Yesterday, I was joined in the Doctor’s Lounge on Substack Live by ER physician and former Biden HHS official Dr. Dara Kass and Professor Elizabeth Sepper of the University of Texas School of Law.
The topic: abortion access. While all three of us are concerned about abortion access in the post-Dobbs environment, we do not believe the Trump administration’s latest move regarding the EMTALA law is as meaningful as many headlines and media quotes seem to suggest. But, we believe that doctors and patients are scared and confused by what they’re reading and seeing on social media.
That’s why I wanted to call upon these two thoughtful experts and have this important conversation. As hoped, this session was packed with insights that I just don’t think we’re hearing enough in the public discourse. I think you’ll find it useful and informative. Highlights are summarized below.
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Closed captions (㏄) and a transcript option (📄) can be found beneath the video playback control bar above.
Highlights from The Doctor’s Lounge with guests Dr. Dara Kass and Professor Elizabeth Sepper.
(Aided by ChatGPT.)
No, EMTALA Wasn’t Repealed—But the Messaging Matters (00:00)
We opened this session of the Doctors Lounge noting the confusion sparked by headlines claiming the Trump administration had revoked emergency abortion protections under EMTALA. That framing made it sound like the law itself was overturned. It wasn’t. As Professor Elizabeth Sepper explained, the underlying statute—the Emergency Medical Treatment and Labor Act—remains fully in effect. What was actually revoked were two Biden-era memos and a letter that supposedly reaffirmed EMTALA obligations after Texas enacted its near-total abortion ban. The law hasn’t changed. But the withdrawal of those memos sent a different kind of message.
The Biden-Era Memos Didn’t Change Law—They Offered Reassurance (02:00)
Dr. Dara Kass shared how, back in 2021-2022, the Biden administration’s guidance aimed to stabilize the post-Dobbs landscape. While the memos didn’t add new legal obligations, they clarified existing ones: if a pregnant patient is facing a medical emergency, physicians are still required to act—even in states where abortion is banned. The memos were less about instructing clinicians and more about signaling to patients, hospital lawyers, and courts that the federal government stood behind life-saving care. That kind of reassurance mattered in the legal chaos that followed Dobbs, when even basic emergency care suddenly became uncertain.
The Real Threat: Confusion, Hesitation, Delay (05:30)
We emphasized that the problem now isn’t a lack of law—it’s fear. Doctors still know what to do in emergencies. But hospital legal teams may hesitate. Providers may stall. Transfer delays are becoming more common in states like Idaho, where physicians face ambiguous laws and legal risks. These delays aren’t benign; they carry real risks for patients, especially those with conditions like PPROM or ectopic pregnancies. EMTALA violations are now more likely to happen not because care is unavailable—but because doctors wait too long to act.
Ectopics, PPROM, and the Dangerous Gray Zone (08:00)
We talked about the very real clinical scenarios where delays in care are causing harm—not in catastrophic emergencies where everyone knows what to do, but in the gray zones where doctors hesitate. Ectopic pregnancies and premature rupture of membranes (PPROM) at 16 or 17 weeks don’t present immediate danger in every case, but they carry significant risk. Before Dobbs, doctors could act early. Now, many wait until a patient is clearly septic or crashing. That’s not better medicine. That’s worse outcomes, driven by fear—not by science.
State Laws vs. Federal Protections (12:00)
Professor Sepper reminded us that EMTALA is federal—and under the Supremacy Clause, it overrides state law. But in practice, state legislatures and courts are defining the boundaries. In Texas, recent rulings clarified that a life-threatening emergency doesn’t have to be imminent before a doctor can act. That’s helpful. But there's still tremendous variability. Hospital systems interpret state laws differently. Some are risk-averse. Some are more permissive. In short: whether you get timely care depends not only on your state, but also your hospital.
The Impact of Delayed Transfers (15:30)
We’ve started to see what happens when hospitals hesitate and instead transfer patients out of state—often to places like Washington. Transfers aren’t benign. They introduce delay, risk, and cost. In some of the worst EMTALA violation cases, patients with ectopics or early PPROM were discharged too early—only to return septic or worse. The lesson: clinicians don’t need a new memo to know what’s right. They need courage to act—and systems that support them when they do.
