A Hospital’s Failure to Provide Emergency Abortion Care

A hospital in Round Rock, Texas, that repeatedly sent home a woman who was bleeding and in pain without ending her nonviable, life-threatening pregnancy violated the law, according to a newly released federal investigation.

The government’s findings, which have not been previously reported, were a small victory for 36-year-old Kyleigh Thurman, who ultimately lost part of her reproductive system after being discharged without any help from her hometown emergency room for her dangerous ectopic pregnancy.

Thurman had hoped the federal government’s investigation, which issued a report in April after concluding its inquiry last year, would send a clear message to hospitals in Texas, which has one of the nation’s strictest abortion bans.

“I didn’t want anyone else to have to go through this,” Thurman said in an interview with the Associated Press from her Texas home this week. “I put a lot of the responsibility on the state of Texas and policy makers and the legislators that set this chain of events off.”

Uncertainty Regarding Emergency Abortion Access

Women around the country have been denied emergency abortions for their life-threatening pregnancies after states swiftly enacted abortion restrictions in response to a 2022 ruling from the U.S. Supreme Court, which includes three appointees of President Donald Trump.

The guidance issued by the Biden administration in 2022 was an effort to preserve access to emergency abortions for extreme cases in which women were experiencing medical emergencies. It directed hospitals — even ones in states with severe restrictions — to provide abortions in those emergency cases. If hospitals did not comply, they would be in violation of a federal law and risk losing some federal funds.

On Tuesday, the Centers for Medicare and Medicaid Services, the federal agency responsible for enforcing the law and inspecting hospitals, announced it would revoke the Biden-era guidance.

An Ectopic Pregnancy Left Untreated

Emergency room staff observed that Thurman’s hormone levels had dropped, a pregnancy was not visible in her uterus and a structure was blocking her fallopian tube — all telltale signs of an ectopic pregnancy, when a fetus implants outside of the uterus and has no room to grow. If left untreated, ectopic pregnancies can rupture, causing organ damage, hemorrhage or even death.

Thurman was sent home and given a pamphlet on miscarriage. She returned three days later, still bleeding, and was given an injected drug intended to end the pregnancy, but it was too late. Days later, she showed up again at the emergency room, bleeding out because the fertilized egg growing on Thurman’s fallopian tube had ruptured it. She underwent an emergency surgery that removed part of her reproductive system.

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)(Eric Gay / AP)

Investigation and Findings

CMS launched its investigation of how Ascension Seton Williamson handled Thurman’s case late last year, shortly after she filed a complaint. Investigators concluded the hospital failed to give her a proper medical screening exam, including an evaluation with an OB-GYN.

The hospital violated the federal Emergency Medical Treatment and Labor Act, which requires emergency rooms to provide stabilizing treatment to all patients. Thurman was “at risk for deterioration of her health and wellbeing as a result of an untreated medical condition,” the investigation said in its report, which was publicly released last month.

Ascension, a vast hospital system that has facilities across multiple states, did not respond to questions about Thurman’s case, saying only that it “is committed to providing high-quality care to all who seek our services.”

Penalties for Doctors, Hospital Staff

Doctors and legal experts have warned abortion restrictions like the one Texas enacted have discouraged emergency room staff from aborting dangerous and nonviable pregnancies, even when a woman’s life is imperiled. The stakes are especially high in Texas, where doctors face up to 99 years in prison if convicted of performing an illegal abortion. Lawmakers in the state are weighing a law that would remove criminal penalties for doctors who provide abortions in certain medical emergencies.

“We see patients with miscarriages being denied care, bleeding out in parking lots. We see patients with nonviable pregnancies being told to continue those to term,” said Molly Duane, an attorney at the Center for Reproductive Rights that represented Thurman. “This is not, maybe, what some people thought abortion bans would look like, but this is the reality.”

Questions Remain About Hospital Investigations

But CMS’ announcement on Tuesday raises questions about whether such investigations will continue if hospitals do not provide abortions for women in medical emergencies.

The agency said it will still enforce the law, “including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy.”

While states like Texas have clarified that ectopic pregnancies can legally be treated with abortions, the laws do not provide for every complication that might arise during a pregnancy. Several women in Texas have sued the state for its law, which has prevented women from terminating pregnancies in cases where their fetuses had deadly fetal anomalies or they went into labor too early for the fetus to survive.

Thurman worries pregnant patients with serious complications still won’t be able to get the help they may need in Texas emergency rooms.

“You cannot predict the ways a pregnancy can go,” Thurman said. “It can happen to anyone, still. There’s still so many ways in which pregnancies that aren’t ectopic can be deadly.”

Conclusion

The case of Kyleigh Thurman highlights the importance of access to emergency abortion care, particularly in states with strict abortion bans. The federal investigation’s findings and the hospital’s violation of the law serve as a reminder that hospitals have a responsibility to provide stabilizing treatment to all patients, including those with life-threatening pregnancies.

As the debate around abortion access continues, it is essential to prioritize the health and well-being of pregnant patients. The revocation of the Biden-era guidance and the ongoing questions about hospital investigations raise concerns about the ability of hospitals to provide necessary care in medical emergencies.

Frequently Asked Questions

Here are some frequently asked questions about the case and the issues surrounding emergency abortion access:

Q: What happened to Kyleigh Thurman? Kyleigh Thurman was sent home from the emergency room without receiving proper treatment for her ectopic pregnancy, which ultimately led to the loss of part of her reproductive system.