Texas Sues Biden Administration: How EMTALA Prevents ‘Patient Dumping’ in a Post-Roe World


By difficult EMTALA, Texas is signaling that it’s okay with affected person dumping—particularly when these sufferers are pregnant.

Abortion rights demonstrators collect close to the State Capitol in Austin, Texas, June 25, 2022. (Picture by SUZANNE CORDEIRO/AFP through Getty Photographs)

Within the weeks following Dobbs v. Jackson Girls’s Well being Group, the case overturning Roe v. Wade and the constitutional proper to abortion, the worst fears of reproductive advocates turned actuality. Set off bans outlawing abortion providers went into impact across the nation. A few of these bans didn’t comprise exceptions for “life” or “well being.” 

And, even the place there have been exceptions, physicians expressed confusion about tips on how to interpret them. How shut does a lady have to be to demise earlier than an abortion could be authorized? A minimum of one study has already proven an uptick in maternal morbidity as physicians struggled with when to intervene in a lady’s miscarriage. Many anecdotal and journalistic accounts of ladies struggling poor care within the context of an abortion or miscarriage at the moment are circulating, with extra tales anticipated to floor within the coming days, months and years.

In response to this disaster, one of many measures taken by the Biden administration was to spotlight the position of the Emergency Medical Treatment and Labor Act (EMTALA). This legislation, handed by the Reagan administration, states that any hospital that acquired Medicare funds should display and stabilize sufferers for emergency medical circumstances no matter whether or not or not a affected person may pay. The legislation was enacted, not less than partially, to forestall “patient dumping”—leaving sufferers with out care on the door of the hospital.

EMTALA has implications for the present abortion panorama as a result of sufferers who’ve tried abortion or who’re going through a life or well being threatening downside with regard to their being pregnant might present up at an emergency room. Following Dobbs, Well being and Human Companies (HHS) clarified that if a doctor believes a pregnant affected person has an emergency medical situation, as outlined by EMTALA and that an abortion is critical, the doctor ought to present that remedy even the place state legislation contravenes. For instance, if a pregnant particular person goes to a hospital emergency room with an ectopic being pregnant, they may probably want an instantaneous abortion. But when a state legislation doesn’t permit abortions even when the mom’s well being or life are in danger, HHS means that the doctor act to offer the particular person the care they want and the doctor could be protected by EMTALA.

In issuing this steerage, HHS was doing what they need to be doing—defending the lives and well being of pregnant Individuals within the context of institutional failure to guard pregnant individuals on the highest ranges. However they’re going through opposition. 

In line with the exhausting line taken by Texas on abortion, Lawyer Basic Ken Paxton filed a go well with difficult this EMTALA steerage. The go well with argues that the “observe of drugs or the style during which medical providers are offered” can’t be dictated by the federal authorities. The go well with additionally argues that EMTALA doesn’t preempt state or native legislation. The suggestion that it’s the Texas abortion ban that’s making it potential for suppliers to make the very best care is patently false as it’s tying the arms of suppliers and placing sufferers in danger. 

Whereas it isn’t shocking that Texas challenged EMTALA, from the angle of caring for pregnant individuals in Texas, the problem is a sign that they proceed to be keen to sacrifice emergency look after pregnant sufferers. And as this backwards and forwards continues, each physicians and sufferers are left within the crosshairs. Because the HHS steerage suggests, physicians can use EMTALA as a protection to a state enforcement motion or they might deliver a federal go well with, however this requires an amazing deal from physicians who’re targeted on offering providers—typically life-saving providers—within the emergency room setting. Sufferers who discover themselves on this state of affairs, typically scared for their very own well being and life, might now discover that their suppliers are too afraid to offer them the care that their greatest medical judgement suggests. 

There may be little doubt that the denial of care will already contribute to Texas’ hovering charges of maternal morbidity and mortality.  

The case additionally represents ongoing challenges for the continued battle to entry abortion. Because the Biden administration seeks to do extra, even with the cautious approach that they’ve taken, they face challenges by conservative management keen to undermine individuals’s lives and well being. Most of the individuals who might be immediately impacted are Black or Latina, immigrants or dwelling in poverty. There may be little doubt that the denial of care will already contribute to Texas’ hovering charges of maternal morbidity and mortality.  

To make sure, EMTALA will not be an ideal resolution. Its constraints have been documented by many together with the American College of Emergency Physicians who’ve famous that a few of this mandatory care would possibly create monetary pressure on emergency rooms. Regardless of this, EMTALA is a robust assertion in opposition to “affected person dumping” and for an individual’s entry to healthcare within the midst of a well being disaster. Difficult HHS’s statements that individuals get the care they want in emergency rooms, Texas is signaling that it’s okay with affected person dumping, particularly when these sufferers are pregnant.

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