Big Sky

Fun Fact Friday for the Ladies:

In Montana, it is illegal for married women to go fishing alone on Sundays, and illegal for unmarried women to fish alone at all.

Montana 'Abortion Trafficking' Bill Could Criminalize Crossing State Lines for an Abortion

Transporting "an unborn child" from Montana to another state "with the intent to obtain an abortion that is illegal" in Montana, or assisting anyone in doing so, would be illegal under House Bill 609.

A new Montana bill "establishing the criminal offense of abortion trafficking" could criminalize pregnant women who cross state lines to get an abortion. Under House Bill 609, from state Rep. Kerri Seekins-Crowe (R–Billings), anyone convicted of "abortion trafficking" would face up to five years in prison, a fine of up to $1,000, or both.

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The bill defines abortion trafficking as purposely or knowingly transporting "an unborn child that is currently located in this state either to a location within this state or to a location outside of this state with the intent to obtain an abortion that is illegal in this state."

Aiding or assisting someone else in such transportation would also make one guilty of abortion trafficking.

Criminalizing driving someone else out of Montana to do something that's legal in another state is itself ridiculous. But the language of this bill would very clearly criminalize some pregnant women who transport themselves out of state too.

But Wait… Isn't Abortion Legal in Montana?

 
Per a constitutional amendment voters passed in 2024, Montana allows abortion up until fetal viability and provides an exception to this limit if the mother's life or health is at risk. This fact may give pause to people who think that's an acceptable limit—after all, it's only criminalizing folks who are getting the bad kind of abortions, right?

Look, I don't love the idea of late-term abortions either. But let's step back here for a moment.

First, there are what many would consider justifiable reasons for getting an abortion after about 24 weeks, including fatal fetal conditions that aren't discovered until later in a pregnancy. "Had a bill like this been law at the time, I wouldn't just be a grieving mother, I'd be a felon," Anne Angus told Jessica Valenti of Abortion, Every Day:

The 35-year-old left Montana for an abortion in 2022, after her fetus was diagnosed with a fatal condition. She was 24 weeks pregnant—which was past the legal abortion window at the time. Under HB 609, she could have faced years in prison. "All for fleeing the state to give my son the compassion and dignity he deserved," she says.

What's more, you needn't cheer on unconstitutional, travel-limiting measures like this just because they might stop a few abortions that don't meet your moral standards. There are other solutions—like pushing for changes to laws in states with no limits—that could address abortion-after-viability concerns without implicating other rights.

It's also possible that Montana voters will someday topple the recent constitutional amendment and the state will ban abortion much earlier in pregnancy or ban it entirely. In that case, a woman leaving the state for a first-trimester abortion could still be found guilty of abortion trafficking.

Perhaps most importantly, we should keep in mind that this is unlikely to stop with Montana. In fact, it's possible that Montana is seen by some as the perfect test ground for this sort of thing precisely because it currently allows abortions until viability.

"By starting in a state where abortion is legal until 'viability,' it gives Republicans a certain amount of PR cover. They can pretend this isn't about restricting women's right to travel—just about stopping 'late' abortion," suggests Valenti. "It's no accident that HB 609 targets later abortion patients… just like it's no coincidence that earlier 'trafficking' laws focused on teens."

That's just speculation, of course. But it wouldn't surprise me if backers of abortion trafficking laws like Montana's H.B. 609 may be counting on people to let this one slide, since it would only implicate post-viability abortions (for now). Meanwhile, they get to test out messaging and legal arguments before moving on to a state where abortion is banned earlier or entirely.

The Politics of 'Trafficking'

 
For now, H.B. 609 has been referred to the Montana House Judiciary Committee and had an initial hearing this morning.

Whatever happens with this bill, it surely won't be the last we'll hear about abortion trafficking, a term Republicans have begun to use and favor more frequently in recent years.

It's a handy framing trick. Calling something "abortion trafficking" sounds a lot more nefarious than "driving out of state for an abortion." The latter implicates Americans' right to freedom of movement and might give some moderate people pause. But trafficking means to deal or trade in something illegal and is used in other criminal statutes (drug trafficking, sex trafficking, labor trafficking). For those not paying close attention, abortion trafficking may seem to mean something worse than it does. And even for those who know the definition, it may unconsciously prime expectations of shiftiness and criminality, even when it's being used to refer to someone who leaves the state to get a legal abortion somewhere else.

