1). “How Many of Us Have to Die?: The anti-abortion movement planned for deaths like Josseli Barnica's”, Oct 30, 2024, Jessica Valenti, Abortion, Every Day, at < https://jessica.substack.com/
2). “A Woman Died After Being Told It Would Be a “Crime” to Intervene in Her Miscarriage at a Texas Hospital: Josseli Barnica is one of at least two pregnant Texas women who died after doctors delayed emergency care. She’d told her husband that the medical team said it couldn’t act until the fetal heartbeat stopped”, Oct 30, 2024, Cassandra Jaramillo & Kavitha Surana, ProPublica, (a joint production of ProPublica & The Texas Tribune), at < https://www.propublica.org/
3). “Dozens of pregnant women, some bleeding or in labor, are turned away from ERs despite federal law”, Aug. 12, 2024, updated on Aug. 14, 2024, Amanda Seitz, Associated Press (AP), at < https://apnews.com/article/
4). “Anti-abortion groups want Supreme Court to get rid of protest-free zones at clinics: Abortion opponents note that when the Supreme Court overturned Roe. v. Wade, justices also criticized a previous ruling on protest-free zones at clinics”, Oct 28, 2024, Maureen Groppe, USA TODAY, at < https://www.usatoday.com/
5). “DeSantis-linked committees add $8.5 million in fight against abortion and pot measures”, Oct 29, 2024, Anon, News Service of Florida, at < https://health.wusf.usf.edu/
6). “ ‘We just have to keep fighting’: a shocking new film on the danger of US abortion laws. In the Hilary Clinton and Jennifer Lawrence-produced documentary Zurawski v Texas, women whose lives have been brutally upended have their say”, Oct 27, 2024, Adrian Horton, The Guardian, at < https://www.theguardian.com/
~~ recommended by dmorista ~~
Introduction by dmorista: As we close in on Election Day, Nov 5th, 2024 the clamor over a weird assortment of issues grows louder; (of course at least 1/3 of votes are submitted before the 5th). A relatively unique division in the American electorate has now emerged, a Gender-Gap of several percentage points. Women, whose understanding of the class issues in the U.S. are relatively well developed, are voting for the Harris / Walz ticket with Abortion Access and Reproductive Health Care Rights the leading issue for many women. Trump has, absurdly, claimed that he is “The Protector of Women (whether they want it or not)”. Trump and the Republicans are trying, with some success, to wriggle our from under their intense long-term relationship with the Forced-Pregnancy / Forced-Birth movement.
In Item 1)., “How Many of Us Have to Die? ….”, Jessica Valenti discusses the shocking fact that the many deaths, and terrible health problems, of women with horrific problems during pregnancy are just “collateral damage” in the right-wing's climb to power in the U.S. The leaders of the Forced-Pregnancy / Forced-Birth movement strategized about this years, even decades, ago knowing that many American Women would die or be harmed by their political agenda. They did not and don't care. Women are pawns in their plans. Jessica Valenti is gaining stature as a critic of the Trumpian Forced-Pregnancy / Forced-Birth Agenda and appeared last night (repeated early this morning) on an MSNBC special, “Your Power, Your Vote”. Item 2)., “A Woman Died After ….”, is the article that was the main inspiration for Valenti's remarks on “Your Power, Your Vote”. It is the 3rd in a series of stories about women who have died because of the Trumpian Abortion Bans around the U.S. A few days ago ProPublica published two stories on women who died, due to Trump Abortion Bans in Georgia, now they are acknowledging that there are two similar cases in Texas. In fact the real numbers are much higher. Statistics out recently showed a 56% rise in Maternal Mortality in Texas in 2022. This amounts to the death of 42 women, due to lack of timely abortions, in Texas alone in just the year 2022. Texas is joined by about 20 other states that now have complete Trump Abortion Bans (a 6-week Heartbeat law is, in fact, a complete Trump Abortion Ban)
Item 3)., “Dozens of pregnant women, ….”, notes that nationwide there are problems with women receiving timely appropriate care, including abortions when necessary. The situation is better in the “Blue States” where abortion remains legal, but is far from ideal. One particularly egregious issue is the presence of large numbers of Catholic Hospitals in Blue States; hospitals that do not offer the complete range of reproductive health care and that do not make that situation clear to women who need care. Colorado and California are both moving to force those Catholic Hospitals to make their policies public information. One Catholic Hospital in California, where a woman who was suffering severe bleeding and who clearly needed a timely abortion instead told her to leave the hospital and actually gave her a bucket and some rags.
And the political attacks on Abortion clinics continues in the Blue States. Item 4)., “Anti-abortion groups want ….” discusses the fact that the legal operatives of the Trumpian Forced-Pregnancy / Forced-Birth forces are continuing to try to end the safe distance rules enabled by the 2000 Hill v. Colorado ruling. This effort has a high likelihood of success as the Supreme Court is now a Discredited Far-Right Political Hack institution. Another example is discussed in Item 5)., “DeSantis-linked committees ….”. DeSantis has raised funds from far-right billionaires and used the power of the state in Florida to attack and harass and intimidate people who support Proposal 4, that would restore access to abortion services and reproductive health care in Florida.
