Hospitals wrestle with Supreme Court ruling on abortion

The high court struck down Roe v. Wade, and with some states already enacting laws to prohibit abortions, health systems face some difficult decisions.

With some states already barring abortions after the Supreme Court overturned Roe v. Wade last week, hospitals and health systems are facing some difficult decisions.

The high court ruled Friday there is no constitutional right to an abortion, leaving the decision up to individual states.

Since the court ruled Friday, 15 states have abortion bans due to “trigger laws” that have taken effect or will take effect within a month, according to The Washington Post. The Guttmacher Institute, which tracks reproductive health policy, estimates 26 states will prohibit abortion in the coming months.

The law raises questions for hospitals and health systems, including their duties under the Emergency Medical Treatment and Labor Act, a federal law requiring hospitals to treat and stabilize patients who arrive in emergency departments.

Melinda Hatton, general counsel of the American Hospital Association, said the court’s ruling “will have practical impacts on hospitals and health systems, including on health care provided across state lines, EMTALA obligations, maternal health care, the clinician-patient relationship, medical education and access to care for individuals regardless of socioeconomic status.”

“We are committed to helping our member hospitals and health systems navigate the evolving landscape consistent with AHA’s mission of advancing the health of all individuals and communities,” she said in a statement.

In Ohio, a state law bars abortion at six weeks of pregnancy, with exceptions to protect the life of the mother. Ohio is expected to enact more sweeping legislation later this year, the Cincinnati Enquirer reports.

The University Hospitals system based in Cleveland said in a statement, “Like other healthcare systems, University Hospitals is carefully reviewing the recent Supreme Court decision on Roe v. Wade and working to understand the full impact it will have on our patients and healthcare providers.”

Revising policy, then a reversal

The BHSH Health System in Michigan reversed course within two days of the ruling. Initially, the system said Friday it would only perform an abortion if the mother’s life was threatened. Abortion remains legal in Michigan, as a court order has blocked a state abortion ban.

The system put out a statement Sunday saying it has “evolved” its approach while a battle over the state law plays out.

“Given the uncertainties and confusion surrounding its enforcement, until there is clarity, we will continue our practice of providing abortions when medically necessary,” the system said.

“We continue to believe that these decisions are both personal and private and best made between a woman and her physician,” the system said. “In 2021, the entire BHSH System performed approximately 60 therapeutic, medically necessary abortions that required hospital level care. We have not and will not perform elective abortions. We continue to provide care for women’s health, including reproductive needs. We will support our physicians and patients through a multidisciplinary, local committee as they navigate this challenging landscape.”

Brian Peters, CEO of the Michigan Health & Hospital Association, said the group is working to understand the implications of the ruling.

“Above all, we will seek legal guidance to protect healthcare providers and patients from incurring any unintentional criminal liability, harassment or negative health consequences due to a lack of clarity about Michigan’s law regarding reproductive healthcare services,” Peters said in a statement Friday.

‘Greater disparities in maternal health’

Some health systems said they intend to do whatever is possible to protect patients.

Leaders at Johns Hopkins said they plan to continue to provide the same services within the scope of the law. The system is concentrated in the Baltimore and Washington, D.C. markets and operates a children’s hospital in St. Petersburg, Florida.

“To the fullest extent allowed under the law, our institutions will continue to be guided by the evidence-based best practices established by medical and public health faculty experts and practitioners, which make clear that access to safe, legal abortion is critical for the health of individuals, families, and communities,” Johns Hopkins leaders said in a statement.

Bruce Siegel, president and CEO of America’s Essential Hospitals, said his organization is worried about the impact of the Supreme Court ruling.

“We are concerned about how today’s U.S. Supreme Court decision might affect access to care and maternal health, especially among low-income and marginalized people, and the ability of providers to deliver care without fear of possible criminalization,” Siegel said in a statement Friday.

Healthcare groups have condemned the court ruling, saying it will threaten the lives of patients and dangerously intrude on the physician-patient relationship. They also say the ruling will worsen healthcare inequality, since many women won’t be able to afford to travel hundreds of miles for an abortion.

Many healthcare officials have said the court’s decision, and subsequent state laws, won’t stop abortions, but will simply stop safe access to abortions.

The Supreme Court ruling could have other profound effects on healthcare, Siegel said.

“This decision could inspire policies that result in an uneven distribution of providers across states, greater disparities in maternal health, and conflicts between state and federal laws,” he said in his statement.

“For example, providers might face concerns about how to reconcile state restrictions with their obligations under federal law to stabilize and treat emergency department patients. A chilling effect on physician training and shortages of obstetrician-gynecologists in some states also could follow this ruling.”