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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 1 of 24
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`WENDY J. OLSON, Bar No. 7634
`wendy.olson@stoel.com
`ALAINA HARRINGTON, Bar No. 11879
`alaina.harrington@stoel.com
`STOEL RIVES LLP
`101 S. Capitol Boulevard, Suite 1900
`Boise, ID 83702
`Telephone: 208.389.9000
`
`LINDSAY C. HARRISON (pro hac vice forthcoming)
`lharrison@jenner.com
`JESSICA RING AMUNSON (pro hac vice forthcoming)
`jamunson@jenner.com
`SOPHIA W. MONTGOMERY (pro hac vice forthcoming)
`smontgomery@jenner.com
`RUBY C. GIAQUINTO (pro hac vice forthcoming)
`rgiaquinto@jenner.com
`JENNER & BLOCK LLP
`1099 New York Avenue, NW, Suite 900
`Washington, D.C. 20001
`Telephone: 202.639.6000
`
`Attorneys for Plaintiff
`
`
`
`IN THE UNITED STATES DISTRICT COURT
`
`FOR THE DISTRICT OF IDAHO
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`ST. LUKE’S HEALTH SYSTEM, LTD.,
`
`Case No.
`
`Plaintiff,
`
`
`
`v.
`
`COMPLAINT
`
`RAÚL LABRADOR, Attorney General of the
`State of Idaho,
`
`
`
`Defendant.
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`
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`Plaintiff, by and through undersigned counsel, brings this civil action for declaratory and
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`injunctive relief, and alleges as follows:
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 2 of 24
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`PRELIMINARY STATEMENT
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`Under federal law, hospitals that receive federal Medicare funds—like Plaintiff St.
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`1.
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`Luke’s Health System, Ltd. (St. Luke’s)—are required to provide necessary stabilizing treatment
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`to patients who arrive at their emergency departments while experiencing a medical emergency.
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`Under the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. § 1395dd, if a
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`person with an “emergency medical condition” seeks treatment at an emergency department at a
`
`hospital that accepts Medicare funds, the hospital must provide medical treatment necessary to
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`stabilize that condition before transferring or discharging the patient. Crucially, “emergency
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`medical conditions” under the statute include not just conditions that present risks to life but also
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`those that place a patient’s “health” in “serious jeopardy” or risk “serious impairment to bodily
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`functions” or “serious dysfunction of any bodily organ or part.”
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`2.
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`In some circumstances, medical care that a state may characterize as an “abortion”
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`is necessary emergency stabilizing care that hospitals are required to provide under EMTALA.
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`Such circumstances may include, but are not limited to, severe preeclampsia and preterm
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`premature rupture of membranes (PPROM). These conditions can sometimes threaten the life of
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`the mother, but they can also cause severe consequences short of death, including loss of
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`reproductive organs or fertility, sepsis, kidney failure, liver damage, stroke, brain damage,
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`increased risk of future cardiovascular disease and heart failure, and severe pain.
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`3.
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`The State of Idaho has passed a near-absolute ban on the termination of a
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`pregnancy. Idaho Code § 18-622 makes it a felony to terminate pregnancy in all but extremely
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`narrow circumstances. The Idaho law makes it a criminal offense for medical providers to comply
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`with EMTALA’s requirement to provide stabilizing treatment, even where a doctor determines
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`PLAINTIFF’S COMPLAINT - 2
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 3 of 24
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`that termination is the medical treatment necessary to prevent a patient from suffering severe health
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`consequences, if the consequences are short of death.
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`4.
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`The law contains certain narrow exceptions, including, as relevant here, an
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`exception permitting termination of pregnancy where “[t]he physician determine[s], in his good
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`faith medical judgment and based on the facts known to the physician at the time, that the abortion
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`was necessary to prevent the [mother’s] death.” Idaho Code § 18-622(2)(a)(i) (2023).1 The law
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`does not permit termination of pregnancy when necessary to stabilize other serious and debilitating
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`health conditions. And, even in dire situations that might qualify for the Idaho law’s limited
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`“necessary to prevent the [mother’s] death” exception, providers have no way of knowing if a
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`prosecutor will agree that the exception applies, and so they may feel it necessary to withhold care
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`based on a well-founded fear of criminal prosecution.
