The U.S. Supreme Court Must Uphold EMTALA!

Written by Aliye Runyan, MD (obgyn, family planning)
ŷ��AƬ Reproductive Health Strategist

I am an ob-gyn and abortion provider in New York. I listened, infuriated, to pieces of the�� oral arguments held at The Supreme Court on Wednesday while between abortion procedures.�� I want to preface this discussion by acknowledging that, like the case against mifepristone brought before The Court in in FDA v. Alliance for Hippocratic Medicine, the fundamental arguments put forth by the State of Idaho this week are flawed.

It’s not an inaccurate statement to describe this case as “the cruelty is the point”.��

The argument is that the Idaho state government has the right to supersede the federal law Emergency Medical Treatment and Labor Act (), that requires any emergency room to stabilize a patient at risk of significant morbidity or mortality. In many cases, including bleeding, infection, or any significant complication from a pregnancy, the appropriate intervention may be an abortion to save the patient’s life. This would mean that any hospitals under the state abortion ban would not have to provide abortion services, even when it would be necessary to save someone’s life. It is inconceivable to me that we are at a place in this country where the value of a pregnant person’s life is quite literally up to a state government, effectively tying the hands of physicians, like my emergency department colleagues, who would not be able to safely intervene in a situation where there are no trained abortion providers.��

As ER physician pointed out, rulings like these have much larger ripple effects – physicians are and will continue to leave states with abortion bans if they are unable to practice medicine within the ethics and standards to which we are trained. To quote ER physician Dr. Esther Choo

“”

I practice in a generally “safe” state – not without its own flaws in abortion access, however, as long as I practice in this state or others like it, I am assured I can practice full spectrum reproductive medical care, including abortion. I will likely not have to suffer the moral injury of watching a patient die because my hospital and my state decided that life saving interventions in complications of pregnancy are just not legal. Pregnancy is not always safe and not always a benign condition. Underlying all the arguments, it is clear that the State of Idaho and some of our justices believe it is a completely reasonable option to wait until a person is at the brink of death (and how do we determine when that is?) to end their pregnancy, which is frankly misogynistic and places the value of even an unviable�� pregnancy before the life of a living human being. I hope to see more outrage from my colleagues in many specialties, as the impact of this ruling will affect safe and ethical medical care far beyond abortion and obstetrics.

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*Note: an excerpt of this Spotlight is included in ŷ��AƬ Reproductive Health Project eNews #13:
Anti-Abortion Movement Showing True Colors, April 27, 2024
Find the current and past issues in the ŷ��AƬ Repro eNews Archive.

Explore the ŷ��AƬ Reproductive Health Project
Find news, tips, tools, opportunities�� & more!

for ŷ��AƬ Repro Project Updates

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Introducing Ashish Chettimada, a remarkable young visionary hailing from Waterloo, Ontario. Ashish’s dedication to innovative healthcare solutions is nothing short of inspiring. As a student enrolled in the esteemed International Baccalaureate program at Cameron Heights Collegiate Institute, Ashish exemplifies the qualities of a future leader in medicine.

From an early age, Ashish has demonstrated a profound interest in the intricate intersection of human biology and technology. His relentless pursuit of knowledge and his unwavering commitment to solving healthcare challenges stand as a testament to his exceptional character and foresight.

At the ŷ��AƬ (ŷ��AƬ), we recognize the immense value of nurturing young talents like Ashish. Our mission is to foster future physician leaders who not only identify pressing healthcare issues but also possess the creativity and determination to devise innovative solutions. Ashish embodies this spirit wholeheartedly, serving as a beacon of inspiration for aspiring healthcare professionals worldwide.

ŷ��AƬ stands firmly behind the belief that healthcare should be equitable and accessible to all. We are committed to advocating for policies and initiatives that promote universal healthcare coverage and address disparities in healthcare access. Ashish’s work on , a diagnostic and , aligns perfectly with this mission. His project not only addresses a critical medical need but also showcases his commitment to making healthcare more accessible to those in need.

Through initiatives like ReAlign, Ashish demonstrates how innovative solutions can help bridge gaps in healthcare access and improve outcomes for marginalized communities. His dedication to using technology for social good embodies ŷ��AƬ’s core values of equity, inclusivity, and compassion.

