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Column: Antiabortion agitators are trying to cripple a lifesaving federal healthcare law
Here’s how the legal departments of two hospitals, legislators in two states and even the Supreme Court turned a pregnancy emergency for Mylissa Farmer into a life-threatening nightmare.
Farmer, 41, was 18 weeks into her pregnancy when her water broke prematurely. Her doctor instructed her to go to her local hospital in Joplin, Mo.
There, the hospital’s labor and delivery doctors determined that she had no amniotic fluid left. Her baby had “‘zero’ chance of survival” and she risked infection, blood loss and even death. The doctors advised her that they could help her undergo an “inevitable miscarriage,” or she could wait, at risk to her life.
Obstetricians in Idaho live in constant fear…. Idaho’s doctors have been warned that they are being tracked and scrutinized and they should fear prosecution for providing an abortion under any circumstances — even when medically necessary.
— Idaho Coalition for Safe Healthcare
She chose the former, and then the hospital’s legal department stepped in. Although Missouri’s antiabortion law has exceptions when continuing a pregnancy might cause the mother’s death or “irreversible physical impairment,” the lawyers determined she was not quite there yet.
The doctors advised Farmer to go out of state, but the only hospital capable of handling her condition was in Kansas, which was then in the thick of a political campaign over a proposed antiabortion constitutional amendment.
She arrived at University of Kansas Hospital on Aug. 2, 2022, the very day the vote was taking place. There the doctors offered either to induce labor or end her pregnancy surgically. Then that hospital’s lawyers stepped in. They forbade the doctors to provide any treatment at all, having ruled, according to a doctor, that it “was too risky in this political environment.” Three days later, she reached a clinic in Illinois that performed the necessary treatment.
Mylissa Farmer’s experience matches those of countless other women whose healthcare has been compromised by antiabortion state laws since 2022, when the Supreme Court in its so-called Dobbs decision overturned the guarantee of abortion rights established by Roe vs. Wade in 1973.
But there’s more to her case. The refusal by two major hospitals to treat her emergency condition violated federal law — the Emergency Medical Treatment and Labor Act of 1986, known as EMTALA.
The law, which was drafted to stop hospitals from “dumping” emergency patients without insurance by denying them treatment, requires all hospitals receiving Medicare funds — pretty much all hospitals — to provide all emergency room patients with the treatment required to “stabilize” their conditions before transferring them or sending them home.
Investigations by Medicare inspectors last year concluded that the Joplin hospital and University of Kansas Hospital violated EMTALA when they released Farmer without providing the requisite treatment. The penalties run up to $50,000 per incident and the termination of the hospitals’ Medicare contracts, but no actions have been announced.
There’s no exception in EMTALA when the required emergency treatment is an abortion. And that has made EMTALA the newest target of antiabortion agitators and politicians. They claim that the Biden administration is using the federal law to promote or even mandate abortions in all cases, which is false.
The claim, however, has caught the eye of the Supreme Court, which has scheduled oral arguments April 24 in a case involving Idaho’s antiabortion law and its manifest conflict with EMTALA.
The court’s decision to take up the case alarmed abortion rights advocates when it was announced on Jan. 5. It looms even larger now: The court has signaled, though not guaranteed, that it will reject a right-wing challenge to the Food and Drug Administration’s approval of mifepristone, the key drug in medication abortions, but the Idaho case could give its conservative majority another crack at strengthening state antiabortion policies nationwide.
“There was a lot of press around the mifepristone lawsuit,” says Michelle Banker of the National Women’s Law Center, which is providing Farmer with legal representation. “This is a bit of a sleeper case.”
The case is rooted in an advisory issued by Medicare authorities two weeks after the Dobbs decision overturned Roe vs. Wade. It emphasized to doctors and hospitals that when a pregnant woman arrived at an emergency room with a condition that required an emergency abortion, “the physician must provide that treatment.”
When a state law prohibited abortion and didn’t include an exemption when the life of the mother was threatened, the advisory said, “that state law is preempted ” by the federal law. (Boldfaced emphases in the original.)
Antiabortion advocates instantly took up arms against the advisory. They scurried to federal court in Lubbock, Texas, which has a single active judge, Trump appointee James Wesley Hendrix, who obligingly blocked it with a permanent injunction. The government’s appeal went to the notoriously right-wing U.S. 5th Circuit Court of Appeals, which upheld the injunction.