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`5.
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`Before Idaho Code § 18-622 went into effect, this Court preliminarily enjoined it
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`to the extent that it conflicts with EMTALA. For two periods of time, that injunction was
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`temporarily stayed. During those periods of time, St. Luke’s saw firsthand how the conflict
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`operated to prevent its physicians and other medical providers from providing the stabilizing care
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`required by EMTALA to prevent severe risk to patients’ health, and how the conflict thus impeded
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`St. Luke’s in its ability to properly treat patients. During those times, six different St. Luke’s
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`patients were airlifted to neighboring states so that they could have available to them the full range
`
`
`1 The law originally provided an affirmative defense requiring medical providers to prove that any
`abortion they provided or assisted with “was necessary to prevent the death of the pregnant
`woman” or that, before performing the abortion, the pregnant patient (or, in some circumstances,
`their parent or guardian) reported an “act of rape or incest” against the patient to a specified agency
`and provided a copy of the report. Idaho Code § 18-622(3). Idaho’s legislature amended the law
`in 2023 to convert this affirmative defense to exceptions, including the “necessary to prevent the
`[mother’s] death” exception described above.
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`PLAINTIFF’S COMPLAINT - 3
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 4 of 24
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`of stabilizing care required by EMTALA. If the injunction were vacated, that conflict would arise
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`again.
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`6.
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`To the extent Idaho’s law prohibits medical providers from providing medically
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`necessary treatment that EMTALA requires as emergency medical care, Idaho law directly
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`conflicts with EMTALA. See 42 U.S.C. § 1395dd(f) (EMTALA preempts state laws “to the extent
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`that the [state law] requirement directly conflicts with a requirement of this section”). To the extent
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`Idaho’s law renders compliance with EMTALA impossible or stands as an obstacle to the
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`accomplishment of federal statutes and objectives, EMTALA preempts the Idaho law under the
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`Supremacy Clause of the United States Constitution.
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`7.
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`In this action, Plaintiff seeks a declaratory judgment that Idaho’s law is invalid under
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`the Supremacy Clause and is preempted by federal law to the extent that it conflicts with
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`EMTALA. Because the existing injunction could be vacated if the United States were to dismiss
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`its related lawsuit, Plaintiff also seeks an order preliminarily and permanently enjoining Idaho’s
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`law to the extent it conflicts with EMTALA.
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`JURISDICTION AND VENUE
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`This Court has jurisdiction over this action under 28 U.S.C. § 1331.
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`Venue is proper in this judicial district under 28 U.S.C. § 1391(b) because
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`8.
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`9.
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`Defendant resides within this judicial district and because a substantial part of the acts or omissions
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`giving rise to this action arose from events occurring within this judicial district.
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`10.
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`Pursuant to District of Idaho Local Civil Rule 3.1, venue is proper in the Southern
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`Division because Defendant legally resides in Ada County, Idaho, and because that is where the
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`claim for relief arose.
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`PLAINTIFF’S COMPLAINT - 4
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 5 of 24
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`PARTIES
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`Plaintiff St. Luke’s Health System, Ltd., is the largest Idaho-based, not-for-profit,
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`11.
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`community-owned and community-led health system. Its mission is to improve the health of
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`people in the communities it serves. To fulfill that mission, St. Luke’s operates hospitals, clinics,
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`and other health facilities across Southwest and South-Central Idaho, including eight emergency
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`departments. Nine trauma centers in Southwest and South-Central Idaho are designated Time
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`Sensitive Emergency centers; St. Luke’s operates six of them. St. Luke’s employs more than
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`18,000 people and is the largest private employer in Idaho. St. Luke’s medical providers treat
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`patients millions of times each year, including over 740,000 hospital visits, 242,000 emergency
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`department visits, and 2.2 million clinic visits in 2024 alone. Many of those patients are pregnant
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`women: In 2023, St. Luke’s helped welcome more than 8,920 newborns, representing 40% of live
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`births in Idaho.2 In 2024, St. Luke’s helped welcome 9,455 newborns.
