Three Is Not The Charm

Another long one.

I don't know what else to do. I try to make calls, and I do some politicking on social media - all I can think of is to keep putting the problem in front of people.

So here it is.

A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments.

Thirty-five-year-old Porsha Ngumezi’s case raises questions about how abortion bans are pressuring doctors to avoid standard care even in straightforward miscarriages.

Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital’s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.

ProPublica condensed 200 pages of medical records into a summary of the case in consultation with two maternal-fetal medicine specialists and then reviewed it with more than a dozen experts around the country, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in maternal health.

Texas doctors told ProPublica the law has changed the way their colleagues see the procedure; some no longer consider it a first-line treatment, fearing legal repercussions or dissuaded by the extra legwork required to document the miscarriage and get hospital approval to carry out a D&C. This has occurred, ProPublica found, even in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.

Misoprostol, the medicine given to Porsha, is an effective method to complete low-risk miscarriages but is not recommended when a patient is unstable. The drug is also part of a two-pill regimen for abortions, yet administering it may draw less scrutiny than a D&C because it requires a smaller medical team and because the drug is commonly used to induce labor and treat postpartum hemorrhage. Since 2022, some Texas women who were bleeding heavily while miscarrying have gone public about only receiving medication when they asked for D&Cs. One later passed out in a pool of her own blood.

“Stigma and fear are there for D&Cs in a way that they are not for misoprostol,” said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.”

Several physicians who reviewed the summary of her case pointed out that Davis’ post-mortem notes did not reflect nurses’ documented concerns about Porsha’s “heavy bleeding.” After Porsha died, Davis wrote instead that the nurses and other providers described the bleeding as “minimal,” though no nurses wrote this in the records. ProPublica tried to ask Davis about this discrepancy. He did not respond to emails, texts or calls.

Houston Methodist officials declined to answer a detailed list of questions about Porsha’s treatment. They did not comment when asked whether Davis’ approach was the hospital’s “routine.” A spokesperson said that “each patient’s care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson added, “including the abortion law in place in Texas.”

“We Need to See the Doctor”

Hope and his two sons outside their home in Houston Credit:Danielle Villasana for ProPublica
Hope marveled at the energy Porsha had for their two sons, ages 5 and 3. Whenever she wasn’t working, she was chasing them through the house or dancing with them in the living room. As a finance manager at a charter school system, she was in charge of the household budget. As an engineer for an airline, Hope took them on flights around the world — to Chile, Bali, Guam, Singapore, Argentina.

The two had met at Lamar University in Beaumont, Texas. “When Porsha and I began dating,” Hope said, “I already knew I was going to love her.” She was magnetic and driven, going on to earn an MBA, but she was also gentle with him, always protecting his feelings. Both were raised in big families and they wanted to build one of their own.

When he learned Porsha was pregnant again in the spring of 2023, Hope wished for a girl. Porsha found a new OB-GYN who said she could see her after 11 weeks. Ten weeks in, though, Porsha noticed she was spotting. Over the phone, the obstetrician told her to go to the emergency room if it got worse.

To celebrate the end of the school year, Porsha and Hope took their boys to a water park in Austin, and as they headed back, on June 11, Porsha told Hope that the bleeding was heavier. They decided Hope would stay with the boys at home until a relative could take over; Porsha would drive to the emergency room at Houston Methodist Sugar Land, one of seven community hospitals that are part of the Houston Methodist system.

At 6:30 p.m, three hours after Porsha arrived at the hospital, she saw huge clots in the toilet. “Significant bleeding,” the emergency physician wrote. “I’m starting to feel a lot of pain,” Porsha texted Hope. Around 7:30 p.m., she wrote: “She said I might need surgery if I don’t stop bleeding,” referring to the nurse. At 7:50 p.m., after a nurse changed her second diaper in an hour: “Come now.”

Still, the doctor didn’t mention a D&C at this point, records show. Medical experts told ProPublica that this wait-and-see approach has become more common under abortion bans. Unless there is “overt information indicating that the patient is at significant risk,” hospital administrators have told physicians to simply monitor them, said Dr. Robert Carpenter, a maternal-fetal medicine specialist who works in several hospital systems in Houston. Methodist declined to share its miscarriage protocols with ProPublica or explain how it is guiding doctors under the abortion ban.

As Porsha waited for Hope, a radiologist completed an ultrasound and noted that she had “a pregnancy of unknown location.” The scan detected a “sac-like structure” but no fetus or cardiac activity. This report, combined with her symptoms, indicated she was miscarrying.

But the ultrasound record alone was less definitive from a legal perspective, several doctors explained to ProPublica. Since Porsha had not had a prenatal visit, there was no documentation to prove she was 11 weeks along. On paper, this “pregnancy of unknown location” diagnosis could also suggest that she was only a few weeks into a normally developing pregnancy, when cardiac activity wouldn’t be detected. Texas outlaws abortion from the moment of fertilization; a record showing there is no cardiac activity isn’t enough to give physicians cover to intervene, experts said.

Dr. Gabrielle Taper, who recently worked as an OB-GYN resident in Austin, said that she regularly witnessed delays after ultrasound reports like these. “If it’s a pregnancy of unknown location, if we do something to manage it, is that considered an abortion or not?” she said, adding that this was one of the key problems she encountered. After the abortion ban went into effect, she said, “there was much more hesitation about: When can we intervene, do we have enough evidence to say this is a miscarriage, how long are we going to wait, what will we use to feel definitive?”

At Methodist, the emergency room doctor reached Davis, the on-call OB-GYN, to discuss the ultrasound, according to records. They agreed on a plan of “observation in the hospital to monitor bleeding.”

Around 8:30 p.m., just after Hope arrived, Porsha passed out. Terrified, he took her head in his hands and tried to bring her back to consciousness. “Babe, look at me,” he told her. “Focus.” Her blood pressure was dipping dangerously low. She had held off on accepting a blood transfusion until he got there. Now, as she came to, she agreed to receive one and then another.

By this point, it was clear that she needed a D&C, more than a dozen OB-GYNs who reviewed her case told ProPublica. She was hemorrhaging, and the standard of care is to vacuum out the residual tissue so the uterus can clamp down, physicians told ProPublica.

“Complete the miscarriage and the bleeding will stop,” said Dr. Lauren Thaxton, an OB-GYN who recently left Texas.

“At every point, it’s kind of shocking,” said Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California, San Francisco who reviewed Porsha’s case. “She is having significant blood loss and the physician didn’t move toward aspiration.”

All Porsha talked about was her devastation of losing the pregnancy. She was cold, crying and in extreme pain. She wanted to be at home with her boys. Unsure what to say, Hope leaned his chest over the cot, passing his body heat to her.

