After feds say hospitals don’t have to perform emergency abortions, more confusion for patients and doctors

President Trump’s administration is telling hospitals that they don’t have to perform abortions for patients in emergencies, rolling back the guidance issued under Biden’s administration.

But some healthcare leaders say the new guidance offers less clarity on when doctors can intervene, particularly in states that have barred or heavily restricted abortion.

The Centers for Medicare & Medicaid Services said this week that it is “rescinding” guidance issued under the Biden administration in July 2022. After the Supreme Court ruled that abortion isn’t a constitutional right, Biden’s administration told hospitals that they had to perform abortions in medical emergencies, which has sparked legal clashes at the state level.

The CMS said that Biden’s directive doesn’t “reflect the policy of this Administration.”

The agency said this week that it would continue to enforce the Emergency Medical Treatment and Labor Act, also known as EMTALA, “including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy.”

“CMS will work to rectify any perceived legal confusion and instability created by the former administration’s actions,” the agency added.

Some healthcare leaders say the Trump administration’s guidance will endanger patients and will lead to more confusion for doctors and hospitals about when and how they can intervene in emergencies.

Molly Meegan, chief legal officer and general counsel of the American College of Obstetricians and Gynecologists, said in a statement that patients are already having trouble getting the care they need, and the government is exacerbating the problem.

“Rescinding guidance clarifying protections for the care of pregnant people experiencing emergencies is a poor decision that will undoubtedly endanger the lives and health of pregnant women, who are already facing difficulties accessing needed abortion care during obstetrical complications,” Meegan said.

Meegan said it also complicates matters for doctors and health systems.

“The HHS announcement will deepen confusion about when emergency care is allowable for both clinicians and patients, and exacerbate already overwhelming barriers to care for people across the country,” she said. “Abortion is an essential part of medical care, and EMTALA protections should be afforded to all patients in need of emergency care, including abortion.”

‘Hospitals need more guidance’

Ryan Oglesby, president of the Emergency Nurses Association, said in a statement sent to Chief Healthcare Executive® that the federal government's new guidance "stands in direct opposition to the fundamental ethics of nursing to promote human health and well-being."

Oglesby said the new guidance also contradicts federal standards and the core of the Emergency Medical Treatment and Labor Act, which ensures all patients get the care they need "regardless of their individual circumstance or where they seek emergency health care."

"ENA is deeply concerned about the unease and confusion this decision might bring to emergency care teams that must contemplate the life-or-death implications of every option for the care of every patient they treat," Oglesby said. "That is especially true for pregnant patients and the unique circumstances which might require them to seek emergency medical help."

Oglesby said he's concerned that emergency care teams will be shifted from making the best determination for their patients to the legal ramifications of their actions.

The CMS has issued the guidance after a federal investigation concluded that a Texas hospital violated the law by refusing to treat a patient who was bleeding and suffering from an ectopic pregnancy, the Associated Press reports.

Kyleigh Thurman was sent home from the hospital and ended up losing part of her reproductive system. As Thurman told the AP, “I didn’t want anyone else to have to go through this.”

Other women have struggled to get abortions in medical emergencies in states that have enacted abortion bans. In Texas, the rate of sepsis surged more than 50% among women who were hospitalized after losing pregnancies in their second trimester, according to a ProPublica investigation.

Since the Supreme Court ruling, 13 states have passed laws barring abortion, while seven other states prohibit abortion after the first 18 weeks of pregnancy, according to the Guttmacher Institute.

Nancy Northup, president and CEO at the Center for Reproductive Rights, said the CMS statement is likely to add to the uncertainty of many physicians.

“In pulling back guidance, this administration is feeding the fear and confusion that already exists at hospitals in every state where abortion is banned,” Northup said in a statement. “Hospitals need more guidance right now, not less.”

Hospitals and doctors have been seeking greater clarity about their ability to act when a pregnant patient is facing a crisis.

In a case stemming from Idaho, the Supreme Court ruled last year that hospitals could provide abortions in emergencies where the patient is facing serious harm. But the ruling also allowed litigation in Idaho to continue, and hospital trade groups lamented that the decision didn’t provide more clarity and a more affirmative statement that hospitals could intervene under federal law.

‘Put lives at risk’

U.S. Rep. Mikie Sherrill, a New Jersey Democrat, said the CMS move to rescind the previous guidance under the Biden administration “puts women’s lives at risk, plain and simple.”

“No woman should have to bleed out in a hospital while doctors scramble to call a lawyer to see if they are allowed to provide medically necessary care,” Sherrill said in a statement she shared on X.

New York Gov. Kathy Hochul criticized the CMS directive.

“The Trump administration just made it clear: They care more about scoring political points than saving women's lives,” she said in a post on X. “We fought for EMTALA protections in New York, and I signed them into law. But for women in other states, this cruel decision from CMS will put lives at risk.”

Those who oppose abortion rights cheered the CMS announcement.

Sen. Cindy Hyde-Smith, a Republican from Mississippi, lauded Mehmet Oz, MD, the CMS administrator, for focusing on “the well-being of pregnant women and their doctors.”

“I commend President Trump and Dr. Oz for rescinding the harmful Biden-era guidance that warped EMTALA obligations and created widespread confusion in emergency rooms nationwide,” Hyde-Smith said on X.

During his presidential campaign, Trump repeatedly said he opposes abortion but he also said that it should be a matter for states.