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`12.
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`St. Luke’s is certified as a Medicare provider by the United States Department of
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`Health and Human Services. Nearly a quarter of St. Luke’s patients have Medicare coverage; if St.
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`Luke’s did not participate in Medicare, 144,200 people St. Luke’s cared for in 2024 would have had
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`to seek primary care, specialty clinic care, emergency care, and inpatient care alike elsewhere.
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`13.
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`Because St. Luke’s participates in Medicare, it is required to comply with EMTALA.
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`And because Idaho Code § 18-622 creates a direct conflict with EMTALA, it places hospitals,
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`including the ones operated by St. Luke’s, in the precarious position of risking the criminal liability
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`and medical licenses of their providers simply for complying with federal law. Alternatively,
`
`
`2 Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital
`Statistics System, Natality on CDC WONDER Online Database. Data are from the Natality
`Records 2016-2023, as compiled from data provided by the 57 vital statistics jurisdictions through
`the Vital Statistics Cooperative Program. Accessed at https://bit.ly/3ZE4rEh (last visited Dec. 20,
`2024).
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`PLAINTIFF’S COMPLAINT - 5
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 6 of 24
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`complying with § 18-622 risks violating EMTALA and the ability of St. Luke’s to participate in
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`Medicare. St. Luke’s could also be subject to civil monetary penalties. And complying with § 18-
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`622 also exposes St. Luke’s to litigation by private plaintiffs, who may sue them under EMTALA’s
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`private right of action. 18 U.S.C. § 1395dd(d)(2). As a result, St. Luke’s and its providers are faced
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`with an irreconcilable conflict that compromises their ability to properly treat patients.
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`14.
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`Defendant Raúl Labrador is the Attorney General of the State of Idaho. He is sued
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`in his official capacity. As Attorney General, he has the authority to enforce Idaho law, including
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`the challenged criminal statute, and is a proper defendant. Planned Parenthood Great Nw., Haw.,
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`Alaska, Ind., Ky. v. Labrador, 122 F. 4th 825, 843 (9th Cir. 2024); Planned Parenthood of Idaho,
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`Inc. v. Wasden, 376 F.3d 908, 919-20 (9th Cir. 2004).3
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`15.
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`State attorneys general are proper defendants where they “intend[] either to enforce
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`a statute or to ‘encourage local law enforcement agencies to do so.”’ Culinary Workers Union,
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`Loc. 226 v. Del Papa, 200 F.3d 614, 618-619 (9th Cir. 1999) (quoting Long v. Van de Kamp, 961
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`F.2d 151, 152 (9th Cir. 1992)). The Attorney General has made clear, including through his July
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`1, 2024, letter, that he intends to “continue to enforce [§ 18-622] in the vast majority of
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`circumstances.”4
`
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`3 In a separate case, the Idaho Boards of Medicine and Nursing stipulated that they will take no
`disciplinary action against a licensee pursuant to § 18-622 absent a criminal conviction. Joint
`Stipulation, Planned Parenthood Great Nw., Haw., Alaska, Ind., Ky. v. Labrador, No. 23-cv-
`00142, ECF No. 182-1 (D. Idaho Dec. 18, 2024). The Attorney General’s decision to bring a
`criminal case is therefore also a precondition to imposition of these deterrent licensure penalties.
`4 Raúl Labrador, Labrador Letter: Idaho Is Committed to Protecting Life, OFFICE OF THE
`ATTORNEY GENERAL (July 1, 2024). https://www.ag.idaho.gov/newsroom/labrador-letter-
`idaho-is-committed-to-protecting-life/.
