The Biden administration told emergency room doctors they must perform emergency abortions when necessary to save a pregnant woman’s health, following last week’s Supreme Court ruling that failed to settle a legal dispute over whether state abortion bans override a federal law requiring hospitals to provide stabilizing treatment.

In a letter being sent Tuesday to doctor and hospital associations, Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Director Chiquita Brooks-LaSure reminded hospitals of their legal duty to offer stabilizing treatment, which could include abortions. A copy of the letter was obtained by The Associated Press.

“No pregnant woman or her family should have to even begin to worry that she could be denied the treatment she needs to stabilize her emergency medical condition in the emergency room,” the letter said.

It continued, “And yet, we have heard story after story describing the experiences of pregnant women presenting to hospital emergency departments with emergency medical conditions and being turned away because medical providers were uncertain about what treatment they were permitted to provide.”

CMS will also resume investigations into complaints against emergency rooms in Idaho, after the Supreme Court ruled last week that hospitals there must be allowed to perform emergency abortions for now, despite the state’s abortion ban.

But enforcement in Texas, the country’s most populous state with a strict six-week abortion ban, will still be on hold because of a lower court ruling.

The letter is the Biden administration’s latest attempt to raise awareness about a 40-year-old federal law that requires almost all emergency rooms — any that receive Medicare dollars — to provide stabilizing treatment for patients in a medical emergency. When hospitals turn away patients or refuse to provide that care, they are subject to federal investigations, hefty fines and loss of Medicare funding.

The Texas Alliance for Life responded to the letter by saying the Biden administration “falsely suggests that Idaho and other state pro-life laws fail to protect women facing life-threatening emergencies during pregnancy.”

“This is untrue,” the anti-abortion group said in a statement. “All state pro-life laws provide an abortion exception for those rare but tragic circumstances in which a pregnancy poses a threat to a mother’s life, including circumstances when death is not imminent. Those include Texas and Idaho.”

The emergency room is the last place that the Democratic White House has argued it can federally require rare emergency abortions to be performed, despite strict state abortion bans. After Roe v. Wade was overturned in 2022, and U.S. women lost the constitutional right to an abortion, HHS quickly sent letters to doctors, saying that they were required to provide abortions in emergency medical situations when they were needed to keep a woman medically stable.

An AP investigation found that complaints about pregnant women being turned away from emergency rooms spiked in 2022 after the U.S. Supreme Court overturned Roe, raising concerns about emergency pregnancy care in states that have enacted strict abortion laws.

The U.S. Supreme Court will take up a case Tuesday that could impact how women get access to mifepristone, one of the two pills used in the most common type of abortion in the nation.

The central dispute in the case is whether the Food and Drug Administration overlooked serious safety problems when it made mifepristone easier to obtain, including through mail-order pharmacies.

Legal briefs filed with the court describe the pill’s safety in vastly different terms: Medical professionals call it “among the safest medications” ever approved by the FDA, while the Christian conservative group suing the agency attributes “tens of thousands” of “emergency complications” to the drug.

Earlier this year, a medical journal retracted two studies that claimed to show the harms of mifepristone. The studies were cited in the pivotal Texas court ruling that brought the matter before the Supreme Court. The publisher cited conflicts of interest by the authors and flaws in their research, although the studies’ lead author called the retractions a baseless attack.

Here’s what to know about the safety of mifepristone, which is typically used with misoprostol in a medication abortion.

The FDA approved mifepristone in 2000 as a safe and effective way to end early pregnancies.

There are rare occasions when mifepristone can cause dangerous, excessive bleeding that requires emergency care. Because of that, the FDA imposed strict safety limits on who could prescribe and distribute it — only specially certified physicians and only as part of three mandatory in-person appointments with the patient getting the drug.

The doctors also had to be capable of performing emergency surgery to stop excess bleeding and an abortion procedure if the drug didn’t end the pregnancy.

Over the years, the FDA reaffirmed mifepristone’s safety and repeatedly eased restrictions, culminating in a 2021 decision doing away with any in-person requirements and allowing the pill to be sent through the mail.

Abortion opponents say the more lax restrictions resulted in many more “emergency complications.” But that argument lumps together women experiencing a range of issues with mifepristone — from the drug not working to people who may simply have questions or concerns but don’t require medical care.

OB-GYNs say a tiny fraction of patients suffer “major” or “serious” adverse events after taking mifepristone.

A legal brief by a group of medical organizations including the American College of Obstetricians and Gynecologists says: “When used in medication abortion, major adverse events — significant infection, excessive blood loss, or hospitalization — occur in less than 0.32% of patients, according to a highly regarded study with more than 50,000 patients.”

