I’m an emergency physician. Pro-life laws don’t threaten my patients.

I am a practicing emergency physician in Texas. My primary practice location is in a high volume, urban, community ER attached to a hospital providing women’s services, i.e. obstetrics. 20-30% of my daily practice is acute-care obstetric triage and treatment prior to 20 weeks, as well as undifferentiated walk in patients beyond 20 weeks with non-obstetrical complaints or unsure dates.  

On Monday 7/11/22, the Secretary of Health and Human Services Xavier Beccera felt obligated to release this statement to emergency physicians and healthcare service providers that contract with CMMS (Center for Medicare and Medicaid Services). The statement reminds them that there are life threatening emergencies associated with pregnancy. No surprises here. Sometimes these conditions require treatment that end the pregnancy (such as removal of ectopic pregnancy). Again, not a great shock to those of us in emergency care. The statement goes on further, placing emergency obstetrical care in the context of Dobbs v. Jackson Women’s Health Organization by explicitly tying abortion services to CMMS funding and the Emergency Medical Treatment and Labor Act, which can levy heavy fines to physicians and hospitals that don’t provide appropriate emergency care. 

For context, the Emergency Medical Treatment and Labor Act (EMTALA) was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to ensure that hospitals and on call physicians did their duty to stabilize and treat patients experiencing medical emergencies or active labor according to their capacity and capability. They are to do this regardless of the patient’s ability to pay, insurance status, or prior relationship with physicians at that facility. It covers all hospitals that provide emergency services and participate in the Medicare and Medicaid programs (the vast majority of hospitals).  In effect, it means that if you go to a given hospital, the emergency department staff is obliged, no questions asked, to provide the following:

1. A Medical Screening Examination (MSE) to determine if you have an emergency medical condition. This exam may include only an interview and exam by a designated nurse, non-physician provider, or physician, or could include lab work, X-rays, and CT scans depending on the condition and the capabilities of the facility.
2. Stabilization, treatment, and possible transfer according to the facility’s ability if an emergency condition or active labor is found. 

In essence, this means that a facility or physician cannot refuse to see someone if a patient is uninsured, cannot dump a patient they COULD take care of on another facility, and are obligated to stablize any condition within their capability prior to any necessary transfer. Enforcement includes fines of $119,000 to facilities, $119,000 to individuals, and loss of participation in CMMS insurance/reimbursement programs. You would think a law like this wouldn’t be necessary, but one of the first cases of its enforcement occurred not too far from my current city in Victoria, Texas in December of 1986. Essentially, an on call OBGYN refused to deliver a laboring patient Ms. Rosa Rivera (who was likely also experiencing preeclampsia) because of her lack of insurance and had her transferred to a facility 170 miles away. She delivered en route and  had major complications. EMTALA protects patients like Ms. Rivera from discrimination and ensures they get the care they need regardless of ability to pay. It also prevents private and for-profit hospitals from dumping uninsured patients they COULD take care of on county or charity facilities because they can’t pay. 

What does all this have to do with abortion? I’m asking myself the same question. I’m an emergency physician. I live and breathe EMTALA. I have to know it better than anybody in the hospital because, as this article correctly states, I could face a potential $119,000 personal fine if I don’t follow federal law. All state abortion laws to my knowledge allow exceptions in situations where the death of the unborn child, whether direct or indirect, is necessary to save the life of the mother (ectopic pregnancy, chorioamnionitis, chemotherapy for GYN cancer, etc.). Even the notoriously pro-abortion Guttmacher Institute notes that all extant state laws restricting abortion provide exceptions to protect the life of the mother. By even MAKING this statement, the Biden administration is pressuring patients, emergency physicians, and hospitals to view the demand for abortion as an emergency condition. I have delivered laboring mothers in an ER 10 minutes from the local OB center because to transfer a dilated patient in active labor would be an unstable transfer: risking major deterioration or birth complications en route. I have no problem treating ectopic pregnancy, and unfortunately I both treat and refer for treatment of ectopic pregnancy not-uncommonly. I treat the early stages of chorioamionitis and preeclampsia. I have even referred a patient to a regional center to have what can only be described as an abortion for a cervical ectopic(they had to kill the baby prior to surgery) because the improperly implanted baby was literally causing the mother to bleed to death. All of this while practicing in a state with one of the strictest abortion laws, even before Dobbs, and primarily in a faith-based hospital system that prohibits elective abortion and elective sterilization procedures. 

I have not once felt like I could not do the right thing medically for my patients. I have never felt that these restrictions put the mother’s life in danger. I still feel this way after Dobbs and I will continue to do the right thing for BOTH my patients in the case of pregnancy. To evoke EMTALA, a law that is very poorly understood even among physicians, in the context of elective abortion is fearmongering, plain and simple. I must confess that I often in practice use even the suggestion of an EMTALA violation to advocate that my patients get the care they require. It scares on call physicians and hospital administrators and rightly so. Providing a vague threat of fines and lengthy litigation at the federal level in reference to a Supreme Court decision that has NOTHING TO DO with life saving emergency care is pandering to the pro-abortion base.  It further plays into the false narrative peddled by abortion advocates of pregnancy as a hostile, dangerous condition that can be “corrected” with the right medication or procedure. A healthy pregnancy does not require an abortion as emergency treatment, full stop. The vast majority of incomplete miscarriages, early ectopic pregnancies, and pregnancies complicated by chromosomal abnormalities do not require emergency intervention as covered by EMTALA, and so to imply that a sudden lack of necessary obstetric services will now follow without HHS intervention is not at all true to real practice. I will continue to practice as I always have, with respect for the dignity of all human beings. I would kindly ask that HHS and the Biden administration extend the courtesy they have ironically asked of pro-life citizens and organizations throughout the nation: keep your ideology out of my physician-patient relationship. 

[Photo credit: Patty Brito on Unsplash]

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