As we celebrate Ashish’s accomplishments, let us also reaffirm our commitment to creating a healthcare system that works for everyone. At ŷ��AƬ, we believe that healthcare is a fundamental human right, and we will continue to support young leaders like Ashish who share our vision of a healthier, more equitable world. Meet Ashish at convention in DC from May 30-June 1, 2024!

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What Future Physicians Need to Know about Threats to EMTALA

Written by Anna Hindman, ŷ��AƬ Reproductive Health Project Fellow
and 4th year medical student at Touro University California College of Osteopathic Medicine

Since the overturning of Roe v. Wade in June 2022, a barrage of strictly limiting abortion, such as Arizona’s Civil War-era ban upheld last week, have flooded in, with some, like the recent hearing on Mifepristone, having been challenged at the federal level.

Next week, on April 24th, another state law will be challenged at the federal level in a case called .�� This , is aiming to prohibit emergency abortion care, raising concerns about potential violations of the federal Emergency Medical Treatment and Labor Act (). This pivotal case underscores the importance of protecting patient access to stabilizing emergency care, mandated by EMTALA, especially in cases where termination is crucial for saving lives or ensuring wellbeing. While this case should be straightforward, since Federal law trumps state law in most cases, as , on top of the clear Human Right to emergency services; the looming Supreme Court’s stance remains uncertain, highlighting the need for future physicians to grasp the gravity of this violation of human rights and voice their concerns.

��“A patient’s health should always come first, and for nearly 40 years,
the federal Emergency Medical Treatment and Labor Act (EMTALA) has mandated that protection.”
This is now in question in The Court.
,

�� was enacted by the U.S. Congress in 1986 and requires hospitals that participate in Medicare, which is most of them, to provide emergency medical treatment to anyone who needs it, regardless of their ability to pay, immigration status, or any other factor. In terms of abortion care, this means that if a pregnant individual is in serious risk of death or injury and it is determined termination will save their life and/or wellbeing, it should be provided. This is very important to the humanity of our healthcare system!

The at the center of the case before The Court calls for a near-complete ban on abortion and prohibits anyone from performing or assisting one except when the pregnancy is ectopic or molar; a result of rape or incest; or a risk to the life of the mother. The risk to life of the mother is a confusing line for many providers and has forced physicians to make impossible decisions as to how long you wait to intervene when loss of life is “possible” but not currently imminent. Some real life examples from OBGYNs around the nation have been outlined in an (a document submitted to a court by someone not directly involved in a case but with an interest in its outcome, providing additional information or arguments to assist the court in making a more informed decision) to the Court filed by , , , and .

further limits a physician’s ability to provide evidence-based medicine and puts pregnant patients in serious risk of harm including death, organ damage, loss of reproductive ability, or other threats to their health and wellbeing. In addition, physicians are further legally at risk if they were to terminate a pregnancy in an emergency situation. This is clearly a dangerous precedent for pregnant individuals in our healthcare system, especially when our country’s is already devastatingly high.

It is crucial that future physicians understand what is happening and voice their concerns for this clear violation of Human Rights. Below are further articles and research from our latest e-news. If any questions arise or you just want to talk about everything that is going on, do not hesitate to reach out to us at the Repro Health Project at rhp@amsa.org.��

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*Note: an excerpt of this Spotlight is included in ŷ��AƬ Reproductive Health Project eNews #12:
Doctors Doing Cesareans & Hysterectomies Instead of Abortions, April 20, 2024.
Find the current and past issues in the ŷ��AƬ Repro eNews Archive.

Explore the ŷ��AƬ Reproductive Health Project
Find news, tips, tools, opportunities�� & more!

for ŷ��AƬ Repro Project Updates

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For medical school admissions, did you know that cuts from primary application submissions will eliminate candidates who fall below a school’s standards for both GPA and MCAT scores? After that, the focus shifts from your intellectual abilities to your non-academic accomplishments.

Check out our article to learn more and find out five MCAT tips to help you get into medical school.

