Dozens of pregnant women, some bleeding or in labor, being turned away from ERs despite federal law
WASHINGTON — Kyleigh Thurman was bleeding and in pain, unaware that her ill-fated pregnancy could cost her her life.
The emergency room doctors at Ascension Seton Williamson in Texas gave her a brochure about miscarriage and told her to let nature take its course before they would discharge her without treatment for her ectopic pregnancy.
When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection intended to end the pregnancy. But it was too late. The fertilized egg growing on Thurman’s fallopian tube would rupture it, destroying part of her reproductive system.
That is according to a complaint Thurman and the Center for Reproductive Rights filed a request last week with the government to investigate whether the hospital violated federal law when staff initially failed to treat her in February 2023.
“I was left to my own devices,” Thurman said. “It was nothing short of being deceived.”
Even though the Biden administration has publicly warned hospitals to treat pregnant patients in emergencies, facilities are still violating federal law.
An Associated Press analysis of federal hospital investigations found that since 2022, more than 100 pregnant women seeking emergency room care in medical distress have been turned away or treated negligently.
Two women – one in Florida and one in texas – were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies have struggled to get any treatment, including a California woman who needed a blood transfusion after sitting in an emergency room for nine hours.
The White House says hospitals must offer abortions when necessary to save a woman’s health, despite state bans. Texas challenges that directive, and earlier this summer the Supreme Court ruled rejected to solve the problem.
In Texas, where doctors face up to 99 years in prison if found guilty of performing an illegal abortion, medical and legal experts say the law complicates decision-making around emergency pregnancy care.
Although state law states that terminating an ectopic pregnancy is not considered an abortion, the draconian penalties in Texas deter doctors from treating such patients, according to the Center for Reproductive Rights.
“As worried as hospitals and doctors are about running afoul of these state abortion bans, they also have to worry about violating federal law,” said Marc Hearron, an attorney for the center. Hospitals face federal investigation, stiff penalties and threats to their Medicare funding if they violate federal law.
The organization filed two complaints with the Centers for Medicare and Medicaid Service last week, alleging that several emergency rooms in Texas failed to treat two patients, including Thurman, with ectopic pregnancies.
Another 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 treating her ectopic pregnancy, even after a doctor said discharge was “not in her best interest.”
“The doctors knew I needed an abortion, but these bans make it nearly impossible to get basic care,” she said in a statement. “I am filing this complaint because women like me deserve justice and accountability from those who hurt us.”
Definitively diagnosing an ectopic pregnancy can be difficult. Doctors can’t always find the location of the pregnancy on an ultrasound, as three separate doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test, and an ultrasound showing an empty uterus all point to an ectopic pregnancy.
“You can’t be 100 percent — that’s the tricky part,” said Kate Arnold, an obstetrician-gynecologist in Washington. “They’re literally time bombs. It’s a pregnancy growing inside this thing that can only grow so much.”
According to Dr. John Seago, executive director of Texas Right to Life, state law clearly protects doctors from prosecution if they terminate an ectopic pregnancy, even if a doctor makes a “mistake” in diagnosing it.
“Sending a woman back home is completely unnecessary and downright dangerous,” Seago said.
But the state law has “absolutely” made doctors afraid to treat pregnant patients, said Hannah Gordon, an emergency physician who worked at a Dallas hospital until last year.
“It will force doctors to create questionable scenarios for patients, even if it is very dangerous,” said Gordon, who left Texas hoping to get pregnant and worried about the care she would receive there.
Gordon recalled a pregnant patient in her Dallas emergency room who showed signs of an ectopic pregnancy. Because gynecologists said they couldn’t definitively diagnose the problem, they waited to terminate the pregnancy until she returned the next day.
“It left a bad taste in my mouth,” Gordon said.
In Thurman’s case, when she returned to Ascension Seton Williamson for the third time, her gynecologist told her she needed surgery to remove the fallopian tube that had ruptured. Thurman, who was still bleeding heavily, refused. Losing the tube would jeopardize her fertility.
But her doctor told her that she risked dying if she waited any longer.
“She came in and she was like, ‘You’re either going to have to get a blood transfusion, or you’re going to have surgery, or you’re going to bleed to death,'” Thurman said through tears. “And I was like, ‘Oh my God, I’m going to, I’m going to die.'”
Ascension Seton Williamson declined to comment on Thurman’s case but said in a statement that the hospital “is committed to providing high-quality care to all who require our services.”
In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in the emergency room at Broward Health Coral Springs, according to federal documents. An ultrasound showed the patient had no amniotic fluid around the fetus, a dangerous condition that can lead to serious infections.
The woman suffered a miscarriage that day in a public toilet after the emergency room doctor declared her condition “improved” and discharged her without consulting the hospital’s gynecologist.
Emergency services rushed 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 inducing labor in anyone presenting with previable preterm rupture of the membranes “has been the standard of care for some time, regardless of heart rate, because of the risk to the mother.”
The hospital declined to comment or share its policy with the AP.
In another Florida case, a doctor admitted that state law complicated emergency pregnancy care.
“Because of the new laws … the staff can’t intervene unless there’s a risk to the patient’s health,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator looking into the hospital’s failure to offer an abortion to a pregnant woman whose waters broke in week 15, long before the fetus could survive.
The AP investigation found that in states with and without abortion bans, serious violations occurred that endangered the health of the mother or her fetus.
In interviews with researchers, two short-staffed hospitals — in Idaho and Washington — admitted they routinely sent pregnant patients to other hospitals.
A pregnant patient in a Bakersfield, California, emergency room was quickly triaged, but staff didn’t realize the urgency of her condition, a uterine rupture. The delay, a researcher concluded, may have contributed to the baby’s death.
The documents show that doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check fetal heart rates and discharge patients in active labor, forcing them to deliver at home or in an ambulance.
Hospitals have been struggling with nurse and doctor shortages since the start of COVID-19, problems staffing 24-hour ultrasounds, and new abortion laws are making emergency rooms dangerous places for pregnant women, warned Dara Kass, an emergency physician and former U.S. Department of Health and Human Services official.
“It is becoming less and less safe to be pregnant and seek emergency care in an emergency department,” she said.