Finally the propaganda and information battles continue to rage. From the progressive side of things we have Item 6)., “ ‘We just have to keep fighting’ ….”, that discusses a new documentary movie. “The film, directed by Texas-bred film-makers Abbie Perrault and Maisie Crow, captures with journalistic clarity the chaos, uncertainty and unnecessary pain and suffering that ensues when a state bans abortion – what happens in court, in hospitals, and in the private aftermath. …. (this is) the Hilary Clinton and Jennifer Lawrence-produced documentary Zurawski v Texas,” My only criticism is that the movie is only being released in theaters. It should be available on-line and for free, some well-healed liberal billionaire (there are a few) should step up and fund such a distribution scheme, up until the actual election day anyways.
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How Many of Us Have to Die?
They are killing us. I don’t know any other way to put it. Yeniifer Alvarez-Estrada Glick. Candi Miller. Amber Nicole Thurman.
And now, Josseli Barnica—a 28-year old mother, whose smiling face in a selfie she took with her daughter made me weep as soon as I read ProPublica’s headline: “A Texas Woman Died After the Hospital Said It Would be a ‘Crime’ to Intervene in Her Miscarriage.”
Josseli died in 2021, before Roe was overturned but after Texas passed SB 8. Even though she was miscarrying at just 17 weeks into her pregnancy with no chance for the fetus’ survival, doctors told Josseli they couldn’t treat her while there was still a heartbeat. By the time her Houston hospital intervened, she had spent two days with a fetus pressed up against her open cervix, exposing her to bacteria. Josseli died of a preventable infection three days later.
I am heartbroken, but more than that I am just so angry. I am angry that this young beautiful woman is dead. I am angry that her now-4 year-old daughter will grow up without a mother. I am angry that we have to live in a country where our lives are treated as disposable. And I am really, truly furious about what I know will come next.
Anti-abortion groups will rush to send out tweets and press releases with phony condolences, insisting that Texas’ law allows life-saving care. They will blame doctors for not acting quickly enough, the hospital for not giving providers clear enough guidance—even pro-choicers for ‘scaring’ doctors out of treating patients. Anything to shirk blame and to wash the blood off their hands.
We cannot let that happen.
When Susan B. Anthony Pro-Life America comes out with a statement promising that abortion bans protect women, I want you to remember that they lobbied against exceptions for women’s lives. When the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) claims that Josseli should have been given care, remember that the ‘care’ they’re referring to isn’t an abortion—but a forced c-section or vaginal labor. That’s because these groups believe abortion is never necessary to save a person’s life. They use language and push for laws accordingly.
Most of all, I want us to remember—and for all Americans to know—that these organizations and legislators knew this would happen. They knew women would suffer and die as a result of their laws and decided to pass them anyway. There is no press release or talking point that can paper over that truth: they decided our deaths were an acceptable trade-off for a political win.
When I say that the anti-abortion movement planned for deaths like Josseli’s, I mean it literally. In October 2022, I warned that conservatives had launched a preemptive messaging campaign to blame doctors and abortion rights activists for women’s deaths. Today, two full years later, we’re watching Republicans insist that it’s not bans endangering women, but pro-choice “misinformation” about the laws.
They didn’t just plan to avoid responsibility for our deaths, though—they planned to cover them up.
There is a reason that Republicans are disbanding maternal mortality review committees, or stacking them with anti-abortion activists. In Texas, where Josseli was killed, Republicans put a well-known extremist on the state's maternal death board just a few months ago: Ingrid Skop has made a career out of arguing that maternal mortality statistics can’t be trusted and that abortion bans won’t lead to maternal deaths.
This comes at the same time that well-funded anti-abortion groups are sowing distrust in maternal mortality statistics across the country, laying the groundwork to argue that the inevitable spike in post-Roe maternal deaths is just bad data.
Then there’s the anti-abortion cultural work: Conservative media outlets have ramped up coverage glorifying women who die for their pregnancies—like cancer patients who decline radiation—as the ultimate good mothers. They’ve published story after story of women sacrificing themselves for their fetuses in the hopes that they can make women’s deaths palatable. Positive, even!
It’s that reality-bending public manipulation that conservatives are counting on most of all. They want Americans to believe that it’s perfectly normal for women to suffer and die during pregnancy, and that Democrats are simply politicizing everyday tragedies. What better way to avoid responsibility for the last two-plus years of nightmares than convincing the country it’s all just business as usual?
Relying on America’s tolerance for women’s pain doesn’t just help Republicans shirk blame for deaths— but for the broad scope of harm people have suffered since Roe was overturned. After all, for every dead woman, there are hundreds more who have lost reproductive organs, gotten sepsis, or suffered terribly and unnecessarily. In a country where women’s suffering is expected, the anti-abortion movement can just frame those cases as a win—proof that their laws are working because the women didn’t die.
Patients who don’t appreciate losing their fallopian tubes or getting deathly ill before being given care will be judged as selfish—those who don’t understand that motherhood requires ‘sacrifice.’ I will never forget the Texas columnist who chastised Kate Cox for not wanting to carry a doomed pregnancy to term, writing that “suffering is part of life...It’s most assuredly part of motherhood.” As if not wanting to be a walking coffin is some kind of moral failing.
We know the truth: It’s not acceptable for women to be left lingering in pain in hospital rooms surrounded by doctors legally prohibited from helping them. It is not normal for women to get sepsis, or to force children to give birth. It is not normal for the government to dictate just how much horror a patient should have to endure before being saved. Nothing about this is normal.
Since Texas passed its abortion ban, maternal mortality has increased by 56%—a trend I expect we’ll see replicated across other anti-abortion states as more data comes out. Republicans would like us to forget that there are women like Josseli behind those numbers. Women who should still be here, smiling in pictures with their children.