The Texas case hasn’t made it yet to the Supreme Court. It was outrun by the Idaho case, in which the federal government moved to block Idaho’s antiabortion law to the extent it conflicted with EMTALA.
The conflict, as the government points out, is that the law requires doctors to perform an emergency abortion if necessary to prevent a patient’s condition from deteriorating or to protect her from potentially severe or permanent injury. Idaho law forbids an abortion unless it’s necessary to avert a patient’s death. Doctors caught in this vise are in effect being told that they must allow a pregnant woman’s condition to deteriorate until she is near death before they can act.
It wasn’t entirely surprising that Idaho would become the battleground for the issue. The state is doing very well in the race to enact the most goonishly malevolent antiabortion policies. Its abortion law criminalizes abortion at all stages of pregnancy, with narrow exceptions for cases in which continuing a pregnancy would threaten the mother’s life.
Idaho law also makes it a felony to help a minor leave the state for an abortion. (A federal judge has temporarily blocked the so-called abortion trafficking law while a lawsuit challenging its constitutionality proceeds.)
The state has claimed that its abortion law makes it a felony for a healthcare provider to refer a patient for an abortion out of state. (Also blocked, for now, by a federal judge.) Another state law exposes professors at Idaho public universities with jail terms of up to 14 years for teaching, discussing, or writing about abortion.
Put all that together, and a ruling that it can flout federal law to protect its antiabortion credentials would be right up Idaho’s alley.
In making its case, Idaho asserts that after the Dobbs decision the Biden administration “reinterpreted” EMTALA “to create a nationwide abortion mandate” — a mandate the administration only “discovered” nearly 40 years after EMTALA’s enactment.
As the government points out, however, the mandate was always within EMTALA; it never had to be spelled out because the right to abortion became the law of the land via Roe vs. Wade 13 years before EMTALA was enacted. Until Dobbs, the role of abortion as an emergency treatment almost never came under question.
Antiabortionists maintain that Dobbs “caused a sea change in the law,” as 5th Circuit appellate judge Kurt D. Englehardt, another Trump appointee, wrote for the three-judge appeals panel upholding the Texas injunction.
That was a cute bit of legerdemain. EMTALA didn’t change as a result of Dobbs — it was healthcare laws in red states that changed to outlaw abortion. “It has always been the case that EMTALA has been understood to require abortion care when that’s necessary to stabilize a patient’s medical condition,” Banker told me. “The only thing that’s new is that Roe vs. Wade has been overturned.”
Indeed, according to a friend-of-the-court brief filed by six former Medicare administrators and former Health and Human Services Secretary Donna Shalala, who served under both President Bush as well as Presidents Clinton and Obama, Medicare repeatedly issued public guidance stressing that abortion should be considered appropriate emergency treatment when warranted, even before Dobbs.
Idaho, like its apologists in the right-wing fever swamp, maintains that EMTALA “merely prohibits emergency rooms from turning away indigent patients with serious medical conditions” and doesn’t mandate “any specific type of medical treatment, let alone abortion.”
This is a crabbed and mendacious interpretation of the law. It’s a cynical attempt to conflate the problem that prompted Congress to act — hospitals were turning away emergency patients without insurance, a process known as “dumping” — with the much broader law Congress enacted.
EMTALA explicitly protects “any individual” who presents at an emergency room, regardless of their financial or insurance situation. Hospitals aren’t even allowed to inquire about the patient’s financial or insurance status if that would delay examination or treatment.
Idaho’s interpretation suggests that hospitals could simply keep indigent patients in their corridors, untreated, until they wasted away, without violating EMTALA. That’s not what the law says. It explicitly mandates that hospitals “provide either … such treatment as may be required to stabilize the medical condition” or transfer the patient to another facility that can provide the treatment — as long as the transfer itself won’t harm the patient.
What does “stabilize” mean? The law defines the term as meaning that “no material deterioration of the condition” would result from discharging or transferring the patient. It also defines an “emergency medical condition” as one that, without treatment, would jeopardize “the health of the individual,” or cause “serious impairment to bodily functions” or to any organ or body part.
Far from ignoring pregnancy issues, EMTALA has always explicitly covered women presenting with a pregnancy emergency. In those cases, the law says, the hospitals are bound to provide treatment that protects “the health of the woman or her unborn child.”
The friend-of-the-court briefs piling up on the Supreme Court’s EMTALA docket include several outlining the horrific moral and legal trap facing doctors caught between EMTALA and antiabortion state laws.
