Supreme Court Won't Review Fifth Circuit Decision Blocking Enforcement of EMTALA Abortion Care Guidance in Texas
- October 11, 2024
The Department of Health and Human Services (HHS) will remain enjoined from enforcing in Texas guidance that physicians must provide abortion care under the Emergency Medical Treatment and Labor Act (EMTALA) as a stabilizing treatment to pregnant women experiencing an emergency medical condition regardless of state restrictions on the procedure, after the U.S. Supreme Court declined to review the Fifth Circuit’s decision in the case.
The Fifth Circuit in January affirmed a preliminary injunction granted to the state, finding HHS exceeded its statutory authority under EMTALA in issuing the guidance. Texas v. Becerra, No. 23-10246 (5th Cir. Jan. 2, 2024).
HHS issued the guidance shortly after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, 142 S. Ct. 2228, 2243 (2022). The agency said the guidance is intended to remind providers that EMTALA requires them to provide life- or health-saving abortion services in emergency situations. The guidance also indicates that “[w]hen a state law prohibits abortion and does not include an exception for the life and health of the pregnant person—or draws the exception more narrowly than EMTALA’s emergency medical condition definition—that state law is preempted.”
Th state of Texas and several organizational plaintiffs challenged the guidance, and the U.S. District for the Northern District of Texas enjoined its enforcement, finding no direct conflict with Texas’ Human Life Protection Act.
The Fifth Circuit panel agreed with the lower court that the guidance goes beyond the scope of the EMTALA statute and must be set aside. “While EMTALA directs physicians to stabilize patients once an emergency medical condition has been diagnosed, . . . the practice of medicine is to be governed by the states,” the Fifth Circuit said.
In June, the Supreme Court declined to resolve the question of EMTALA’s reach in the context of state abortion restrictions in a lawsuit that the federal government brought against the state of Idaho. A divided Court held that the petition for review was “improvidently granted” and dissolved a stay of a preliminary injunction blocking the state from enforcing an Idaho statute that criminalizes abortions to the extent the law prevented care mandated by EMTALA. Moyle v. United States, Nos. 23-726 and 23-727 (U.S. June 27, 2024).
The government in April sought review of the Fifth Circuit decision in Texas v. Becerra, but then asked the Court to hold the petition pending its decision in Moyle. In light of “intervening developments,” including the Moyle decision, the Court’s ruling in Food and Drug Admin. v. Alliance for Hippocratic Med., No. 23–235 (U.S. June 13, 2024), and a recent Texas Supreme Court decision “that has led respondents to expressly disclaim any conflict between Texas law and HHS’s understanding of EMTALA,” the government now asked the Court to vacate the Fifth Circuit decision and remand.
The state argued that the instant action presented a different question than Moyle—i.e., whether HHS exceeded its authority in issuing the EMTALA guidance. And unlike the Idaho statute at issue in Moyle, Texas law includes an exception for protecting the health of the mother, the state said.
Becerra v. Texas, No. 23-1076 (U.S. petition for cert. denied, Oct. 7 2024).