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A Texas Woman Died After Waiting 40 Hours for Miscarriage Care
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
Josseli Barnica grieved the news as she lay in a Houston hospital bed on Sept. 3, 2021: The sibling she’d dreamt of giving her daughter would not survive this pregnancy.
The fetus was on the verge of coming out, its head pressed against her dilated cervix; she was 17 weeks pregnant and a miscarriage was “in progress,” doctors noted in hospital records. At that point, they should have offered to speed up the delivery or empty her uterus to stave off a deadly infection, more than a dozen medical experts told ProPublica.
But when Barnica’s husband rushed to her side from his job on a construction site, she relayed what she said the medical team had told her: “They had to wait until there was no heartbeat,” he told ProPublica in Spanish. “It would be a crime to give her an abortion.”
For 40 hours, the anguished 28-year-old mother prayed for doctors to help her get home to her daughter; all the while, her uterus remained exposed to bacteria.
Three days after she delivered, Barnica died of an infection.
Barnica is one of at least two Texas women who ProPublica found lost their lives after doctors delayed treating miscarriages, which fall into a gray area under the state’s strict abortion laws that prohibit doctors from ending the heartbeat of a fetus.
Neither had wanted an abortion, but that didn’t matter. Though proponents insist that the laws protect both the life of the fetus and the person carrying it, in practice, doctors have hesitated to provide care under threat of prosecution, prison time and professional ruin.
ProPublica is telling these women’s stories this week, starting with Barnica’s. Her death was “preventable,” according to more than a dozen medical experts who reviewed a summary of her hospital and autopsy records at ProPublica’s request; they called her case “horrific,” “astounding” and “egregious.”
The doctors involved in Barnica’s care at HCA Houston Healthcare Northwest did not respond to multiple requests for comment on her case. In a statement, HCA Healthcare said “our responsibility is to be in compliance with applicable state and federal laws and regulations” and said that physicians exercise their independent judgment. The company did not respond to a detailed list of questions about Barnica’s care.
Like all states, Texas has a committee of maternal health experts who review such deaths to recommend ways to prevent them, but the committee’s reports on individual cases are not public and members said they have not finished examining cases from 2021, the year Barnica died.
ProPublica is working to fill gaps in knowledge about the consequences of abortion bans. Reporters scoured death data, flagging Barnica’s case for its concerning cause of death: “sepsis” involving “products of conception.” We tracked down her family, obtained autopsy and hospital records and enlisted a range of experts to review a summary of her care that ProPublica created in consultation with two doctors.
Among those experts were more than a dozen OB-GYNs and maternal-fetal medicine specialists from across the country, including researchers at prestigious institutions, doctors who regularly handle miscarriages and experts who have served on state maternal mortality review committees or held posts at national professional medical organizations.
After reviewing the four-page summary, which included the timeline of care noted in hospital records, all agreed that requiring Barnica to wait to deliver until after there was no detectable fetal heartbeat violated professional medical standards because it could allow time for an aggressive infection to take hold. They said there was a good chance she would have survived if she was offered an intervention earlier.
“If this was Massachusetts or Ohio, she would have had that delivery within a couple hours,” said Dr. Susan Mann, a national patient safety expert in obstetric care who teaches at Harvard University.
Many noted a striking similarity to the case of Savita Halappavanar, a 31-year-old woman who died of septic shock in 2012 after providers in Ireland refused to empty her uterus while she was miscarrying at 17 weeks. When she begged for care, a midwife told her, “This is a Catholic country.” The resulting investigation and public outcry galvanized the country to change its strict ban on abortion.
But in the wake of deaths related to abortion access in the United States, leaders who support restricting the right have not called for any reforms.
Last month, ProPublica told the stories of two Georgia women, Amber Thurman and Candi Miller, whose deaths were deemed “preventable” by the state’s maternal mortality review committee after they were unable to access legal abortions and timely medical care amid an abortion ban.
Georgia Gov. Brian Kemp called the reporting “fear mongering.” Former President Donald Trump has not weighed in — except to joke that his Fox News town hall on women’s issues would get “better ratings” than a press call where Thurman’s family spoke about their pain.
Leaders in Texas, which has the nation’s oldest abortion ban, have witnessed the consequences of such restrictions longer than those in any other state.
In lawsuits, court petitions and news stories, dozens of women have said they faced dangers when they were denied abortions starting in 2021. One suffered sepsis like Barnica, but survived after three days in intensive care. She lost part of her fallopian tube. Lawmakers have made small concessions to clarify two exceptions for medical emergencies, but even in those cases, doctors risk up to 99 years in prison and fines of $100,000; they can argue in court that their actions were not a crime, much like defendants can claim self-defense after being charged with murder.
Amid the deluge of evidence of the harm, including research suggesting Texas’ legislation has increased infant and maternal deaths, some of the ban’s most prominent supporters have muted their public enthusiasm for it. U.S. Sen. Ted Cruz, who once championed the fall of Roe v. Wade and said, “Pregnancy is not a life-threatening illness,” is now avoiding the topic amid a battle to keep his seat. And Gov. Greg Abbott, who said early last year that “we promised we would protect the life of every child with a heartbeat, and we did,” has not made similar statements since.