“Obstetricians in Idaho live in constant fear,” states a brief filed by a coalition representing 678 Idaho doctors and other medical professionals. “Always at the back of their minds is the worry that a pregnant patient will arrive at their hospital needing emergency care that they will not be able to provide.”
Under Idaho law, doctors face prison terms of up to five years and the loss of their medical licenses for following medical protocols unless “the patient is face-to-face with death.” The federal and state laws are totally irreconcilable: Doctors confronted with an emergency pregnancy, the brief says, have the choice of complying with EMTALA and thus risking a stiff prison term and the end of their careers, or complying with state law and thus risking their patient’s health or even causing her death.
What’s worse, “the culture of fear surrounding Idaho’s abortion laws has only exacerbated the struggle,” the brief says. “Idaho’s doctors have been warned that they are being tracked and scrutinized and they should fear prosecution for providing an abortion under any circumstances — even when medically necessary.”
Is there any mystery why OB/GYNS are leaving Idaho by the score? Half of the state’s 44 counties have no practicing obstetricians at all.
A solution, albeit a modest one, to the confusion over the responsibilities of obstetricians in antiabortion states would be for the Supreme Court to clarify that federal law prevails when it runs up against a more restrictive state law. Making that clear in Idaho would send a signal to Texas, Missouri and other states that a mother’s life and health can’t be legislated away.
The EMTALA case gives the Supreme Court an opportunity to uphold science and morality on women’s reproductive healthcare, as it appears to be preparing to do on mifepristone. But what if it follows that case by allowing states to sentence pregnant women to substandard emergency care?
A federal jury sided with OpenAI and its top executives on Monday in a feud with Elon Musk, who accused them of betraying a shared vision for it to guide artificial intelligence’s development as a nonprofit.
The nine-person jury unanimously found that Musk waited too long to file his lawsuit and missed the deadline for the statute of limitations.
Musk, the world’s richest man, was a co-founder of OpenAI, the company that launched in 2015 and went on to create ChatGPT. After investing $38 million in its first years, Musk accused OpenAI CEO Sam Altman and his top deputy of shifting into a moneymaking mode behind his back.
The jury served in an advisory role, but Judge Yvonne Gonzalez Rogers accepted the verdict Monday as the court’s own and dismissed Musk’s claims.
The trial that began on April 27 in Oakland shed light on the bitter falling-out between the two Silicon Valley titans and the origins of OpenAI, now a company valued at $852 billion and poised to become one of the largest initial public offerings in history.
The high-profile high-stakes showdown between two of the most powerful companies and leaders in technology was billed as a battle that could change the trajectory of AI.
There were two weeks of testimony from the dueling entrepreneurs and other key players in OpenAI’s history, providing a rare inside glimpse into the company, which evolved from a startup to one of the world’s most influential companies.
Musk had fallen out with his fellow co-founders, then, after OpenAI became arguably the most important company in AI, he decided he was not happy with how the trailblazer was managed after he left.
Musk claimed Altman, the startup’s chief executive officer, and OpenAI President Greg Brockman “stole a charity” by exploiting his early support for an altruistic research project so that they could later get rich by turning into a regular for-profit company.
OpenAI and its leaders said Musk was suing them to gain a competitive advantage for his own startup, xAI.
Musk was seeking more than $100 billion in damages — to be awarded to OpenAI’s nonprofit arm instead of to himself — as well as the removal of Altman and Brockman.
The case was seen as an existential threat to OpenAI. If the decision had gone the other way, it would have sparked a shakeup that would have destabilized the company just as it is working to ensure the U.S. takes the lead in AI and prepares for a public offering with a valuation approaching $1 trillion.
Associated Press and Bloomberg contributed to this article.
In 1926, director Cecil B. DeMille hired hundreds of workers to build a set of Jerusalem inside the DeMille Studios in Culver City for the classic silent film “The King of Kings.”
A century later, Jon Erwin filmed his biblical epic ‘The Old Stories: Moses,’ starring Ben Kingsley, on the same studio lot now owned by Amazon MGM Studios.
Except now, much of the architecture, desert location, and supernatural parts of the three-episode miniseries were generated through artificial intelligence. The prequel to ‘The House of David’ series debuts on Amazon Prime on Thursday.
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A production that traditionally would have taken months to shoot and require multiple locations was filmed entirely in one week with a crew of just 100 people — who never left Los Angeles.