At 9:45 p.m., Esmeralda Acosta, a nurse, wrote that Porsha was “continuing to pass large clots the size of grapefruit.” Fifteen minutes later, when the nurse learned Davis planned to send Porsha to a floor with fewer nurses, she “voiced concern” that he wanted to take her out of the emergency room, given her condition, according to medical records.

At 10:20 p.m., seven hours after Porsha arrived, Davis came to see her. Hope remembered what his mother had told him on the phone earlier that night: “She needs a D&C.” The doctor seemed confident about a different approach: misoprostol. If that didn’t work, Hope remembers him saying, they would move on to the procedure.

A pill sounded good to Porsha because the idea of surgery scared her. Davis did not explain that a D&C involved no incisions, just suction, according to Hope, or tell them that it would stop the bleeding faster. The Ngumezis followed his recommendation without question. “I’m thinking, ‘He’s the OB, he’s probably seen this a thousand times, he probably knows what’s right,’” Hope said.

But more than a dozen doctors who reviewed Porsha’s case were concerned by this recommendation. Many said it was dangerous to give misoprostol to a woman who’s bleeding heavily, especially one with a blood clotting disorder. “That’s not what you do,” said Dr. Elliott Main, the former medical director for the California Maternal Quality Care Collaborative and an expert in hemorrhage, after reviewing the case. “She needed to go to the operating room.” Main and others said doctors are obliged to counsel patients on the risks and benefits of all their options, including a D&C.

Performing a D&C, though, attracts more attention from colleagues, creating a higher barrier in a state where abortion is illegal, explained Goulding, the OB-GYN in Houston. Staff are familiar with misoprostol because it’s used for labor, and it only requires a doctor and a nurse to administer it. To do a procedure, on the other hand, a doctor would need to find an operating room, an anesthesiologist and a nursing team. “You have to convince everyone that it is legal and won’t put them at risk,” said Goulding. “Many people may be afraid and misinformed and refuse to participate — even if it’s for a miscarriage.”

Davis moved Porsha to a less-intensive unit, according to records. Hope wondered why they were leaving the emergency room if the nurse seemed so worried. But instead of pushing back, he rubbed Porsha’s arms, trying to comfort her. The hospital was reputable. “Since we were at Methodist, I felt I could trust the doctors.”

On their way to the other ward, Porsha complained of chest pain. She kept remarking on it when they got to the new room. From this point forward, there are no nurse’s notes recording how much she continued to bleed. “My wife says she doesn’t feel right, and last time she said that, she passed out,” Hope told a nurse. Furious, he tried to hold it together so as not to alarm Porsha. “We need to see the doctor,” he insisted.

Her vital signs looked fine. But many physicians told ProPublica that when healthy pregnant patients are hemorrhaging, their bodies can compensate for a long time, until they crash. Any sign of distress, such as chest pain, could be a red flag; the symptom warranted investigation with tests, like an electrocardiogram or X-ray, experts said. To them, Porsha’s case underscored how important it is that doctors be able to intervene before there are signs of a life-threatening emergency.

But Davis didn’t order any tests, according to records.

Around 1:30 a.m., Hope was sitting by Porsha’s bed, his hands on her chest, telling her, “We are going to figure this out.” They were talking about what she might like for breakfast when she began gasping for air.

“Help, I need help!” he shouted to the nurses through the intercom. “She can’t breathe.”

“All She Needed”

Hours later, Hope returned home in a daze. “Is mommy still at the hospital?” one of his sons asked. Hope nodded; he couldn’t find the words to tell the boys they’d lost their mother. He dressed them and drove them to school, like the previous day had been a bad dream. He reached for his phone to call Porsha, as he did every morning that he dropped the kids off. But then he remembered that he couldn’t.

Friends kept reaching out. Most of his family’s network worked in medicine, and after they said how sorry they were, one after another repeated the same message. All she needed was a D&C, said one. They shouldn’t have given her that medication, said another. It’s a simple procedure, the callers continued. We do this all the time in Nigeria.

Since Porsha died, several families in Texas have spoken publicly about similar circumstances. This May, when Ryan Hamilton’s wife was bleeding while miscarrying at 13 weeks, the first doctor they saw at Surepoint Emergency Center Stephenville noted no fetal cardiac activity and ordered misoprostol, according to medical records. When they returned because the bleeding got worse, an emergency doctor on call, Kyle Demler, said he couldn’t do anything considering “the current stance” in Texas, according to Hamilton, who recorded his recollection of the conversation shortly after speaking with Demler. (Neither Surepoint Emergency Center Stephenville nor Demler responded to several requests for comment.)

They drove an hour to another hospital asking for a D&C to stop the bleeding, but there, too, the physician would only prescribe misoprostol, medical records indicate. Back home, Hamilton’s wife continued bleeding until he found her passed out on the bathroom floor. “You don’t think it can really happen like that,” said Hamilton. “It feels like you’re living in some sort of movie, it’s so unbelievable.”

Across Texas, physicians say they blame the law for interfering with medical care. After ProPublica reported last month on two women who died after delays in miscarriage care, 111 OB-GYNs sent a letter to Texas policymakers, saying that “the law does not allow Texas women to get the lifesaving care they need.”

Dr. Austin Dennard, an OB-GYN in Dallas, told ProPublica that if one person on a medical team doubts the doctor’s choice to proceed with a D&C, the physician might back down. “You constantly feel like you have someone looking over your shoulder in a punitive, vigilante type of way.”

The criminal penalties are so chilling that even women with diagnoses included in the law’s exceptions are facing delays and denials. Last year, for example, legislators added an update to the ban for patients diagnosed with previable premature rupture of membranes, in which a patient’s water breaks before a fetus can survive. Doctors can still face prosecution for providing abortions in those cases, but they are offered the chance to justify themselves with what’s called an “affirmative defense,” not unlike a murder suspect arguing self defense. This modest change has not stopped some doctors from transferring those patients instead of treating them; Dr. Allison Gilbert, an OB-GYN in Dallas, said doctors send them to her from other hospitals. “They didn’t feel like other staff members would be comfortable proceeding with the abortion,” she said. “It’s frustrating that places still feel like they can’t act on some of these cases that are clearly emergencies.” Women denied treatment for ectopic pregnancies, another exception in the law, have filed federal complaints.

In response to ProPublica’s questions about Houston Methodist’s guidance on miscarriage management, a spokesperson, Gale Smith, said that the hospital has an ethics committee, which can usually respond within hours to help physicians and patients make “appropriate decisions” in compliance with state laws.

After Porsha died, Davis described in the medical record a patient who looked stable: He was tracking her vital signs, her bleeding was “mild” and she was “said not to be in distress.” He ordered bloodwork “to ensure patient wasn’t having concerning bleeding.” Medical experts who reviewed Porsha’s case couldn’t understand why Davis noted that a nurse and other providers reported “decreasing bleeding” in the emergency department when the record indicated otherwise. “He doesn’t document the heavy bleeding that the nurse clearly documented, including the significant bleeding that prompted the blood transfusion, which is surprising,” Grossman, the UCSF professor, said.