Both declined to comment to ProPublica, as did state Attorney General Ken Paxton, whose commitment to the ban remains steadfast as he fights for access to the out-of-state medical records of women who travel for abortions. Earlier this month, as the nation grappled with the first reported, preventable deaths related to abortion access, Paxton celebrated a decision by the U.S. Supreme Court that allowed Texas to ignore federal guidance requiring doctors to provide abortions that are needed to stabilize emergency patients.
“This is a major victory,” Paxton said.
“They Had to Wait Until There Was No Heartbeat”
To Barnica, an immigrant from Honduras, the American dream seemed within reach in her corner of Houston, a neighborhood filled with restaurants selling El Salvadoran pupusas and bakeries specializing in Mexican conchas. She found work installing drywall, saved money to support her mother back home and met her husband in 2019 at a community soccer game.
A year later, they welcomed a big-eyed baby girl whose every milestone they celebrated. “God bless my family,” Barnica wrote on social media, alongside a photo of the trio in matching red-and-black plaid. “Our first Christmas with our Princess. I love them.”
Barnica longed for a large family and was thrilled when she conceived again in 2021.
Trouble struck in the second trimester.
On Sept. 2, 2021, at 17 weeks and four days pregnant, she went to the hospital with cramps, according to her records. The next day, when the bleeding worsened, she returned. Within two hours of her arrival on Sept. 3, an ultrasound confirmed “bulging membranes in the vagina with the fetal head in the open cervix,” dilated at 8.9 cm, and that she had low amniotic fluid. The miscarriage was “in progress,” the radiologist wrote.
When Barnica’s husband arrived, she told him doctors couldn’t intervene until there was no heartbeat.
The next day, Dr. Shirley Lima, an OB on duty, diagnosed an “inevitable” miscarriage.
In Barnica’s chart, she noted that the fetal heartbeat was detected and wrote that she was providing Barnica with pain medication and “emotional support.”
In a state that hadn’t banned abortion, Barnica could have immediately been offered the options that major medical organizations, including international ones, say is the standard of evidence-based care: speeding up labor with medication or a dilation and evacuation procedure to empty the uterus.
“We know that the sooner you intervene in these situations, the better outcomes are,” said Dr. Steven Porter, an OB-GYN in Cleveland.
But Texas’ new abortion ban had just gone into effect. It required physicians to confirm the absence of a fetal heartbeat before intervening unless there was a “medical emergency,” which the law did not define. It required doctors to make written notes on the patient’s condition and the reason abortion was necessary.
The law did not account for the possibility of a future emergency, one that could develop in hours or days without intervention, doctors told ProPublica.
Barnica was technically still stable. But lying in the hospital with her cervix open wider than a baseball left her uterus exposed to bacteria and placed her at high risk of developing sepsis, experts told ProPublica. Infections can move fast and be hard to control once they take hold.
The scenario felt all too familiar for Dr. Leilah Zahedi-Spung, a maternal-fetal medicine specialist who used to work in Tennessee and reviewed a summary of Barnica’s records at ProPublica’s request.
Abortion bans put doctors in an impossible position, she said, forcing them to decide whether to risk malpractice or a felony charge. After her state enacted one of the strictest bans in the country, she also waited to offer interventions in cases like Barnica’s until the fetal heartbeat stopped or patients showed signs of infection, praying every time that nothing would go wrong. It’s why she ultimately moved to Colorado.
The doctors treating Barnica “absolutely didn’t do the right thing,” she said. But she understood why they would have felt “totally stuck,” especially if they worked at a hospital that hadn’t promised to defend them.
Even three years after Barnica’s death, HCA Healthcare, the hospital chain that treated Barnica, will not disclose whether it has a policy on how to treat miscarriages.
Some HCA shareholders have asked the company to prepare a report on the risks to the company related to the bans in states that restrict abortion, so patients would understand what services they could expect and doctors would know under what circumstances they would be protected. But the board of directors opposed the proposal, partly because it would create an “unnecessary expense and burdens with limited benefits to our stockholders.” The proposal was supported by 8% of shareholders who voted.
The company’s decision to abstain has repercussions far beyond Texas; the nation’s largest for-profit hospital chain has said it delivers more babies than any other health care provider in America, and 70% of its hospitals are in states where abortion is restricted.
As the hours passed in the Houston hospital, Barnica couldn’t find relief. On the phone with her aunt Rosa Elda Calix Barnica, she complained that doctors kept performing ultrasounds to check the fetal heartbeat but were not helping her end the miscarriage.
Around 4 a.m. on Sept. 5, 40 hours after Barnica had arrived, doctors could no longer detect any heart activity. Soon after, Lima delivered Barnica’s fetus, giving her medication to help speed up the labor.
Dr. Joel Ross, the OB-GYN who oversaw her care, discharged her after about eight more hours.
The bleeding continued, but when Barnica called the hospital, she was told that was expected. Her aunt grew alarmed two days later when the bleeding grew heavier.
Go back, she told her niece.
On the evening of Sept. 7, Barnica’s husband rushed her to the hospital as soon as he got off from work. But COVID-19 protocols meant only one visitor could be in the room with her, and they didn’t have a babysitter for their 1-year-old daughter.
So he left and tried to get some sleep.
“I fully expected her to come home,” he said.
But she never did. Her family planned two funerals, one in Houston and another in Honduras.
Nine days after her death, Barnica’s husband was processing his shock, learning how to be a single dad and struggling to raise funds to bury his wife and the son he had hoped to raise.
Meanwhile, Lima was pulling up Barnica’s medical chart to make an addition to her records.
The notes she added made one point abundantly clear: “When I was called for delivery,” she wrote, “the fetus no longer had detectable heart tones.”
