Texas Women Denied Care for Ectopic Pregnancies Due to State’s Abortion Ban Take Legal Action

This week, two Texas women represented by the Center for Reproductive Rights filed legal complaints to the Biden administration against hospitals that denied them emergency care for ectopic pregnancies. Abortion is the only treatment for an ectopic pregnancy, which is a nonviable, potentially life-threatening condition that occurs when a fertilized egg develops outside the uterine wall, often in the fallopian tubes, and is incompatible with life. As the Center notes in both complaints, ectopic pregnancy is the leading cause of maternal mortality in the first trimester, accounting for close to 10% of pregnancy-related deaths across the country.

The legal complaints say that, under Texas state law, treating an ectopic pregnancy isn’t considered an abortion and should be permitted. The women say that these hospitals, based in Arlington and Round Rock, violated their rights under the Emergency Medical Treatment and Labor Act, or EMTALA, which requires hospitals that receive Medicare funding to provide emergency, stabilizing care (including abortion) when necessary. 

Most pregnancy-related deaths in Texas in 2022 resulted from hemorrhage, and ectopic pregnancy is the most common cause of hemorrhage. Still, the women’s complaints say that Texas’ total abortion ban—which threatens abortion providers with life in prison, a $100,000 fine, and loss of their medical license—stopped medical staff from offering potentially life-saving, time-sensitive treatment. Texas’ ban offers only an ambiguous, highly inaccessible exception for threats to the pregnant person’s life, but doctors have been highly conservative with interpreting what actually qualifies as a threat due to legal concerns. 

Kyleigh Thurman, one of the women who filed a legal complaint to the Biden administration this week, learned she was pregnant in February 2023 after a month of nonstop vaginal bleeding. Thurman’s OBGYN suspected she had an ectopic pregnancy and recommended that she terminate the pregnancy with a methotrexate shot, which the OBGYN didn’t have the supplies to provide. Thurman sought care at an emergency room an hour away, but they also didn’t have methotrexate, nor did her local hospital. On February 21, Thurman went to Ascension Seton Williamson Hospital in Round Rock, which identified numerous signs of an ectopic pregnancy, but turned her away and asked her to return in a few days. Thurman continued to experience intense vaginal bleeding and returned on February 24, relating what her OBGYN had told her; Ascension still denied her treatment until Thurman’s OBGYN came to the hospital and pleaded with medical staff to provide the emergency treatment. 

Medical staff finally complied and provided the methotrexate shot, but at this point, it was too late. “Several days later, Ms. Thurman experienced sudden, blinding pain on her right side, began bleeding, and almost passed out. The ectopic pregnancy was rupturing—a life-threatening condition,” Thurman’s legal complaint says. She returned to her emergency room but was transferred again to Ascension, where she was told she was bleeding out. Doctors had to remove her right fallopian tube to save her life, jeopardizing Thurman’s future fertility. “After the surgery, Kyleigh was overwhelmed by the horror of the ordeal,” the legal complaint says. “Waiting any longer could have cost Ms. Thurman her life.”

Some facts:
➡️ In 2022, most pregnancy-related deaths in TX were from hemorrhage.
➡️ The MOST COMMON CAUSE of hemorrhage was a ruptured ectopic pregnancy.
➡️ Under TX abortion ban, even treatment for deadly ectopic pregnancies has become inaccessible. https://t.co/NzRwdUod3l

— Center for Reproductive Rights (@ReproRights) August 12, 2024

The other woman, Kelsie Norris-De La Cruz, says she was denied an emergency abortion for her ectopic pregnancy in February this year by Texas Health Arlington Memorial Hospital in Arlington. Norris-De La Cruz said she was excited to learn she was pregnant in January, but began experiencing intense bleeding and severe cramping the following month. The hospital informed her she likely had an ectopic pregnancy but still sent her home to see if she would miscarry or if the embryo would move elsewhere as her pregnancy developed. Within a month, when her health worsened and cramping became so painful that she could barely stand, Norris-De La Cruz returned. A doctor determined that she should have an emergency abortion immediately, but two OBGYNs refused to approve the procedure, which Texas state law requires before emergency abortions are performed. 

