Update on Dobbs and Obstetrical Care in Idaho

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Last week, following oral arguments in April, the U.S. Supreme Court dismissed the case United States v. Idaho and remanded the case back to the U.S. Court of Appeals.  Importantly, the decision also reinstated the prior injunction against Idaho’s prohibition of abortion under the Emergency Medicine and Active Labor Act (EMTALA), meaning that hospitals can once again perform abortion as part of medically necessary stabilizing care for patients presenting with emergent complications of pregnancy.

Since the Dobbs decision overturned federal protections on abortion, Idaho is currently one of 14 states with the most restrictive laws prohibiting abortion, except in cases of rape or incest or to save the life of a pregnant patient.  Shortly following the inception of Idaho’s laws in August 2022, the federal government sued Idaho under the premise that EMTALA preempted state law in cases of emergency, and that it requires hospitals to perform abortions as part of emergency medical care, if necessary to preserve the health of the mother.

In the federal case, the district court issued a preliminary injunction that allowed physicians working in hospitals to continue performing abortions, if necessary to prevent injury to pregnant patients with certain pregnancy-related complications.  That injunction was challenged but ultimately remained in effect until January 2024, when the U.S. Supreme Court took up the case and paused the injunction.  Therefore, from January until just last week, hospitals were barred again from performing abortions unless necessary to save the life of the mother.

This inability to perform abortions as part of the continuum of care for obstetrical complications has led to patient transfers, workarounds, and concerns about violations of standards of care and the potential loss of life for pregnant patients presenting with certain emergent conditions.

Again, the reinstatement of the EMTALA injunction means that hospitals can currently perform an abortion if necessary to protect the health of the mother, in addition to saving her life, if the patient presents with an emergent medical condition or in active labor.  This may change again pursuant to the decision of the U.S. Court of Appeals, which has not yet announced the next hearing date.

Meanwhile, Idaho and other states with restrictive abortion laws continue to lose obstetricians.  A February 2024 study by the Idaho Well Being Action Collaborative revealed that Idaho lost 22% of its practicing obstetricians in the 15 months following the post-Dobbs abortion bans.  In the same time period, 55% of maternal fetal medicine specialists left the state, leaving only five practicing MFM specialists in the entire state.  The study noted that nearly 85% of the remaining Ob/Gyns practice in the seven most populous counties of Idaho, leaving 22 out of 44 counties without any practicing obstetricians at all.  In recent months, three critical access hospitals have closed their Labor and Delivery Departments due to staffing shortages.

MIEC will continue to our members updated on this important topic.