“They Should Vote With Their Feet”
Texas has been on the forefront of fighting abortion access.
At the time of Barnica’s miscarriage in 2021, the Supreme Court had not yet overturned the constitutional right to terminate a pregnancy. But Texas lawmakers, intent on being the first to enact a ban with teeth, had already passed a harsh civil law using a novel legal strategy that circumvented Roe v. Wade: It prohibited doctors from performing an abortion after six weeks by giving members of the public incentives to sue doctors for $10,000 judgments. The bounty also applied to anyone who “aided and abetted” an abortion.
A year later, after the Dobbs v. Jackson ruling was handed down, an even stricter criminal law went into effect, threatening doctors with up to 99 years in prison and $100,000 in fines.
Soon after the ruling, the Biden administration issued federal guidance reminding doctors in hospital emergency rooms they have a duty to treat pregnant patients who need to be stabilized, including by providing abortions for miscarriages.
Texas Attorney General Ken Paxton fought against that, arguing that following the guidance would force doctors to “commit crimes” under state law and make every hospital a “walk-in abortion clinic.” When a Dallas woman asked a court for approval to end her pregnancy because her fetus was not viable and she faced health risks if she carried it to term, Paxton fought to keep her pregnant. He argued her doctor hadn’t proved it was an emergency and threatened to prosecute anyone who helped her. “Nothing can restore the unborn child’s life that will be lost as a result,” he wrote to the court.
No doctor in Texas, or the 20 other states that criminalize abortion, has been prosecuted for violating a state ban. But the possibility looms over their every decision, dozens of doctors in those states told ProPublica, forcing them to consider their own legal risks as they navigate their patient’s health emergencies. The lack of clarity has resulted in many patients being denied care.
In 2023, Texas lawmakers made a small concession to the outcry over the uncertainty the ban was creating in hospitals. They created a new exception for ectopic pregnancies, a potentially fatal condition where the embryo attaches outside the uterine cavity, and for cases where a patient’s membranes rupture prematurely before viability, which introduces a high risk of infection. Doctors can still face prosecution, but are allowed to make the case to a judge or jury that their actions were protected, not unlike self-defense arguments after homicides. Barnica’s condition would not have clearly fit this exception.
This year, after being directed to do so by the state Supreme Court, the Texas Medical Board released new guidance telling doctors that an emergency didn’t need to be “imminent” in order to intervene and advising them to provide extra documentation regarding risks.
But in a recent interview, the board’s president, Dr. Sherif Zaafran, acknowledged that these efforts only go so far and the group has no power over criminal law: “There’s nothing we can do to stop a prosecutor from filing charges against the physicians.”
Asked what he would tell Texas patients who are miscarrying and unable to get treatment, he said they should get a second opinion: “They should vote with their feet and go and seek guidance from somebody else.”
An immigrant from El Salvador who works 12-hour shifts, Barnica’s husband doesn’t follow American politics or the news. He had no inkling of the contentious national debate over how abortion bans are affecting maternal health care when ProPublica contacted him.
Now he is raising a 4-year-old daughter with the help of Barnica’s younger brother; every weekend, they take her to see her grandmother, who knows how to braid her hair in pigtails.
All around their home, he keeps photos of Barnica so that the little girl grows up knowing how much her mother loved her. He sees flashes of his wife when his daughter dances. She radiates the same delight.
When asked about Barnica, he can’t get out many words; his leg is restless, his eyes fixed on the floor. Barnica’s family calls him a model father.
He says he’s just doing his best.
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Dozens of pregnant women, some bleeding or in labor, are turned away from ERs despite federal law
An Associated Press analysis of federal hospital investigations finds that more than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2021. (AP Video: Kendria LaFleur)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)
WASHINGTON (AP) — Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her.
Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course” before discharging her without treatment for her ectopic pregnancy.
When she returned three days later, still bleeding, doctors finally agreed to give her an injection to end the pregnancy. It was too late. The fertilized egg growing on Thurman’s fallopian tube ruptured it, destroying part of her reproductive system.
That’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated federal law when staff failed to treat her initially in February 2023.
“I was left to flail,” said Thurman, 35. “It was nothing short of being misled.”
The Biden administration says hospitals must offer abortions when needed to save a woman’s life, despite state bans enacted after the Supreme Court overturned the constitutional right to an abortion more than two years ago. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.
More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations found.
Two women — one in Florida and one in Texas — were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting treatment, including one in California who needed a blood transfusion after she sat for nine hours in an emergency waiting room.
Abortion bans complicate risky pregnancy care
In Texas, where doctors face up to 99 years of prison if convicted of performing an illegal abortion, medical and legal experts say the law is complicating decision-making around emergency pregnancy care.
Although the state law says termination of ectopic pregnancies isn’t considered abortion, the draconian penalties scare Texas doctors from treating those patients, the Center for Reproductive Rights argues.
“As fearful as hospitals and doctors are of running afoul of these state abortion bans, they also need to be concerned about running afoul of federal law,” said Marc Hearron, a center attorney. Hospitals face a federal investigation, hefty penalties and threats to their Medicare funding if they violate the federal law.
The organization filed complaints last week with the Centers for Medicare and Medicaid Service alleging that different Texas emergency rooms failed to treat two patients, including Thurman, with ectopic pregnancies.
