WASHINGTON — Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her.
Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course” before discharging 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’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated a federal law when staff failed to treat her initially in February 2023.
“I was left to flail,” Thurman said. “It was nothing short of being misled.”
Even as the Biden administration publicly warned hospitals to treat pregnant patients in emergencies, facilities continue to violate the federal law. The issue became a focus for the administration following reports of women being improperly treated in emergency rooms after the Supreme Court’s decision to overturn the constitutional right to an abortion more than two years ago.
More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations has found.
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 had trouble getting any treatment, including one California woman who needed a blood transfusion after she sat for nine hours in an emergency waiting room.
The White House says hospitals must offer abortions when needed to save a woman’s health, despite state bans. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.
In Texas, where doctors face up to 99 years of prison if convicted of performing an illegal abortion, medical and legal experts say the law is complicating decision-making around emergency pregnancy care.
Although the state law says termination of ectopic pregnancies is not considered abortion, the draconian penalties scare Texas doctors from treating those patients, the Center for Reproductive Rights argues.
“As fearful as hospitals and doctors are of running afoul of these state abortion bans, they also need to be concerned about running afoul of federal law,” said Marc Hearron, a center attorney. Hospitals face a federal investigation, hefty penalties and threats to their Medicare funding if they break the federal law.
The organization filed two complaints last week with the Centers for Medicare and Medicaid Service alleging that different Texas emergency rooms failed to treat two patients, including Thurman, with ectopic pregnancies.
Another 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 are making it nearly impossible to get basic emergency healthcare,” she said in a statement. “I’m filing this complaint because women like me deserve justice and accountability from those that hurt us.”
Conclusively diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the pregnancy’s location on an ultrasound, three separate doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test and ultrasound of an empty uterus all indicate an ectopic pregnancy.
“You can’t be 100% — that’s the tricky part,” said Kate Arnold, an OB-GYN in Washington. “They’re literally time bombs. It’s a pregnancy growing in this thing that can only grow so much.”
Texas Right to Life Director John Seago said the state law clearly protects doctors from prosecution if they terminate ectopic pregnancies, even if a doctor “makes a mistake” in diagnosing it.
“Sending a woman back home is completely unnecessary, completely dangerous,” Seago said.
But the state law has “absolutely” made doctors afraid of treating pregnant patients, said Hannah Gordon, an emergency medicine physician who worked in a Dallas hospital until last year.
“It’s going to force doctors to start creating questionable scenarios for patients, even if it’s very dangerous,” said Gordon. She left Texas hoping to become pregnant and worried about the care she’d get there.
Gordon recalled a pregnant patient at her Dallas emergency room who had signs of an ectopic pregnancy. Because OB-GYNs said they couldn’t definitively diagnose the problem, they waited to end the pregnancy until she came back the next day.
“It left a bad taste in my mouth,” Gordon said.
In Thurman’s case, when she returned to Ascension Seton Williamson a third time, her OB-GYN told her she’d need surgery to remove the fallopian tube, which had ruptured. Thurman, still heavily bleeding, balked. Losing the tube would jeopardize her fertility.
But her doctor told her she risked death if she waited any longer.
“She came in and she’s like, you’re either going to have to have a blood transfusion, or you’re going to have to have surgery or you’re going to bleed out,” Thurman said, through tears. “That’s when I just kind of was like, “oh my God, I’m, I’m dying.”
Ascension Seton Williamson declined to comment on Thurman’s case, but said in a statement the hospital “is committed to providing high-quality care to all who seek our services.”
In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in Broward Health Coral Springs’ emergency wait room, according to federal documents. An ultrasound revealed the patient had no amniotic fluid surrounding the fetus, a dangerous situation that can cause serious infection.
The woman miscarried in a public bathroom that day, after the emergency room doctor listed her condition as “improved” and discharged her, without consulting the hospital’s OB-GYN.
Emergency crews rushed her to another hospital, where she was placed on a ventilator and discharged after six days.
Abortions after 15 weeks were banned in Florida at the time. Broward Health Coral Springs’ obstetrics medical director told an investigator that inducing labor for anyone who presents with pre-viable premature rupture of membranes is “the standard of care, has been a while, regardless of heartbeat, due to the risk to the mother.”
The hospital declined to comment or share its policies with the AP.
In another Florida case, a doctor admitted state law had complicated emergency pregnancy care.
“Because of the new laws … staff cannot intervene unless there is a danger to the patient’s health,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator who was probing the hospital’s failure to offer an abortion to a pregnant woman whose water broke at 15 weeks, well before the fetus could survive.
Serious violations that jeopardized a mother or her fetus’ health occurred in states with and without abortion bans, the AP’s review found.
In interviews with investigators, two short-staffed hospitals – in Idaho and Washington – admitted to routinely directing pregnant patients to drive to other hospitals.
A pregnant patient at a Bakersfield, California, emergency room was quickly triaged, but staff failed to realize the urgency of her condition, a uterine rupture. The delay, an investigator concluded, may have contributed to the baby’s death.
Doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for fetal heartbeats or discharged patients who were in active labor, leaving them to deliver at home or in ambulances, according to the documents.
Nursing and doctor shortages that have plagued hospitals since the onset of COVID-19, trouble staffing ultrasounds around-the-clock, and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official.
“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” she said.
Pregnancy is a time of joy and anticipation for many women, but it can also be a time of uncertainty and anxiety. One of the biggest concerns for pregnant women is access to emergency medical care in case of complications. Despite federal protections in place to ensure that pregnant women receive timely and appropriate care, many women still face challenges when seeking emergency medical treatment.
The Pregnancy Discrimination Act of 1978 prohibits discrimination against pregnant women in the workplace, including when it comes to access to medical care. This means that pregnant women should not be denied emergency medical treatment or be treated differently because of their pregnancy. However, a recent study published in the Journal of Obstetrics and Gynecology found that pregnant women are still facing barriers when seeking emergency care.
One of the main challenges pregnant women face is the lack of awareness among healthcare providers about the unique needs of pregnant patients. Many emergency room staff may not be trained to properly assess and treat pregnant women, leading to delays in care or inappropriate treatment. In some cases, pregnant women may be turned away from emergency rooms or told to wait longer than non-pregnant patients, which can have serious consequences for both the mother and the baby.
Another issue is the lack of access to specialized care for pregnant women in certain areas. In rural or underserved communities, there may be a shortage of obstetricians or maternal-fetal medicine specialists who can provide the necessary care for pregnant women with complications. This can result in delays in diagnosis and treatment, putting both the mother and the baby at risk.
Additionally, financial barriers can also prevent pregnant women from accessing emergency care. Even with insurance, some women may face high out-of-pocket costs for emergency room visits or hospital stays, leading them to delay seeking care or avoid it altogether. This can have serious consequences for both the mother and the baby, as delays in treatment can lead to complications or even death.
To address these challenges, it is important for healthcare providers to receive training on how to properly assess and treat pregnant patients in emergency situations. Hospitals and healthcare facilities should also ensure that they have the necessary resources and staff to provide specialized care for pregnant women. Additionally, policymakers should work to address disparities in access to care for pregnant women, particularly in underserved communities.
In conclusion, while federal protections are in place to ensure that pregnant women receive timely and appropriate emergency care, many women still face challenges when seeking treatment. It is crucial for healthcare providers, hospitals, and policymakers to work together to address these barriers and ensure that pregnant women receive the care they need to have a healthy pregnancy and delivery.
