Idaho Federal Judge Warns of Conflicts Between Restrictive Abortion Laws and EMTALA

In a 60-page decision issued on March 20, 2025, Judge Lynn Winmill, a Federal District Judge for the District of Idaho, granted a preliminary injunction that enjoins Attorney General Raúl Labrador and his officers, employees, and agents from enforcing the Idaho Defense of Life Act (Idaho Code § 18-622), a restrictive abortion ban, against St. Luke’s Health System, Ltd., or any of its providers, “as applied to medical care required by the Emergency Medical Treatment and Labor Act (EMTALA),” identifying a critical conflict between restrictive abortion statutes and EMTALA.

EMTALA, acknowledged by the court as a “generally uncontroversial” law, was enacted to ensure public access to emergency services regardless of ability to pay, and requires that hospitals receiving Medicare funds to provide stabilizing treatment to patients who present with emergency medical conditions. Specifically, EMTALA mandates that emergency departments provide care to prevent the “material deterioration of the” emergency medical condition that a patient presents with to the emergency department. 42 U.S.C. § 1395dd(b).

Idaho’s abortion ban, one of the strictest in the nation, criminalizes abortion in nearly all circumstances, allowing for the termination of a pregnancy only when “necessary to prevent the death of the pregnant woman.” Idaho Code § 18-622(2)(a)(i). Herein lies the inherent conflict: How can an emergency department treat a patient who requires an abortion to prevent the material deterioration of their medical condition, but only if it is to prevent death? If the emergency department treats that patient and there is a factual issue as to whether death was likely, the providers could be exposed to liability under Idaho law if an abortion was provided (e.g., to prevent future infertility or to treat an ectopic pregnancy). However, if the emergency department does not treat that patient, they could be exposed to liability under EMTALA, creating a catch-22 for providers, not to mention an ethical dilemma for clinicians. The court identified this very issue as more than a mere hypothetical, finding that the evidence presented established that “[o]ccasionally-and devastatingly-” patients present at St. Luke’s “with emergency medical conditions that threaten their health, but not their lives[,]” and “these patients can be stabilized only through the termination of their pregnancies.”

Relying on established Ninth Circuit law, which affirms that Congress expressly intended to displace state law through EMTALA, the court found that the Idaho Defense of Life Act was preempted (i.e., superseded) by EMTALA through “impossibility preemption”. This was because there are scenarios in which it would be impossible for physicians to comply with both laws. In reaching this conclusion, the court noted that the United States Supreme Court has weighed in on this conflict in the context of preterm premature rupture of membranes, with six Justices of the Supreme Court expressly acknowledging the conflict and the three remaining Justices recognizing it (though they disputed the idea that EMTALA could ever require hospitals to perform emergency abortions). Even if it were not impossible to comply with both laws, the court reasoned that EMTALA would still preempt the Idaho Defense of Life Act because the latter poses “an obstacle to the fulfillment of EMTALA’s purpose of ensuring that patients receive adequate emergency medical care.” The message of the decision is clear: a law hindering an emergency department’s ability to provide stabilizing care, even if that stabilizing care is an abortion, cannot be reconciled with EMTALA.

In rejecting Idaho’s argument against preemption, the court acknowledged the difficulties providers are faced with when providing emergency care, noting that the Attorney General was “attempting to impose the rigidities of criminal law onto the fluid nature of delivering emergency medical care.” The court further criticized the Attorney General’s argument that the emergency department could simply transfer the patients to out-of-state hospitals, calling this approach “antithetical to EMTALA’s key purpose,” which is to curb “patient dumping.” The court also rejected the argument that interpreting the Idaho Defense of Life Act as conflicting with EMTALA was akin to reading EMTALA as an “abortion mandate,” holding that “references to the unborn child do not alter a hospital’s core obligation to offer an abortion if that is the stabilizing treatment EMTALA guarantees[,]” and recognizing that, in instances where an abortion is the stabilizing treatment necessary, “the pregnancy complication means that the fetus will almost surely not survive, even absent an immediate termination.”

Acknowledging that injunctions must be narrowly tailored to remedy specific harm, the court limited the injunction to the plaintiff, St. Luke’s, expanding it only to the extent it was empowered to by also applying the injunction St. Luke’s medical providers. While the injunction does not apply to any other providers, it delivers a clear warning regarding the validity of laws that impact a provider’s ability to provide stabilizing care. Given the rise of restrictive anti-abortion laws being adopted across the country, this decision may provide some insight into how the conflicts presented by those laws may be handled by courts in the future.

As new developments arise, we will continue to update our Dobbs Decision Resource Center. In the meantime, please contact one of the lawyers in Shipman’s Health Law practice group if you have questions about this ever-changing legal landscape.