A Texas Woman Was Denied an Abortion and Died, Days After the State’s Ban Took Effect

In September 2021, Texas enacted SB 8, a six-week abortion ban enforced by the threat of costly civil lawsuits. The ban took effect nearly a year before the Supreme Court overturned Roe v. Wade in June 2022, activating the state’s trigger abortion law, which bans abortion from conception and threatens doctors with life in prison. But SB 8 alone was already lethal: According to a new ProPublica report published Wednesday, just days after SB 8 became the law of the land in 2021, a 28-year-old mother named Josseli Barnica died a preventable death as a result of the law.

At HCA Houston Healthcare Northwest, Barnica and her husband learned she was experiencing a miscarriage 17 weeks into her pregnancy. The date was September 3, 2021. An ultrasound confirmed “bulging membranes in the vagina with the fetal head in the open cervix,” which was dilated at 8.9 cm, and that Barnica had low amniotic fluid. Doctors and medical experts told ProPublica that, at that point, Barnica needed an immediate abortion to prevent potentially fatal infections like sepsis. But, fearing consequences under Texas’ newly enacted abortion ban, the hospital waited 40 hours until they could no longer detect a fetal heartbeat to treat Barnica. At that point, they gave her medication to speed up her labor, then discharged her after it was complete.

Upon returning to her aunt’s home, Barnica continued to bleed, but the hospital maintained that this was normal. When her bleeding only became heavier after two days, she returned to the hospital. Due to covid precautions allowing only one person to be in the room with Barnica, her husband remained home with their 1-year-old daughter. He never saw Barnica alive again.

Barnica’s autopsy, reviewed by ProPublica, says she died of “sepsis” involving “products of conception.” More than a dozen medical experts who reviewed Barnica’s autopsy and hospital records told the outlet her death was “preventable” and called her case “horrific,” “astounding,” and “egregious.” Dr. Susan Mann, a national patient safety expert in obstetric care who teaches at Harvard University, told ProPublica, “If this was Massachusetts or Ohio, she would have had that delivery within a couple hours.” 

According to ProPublica, the doctors involved in Barnica’s care didn’t respond to multiple requests for comment. HCA Healthcare said in a statement, “Our responsibility is to be in compliance with applicable state and federal laws and regulations,” but the company didn’t respond to a list of questions from the outlet about Barnica’s case. HCA is the largest for-profit hospital chain in the nation, delivering more babies than any other U.S. health care provider. It’s concerning that the company can’t answer questions about how it’s navigating abortion bans, when 70% of its hospitals are in states that ban or severely restrict abortion, according to ProPublica.

New: Josseli Barnica is one of at least two pregnant Texas women who died after doctors delayed emergency care. She’d told her husband that the medical team said it couldn’t act until the fetal heartbeat stopped. https://t.co/8qxo6obNP4

— ProPublica (@propublica) October 30, 2024

Reporting on Barnica’s story comes a month after ProPublica’s reports on two women from Georgia, Amber Thurman and Candi Miller, who died in 2022 as a result of their state’s abortion ban, according to investigations from Georgia’s maternal mortality committee. So far, all three of these reported deaths caused by abortion bans involve women of color, who suffer from higher rates of maternal mortality. 

In 2022, Texas sued the Biden administration for telling hospitals to follow federal laws that require them to provide emergency, stabilizing care, including abortion, to all patients. Texas Attorney General Ken Paxton (R) argued the guidance forces doctors to “commit crimes” under state law and makes every hospital a “walk-in abortion clinic.” The state won its legal challenge in January. 

In 2023, about two dozen Texas women sued the state seeking to clarify the abortion ban’s medical emergency exception. The women said the state ban had almost killed them because doctors, fearing life in prison, didn’t know at what point they could take action to save a pregnant person’s life. One of the plaintiffs, Amanda Zurawski, almost died of sepsis like Barnica; Zurawski survived, but one of her fallopian tubes permanently closed. Despite their harrowing stories, the state Supreme Court dismissed their case in May.

Dr. Sherif Zaafran, president of the Texas Medical Board, told ProPublica that Texas patients who are impacted by the state’s abortion ban “should vote with their feet and go and seek guidance from somebody else.” But healthcare shouldn’t be political: ProPublica notes that Barnica’s husband is “an immigrant from El Salvador who works 12-hour shifts,” who “doesn’t follow American politics or the news” and “had no inkling” about the contentious politics surrounding abortion bans. Thanks to Texas’ laws and a hospital’s fatally poor judgment, he’s now a single father to a 4-year-old girl.

In September, the Gender Equity Policy Institute reported that maternal deaths in Texas increased by 56% between 2019 and 2022, compared to an 11% increase nationwide during the same time period. “There’s only one explanation for this staggering difference in maternal mortality. All the research points to Texas’ abortion ban [SB 8, which took effect in September 2021] as the primary driver of this alarming increase,” the organization’s president told NBC.

Texas Sen. Ted Cruz, who’s currently running in a competitive race for reelection, in 2021 called SB 8 “perfectly reasonable” shortly after it took effect.