Idaho hospital moves forward with emergency abortion care case despite DOJ dismissal

On the same day the U.S. Department of Justice moved to dismiss the federal case that will determine whether emergency abortion care in Idaho is subject to prosecution under the state abortion ban, a federal court held the first hearing for a new version of the case filed by the state’s largest health system. 

St. Luke’s Health System anticipated the government would drop the case, which former Democratic President Joe Biden’s DOJ filed in 2022, shortly after the U.S. Supreme Court overturned Roe v. Wade. St. Luke’s sued the state of Idaho in January shortly before Republican President Donald Trump was inaugurated, arguing that the state’s near-total abortion ban is in conflict with federal law. The Emergency Medical Treatment and Labor Act, also known as EMTALA, requires hospitals that accept Medicare funding to provide stabilizing treatment to those seeking emergency care.

At the core of the argument is whether federal law takes precedence over state law in this situation, when care that would prevent detrimental health effects includes a procedure that the state has outlawed almost entirely. Doctors have said emergency abortion can become necessary when a pregnant person’s water breaks before the fetus is viable, when high blood pressure is not responding to medication, and when other conditions make continuing a pregnancy too risky.

U.S. District Judge B. Lynn Winmill, appointed by former President Bill Clinton, presided over Wednesday’s hearing, just as he presided over the DOJ case for the past two years. Winmill issued a preliminary injunction early on in that case to block Idaho from prosecuting physicians for terminating a pregnancy in a medical emergency. St. Luke’s has asked the court to grant a new injunction in their case to maintain that protection, and Winmill granted a temporary restraining order on Tuesday.

Attorneys for St. Luke’s have said they don’t want any gaps in that protection, because for three months in 2024 when the injunction was not in place, six patients were airlifted out of state because they might have needed to end their pregnancies to preserve their health. That situation only came up once in the entire year before.

Idaho Attorney General Raúl Labrador’s office has asked Winmill to dismiss the case, arguing there is no conflict between Idaho’s abortion law and EMTALA, and maintaining that the abortion ban protects “both the mother and their unborn child.”

Winmill said for the first time in his judicial career, he listened to the U.S. Supreme Court arguments when the court heard the DOJ case in April 2024. He also listened to the 9th Circuit Court of Appeals hearing after the Supreme Court sent it back to the appellate level for further review instead of making a decision.

“I haven’t heard anything that suggested to me that I am swimming upstream in terms of what my decision was,” Winmill said. “But of course, this case presents somewhat different circumstances.”

Idaho’s abortion ban applies to any stage of pregnancy, and only contains exceptions for documented rape and incest victims, and to save a pregnant patient’s life. There is no exception for preventing detrimental health effects, which include organ damage and potential loss of fertility.

Doctors have said it is too difficult to determine at what point a medical condition becomes life-threatening enough to prevent them from being charged with a felony under the ban, which calls for two to five years in prison and the loss of the physician’s medical license. 

Maternal-fetal medicine specialist Dr. Stacy Seyb told States Newsroom in April that in some cases, termination is not necessary, but there’s no way of knowing that immediately. Some conditions can be treated, such as an infection, but a doctor would rather not push a patient to the point of an infection becoming life-threatening before taking action. To have a full range of treatment options, some patients opted to be sent out of state when the injunction was lifted.

No scenario when abortion is stabilizing care, AG deputies argue

Labrador’s office has argued case law from the Idaho Supreme Court’s interpretation of the ban, saying it does not require an immanency of death, only a subjective, good faith medical judgment that the person’s life is threatened. At the same time, in court on Wednesday, Deputy Attorney General David Myers told Winmill there is no medical situation in which it is necessary to perform an abortion as stabilizing care.

“If you are able to provide care that stabilizes that patient enough to transfer them, then you didn’t need to perform an abortion,” Myers said.

Winmill said he assumed Myers didn’t have a medical degree, and asked why he should consider their medical assessment over the physicians who have submitted declarations to the court about the situations they have encountered.

“Are we to substitute the attorney general’s judgment over what the doctors decided?” Winmill said.

Myers said the attorney general wasn’t contradicting any doctor’s testimony, because they have not testified that abortion was the necessary stabilizing care. Instead, he said, all EMTALA required was stabilization, and after that point, the federal law no longer applies.

“Then all a doctor can do is stabilize in some abstract way that would allow transport and then let them sit there without the medical care that a doctor believes is necessary to preserve their health?” Winmill said.

Myers said the doctors have not alleged anyone had to be transferred because they needed an abortion as part of their stabilizing care, and he did not believe that could ever happen.

Lindsay Harrison, an attorney from a Washington, D.C. law firm representing St. Luke’s, said the argument that EMTALA only requires stabilization and then allows a patient to be transferred would be the exact opposite of what Congress intended when it passed the law in 1986 and Republican President Ronald Reagan signed it into law. It was meant to prevent “patient dumping,” when hospitals would often turn patients away because of an inability to pay. The portion of EMTALA that says a patient must be stabilized and transferred is referring to transfer within the same hospital system, Harrison said, to a nonemergency department.

Winmill indicated he might narrow the scope of the temporary restraining order while he considers Labrador’s motion to dismiss the case or issue a new preliminary injunction. The current restraining order applies to any medical provider or hospital subject to EMTALA. Labrador’s attorneys argued that is overly broad, and said it should be tailored only to St. Luke’s. The hospital system’s attorneys said if it was narrowed, it could cause an influx of patients and create a situation where other hospitals would be transferring patients to their facilities.

The restraining order will stay in place until a decision is issued on the injunction, which Winmill said he hopes will be released within two weeks.

This story was updated March 6, 2025 at 8:41 a.m. EST to correct where Harrison works.