by Audrey Dutton, ProPublica, and Kelcie Moseley-Morris, States Newsroom

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With a steady but urgent cadence, Dr. Jim Souza told reporters what would become one of the most cited talking points in a protracted legal fight over Idaho’s abortion ban: Without a court order protecting emergency room doctors from prosecution, his hospital system was sending patients to nearby states when certain pregnancy complications meant termination might be necessary.

It was April 2024. Souza said Boise-based St. Luke’s Health System had airlifted six pregnant patients in a span of four months to states where abortion was a legal treatment option in health emergencies. That happened once in all of 2023, a time when a court order kept Idaho from enforcing the ban in those cases.

Souza, the hospital system’s chief physician executive, said Idaho’s law was a looming threat to hospital workers and quality health care. St. Luke’s delivered about 41% of Idaho babies last year.

“Fear is the problem. Fear of prosecution,” Souza said at the time. “And even if it doesn’t occur, it doesn’t fix the jeopardy that is actively eroding our system of care.”

Less than a year later, St. Luke’s is the one major institution — other than advocacy groups — standing in the way of restrictions on emergency abortion care in Idaho, a state with one of the most absolute abortion bans in the country.

The Justice Department on March 5 dropped a lawsuit brought under President Joe Biden that claimed Idaho’s ban, which does not allow abortions to protect a patient’s health, violated a federal law mandating access to emergency medical care. St. Luke’s administrators, who made the same claim in their own lawsuit in January, vowed to press on. A temporary court order in the St. Luke’s case will allow emergency abortions to take place for now.

The abortion lawsuit is the latest controversial stance for a hospital system operating in a state whose political climate treats public institutions — hospitals, libraries, schools, health departments — not as the basic infrastructure of society but as ideological battlegrounds.

St. Luke’s defended its medical staff during the pandemic in 2020 and 2021, when residents objected to masks and vaccines. It took on Ammon Bundy, one of the state’s flagbearers of far-right extremism, whose followers protested against hospital employees caught up in a child welfare case involving the grandchild of one of Bundy’s friends.

St. Luke’s administrators declined to speak with States Newsroom and ProPublica for this story, citing the ongoing litigation.

Idaho Attorney General Raúl Labrador, who is defending against the abortion challenge, has accused health care providers of deliberately misconstruing the ban’s prohibitions. Labrador, whose career was built on being to the right of mainstream Republicans, also has said, without providing evidence, that the reason doctors are leaving Idaho is because they made “the vast majority of their money on abortions, or they wanted to live in a place that allowed abortions.”

The state lost 22% of its OB-GYN workforce and more than half the specialists who handle high-risk pregnancies in the 15 months after the Supreme Court abortion decision, according to a report from the Idaho Coalition for Safe Healthcare.

Odette Bolano, the former CEO of Saint Alphonsus Health System, a St. Luke’s competitor, said health care institutions have historically been reluctant to take on anything with political implications. They often stay neutral because they care for all patients regardless of politics.

But Bolano, who led the Catholic-based system for six years, said everything seems to have taken on political undertones in recent years. She said health systems now have to take difficult positions when they feel something keeps........

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