Why Idaho’s hospitals are having pregnant patients airlifted out of state

Since January, Dr. Stacy Seyb, a maternal-fetal medicine specialist in Boise, Idaho, has had at least four of his patients wheeled onto emergency flights and airlifted out of the state while experiencing severe pregnancy complications.

One of them was a woman whose water broke around 20 weeks into her pregnancy, putting her at risk of infection. In these types of emergencies, ending the patient’s pregnancy can be part of the standard of care. But doctors at the hospital where Seyb works say they have been forced to transfer patients who have these complications out of state to comply with the state’s abortion ban.

“This has become the new normal, which is sad,” he said.

Idaho bans all abortions, with criminal penalties of up to five years in prison for anyone who performs one or assists. The law includes limited exceptions for rape, incest and to save the life of a mother, but there is no exception to protect her health.

After oral arguments Wednesday, the Supreme Court is now considering whether Idaho’s abortion ban violates a federal law that requires hospitals to offer emergency care to patients in crisis. Thus far, the justices seem split on that question, with some of the more conservative justices appearing to lean toward the state of Idaho, which has argued that federal law should not supersede its own laws on health care.

St. Luke’s Health System, which includes the hospital where Seyb works, filed an amicus brief in the case, noting that an abortion may be critical to protect a patient from nonfatal harms like loss of organs, permanent disability, severe pain or loss of fertility. It also said the ban forces patients to endure potentially risky out-of-state transfers.

Since Jan. 5, when the Supreme Court lifted an injunction that had shielded doctors providing emergency care, six pregnant patients at St. Luke’s have had to be airlifted out of Idaho, according to Dr. Jim Souza, the chief physician executive for St. Luke’s. Last year, the system saw only one such transfer, he said.

In a press conference after Wednesday's arguments, Idaho Attorney General Raúl Labrador, a Republican, questioned accounts of doctors transferring patients. “It’s really hard for me to conceive of a single instance where a woman has to be airlifted out of Idaho to perform an abortion,” he said.

“Our law is very clear,” he said. “It protects doctors, it protects women, it protects unborn children, and it ensures that the doctors can use a subjective standard if they believe that the life of the mother is in jeopardy.”

Out-of-state medical transfers can delay needed care and carry immense financial and emotional costs for pregnant patients, who may wind up far from home during some of the most difficult moments of their lives. The cost of the flights can exceed $10,000, and the transportation may also be considered out-of-network by insurance, increasing the share patients must shoulder themselves.

One of the most common complications is when a patient’s water breaks in the first two trimesters of pregnancy, according to Souza. Last year, the hospital system had 54 such cases, most occurring before fetal viability.

Physicians for Human Rights, an organization that has advocated for abortion rights, also filed an amicus brief in the Supreme Court case. It cites a March report for which the group interviewed several doctors who practice or practiced in Idaho, along with doctors based in neighboring states who received patients who were transferred.

Dr. Sarena Hayer, a physician in Oregon, described receiving a patient from Idaho who was gravely ill when she arrived by air. The patient was 18 weeks pregnant with twins when she suffered a severe pregnancy complication. The patient also had a history of kidney issues and had previously received a transplant.

Doctors at her Idaho hospital determined that one of her fetuses had died and her lab results were troubling. She told her doctors she “wanted them to do whatever they had to, including termination,” according to the report. But she was ultimately airlifted to Oregon. The following morning, she lost her other fetus too.

If the woman had started her care in Oregon, she would have been offered a termination almost immediately, Hayer said.

“What other medical condition can we think of that would require a patient who’s sick to get transported to another state for a legal reason?” Hayer told NBC News. “It just really feels unjust.”

“In a way, you’re torturing the women because you’re not providing the definitive care until you can say they’re at the brink of death,” Dr. Michele Heisler, the medical director for Physicians for Human Rights, said in an interview. “I think that’s the stake here.”

Doctors in Idaho also described situations in which patients with severe pregnancy complications were unable to leave the state to seek treatment.

Dr. Michael Schneider, a maternal-fetal medicine specialist in Boise, recalled a patient whose water broke around 20 weeks but declined to be airlifted out of state, in part because she could not leave her family. Expenses were another concern. The woman left the hospital, he said, then returned once she experienced contractions. She went into labor, but her fetus did not survive.

Over his decades in medicine, Schneider has learned that vulnerabilities for pregnant women are acute. On his first night of a residency at a hospital in Memphis, Tennessee, a patient with sepsis died.

“That’s what keeps me up — that somebody’s going to be placed in harm’s way, or a transport is going to go bad and there’s going to be a significant injury to the mother,” he said. “It doesn’t get any worse than losing two.”