Texas women denied abortions for ectopic pregnancies file federal complaints against hospitals
After a month of cramps, dizziness and nonstop bleeding, Kyleigh Thurman sought help from her OB-GYN. Her symptoms and positive pregnancy test had led her doctor to suspect that Thurman had an ectopic pregnancy, in which a fertilized egg grows outside of the uterus, where it cannot survive and can pose life-threatening health risks.
Because Thurman's OB-GYN and emergency room facility in Burnet County did not carry the medication she needed for treatment, she drove an hour to Ascension Seton Williamson in Round Rock. The hospital found signs of a tubal ectopic pregnancy but discharged her, instructing her to return in two days.
After she returned, the hospital again saw signs of a possible ectopic pregnancy after finding no intrauterine pregnancy but did not offer treatment. It took Thurman's OB-GYN driving to the hospital to plead with the medical staff for Thurman to be given methotrexate as a treatment, according to a federal complaint filed last week. Methotrexate is the most commonly used medication to treat ectopic pregnancy, according to the American College of Obstetrician-Gynecologists.
The hospital's intervention was too late, her attorneys say. Her ectopic pregnancy ruptured days later, leaving her bleeding heavily and in blinding pain. She was transferred from a facility in Burnet County to Ascension Seton, where she was told she was "bleeding out," according to the complaint.
To save her life, doctors removed her right fallopian tube, leaving her with lower chances of having a successful pregnancy in the future.
"I was completely in shock," Thurman told the American-Statesman in an interview Monday.
Thurman is one of two Texas women who last week filed federal complaints against hospitals in the state that denied them abortions for ectopic pregnancies. They say the hospitals violated the Emergency Medical Treatment and Active Labor Act, a federal law that requires hospitals to provide "stabilizing care" to patients facing emergency medical conditions.
Texas law allows doctors to terminate ectopic pregnancies, which are never viable and are the leading cause of maternal mortality during the first trimester. They are also one of the most common pregnancy complications, occurring in two of every 100 pregnancies.
The federal complaints, announced Monday, ask the U.S. Department of Health and Human Services to investigate Ascension Seton Williamson and Texas Health Arlington Memorial Hospital in Arlington.
"No one would know my story if I had died," Thurman said. "It can't happen again to any other person. … It's all preventable."
More: Texas abortion laws are preventing women from accessing crucial miscarriage care
Attorneys with the Center for Reproductive Rights, an abortion rights advocacy organization, filed the complaints on behalf of the two women. The group has represented Texas women in several major lawsuits, including Zurawski v. Texas, in which 22 patients and two OB-GYNs sued the state over what they said was a lack of clarity in the state's abortion laws.
The plaintiffs in the case, which was decided in favor of the state in May, alleged that vague medical emergency exceptions led Texas OB-GYNs to delay or deny abortion care to women facing serious pregnancy complications.
The Biden administration's guidance on emergency abortions under EMTALA has been blocked in Texas since 2022, after Texas Attorney General Ken Paxton won an injunction in federal court against the order. Paxton argued that the federal rule — which states that hospitals must terminate pregnancies when doing so is necessary to stabilize emergency patients — would force hospitals to provide abortions in cases in which Texas law would not permit them. The federal 5th Circuit Court of Appeals upheld the injunction in January.
Given the injunction currently in effect, it's unclear how or whether EMTALA will apply in the women's cases. Their attorney, Molly Duane, argues that EMTALA still requires hospitals in Texas to provide emergency abortions when they are legal in the state, including when a woman has an ectopic pregnancy.
"(EMTALA) is the most direct path towards getting this hospital in line and others in Texas in line as well," Duane told the Statesman in an interview Monday. She noted that the federal government can require noncompliant hospitals to prove their policies and procedures will prevent repeat incidents.
More: SCOTUS ruling restores emergency abortion rights in Idaho, leaves Texas case hanging
In a statement, Ascension Seton Williamson, which is part of a nationwide network of Catholic hospitals, declined to specifically address Thurman's allegations.
"While we cannot speak to specifics of this case, Ascension is committed to providing high-quality care to all who seek our services," a spokesperson for the hospital wrote in an emailed statement to the Statesman on Monday.
'I would have died... Women like me deserve justice'
Nearly three hours away from Ascension Seton Williamson, Kelsie Norris-De La Cruz had a similarly harrowing experience at a hospital in Arlington — a city of roughly 400,000 that sits halfway between Dallas and Fort Worth.