One complaint says Kelsie Norris-De La Cruz, 25, lost a fallopian tube and most of an ovary after an Arlington, Texas, hospital sent her home without treating her ectopic pregnancy, even after a doctor said discharge was “not in her best interest.”
“The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency healthcare,” she said in a statement. “I’m filing this complaint because women like me deserve justice and accountability from those that hurt us.”
Conclusively diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the pregnancy’s location on an ultrasound, three doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test and an ultrasound of an empty uterus all indicate an ectopic pregnancy.
“You can’t be 100% — that’s the tricky part,” said Kate Arnold, an OB-GYN in Washington. “They’re literally time bombs. It’s a pregnancy growing in this thing that can only grow so much.”
Texas Right to Life Director John Seago said state law protects doctors from prosecution for terminating ectopic pregnancies, even if a doctor “makes a mistake” in diagnosing it.
“Sending a woman back home is completely unnecessary, completely dangerous,” Seago said.
But the state law has “absolutely” made doctors afraid of treating pregnant patients, said Hannah Gordon, an emergency medicine physician who worked in a Dallas hospital until last year.
She recalled a patient with signs of an ectopic pregnancy at her Dallas emergency room. Because OB-GYNs said they couldn’t definitively diagnose the problem, they waited to end the pregnancy until she came back the next day.
“It left a bad taste in my mouth,” said Gordon, who left Texas hoping to become pregnant and worried about the care she’d receive there.
“Oh my God, I’m dying”
When Thurman returned to Ascension Seton Williamson a third time, her OB-GYN told her she’d need surgery to remove the fallopian tube, which had ruptured. Thurman, still heavily bleeding, balked. Losing the tube would jeopardize her fertility.
Her doctor told her she risked death if she waited any longer.
“She came in and she’s like, you’re either going to have to have a blood transfusion, or you’re going to have to have surgery or you’re going to bleed out,” Thurman said, through tears. “That’s when I just kind of was like, ‘Oh my God, I’m, I’m dying.’”
The hospital declined to comment on Thurman’s case, but said in a statement it “is committed to providing high-quality care to all who seek our services.”
In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in Broward Health Coral Springs’ emergency wait room, according to federal documents. An ultrasound revealed the patient had no amniotic fluid surrounding the fetus, a dangerous situation that can cause serious infection.
The woman miscarried in a public bathroom that day, after the emergency room doctor listed her condition as “improved” and discharged her, without consulting the hospital’s OB-GYN.
Emergency crews rushed her to another hospital, where she was placed on a ventilator and discharged after six days.
Abortions after 15 weeks were banned in Florida at the time. Broward Health Coral Springs’ obstetrics medical director told an investigator that inducing labor for anyone who presents with pre-viable premature rupture of membranes is “the standard of care, has been a while, regardless of heartbeat, due to the risk to the mother.”
The hospital declined comment.
In another Florida case, a doctor admitted state law had complicated emergency pregnancy care.
“Because of the new laws ... staff cannot intervene unless there is a danger to the patient’s health,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator who was probing the hospital’s failure to offer an abortion to a woman whose water broke at 15 weeks, well before the fetus could survive.
Troubles extend beyond abortion ban states
Serious violations that jeopardized a mother or her fetus’ health occurred in states with and without abortion bans, the AP’s review found.
Two short-staffed hospitals — in Idaho and Washington — admitted to investigators they routinely directed pregnant patients to other hospitals.
A pregnant patient at a Bakersfield, California, emergency room was quickly triaged, but staff failed to realize the urgency of her condition, a uterine rupture. The delay, an investigator concluded, may have contributed to the baby’s death.
Doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for fetal heartbeats or discharged patients who were in active labor, leaving them to deliver at home or in ambulances, according to the documents.
Nursing and doctor shortages, trouble staffing ultrasounds around-the-clock and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official.
“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” she said.
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Anti-abortion groups want Supreme Court to get rid of protest-free zones at clinics
WASHINGTON − Days after the Supreme Court in 2022 overturned the constitutional right to an abortion, a New York county passed a law barring anti-abortion activists from approaching women outside abortion clinics.
When a religious group asked the Supreme Court to intervene, Westchester County officials got rid of the restrictions – and last year the justices declined to get involved.
Now anti-abortion groups are urging the justices not to fall for another “bait and switch.”
They’ve asked the Supreme Court to hear a challenge to a similar law in Carbondale, Illinois, that was repealed as the case was heading to the high court.
Anti-abortion groups, as well as a number of Republican attorneys general, want the justices to use it to overturn a 2000 decision − Hill v. Colorado − that upheld protest restrictions around abortion clinics.
“The time has come for the Court to restore the constitutional rights that Hill eviscerated, and this case provides a perfect opportunity to do so,” Paul Clement, a former U.S. solicitor general who has argued more than 100 Supreme Court cases and is representing the anti-abortion group Coalition Life, wrote in a filing.
Close enough for eye contact versus 8-foot buffer
Coalition Life, a Missouri group, says its members need to get close enough to women to make eye contact as they advocate against abortion.
In Hill v. Colorado, the court ruled 6-3 that Colorado could prevent activists from coming within 8 feet of another person within a 100-foot zone surrounding a health care facility.
The justices kept that decision intact in 2014 when it struck down a 35-foot protest-free zone outside abortion clinics in Massachusetts.
Alito criticized 2000 decision when overturning Roe
But the court slammed the 2000 ruling when overturning Roe v. Wade in 2022. Criticizing the effect of abortion cases on other areas of the law, Justice Samuel Alito wrote that Hill “distorted First Amendment doctrines.”
