Medical treatment

Post Roe: Women still have the right to emergency medical treatment

The recent reversal of Roe c. Wade took away a woman’s constitutional right to an abortion. But that didn’t take away his right to life-saving health care, or my right as a doctor to provide that care. Pregnancy is a medical condition. As an emergency physician, I see medical complications that women endure throughout their pregnancies, including severe and life-threatening bleeding and ectopic pregnancy ruptures, as well as childbirth-related complications like high blood pressure, seizures, heart problems and infections, all of which can pose serious threats to a woman’s life. Pregnancy can also lead to loss of work and wages for women when complications leave them bedridden, unable to go to work let alone care for other family members.

By taking away a woman’s right to choose to terminate a pregnancy, our country is not only forcing women who don’t want or can’t have children to do so — we’re putting those same women at risk of medical problems. related to pregnancy, the consequences of which can range from loss of wages to death. The United States has the highest maternal mortality rate of any developed country, more than double that of most other high-income countries. Non-Hispanic black women have three times that risk, and women over 40 have nearly 8 times the risk of women under 25. Maternal mortality rates in the United States have been increasing since 2018, and it is in this context that our country will also become the only country to restrict, not increase, access to abortion outside of Nicaragua.

Fortunately, one thing all women are entitled to under federal law is to seek emergency medical treatment. The federal Emergency Medical Treatment and Labor Act (EMTALA) means that all people – including pregnant women – have the right to a screening medical examination, which includes stabilization treatment, at a facility. emergency. Our job as physicians is to provide the highest quality emergency care to all of our patients, and in this era of restricted access to abortion, we anticipate that more women will come to us not only with complications resulting from illegal abortions, but also seeking care. after unprotected sex, sexual assault and to assess early pregnancy.

Patients must have the right to privacy when undergoing medical treatment based on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is supposed to protect sensitive health information patients against any disclosure without the patient’s consent. Yet since the overturning of Roe v. Wade, pregnant women — in states that allowed triggering laws to take effect — were forced to continue pregnancies even when their lives were in grave danger. Disturbingly, the physicians’ determination that their patient faced a life-threatening situation was not good enough for their laws to authorize dismissal – instead, the opinions of hospital administrators and lawmakers not involved in the patient’s care were sought, apparently in violation of HIPAA’s patient privacy laws.

On July 11, the Centers for Medicare & Medicaid Services (CMS) clarified that EMTALA overrules state laws relating to medical screening examination, treatment stabilization, and transfer requirements. Under EMTALA, if a physician believes an abortion is necessary to stabilize a patient with an emergency medical condition, that treatment must be provided regardless of state law. It also states that the physician or other qualified medical personnel determine what is and is not an emergency medical condition. EMTALA also protects physicians who perform an abortion to treat a pregnant woman’s emergency medical condition from state lawsuits. Unfortunately, EMTALA does not protect against a hospital or physician being sued, and in the state of Texas, a lawsuit has already been filed challenging EMTALA’s protections for abortion care.

Of course, emergency physicians are not abortion providers, and we rely on our OB/GYN colleagues to work with us when a pregnant woman’s life is in danger. Doctors and their hospitals must fight to ensure that EMTALA continues to provide the protections for which it was designed. For politicians and lawmakers who propose to deny care to critically ill pregnant women who need emergency abortions, or who attempt to persecute treating physicians who are simply doing their job, the courts must make it clear that EMTALA is pre-emptive over state laws which may be more restrictive.

Patients have the right to privacy under HIPAA, and physicians not only have the right, but also the obligation, to provide unrestricted emergency medical care under EMTALA. If you want to weigh in further, go to medical school.

Dr. Maria C. Raven (MD, MPH, MS, FACEP) is a practicing emergency physician and chief of emergency medicine at UCSF Medical Center. She is a professor and vice chair of the Department of Emergency Medicine at UCSF. She studies the intersection of medical, behavioral and social needs in the emergency department.