Health Law

Federal guidance on stabilizing emergency abortions can't be enforced in Texas, 5th Circuit says

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5th Circuit Court building Wikimedia Commons

The 5th U.S. Circuit Court of Appeals at New Orleans has ruled for Texas in its challenge to federal guidance interpreting the Emergency Medical Treatment and Active Labor Act, known as the EMTALA. Photo by Infrogmation, CC-BY-SA-3.0, via Wikimedia Commons.

A federal appeals court ruled Tuesday that the federal government can’t enforce guidance in Texas that requires hospitals to provide stabilizing emergency abortions to prevent serious jeopardy to a patient’s health in emergency situations.

The 5th U.S. Circuit Court of Appeals at New Orleans ruled for the state of Texas in its challenge to federal guidance interpreting the Emergency Medical Treatment and Active Labor Act, known as the EMTALA. The federal law applies to hospitals that receive Medicare funds.

The appeals court said the guidance “exceeds the statutory language” and “goes beyond EMTALA by mandating abortion.” The guidance alters a substantive legal standard, and it should have been subject to notice and comment, as required by the Medicare Act, the 5th Circuit said in a Jan. 2 opinion by Judge Kurt D. Engelhardt.

The appeals court upheld an injunction barring enforcement of the guidance in Texas and against members of two organizations that joined Texas to challenge the law. The two groups are the American Association of Pro-Life Obstetricians & Gynecologists and Christian Medical & Dental Associations.

Reuters, Bloomberg Law and Courthouse News Service are among the publications with coverage. How Appealing linked to additional coverage.

The EMTALA requires necessary stabilizing treatment for an emergency medical condition regardless of a patient’s ability to pay. The law defines an emergency medical condition as a condition that, without medical treatment, could reasonably be expected to result in serious impairment to bodily functions, serious dysfunction to any bodily organ, or serious jeopardy to the health of the patient (or in the case of a pregnant person, the health of the person or their unborn child).

The guidance issued by the Biden administration states that a physician must perform an abortion if a pregnant patient has an emergency condition as defined by the EMTALA, and abortion is the necessary stabilizing treatment. The guidance states that state law is preempted if it categorically bans abortion or if the state law has a lifesaving exception that is more narrow than the EMTALA’s definition of an emergency medical condition.

But the EMTALA “does not govern the practice of medicine,” the appeals court said. “While EMTALA directs physicians to stabilize patients once an emergency medical condition has been diagnosed,” the 5th Circuit said, “the practice of medicine is to be governed by the states.”

The Texas abortion ban, known as the Human Life Protection Act, bans abortions unless the pregnancy “places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function.”

The Texas law does not directly conflict with the EMTALA, the appeals court said, because it “does not stand in the way of providing stabilizing treatment for a pregnant woman or the unborn child.” The EMTALA requires hospitals “to stabilize both the pregnant woman and her unborn child.”

“EMTALA does not provide an unqualified right for the pregnant mother to abort her child especially when EMTALA imposes equal stabilization obligations,” the appeals court said.

The case is Texas v. Becerra.

It follows a Texas Supreme Court ruling last month that held that a woman whose fetus has a genetic abnormality that is nearly always fatal can’t get an abortion under Texas law.

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