Norris-De La Cruz, a college student in her last year, had begun planning for her baby after a pregnancy test she took came back positive in January. But after she began cramping and having abnormal vaginal discharge several weeks later, she was told by the Medical City Healthcare center that she might have miscarried or might have been carrying an ectopic pregnancy.
Over the next several weeks, she continued to suffer symptoms, sometimes experiencing "pain so intense she struggled to stand and was afraid to drive herself to school," according to the complaint written Duane, a Center for Reproductive Rights attorney, and filed last week.
After staff members at her college's health center noticed she was experiencing severe localized pain on her right side, Norris-De La Cruz rushed to Texas Health Arlington.
An ultrasound revealed a large mass near her uterus and other signs of ectopic pregnancy, and an emergency room physician told Norris-De La Cruz that she could chose to receive a methotrexate injection, which would cause the mass to be absorbed by her body over several weeks, or surgery. She opted for the surgery to prevent more weeks or months of bleeding.
Then, according to the complaint, two different on-call OB-GYNs "acknowledged that her pregnancy could rupture but still denied her medical care," telling Norris-De La Cruz to return in 48 hours. Records show they doubted her account of her sexual history and suspected she could be suffering a miscarriage from a new pregnancy as a result.
Convinced that Texas Health Arlington would not provide her care, the 25-year-old and her mother called an abortion clinic in New Mexico, which told them the treatment of ectopic pregnancies was legal in Texas.
They then tried another OB-GYN who had been recommended to them by a friend.
The day after Norris-De La Cruz was admitted to the hospital, that doctor performed emergency surgery and found the mass had grown so much that they had to remove most of Norris-De La Cruz’s right fallopian tube and roughly three-fourths of her right ovary.
“Despite the fact that my life was clearly in danger, the hospital told me that they could not help me,” Norris-De La Cruz said in a news release Monday. "I ended up losing half of my fertility and if I was made to wait any longer, it’s very likely I would have died."
Texas Health Arlington did not respond to a request for comment Monday.
Texas lawmaker: The women 'should have received treatment'
Texas' near-total abortion ban prohibits doctors from performing the procedure except when a patient faces "a life-threatening condition" that places them at risk of death or "substantial impairment of a major bodily function." Physicians who are found guilty of violating the ban could face criminal penalties up to life in prison.
In response to questions from the Statesman, state Sen. Bryan Hughes, who authored Texas' 2021 abortion ban, emphasized that termination of an ectopic pregnancy is excluded from the definition of an abortion under the Texas Health Code.
"Moms in (these) situations ... should have received treatment because there is nothing in Texas law that prevents doctors from treating them," Hughes wrote in an email Monday. "Clearly, these moms' lives were in danger, so they are covered under the exceptions as well."
In her statement, Norris-De La Cruz largely blamed the state's abortion bans for the delay in care, though it's unclear what drove the hospital's physicians to turn her away.
“The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency health care," she said. "So, I’m filing this complaint because women like me deserve justice and accountability from those that hurt us. Texas state officials can’t keep ignoring us. We can’t let them.”
The Dallas-Fort Worth native is among a growing group of women and OB-GYNs who say state lawmakers have not done enough to ensure that pregnancy remains safe under new, strict abortion bans.
“These women are proof that exceptions do not make abortion bans less dangerous, even when they are exceedingly clear," Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights, said in Monday's news release. “It’s impossible to have the best interest of your patient in mind when you’re staring down a life sentence. Texas officials have put doctors in an impossible situation.”
Numerous Texas OB-GYNs and medical associations have said that the severe repercussions, combined with the state's abortion ban's complicated wording, leave doctors hesitant to administer treatment.
"Pregnancy is not straightforward; it's not black and white," Thurman said. "But the way I was treated in the ER was, 'You're either pregnant or you're not.’”
Some Texas women and OB-GYNs also continue to struggle to access drugs used to administer medically necessary abortions and treat miscarriages and ectopic pregnancies, as the American-Statesman reported in June. Methotrexate is strictly regulated in Texas under Senate Bill 4, a 2021 law that restricts access to “abortion-inducing drug(s)."
The groups that advocated for the bans, however, maintain that medical exceptions to the ban protect women's lives and health while preserving the lives of the fetuses they carry. Texas Alliance for Life in monthly news releases has highlighted that one to 10 "medical-necessity" abortions have been recorded in Texas each month since the U.S. Supreme Court struck down the federal right to an abortion established in Roe v. Wade. More than 50,000 took place each year between 2008 and 2020.
The issue has galvanized Democrats and abortion rights advocates across the state and the country who hope to turn outrage over the laws into increased voter turnout in November.