“We did this massive sword-and-sandal epic, and we never left a soundstage, very similar to how James Cameron does Avatar or how Jon Favreau does ‘The Mandalorian,’” said Erwin, the director of the series. “When you preserve the performance and the work of the crews and the department heads, then you can do things that are incredibly cost-effective for studios.”
As Hollywood grapples with rapid technological change, a growing number of filmmakers and companies in Southern California are using AI tools to radically rethink how films and TV shows are made.
“Some are still resisting, but many are recognizing that, for better or worse, AI is here and not going anywhere and it is important to reimagine what film creation can look like in light of the new possibilities AI creates,” said Victoria Schwartz, director of the entertainment, media, and sports law program at Pepperdine Caruso School of Law.
A screen of LED panels called “the Volume” is used to film scenes for director Jon Erwin’s series “The Old Stories: Moses.”
(Genaro Molina / Los Angeles Times)
Erwin is among the first working directors at a major streaming platform to fully integrate AI into a commercial production.
Last month, he launched Innovative Dream, a Manhattan Beach production services company backed by Amazon. The company will rent its virtual production facilities to other studios and develop training programs for emerging filmmakers.
Although much of Hollywood is bracing for AI to hollow out jobs, Erwin argues the opposite: that AI, applied ethically around human performances, can return at least some production jobs that have been outsourced even as other positions are eliminated.
“I think the greater threat of job loss in our industry is actually just how expensive things have gotten and how long they take to make,” Erwin said. “If you can make things quicker, and you can make things at a price point that studios will say ‘yes,’ you can employ more people in aggregate and create jobs.”
Although computer graphics have been essential to Hollywood since the 1990s, they traditionally required hundreds of artists and months of post-production work to place actors or crowds in digital worlds. Much of the labor-intensive visual effects work known as rotoscoping was outsourced to shops in India and other countries with much lower labor costs than in California.
By 2019, productions such as Disney’s “The Mandalorian” series advanced this further by using massive LED screens to project images of photorealistic digital worlds — “Star Wars” ships, forests, or deserts — as actors’ performed in costume in front of them. A virtual art department spent months designing the digital environments, and then loading them onto the large screen on the day of the shoot.
AI takes the process a step further.
Through “Moses,” Erwin is championing what he calls “hybrid” filmmaking: a workflow that marries live-action with AI-enhanced workflows in virtual production. The process combines what used to be separate phases — filming with actors and visual effects — to occur almost simultaneously. Scenes shot on set is made available to multiple editors and AI artists within minutes on the production floor, as they show near-finished sequences back to the cast and director.
“You can create assets in three or four days, not 10 weeks. And that means you can actually kind of generate the environment while you’re shooting,” he said.
Erwin, 43, grew up in Alabama and built his career around faith-based films such as ‘I Still Believe’ and ‘Jesus Revolution.’ He had spent years trying to tell biblical stories at the scale portrayed in the source material.
When he pitched “House of David,” a drama about the life of King David, studio executives were initially skeptical. “I was told to just come up with a smaller idea,” he said.
To portray Goliath’s origin story, actors were filmed on green screens and AI was used to generate a mythical sequence involving dark sky, rain, mountains and angels with wings.
It marked one of the first integrations of generative AI in a major commercial production. The series, which premiered last year was viewed by 44 million viewers worldwide and reached No. 1 on Prime Video in the U.S.
By Season 2, the team used 30 different tools, both traditional and AI, to generate images, sounds and video. They pivoted from shooting solely on location in Greece to filming some parts in L. A. in front of an LED wall.
AI was used to generate battle scenes and expand the background crowd size to thousands of people in a fraction of the time traditional CGI required. The use of AI-generated scenes jumped from 70 in Season 1 to 400 shots in the second season.
Jeff Thomas, a generative AI filmmaker who directed two episodes of Season 2, said each episode was made for less than $5 million, defying studio consensus that the show required a “Game of Thrones”-level budget of $12 million to $15 million per episode. Erwin declined to disclose the budgets for the “House of David” series or the “Moses” prequel..
“The Bible describes that battle as there was 100,000 people on each side. Well, it’s never been portrayed like that because we’ve never had the resources,” Erwin said. “We’re finally able to show that scope and scale.”
Erwin conceived of the idea of “Moses” over Christmas, wrote the script in January and created a four-minute trailer entirely created by AI. Amazon greenlighted the series later that month.
