Washington state hospitals must provide emergency abortions, Gov. Inslee says

SEATTLE — The U.S. Supreme Court will soon rule on whether a federal law requires hospitals to provide emergency abortions. Whatever the justices rule, Washington will be unaffected, Gov. Jay Inslee said Tuesday.

That’s because of separate state laws around emergency services — laws that nonetheless may not be absolutely clear as they pertain to abortion. So the Democratic governor is directing the state Department of Health to write a rule clarifying that such laws require hospitals and affiliated facilities providing emergency services to perform abortions when patients’ health is in jeopardy.

“We’re making it clear so that everybody will understand the rules,” Inslee said at a news conference Tuesday in downtown Seattle, noting he was speaking close to the two-year anniversary of the Supreme Court decision that overturned Roe v. Wade.

Inslee’s directive underscores the profoundly different directions states have been moving during those two years. Some, like Idaho, where the current Supreme Court case involving emergency abortions originated, have been outlawing pregnancy terminations in virtually all cases. Others, such as Washington, have enacted a series of strengthened protections for abortion providers and patients — including those coming from states with abortion bans.

A University of Washington study published last month found a 50% increase in out-of-state patients going to Cedar River Clinics, which offers reproductive and sexual health care in Seattle, Tacoma, Renton and Yakima. Cedar River provides about 15% of the state’s abortions, according to lead author and UW graduate student Taylor Riley.

Inslee casts his directive not so much as an answer to a current problem but as a preventive move prompted by the looming Supreme Court decision and what he said was an attack on abortion access by local Republican politicians.

His office has compiled a list of more than 40 anti-abortion state bills in recent years. They inevitably went nowhere in this state, which legalized abortion in 1970, three years before the Roe vs. Wade decision.

In addition to laws legalizing abortion and mandating appropriate emergency services, Washington also has a statute, passed by lawmakers in 2021, that prohibits health care facilities from restricting providers’ care of patients with pregnancy complications.

[Complaints that emergency rooms refused to treat pregnant women spiked after Roe v. Wade was overturned]

Still, Inslee said, “some hospitals have claimed that they don’t have to provide legitimate health care services because of some religious beliefs.”

Hospital consolidations have left almost half of the state’s acute care beds in facilities operated by religious organizations, according to a 2023 Seattle Times analysis.

Dr. Sarah Prager, an obstetrics and gynecology professor at UW School of Medicine, said in an interview after Tuesday’s news conference that she and her colleagues sometimes see patients who have been transferred for emergency abortions from other Washington facilities though it would have benefited them to remain closer to home.

“If a patient is, for instance, bleeding heavily, then the sooner they’re able to access care the better,” Prager said. The patient’s life might not be in danger, but quick care might prevent the necessity of a transfusion.

The state hospital association, however, said in a statement “there’s no evidence that Washington hospitals are not providing appropriate emergency care.”

“A lot of times, physicians, when they receive a transfer, don’t know necessarily where the transfer is coming from or why,” said association CEO Cassie Sauer.

“What we’ve discovered is most of the transfers are coming out of smaller rural hospitals,” she continued. Those facilities may not do surgeries and are ill-equipped to treat, for instance, a high-risk ectopic pregnancy, in which a fetus grows outside the uterus.

Providence, a Catholic organization with 15 hospitals in Washington, does not provide “elective” abortions but said in a statement it provides emergency care, “including for complex pregnancies or situations in which a pregnant person’s life is at risk. Our clinicians exercise their best medical judgment and provide all necessary interventions to protect and save the life of the mother.”

“How close to death must somebody be before a doctor is able to step in and provide care?” Prager said that’s a question physicians face most acutely in states like Idaho that have abortion bans with an exception for when a patient’s life is at risk.

The ongoing Supreme Court case concerns a U.S. Justice Department challenge to that narrow exception based on the federal Emergency Medical Treatment and Labor Act, which requires “stabilizing treatment” in emergency situations.

Washington’s policy will address a broader array of emergencies than ones in which a patient’s life is in danger, according to Inslee. It will not detail every situation but instead refer to standards of care.

Julie Barrett, president of Conservative Ladies of Washington, said she worries that a hospital with values opposed to abortion might have a different judgment about what constitutes an emergency than a judge or state official interpreting DOH’s policy.

Sen. Mike Padden, a Spokane Valley Republican, predicted the policy will be challenged in court. “I think it would violate the mission of probably over 40% of hospitals in this state,” he said, also describing Inslee’s directive as “overreach.”

Inslee acknowledged the possibility of a lawsuit but said: “We think we’re on firm ground.”

The governor said his successor, to be elected in November, could reverse the policy, but declared it unlikely that voters will elect a candidate who would do so.

Democratic gubernatorial candidate Bob Ferguson has used his position as state attorney general to defend abortion access and said Republican opponent Dave Reichert cannot be trusted to rally behind the cause.

Reichert said Tuesday he would not change Washington’s abortion laws if he was elected governor — a point he made in a campaign ad released last week.

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Seattle Times staff reporter Elise Takahama contributed to this report.