This is a well-worn strategy. As Mistress Matisse pointed out on X, "They tested 'self-trafficking' charges on sex workers first." Sex workers have sometimes been charged with "sex trafficking" themselves. In addition, sex work customers or prospective customers are sometimes described as sex traffickers and charged with sex trafficking. Because sex trafficking can also refer to terrible crimes, like forcing someone else to sell sex, the term is a muddled mess that allows authorities to invoke evil criminals and heroic rescues when what they're doing is arresting people for trying to have consensual sex.

Some Republicans seem intent on pulling a similar trick with abortion trafficking.

The term is being defined differently in the various states that have considered abortion trafficking legislation. In Idaho and Tennessee, abortion trafficking laws ban helping a minor get an out-of-state abortion.

Regardless of precise definition, invoking trafficking suggests some sort of coercion—a girl or woman being ferried across state lines for an abortion against her will—or the involvement of a black-market abortionist, when the reality is usually people taking advantage of freedom of movement and federalism in order to have abortions.

Heckler's Veto

When the minority's objection to the actions of the majority results in the restriction of the majority's rights (and rightful actions), you have a form of The Heckler's Veto.

The rights of the minority should be protected - that's one of the foundational principles of American democracy - but that's being turned on its head by anti-choicers, and my case-in-point is the fucked-up Handmaid's Tale bullshit playing out in Texas.

And it goes far beyond this one case where this one woman (the minority) has to fight for her right to self-determination because the full weight of Texas law (the majority) is being brought to bear.

And not just that. By pursuing legal action, the state of Texas is attempting to impose its abortion ban on the people of Colorado.

Texas man files legal action to probe ex-partner’s out-of-state abortion

The previously unreported petition reflects a potential new antiabortion strategy to block women from ending their pregnancies in states where abortion is legal.

As soon as Collin Davis found out his ex-partner was planning to travel to Colorado to have an abortion in late February, the Texas man retained a high-powered antiabortion attorney — who court records show immediately issued a legal threat.

If the woman proceeded with the abortion, even in a state where the procedure remains legal, Davis would seek a full investigation into the circumstances surrounding the abortion and “pursue wrongful-death claims against anyone involved in the killing of his unborn child,” the lawyer wrote in a letter, according to records.

Now, Davis has disclosed his former partner’s abortion to a state district court in Texas, asking for the power to investigate what his lawyer characterizes as potentially illegal activity in a state where almost all abortions are banned.

The previously unreported petition was submitted under an unusual legal mechanism often used in Texas to investigate suspected illegal actions before a lawsuit is filed. The petition claims Davis could sue either under the state’s wrongful-death statute or the novel Texas law known as Senate Bill 8 that allows private citizens to file suit against anyone who “aids or abets” an illegal abortion.

The decision to target an abortion that occurred outside of Texas represents a potential new strategy by antiabortion activists to achieve a goal many in the movement have been working toward since Roe v. Wade was overturned: stopping women from traveling out of state to end their pregnancies. Crossing state lines for abortion care remains legal nationwide.

The case also illustrates the role that men who disapprove of their partners’ decisions could play in surfacing future cases that may violate abortion bans — either by filing their own civil lawsuits or by reporting the abortions to law enforcement.

Under Texas law, performing an abortion is a crime punishable by up to life in prison and up to $100,000 in civil penalties. Women seeking abortions cannot be charged under the state’s abortion restrictions, but the laws target anyone who performs or helps to facilitate an illegal abortion, including those who help distribute abortion pills.

Davis’s petition — filed under Texas’s Rule 202 by Jonathan Mitchell, a prominent antiabortion attorney known for devising new and aggressive legal strategies to crack down on abortion — follows a lawsuit filed last spring by another Texas man, Marcus Silva, who is attempting to sue three women who allegedly helped his ex-wife obtain abortion pills.

