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CNN
14 hours ago
- Health
- CNN
Trump administration's guidance on emergency care law adds to ‘chaos,' not clarity, in states with strict abortion laws, some doctors say
Abortion rights Maternal health Women's healthFacebookTweetLink Follow Federal guidance that the Trump administration says is intended to offer clarity is instead leaving health care providers even more confused about whether they can provide an abortion in an emergency, particularly in states with strict abortion laws. This month, the Trump administration rescinded 2022 federal guidance specifying that under the Emergency Medical Treatment and Labor Act, or EMTALA, people should be able to get an abortion if a medical emergency makes it necessary, even in states with laws that restrict such procedures. HHS and the Centers for Medicare & Medicaid Services said they would continue to enforce the federal law, specifying that the policy included emergency medical conditions that placed the health of a pregnant woman or her unborn child in serious jeopardy. Then, in a letter to health care providers last week, US Health and Human Services Secretary Robert F. Kennedy Jr. emphasized that under EMTALA, stabilizing care should be given to a person who is pregnant and having a medical emergency – but it doesn't specify what that care might involve. In the June 13 letter, Kennedy says that it was the 2022 memo that 'created confusion. But that is no more.' Some doctors beg to differ. It's unclear exactly what the recision of the previous guidance meant for emergency care, particularly in states with highly restrictive abortion laws, some doctors said. The latest letter doesn't mention abortion at all — and the absence of specifics is creating more uncertainty. 'I do think this just contributes to all of the chaos that clinicians are having to deal with as they just attempt to take care of the patient in front of them and navigate state laws and federal guidance to provide care for patients,' said Dr. Nisha Verma, a practicing obstetrician-gynecologist and senior adviser for reproductive health policy and advocacy at the American College of Obstetricians and Gynecologists, a professional organization that represents the majority of practitioners in the United States. 'It's not something you want to get wrong, because the consequences are so severe and it feels so scary.' Verma appreciates that the new letter from Kennedy clarifies that EMTALA is still the law of the land, even after the administration rescinded the 2022 guidance. But without a specific mention of abortion, she said, the nation's patchwork of laws makes it difficult for doctors to navigate emergency situations. Some of those state laws could even send doctors to jail if they make the wrong decision about when an emergency necessitates an abortion. 'I think it was helpful to specify abortion is covered under EMTALA' in the 2022 guidance, Verma said. 'I do think that having that language specifically in this really scary, chilling environment was helpful.' Dr. Alison Haddock, an emergency room doctor who is president of American College of Emergency Physicians, said she was happy that Kennedy's letter confirmed that pregnant patients need access to care and that it included examples of common problems like miscarriages, ectopic pregnancies and premature rupture of membranes. 'Those are some of the situations that have been really challenging for our physicians. Noting that those can represent an obstetric emergency where EMTALA would apply is really good to see,' Haddock said. But she added that the Trump administration's guidance does not clear up everything. 'I think physicians are still going to have issues with conflicting state law where they are still going to be left in a gray area of uncertainty about how to balance adhering to EMTALA and adhering to state law, and that's going to leave patients in the same place,' Haddock said. Trips to the emergency room are common for pregnant people, studies show. The majority of emergency providers say they treat pregnant patients in virtually every shift, according to the American College of Obstetricians and Gynecologists, and in some circumstances, treatment to protect a pregnant person's health or life may require an abortion. Pregnancy emergencies don't always happen during standard work hours, Haddock said, and the 'ability to convene the ethics committee at 2 a.m. is very limited, and then it can be a lot of layers to get through at the hospital.' Haddock said her association sent a letter to its members encouraging them to advocate for clearer guidance from their own hospitals. 'Achieving greater clarity on this is really important to make sure physicians feel like they have the protections they need to provide lifesaving medical care,' she added. Specifics have been important when it comes to EMTALA. When it became federal law in 1986, some hospitals refused to care for uninsured women in labor, so in 1989, Congress spelled out that pregnant people who were having contractions had to be given emergency care even if they couldn't pay for it. In 2021, guidance from the Biden administration added more specifics, saying it was a doctor's duty to provide stabilizing treatment that 'preempts any directly conflicting state law or mandate that might otherwise prohibit or prevent such treatment.' However, it wasn't until the 2022 guidance that it was spelled out that an abortion had to be provided when necessary. The Biden administration guidance was meant to eliminate confusion in states with anti-abortion laws that did not include an exception for the life or health of a pregnant person, and it stated that federal law preempted the state statutes in the case of such laws. That memo was issued just weeks after the US Supreme Court overturned Roe v. Wade, the 1973 ruling that gave pregnant people a constitutional right to an abortion. A case before the court last year would have clarified whether federal law requires health care services to provide access to emergency care in every state, regardless of abortion laws, but the high court sent it back to the lower courts. In March, the Trump administration dropped the lawsuit. Some legal experts interpreted that as a signal that the administration would not enforce EMTALA. Even when the 2022 guidance was in place, provider surveys in states that criminalized abortion found that doctors were operating in 'chaos and confusion,' said Payal Shah, director of research, legal and advocacy with the Physicians for Human Rights a Nobel Peace Prize-winning medical and human rights organization. Providers were still having a hard time determining whether EMTALA really would protect them if they had to perform an abortion, even in an emergency situation. 