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`PLAINTIFF’S COMPLAINT - 6
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 7 of 24
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`SUPREMACY OF FEDERAL LAW
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`I. The Supremacy Clause and Preemption
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`The Supremacy Clause of the U.S. Constitution mandates that “[t]his Constitution,
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`16.
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`and the Laws of the United States which shall be made in Pursuance thereof . . . , shall be the
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`supreme Law of the Land . . . , any Thing in the Constitution or Laws of any State to the Contrary
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`notwithstanding.” U.S. Const. art. VI, cl. 2.
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`17.
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`“[S]tates have no power . . . to retard, impede, burden, or in any manner control the
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`operations of the Constitutional laws enacted by [C]ongress to carry into effect the powers vested
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`in the national government.” M’Culloch v. Maryland, 17 U.S. (4 Wheat.) 316, 317 (1819). “There
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`is no doubt Congress may withdraw specified powers from the States by enacting a statute
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`containing an express preemption provision,” and a state law is invalid if it conflicts with such a
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`provision. Arizona v. United States, 567 U.S. 387, 399 (2012). Likewise, a state law is invalid if
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`compliance with the state and federal law is impossible or if the state law “stands as an obstacle
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`to the accomplishment and execution of the full purposes and objectives of Congress.” Hines v.
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`Davidowitz, 312 U.S. 52, 67 (1941).
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`II. The Emergency Medical Treatment and Labor Act (EMTALA)
`
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`18. Medicare, enacted in 1965 as Title XVIII of the Social Security Act, 42 U.S.C.
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`§ 1395 et seq., is a federally funded program, administered by the Secretary of the Department of
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`Health and Human Services (HHS), that pays healthcare providers or insurers for healthcare
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`services under certain circumstances.
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`19. Medical providers’ participation in Medicare is voluntary. When providers agree
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`to participate in Medicare, they submit provider agreements to the Secretary of HHS. See 42
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`U.S.C. § 1395cc. Hospitals submitting such agreements agree that they will “adopt and enforce a
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`PLAINTIFF’S COMPLAINT - 7
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 8 of 24
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`policy to ensure compliance with the requirements of [EMTALA] and to meet the requirements of
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`[EMTALA].” Id. § 1395cc(a)(1)(I)(i).
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`20.
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`Under EMTALA, hospitals participating in Medicare are generally required to
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`provide stabilizing healthcare to all patients who arrive at an emergency department suffering from
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`an emergency medical condition. See id. § 1395dd.
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`21.
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`Specifically, EMTALA requires participating hospitals to “screen” patients who
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`request treatment at the hospital’s emergency department and provide “necessary stabilizing
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`treatment,” including an appropriate transfer to another facility that is able to provide stabilizing
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`care not available at the originating hospital, for any “emergency medical condition” the hospital
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`identifies. Id.
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`22.
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`The screening requirement necessitates that hospitals act “to determine whether or
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`not an emergency medical condition” exists. Id. § 1395dd(a); see also 42 C.F.R. § 489.24(a)
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`(noting that EMTALA requires “an appropriate medical screening examination within the
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`capability of the hospital’s emergency department”).
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`23.
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`Congress defined an “emergency medical condition” in EMTALA as:
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`(A) a medical condition manifesting itself by acute symptoms of sufficient severity
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`(including severe pain) such that the absence of immediate medical attention could
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`reasonably be expected to result in-
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`(i)
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`placing the health of the individual (or, with respect to a pregnant woman,
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`the health of the woman or her unborn child) in serious jeopardy,
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`(ii)
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`serious impairment to bodily functions, or
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`(iii)
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`serious dysfunction of any bodily organ or part …
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`(B) with respect to a pregnant woman who is having contractions-
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`PLAINTIFF’S COMPLAINT - 8
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 9 of 24
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`(i)
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`that there is inadequate time to effect a safe transfer to another hospital
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`before delivery, or
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`(ii)
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`that transfer may pose a threat to the health or safety of the woman or the
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`unborn child.
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`42 U.S.C. § 1395dd(e)(1).
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`24.