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ŷ��AƬ’s mission is to educate and empower diverse future physicians to become unapologetic advocates for equitable healthcare and foster generations of culturally respectful leaders. Our vision is ambitious yet hopeful – we envision a world where healthcare is accessible, medicine is affordable, and systems support the diversity we see around us.

At ŷ��AƬ, we deeply care about maintaining and striving for upholding these values. Our Preamble, Purposes, and Principles (PPP) embody these values, while our Constitution, Bylaws, and Internal Affairs (CBIA) dictate how we govern and manage our organization to uphold our mission and vision.

This year, the discussions held during the Annual HOD Meeting and our Board of Trustees(BOT) meeting were particularly impactful. We deliberated on a wide range of topics, including proposed changes to ŷ��AƬ’s membership types, the restructuring of the Action Committees, the role of artificial intelligence in healthcare, human rights issues, and our relationship with industry. Our unwavering commitment to equity in health care has never been more vital, guiding us to navigate the complexities of our mission with integrity and pragmatism. In response to the evolving challenges, we have thoughtfully decided to accept funding from commercial actors within the health care sector, strictly aimed at enhancing our operational capacities. This strategic decision, motivated by the urgent need to broaden our reach and capabilities, is carefully considered to ensure it does not undermine our mission, vision, goals, or the integrity of our work. Through strategic partnerships with commercial entities, we seek to harness additional resources, expertise, and networks to substantially amplify our impact, ensuring these collaborations align with our core values and objectives and contribute meaningfully to our vision for health care equity.

We recognize the potential complexities and concerns this decision may generate and wish to assure our community of our deep commitment to transparency, accountability, and our mission. Our resolve to drive meaningful, positive change is stronger than ever, and we remain devoted to engaging in open dialogue, listening attentively, and transparently sharing our strategies and decisions. Together, with our partners, supporters, and the communities we serve, we are committed to forging a future where health care equity is achieved for everyone. Through collective effort, mutual understanding, and shared ambition, we will confront these challenges and realize the profound change we strive for.

As we move forward, ŷ��AƬ remains dedicated to fostering a community of future physicians who are not only clinically proficient but also compassionate advocates for change. Some of ŷ��AƬ’s impactful initiatives this fiscal year include:

1. ŷ��AƬ Digital Rural Health Corps Initiative: Addressing rural healthcare disparities through Telehealth and digital resources, enhancing digital literacy in targeted counties.
2. ��Doris Duke Foundation Collaboration: Leading a study and advocacy plan to drive change in medical research, with the help of our Racial Equity Civic Science Fellow to promote diversity and inclusivity in healthcare.
3. Healing the Gap Initiative: Promotes inclusive medical research with three pillars: a Research Directory for student opportunities, Advocacy for awareness and change, and a Spotlight Series on equitable research. Leveraging ŷ��AƬ’s network and social justice commitment, it tackles under-representation, offering resources and advocacy for inclusivity and effectiveness in healthcare.
4. Reproductive Health Project: Advocating for full access to reproductive health services, providing education and training, and offering scholarships for projects focusing on reproductive justice research.

To learn more about the PPP and CBIA changes, please check out our updated governing documents and our proposed resolution. Together, let’s continue to strive for a better, more equitable healthcare system for all.

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Good News, Bad News, Headlines Spotlight Abortion Care��

Written by Becky Martin, ŷ��AƬ Senior Manager of Reproductive Health Advocacy

Headlines in the news shine more light on abortion care, reproductive justice, injustice – and nearly write this Spotlight. This week we’ve seen some good, and some stunningly unbelievable, news about abortion care.��

Starting with some good news from Europe. Lawmakers in Poland began , and the with President of Renew Europe, Valérie Hayer, stating:

“Women’s rights must never fall victim to populism. While Europe’s radical right works hard to find new ways to push through their reactionary agenda, we need to remain a frontrunner and be firmer than ever in upholding women’s rights.
It is time for the right to abortion to be enshrined in law for all Europeans.
Your body, your rights.”����

