Nicole Miller had gone to the emergency room in Boise, Idaho, after waking up with heavy bleeding in her 20th week of pregnancy. By afternoon, she was still leaking amniotic fluid and hemorrhaging and, now in a panic, struggling to understand why the doctor was telling her that she needed to leave the state to be treated.
“If I need saving, you’re not going to help me?” she recalls asking. She remembers his answer vividly: “He told me he wasn’t willing to risk his 20-year career.”
Instead, that evening, hospital workers at St. Luke’s Boise Medical Center put Miller on a small plane to Utah, where she said she gripped her husband’s hand — scared of flying but more terrified that she would never see her young daughters again. “I just need to stay alive so I can be around for my two other kids,” nurses reported her saying as she arrived at the hospital in Salt Lake City, 14 hours after she had arrived in the emergency room back home.
Only when she woke up the next morning did she understand, because a nurse told her, that she was airlifted so she could have an abortion.
“I couldn’t comprehend: I’m standing in front of doctors who know exactly what to do and how to help, and they’re refusing to do it,” Miller said in an interview, her first since going through the ordeal in the fall.
Last week, the U.S. Supreme Court declined to decide whether states that ban abortions, including Idaho, must comply with a federal law that requires emergency room doctors to provide abortions necessary to protect the health of a pregnant woman.
The justices sent the question back to the lower courts for trial and in the meantime reinstated a lower-court order saying that the federal law, the Emergency Medical Treatment and Labor Act, did apply.
Abortion opponents accuse the Biden administration of trying to use the federal law to turn emergency rooms into “abortion havens.” Exceptions to abortion bans, they say, already give doctors the same leeway to provide abortions in true medical emergencies.
The Biden administration’s push to apply the law “is a PR stunt to spread the lie that pro-life laws prevent women from receiving emergency care,” Katie Daniel, state policy director for Susan B. Anthony Pro-Life America, said after the court ruling Thursday.
But doctors in Idaho and other states with near-total bans say that even with the renewed protection of federal law, they have little clarity about what medical emergencies are covered and little reassurance that they will not face charges, jail time, large fines and loss of their medical licenses if they provide care a prosecutor says was not necessary.
“The transfers and the difficulty finding OB-GYNs who are willing to do the care are going to continue,” said Dr. Alison Haddock, president-elect of the American College of Emergency Physicians, who is leaving her job in Houston this week for a position in the Pacific Northwest, in part because of the difficulty of working under Texas’ abortion ban.
Miller’s case illustrates the struggle for doctors. When she arrived at the emergency room at St. Luke’s in Boise just before 6 a.m. Sept. 11, the federal law was under effect, because of the lower court ruling.
According to her account, which was verified by The New York Times, she had placental abruption, and her water had broken prematurely, but doctors at St. Luke’s said they could not legally give her the care she needed. By the time they put her on the plane to Utah, they estimated she had lost a liter of blood.
Doctors at St. Luke’s, Idaho’s largest hospital system and biggest employer, say there was even more uncertainty after the Supreme Court temporarily suspended the law in January. In the four months after that, the hospital airlifted six pregnant women to other states for care; the previous year, there was just one, presumably Miller. (The hospital declined to discuss her case specifically, citing privacy laws.)
Raúl Labrador, Idaho’s attorney general, a Republican, has questioned those numbers, noting that the doctors were not under oath when they provided them. “I would hate to think that St. Luke’s or any other hospital is trying to do something like this just to make a political statement,” he said after the Supreme Court heard oral arguments in the case in April.
Miller, now 39, will tell her story under oath this fall, as a fact witness in a lawsuit brought against the state by the Center for Reproductive Rights. “I want people to know that this can happen to anyone; it can happen to your sister, your wife or your daughter,” she said. “I never expected this to happen to me.”
She and her husband, Michael, had debated whether to have a third child. It took longer than expected, but they were thrilled when she became pregnant through intrauterine insemination and even more excited when they found out they were having a boy.
They had already named him — Maddox David — when Miller started spotting around 17 weeks of pregnancy. Her obstetrician could see from ultrasounds that she was leaking amniotic fluid and suggested a maternal fetal medicine specialist.
Before Miller could see the specialist, she woke up hemorrhaging. She called her mother to watch her girls, then she and Miller went to the emergency room.
Miller said that doctors told her that the fetus still had a heartbeat, and that she would need to leave Idaho for care. They transferred her first to a labor and delivery triage unit, where doctors said the fetus was in danger. As the doctor told Miller that he could not risk his career to give her the care she needed, the medical student standing next to him cried. “I’m assuming that was because she was in shock as well as to what was happening,” Miller said.
Still, no one mentioned abortion or termination, she said. “It was, ‘We need to get you to a place where you have all of your options.’”
Miller knew little at the time about the Idaho law that bans abortion except to prevent the death of a pregnant woman, for some nonviable pregnancies, or in some cases of rape and incest.
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