Speaking to the Washington Post in February, Norris-De La Cruz recounted a tense exchange with her doctor. “Does this have anything to do with the abortion law?” she says she asked. When he didn’t answer, Norris-De La Cruz says she told him, “Whenever I fucking rupture, I’m giving my lawyers your fucking name.” Norris-De La Cruz and her mother realized Texas Health Arlington wouldn’t provide her care, so they began looking elsewhere. They called a clinic in New Mexico, which was shocked by her experience because emergency abortions for ectopic pregnancy are legal in Texas. They looked for other hospitals in Texas “but staff told them that Ms. Norris-De La Cruz may face the same treatment because hospitalists around the state were delaying treatment for ectopic pregnancy,” the complaint says.

Medical records reviewed by the Post showed Norris-De La Cruz’s doctor wrote that he didn’t “feel comfortable discharging her home” and it wasn’t “in her best interest” to leave the hospital without an emergency abortion. Still, Texas Health Arlington discharged her. The following day, she received an emergency abortion from a different hospital. The OBGYN who treated her said her life would have been “in extreme danger” if she had been delayed any longer. Like Thurman, Norris-De La Cruz lost a fallopian tube. “Despite the fact that my life was clearly in danger, the hospital told me that they could not help me. 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,” Norris-De La Cruz said in a statement shared with Jezebel.

Both Thurman and Norris-De La Cruz say these hospitals violated EMTALA, and are asking the Health and Human Services Department’s Centers for Medicare & Medicaid Services (CMS), the U.S. Office of Inspector General, and the Office of Civil Rights to investigate Ascension and Texas Health Arlington to “remedy all unlawful conduct identified in its investigation, including by imposing all appropriate penalties.”

“It’s impossible to have the best interest of your patient in mind when you’re staring down a life sentence,” Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights, said in a statement shared with Jezebel. “Texas officials have put doctors in an impossible situation.”

Considering that more than 1/2 of pregnant people seek emergency treatment at some point during their pregnancy, and up to 15% suffer a life-threatening condition, EMTALA’s safeguards are critical for everyone who can become pregnant in the United States. pic.twitter.com/Q6AQMM88xd

— Legal Defense Fund (@NAACP_LDF) August 10, 2024

In May 2023, CMS investigated the case of Mylissa Farmer—a woman who was denied an emergency abortion for a nonviable, life-threatening pregnancy from two hospitals in Kansas and Missouri—and determined these hospitals violated EMTALA by turning her away. In July, Farmer filed a federal lawsuit against the University of Kansas Health System for violating EMTALA and Kansas discrimination law by “citing the political climate” to turn her away, even though abortion is legal in Kansas. An attorney for Farmer told Jezebel the U.S. abortion landscape has led to widespread confusion among doctors, “but the law is clear”: When a patient comes to a hospital with a condition requiring emergency abortion care, they’re “statutorily required” to provide stabilizing abortion care—they “don’t have to, and must not” wait until a patient is on the brink of death to provide that care. 

In 2022, the Biden administration issued a guidance reminding hospitals in all states—regardless of their state abortion bans—of their obligation to provide emergency, stabilizing abortions under EMTALA. Shortly after, Texas sued Biden’s HHS over this guidance and won. Thurman and Norris-De La Cruz’s complaints this week call on HHS to enforce EMTALA to hold these hospitals accountable and reassure doctors that they can provide emergency abortion care without fear of punishment.

Last year, more than 20 Texas women who said their lives were threatened from being denied emergency abortions filed a lawsuit seeking clarity in the state abortion ban’s exception for threats to the pregnant person’s life. In May, the state Supreme Court dismissed their case, saying it “[opened] the door to permit abortion to address any pregnancy risk.” In December, the state Supreme Court also denied the time-sensitive legal petition of a woman named Kate Cox who sought an emergency abortion for a dangerous, nonviable pregnancy.

Over a year after her ectopic pregnancy and loss of one of her fallopian tubes, Thurman says she “now [has] to live with the consequences of these extreme laws every day.” She continued, “None of this should have happened to me, and I want to make sure this doesn’t happen to anyone else.”