Patients who are miscarrying still don’t know what to expect from Houston Methodist.

This past May, Marlena Stell, a patient with symptoms nearly identical to Porsha’s, arrived at another hospital in the system, Houston Methodist The Woodlands. According to medical records, she, too, was 11 weeks along and bleeding heavily. An ultrasound confirmed there was no fetal heartbeat and indicated the miscarriage wasn’t complete. “I assumed they would do whatever to get the bleeding to stop,” Stell said.

Instead, she bled for hours at the hospital. She wanted a D&C to clear out the rest of the tissue, but the doctor gave her methergine, a medication that’s typically used after childbirth to stop bleeding but that isn’t standard care in the middle of a miscarriage, doctors told ProPublica. "She had heavy bleeding, and she had an ultrasound that's consistent with retained products of conception." said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed the records. "The standard of care would be a D&C."

Stell says that instead, she was sent home and told to “let the miscarriage take its course.” She completed her miscarriage later that night, but doctors who reviewed her case, so similar to Porsha’s, said it showed how much of a gamble physicians take when they don’t follow the standard of care. “She got lucky — she could have died,” Abbott said. (Houston Methodist did not respond to a request for comment on Stell’s care.)

It hadn’t occurred to Hope that the laws governing abortion could have any effect on his wife’s miscarriage. Now it’s the only explanation that makes sense to him. “We all know pregnancies can come out beautifully or horribly,” Hope told ProPublica. “Instead of putting laws in place to make pregnancies safer, we created laws that put them back in danger.”

For months, Hope’s youngest son didn’t understand that his mom was gone. Porsha’s long hair had been braided, and anytime the toddler saw a woman with braids from afar, he would take off after her, shouting, “That’s mommy!”

A couple weeks ago, Hope flew to Amsterdam to quiet his mind. It was his first trip without Porsha, but as he walked the city, he didn’t know how to experience it without her. He kept thinking about how she would love the Christmas lights and want to try all the pastries. How she would have teased him when he fell asleep on a boat tour of the canals. “I thought getting away would help,” he wrote in his journal. “But all I’ve done is imagine her beside me.”

Overheard

Did you hear about the man

who went to the ER

because he was in dire need

of surgery on his balls,

but the doctors had to consult

their lawyers before

saving his life

and then he died?

Yeah, me neither.

Nobody has.

Ever.

Today's Jessica

Women are dying because of all this fucked up Republican "policy" on abortion.

A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms

It took three ER visits and 20 hours before a hospital admitted Nevaeh Crain, 18, as her condition worsened. Doctors insisted on two ultrasounds to confirm “fetal demise.” She’s one of at least two Texas women who died under the state’s abortion ban.

Candace Fails screamed for someone in the Texas hospital to help her pregnant daughter. “Do something,” she pleaded, on the morning of Oct. 29, 2023.

Nevaeh Crain was crying in pain, too weak to walk, blood staining her thighs. Feverish and vomiting the day of her baby shower, the 18-year-old had gone to two different emergency rooms within 12 hours, returning home each time worse than before.

The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.

Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.

By then, more than two hours after her arrival, Crain’s blood pressure had plummeted and a nurse had noted that her lips were “blue and dusky.” Her organs began failing.

Hours later, she was dead.

Fails, who would have seen her daughter turn 20 this Friday, still cannot understand why Crain’s emergency was not treated like an emergency.

But that is what many pregnant women are now facing in states with strict abortion bans, doctors and lawyers have told ProPublica.

“Pregnant women have become essentially untouchables,” said Sara Rosenbaum, a health law and policy professor emerita at George Washington University.

Texas’s abortion ban threatens prison time for interventions that end a fetal heartbeat, whether the pregnancy is wanted or not. It includes exceptions for life-threatening conditions, but still, doctors told ProPublica that confusion and fear about the potential legal repercussions are changing the way their colleagues treat pregnant patients with complications.

In states with abortion bans, such patients are sometimes bounced between hospitals like “hot potatoes,” with health care providers reluctant to participate in treatment that could attract a prosecutor, doctors told ProPublica. In some cases, medical teams are wasting precious time debating legalities and creating documentation, preparing for the possibility that they’ll need to explain their actions to a jury and judge.

Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, said patients are left wondering: “Am I being sent home because I really am OK? Or am I being sent home because they’re afraid that the solution to what’s going on with my pregnancy would be ending the pregnancy, and they’re not allowed to do that?”

There is a federal law to prevent emergency room doctors from withholding lifesaving care.

Passed nearly four decades ago, it requires emergency rooms to stabilize patients in medical crises. The Biden administration argues this mandate applies even in cases where an abortion might be necessary.

No state has done more to fight this interpretation than Texas, which has warned doctors that its abortion ban supersedes the administration’s guidance on federal law, and that they can face up to 99 years in prison for violating it.

ProPublica condensed more than 800 pages of Crain’s medical records into a four-page timeline in consultation with two maternal-fetal medicine specialists; reporters reviewed it with nine doctors, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in emergency medicine and maternal health.

Some said the first ER missed warning signs of infection that deserved attention. All said that the doctor at the second hospital should never have sent Crain home when her signs of sepsis hadn’t improved. And when she returned for the third time, all said there was no medical reason to make her wait for two ultrasounds before taking aggressive action to save her.

“This is how these restrictions kill women,” said Dr. Dara Kass, a former regional director at the Department of Health and Human Services and an emergency room physician in New York. “It is never just one decision, it’s never just one doctor, it’s never just one nurse.”

While they were not certain from looking at the records provided that Crain’s death could have been prevented, they said it may have been possible to save both the teenager and her fetus if she had been admitted earlier for close monitoring and continuous treatment.

There was a chance Crain could have remained pregnant, they said. If she had needed an early delivery, the hospital was well-equipped to care for a baby on the edge of viability. In another scenario, if the infection had gone too far, ending the pregnancy might have been necessary to save Crain.

Doctors involved in Crain’s care did not respond to several requests for comment. The two hospitals, Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth, declined to answer detailed lists of questions about her treatment.

Fails and Crain believed abortion was morally wrong. The teen could only support it in the context of rape or life-threatening illness, she used to tell her mother. They didn’t care whether the government banned it, just how their Christian faith guided their own actions.

When they discovered Crain was pregnant with a girl, the two talked endlessly about the little dresses they could buy, what kind of mother she would be. Crain landed on the name Lillian. Fails could not wait to meet her.

But when her daughter got sick, Fails expected that doctors had an obligation to do everything in their power to stave off a potentially deadly emergency, even if that meant losing Lillian. In her view, they were more concerned with checking the fetal heartbeat than attending to Crain.