Now, onto some of the unbelievable U.S. headlines and news:��

• One in Five Women of Reproductive Age in States with Abortion Bans Say They or Someone They Know Has Had Difficulty Accessing an Abortion Since Dobbs, KFF –
• In states with abortion bans, women often take the pill alone, afraid, Washington Post�� –
• Arizona Supreme Court rules state must adhere to century-old law banning nearly all abortions, CNN –

As we move closer to the 6-week abortion ban in Florida that starts May 1, we read with horror headlines such as ; and Advocates fear Florida’s 6-week abortion ban will .��

And, deeper dives into headlines from Arizona found shouts of ‘ followed by disgust as . With all this, it should be no surprise that .��

Yet, . Dr. DeShawn Taylor, an OB-GYN physician, abortion provider and the CEO of the only Black woman-operated abortion clinic in Arizona emphasizes she “will continue to provide abortions until we are made to stop.”��

State attorneys general are stepping up! Arizona AG says she . Additionally, announcing:

“Arizonans dismayed by today’s ruling should know this – if your needs bring you to Nevada,
Nevada will protect you.”

Without surprise, doctors – who like ŷ��AƬ, believe legal, safe, voluntary abortions should be available to all who need them, regardless of how much they earn, who they work for, or what state they live in – are stepping up too! ��Read – Groups such as Aid Access, Hey Jane and Just the Pill stay in close contact to help women seeking abortions in states with bans. Find out what you should and the .

We also invite you to explore the resources below, and consider sharing them with friends and colleagues:

• Destigmatizing Abortion: Actually, Medication Abortion Is Totally Safe, National Women’s Law Center –
• Mifepristone in the Court: What Future Physicians Need to Know, ŷ��AƬ Repro eNews #9 –
• Self-Managed Abortion in the United States, Current Obstetrics and Gynecology Reports –
  • Recent Findings: Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective.
• Self-Managed Abortion: Fact Sheet, Physicians for Reproductive Health –
• How to have a safe self-managed abortion: A self-managed abortion can be just as safe and effective as the more traditional, facility-based approach. Here’s how. Doctors Without Borders –
• Let’s talk about self-managed abortion, Planned Parenthood –
• Legal Rights & Risks: Self-managed abortion & abortion pills, Repro Legal Helpline –
• Patient Confidentiality & Self-Managed Abortion: A Guide to Protecting Your Patients & Yourself, If/When/How: Lawyering for Reproductive Justice –
• Confronting Pregnancy Criminalization: A Practical Guide for Healthcare Providers, Lawyers, Medical Examiners, Child Welfare Workers, and Policymakers. Pregnancy Justice –

Please send any related resources you find interesting and your comments to rhp@amsa.org.

*Note: an excerpt of this Spotlight is included in��ŷ��AƬ Reproductive Health Project eNews #11: Good News, Bad News, Headlines Spotlight Abortion Care, April 13, 2024. Find the current and past issues in the��ŷ��AƬ Repro eNews Archive.

Explore the ŷ��AƬ Reproductive Health Project
Find news, tips, tools, opportunities�� & more!

for ŷ��AƬ Repro Project Updates

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Speaking Truth to Power, Lifting Voices for Reproductive Freedom

Written by Becky Martin, ŷ��AƬ Senior Manager of Reproductive Health Advocacy
and Aliye Runyan, MD, ŷ��AƬ Reproductive Health Strategist

To paraphrase an old saying: evil thrives when good people do or say nothing. Doing and saying nothing has never been ŷ��AƬ’s approach. Rather, ŷ��AƬ strives to embody the sage words of civil rights freedom fighter and former U.S. House Representative John Lewis, may�� he rest in power:

When you see something that is not right, not fair, not just, you have to speak up.
You have to say something; you have to do something.
You must find a way to get in the way and get in good trouble, necessary trouble.

Last year at our Future Physicians for Change 2023 conference, as we approached the 1-year mark of the Dobbs decision overturning Roe v. Wade, Dr. Kristyn Brandi (then the Darney-Landy Fellow at the American College of Obstetricians and Gynecologists and Immediate Past Board Chair, Physicians for Reproductive Health) gave an inspiring and thought-provoking keynote address: Following the Oath or the Law: Teaching Civil Disobedience in Medical Training.

