Texas women denied care for ectopic pregnancies proves exceptions are a "farce", experts say

Several days after Kelsie Norris-De La Cruz found out she was pregnant in Texas, she started to experience bleeding and cramping. When she went to the emergency room, she was told that she was likely having a miscarriage and to seek medical care if the symptoms continued.

Over the next several weeks, her symptoms worsened. She went to the emergency room at Texas Health Arlington Memorial Hospital, where staff noted she was showing signs of an ectopic pregnancy, which is when a fertilized egg implants and grows outside of the uterus in the abdomen, a female's cervix or more commonly, the fallopian tubes. An ectopic pregnancy is a life-threatening condition; there is no way that an ectopic pregnancy can become a full-term pregnancy.

But when Norris-De La Cruz spoke to the hospital’s on-call OB-GYN, the doctor said once again she was experiencing a miscarriage. After being denied care, and being told hospitals around the state were delaying treatment for ectopic pregnancies, Norris-De La Cruz explained her situation to a friend who was an OB-GYN. She showed the doctor a photo of her sonogram. Immediately, the OB-GYN friend brought her in for emergency surgery. However, it required the removal of most of her right fallopian tube.

“Despite the fact that my life was clearly in danger, the hospital told me that they could not help me,” Norris-De La Cruz said in a media statement. “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.”

This week, the Center for Reproductive Rights filed two complaints against two Texas hospitals — Texas Health Arlington Memorial Hospital and Ascension Seton Williamson Hospital — alleging that the two hospitals violated the Emergency Medical Treatment and Labor Act (EMTALA) and refused to provide “stabilizing treatment,” including emergency abortion care for ectopic pregnancies.

Similar to Norris-De La Cruz’s story, a Texas woman named Kyleigh Thurman was turned away from an emergency room while experiencing cramping and dizziness. Several days later, she experienced severe pain on her right side, bleeding, and almost passed out. She was eventually rushed into surgery and also had to have her right fallopian tube removed. Her story is told in the second complaint filed by the Center for Reproductive Rights.

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

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In 2022, Texas enacted laws that prohibit all abortions except when the life or health of the pregnant patient is at risk, including an exception to terminate ectopic pregnancies, which are always nonviable and life-threatening. Still, these complaints show that some doctors in Texas are fearful of terminating ectopic pregnancies. If physicians violate the law in Texas, they face up to 99 years in prison, loss of their medical license, and at least $100,000 in fines.

“This is the first time that patients with ectopic pregnancies who were denied timely care have submitted EMTALA complaints since Roe was overturned,” Molly Duane, a senior attorney at the Center for Reproductive Rights, told Salon. “And I think that is an indication of something much more insidious about state abortion bans.”

Duane emphasized that Attorney General of Texas, Ken Paxton, would “surely agree” that this is an EMTALA violation. “The Attorney Generals in Idaho and Texas and everywhere else are fond of saying there's an explicit exception in our lives for at ectopic pregnancies, but the reality is that when the rubber hits the road, that is not how medical care functions in practice,” Duane said.

In fact, in June, the Texas Supreme Court ruled that the state’s abortion bans are clear in their exceptions. “Texas law permits a life-saving abortion,” the court wrote. “Under the Human Life Protection Act, a physician may perform an abortion if, exercising reasonable medical judgment, the physician determines that a woman has a life-threatening physical condition that places her at risk of death or serious physical impairment unless an abortion is performed.”

Duane said medical professionals are “deeply confused” and “concerned” that if they are wrong about, for example, an ectopic pregnancy diagnosis, they're going to spend the rest of their lives in jail.

“I think it is really important in this situation, regardless of what the Supreme Court does and when, that the federal government clarifies that patients with ectopic pregnancies need to be treated immediately,” Duane said, adding that since the complaints have been public she’s received outreach from other patients in Texas. “Saying ‘the same thing happened to me with my ectopic pregnancy,’ these are not one-offs, this is a pattern of behavior that is continuing to harm patients every single day.”

In June, the U.S. Supreme Court had an opportunity to clarify EMTALA beyond the state of Idaho. Instead, it dismissed the case "improvidently granted” without considering the core issues in the case, returning it to the lower courts for further litigation leaving access to emergency care for pregnant people across the country in a precarious situation.

According to Planned Parenthood, one in 50 pregnancies are ectopic.

“Texas law clearly allows for abortions to treat ectopic pregnancies, and federal law requires it. Yet, Kelsie and Kyleigh were denied absolutely urgent care,” said Beth Brinkmann, senior director of U.S. Litigation at the Center for Reproductive Rights. “It’s impossible to have the best interest of your patient in mind when you’re staring down a life sentence. Texas officials have put doctors in an impossible situation.”

“It is clear that these exceptions are a farce,” she added.