Rather than take that as the warning it was intended to be, anti-abortion groups say, some municipalities flouted it.
Officials in New York’s Westchester County enacted restrictions similar to those that had been upheld in Hill.
A Catholic “sidewalk counselor” challenged the rules, saying they violated her First Amendment right to engage in face-to-face conversation with women entering a Planned Parenthood clinic.
The restrictions were upheld by an appeals court relying on the Supreme Court’s 2000 decision. But when the Becket Fund for Religious Liberty then asked the Supreme Court to revisit that 2000 decision, county officials repealed the restrictions. Their reversal was supported by Planned Parenthood, which agreed with the county that the restrictions were unnecessary and difficult to enforce.
The Becket Fund, however, drew the Supreme Court’s attention to the fact that the county’s attorney had hoped that the law would not be reviewed by the high court, because “I think we know what the Supreme Court would rule if this ever got there.”
Still, the justices declined last year to take the case.
Now they’re being given another chance to overturn their 2000 decision.
Illinois city responds to increase in abortion protests
The Southern Illinois city of Carbondale saw an increase in anti-abortion protests after two reproductive health facilities opened to accommodate women from nearby states that restricted abortion after Dobbs v. Jackson Women’s Health Organization.
City officials responded by passing restrictions modeled after Colorado’s. But the city council repealed the ordinance in July, before anyone had been charged with violating it.
The city’s lawyers told the Supreme Court they had determined existing laws provided sufficient protection from any “disorderly conduct.”
Ant-abortion groups’ assertion that the ordinance was repealed to avoid the Supreme Court getting involved is just speculation, Carbondale’s lawyers said. In any case, they added, the city is entitled to reconsider its position for any reason.
The attorneys general of Kentucky and 14 other states are among those calling foul.
“If the Court countenances the repeal-the-law strategy again, then every government has a blueprint to follow if it wants,” they told the court in a filing. “It can enact a law modeled on Hill, ensure a year, two, or more of effectiveness while a legal challenge works through the lower courts, and then repeal it when the case gets to this Court. And all the while Hill remains on the books.”
Buffer zone in New Jersey city also before Supreme Court
The Supreme Court could decide soon whether to take the case, as well as a different challenge from New Jersey.
An anti-abortion activist, represented by the American Center for Law and Justice, is contesting a 2014 ordinance in Englewood, New Jersey, that created a protest-free buffer zone around certain health care facilities. The buffer bars the public from coming within 8 feet of clinic entrances.
The Philadelphia-based 3rd U.S. Circuit Court of Appeals ruled in January that the restrictions were narrowly tailored, do not violate protesters’ First Amendment rights, and are less restrictive than what the Supreme Court sanctioned in 2000.
But challengers will keep asking the Supreme Court to intervene, Jay Sekulow of the American Center for Law and Justice told the court, until that 2000 decision has been overturned.
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DeSantis-linked committees add $8.5 million in fight against abortion and pot measures
Keep Florida Clean raised about $7.75 million and Florida Freedom Fund picked up nearly $763,000 over a two-week period ending Saturday, according to reports filed with the state.
Two political committees linked to Gov. Ron DeSantis opposed to Florida ballot measures on abortion and marijuana raised about $8.51 million from Oct. 12 to 26, according to state finance reports.
Keep Florida Clean raised about $7.75 million during the two-week period and had about $6.92 million in cash on hand as of Saturday. Contributions included $4.25 million from St. Petersburg-based Save Our Society from Drugs, according to the state Division of Election website.
Florida Freedom Fund raised nearly $763,000 during the period and had about $2.25 million in cash on hand.
Both committees are chaired by DeSantis’ chief of staff, James Uthmeier.
The governor is spearheading efforts to defeat Amendment 3 and Amendment 4 on the Nov. 5 ballot.
Amendment 3 would allow people 21 or older “to possess, purchase, or use marijuana products and marijuana accessories for non-medical personal consumption by smoking, ingestion, or otherwise.”
Amendment 4, in part, says no “law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient's health, as determined by the patient's healthcare provider.”
Both measures require 60% of the vote to pass.
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‘We just have to keep fighting’: a shocking new film on the danger of US abortion laws
In the Hilary Clinton and Jennifer Lawrence-produced documentary Zurawski v Texas, women whose lives have been brutally upended have their say
In August 2022, Amanda and Josh Zurawski were 18 weeks into a much-wanted pregnancy with their first child when her water broke early. The complication ended her chances of delivering a healthy baby and imperiled her health – but doctors in Austin, where the couple live, said they could not end her pregnancy under Texas law, because they could still detect fetal cardiac activity.
In the wake of the supreme court’s decision in Dobbs v Jackson Women’s Health Organization in June 2022, which reversed half a century of precedent and overturned Roe v Wade, the Texas legislature, like those in 13 other states, passed a near-total abortion ban. Though the ban allowed for medical exceptions, doctors have said that the law – written by politicians, not medical professionals – is so vaguely worded, and the criminal penalties so severe (up to 99 years in prison for violating state abortion law), that it was unworkable in practice, blocking doctors from helping patients.
