'AMA Urged to Speak Out Against EMTALA Guidelines Withdrawal'

 The American Medical Association (AMA) should speak out more forcefully on the Trump administration's rescission of guidance on provision of abortions during a medical emergency, AMA delegates said Saturday.

"I'm terrified for my patients," Allie Conry, MD, of Memphis, Tennessee, a delegate for the Resident and Fellows Section who spoke for herself during a reference committee hearingopens in a new tab or window. "I work in a county hospital that is publicly funded and will likely get wrapped up in this in some way or shape or form." Conry was referring to the Trump administration's recession of guidelines for hospitalsopens in a new tab or window related to the Emergency Medical Treatment and Active Labor Act (EMTALA), issued in 2022 by the Biden administration. The guidelines outline the circumstances under which hospitals can provide abortions during a medical emergency, including in states where abortion is outlawed.

"My patients are sick. We already have doctors at other hospitals that don't have obstetrics coverage ... Patients are dying from ruptured ectopics, dying from head entrapment -- babies that should have been born, but they don't have the [obstetrical] coverage," Conry said. "People will die because of this, and our AMA needs to be on the right side, and swiftly speaking, on this topic."

"Physicians Should Not Be Penalized"

Conry was testifying in favor of a resolution from the Young Physicians Section that the AMA "advocate for the reinstatement of federal guidance affirming hospitals' obligation under EMTALA to provide necessary emergency pregnancy care, including, but not limited to, abortion care." The resolution also calls for the AMA to "support legal and policy measures that protect physicians and other healthcare providers from criminal, civil, or professional repercussions when providing necessary emergency pregnancy care" and to develop recommendations for hospitals trying to navigate conflicting state and federal regulations on emergency pregnancy care.

"Physicians should not be penalized for providing necessary life-saving care," said Sean Figy, MD, of Omaha, Nebraska, a delegate for the Young Physicians Section who was speaking for the delegation. "Physicians should not have to double-check with their lawyers to make sure what they can and cannot do to save their patients, no matter the scenario. This resolution will make sure that our AMA continues to advocate for our protection of our patients in emergency situations."

Rachel Solnick, MD, MSc, of New York City, an alternate delegate from the Women Physicians Section, said the resolution "addresses a critical threat to women's health." She noted that although patients are entitled to stabilizing care -- including abortions -- under EMTALA, since the Dobbs decision that returned control of abortion laws to the states, "physicians in restrictive states face fear of prosecution for providing medically necessary treatment. The result is delayed or non-care for women experiencing miscarriage, hemorrhage, and other life-threatening complications. These delays can lead to harm to fertility, infertility, and death, particularly among women of color, low-income populations and those in rural areas."

"As an [emergency department] doctor that worked in South Dakota at a critical access hospital, I can tell you, if I had to send an unstable pregnant woman to the next state, that would be an over 8-hour drive," she added. "We need to see more from the AMA in terms of speaking out for this completely unacceptable state of affairs."

There were no speakers in opposition to the resolution.

Concerns About WHO Withdrawal

The AMA received criticism for its failure to speak out about the U.S. withdrawing from the World Health Organization opens in a new tab or window(WHO). "It is remarkable to myself and many other AMA members that it's even necessary for our AMA membership to call for this policy of opposition," said Charles Lopresto, DO, of Long island City, New York, a member of the New York delegation who was speaking for himself. "It should seem obvious that our AMA would oppose the U.S. withdrawal from the World Health Organization. However, in our divided political atmosphere, the Board of Trustees has taken a 'watch and wait' approach rather than take action and state the obvious."

Lopresto spoke in favor of a resolution from the Senior Physicians Section calling for the AMA to oppose the withdrawal from the WHO. "Our AMA stands alone as a major medical organization without strong statements against this madness," Lopresto said. "Countless other membership-based physician organizations have made strong statements opposingopens in a new tab or window these and other actions of the current administration that are contrary to advancing the art and science of medicine and public health. And it is high time that our AMA uses the bully pulpit as the largest representative organization of physician voices in the United States to oppose the U.S. withdrawal from the WHO."

The resolution also asked the AMA to oppose cuts to funding for the U.S. Agency for International Development (USAID). "The USAID has educated and provided medical care to many smaller and less-monetarily-endowed countries," said Virginia Hall, MD, of Hummelstown, Pennsylvania, who spoke on behalf of the Senior Physicians Section. "This has made friends for our country, and indeed, many ... medical care recipients have become government friends to our USA. So it's important that we restore the monies back and let these agencies work as they have been." As with the EMTALA resolution, no one spoke in opposition to the WHO resolution.

Protecting Immigrant Physicians

Delegates also spoke out in favor of a resolution from the Organized Medical Staff Section (OMSS) and the International Medical Graduate (IMG) Section calling on the AMA to develop model workplace policies to address unfair treatment or targeting of physicians and other healthcare workers, based upon migration status or country of origin, and also to develop model policies for hospitals and other health workplaces to address situations in which U.S. Immigration and Customs Enforcement (ICE) officers seek entry into "protected areas" such as hospitals and healthcare settings.

"Our physician colleagues are now in need of urgent help and action," said Alan Klitzke, MD, of Buffalo, New York, a delegate from the American College of Nuclear Medicine who spoke for the OMSS. "There are many IMGs and other immigrant physicians who now live and work in continual fear of being targets of harassment or detention or even possible deportation based upon their country of origin ... There are resident physicians who are now advised to carry their papers...at all times for their protection. Our physicians in training should be able to perform their training duties and patient care without such threats to their protection and personal safety."

https://www.medpagetoday.com/meetingcoverage/ama/115955