Texas women denied abortions for ectopic pregnancies file complaints against hospitals

AUSTIN, Texas — Two Texas women have filed federal complaints against hospitals that denied them abortions for ectopic pregnancies, saying they nearly died and suffered losses of fallopian tubes after they were repeatedly turned away for treatment.

Texas law allows doctors to terminate ectopic pregnancies, in which a fertilized egg grows outside of the uterus where it cannot survive. They are the leading cause of maternal mortality during the first trimester and one of the most common complications, occurring in two of every 100 pregnancies.

"For weeks, I was in and out of emergency rooms trying to get the abortion that I needed to save my future fertility and life," Kyleigh Thurman said in a statement Monday. "This should have been an open and shut case. Yet, I was left completely in the dark without any information or options for the care I deserved."

The 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, Texas, for what they say are violations of the Emergency Medical Treatment and Active Labor Act, a federal law that requires hospitals to provide "stabilizing care" to patients facing emergency medical conditions.

Fourteen states have enacted abortion bans since the U.S. Supreme Court overturned Roe v. Wade two years ago, eliminating the constitutional right to abortions. While the bans have exceptions for when a pregnancy endangers the mother's life, doctors have said the complicated wording of the new laws and severe punishments for performing abortions – including up to life imprisonment in Texas and elsewhere – have stirred fear and confusion.

"How many more people will nearly die before we see change?" said Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights. "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."

Lawsuit: Doctors' inaction threatened patients' lives

After a month of cramps, dizziness, and nonstop bleeding, Thurman sought help from her OB-GYN, who suspected she had an ectopic pregnancy and recommended methotrexate to terminate it, according to the complaint filed last week. Her doctor didn't have the medication in her office and told her to go to an emergency room, which also appeared not to have it stocked.

Thurman, who lives roughly 60 miles northwest of Austin in Burnet County, then drove an hour away for treatment to Ascension Seton Williamson in Round Rock, Texas. The complaint said doctors found signs of a tubal ectopic pregnancy but discharged her and instructed her to return in two days.

After she returned, the hospital again saw signs of a possible ectopic pregnancy but did not offer treatment. It took Thurman's OB-GYN driving to the hospital to plead with medical staff for Thurman to be given methotrexate as treatment, according to the complaint.

It was too late, her attorneys say. The ectopic pregnancy ruptured days later, leaving her bleeding heavily and in blinding pain. Doctors removed her right fallopian tube to save her life, the complaint said, effectively lowering her chances of having a successful pregnancy in the future.

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 email Monday to the Austin American-Statesman, part of the USA TODAY Network.

Complaint: Woman denied care after diagnosis

Nearly three hours away, Kelsie Norris-De La Cruz said she had a similarly harrowing experience at a hospital in Arlington — a city of roughly 400,000 people that sits halfway between Dallas and Fort Worth.

Norris-De La Cruz, a college student in her last year, began planning for her baby after a pregnancy test came back positive. But after suffering from cramps and other symptoms, Medical City Healthcare Center told her she may have miscarried or was carrying an ectopic pregnancy, per the complaint filed last week.

After weeks of intense pain, Norris-De La Cruz went to Texas Health Arlington, where an ultrasound revealed a large mass near her uterus and other signs of ectopic pregnancy. An emergency room physician told her she could choose to receive a methotrexate injection, which would cause the mass to be absorbed by her body over several weeks, or surgery, according to the complaint. She opted for the surgery to prevent more bleeding.

Then, per 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, the complaint said. They tried another OB-GYN that had been recommended to them by a friend, who then performed emergency surgery. 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, according to the complaint.

“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.” 

Texas Health Arlington did not respond to a request for comment Monday.

Biden administration, Texas AG battle over abortion access

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 the Emergency Medical Treatment and Active Labor Act (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 when Texas law would not permit them. The federal Fifth Circuit Court of Appeals upheld the injunction in January.

Given the injunction, 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.

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."

Methotrexate is the most commonly used medication to treat ectopic pregnancy, according to the American College of Obstetrician-Gynecologists, and it 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 fetuses they carry. Texas Alliance for Life in monthly news releases has highlighted that between 1 in 10 "medical-necessity" abortions have been recorded in Texas each month since Roe v. Wade was overturned.

Before the landmark Supreme Court decision, the Texas Tribune reported at least 50,000 abortions took place in the state each year between 2014 and 2021.