing treatment EMTALA requires.

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If a physician concludes that abortion is the stabilizing treatment needed, refusing such care is and always has been directly contrary to EMTALA’s mandate and basic principles of medical ethics, the brief states. The district court was therefore wrong to suggest that the guide sets new requirements or interprets EMTALA in a new way. It simply acknowledges the reality of emergency medicine and reassures physicians that they can follow their professional obligations and federal law without conflicting with state laws.

Any other interpretation amounts to a new, dangerous and unworkable constraint on how emergency medicine is practiced. Indeed, the AMA and others told the court, the impact of state laws limiting the judgment of physicians in emergency medicine is already being seen.

One of the first analyzes found that after Texas laws banned abortion after cardiac activity and criminalized the provision of abortion drugs after seven weeks even in emergency situations, maternal morbidity nearly doubled for cases involving premature rupture of membranes in two Texas hospitals.

3 ways the lower court got it wrong

The brief tells the US 5th Circuit Court of Appeals that the Federal District Court misunderstood these three key aspects of EMTALA and how emergency medicine is practiced in its decision to issue a preliminary injunction.

There is no difference between emerging conditions and probable emerging conditions. The District Court ruled that the federal guidance was broader than EMTALA and conflicts with Texas law because the Guidance states that an abortion can be requested for emergency medical conditions that may become emergent, while [Texas law] requires the condition to be present.

But the brief explains that this is incorrect because there is no meaningful distinction between an emergency medical dentition that is currently emerging and one that is likely to become emerging.

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Government guidance does not require doctors to perform, assist with or refer patients for elective abortions. The district court wrongly credited the plaintiffs’ concern that driving requires doctors to participate in or assist in elective abortions, doctors tell the court.

The brief states that EMTALA and the guidance are clear that if an individual physician treating a patient does not believe an abortion is needed to stabilize the patient, they are not required to provide one.

An incomplete medical abortion is no different from any other condition that may require emergency surgery. Here, the friends say the district court blatantly misunderstood the Guidance’s statements about incomplete abortions and would have effectively discriminated against emergency patients based on the source of their condition.

For example, patients with car accidents are not asked if they were speeding and patients with gunshot wounds are not asked what they were doing when they received the wound. Medical ethics do not permit such a dangerous practice and EMTALA would override any state law that requires it, the brief said asking the court to override the preliminary injunction.

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