'Criminalization causes fear, and then clinicians feel paralyzed,' Shah said. 'They don't feel like they have the authority to make decisions about reproductive health care in line with their medical judgment and medical ethics and pregnant patients' preferences. Instead, it becomes a legal decision.' After the Dobbs decision removed the federal right to an abortion in 2022, some women died after doctors told them it would be a 'crime' to intervene in a miscarriage or they couldn't access timely medical care. Idaho's strict abortion law has led some doctors to tell pregnant patients that they should consider buying 'life flight insurance' in case a local hospital wouldn't be able to take care of a pregnancy complication. Rescinding the 2022 guidance will probably make stories like these more common, several experts said. 'Rescinding this guidance serves no purpose other than to try to strengthen or deepen that confusion,' Shah said. 'This is an attempt to gaslight the American public and to say that criminalization of abortion is working. Criminalization is not working, and that is something the evidence really shows.' Alexa Kolbi-Molinas, deputy director of the ACLU's Reproductive Freedom Project, interprets the new HHS letter to mean the law does require emergency abortion care, but she added that the administration's actions on the matter 'have been reckless at best and outright dangerous at worst.' 'The Trump administration is scrambling to clean up a mess entirely of its own making,' Kolbi-Molinas said in an email. 'The law has been clear for forty years: pregnant patients who go to a hospital in medical crisis must receive health- and lifesaving care, regardless of state law. If the administration had not rescinded the previous guidance reaffirming hospitals' obligations to provide this care earlier this month, there would have been no need to issue Friday's letter.' HHS did not respond to direct questions about what 'stabilizing care' meant and whether its interpretation of EMTALA included abortion as stabilizing care. Instead, a spokesperson for the agency sent a link to a June 4 message on X from Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. 'Don't believe the spin and fearmongering of the fake news,' the post said. 'The Biden Administration created confusion, but EMTALA is clear and the law has not changed: women will receive care for miscarriage, ectopic pregnancy, and medical emergencies in all fifty states- this has not and will never change in the Trump Administration.' 'To me, this question remains: Why won't they use the word 'abortion' if they really believe that abortion is sometimes part of emergency medical care for pregnant people? They won't do it,' said Rebecca Hart Holder, president of Reproductive Equity Now. 'If the Trump administration or Secretary Kennedy truly intended to reassure providers that abortion in the case of a medical emergency, is protected under EMTALA, they would have used those words explicitly as a qualifying example of emergency medical care,' Hart Holder added. 'I think it's a fair assumption to make that even more people are going to die when they're in emergency situations.' In the wake of Dobbs, the Kennedy letter presents another potential problem, said reproductive law expert Rolonda Donelson. 'In the letter, he mentions that EMTALA requires caring for the pregnant woman and their unborn child. Pre-Dobbs, that might not have meant much, but post-Dobbs, with the rise in fetal personhood in state abortion bans, it raises questions on whether the providers in these emergency departments have any duty to the unborn fetus and whether they can provide this emergency stabilizing care when it conflicts with their state abortion ban,' said Donelson, the Huber Reproductive Health Equity Legal Fellow at the National Partnership for Women & Families. 'This guidance does not provide any clarification. It increases chaos and confusion among patients, providers and everyone on whether they can go into an emergency department if they're experiencing a medical emergency and receive an abortion as necessary stabilizing care.' In March, concerned that even more clarity was needed, 88 lawmakers reintroduced a resolution that affirmed EMTALA protects access to emergency abortion care. But even if such a bill were to make its way through Congress, it's unclear whether Trump would sign it. In the absence of additional legislation, legal experts say, the confusion will continue placing an unfair burden on doctors and patients. 'It's unrealistic to have doctors who should be saving patient lives and doing all of those important things to try and also be lawyers and policy advocates and figure out the nitty gritty of what these things mean,' Donelson said. But it's important for patients to know, she said, that they should go to an emergency room if they are experiencing a medical emergency. 'The last thing I would want is a pregant person who is experiencing a medical emergency to think that they won't be able to get care at a hospital and forgo going and then something bad happen to them.'