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`If the hospital determines an individual has an emergency medical condition, “the
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`hospital must . . . either” (1) provide “further medical examination and such treatment as may be
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`required to stabilize the medical condition,” or (2) “transfer of the individual to another medical
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`facility in accordance with” certain requirements. Id. § 1395dd(b)(1); see also 42 C.F.R.
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`§ 489.24(a)(1)(i)-(ii). The hospital may also “admit[] th[e] individual as an inpatient in good faith
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`in order to stabilize the emergency medical condition.” 42 C.F.R. § 489.24(d)(2)(i).
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`25.
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`EMTALA defines “to stabilize” to mean “to provide such medical treatment of the
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`condition as may be necessary to assure, within reasonable medical probability, that no material
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`deterioration of the condition is likely to result from or occur during the transfer of the individual
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`from a facility.” 42 U.S.C. § 1395dd(e)(3)(A). The term “transfer” is defined to include
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`“discharge” of a patient. Id. § 1395dd(e)(4).
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`26.
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`A hospital may not transfer (including by discharging) an individual with an
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`emergency medical condition who has not been stabilized, unless, inter alia, the individual requests
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`a transfer or a physician certifies that the benefits of a transfer to another medical facility outweigh
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`the increased risks to the patient. Id. § 1395dd(c).
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`27.
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`In short, when an emergency medical condition exists, EMTALA requires
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`participating hospitals to provide “stabilizing” treatment, as determined by the particular hospital’s
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`facilities and the treating physician’s professional medical judgment.
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`PLAINTIFF’S COMPLAINT - 9
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 10 of 24
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`28. As relevant here,
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`there are some pregnancy-related emergency medical
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`conditions—including, but not limited to, severe preeclampsia and PPROM—for which a
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`physician could determine that the necessary stabilizing treatment is care that could be deemed an
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`“abortion” under Idaho law. In that scenario, EMTALA requires the hospital to provide that
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`stabilizing treatment.5
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`29.
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`EMTALA contains an express preemption provision, which preempts state laws “to
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`the extent that the [state law] requirement directly conflicts with a requirement of this section.”
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`42 U.S.C. § 1395dd(f).
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`IDAHO’S ABORTION LAW
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`In 2020, Idaho enacted a law that severely restricts abortions and threatens criminal
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`30.
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`prosecution against anyone who performs an abortion. The law, codified at Idaho Code § 18-622,
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`was initially set to take effect on August 25, 2022, 30 days after issuance of the judgment in Dobbs
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`v. Jackson Women’s Health Organization, 142 S. Ct. 2228 (2022). See Idaho Code § 18-622(1)(a).
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`31.
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`This Court, however, preliminary enjoined § 18-622 on August 24, 2022—the day
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`before the law was set to take effect. United States v. Idaho, 623 F. Supp. 3d 1096 (D. Idaho 2022)
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`(No. 1:22-cv-329-BLW). After this Court denied reconsideration of its decision, the State of Idaho
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`and intervenors, including Republican state legislators and the Idaho legislature, obtained a stay
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`
`5 See Dep’t of Health and Human Servs., Reinforcement of EMTALA Obligations specific to
`Patients who are Pregnant or are Experiencing Pregnancy Loss, CENTERS FOR MEDICARE &
`MEDICAID SERVICES (July 11, 2022), https://www.cms.gov/files/document/qso-22-22-
`hospitals.pdf; see also Reinforcement of EMTALA Obligations specific to Patients who are
`Pregnant or are Experiencing Pregnancy Loss, CENTERS FOR MEDICARE &
`MEDICAIDSERVICES
`(Sept. 17, 2021), https://www.cms.gov/files/document/qso-21-22-
`hospital.pdf; Biden-Harris Administration Reaffirms Commitment to EMTALA Enforcement,
`DEPARTMENT OF HEALTH & HUMAN
`SERVICES
`(July
`2,
`2024),
`https://www.hhs.gov/about/news/2024/07/02/biden-harris-administration-reaffirms-commitment-
`emtala-enforcement.html.