This year, in what PBS NewsHour recently called “” (see NEWS link below) the ŷ��AƬ Reproductive Health Project is proud to bring another innovative voice calling for reproductive freedom and justice for all as a keynote speaker at in Washington DC:��

, co-creator of the theory of Reproductive Justice, 2022 MacArthur Fellow, and Professor at Smith College where she teaches courses on white supremacy, human rights, and Calling In the Call Out culture, will join us in Washington DC to give a keynote address at .

As we approach another year without federal protection for abortion rights in the U.S, lifting voices speaking truth to power, along with those of allies advocating for comprehensive reproductive health care, including�� legal, safe, voluntary abortions for all who need them (regardless of how much they earn, who they work for, or what state they live in) and connecting them with future physicians is critically important if we are to turn the tide on rising , reclaim the right to abortion care, and ensure reproductive freedom and justice for all.

Voices willing to speak truth to power in the face of growing threats to our democracy are also vitally important as we move deeper into our post-Roe reality. As reported in Health Affairs: . Countries with universal health care also have far rates than we do in the U.S. These are true, but far too little known, facts. Lack of wide understanding of these facts by many Americans, including many elected officials who are crafting and funding our health care policies, does not make them untrue despite what many might choose to believe. With truth as our north star and understanding that there “aren’t two sides to facts” we commend to you this thought-provoking voice speaking truth to power: .��

As always we welcome your thought and comments, please email rhp@amsa.org

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Mifepristone in the Court: What Future Physicians Need to Know

Written by Anna Hindman, ŷ��AƬ Reproductive Health Project Fellow and 4th year medical student at Touro University California College of Osteopathic Medicine

This week, the US Supreme Court heard oral arguments regarding a challenge to severely restrict , a progesterone blocker that is one of two medications that has been used safely and effectively in the US and around the world for medication abortions for over 20 years.�� While the news has been relatively and hopeful that the Justices will not further restrict access YET, the fight is unfortunately far from over.��

For years, the FDA’s stringent restrictions on mifepristone, driven by politics and not evidence based medicine, have posed significant barriers to access for individuals seeking abortion care, particularly those in underserved communities. ��required Mifepristone to only be dispensed in-person at a clinic, hospital, or medical office by a certified clinician, preventing mifepristone from being dispensed at pharmacies and via telehealth. The FDA expanded access to mifepristone in two key cases: one in 2016 that increased its usage from 7 weeks gestation to 10 weeks gestation and the second in 2021, fueled by the devastating COVID-19 pandemic and long standing evidence showing mifepristone’s safety, removed the in-person dispensing requirement and added a requirement that pharmacies can become certified to dispense the drug.��

These two changes by the FDA are what is being challenged during this week’s oral arguments. The Court’s final decision is expected at the end of�� June 2024.��

An important warning from legal experts involves the crazy and truly antiquated , an act that was made law in 1873 that “made it illegal to send obscene, lewd or lascivious, “immoral,” or “indecent” publications through the mail. The law also made it a misdemeanor for anyone to sell, give away, or possess an obscene book, pamphlet, picture, drawing, or advertisement.” This included birth control, abortion pills, and abortion instruments. While this seems like something that should be illegal, this Act was in this week’s Mifepristone hearing, including as a “Prominent Provision” by Justices Samuel Alito and Clarence Thomas.

The Podcast Constitutional Law Professors – Leah Litman, Kate Shaw and Melissa Murray –�� have an important message for voters in this very important presidential election this year:�� “it seems like the Justices are deferring a lot of their fire power for after the [2024 Presidential] election and Republican Candidates and supporters are down for it because I think they would actually like to keep this whole curious issue under wraps so that most of us in the electorate won’t understand that one of the biggest issues in the upcoming election isn’t whether or not there is going to be a republican congress that can pass a nationwide ban [on abortion] but rather whether they can sneak in a republican president with a new attorney general who is ready and prepared to revive this zombie law from 1873 [] and begin enforcing it against individuals providing abortion or distributing medication or even implements used for abortion and again they can do all of this without ever getting congress.”��

for more resources on analysis of the US Supreme Court Hearing on Mifepristone in our weekly newsletter, click below to find action and skill-building opportunities with the ASA Repro Health Project. ��

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*Remember this is an election year! It is more important than ever to make sure you are registered to vote, that you vote, and take 5 friends with you!