The definition that scientists generally use for serious adverse events includes blood transfusions, major surgery, hospital admissions and death, said Ushma Upadhyay, one of the authors of that 2015 study. She added: “The hospital admission is a catch-all for the very serious but more rare events such as major infection.”

The prescribing information included in the packaging for mifepristone tablets lists slightly different statistics for what it calls “serious adverse reactions.” It cites ranges for how frequently various complications occur: 0.03% to 0.5% for transfusion; 0.2% for sepsis and 0.04% to 0.6% for hospitalization related to medication abortions. The ranges reflect findings across various relevant studies, experts said.

Hyperbaric oxygen therapy (HBOT) is a medical treatment which enhances the body’s natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is increased and controlled. It is used for a wide variety of treatments usually as a part of an overall medical care plan. Diiamond Bar CA, Hyperbaric oxygen therapy (HBOT) center

Under normal circumstances, oxygen is transported throughout the body only by red blood cells. With HBOT, oxygen is dissolved into all of the body’s fluids, the plasma, the central nervous system fluids, the lymph, and the bone and can be carried to areas where circulation is diminished or blocked. In this way, extra oxygen can reach all of the damaged tissues and the body can support its own healing process. The increased oxygen greatly enhances the ability of white blood cells to kill bacteria, reduces swelling and allows new blood vessels to grow more rapidly into the affected areas. It is a simple, non-invasive and painless treatment.

It has long been known that healing many areas of the body cannot take place without appropriate oxygen levels in the tissue. Most illnesses and injuries occur, and often linger, at the cellular or tissue level. In many cases, such as: circulatory problems; non-healing wounds; and strokes, adequate oxygen cannot reach the damaged area and the body’s natural healing ability is unable to function properly. Hyperbaric oxygen therapy provides this extra oxygen naturally and with minimal side effects.

Hyperbaric oxygen therapy improves the quality of life of the patient in many areas when standard medicine is not working. Many conditions such as stroke, cerebral palsy, head injuries, and chronic fatigue have responded favorably to HBOT.

Picketing began Wednesday at Kaiser Permanente hospitals as some 75,000 health care workers went on strike in Virginia, California and three other states over wages and staffing shortages, marking the latest major labor unrest in the United States.

Kaiser Permanente is one of the country’s larger insurers and health care system operators, with 39 hospitals nationwide. The nonprofit company, based in Oakland, California, provides health coverage for nearly 13 million people, sending customers to clinics and hospitals it runs or contracts with to provide care.

The Coalition of Kaiser Permanente Unions, representing about 85,000 of the health system’s employees nationally, approved a strike for three days in California, Colorado, Oregon and Washington, and for one day in Virginia and Washington, D.C.

A cheer went up from union members outside Kaiser Permanente Los Angeles Medical Center when the strike deadline arrived before dawn.

The strikers include licensed vocational nurses, home health aides and ultrasound sonographers, as well as technicians in radiology, X-ray, surgical, pharmacy and emergency departments.

Doctors are not participating, and Kaiser says its hospitals, including emergency rooms, will remain open during the picketing. The company said it was bringing in thousands of temporary workers to fill gaps during the strike. But the strike could lead to delays in getting appointments and non-urgent procedures being rescheduled.

It comes amid unprecedented worker organizing — from strike authorizations to work stoppages — within multiple industries this year, including, transportation, entertainment and hospitality.

Wednesday’s strike is the latest one for the health care industry this year as it continues to confront burnout with the heavy workloads — problems that were exacerbated greatly by the pandemic.

Unions representing Kaiser workers in August asked for a $25 hourly minimum wage, as well as increases of 7% each year in the first two years and 6.25% each year in the two years afterward.

They say understaffing is boosting the hospital system’s profits but hurting patients, and executives have been bargaining in bad faith during negotiations.

A federal judge on Saturday blocked two portions of North Carolina’s new abortion law from taking effect while a lawsuit continues. But nearly all of the restrictions approved by the legislature this year, including a near-ban after 12 weeks of pregnancy, aren’t being specifically challenged and remain intact.

U.S. District Judge Catherine Eagles issued an order halting enforcement of a provision to require surgical abortions that occur after 12 weeks — those for cases of rape and incest, for example — be performed only in hospitals, not abortion clinics. That limitation would have otherwise taken effect on Sunday.

And in the same preliminary injunction, Eagles extended beyond her temporary decision in June an order preventing enforcement of a rule that doctors must document the existence of a pregnancy within the uterus before prescribing a medication abortion.

