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Federal Appeals Court Rules Emergency Rooms Not Mandated to Perform Abortions in Violation of State Laws

In a significant legal development, a federal appeals court ruled on Tuesday that federal regulations do not compel emergency rooms to conduct life-saving abortions if such procedures would conflict with state laws. The decision follows the overturning of Roe v. Wade in June 2022, prompting the U.S. Department of Health and Human Services (HHS) to issue guidance to hospitals, reminding them of their responsibility to provide stabilizing care, including medically necessary abortions, under the Emergency Medical Treatment and Labor Act (EMTALA).

The HHS guidance specified that when a state law restricts or prohibits abortion without including an exception for the life of the pregnant person, or if the exception is narrower than EMTALA’s definition of an emergency medical condition, the state law is preempted. Texas contested this, arguing that it amounted to a “nationwide mandate” for hospitals and emergency-room physicians to perform abortions, a stance supported by several anti-abortion medical associations.

Since the summer of 2022, nearly all abortions have been prohibited in Texas, except in cases where it is necessary to save the life of the pregnant patient. However, challenges have arisen in implementing the medical exception, with doctors and patients facing dilemmas amid the risk of severe legal consequences, including imprisonment and license revocation.

In November, a lawyer for the U.S. Department of Justice highlighted the need for ensuring care is offered as required by statute, particularly for individuals presenting emergency medical conditions in hospital emergency rooms. The HHS guidance aimed to address concerns about hospitals fulfilling their obligations under EMTALA, especially considering the limitations imposed by state laws.

In August 2022, a federal district judge in Lubbock sided with Texas, characterizing the guidance as a new interpretation of EMTALA. The judge granted a temporary injunction, later extended, prompting the 5th Circuit to hear arguments in November. During the hearing, judges expressed reservations about the expansive nature of the HHS guidance.

Tuesday’s ruling, authored by Judge Kurt D. Engelhardt, declined to broaden the scope of EMTALA. Englehardt emphasized that EMTALA does not provide an unqualified right for pregnant individuals to undergo abortions and does not mandate medical treatments, including abortion care. The court asserted that EMTALA does not preempt Texas law. This decision marks a significant legal development in the ongoing legal challenges following the overturning of Roe v. Wade.