“I know it sounds selfish, and God knows I would rather have both of them, but if I had to choose,” Fails said, “I would have chosen my daughter.”

“I’m in a Lot of Pain”

Crain had just graduated from high school in her hometown of Vidor, Texas, in May of 2023 when she learned that she was pregnant.

She and her boyfriend of two years, Randall Broussard, were always hip to hip, wrestling over vapes or snuggling on the couch watching vampire movies. Crain was drawn to how gentle he was. He admired how easily she built friendships and how quickly she could make people laugh. Though they were young, they’d already imagined starting a family. Broussard, who has eight siblings, wanted many kids; Crain wanted a daughter and the kind of relationship she had with her mom. Earlier that year, Broussard had given Crain a small diamond ring — “a promise,” he told her, “that I will always love you.”

On the morning of their baby shower, Oct. 28, 2023, Crain woke with a headache. Her mom decorated the house with pink balloons and Crain laid out Halloween-themed platters. Soon, nausea set in. Crain started vomiting and was running a fever. When guests arrived, Broussard opened gifts — onesies and diapers and bows — while Crain kept closing her eyes.

Around 3 p.m., her family told her she needed to go to the hospital.

Broussard drove Crain to Baptist Hospitals of Southeast Texas. They sat in the waiting room for four hours. When Crain started vomiting, staff brought her a plastic pan. When she wasn’t retching, she lay her head in her boyfriend’s lap.
New here?

A nurse practitioner ordered a test for strep throat, which came back positive, medical records show. But in a pregnant patient, abdominal pain and vomiting should not be quickly attributed to strep, physicians told ProPublica; a doctor should have also evaluated her pregnancy.

Instead, Baptist Hospitals discharged her with a prescription for antibiotics. She was home at 9 p.m. and quickly dozed off, but within hours, she woke her mother up. “Mom, my stomach is still hurting,” she said into the dark bedroom at 3 a.m. “I’m in a lot of pain.”

Fails drove Broussard and Crain to another hospital in town, Christus Southeast Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins saw that Crain had a temperature of 102.8 and an abnormally high pulse, according to records; a nurse noted that Crain rated her abdominal pain as a seven out of 10.

Her vital signs pointed to possible sepsis, records show. It’s standard medical practice to immediately treat patients who show signs of sepsis, which can overtake and kill a person quickly, medical experts told ProPublica. These patients should be watched until their vitals improve. Through tests and scans, the goal is to find the source of the infection. If the infection was in Crain’s uterus, the fetus would likely need to be removed with a surgery.

In a room at the obstetric emergency department, a nurse wrapped a sensor belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard told Fails, who was sitting in the hallway.

After two hours of IV fluids, one dose of antibiotics, and some Tylenol, Crain’s fever didn’t go down, her pulse remained high, and the fetal heart rate was abnormally fast, medical records show. Hawkins noted that Crain had strep and a urinary tract infection, wrote up a prescription and discharged her.

Hawkins had missed infections before. Eight years earlier, the Texas Medical Board found that he had failed to diagnose appendicitis in one patient and syphilis in another. In the latter case, the board noted that his error “may have contributed to the fetal demise of one of her twins.” The board issued an order to have Hawkins’ medical practice monitored; the order was lifted two years later. (Hawkins did not respond to several attempts to reach him.)

All of the doctors who reviewed Crain’s vital signs for ProPublica said she should have been admitted. “She should have never left, never left,” said Elise Boos, an OB-GYN in Tennessee.

Kass, the New York emergency physician, put it in starker terms: When they discharged her, they were “pushing her down the path of no return.”

“It’s bullshit,” Fails said as Broussard rolled Crain out in a wheelchair; she was unable to walk on her own. Fails had expected the hospital to keep her overnight. Her daughter was breathing heavily, hunched over in pain, pale in the face. Normally talkative, the teen was quiet.

Back home, around 7 a.m., Fails tried to get her daughter comfortable as she cried and moaned. She told Fails she needed to pee, and her mother helped her into the bathroom. “Mom, come here,” she said from the toilet. Blood stained her underwear.

The blood confirmed Fails’ instinct: This was a miscarriage.

At 9 a.m, a full day after the nausea began, they were back at Christus St. Elizabeth. Crain’s lips were drained of color and she kept saying she was going to pass out. Staff started her on IV antibiotics and performed a bedside ultrasound.

Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal heart rate, according to records; he told the family he was sorry for their loss.

Standard protocol when a critically ill patient experiences a miscarriage is to stabilize her and, in most cases, hurry to the operating room for delivery, medical experts said. This is especially urgent with a spreading infection. But at Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour later, as nurses placed a catheter, Fails noticed her daughter’s thighs were covered in blood.

At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica about Crain’s condition. The teen was now having contractions. “Dr. Totorica states to not move patient,” she wrote after talking with him. “Dr. Totorica states there is a slight chance patient may need to go to ICU and he wants the bedside ultrasound to be done stat for sure before admitting to room.”

Though he had already performed an ultrasound, he was asking for a second.

The first hadn’t preserved an image of Crain’s womb in the medical record. “Bedside ultrasounds aren’t always set up to save images permanently,” said Abbott, the Boston OB-GYN.

The state’s laws banning abortion require that doctors record the absence of a fetal heartbeat before intervening with a procedure that could end a pregnancy. Exceptions for medical emergencies demand physicians document their reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain this isn’t a normal pregnancy, we can’t do anything, because it could be alleged that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San Antonio.

At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was paging for an emergency team over the loudspeakers.

Around 11 a.m., two hours after Crain had arrived at the hospital, a second ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to confirm fetal demise per Dr. Totorica’s orders.”

When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side, rubbing her head, as her daughter dipped in and out of consciousness. Crain couldn’t sign consent forms for her care because of “extreme pain,” according to the records, so Fails signed a release for “unplanned dilation and curettage” or “unplanned cesarean section.”

But the doctors quickly decided it was now too risky to operate, according to records. They suspected that she had developed a dangerous complication of sepsis known as disseminated intravascular coagulation; she was bleeding internally.

Frantic and crying, Fails locked eyes with her daughter. “You’re strong, Nevaeh,” she said. “God made us strong.”

“The Law Is on Our Side”

Crain is one of at least two pregnant Texas women who died after doctors delayed treating miscarriages, ProPublica found.

Texas Attorney General Ken Paxton has successfully made his state the only one in the country that isn’t required to follow the Biden administration’s efforts to ensure that emergency departments don’t turn away patients like Crain.

After the U.S. Supreme Court overturned the constitutional right to abortion, the administration issued guidance on how states with bans should follow the Emergency Medical Treatment and Labor Act. The federal law requires hospitals that receive funding through Medicare — which is virtually all of them — to stabilize or transfer anyone who arrives in their emergency rooms. That goes for pregnant patients, the guidance argues, even if that means violating state law and providing an abortion.