Miscarriage Isn’t a Crime—and It Shouldn’t Be Treated Like One (19:00)
We discussed the heartbreaking reality that even patients with confirmed miscarriages are sometimes denied care. One EMTALA complaint filed just this week involved a patient who no longer had a heartbeat or fetal pole—yet still didn’t receive appropriate miscarriage management. This isn’t hypothetical. This is happening now. We emphasized that there’s no moral or medical distinction between a “good” abortion and a “bad” one, or between miscarriage and elective termination. All these patients deserve timely, compassionate care—and right now, fear and confusion are standing in the way.
Messaging Misfires and the Role of Doctors (23:30)
A lot of the panic surrounding this memo revocation stems from poor communication. We’re seeing smart people—some of whom we admire—declare that this means ERs won’t be able to treat ectopic pregnancies. That’s just not true. But in a political climate charged with alarmism, misinformation travels fast. Dr. Kass made the case that this is exactly why doctors need to be central messengers. We know what EMTALA does. We know what emergency care looks like. If we don’t correct the record, no one else will.
Mifepristone Under Threat, Despite Its Safety (27:30)
We then shifted to medication abortion—specifically, mifepristone. Dr. Kass walked us through what it is, how it works, and how safe it is. It’s been used by millions. It’s not just for abortion—it’s essential for miscarriage care too. Professor Sepper explained how the drug is under federal REMS restrictions, despite its safety, and how recent lawsuits have tried to roll back telehealth access. While the Supreme Court tossed one challenge for lack of standing, states like Missouri are pushing new cases with bizarre claims, like needing more teen births to support their tax base. It’s as dystopian as it sounds.
A Dangerous Double Standard on Drug Safety (33:00)
We pointed out the double standard in how mifepristone is treated compared to far riskier drugs. The only reason mifepristone faces this level of scrutiny is because it terminates pregnancies—not because of any actual safety concern. Anti-abortion groups are flooding the field with junk science to create a false narrative of danger. But in our experience, complications from medication abortion are extremely rare. The real danger comes from delaying care—not from the pill.
Harm Reduction and Self-Managed Abortion (36:30)
As legal access narrows, more people are turning to self-managed abortions. And while medication sourced online can be effective and safe, we’re deeply concerned about what happens next. Patients may be afraid to seek follow-up care. They may not come to the ER when they need to. And that fear—of being criminalized, judged, or misunderstood—can cost lives. We made it clear: the bigger threat isn’t misuse of medication. It’s that stigma and restriction are keeping patients away.
The Big Picture: Legal Chaos, Uneven Care (40:00)
We closed with a reminder that reproductive care in the U.S. is now a patchwork. State laws vary wildly. One procedure may be standard in California but criminalized in Texas. Even within states, hospital policies differ. And while federal law like EMTALA still technically reigns, enforcement is uneven and political. We urged lawyers, hospital leaders, and clinicians to coordinate—to build systems that prioritize patient care and allow doctors to act on their training without fear.
What’s Next—and Why We Can’t Tune Out (45:00)
Looking ahead, we flagged a Supreme Court case with major implications: whether states can exclude Planned Parenthood from Medicaid. If the Court sides with the state, it could undermine access to care for millions, especially low-income patients. More broadly, we’re bracing for regulatory attacks on mifepristone from the FDA itself—potentially cloaked in junk science and framed as a safety review.
Final Thoughts: Stay Calm, Stay Focused, Keep Fighting (50:00)
We wrapped with a message of clarity and urgency. EMTALA still protects patients. Doctors still have obligations—and rights. But the politicization of emergency care is creating fear, confusion, and delays that are already harming patients. We need responsible messaging. We need doctor voices front and center. And we need everyone—from lawyers to legislators to journalists—to understand what’s really at stake. This is about reproductive freedom, yes—but it’s also about basic, life-saving emergency medicine.
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