A Montana ER doctor spoke Friday on a panel of doctors from across the nation concerned about what an upcoming U.S. Supreme Court decision could mean for pregnant women in need of lifesaving abortions.
Dr. Emily Fleming, of Whitefish, described how failing to protect emergency abortions is even more dangerous for women in rural places, such as Montana, who already must travel long distances for emergency care and could not travel to another state for care in the timeframe of an emergency if they were to lose abortion rights in their home state.
The ruling, expected this month, will determine the extent to which state abortion bans apply to women with pregnancy complications whose lives could be in jeopardy. At issue is the Emergency Medical Treatment and Labor Act, a federal law requiring hospitals to provide patients with lifesaving care.
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The Committee to Protect Health Care, an organization of doctors advocating for better health care, released an open letter signed by 6,000 doctors in May and organized Friday’s panel.
Without EMTALA, in states with abortion bans “a woman would be denied care at an emergency department even though her organs are shutting down due to a ruptured placental membrane. Patients would be turned away from emergency departments because they have an ectopic pregnancy that endangers their lives. Doctors would be forced to wait for fetal cardiac activity to cease before they can treat a woman who is bleeding profusely from a miscarriage,” the letter said.
“Sometimes abortion may be necessary to stabilize a patient to prevent serious injury or death,” Fleming said.
Fleming acknowledged that Montana does not currently face abortion restrictions that could prevent lifesaving care. But state lawmakers passed several bills during the last two legislative sessions to restrict abortion access, which have been temporarily enjoined or struck down by the Montana Supreme Court.
“Anti-abortion politicians could change the makeup of the Supreme Court and Montanans could be denied lifesaving care,” she said, adding that she supports the upcoming ballot initiative to enshrine the right to an abortion in the state constitution.
Dr. Jennifer Smith, an OBGYN from St. Louis, Missouri, where there is an abortion ban with no exceptions for rape or incest, spoke of a patient of hers who drove to Illinois to receive a life-saving abortion while bleeding through her clothes.
“We’re able to help patients get help across the border, being so close to Illinois,” she said.
Fleming explained that this is not a possibility for Montana women, who may already have driven several hours to seek emergency care.
“Because of where we are geographically located, there are patients that come from an hour, two hours, three hours away,” she said. “I fear that eliminating this could further jeopardize the lives of patients. There isn’t time to adequately stabilize these patients.”
Furthermore, there are no abortion providers in North Dakota, South Dakota, or Idaho. There is one abortion provider in Casper, Wyoming, which reopened earlier this year after being closed due to arson.
Smith said that in states with abortion bans, doctors are “forced to wait until conditions get worse” to intervene. She said that since Missouri passed an abortion ban in 2022, the state has seen a 25% drop in applications for OBGYN residency positions.
Idaho has seen a similar decline in practicing obstetricians.
“Physicians don’t want to practice in states where they’re forced to watch patients suffer and die,” Smith said.
Panelists described the fear and dangerous calculations that come when abortion is only allowed to save the life of the mother.
Dr. Rob Davidson, executive director of the Committee to Protect Health Care and an emergency physician in Michigan, said that under these conditions, doctors have to wait until a woman’s life is in danger and to evaluate how in danger her life is.
“How do we measure that? In pints of blood lost? In number of blood transfusions?” he said.
“In no other health condition would we say, ‘If it’s a matter of just being medically compromised or disabled from health failure, don’t do it,’” he said.
Dr. Hiral Tipirneni, an emergency physician in Arizona, called this a “political definition of when a woman’s life is in danger.”
“There’s no room for politicians in that conversation,” she said.
Extremists vs. activists?
The earlier letter from the Committee to Protect Health Care called the case before the Supreme Court as “radical,” “draconian” and as “yet another part of the extremists’ strategy to ban abortion care.”
Meanwhile, in a post from Gov. Greg Gianforte on X, formerly known as Twitter, he said that an anti-abortion bill he signed into law has not yet gone into effect “thanks to the effort of far-left activists.”
Gianforte has also said that “the Montana Supreme Court is controlled by liberal activist judges.” This word comes up often when judicial decision-making is deemed unfavorable: Attorney General Austin Knudsen called a district court judge an activist for striking down a law allowing permitless carry on college campuses; Secretary of State Christi Jacobsen called “judicial activism” when the Montana Supreme Court struck down voting restrictions passed by the legislature.
Although the Montana Supreme Court has been scrutinized by Republicans in recent years for ruling in favor of abortion access, pro-life Montana Republicans refrained from criticizing the U.S. Supreme Court unanimously deciding to uphold access to medication abortion last month.
Both Gianforte and U.S. Sen. Steve Daines said they respected the court’s decision.