Paxton responded by filing a lawsuit in 2022, saying the federal guidance “forces hospitals and doctors to commit crimes,” and was an “attempt to use federal law to transform every emergency room in the country into a walk-in abortion clinic.”

Part of the battle has centered on who is eligible for abortion. The federal EMTALA guidelines apply when the health of the pregnant patient is in “serious jeopardy.” That’s a wider range of circumstances than the Texas abortion restriction, which only makes exceptions for a “risk of death” or “a serious risk of substantial impairment of a major bodily function.”

The lawsuit worked its way through three layers of federal courts, and each time it was met by judges nominated by former President Donald Trump, whose court appointments were pivotal to overturning Roe v. Wade.

After U.S. District Judge James Wesley Hendrix, a Trump appointee, quickly sided with Texas, Paxton celebrated the triumph over “left-wing bureaucrats in Washington.”

“The decision last night proves what we knew all along,” Paxton added. “The law is on our side.”

This year, the U.S. Court of Appeals for the 5th Circuit upheld the order in a ruling authored by Kurt D. Engelhardt, another judge nominated by Trump.

The Biden administration appealed to the U.S. Supreme Court, urging the justices to make it clear that some emergency abortions are allowed.

Even amid news of preventable deaths related to abortion bans, the Supreme Court declined to do so last month.

Paxton called this “a major victory” for the state’s abortion ban.

He has also made clear that he will bring charges against physicians for performing abortions if he decides that the cases don’t fall within Texas’ narrow medical exceptions.

Last year, he sent a letter threatening to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. He insisted that the doctor and her patient had not proven how, precisely, the patient’s condition threatened her life.

Many doctors say this kind of message has encouraged doctors to “punt” patients instead of treating them.

Since the abortion bans went into effect, an OB-GYN at a major hospital in San Antonio has seen an uptick in pregnant patients being sent to them from across Southern Texas, as they suffer from complications that could easily be treated close to home.

The well-resourced hospital is perceived to have more institutional support to provide abortions and miscarriage management, the doctor said. Other providers “are transferring those patients to our centers because, frankly, they don’t want to deal with them.”

After Crain died, Fails couldn’t stop thinking about how Christus Southeast Hospital had ignored her daughter’s condition. “She was bleeding,” she said. “Why didn’t they do anything to help it along instead of wait for another ultrasound to confirm the baby is dead?”

It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.” He did note, however, that Crain was “repeatedly seeking medical care for a progressive illness” just before she died.

Last November, Fails reached out to medical malpractice lawyers to see about getting justice through the courts. A different legal barrier now stood in her way.

If Crain had experienced these same delays as an inpatient, Fails would have needed to establish that the hospital violated medical standards. That, she believed, she could do. But because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”

No lawyer has agreed to take the case.

How Bad?

Pretty fuckin' bad.

From back in July. Funny how this kinda thing barely sees the light of day.

JD Vance called for ‘federal response’ to block women from traveling for abortions

VP nominee pushed baseless warning in 2022 that George Soros would pack planes of Black women to get abortions

JD Vance, the Ohio senator and Donald Trump’s running mate, promoted a baseless rightwing talking point in 2022 when he warned of George Soros-funded planes transporting Black women across state lines for abortions.

“I’m sympathetic to the view that like, okay, look here, here’s a situation – let’s say Roe v Wade is overruled,” Vance said in a recently resurfaced podcast interview. “Ohio bans abortion in 2022, or let’s say 2024. And then, you know, every day George Soros sends a 747 to Columbus to load up disproportionately Black women to get them to go have abortions in California. And of course, the left will celebrate this as a victory for diversity – uh, that’s kind of creepy.”

The US supreme court overturned Roe in 2022. Vance’s statements echo a common anti-abortion talking point accusing abortion providers and their supporters of targeting people of color.

Black women did seek abortions at a higher rate before Roe fell, but public health experts say that this is far from proof of a racist conspiracy. They point to a number systemic factors – for example, Black women are more likely to live in areas where it’s harder to access contraception. They are also disproportionately harmed by abortion bans.

Vance continued: “And, and it’s like, if that happens, do you need some federal response to prevent it from happening? Because it’s really creepy. And I’m pretty sympathetic to that actually. So, you know, how hopefully we get to a point where Ohio bans abortion in California and the Soroses of the world respect it.”

While Open Society Foundations, which was founded by Soros, does support reproductive rights, the billionaire philanthropist is not directing planes to swoop up Black women for abortions. He has been the target of antisemitic conspiracy theories for years.

Vance’s comments were reported by CNN. On Thursday evening, Kamala Harris’s campaign posted audio of the remarks on X.

Vance’s record on abortion has come under national scrutiny since Trump picked the Hillbilly Elegy author as his vice-presidential running mate. In 2022, Vance suggested he would support a national 15-week abortion ban with exceptions. But, like other Republicans wary of the political fallout of Roe’s demise, Vance has more recently sought to soften his position and said in an interview that “we have to accept people do not want abortion bans”. He has also expressed support for the availability of mifepristone, a common abortion pill, and said he agrees with Trump’s position that states should decide their own abortion laws. (Trump has flip-flopped on this stance.)

But in January 2023, Vance signed ont o a letter urging the Department of Justice to use the Comstock Act, a 19th-century anti-obscenity law, to ban the mailing of abortion pills nationwide. Since Roe’s fall, anti-abortion activists have begun claiming that the Comstock Act remains good law and can be used to enforce a federal abortion ban. Project 2025, a wish list for a conservative administration written by the influential thinktank Heritage Foundation, reiterates this argument.

“Senator Vance has made his position clear: he agrees with President Trump that each state should have the chance to individually set their own abortion laws,” Taylor Van Kirk, a spokeswoman for Vance, said in a statement. “Desperate attacks from Democrats will not distract voters from the deadly effects of Kamala’s wide-open border, the untenable cost of living caused by her inflationary spending or any other aspect of her far-left, radical agenda.”

JD Vance: from 'never-Trump guy' to vice-presidential candidate – video profile
Vance’s vice-presidential run is off to a rocky start, and he has spent the last week haunted by other resurfaced remarks. In a 2021 interview with Tucker Carlson, Vance said that the United States and the Democratic party wwere run “by a bunch of childless cat ladies, who are miserable at their own lives and the choices that they’ve made and so they want to make the rest of the country miserable too”.

He then named Harris, who has two step-children, as an example, along with Pete Buttigieg (who has since had children) and Alexandria Ocasio-Cortez. “The entire future of the Democrats is controlled by people without children,” he said. “And how does it make sense that we’ve turned our country over to people who don’t really have a direct stake in it?”