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`PLAINTIFF’S COMPLAINT - 10
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 11 of 24
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`of the preliminary injunction from the United States Court of Appeals for the Ninth Circuit on
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`September 28, 2023. United States v. Idaho, 83 F.4th 1130 (9th Cir. 2023). Days later, on October
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`10, 2023, the Ninth Circuit granted rehearing en banc and vacated the panel decision granting the
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`stay. United States v. Idaho, 82 F.4th (9th Cir. 2023). Shortly thereafter, on January 5, 2024, upon
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`request by Idaho and the intervenors, the United States Supreme Court reinstated the stay of the
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`district court’s preliminary injunction, treated the stay request as a petition for certiorari before
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`judgment, and granted that petition. Idaho v. United States, 144 S. Ct. 541 (2024) (mem.); Moyle
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`v. United States, 144 S. Ct. 540 (2024) (mem.). Several months later, however, on June 27, 2024,
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`the Supreme Court dismissed the writs of certiorari as improvidently granted and vacated the stay
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`of the injunction. Moyle v. United States, 144 S. Ct. 2015 (2024) (mem.). As a result, Idaho’s
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`abortion law was briefly in full effect without any limiting injunction in place allowing providers
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`to comply with EMTALA between September 28 and October 10, 2023, and again between
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`January 5 and June 27, 2024. Since then, the en banc Ninth Circuit has heard argument on the
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`appeal of the preliminary injunction, which is again in place, but has yet to issue a decision.
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`32.
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`Under Idaho’s abortion law, “[e]very person who performs or attempts to perform
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`an abortion . . . commits the crime of criminal abortion.” Id. § 18-622(1). The crime of “criminal
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`abortion” is a felony, punishable by two to five years imprisonment. Id.
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`33.
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`Idaho’s law also requires that “[t]he professional license of any health care
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`professional who performs or attempts to perform an abortion or who assists in performing or
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`attempting to perform an abortion in violation of this subsection shall be suspended by the
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`appropriate licensing board for a minimum of six (6) months upon a first offense and shall be
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`permanently revoked upon a subsequent offense.” Id. (emphasis added).
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`PLAINTIFF’S COMPLAINT - 11
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 12 of 24
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`34.
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`The Idaho law defines “[a]bortion” to mean “the use of any means to intentionally
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`terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination
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`by those means will, with reasonable likelihood, cause the death of the unborn child.” Id. § 18-
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`604(1).
`
`35.
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`The criminal prohibition in Idaho’s law contains an exception for when abortion is
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`necessary to prevent the pregnant patient’s death, but there is no exception applicable in
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`circumstances where an abortion is necessary to ensure the health of the pregnant patient—even
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`where the patient faces serious medical jeopardy or permanent impairment or disability.
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`36.
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`Thus, the mere act of terminating a pregnancy in an emergency scenario could
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`subject a provider to criminal prosecution. Physicians cannot be sure that prosecutors will not
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`second-guess their “good faith medical judgments” that termination was necessary to prevent the
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`death of a pregnant patient. Id. § 18-622(2)(a)(i). Indeed, both Idaho’s Supreme Court and counsel
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`for Idaho before the United States Supreme Court have acknowledged that Idaho prosecutors are
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`free to—and very well may—do precisely that. See Planned Parenthood Great Nw. v. Idaho, 522
`
`P.3d 1132, 1204 (Idaho 2023) (“Of course, a prosecutor may attempt to prove that the physician’s
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`subjective judgment … was not made in ‘good faith’ by pointing to other medical experts on
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`whether the abortion was, in their expert opinion, medically necessary.”); Tr. of Oral Arg. 29,
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`Moyle, 144 S. Ct. 2015, https://tinyurl.com/55h456n7 (hereinafter “Tr. of Oral Arg.”) (Justice
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`Barrett: “What if the prosecutor thought, well, I don’t think any good-faith doctor could draw that
`
`conclusion, I’m going to put on my expert?” Idaho’s Counsel: “[T]hat, Your Honor, is the nature
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`of prosecutorial discretion, and it may result in ... a case.”); see also Tr. of Oral Arg. at 31-32
`
`(Justice Alito: “I would think that the concept of good-faith medical judgment must take into
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`account some objective standards .... That was how I interpreted what the—what the state supreme
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`PLAINTIFF’S COMPLAINT - 12
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 13 of 24
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`court said.”). And if a prosecutor does second-guess the physician’s good-faith judgment, an
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`accused physician must litigate their subjective judgment and bear the associated expense,
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`uncertainty, and risk of imprisonment and license suspension.