Yahoo
7 days ago
- Health
- Yahoo
Our film imagined a post-Roe nightmare. Then it came true
When I first met Amy in the emergency room, she had a minor laceration on her finger. She claimed it was from an accident in the kitchen, but her cowering posture, downcast eyes and hesitant responses to basic questions suggested there was more to her visit than she was letting on. Amy reminds me of the girls I grew up with. Delicate, but exhausted and under pressure. She works long hours at a convenience store with a manager who offers no flexibility. Determined to save enough for college classes toward her degree, Amy has also shouldered the responsibility of supporting her mother, who has grown dependent on painkillers. She cleans homes to cover unexpected expenses, like becoming pregnant after a condom broke during sex, but she was unable to scrape together enough cash to purchase the morning-after pill. On June 3, the Trump administration revoked guidance that required hospitals to provide emergency abortions for patients in need. This national directive was issued in 2022 by the Biden administration, using the Emergency Medical Treatment and Active Labor Act (EMTALA), after the Supreme Court overturned Roe v. Wade, and it was intended to assist women facing medical emergencies and other serious complications. The Trump administration's action is just the latest salvo in an ongoing battle, one in which reproductive freedom seems to be losing ground every day. The mood, among both doctors and patients, is one of persistent uncertainty and fear. Here in the emergency room, Amy and I both feel it. The cut on Amy's finger was a ruse — a desperate act to access care. She is pregnant and doesn't want to be. But in our state, abortion is illegal. As an emergency physician, I tell her – quietly – that if she travels to another state, she can receive proper care. She'll need to budget a certain amount of cash for travel expenses. We keep this conversation between us. The possibility of this scene has become all too familiar a worry in real life, but the truth is that Amy isn't real. And I'm not really an emergency physician, I just play one in a movie. A few months after the Supreme Court overturned Roe v. Wade on June 24, 2022, while we were both still attending journalism school at New York University, my friend Nate Hilgartner approached me about a film he wanted to write and direct about the ethical implications of a post-Roe world. He had me in mind to play a doctor in a rural town torn between her duty to help her patient and the imperative to obey restrictive new laws. It would be an American horror story, he told me. At the time, it seemed prophetic but impossible, a bit of artful exaggeration to warn against a dystopian tendency. Today, it's our reality, and in some ways, things are worse. The consequences of a woman not receiving the reproductive healthcare of her choice could lead someone like our fictional protagonist to lose her ability to create a life on her own terms, trapping her in a cycle of poverty with a lack of education. In Georgia, a pregnant woman who has been declared brain-dead is being kept on life support until her baby can be delivered. Across the country, women have been turned away from emergency rooms after suffering ectopic pregnancies, which require an emergency abortion to prevent potentially fatal outcomes. Doctors have been reprimanded and fined, including Caitlin Bernard, an OB-GYN from Indiana, who performed an abortion on a 10-year-old rape victim denied an abortion in Ohio. Three years ago, all of this would have sounded like fiction, a fever-dream storyline out of The Handmaid's Tale. An investigation by ProPublica in December 2024 revealed that doctors in states with abortion bans often feel abandoned by lawyers and hospital leaders when seeking guidance on how to proceed with patients in emergencies. Since information about managing the bans in each state have been provided only on a 'need-to-know' basis, many doctors are left to navigate alternative options on their own, with some becoming too afraid to offer care, fearing professional and personal consequences. Sen. Ron Wyden (D-Oreg.) described the situation as doctors 'playing lawyer' and lawyers 'playing doctor,' leaving pregnant women facing life-or-death situations caught in the middle. Experts warn that the decision to eliminate access to emergency life-saving abortions will further exacerbate the crisis for doctors. The Trump administration's order to revoke emergency abortions sends a clear message to women who lack adequate resources to afford proper care. EMTALA, enacted in 1986, was designed to protect patients and ensure they receive stabilizing emergency care, regardless of their insurance status or ability to pay. While