Texas judge rules against HHS guidance regarding EMTALA and abortions

In granting a temporary injunction, a federal judge in Texas ruled that physicians cannot be required to perform abortions under the Emergency Medical Treatment and Active Labor Act (EMTALA). The ruling also means that physicians will not be protected for violating state law when performing an illegal abortion.

“That [HHS] guidance goes well beyond EMTALA’s text, which protects both mothers and unborn children, is silent as to abortion, and preempts state law only when the two directly conflict. Since the statute is silent on the question, the guidance cannot answer how doctors should weigh risks to both a mother and her unborn child. Nor can it, in doing so, create a conflict with state law where one does not exist,” US District Court Judge James Wesley Hendrix wrote in his ruling. The ruling came in a challenge to Department of Health and Human Services (HHS) guidance released in July,  reminding hospitals of their obligations under EMTALA to help pregnant patients who are experiencing a medical emergency, including pregnancy loss, but with an added emphasis that care must be offered “irrespective of any state laws or mandates that apply to specific procedures.” The memo was seen by many as one way the Biden administration was pushing back against the overturning of Roe v. Wade.

The guidance stated: “If a physician believes that a pregnant patient presenting at an emergency department is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment. When a state law prohibits abortion and does not include an exception for the life of the pregnant person—or draws the exception more narrowly than EMTALA’s emergency medical condition definition—that state law is preempted.”

Days after the guidance was released, the state of Texas sued, claiming the memo was an attempt to get around the Supreme Court ruling, which held that each state should be able to decide when or if abortions are allowed. Texas has one of the most restrictive laws against abortion. The ruling bars the guidance from being enforced in Texas.