Kingsley had a short window before his next commitment, so Erwin prepared and shot all three episodes on a soundstage in a week — a project that would have previously taken six months to prepare.
For the pivotal Red Sea scene, Erwin generated the water volumes and tidal waves in less than hour using AI models from Chinese company Kling AI and Palo Alto-based Luma AI, which would have taken weeks in the traditional process. They wrote text prompts that explored 18 different variations of the sea parting and discarded the ones that didn’t work, enabling Kingsley to react to a tidal wave projected onto a 360-degree LED wall screen.
“‘Moses’ really represented a whole new method of filmmaking for me,” Erwin said.
For “The Old Stories: Moses,” director Jon Erwin used AI for wide shots, stunt-heavy battle sequences and to generate large crowds to showcase the grand scope of biblical stories. The red line he said he wouldn’t cross is using it in place of actors.
(Genaro Molina / Los Angeles Times)
For crucial scenes portraying the palace hallway in Egypt, where Moses talks to the Pharaoh, they built cardboard boxes as the columns in the palace, and “reskinned” them with intricate carvings using AI. Although the set could accommodate only 20 extras, they used AI to create hundreds of background actors.
Erwin also used generative AI to synthetically expand partially built sets featuring sand and rocks and to “de-age” Kingsely to appear as a young Moses.
But some things were off limits for AI, including Kingsley’s performance.
“I just think our faces are so intricate and the micro expressions are so intricate, so that’s always real,” he said.
Instead, AI was used to co-design the character: Erwin originally imagined a bald Moses, but based on Kingsley’s feedback, they fine-tuned the look with weathered hair and mustache.
“The line in the sand for me is replacing an actor,” Erwin said. “I don’t want to be in the industry if I can’t work with actors.”
Jon Erwin’s “hybrid” production involves generating a variety of environments such as forests, deserts, or battle sequences using AI, and projecting them on the LED screen.
(Genaro Molina / Los Angeles Times)
When asked about the background extras displaced by AI crowd generation, Erwin said that’s the wrong way to think about it.
“It’s not a comparison of what would “Moses” have cost otherwise. It’s a comparison of “Moses” would have never been made otherwise, and that’s the way you have to think about it,” he said.
Overall contraction in Hollywood has led to fewer films being shot on location in Los Angeles, and a 30% drop in entertainment industry jobs since its 2022 peak.
“I think you can do those things three to five times faster, at less than 30% the cost,” he said. “I actually see this tool set as an antidote to the job loss problem in our industry.”
Waymo is recalling 3,791 autonomous taxis after a software defect caused some vehicles to drive into flooded roadways, according to a recall report from the National Highway Traffic Safety Association.
The voluntary recall filed April 30 affects Waymo vehicles operating on the company’s fifth and sixth generation Automated Driving System. The software “may allow the vehicle to slow and then drive into standing water on higher speed roadways,” a NHTSA report said.
“Entering a flooded roadway can cause a loss of vehicle control, increasing the risk of a crash or injury,” NHTSA said.
The recall followed severe weather in San Antonio, during which a Waymo entered a flooded and impassable road, the company said.
In response, Waymo has increased weather-related constraints on its vehicles and says it is working on additional software safeguards.
“We have identified an area of improvement regarding untraversable flooded lanes specific to higher-speed roadways, and have made the decision to file a voluntary software recall with NHTSA related to this scenario,” a Waymo spokesperson said. “Waymo provides over half a million trips every week in some of the most challenging driving environments across the U.S., and safety is our primary priority.”
Waymo operates in 10 major cities and has issued prior safety-related recalls. Last year, the company recalled more than 1,200 autonomous vehicles after minor crashes involving obstacles in the road.
The Alphabet-owned company has also come under fire for safety incidents, including striking a child outside a school in Santa Monica earlier this year and fatally running over a neighborhood cat in San Francisco.
According to data collected by Waymo over 170 million fully autonomous miles driven, Waymo is 13 times safer than human drivers in crashes involving pedestrians.
The Mountain View-based company is currently ahead in the race to scale robotaxis across the country, with thousands of vehicles transporting paying customers in cities including Los Angeles, Miami and Phoenix.
Competitors Zoox and Tesla are trying to catch up with their own self-driving technology, but have yet to match Waymo’s scale and reach.
According to NHSTA, all affected Waymo vehicles received an interim software update to mitigate the issue, but a full remedy for the recall is still under development.
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