Those comments have provoked an uproar, drawing condemnation even from relatively apolitical celebrities like Jennifer Aniston. Kerstin Emhoff, the ex-wife of Harris’s husband Doug Emhoff, called the attacks on the presumptive Democratic nominee “baseless” and praised her co-parenting. In an Instagram story, Harris’s step-daughter Ella Emhoff posted: “I love my three parents.”

A Very Different Country

Overheard

When you vote Republican,

you're saying a rapist

should be able to choose

the mother of his children.

An Ad

The dialog is a bit obvious and the acting isn't great, but why the fuck would I demand anything Oscar-worthy when women are dying?

And by the way, there are babies dying as well. The precious little bundles these fuckin' fanatics claim they care about are becoming casualties too.

I can't believe how stupidly we behave sometimes.

Shut the fuck up. Get your fat ass outa the way. And leave people alone.

Cold Comfort

If the Press Poodles bring it up at all, I'm sure the spinmeisters will handle it with something like, "See? We can all agree to disagree, and disagree without being disagreeable."

I'll go farther out on the limb, and say this could easily be another way to create confusion and chaos - to distract some of us, while making others feel a little better about how maybe Trump isn't all that bad after all.

I can hate my cynicism, and still be glad of it because it serves to keep me on my toes.

None of it changes my thinking that Republicans are manipulative assholes who pet, and coo, and soothe - as they gently force the knife into the body politic's heart.

Melania Trump Says Women Should Be Able to Make Their Own Decisions About Abortion, a Right Her Husband Helped Take Away From Millions

She claims she “privately” addressed her views with her spouse, believing that was the better route that “publicly challenging” him.

Melania Trump has a memoir out later this month that Donald Trump has told supporters he was too busy to read. So it may come as a surprise to him that his wife wrote about how she’s apparently passionately pro-choice, and believes women should be able to obtain abortions any time they want—a right the ex-president took away from millions of people.

According to the Guardian, which obtained a copy of Melania ahead of its release next week, the former first lady says in her book: “It is imperative to guarantee that women have autonomy in deciding their preference of having children, based on their own convictions, free from any intervention or pressure from the government. Why should anyone other than the woman herself have the power to determine what she does with her own body? A woman’s fundamental right of individual liberty, to her own life, grants her the authority to terminate her pregnancy if she wishes. Restricting a woman’s right to choose whether to terminate an unwanted pregnancy is the same as denying her control over her own body. I have carried this belief with me throughout my entire adult life.” And she doesn’t stop there.

“It’s a very straightforward concept,” Melania continues. “In fact, we are all born with a set of fundamental rights, including the right to enjoy our lives. We are all entitled to maintain a gratifying and dignified existence. This common-sense approach applies to a woman’s natural right to make decisions about her own body and health.”

Wondering if the former first lady believes there should be a cutoff point as to when a person can no longer obtain an abortion, as her husband’s running mate declared during the vice-presidential debate this week? She does not. “It is important to note that historically, most abortions conducted during the later stages of pregnancy were the result of severe fetal abnormalities that probably would have led to the death or stillbirth of the child,” she says. “Perhaps even the death of the mother. These cases were extremely rare and typically occurred after several consultations between the woman and her doctor.” She also writes that while she is “in favor of the requirement that juveniles obtain parental consent before undergoing an abortion,” she “realize[s] this may not always be possible.“

The former first lady’s views on abortion are, of course, wildly out of step with those of her husband and his Republican brethren. While running for office in 2016, Trump vowed to exclusively nominate Supreme Court judges who would overturn Roe v. Wade; after that happened in June 2022, he bragged about killing the national right to an abortion and has not stopped bragging about it in the years since. While he defends his actions as simply sending the matter back to the “states” to decide, the overturning of Roe led to extreme or total abortion bans in numerous states, where some women have died as a result. Meanwhile, the ex-president regularly lies about abortion, claiming Democrats support “executing” babies after they are born. His running mate, JD Vance has previously called for a national abortion ban, and it is not at all out of the realm of possibility that one could go into effect in a second Trump administration, despite misleading claims to the contrary.

Touching on their opposing beliefs, Melania writes: “Occasional political disagreements between me and my husband...[are] part of our relationship, but I believed in addressing them privately rather than publicly challenging him.” Which, obviously, is pretty unfortunate for the many people who have been stripped of their reproductive rights thanks to Trump’s handiwork.

Why are we hearing about the former first lady’s views on abortion now, eight years after her spouse first ran for president? Abortion rights advocate Jessica Valenti has an idea:

It’s not a coincidence that her supposed full-throated support is being leaked right before the election....This woman has been complicit in her husband’s nightmare reign and bigotry, and now she wants to help put a glossy, softened sheen on his anti-abortion extremism. This is about covering up and distracting from how dangerous a Trump administration would be for women.

Which, if it’s not already abundantly clear, would be Handmaid’s Tale–level dangerous. On the bright side, anyone dying in a parking lot as a result of Trump’s Supreme Court nominations can take comfort in the fact that Melania “privately” complained to her husband.

Overheard

I'm trying to get everything ready for when I go to the clinic for my vasectomy. So I've made a few calls, and I'm happy to report that I don't have to get any invasive scans, and I don't have to worry about being accosted by a mob of "Pro-Lifers" who loudly insist that I need to change my mind, and there's no waiting period, and they won't refer me to a Crisis Center for a lecture on - something.

It's like they trust me to make my own decisions on what I do with my own reproductive system.

Kind of a shocker, right?

Today's Belle

In case you needed to know the whole story.

Vote Blue

Honestly - Blood On Their Hands

That's not hyperbolic. It is indeed, something a lot of people say when they're wittingly or otherwise overstating the case.

Not in this case. This is exactly what everybody knew was going to happen.

Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable.

At least two women in Georgia died after they couldn’t access legal abortions and timely medical care in their state, ProPublica has found. This is one of their stories.

In her final hours, Amber Nicole Thurman suffered from a grave infection that her suburban Atlanta hospital was well-equipped to treat.

She’d taken abortion pills and encountered a rare complication; she had not expelled all of the fetal tissue from her body. She showed up at Piedmont Henry Hospital in need of a routine procedure to clear it from her uterus, called a dilation and curettage, or D&C.

But just that summer, her state had made performing the procedure a felony, with few exceptions. Any doctor who violated the new Georgia law could be prosecuted and face up to a decade in prison.

Thurman waited in pain in a hospital bed, worried about what would happen to her 6-year-old son, as doctors monitored her infection spreading, her blood pressure sinking and her organs beginning to fail.

It took 20 hours for doctors to finally operate. By then, it was too late.

The otherwise healthy 28-year-old medical assistant, who had her sights set on nursing school, should not have died, an official state committee recently concluded.

