Moyle v. United States (23-726)

argument 23-726

Moyle v. United States

Supreme Court of the United States 1h 53m 8 speakers 8 chapters transcribed 8 days ago official recording ↗

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What is EMTALA and how does it relate to state medical licensing?

John G. Roberts 0:00

We will hear argument this morning in Case 23-726, Moyle v. United States, and the consolidated case. Mr. Turner.

Mr. Turner 0:09

Thank you, Mr. Chief Justice, and may it please the Court. When Congress amended the Medicare Act in 1986, it put EMTALA on a centuries-old foundation of state law. States have always been responsible for licensing doctors and setting the scope of their professional practice. Indeed, EMTALA works precisely because states regulate the practice of medicines. And nothing in EMTALA requires doctors to ignore the scope of their license and offer medical treatments that violate state law. Three statutory provisions make this clear. First, Section 1395, the Medicare Act's opening provision, forbids the federal government from controlling the practice of medicine. That's the role of state regulation. Second, Subdivision F in EMTALA codifies a statutory presumption against preemption of state medical regulations.

Mr. Turner 0:56

And third, EMTALA stabilization provision is limited to available treatments, which depends on the scope of the hospital staff's medical license. Illegal treatments are not available treatments. add in this court's own presumption against preemption of state regulations, combine that with the need for clear and unambiguous spending clause conditions, and the administration's reading becomes wholly untenable. The administration's misreading also lacks any limiting principle. If ER doctors can perform whatever treatment they determine is appropriate, then doctors can ignore not only state abortion laws, but also state regulations on opioid use and informed consent requirements. that turns the presumption against preemption on its head and leaves emergency rooms unregulated under state law.

Mr. Turner 1:44

It's unsurprising that no court has endorsed such an expansive view of EMTALA. And until Dobbs, Norhead HHS, everyone understands that licensing laws limit medical practice. That's why a nurse isn't available to perform open heart surgery, no matter the need, no matter her knowledge. the answer doesn't change just because we're talking about abortion. The court should reject the administration's unlimited reading of EMTALA and reverse the district court's judgment. I welcome the court's questions.

Clarence Thomas 2:18

Normally, when we have a preemption case, there's some relationship between the parties. Is the state being regulated by the federal government under EMTALA, or is the state in engaged in some sort of quasi-contractual relationship.

Mr. Turner 2:41

Yes, Your Honor. In this case, Idaho, for example, has no state hospitals that participate with the emergency rooms in EMTALA. And so in this case, there isn't even a quasi-relationship. The parties being regulated by EMTALA, here are hospitals and doctors. And I think your question is getting at the Armstrong issue, and we think that is a significant question. It wasn't part of the question presented. We think the Indiana amicus brief raises significant questions and deals with that argument well. But the question presented here is one of direct conflict between Idaho's law and EMTALA, and on that question, we don't think it's hard at all. And, Your Honors, going to that direct conflict, I think if you consider the express limitation within the statute of availability...

Ketanji Brown Jackson 3:30

Well, before we do that, can I just... step back and get your understanding of the statute. You made some representations as to how you see it working, and so let me tell you what I think, and then you can tell me whether you agree, disagree, or otherwise. So I think that there are two things that are plain, pretty plain, on the face of this statute. One is that EMTALA is about the provision of stabilizing care for people who are experiencing emergency medical conditions. That's one thing, I think. the statute is doing. And I also think that it is operating to displace the prerogatives of hospitals or states or whomever with respect to that fairly narrow slice of the healthcare universe. this idea of emergency medical services is like one very minor part or small part of the sort of overall healthcare, provision of healthcare.