“Mr. Davis is considering whether to sue individuals and organizations that participated in the murder of his unborn child,” Mitchell, widely known as the architect of Senate Bill 8, wrote in Davis’s complaint in March.

Davis’s petition includes no evidence of illegal activity. Davis’s former partner ultimately obtained her abortion in Colorado, Davis claims in the court documents. Mitchell suggests in the petition that people who helped her procure the abortion could be found liable.

Antiabortion advocates have tried various tactics to dissuade women from traveling out of state for abortions. Idaho has passed a law making it illegal for someone to help a minor leave the state for an abortion without parental consent — which is currently blocked by the courts — and Tennessee is pursuing similar restrictions. Several Texas cities and counties have passed local ordinances attempting to stop women seeking abortions from using key portions of high-traffic highways.

Mitchell said in a statement that abortions that occur outside Texas can be targets for civil litigation.

“Fathers of aborted fetuses can sue for wrongful death in states with abortion bans, even if the abortion occurs out-of-state,” he wrote. “They can sue anyone who paid for the abortion, anyone who aided or abetted the travel, and anyone involved in the manufacture or distribution of abortion drugs.”

Molly Duane, a senior staff attorney with the Center for Reproductive Rights, described Mitchell’s statement and general approach as misleading “fearmongering.”

“People need to understand that it is not a crime to leave Texas or any other state in the country for an abortion,” said Duane, who is working with lawyers from the firm Arnold & Porter to represent the woman and others targeted in the Davis case. “I don’t want people to be intimidated, but they should be outraged and alarmed.”

Duane described the woman’s relationship with Davis as “toxic and harmful.”

Davis — who claims in the petition to have helped conceive what he calls his “unborn child” — did not respond to requests for comment. Mitchell declined to comment on Duane’s description of the relationship.

Abortion rights advocates say these types of legal actions amount to “vigilante justice” designed to intimidate people who have done nothing wrong. Duane and other lawyers representing the woman asked the court to redact the names of those involved from the public court filings, out of a concern for their privacy and safety.

The judge agreed to seal the original petition with the identifying information.

“The document at issue contains confidential and sensitive information including the Respondents’ full names ... and sensitive allegations about health care that the Respondents have a substantial interest in keeping confidential,” the judge wrote in an order signed Wednesday.

Over the past two years, many antiabortion activists have grown frustrated by what they see as a lack of enforcement of abortion bans — particularly as abortion pills become more widely available in antiabortion states because of growing online and community-based pill networks.

Some antiabortion advocates are searching for a way to crack down.

“You have laws being ignored systematically — so what are we going to do about it?” said John Seago, president of Texas Right to Life, the state’s largest antiabortion group. The pill networks, he added, “can and should be prosecuted.”

Several district attorneys in conservative areas told The Washington Post that abortion laws are difficult to enforce in practice, largely because they have no clear way to find out about these cases.

“First you would have to have some sort of complaining party … then law enforcement would have to do a full investigation,” said Kent Volkmer, county attorney for Pinal County in Arizona, where the Republican-led legislature has voted to repeal an 1864 abortion law. “I think it’s extremely unlikely that an abortion-related criminal charge would ever be submitted to our office.”

If one of these cases did surface, Volkmer said, it would probably be reported by an employee of a doctor’s office who was aware of the abortion — or by the “purported father.”

Volkmer added that, because of his office’s policy to only prosecute cases with a reasonable likelihood of conviction, he would only anticipate prosecuting what he characterized as an “extreme” situation, such as an abortion that occurred late in the third trimester.

In the Davis case, Mitchell is attempting to depose the woman who had the abortion, along with several other people he writes may be “complicit” in the abortion. If deposed, they would be asked about others involved in the abortion, including any abortion funds or any other entities that provided financial support, according to court records. They would also have to provide all documentation relevant to the abortion.

“Mr. Davis expects to be able to better evaluate the prospects for legal success after deposing [the people listed], and discovering the identity of their co-conspirators and accomplices,” Mitchell wrote in the complaint, which he filed on March 22.

Davis is awaiting a decision from the state district court.