all pregnant women benefited from this law, it now appears that only those with sufficient health care and life circumstances will be able to survive potential emergencies. I am a writer and an actor, not a doctor. But for a time I imagined what it was like to be seated across from a woman scared and uncertain about the choices she could make about her body. Amy may not be real, but her plight is. Many of us may not admit it, but we've had our scares, moments where we've had to seriously consider the possibility of what we'd do if confronted with a pregnancy we weren't ready to have. At an age where I contemplate my own reproductive future, I am given pause: How can anyone assume there will never be complications in their pregnancy? Stories like Amy's aren't just about the right to make decisions about our bodies; they're also about the painful truth that those choices often come with a cost. When we set out to make this film, No Choice, we hoped to imagine a plausible future — not to prophesy our present reality. We could never have predicted just how quickly real-world headlines would not only validate our story, but outpace its darkest possibilities. Making a film was just one of many actions we hope other people will take to challenge the belief that a woman's body belongs to the state, not to herself. No Choice premieres in Los Angeles at the Dances With Films festival on June 23 — just one day shy of the third anniversary marking the fall of Roe v. Wade.
Yahoo
10-06-2025
- Health
- Yahoo
Despite Trump directive, emergency abortion care is still a legal right
In the days since the Trump administration rescinded federal guidance tied to the Emergency Medical Treatment and Labor Act, EMTALA, a wave of alarming headlines has swept across social media: 'Trump just made it legal for hospitals to let pregnant people die.' 'Emergency rooms can now refuse life-saving abortion care.' As a clinician, I know that isn't true. As a reproductive health strategist, I know those headlines are dangerous. And we all know what happens next: confusion, delay, and harm. Let's be clear — EMTALA is still in effect. The Emergency Medical Treatment and Labor Act requires hospitals to provide stabilizing emergency care to all patients, regardless of their ability to pay. That includes emergency abortion when it's the necessary treatment to prevent serious harm or death, even in states with abortion bans. What was rescinded is the Biden-era guidance — a post-Roe clarification that reinforced these obligations and gave clinicians added protections in legally ambiguous states. Without it, hospitals and providers are left to navigate complexity and risk on their own. And in emergency medicine, hesitation can be deadly. When a provider has to stop and ask, 'Will I get sued or arrested for doing what I know is right?' that delay can cost a life. Complications can escalate in minutes. And legal fear, not clinical doubt, can make even experienced clinicians pause. We don't need to wait for another preventable tragedy. We need to act now. We must correct the fear-based narrative and demand clarity and courage from our hospitals. More opinion: Elon Musk-Trump spat on X is a distraction from the failures of DOGE Well meaning advocates and organizations have flooded timelines with warnings suggesting emergency abortion care is no longer available. The fear is valid. But the messaging is misleading, and that matters. When headlines tell the public that hospitals are 'allowed to let women die,' we create a different kind of emergency — one rooted in mistrust. Patients internalize those messages. They begin to doubt the health care system. They wonder if anyone will help them. Some bleed at home instead of going to the ER. I've already heard from patients who are scared to seek emergency care because they believe hospitals will turn them away. That fear isn't irrational — it's the natural outcome of a system that has failed too many women, including Amber Nicole Thurman, who died in Georgia after being denied abortion care during a miscarriage. Her story is one of several that underscore just how high the stakes are. And it affects health care providers too. When social media, national news and even advocacy organizations circulate panic without context, our instinct is to pause and wonder if the legal ground has shifted again. In medicine, uncertainty delays care. And in emergency medicine, that delay can be fatal. Here's what's still true: EMTALA is still in effect. Hospitals are still required to provide abortion when it's the necessary emergency treatment. Patients still have the right to receive stabilizing care. But rights only matter if people trust they can use them, and clinicians can only act if they trust their institutions will back them up. We