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`37.
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`In addition, it is a requirement for the “necessary to prevent the [mother’s] death”
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`exception that the physician “performed or attempted to perform the abortion in the manner that,
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`in his good faith medical judgment and based on the facts known to the physician at the time,
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`provided the best opportunity for the unborn child to survive, unless, in his good faith medical
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`judgment, termination of the pregnancy in that manner would have posed a greater risk of the death
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`of the pregnant woman.” Id. § 18-622(2)(a)(ii).
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`IDAHO’S ABORTION LAW CONFLICTS WITH EMTALA.
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`St. Luke’s conscientiously complies with Medicare requirements and operates eight
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`38.
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`emergency departments, including six Time Sensitive Emergency departments.
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`39.
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`Idaho’s criminal prohibition of all abortions, with narrow exceptions, conflicts with
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`EMTALA. Idaho’s criminal prohibition extends even to abortions that a physician determines are
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`necessary stabilizing treatment that must be provided under EMTALA.
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`40.
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`In particular, EMTALA’s definition of an emergency medical condition—for
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`which St. Luke’s would be required to facilitate stabilizing treatment—is broader than just those
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`circumstances where treatment is “necessary to prevent . . . death” under Idaho law. For example,
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`EMTALA requires stabilizing treatment where “the health” of the patient is “in serious jeopardy,”
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`or where continuing a pregnancy could result in a “serious impairment to bodily functions” or a
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`“serious dysfunction of any bodily organ or part.” 42 U.S.C. § 1395dd(e)(1)(A)(i)-(iii). Idaho has
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`criminalized terminating a pregnancy in those circumstances, even when a physician has
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`PLAINTIFF’S COMPLAINT - 13
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 14 of 24
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`determined that is the necessary stabilizing treatment for a patient’s emergency medical condition.
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`The Idaho law therefore conflicts with federal law and is, in this respect, preempted.
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`41.
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`The Idaho law also conflicts with EMTALA because the only limited protection it
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`affords for even life-saving terminations is a narrow exception that potentially requires physicians
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`to litigate the line between life-saving care and care that is only necessary for the health of a patient.
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`Idaho’s law subjects every provider and employee who performs or assists in terminating a
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`pregnancy to potential loss of their professional license unless, as relevant here, that abortion was
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`“necessary to prevent . . . death”—and not only necessary to preserve the health of the pregnant
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`patient. The Idaho law will deter St. Luke’s physicians from terminating pregnancies even when
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`they have determined that care is medically necessary and thus must be provided under federal law.
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`This is true even in the limited situations in which terminating the pregnancy was in fact “necessary
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`to prevent . . . death,” because physicians may fear that prosecutors or jurors will not agree that
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`the circumstances fit into this narrow exception. Here, the law’s obvious chilling effect on
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`providers’ willingness to provide care, even when that care is determined to be a necessary medical
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`treatment, is itself an impediment to the accomplishment of EMTALA’s goal of ensuring that
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`patients receive emergency care. The Idaho law is therefore preempted.
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`IDAHO’S ABORTION LAW CAUSES INJURY TO ST. LUKE’S,
`PUBLIC HEALTH, AND FEDERAL INTERESTS.
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`The Idaho abortion law was initially set to become effective on August 25, 2022; it
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`42.
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`is currently subject to a preliminary injunction.
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`43.