Tasked with examining pregnancy-related deaths to improve maternal health, the experts, including 10 doctors, deemed hers “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome.

Their reviews of individual patient cases are not made public. But ProPublica obtained reports that confirm that at least two women have already died after they couldn’t access legal abortions and timely medical care in their state.

There are almost certainly others.

Committees like the one in Georgia, set up in each state, often operate with a two-year lag behind the cases they examine, meaning that experts are only now beginning to delve into deaths that took place after the Supreme Court overturned the federal right to abortion.

Thurman’s case marks the first time an abortion-related death, officially deemed “preventable,” is coming to public light. ProPublica will share the story of the second in the coming days. We are also exploring other deaths that have not yet been reviewed but appear to be connected to abortion bans.

Doctors warned state legislators women would die if medical procedures sometimes needed to save lives became illegal.

Though Republican lawmakers who voted for state bans on abortion say the laws have exceptions to protect the “life of the mother,” medical experts cautioned that the language is not rooted in science and ignores the fast-moving realities of medicine.

How Do Abortion Pills Work? Answers to Frequently Asked Questions.

The most restrictive state laws, experts predicted, would pit doctors’ fears of prosecution against their patients’ health needs, requiring providers to make sure their patient was inarguably on the brink of death or facing “irreversible” harm when they intervened with procedures like a D&C.

“They would feel the need to wait for a higher blood pressure, wait for a higher fever — really got to justify this one — bleed a little bit more,” Dr. Melissa Kottke, an OB-GYN at Emory, warned lawmakers in 2019 during one of the hearings over Georgia’s ban.

Doctors and a nurse involved in Thurman’s care declined to explain their thinking and did not respond to questions from ProPublica. Communications staff from the hospital did not respond to multiple requests for comment. Georgia’s Department of Public Health, which oversees the state maternal mortality review committee, said it cannot comment on ProPublica’s reporting because the committee’s cases are confidential and protected by federal law.

The availability of D&Cs for both abortions and routine miscarriage care helped save lives after the 1973 Supreme Court ruling in Roe v. Wade, studies show, reducing the rate of maternal deaths for women of color by up to 40% the first year after abortion became legal.

But since abortion was banned or restricted in 22 states over the past two years, women in serious danger have been turned away from emergency rooms and told that they needed to be in more peril before doctors could help. Some have been forced to continue high-risk pregnancies that threatened their lives. Those whose pregnancies weren’t even viable have been told they could return when they were “crashing.”

Such stories have been at the center of the upcoming presidential election, during which the right to abortion is on the ballot in 10 states.

But Republican legislators have rejected small efforts to expand and clarify health exceptions — even in Georgia, which has one of the nation’s highest rates of maternal mortality and where Black women are three times more likely to die from pregnancy-related complications than white women.

When its law went into effect in July 2022, Gov. Brian Kemp said he was “overjoyed” and believed the state had found an approach that would keep women “safe, healthy and informed.”

After advocates tried to block the ban in court, arguing the law put women in danger, attorneys for the state of Georgia accused them of “hyperbolic fear mongering.”

Two weeks later, Thurman was dead.

Thurman, who carried the full load of a single parent, loved being a mother. Every chance she got, she took her son to petting zoos, to pop-up museums and on planned trips, like one to a Florida beach. “The talks I have with my son are everything,” she posted on social media.

But when she learned she was pregnant with twins in the summer of 2022, she quickly decided she needed to preserve her newfound stability, her best friend, Ricaria Baker, told ProPublica. Thurman and her son had recently moved out of her family’s home and into a gated apartment complex with a pool, and she was planning to enroll in nursing school.

The timing could not have been worse. On July 20, the day Georgia’s law banning abortion at six weeks went into effect, her pregnancy had just passed that mark, according to records her family shared with ProPublica.

Thurman wanted a surgical abortion close to home and held out hope as advocates tried to get the ban paused in court, Baker said. But as her pregnancy progressed to its ninth week, she couldn’t wait any longer. She scheduled a D&C in North Carolina, where abortion at that stage was still legal, and on Aug. 13 woke up at 4 a.m. to make the journey with her best friend.

On their drive, they hit standstill traffic, Baker said. The clinic couldn’t hold Thurman’s spot longer than 15 minutes — it was inundated with women from other states where bans had taken effect. Instead, a clinic employee offered Thurman a two-pill abortion regimen approved by the U.S. Food and Drug Administration, mifepristone and misoprostol. Her pregnancy was well within the standard of care for that treatment.

Getting to the clinic had required scheduling a day off from work, finding a babysitter, making up an excuse to borrow a relative’s car and walking through a crowd of anti-abortion protesters. Thurman didn’t want to reschedule, Baker said.

At the clinic, Thurman sat through a counseling session in which she was told how to safely take the pills and instructed to go to the emergency room if complications developed. She signed a release saying she understood. She took the first pill there and insisted on driving home before any symptoms started, Baker said. She took the second pill the next day, as directed.

Deaths due to complications from abortion pills are extremely rare. Out of nearly 6 million women who’ve taken mifepristone in the U.S. since 2000, 32 deaths were reported to the FDA through 2022, regardless of whether the drug played a role. Of those, 11 patients developed sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.

Baker and Thurman spoke every day that week. At first, there was only cramping, which Thurman expected. But days after she took the second pill, the pain increased and blood was soaking through more than one pad per hour. If she had lived nearby, the clinic in North Carolina would have performed a D&C for free as soon as she followed up, the executive director told ProPublica. But Thurman was four hours away.

Thurman, left, and her best friend, Ricaria Baker, in 2020 Credit:Courtesy of Ricaria Baker
On the evening of Aug. 18, Thurman vomited blood and passed out at home, according to 911 call logs. Her boyfriend called for an ambulance. Thurman arrived at Piedmont Henry Hospital in Stockbridge at 6:51 p.m.

ProPublica obtained the summary narrative of Thurman’s hospital stay provided to the maternal mortality review committee, as well as the group’s findings. The narrative is based on Thurman’s medical records, with identifying information removed. The committee does not interview doctors involved with the case or ask hospitals to respond to its findings. ProPublica also consulted with medical experts, including members of the committee, about the timeline of events.

Within Thurman’s first hours at the hospital, which says it is staffed at all hours with an OB who specializes in hospital care, it should have been clear that she was in danger, medical experts told ProPublica.

Her lower abdomen was tender, according to the summary. Her white blood cell count was critically high and her blood pressure perilously low — at one point, as Thurman got up to go to the bathroom, she fainted again and hit her head. Doctors noted a foul odor during a pelvic exam, and an ultrasound showed possible tissue in her uterus.

The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.

After assessing her at 9:38 p.m., doctors started Thurman on antibiotics and an IV drip, the summary said. The OB-GYN noted the possibility of doing a D&C the next day.