While the vast majority of Texas abortion funds stopped providing funding for out-of-state abortions after Roe was overturned — concerned for their legal risk amid vague laws they worried might allow prosecutors to target them — many resumed operations in the spring of 2023, reassured by a court ruling that has temporarily blocked some prosecutors from going after people who help Texans obtain abortions across state lines.

“I want people to know we don’t think there’s anything illegal about helping someone leave the state for an abortion,” said Duane, with the Center for Reproductive Rights. “These are Jonathan Mitchell … tactics to discourage people.”

How To Pregnant

One truly shitty part of this GOP-led madness to criminalize the right to abortion care is the fact that good journalism is required to publish guides to help women be clinically safe during pregnancy, and how to keep from getting tangled up in the bullshit legal hassles that fuckwad Republicans have set up for them.

If You’re Pregnant, Here’s What You Should Know About the Medical Procedures That Could Save Your Life

Women experiencing pregnancy loss in states with abortion bans told us they wished they had known what to expect and how to advocate for themselves. We created this guide for anyone who finds themselves in the same position.

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We heard the same story again and again this year:

The women were having miscarriages. They were bleeding and in pain.

They needed a medical procedure to clear their uterus, but their doctors delayed it or didn’t even counsel them about it. Our yearlong investigation found that abortion laws are affecting how physicians treat pregnancy loss and other complications because the procedures used in these cases are also used for abortions.

We spoke to women who survived terrifying experiences, and we interviewed family members of those who died without care. They all felt unprepared as they entered emergency rooms, unaware of how abortion laws were reaching into pregnancy care.

They wished they had known what to expect and how to advocate for themselves and their loved ones.

We created this guide for them and anyone who finds themselves in the same position.

We wrote it in consultation with dozens of doctors, including those who hold positions at leading medical organizations and those who regularly treat patients who are miscarrying.

This guide does not provide medical or legal advice. We encourage you to seek out other reliable resources and consult with experts you trust.

In this article:

• What Is a Miscarriage?
• What Are the Treatment Options?
• What Is a D&C?
• What Is a D&E?
• How Have D&Cs and D&Es Been Affected by Abortion Bans?
• How to Find Doctors Who Will Offer All Options
• How to Prepare for Emergencies
• How to Choose a Hospital
• What to Do if You’re Experiencing Signs of a Miscarriage
• What to Do if You Aren’t Getting Care You Need

What Is a Miscarriage?

When a pregnancy has stopped developing before 20 weeks, that is considered a miscarriage.
This is common — it happens in up to 1 out of every 4 known pregnancies. The medical term for miscarriage is “spontaneous abortion.”

During a pregnancy loss, someone might experience symptoms like bleeding and cramping and pass pregnancy tissue. Or an ultrasound might show that there’s no fetal cardiac activity even if the patient had no miscarriage symptoms.

While most miscarriages resolve on their own, some lead to dangerous complications, including hemorrhage and infection.

Eight in 10 miscarriages occur in the first trimester. A pregnancy that ends after 20 weeks is considered a stillbirth, but sometimes it is still referred to as a miscarriage.

Other rare complications, like premature rupture of membranes (when the water breaks too early) or preeclampsia (life-threatening high blood pressure), can develop in the second trimester of pregnancy and endanger both the pregnant patient and the fetus. Choosing not to intervene may mean there is some chance the fetus could survive, but it also may put the patient at risk of developing life-threatening complications.

Each situation is unique. In these circumstances, doctors should talk to patients about the risks and benefits of continuing the pregnancy and the option of ending it to protect their health, experts said. Sometimes these cases are referred to as a miscarriage.

What Are the Treatment Options?

When a patient is having a miscarriage or is at high risk for one, they should be offered three choices, according to major medical organizations like the American College of Obstetricians and Gynecologists:

1. Expectant management: Waiting to see if the body will pass the pregnancy on its own.
2. Medication: Taking medicine to help the body clear the tissue. This can include misoprostol or mifepristone with misoprostol, which causes the uterus to contract and can speed up the process
3. Procedure: Getting a dilation and curettage (D&C) in the first trimester or a dilation and evacuation (D&E) in the second trimester to empty the uterus.

