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Two Texans ask HHS to investigate hospitals for EMTALA violations over denied abortions

The women each lost a fallopian tube because of delayed treatment for ectopic pregnancies.

Two Texans are asking the federal government to intervene after they were allegedly denied abortions for ectopic pregnancies, leading to each woman losing a fallopian tube, according to complaints filed with the U.S. Department of Health and Human Services last week.

The women — Kelsie Norris-De La Cruz, who was seen at Texas Health Arlington Memorial Hospital in Arlington, and Kyleigh Thurman, who was seen at Ascension Seton Williamson Hospital in Round Rock — say the hospitals violated the Emergency Medical Treatment and Active Labor Act, which requires Medicare-participating hospitals to stabilize or transfer patients in emergency medical situations, regardless of their ability to pay.

“Despite the fact that my life was clearly in danger, the hospital told me that they could not help me. I ended up losing half of my fertility, and if I was made to wait any longer, it’s very likely I would have died,” Norris-De La Cruz said in a statement. “The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency health care.”

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A spokesperson for Ascension said in a statement that, while they cannot comment on the specifics of the case, “Ascension is committed to providing high-quality care to all who seek our services.”

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

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Texas abortion law explicitly allows abortion in cases of ectopic pregnancy, which occur outside of the uterus and are never viable. In its filings on behalf of Norris-De La Cruz and Thurman, the Center for Reproductive Rights argues fear of penalties for violating the abortion ban — loss of medical licenses, $100,000 fines and even jail time — have interfered with doctors’ willingness to provide necessary abortion care.

EMTALA and its intersection with abortion laws has been the subject of two major federal cases, including one in Texas where the state has argued the federal government is using the legislation to force doctors to provide abortions. A federal district court blocked HHS from enforcing EMTALA when it contradicts Texas abortion law, an order that the 5th Circuit Court of Appeals upheld in January.

The Supreme Court took up the other case, between the Biden administration and Idaho, in its latest term, deciding to reinstate a district court’s order to block Idaho’s ban when it goes against EMTALA. The court punted the case back to lower courts, however, and made no decisions on the lawsuit’s central questions.

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Norris-De La Cruz and Thurman are the latest Texans to raise alarm about abortion access. Twenty-two women, including two doctors, sued the state last year over abortions they alleged were delayed or denied because of vague wording in the laws’ medical exemption clauses. Separately, Kate Cox, a mother from Dallas, was denied permission by the Texas Supreme Court to terminate her pregnancy with a fatal fetal anomaly. Each case was filed by the Center for Reproductive Rights.

“What we’re hoping this complaint will do is send a message to hospitals that, while we understand the fear and the uncertainty around the abortion bans, it can’t justify turning patients away when they have an emergency medical condition,” Center for Reproductive Rights senior counsel Marc Hearron said. “Federal law requires it.”

The case against Texas Health Arlington

Kelsie Norris-De La Cruz, 25, knew that she was miscarrying for the third time. She went to the doctor, who told her the pregnancy would likely pass on its own and warned her of symptoms of ectopic pregnancy she needed to look out for.

On Feb. 12, nearly a month after learning her pregnancy would end in miscarriage, she visited her college’s health center for severe pain on her right side and vaginal bleeding. They instructed her to go to the emergency room immediately.

Norris-De La Cruz met her mother at Texas Health Arlington, where doctors ordered blood tests and an ultrasound that showed a mass outside of the uterus so large she could see it on the screen. It was likely an ectopic pregnancy, and the hospital emergency room physician counseled her on treatment options. She elected surgery to remove the pregnancy and waited for the on-call OB/GYN.

Over several hours, two OB/GYNs examined Norris-De La Cruz and instructed her to go home and come back in two days for additional bloodwork, despite the possibility that her pregnancy could rupture during that time, according to the legal filings. The emergency room doctor noted in the woman’s file that, “I do not feel comfortable discharging her home and do not think that it is in her best interest.”

Norris-De La Cruz’s mother called around to abortion clinics in other cities and even out of state searching for someone who would provide the abortion, but had no luck. Norris-De La Cruz was able to connect with a local OB/GYN who happened to be seeing her friend that day, and on Feb. 13 the doctor performed surgery to remove the ectopic pregnancy.

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She lost most of her right fallopian tube and about 75% of her right ovary, which will probably impact her future fertility.

“I’m filing this complaint because women like me deserve justice and accountability from those that hurt us,” Norris-De La Cruz said in a statement. “Texas state officials can’t keep ignoring us. We can’t let them.”

The filing alleges Texas Health Arlington violated the law when it discharged Norris-De La Cruz without providing her stabilizing care. Because terminating an ectopic pregnancy is legal under Texas law, the decision does not fall into the gray space of conflicting language in Texas’ abortion bans and EMTALA, the complaint argues.

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Hospitals and physicians found to have violated EMTALA can be assessed civil penalties and be blocked from participating in Medicare programs.

The case against Ascension Seton Williamson

After several days of visits to the local emergency room for a pregnancy that was likely ectopic, Kyleigh Thurman, who lives in Burnet County, drove an hour to Ascension Seton Williamson Hospital on Feb. 21. The bigger facility stocked methotrexate, a medication that can be injected to terminate ectopic pregnancies.

Thurman’s ultrasound showed no pregnancy in her uterus but did show a two-centimeter “rounded structure” on her right fallopian tube. The hospital denied her the medication and sent her home with instructions to return in two days, according to the filings.

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On Feb. 24, Thurman again drove to Ascension Seton Williamson and again was denied the treatment. Thurman’s hometown OB/GYN met her at the hospital and begged the staff to give her the methotrexate, which they eventually did.

The injection was too late, according to the complaint, and several days later she was again brought to Ascension Seton Williamson where she was told she was bleeding out. She had emergency surgery, and her right fallopian tube was removed.

“This should have been an open and shut case,” Thurman said in a statement. “Yet, I was left completely in the dark without any information or options for the care that I deserved.”

Similar to Norris-De La Cruz’s petition, Thurman’s filing alleges Ascension Seton Williamson violated EMTALA by discharging her without providing her stabilizing care, knowing that failing to treat the ectopic pregnancy could be a serious risk to her health.

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Neither woman has filed a lawsuit against the providers.

“Pregnancy is not straightforward, and I now have to live with the consequences of these extreme laws every day,” Thurman said. “None of this should have happened to me, and I want to make sure this doesn’t happen to anyone else.”

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