But that didn’t happen the following morning, even when an OB diagnosed “acute severe sepsis.” By 5:14 a.m., Thurman was breathing rapidly and at risk of bleeding out, according to her vital signs. Even five liters of IV fluid had not moved her blood pressure out of the danger zone. Doctors escalated the antibiotics.

Instead of performing the newly criminalized procedure, they continued to gather information and dispense medicine, the summary shows.

Doctors had Thurman tested for sexually transmitted diseases and pneumonia.

They placed her on Levophed, a powerful blood pressure support that could do nothing to treat the infection and posed a new threat: The medication can constrict blood flow so much that patients could need an amputation once stabilized.

At 6:45 a.m., Thurman’s blood pressure continued to dip, and she was taken to the intensive care unit.

At 7:14 a.m., doctors discussed initiating a D&C. But it still didn’t happen. Two hours later, lab work indicated her organs were failing, according to experts who read her vital signs.

At 12:05 p.m., more than 17 hours after Thurman had arrived, a doctor who specializes in intensive care notified the OB-GYN that her condition was deteriorating.

Thurman was finally taken to an operating room at 2 p.m.

By then, the situation was so dire that doctors started with open abdominal surgery. They found that her bowel needed to be removed, but it was too risky to operate because not enough blood was flowing to the area — a possible complication from the blood pressure medication, an expert explained to ProPublica. The OB performed the D&C but immediately continued with a hysterectomy.

During surgery, Thurman’s heart stopped.

Her mother was praying in the waiting room when one of the doctors approached. “Come walk with me,” she said.

Until she got the call from the hospital, her mother had no idea Thurman had been pregnant. She recalled her daughter’s last words before she was wheeled into surgery — they had made no sense coming from a vibrant young woman who seemed to have her whole life ahead of her:

“Promise me you’ll take care of my son.”

There is a “good chance” providing a D&C earlier could have prevented Amber Thurman’s death, the maternal mortality review committee concluded.

Every state has a committee of experts who meet regularly to examine deaths that occurred during or within a year after a pregnancy. Their goal is to collect accurate data and identify the root causes of America’s increasing maternal mortality rate, then translate those lessons into policy changes. Their findings and recommendations are sent to the Centers for Disease Control and Prevention, and their states publish an annual report, but their reviews of individual cases are never public.

Georgia’s committee has 32 regular members from a variety of backgrounds, including OB-GYNs, cardiologists, mental health care providers, a medical examiner, health policy experts, community advocates and others. This summer, the committee reviewed deaths through Fall 2022, but most states have not gotten that far.

After reviewing Thurman’s case, the committee highlighted Piedmont’s “lack of policies/procedures in place to evacuate uterus immediately” and recommended all hospitals implement policies “to treat a septic abortion on an ongoing basis.”

It is not clear from the records available why doctors waited to provide a D&C to Thurman, though the summary report shows they discussed the procedure at least twice in the hours before they finally did.

Piedmont did not have a policy to guide doctors on how to interpret the state abortion ban when Thurman arrived for care, according to two people with knowledge of internal conversations who were not authorized to speak publicly. In the months after she died, an internal task force of providers there created policies to educate staff on how to navigate the law, though they are not able to give legal advice, the sources said.

In interviews with more than three dozen OB-GYNs in states that outlawed abortion, ProPublica learned how difficult it is to interpret the vague and conflicting language in bans’ medical exceptions — especially, the doctors said, when their judgment could be called into question under the threat of prison time.

Take the language in Georgia’s supposed lifesaving exceptions.

It prohibits doctors from using any instrument “with the purpose of terminating a pregnancy.” While removing fetal tissue is not terminating a pregnancy, medically speaking, the law only specifies it’s not considered an abortion to remove “a dead unborn child” that resulted from a “spontaneous abortion” defined as “naturally occurring” from a miscarriage or a stillbirth.

Thurman had told doctors her miscarriage was not spontaneous — it was the result of taking pills to terminate her pregnancy.

There is also an exception, included in most bans, to allow abortions “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” There is no standard protocol for how providers should interpret such language, doctors said. How can they be sure a jury with no medical experience would agree that intervening was “necessary”?

ProPublica asked the governor’s office on Friday to respond to cases of denied care, including the two abortion-related deaths, and whether its exceptions were adequate. Spokesperson Garrison Douglas said they were clear and gave doctors the power to act in medical emergencies. He returned to the state’s previous argument, describing ProPublica’s reporting as a “fear-mongering campaign.”

Republican officials across the country have largely rejected calls to provide guidance.

When legislators have tried, anti-abortion groups have blocked them.

In 2023, a group of Tennessee Republicans was unable to push through a small change to the state’s abortion ban, intended to give doctors greater leeway when intervening for patients facing health complications.

“No one wants to tell their spouse, child or loved one that their life is not important in a medical emergency as you watch them die when they could have been saved,” said Republican Rep. Esther Helton-Haynes, a nurse who sponsored the bill.

The state’s main anti-abortion lobbyist, Will Brewer, vigorously opposed the change. Some pregnancy complications “work themselves out,” he told a panel of lawmakers. Doctors should be required to “pause and wait this out and see how it goes.”

At some hospitals, doctors are doing just that. Doctors told ProPublica they have seen colleagues disregard the standard of care when their patients are at risk of infection and wait to see if a miscarriage completes naturally before offering a D&C.

Although no doctor has been prosecuted for violating abortion bans, the possibility looms over every case, they said, particularly outside of well-funded academic institutions that have lawyers promising criminal defense.

Doctors in public hospitals and those outside of major metro areas told ProPublica that they are often left scrambling to figure out on a case-by-case basis when they are allowed to provide D&Cs and other abortion procedures. Many fear they are taking on all of the risk alone and would not be backed up by their hospitals if a prosecutor charged them with a crime. At Catholic hospitals, they typically have to transfer patients elsewhere for care.

When they do try to provide care, it can be a challenge to find other medical staff to participate. A D&C requires an anesthesiologist, nurses, attending physicians and others. Doctors said peers have refused to participate because of their personal views or their fear of being exposed to criminal charges. Georgia law allows medical staff to refuse to participate in abortions.

Thurman’s family members may never learn the exact variables that went into doctors’ calculations. The hospital has not fulfilled their request for her full medical record. There was no autopsy.

For years, all Thurman’s family had was a death certificate that said she died of “septic shock” and “retained products of conception” — a rare description that had previously only appeared once in Georgia death records over the last 15 years, ProPublica found. The family learned Thurman’s case had been reviewed and deemed preventable from ProPublica’s reporting.

The sting of Thurman’s death remains extremely raw to her loved ones, who feel her absence most deeply as they watch her son grow taller and lose teeth and start school years without her.

They focus on surrounding him with love but know nothing can replace his mother.

On Monday, she would have turned 31.