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Congressman Murphy’s assertion that American medical schools are immune to discrimination is not only erroneous but dangerously dismissive of the persistent disparities that plague our healthcare system. The representation of DEI as a tool for discrimination is a gross misrepresentation and threatens the very foundation of equitable healthcare for all.

DEI initiatives are not merely symbolic gestures; they are critical components in saving lives. Study after study has demonstrated that . By banning DEI, Congressman Murphy threatens the well-being of both future physicians and patients.

The statistics are stark: —a clear indication of the glaring workforce disparity that fails to represent the communities it serves. This . The “Ban DEI in Medicine” bill would strip federal funding, including crucial student loans, from medical schools with DEI initiatives—a move that would not only hinder diversity efforts but also exacerbate healthcare disparities.

It is imperative to acknowledge that healthcare disparities persist, disproportionately affecting racial and ethnic minority groups who face increased barriers to care and worse health outcomes. These capable of understanding and .

Congressman Murphy’s proposal is not only short-sighted but detrimental to the health and well-being of all Americans. Rather than diminishing DEI efforts, we must redouble our commitment to fostering an inclusive healthcare environment that reflects the diversity of our nation.

ŷ��AƬ calls on Congress to reject this misguided proposal and instead work towards bolstering DEI initiatives in medicine. Our nation’s health depends on it.

ACTION ALERT: ŷ��AƬ urges all its members to call Congressman Murphy’s office and their respective congressional representatives to express opposition to the “Ban DEI in Medicine” bill. Use this and let your voices be heard in defense of equitable healthcare for all.

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Written by Anna Hindman, ŷ��AƬ Reproductive Health Project Fellow and 4th year medical student at Touro University California College of Osteopathic Medicine

14 years ago, the Affordable Care Act (ACA) . This milestone in history had a major impact on women’s health, reproductive rights, and access to healthcare which stands as a testament to its . Since its enactment, the ACA has played a pivotal role in advancing women’s health by ensuring comprehensive coverage and access to essential services. One of the most notable achievements has been the , including mammograms, cervical cancer screenings, prenatal care, and birth control, without cost-sharing. This provision has empowered millions of women to prioritize preventive care, leading to improved health outcomes.

Moreover, the ACA has been instrumental in expanding access to reproductive healthcare for women across the United States. By requiring insurance plans to and counseling without copayments, the ACA has made family planning services more accessible and affordable, promoting reproductive autonomy. Additionally, the has provided coverage for essential reproductive health services to low-income women who were previously underserved, ensuring that economic status is not a barrier to accessing reproductive healthcare, leading to many improvements including .

Overall, this anniversary of the ACA serves as an opportunity to celebrate its many achievements, including those in advancing women’s health and reproductive rights. While , including certain provisions of the ACA, its legacy in improving access to healthcare for women, particularly in the realms of preventive care and reproductive health, remains undeniable. continue to show that public opinion on the ACA is more favorable than not and has . As the nation commemorates this milestone, it is imperative to continue advocating for these vital gains, including in women’s healthcare. Please see ACA Resources below to learn more about benefits available to you, your family and future patients.

As we celebrate and build on the ACA we also want to highlight an important new White House Initiative on , led by the First Lady, Dr. Jill Biden, that was announced last week:

• Executive Order on Advancing Women’s Health Research and Innovation –
• Watch President Biden’s Announcement –
• Fact Sheet –

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ACA Resources:��

• Health Coverage for Women Under the Affordable Care Act, HHS –
• Health Coverage for People Under 30 – HealthCare.gov –
• Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses, CMS –
• 14 Features to Celebrate on the ACA’s 14th Anniversary, Health Care for America Now –
• 14 Years After the ACA’s Passage, Policymakers Should Build on Its Pillars of Affordable and Accessible Care, Center for American Progress –

*REMINDER*

Research Presenter Conference Scholarships Available – Apply Today!
Join Us! May 30-June1 in Washington DC at
Apply by March 25 –

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