must sound the alarm, but we cannot afford to fuel panic. Because fear doesn't just spread — it paralyzes. And that paralysis costs lives. While courts and lawmakers dominate the headlines, we must remember that hospital systems are power players, too. They're institutions with boards, reputations, legal teams and responsibility. Every hospital in the U.S. — especially those in abortion-restricted states — should be urgently reviewing their EMTALA protocols, issuing clear guidance to staff and publicly affirming that abortion will be provided when medically necessary. Silence from leadership isn't neutrality. It's complicity — and it's deadly. Providers need to know they'll be protected for doing their jobs. Patients need to know their care won't be delayed by legal ambiguity. The moment of crisis is not the time to call a lawyer or fumble through a policy binder. Hospitals must act before the next emergency, not after. We have a constitutional mandate. Let's lead like it. In 2022, Michigan voters passed Proposal 3 by a wide margin, enshrining the right to reproductive freedom, including abortion, into our state constitution. That makes this moment even easier for our hospitals — a no-brainer, if you will. We have legal clarity. We have the public mandate. Now we have a responsibility to lead by example for the rest of the country. We've seen what happens when hospitals fail to lead. A ProPublica investigation in Texas found that after the state's abortion ban took effect, the sepsis rate among pregnant patients in Houston surged by 63%. In Dallas — where hospitals empowered doctors to act — it rose by just 29%. The difference? Hospital policy. Some institutions supported their clinicians. Others left them to weigh legal risk against patient safety. People suffered. Some died. Michigan's hospitals don't face the same legal barriers. We've enshrined reproductive rights into our constitution. The only question now is whether our institutions will rise to meet this moment — not just for Michiganders, but as a model for the nation. We have the opportunity to set a precedent of leadership. Of valor. Of honoring the Hippocratic Oath and protecting half of our population. This is a chance to show that when legal clarity and public support align, health systems don't hesitate — they lead. To Corewell Health, Henry Ford Health, Trinity Health Michigan, McLaren Health Care, Michigan Medicine and the Detroit Medical Center: this is your moment. Issue clear EMTALA guidance. Protect your providers. Affirm your commitment to emergency abortion care loudly and publicly. And to Gov. Gretchen Whitmer: Michigan has already set a national example by enshrining reproductive freedom into our state constitution. Now, we need your leadership again. Issue state-based guidance that reinforces EMTALA protections and directs hospitals to act swiftly and decisively when patients need life-saving abortion care. Then go one step further. Call on your fellow governors, especially in states where abortion is banned. Governors like Andy Beshear in Kentucky. If they said they were 'sending it back to the states,' then let's show them what the states can do. Let's show the country what leadership looks like when it centers care, not politics. Because silence is not safety, and neutrality is not leadership. More opinion: Democrats better hope Michigan Gov. Whitmer changes her mind about presidential run If you're reading this from another state, you're not powerless. Call your local hospital and ask if they have clear EMTALA guidance for emergency pregnancy care. Push your lawmakers to require transparency and protect providers. Share accurate information — panic spreads fast, but facts save lives. Support front-line providers who are navigating unclear laws with courage. Even without constitutional protections, your voice can demand clarity, accountability and care. Hospitals everywhere need to hear it. Nikki Vinckier is an OBGYN physician assistant, reproductive rights advocate and founder of Take Back Trust, a national patient education platform helping people navigate and protect their reproductive health care. This article originally appeared on Detroit Free Press: Emergency abortion still a legal right despite Trump move | Opinion
Yahoo
07-06-2025
- Health
- Yahoo
Trump stokes fear, confusion with pulled emergency abortion guidance