Short of successful appeals by Republican legislative leaders defending the laws, the order will remain in effect until a lawsuit filed by Planned Parenthood South Atlantic and a physician who performs abortions challenging the sections are resolved. The lawsuit also seeks to have clarified whether medications can be used during the second trimester to induce labor of a fetus that can’t survive outside the uterus.

The litigation doesn’t directly seek to topple the crux of the abortion law enacted in May after GOP legislators overrode Democratic Gov. Roy Cooper’s veto. North Carolina had a ban on most abortions after 20 weeks before July 1, when the law scaled it back to 12 weeks.

The law, a response to the 2022 U.S. Supreme Court ruling that struck down Roe v. Wade, also added new exceptions for abortions through 20 weeks for cases of rape and incest and through 24 weeks for “life-limiting” fetal anomalies. A medical emergency exception also stayed in place.

On medication abortions, which bill sponsors say also are permitted through 12 weeks of pregnancy, the new law says a physician prescribing an abortion-inducing drug must first “document in the woman’s medical chart the ... intrauterine location of the pregnancy.”

Eagles wrote the plaintiffs were likely to be successful on their claim that the law is so vague as to subject abortion providers to claims that they broke the law if they can’t locate an embryo through an ultrasound because the pregnancy is so new.

States that declared themselves refuges for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home.

Now that bans on such care for minors are taking effect around the country — Texas could be next, depending on the outcome of a court hearing this week — patients and their families are testing clinics’ capacity. Already-long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day.

For those refuge states — so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, Washington and Vermont, plus Washington, D.C. — the question is how to move beyond promises of legal protection and build a network to serve more patients.

“We’re trying our best to make sure we can get those kids in so that they don’t experience an interruption in their care,” said Dr. Angela Kade Goepferd, medical director of the gender health program at Children’s Minnesota hospital in the Twin Cities. “For patients who have not yet been seen and would be added to a general waiting list, it is daunting to think that it’s going to be a year or more before you’re going to be seen by somebody.”

Appointment requests are flooding into Children’s from all over the country — including Texas, Montana and Florida, which all have bans. Requests have grown in a year from about 100 a month to 140-150. The program hopes to hire more staff to meet demand, but it will take time, Goepferd said.

More than 89,000 transgender people ages 13 to 17 live in states that limit their access to gender-affirming care, according to a research letter published in late July in the Journal of the American Medical Association, though not all trans people choose or can afford gender-affirming care.

Rhys Perez, a transmasculine and nonbinary 17-year-old, is preparing to move this month from Houston to Los Angeles to start college. The teen, who said they’re “escaping Texas in the nick of time,” said California’s protection for gender-affirming care was one of the main factors in their decision on where to go for college.

Perez has just begun their search for a provider in Southern California but already has encountered several clinics with waits for an initial consultation between nine and 14 months. They were disappointed to learn they likely could not begin hormone replacement therapy until their sophomore year.

Wyoming Gov. Mark Gordon has signed into law the nation’s first explicit ban on abortion pills since the U.S. Supreme Court overturned Roe v. Wade last summer.

Gordon, a Republican, signed the bill Friday night while allowing a separate measure restricting abortion to become law without his signature.

The pills are already banned in 13 states that have blanket bans on all forms of abortion, and 15 states already have limited access to abortion pills. Until now, however, no state had passed a law specifically prohibiting such pills, according to the Guttmacher Institute.

A group seeking to open an abortion and women’s health clinic in Casper said it was evaluating legal options.

“We are dismayed and outraged that these laws would eradicate access to basic health care, including safe, effective medication abortion,” Wellspring Health Access President Julie Burkhart said in a statement Saturday.

The clinic, which a firebombing prevented from opening last year, is one of two nonprofits suing to block an earlier Wyoming abortion ban. No arrests in the arson have been made, and organizers say the clinic is now tentatively scheduled to open in April, depending on abortion’s legal status in Wyoming then.

Currently Wyoming has only one abortion provider, a physician in Jackson who performs only medication abortions.

The Republican governor’s decision on the two measures comes after the issue of access to abortion pills took center stage this week in a Texas court. A federal judge there raised questions about a Christian group’s effort to overturn the decades-old U.S. approval of a leading abortion drug, mifepristone.

Medication abortions became the preferred method for ending pregnancy in the U.S. even before the Supreme Court overturned Roe v. Wade, the ruling that protected the right to abortion for nearly five decades. A two-pill combination of mifepristone and another drug is the most common form of abortion in the U.S.