All of these can be safe choices for an uncomplicated miscarriage, and a first trimester-miscarriage is rarely an emergency. The standard of care is for doctors to explain all options along with their risks and benefits, and then let their patients choose what they prefer. All major medical societies say that patients should be given that choice.

If a patient is bleeding heavily or showing signs of infection, doctors should recommend a procedure (D&C or D&E) to protect their health, medical experts say.

What Is a D&C?

A D&C is a procedure to empty the uterus and is one of several safe ways to navigate pregnancy loss.

The term D&C stands for dilation and curettage and the procedure is often called “surgical” — but that’s a bit of a misnomer. It is more accurately called “uterine aspiration.” Doctors don’t need to make incisions or use sharp tools. They insert a straw-like tube into the uterus and use suction to gently draw out pregnancy tissue. The patient can be awake, sedated or asleep. It only takes a few minutes and typically ends the bleeding quickly.

When this suction procedure was popularized in the 1970s, after abortion became legal nationwide, “it was a real awakening” in maternal health care, said Dr. Philip Darney, a reproductive health care expert at the University of California, San Francisco. It made emptying the uterus faster, safer and more accessible, he said, saving countless lives.

Today, the simple procedure is usually used for pregnancies up to 12 weeks. Some prefer it as a quick and thorough way to complete a miscarriage and minimize ongoing pain and bleeding, as well as infection risks. For patients with heavy bleeding or infections in the first trimester, a D&C could be lifesaving, doctors told us.

What Is a D&E?

A D&E, or dilation and evacuation, is a procedure used in the second trimester to empty the uterus. The doctor uses suction and tools like forceps. The patient is sedated or asleep in an operating room. It takes less time than an induction, allows the patient to avoid a labor experience and generally is associated with less blood loss and infection risk than other options. For patients with heavy bleeding or infections in the second trimester, a D&E could be lifesaving, doctors told us.

How Have D&Cs and D&Es Been Affected by Abortion Bans?

The same procedures are used for both abortions and miscarriages; whether they’re used to remove pregnancy tissue because of a complication or because the patient has decided to end the pregnancy for another reason, there’s no difference in how the procedures are carried out, and most state abortion bans aren’t clear about when physicians are legally allowed to perform them. The American College of Obstetricians and Gynecologists, the leading organization representing OB-GYNs, calls the language these laws use to describe exceptions “unclear” and “inherently vague.”

This can create confusion and fear around the procedures. For example, a patient can be in the process of miscarrying, but there might still be fetal cardiac activity. Some doctors consider intervening to be a risk because managing the miscarriage in that situation could be defined as an abortion.

The laws attach criminal penalties to a violation — in Texas, for example, doctors can face up to 99 years in prison for performing an abortion. State laws usually include exceptions for “medical emergencies.” (Patients can check their state law and discuss it with their doctors.)

Many physicians have told us, however, that the exceptions do not account for how quickly emergencies can develop or how medical decisions are made. While many miscarriages resolve on their own, infections and other complications like heavy bleeding can rapidly become life-threatening, leaving doctors little time to intervene.

While some OB-GYNs who work in abortion-ban states interpret these laws as allowing them to offer all options for a miscarriage, sticking to longstanding medical best practices, our reporting has found that confusion around the grey areas in the laws and the need for extra documentation have caused some doctors to change their approach to counseling and treating miscarriages, even in cases where there is no fetal cardiac activity.

We have found that sometimes doctors didn’t talk about any procedures or medication management options with patients and only told them about the “watch and wait” approach. We’ve heard from doctors who say that it can be difficult to get these procedures approved by their hospitals and that sometimes other medical staff such as OB-GYNs, anesthesiologists or nurses don’t feel comfortable participating. In still other cases, we have reported on doctors delaying care while they take extra steps to document that there is no fetal heartbeat.

At least five women — Amber Thurman, Candi Miller, Josseli Barnica, Nevaeh Crain and Porsha Ngumezi — died after they didn’t receive these procedures in time, we found.

How to Find Doctors Who Will Offer All Options

Talk to people and organizations you trust for recommendations. This can include local doulas, midwives, nurses who work on labor and delivery wards, and reproductive health organizations.