The Trump administration sowed confusion and fear among physicians with its move this past week to rescind Biden-era guidelines to hospitals that provide life-saving abortions. While the move doesn't change the law, doctors and reproductive-rights advocates fear it will have a chilling effect on health care workers in states with abortion bans, ultimately harming pregnant women. Earlier this past week, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced they would rescind guidance issued during the Biden administration, which reinforced to hospitals that under the Emergency Medical Treatment and Labor Act (EMTALA,) abortions qualify as stabilizing care in medical emergencies. Emergency rooms in states with abortion bans have been struggling since the 2022 overturning of Roe v. Wade to understand when they can legally provide emergency abortions. After President Trump pulled the Biden-era guidance seeking to clarify that question, emergency room doctors will experience 'more confusion' and 'more fear,' according to health and legal experts who spoke with The Hill. 'Clinicians are scared to provide basic medical care, and this care is clearly in line with medical ethics … medical standards of care, and they're being put in this situation where they can't win,' said Payal Shah, director of research, legal and advocacy at Physicians for Human Rights. Since the Supreme Court overturned Roe v. Wade in 2022, at least 13 states have enacted near-total abortion bans, according to data from the Guttmacher Institute. There are exceptions in these states when continuing a pregnancy poses a threat to the health or life of the mother. However, most of the language in state laws is unclear on how that determination is made, resulting in instances of emergency rooms denying care. Doctors in states like Idaho, Texas and Tennessee have filed lawsuits requesting that lawmakers clarify when an abortion is allowed to save the life of a pregnant person. The doctors and patients involved in the lawsuits argue that state laws do not adequately protect pregnant patients in emergencies. Many of these states have severe punishments for doctors who violate abortion bans, like steep fines and prison time. 'For clinicians, there is actually no safe way to navigate this in this moment, and ultimately, that's how these laws are designed,' Shah said. 'They're designed to cause chaos and confusion. They're often written in ways that don't use medical terminology.' Without clear guidance, pregnant women suffer and sometimes die, as ProPublica has reported. One striking example of this is the 2023 case of Kyleigh Thurman, a Texas woman who was repeatedly denied care for a nonviable pregnancy after days of experiencing bleeding and pain. Health care workers discovered that she had an ectopic pregnancy, which is when a fertilized egg implants and begins to grow outside of the uterus, usually in a fallopian tube. Ectopic pregnancies are never viable and are life-threatening if not treated properly. It wasn't until her OB/GYN 'pleaded to hospital staff that she be given care,' that the hospital administered a shot ending her pregnancy, according to a complaint filed by the Center for Reproductive Rights on behalf of Thurman. The shot came too late, and the ectopic pregnancy ruptured Thurman's right fallopian tube, which was then removed. 'If a patient is actively hemorrhaging or experiencing an ectopic pregnancy which is also life-threatening, doctors need that clear guidance that yes, EMTALA applied,' said Autumn Katz, associate director of U.S. litigation at the Center for Reproductive Rights. A federal investigation into Thurman's case found that the Texas hospital violated EMTALA, according to a recent letter from the CMS. 'I finally got some justice,' Thurman said in a statement. 'I hope this decision will do some good in encouraging hospitals to help women in situations like mine.' Hospitals that violate EMTALA are subject to heavy fines and, in some extreme cases, risk losing a portion of their Medicare and Medicaid hospital funding, according to the National Institutes of Health. Former President Biden leaned on the law to preserve access to emergency abortion across the country, leading to a legal fight with Idaho, which has a strict abortion ban. The Supreme Court last year dismissed the case, declining to rule on the merits of a politically charged case. The rescinding of these guidelines also means hospitals that violate the law will likely not be investigated as often as they were under previous administrations, according to Shah. That lack of punitive risk means that hospitals could be incentivized to deny life-saving care for patients. 'The standard of EMTALA is pretty high,' said Katherine Hempstead, senior policy adviser at Robert Wood Johnson Foundation. 'This kind of takes that layer of reassurance away, and it will make a lot of providers feel very vulnerable.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
The Hill
07-06-2025
- Health
- The Hill
Trump stokes fear, confusion with pulled emergency abortion guidance
