Dozens of pregnant women are turned away from emergency rooms despite the law

WASHINGTON (AP) — Bleeding and in pain, Kyleigh Thurman didn’t know her unfortunate pregnancy could kill her.

Emergency room doctors at Ascension Seton Williamson Hospital in Texas gave her a pamphlet about miscarriages and advised her to “let nature take its course” before discharging her without treating her ectopic pregnancy.

When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection to terminate the pregnancy. It was too late. The fertilized egg that grew in Thurman’s fallopian tube ruptured it and destroyed part of her reproductive system.

According to a Complaint Thurman and the Center for Reproductive Rights last week, asking the government to investigate whether the hospital violated federal law when staff initially refused to treat her in February 2023.

“I was just left helpless,” Thurman said. “I was just misled.”

The Biden administration says hospitals must offer abortions when it is necessary to save a woman’s life, despite state bans enacted after the Supreme Court ruling the constitutional right to abortion abolished more than two years ago. Texas challenged this policy, and earlier this summer the Supreme Court rejected to fix the problem.

More than 100 pregnant women in medical distress seeking care in emergency rooms have been turned away or treated negligently since 2022, an Associated Press analysis of investigations at federal hospitals found.

Two women – one in Florida and one in Texas – suffered miscarriages in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after being sent home in the emergency room. At least four other women with ectopic pregnancies have had trouble getting treatment, including one in California who needed a blood transfusion after sitting in an emergency room waiting room for nine hours.

Abortion bans make it difficult to care for high-risk pregnancies

In Texas, doctors face up to 99 years in prison if convicted of performing an illegal abortion. Medical and legal experts say the law makes it harder to make decisions about emergency pregnancy care.

Although terminating an ectopic pregnancy is not considered an abortion under state law, the draconian penalties deter Texas doctors from treating these patients, argues the Center for Reproductive Rights.

“As much as hospitals and doctors are afraid of violating these state abortion bans, they also have to worry about violating federal law,” said Marc Hearron, a federal government attorney. Hospitals face a federal investigation, hefty fines and the threat of having their Medicare funding cut off if they violate federal law.

The organization filed a complaint with the Centers for Medicare and Medicaid Service last week alleging that several Texas emergency rooms failed to treat two patients with ectopic pregnancies, including Thurman.

One Complaint says Kelsie Norris-De La Cruz, 25, lost a fallopian tube and most of an ovary after an Arlington, Texas, hospital sent her home without treatment for her ectopic pregnancy, even though a doctor said discharge was “not in her best interest.”

“Doctors knew I needed an abortion, but these bans make it nearly impossible to get basic emergency care,” she said in a statement. “I am filing this complaint because women like me deserve justice and accountability from those who have hurt us.”

Diagnosing an ectopic pregnancy definitively can be difficult. Doctors can’t always determine the location of the pregnancy through an ultrasound, explained three doctors consulted for this article. Hormone levels, bleeding, a positive pregnancy test and an ultrasound of an empty uterus all indicate an ectopic pregnancy.

“You can’t be 100 percent sure — that’s the hard part,” said Kate Arnold, a Washington gynecologist. “They’re literally time bombs. It’s a pregnancy growing inside this thing that can only grow to a certain extent.”

John Seago, director of Texas Right to Life, said state law protects doctors from prosecution if they terminate an ectopic pregnancy, even if the doctor “makes an error” in diagnosis.

“Sending a woman home is totally unnecessary and totally dangerous,” Seago said.

But the state law has made doctors “absolutely” afraid to treat pregnant patients, says Hannah Gordon, an emergency physician who worked at a Dallas hospital until last year.

She recalled a patient in her emergency room in Dallas who had signs of an ectopic pregnancy. Because the gynecologists said they could not clearly diagnose the problem, they waited to terminate the pregnancy until the patient returned the next day.

“It left a bad taste in my mouth,” said Gordon, who left Texas hoping to become pregnant and worried about the treatment she would receive there.

“Oh my God, I’m dying”

When Thurman returned to Ascension Seton Williamson for a third time, her gynecologist told her she would need surgery to remove the ruptured fallopian tube. Thurman, who was still bleeding heavily, was reluctant to undergo the procedure. Losing the fallopian tube would endanger her fertility.

Her doctor told her that if she waited any longer, she would be risking her life.

“She came in and said, either you need a blood transfusion, or you need surgery, or you’re going to bleed to death,” Thurman said through tears. “I just thought, ‘Oh my God, I’m dying.'”

The hospital declined to comment on Thurman’s case, but said in a statement that it is “committed to providing quality care to all who use our services.”

In Florida, a 15-week pregnant woman lost amniotic fluid for an hour in the emergency room at Broward Health Coral Springs, federal documents show. An ultrasound revealed that the patient’s fetus was not surrounded by amniotic fluid, a dangerous situation that can lead to serious infections.

The woman suffered a miscarriage in a public toilet that same day after the emergency room doctor declared her condition “improved” and discharged her without consulting the hospital’s gynecologist.

Emergency personnel took her to another hospital, where she was put on a ventilator and discharged after six days.

Abortions after 15 weeks were illegal in Florida at the time. The medical director of obstetrics at Broward Health Coral Springs told an investigator that induction of labor in women with premature rupture of the membranes “has been the standard of care for some time, regardless of the heartbeat, because of the risk to the mother.”

The hospital declined to comment.

In another case in Florida, a doctor admitted that state law made emergency pregnancy care more difficult.

“Because of the new laws … staff can only intervene when the patient’s health is in danger,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator looking into the hospital’s refusal to offer an abortion to a woman whose water ruptured at 15 weeks, long before the fetus could survive.

Problems go beyond states with abortion bans

In both states with and without abortion bans, serious violations occurred that endangered the health of the mother or her fetus, according to the AP investigation.

Two hospitals in Idaho and Washington that were suffering from staff shortages admitted to investigators that they regularly referred pregnant patients to other hospitals.

A pregnant patient in an emergency room in Bakersfield, California, was examined quickly, but staff failed to recognize that she was suffering from a uterine rupture. The delay, an investigator concluded, may have contributed to the baby’s death.

According to the documents, doctors in emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for a fetal heartbeat or discharged patients in mid-labor and left them to give birth at home or in an ambulance.

Nursing and doctor shortages, problems with round-the-clock staffing of ultrasound exams and new abortion laws have made the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency physician and former U.S. Department of Health and Human Services official.

“It is increasingly unsafe to be pregnant and seek medical help in an emergency room,” she said.