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`Following the Supreme Court’s decision in Dobbs, the Governor of Idaho issued a
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`press release stating that “Idaho has been at the forefront of enacting new laws” to restrict abortion,
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`and specifically referencing § 18-622 as a bill that the Governor “signed into law” and “will go
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`PLAINTIFF’S COMPLAINT - 14
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 15 of 24
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`into effect later this summer.”6 The Attorney General has also recently reaffirmed his view that
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`“Dobbs clearly allowed states to protect the sanctity of life for unborn children” by enacting laws
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`like § 18-622, and made clear that he intends to “enforce [§ 18-622] in the vast majority of
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`circumstances” in accordance with his understanding of the limitations in place “while the
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`litigation continues.”7
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`44.
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`If the preliminary injunction issued in United States v. Idaho is no longer in place
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`and the law goes into full effect, St. Luke’s providers will once again immediately be subject to
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`the threat of arrest, imprisonment, criminal liability, and loss of license for providing federally
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`required care, and St. Luke’s will immediately be at risk of losing its Medicare funding and facing
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`civil litigation and liability.
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`45.
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`Severe harm will result from Idaho’s law, which violates the Supremacy Clause.
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`See New Orleans Pub. Serv., Inc. v. Council of City of New Orleans, 491 U.S. 350, 366-67 (1989)
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`(assuming that irreparable injury may be established “by a showing that the challenged state statute
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`is flagrantly and patently violative of . . . the express constitutional prescription of the Supremacy
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`Clause” (citation omitted)).
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`I.
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`Idaho’s Abortion Law Sharply Curtails the Ability of St. Luke’s to
`Properly Care for Patients and thus Threatens Severe Public Health
`Consequences.
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`If Idaho’s abortion law takes effect without a limiting injunction, St. Luke’s medical
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`46.
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`providers will be threatened with prosecution under a state law that prohibits them from providing
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`6 Press Release, Gov. Little Comments on SCOTUS Overrule of Roe v. Wade, Office of the
`Governor (June 24, 2022), https://gov.idaho.gov/pressrelease/gov-little-comments-on-scotus-
`overrule-of-roe-v-wade/.
`7 Raúl Labrador, Labrador Letter: Idaho Is Committed to Protecting Life, OFFICE OF THE
`ATTORNEY GENERAL (July 1, 2024), https://www.ag.idaho.gov/newsroom/labrador-letter-
`idaho-is-committed-to-protecting-life/ (emphasis added).
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`PLAINTIFF’S COMPLAINT - 15
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`Case 1:25-cv-00015-DKG Document 1 Filed 01/14/25 Page 16 of 24
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`necessary stabilizing medical treatment required by EMTALA. St. Luke’s medical providers will
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`be faced with an untenable choice—either to withhold critical stabilizing treatment required under
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`EMTALA or to risk criminal prosecution and potential loss of their professional licenses.
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`47.
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`If St. Luke’s medical providers faced with this conflict choose the path that risks
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`violating § 18-622, St. Luke’s in turn risks losing its medical providers, hampering its ability to
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`properly treat patients. If instead St. Luke’s medical providers choose to violate EMTALA, St.
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`Luke’s may lose its Medicare funds—which would also jeopardize its ability to properly care for
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`patients—or face civil liability and litigation brought by patients.
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`48. More fundamentally, this conflict hampers the ability of St. Luke’s to fulfill its
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`mission of improving the health of people in the communities it serves because patients will
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`suffer—including by losing access to necessary healthcare that is guaranteed under federal law or
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`having their care delayed. Such delay may arise when physicians and non-physician attorneys must
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`debate whether termination of a pregnancy is truly “necessary to prevent the death” of the patient
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`or “only” necessary to avert a serious but non-lethal threat to the patient’s health. Or delay may
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`arise when providers wait to provide medically necessary treatment until the patient is close to
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`death to avoid prosecution, even though the provider understands that the condition will likely
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`worsen and even though the patient suffers in the meantime.
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`49.
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`Particularly in emergency circumstances, or when dealing with considerations of
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`risk to an individual’s life or health,