The Trump administration sowed confusion and fear among physicians with its move this past week to rescind Biden-era guidelines to hospitals that provide life-saving abortions. While the move doesn't change the law, doctors and reproductive-rights advocates fear it will have a chilling effect on health care workers in states with abortion bans, ultimately harming pregnant women. Earlier this past week, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced they would rescind guidance issued during the Biden administration, which reinforced to hospitals that under the Emergency Medical Treatment and Labor Act (EMTALA,) abortions qualify as stabilizing care in medical emergencies. Emergency rooms in states with abortion bans have been struggling since the 2022 overturning of Roe v. Wade to understand when they can legally provide emergency abortions. After President Trump pulled the Biden-era guidance seeking to clarify that question, emergency room doctors will experience 'more confusion' and 'more fear,' according to health and legal experts who spoke with The Hill. 'Clinicians are scared to provide basic medical care, and this care is clearly in line with medical ethics … medical standards of care, and they're being put in this situation where they can't win,' said Payal Shah, director of research, legal and advocacy at Physicians for Human Rights. Since the Supreme Court overturned Roe v. Wade in 2022, at least 13 states have enacted near-total abortion bans, according to data from the Guttmacher Institute. There are exceptions in these states when continuing a pregnancy poses a threat to the health or life of the mother. However, most of the language in state laws is unclear on how that determination is made, resulting in instances of emergency rooms denying care. Doctors in states like Idaho, Texas and Tennessee have filed lawsuits requesting that lawmakers clarify when an abortion is allowed to save the life of a pregnant person. The doctors and patients involved in the lawsuits argue that state laws do not adequately protect pregnant patients in emergencies. Many of these states have severe punishments for doctors who violate abortion bans, like steep fines and prison time. 'For clinicians, there is actually no safe way to navigate this in this moment, and ultimately, that's how these laws are designed,' Shah said. 'They're designed to cause chaos and confusion. They're often written in ways that don't use medical terminology.' Without clear guidance, pregnant women suffer and sometimes die, as ProPublica has reported. One striking example of this is the 2023 case of Kyleigh Thurman, a Texas woman who was repeatedly denied care for a nonviable pregnancy after days of experiencing bleeding and pain. Health care workers discovered that she had an ectopic pregnancy, which is when a fertilized egg implants and begins to grow outside of the uterus, usually in a fallopian tube. Ectopic pregnancies are never viable and are life-threatening if not treated properly. It wasn't until her OB/GYN 'pleaded to hospital staff that she be given care,' that the hospital administered a shot ending her pregnancy, according to a complaint filed by the Center for Reproductive Rights on behalf of Thurman. The shot came too late, and the ectopic pregnancy ruptured Thurman's right fallopian tube, which was then removed. 'If a patient is actively hemorrhaging or experiencing an ectopic pregnancy which is also life-threatening, doctors need that clear guidance that yes, EMTALA applied,' said Autumn Katz, associate director of U.S. litigation at the Center for Reproductive Rights. A federal investigation into Thurman's case found that the Texas hospital violated EMTALA, according to a recent letter from the CMS. 'I finally got some justice,' Thurman said in a statement. 'I hope this decision will do some good in encouraging hospitals to help women in situations like mine.' Hospitals that violate EMTALA are subject to heavy fines and, in some extreme cases, risk losing a portion of their Medicare and Medicaid hospital funding, according to the National Institutes of Health. Former President Biden leaned on the law to preserve access to emergency abortion across the country, leading to a legal fight with Idaho, which has a strict abortion ban. The Supreme Court last year dismissed the case, declining to rule on the merits of a politically charged case. The rescinding of these guidelines also means hospitals that violate the law will likely not be investigated as often as they were under previous administrations, according to Shah. That lack of punitive risk means that hospitals could be incentivized to deny life-saving care for patients. 'The standard of EMTALA is pretty high,' said Katherine Hempstead, senior policy adviser at Robert Wood Johnson Foundation. 'This kind of takes that layer of reassurance away, and it will make a lot of providers feel very vulnerable.'