Medical experts suggested asking physicians direct questions like: I’ve seen stories about patients who were unable to get care for miscarriage or pregnancy complications because of state abortion laws. Can you explain to me how the law in our state could affect my care?

They suggested following up with questions like:

• Considering the law in our state, are there options you would not be able to offer?
• If I were having a miscarriage, would you do a D&C if I wanted one?
• Would you do a D&C if I needed one for medical safety?
• If I were having a miscarriage in the second trimester, would you perform a D&E?
• Are you allowed to tell me my options or give me information in the event of a miscarriage?
• If you can’t provide these services, where should I go?

How to Prepare for Emergencies

Experts told us patients can talk to their doctors early about what to do if something goes wrong.

Here are some questions they recommend asking:

• If I think I’m miscarrying, can I receive care at your office, or do I need to go to the ER?
• Do you do D&Cs and D&Es? How often and where?
• If my water breaks in the second trimester, do you offer the option of abortion care or do you wait until there are signs of infection?
• Which hospital do you recommend if I need emergency care?

How to Choose a Hospital

• Here are some things doctors and patients told us you can do:
• Ask to see the hospital’s miscarriage management guidelines.
• Ask whether doctors are expected to counsel patients on all three treatment options and provide whichever the patient chooses.
• Ask if the hospital has any physicians who have expertise in D&Es. One sign that a doctor may be well-qualified to perform this procedure is if they have done a Complex Family Planning fellowship.
• Check what organizations a hospital is affiliated with. Hospitals with religious affiliations sometimes don’t perform procedures to empty the uterus. Hospitals affiliated with universities tend to provide more comprehensive care and are more likely to have doctors with extra training in D&Es.
• Don’t delay seeking emergency care, even if it’s difficult to find an ideal hospital.

What to Do if You’re Experiencing Signs of a Miscarriage

Cramping and bleeding can be signs of miscarriage, but not always. Call your doctor or midwife to discuss symptoms first.

• You may be advised to wait and monitor your symptoms. Most miscarriages resolve without intervention within two weeks.
• If a doctor says to go to a hospital or a clinic, experts suggest asking for:
• An ultrasound to guide your care
• An OB-GYN to be involved in your care
• Information about all three treatment options
• The treatment option you prefer to get
• Be on the lookout for symptoms like high pulse and feeling faint, which could mean you have a serious complication. Bleeding heavily, such as soaking a pad in 30 minutes or less, is a reason to ask doctors if it’s necessary to empty the uterus, experts told us.

What to Do if You Aren’t Getting Care You Need

Medical experts recommend the following:

• Documenting the care.
• Asking directly for the desired treatment.
• Asking why care is being denied.
• Asking to see another doctor if the one assigned to the case is not providing the desired care.
• Requesting a transfer to another hospital if the one you’re at will not provide the care. Patients can cite EMTALA, the Emergency Medical Treatment and Labor Act, and remind physicians that federal law requires hospitals to stabilize anyone experiencing an emergency. If they can’t, they must transfer the patient to another hospital that will.
• Showing doctors evidence-based standards of care from professional medical organizations to explain that you should be offered these options. Here are guidelines from the American College of Obstetricians and Gynecologists.
• Asking to speak with patient advocates, who work at hospitals to help patients understand their rights and answer questions about their care. Or asking to speak to the hospital’s legal team. Hospitals have processes for escalating concerns.
• Asking for an ethics consult if you still aren’t getting straight answers or are being denied a procedure. Another option is an interdisciplinary meeting with your doctors and nurses, nursing leaders and hospital administrators.
• Reminding doctors that you are being denied the standard of care, which could mean the providers are committing malpractice.
• Filing complaints with the state survey agency, if you think EMTALA was violated, and with the state medical board.
• Calling your state representatives or contacting legal advocacy groups that can advocate for patients’ rights, including the Repro Legal Helpline at If/When/How (844-868-2812), the Center for Reproductive Rights (917-637-3600), the American Civil Liberties Union or the National Women’s Law Center.
• You can also reach out to journalists at ProPublica at reproductivehealth@propublica.org. We are continuing to investigate cases of denied care.

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.”