So Zurawski, against her wishes and the common standard of care, remained pregnant, knowing her daughter stood no chance of survival, as she grew sicker and sicker. As she testified to the state in a lawsuit that bears her name – the first post-Roe v Wade to be filed by women who said that their health, lives or fertility had been endangered by abortion bans, and the subject of a new documentary executive produced by Hillary and Chelsea Clinton and Jennifer Lawrence – she listened to the cardiac activity with a terrible mix of love, for the child she and Josh desperately wanted, and dread, for her deteriorating health. Doctors eventually performed an emergency induction abortion – but only after she developed sepsis and nearly died. The infection kept her in the ICU for days and cost her one of her fallopian tubes, permanently compromising her future ability to have children.
Aided by the Center for Reproductive Rights, Zurawski sued the state of Texas, looking for clarity in the law as written, and responsibility for a policy that has led to a 13% increase in infant deaths, forced doctors to provide substandard care and inflicted incalculable trauma on women seeking basic healthcare.
“Somebody had to file the first suit,” Zurawski says in the film named after her lawsuit, Zurawski v Texas, released just before a pivotal election in which reproductive rights across the country are on the line.
“What we’re asking for in this lawsuit is the bare minimum human decency requires,” says Molly Duane, the Center’s leading attorney for the suit, in the film. “People are going to die. And the question is, does anyone in the state of Texas in a position of power actually care?”
The film, directed by Texas-bred film-makers Abbie Perrault and Maisie Crow, captures with journalistic clarity the chaos, uncertainty and unnecessary pain and suffering that ensues when a state bans abortion – what happens in court, in hospitals, and in the private aftermath. It is one particular slice of post-Roe America – life-saving or simply dignifying healthcare denied, because of legal uncertainty, to women who wanted to be pregnant in the first place.
“It’s like we’re in triage mode,” Crow told the Guardian. “If someone has to go septic before they can get an abortion, that means that for everyone else who needs abortion for all the reasons that women seek abortion care, they are not getting that care either. We really felt like we needed to highlight the most dire situation that was unfolding in front of us to emphasize the fact that if the women in this lawsuit aren’t getting care, then no one else is.”
And the situation, as the film-makers found, was dire. As soon as Zurawski filed her suit, dozens of women, along with their partners and families, reached out with similarly harrowing stories. In a collage of voicemails played during the film, others share similar experiences: an ectopic pregnancy denied care until her fallopian tube ruptured, another inviable pregnancy carried to term. Share my story, tell people what is happening. “The state absolutely wants to sweep their experiences under the rug,” says Duane. “They just want to pretend like real people don’t exist at all.”
Zurawski v Texas follows three of the eventual 22 plaintiffs, who provided in-person testimony on their abortion stories, something that was happening in court for the first time since the 1970s. Samantha Casiano, who lived in East Texas with her partner and their children, learned at her 20-week scan that her daughter, Halo, would be born without most of her brain – a defect called anencephaly that was incompatible with life. Unable to afford travel out of state for an abortion, she was forced to carry the pregnancy to term while planning for her daughter’s funeral, then watch as Halo gasped for air for four hours after birth. Dr Austin Dennard, an OB-GYN based in Dallas, also learned her long-awaited third child had anencephaly, and had to travel out of state for the medical care she used to be able to provide her patients in her home community. “Having these laws cripple our ability to provide care – it feels like a slap in the face,” she says. Zurawski, traumatized by her medical experience, resorts to surrogacy in another state.
The film is part behind the scenes of their court hearing – nerves, fury, pride, inexpressible pain (Casiano, recounting Halo’s short life after birth, vomited on the stand) – and part documentation of trauma, healing and action. “We didn’t want to politicize it, because this is a healthcare issue that’s been politicized, but it should be a nonpartisan issue,” said Perrault. “We really just wanted to present what’s happening to people under these laws and let the audience take that in on a very human, intimate, personal level from each of these women.”
For the participants – Zurawski, Dennard, Casiano, along with their partners and families – “the horror of what they had to experience and the impact of that on their families and their own reproductive journeys was evident throughout the film-making process,” said Crow. “But we also were just incredibly in awe of their bravery and their willingness to stand up for women across the country in filing this lawsuit and taking the stand to share their testimony.”
The state, ultimately, did not listen to them. On 31 May, the Texas supreme court unanimously rejected the women’s legal challenge, declaring that the state abortion ban could stand as is, without clarifying when medically necessary abortions can be performed. The decision barely mentioned the women. “To know that people in the position of power feel that pregnant individuals should simply be vessels,” says Dennard in the film. “We just have to keep fighting, and we have to keep talking about it, and we have to keep telling our stories, without fear.” The film will be released directly for home viewing to do just that, as an explicitly urgent call to understand the stakes of abortion bans that many who do not experience them first hand do not understand. “Twenty-five million women in America live under bans like this,” said Perrault. “It’s not only these women, it’s also their partners and their children and their parents. Understanding that this issue could affect you in your lifetime is so key.”
The landscape for reproductive rights captured in Zurawski v Texas is staggeringly bleak, even as similar lawsuits in other four other states with near-total abortion bans, including Idaho and Tennessee, remain in legal limbo. But Duane, along with Perrault and Crow, see power in what they witnessed with the lawsuit: people – such as Zurawski’s conservative family members – changing their minds and their votes through hearing the women’s experiences.
“What we’re seeing now that we didn’t see pre-Dobbs is that families are talking about this,” said Crow. “It’s going to take a lot of time before abortion is accessible again. But in a pre-Dobbs era, abortion was not accessible to so many people who needed it to begin with. If there is a restructuring of how abortion becomes more accessible, I think that that’s something to be hopeful towards.”
Zurawski v Texas is out now in New York and Los Angeles with more cities to follow
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