As expected after the court said it inadvertently uploaded the opinion prematurely on Wednesday, the U.S. Supreme Court issued a decision Thursday remanding a case about emergency abortions in Idaho back to the Ninth Circuit Court of Appeals for now.
The decision was 6-3, with conservative Justices Samuel Alito, Neil Gorsuch and Clarence Thomas dissenting. It was issued “per curiam,” meaning there is no lead author of the overall opinion.
Idaho’s OB-GYN exodus throws women in rural towns into a care void
The justices affirming the decision wrote that they determined the court took the case too early in the process. It granted the request to hear the case in January before the Ninth Circuit Court of Appeals could hold its own hearing on an injunction that blocked enforcement of the law against emergency room physicians who might need to perform an abortion to prevent a pregnant patient from experiencing significant health effects from infection or other conditions.
The federal government argued Idaho could not enforce its criminal abortion ban in emergency rooms because it would violate a federal law known as the Emergency Medical Treatment and Labor Act, or EMTALA, which requires Medicare-funded hospitals to treat patients who come to an emergency room regardless of their ability to pay.
Idaho’s abortion laws and emergency room physicians
When justices agreed to hear the case, the court also dropped the injunction, leaving doctors in Idaho open to prosecution under its criminal abortion ban, which carries penalties of jail time, fines and the loss of a medical license. Idaho’s civil law also allows immediate and extended family members to sue the doctors for up to $20,000 over an abortion procedure.
Idaho’s ban contains only an exception to save the pregnant patient’s life, not to prevent detrimental health outcomes, including the loss of future fertility, which is a risk with severe infection or bleeding. Without further clarity written into the law, doctors have said they can’t confidently assess when to safely intervene to save someone’s life.
Rather than take the chance, high-risk obstetric specialists have airlifted patients to a facility out of state that can freely perform the procedure before it’s too late. In 2023, the state’s largest hospital system said at their facilities such transfers happened once, but occurred six times between January and April, when the injunction was lifted.
Justice Amy Coney Barrett, who is typically conservative in her rulings, said the court’s decisions to hear the case and drop the injunction were premised on the belief that Idaho would suffer “irreparable harm” under the injunction and that the cases were ready for the court’s immediate determination. She wrote that the briefings and oral argument in April shed more light on the case, and made it clear that conscience objections were covered under EMTALA and other concerns about an interpretation that would include emergency mental health concerns did not apply.
“I am now convinced that these cases are no longer appropriate for early resolution,” Barrett wrote.
Dr. Caitlin Gustafson, president of a group of Idaho physicians who have spoken out against the ban and submitted a brief to the court in the case, said the decision is not the end of her coalition’s work.
“We are relieved by the Supreme Court’s decision,” Gustafson said. “However, this ruling addresses only a small part of the ever-increasing barriers across the health care landscape. The coalition remains committed to advocating for comprehensive policy updates to fill the gaps in health care access created by Idaho’s restrictive laws, which jeopardize patient safety. We will not relent until private health care decisions are once again at the discretion of patients and their physicians, free from political interference.”
Ahead of the decision, more than 6,000 doctors from around the country also appealed to the court to protect ER physicians, along with medical professionals in Idaho and advocacy organizations.
The case now returns to the Ninth Circuit to resume the process, but it could ultimately return to the Supreme Court at a later date.
Idaho officials and groups react to ruling
Idaho Democratic Party Chair Lauren Necochea: “This ruling provides a temporary sliver of relief to patients facing dire medical emergencies and the doctors and nurses who desperately want to treat them without risking a prison sentence. It does not change that the Idaho Republican supermajority has completely yielded to the anti-abortion hardliners. Patients with a non-emergency health threat, patients with a nonviable pregnancy, rape victims who will almost always be unable to meet the paperwork requirements, and any woman who simply does not want to carry a pregnancy will have no options unless they have the means and time to travel out of state.”
Idaho Attorney General Raúl Labrador: “… Today, the court said that Idaho will be able to enforce its law to save lives in the vast majority of circumstances while the case proceeds. The Biden administration’s concession that EMTALA will rarely override Idaho’s law caused the Supreme Court to ask the 9th Circuit for review in light of the federal government’s change in position. Justice Barrett wrote those concessions mean that Idaho’s Defense of Life Act ‘remains almost entirely intact.’ The 9th Circuit’s decision should be easy. As Justice Alito explained well: The Biden administration’s ‘preemption theory is plainly unsound.’ I remain committed to protect unborn life and ensure women in Idaho receive necessary medical care, and I will continue my outreach to doctors and hospitals across Idaho to ensure that they understand what our law requires. We look forward to ending this administration’s relentless overreach into Idahoans’ right to protect and defend life.”
Dr. Megan Kasper, an OB-GYN practicing in Canyon County, and chair of the Idaho Medical Association Reproductive Health subcommittee: “We still need more clarity for our state’s doctors. Even with the court reinstating EMTALA protections, Idaho’s restrictive abortion laws create confusion about whether necessary care is legal care. No Idaho woman should be forced to leave the state to get the care she needs.”
Planned Parenthood Great Northwest Hawai‘i, Alaska, Indiana, Kentucky including Idaho CEO Rebecca Gibron: “For now, we can take a collective sigh of relief for pregnant people in Idaho. But the truth is that access to life-saving abortion care in an emergency should never have been in doubt. The fact that this right remains in legal limbo is outrageous and shameful. Protecting pregnant people in emergency situations is the bare minimum this court could do, and yet they kicked the decision down to a lower court. Two years after the fall of Roe v. Wade, we are seeing just how serious the dangers are to patients’ lives and health without the right to abortion. To patients in Idaho, we know how important it is that health care options remain available and accessible to you when you need them most, including emergency abortion care. We won’t stop fighting for our patients.”
U.S. Sen. Jim Risch, R-Idaho: “When the Supreme Court released its decision in Dobbs in 2022, the court returned the power to determine abortion laws to the states. That is exactly what Idaho chose to do with our strong pro-life legislation. With legislative leaders in the Gem State, we will continue to fight to protect the lives of the unborn, women, and families.”
Susie Keller, Idaho Medical Association CEO: “We need a clear maternal health exception in Idaho’s abortion ban because physicians are leaving, patients are suffering, and the inability to replace these doctors is putting our entire health care system at risk. We have to stop digging this physician workforce hole that will take years, if not decades, to backfill.”
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