From The Texas Tribune:

Two women have filed a complaint with a federal agency against Texas hospitals because they say they refused to treat their ectopic pregnancies, which resulted in the loss of both women’s fallopian tubes and thus endangered their future fertility.

Under Texas law, doctors are allowed to terminate ectopic pregnancies. In ectopic pregnancies, the fertilized egg implants in the fallopian tubes, not the uterus. Ectopic pregnancies are always nonviable and can quickly become life-threatening if left untreated.

Despite these protections, these women say they were turned away by two different hospitals that refused to treat them. The lawsuit alleges that the doctors and hospitals are so afraid of the state’s abortion laws, violation of which can carry up to life in prison, that they are hesitant to perform even protected abortions.

The complaints were filed with the U.S. Department of Health and Human Services and are based on the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires hospitals to provide stabilizing medical care to every patient who presents to them. That rule has long been interpreted to include medically necessary abortions, but it has run into state bans, including in Texas.

Typically, federal EMTALA complaints are investigated by each state’s health department, but the Center for Reproductive Rights, which filed the complaint, is requesting that it be handled by the federal Centers for Medicare and Medicaid Services (CMS) instead.

“CMS should not rely solely on a state agency’s factual assessment in making its decision because Texas agencies oppose an interpretation of EMTALA that requires hospitals to provide abortions to pregnant patients with a medical emergency,” the complaint states.

The U.S. Supreme Court refused earlier this year to declare that Idaho’s abortion ban overrides EMTALA, but a federal appeals court in New Orleans ruled that Texas hospitals cannot be required to provide life-saving abortions under EMTALA.

Similar diagnoses, similar results

Kyleigh Thurman states in the complaint that she came to Ascension Seton Williamson Hospital in Round Rock, north of Austin, with an ectopic pregnancy.

She says the hospital initially discharged her without treating the ectopic pregnancy, but three days later she returned with vaginal bleeding and worsening symptoms. Despite her doctor’s orders, the hospital refused to give her methotrexate, a common medication that prevents ectopic pregnancy.

“Angry, Ms. Thurman’s gynecologist met with Ms. Thurman at Ascension Williamson to beg the medical staff to give her methotrexate,” the complaint states. They eventually agreed. But it was too late; the ectopic pregnancy had grown too large and ruptured. Thurman nearly bled to death and her right fallopian tube had to be removed.

An Ascension spokesman declined to comment on the details of the case, but said in a statement that the company is “committed to providing quality care to all who use our services.”

Kelsie Norris-De La Cruz had a similar experience at Texas Health Arlington Memorial Hospital outside Dallas. An emergency room doctor diagnosed her with an ectopic pregnancy and told her she should get a methotrexate injection or undergo surgery to terminate the pregnancy.

She opted for surgery, but when on-call gynecologists arrived, the hospital refused to treat her and told her to return in 48 hours, the lawsuit says.

“Ms. Norris-De La Cruz’s mother asked if the hospital’s refusal to treat her had anything to do with the Texas abortion ban, but received no response,” the complaint states. “As the conversation became more heated, the gynecologist confirmed that Ms. Norris-De La Cruz was at risk of a possible rupture within the next 48 hours and then stormed out of the room.”

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

Norris-De La Cruz eventually found a gynecologist through a friend who agreed to perform emergency surgery to remove the ectopic pregnancy. By this point, the mass had grown so large that her right fallopian tube and 75% of her right ovary also had to be removed.

“I have lost half of my fertility and if I had to wait any longer, I probably would have died,” Norris-De La Cruz said in a statement. “These bans make it nearly impossible to get basic emergency care. That’s why I’m filing this complaint because women like me deserve justice and accountability from those who have hurt us. Texas state officials cannot continue to ignore us. We cannot allow this to happen.”

EMTALA Fights

EMTALA was created nearly 40 years ago to prevent hospitals from denying treatment to patients simply because they cannot pay. It requires hospitals to stabilize any patient experiencing a medical emergency before they can be transferred or discharged.

The regulation has generally been interpreted to require hospitals to provide an abortion when it is the necessary stabilizing treatment. Hospitals have been sued in the past for violating EMTALA for failing to provide a medically necessary abortion.

But that was before the Roe v. Wade ruling was overturned in 2022. Now, more than a dozen states, including Texas, have banned nearly all abortions with only a few exceptions to save the life of the pregnant patient.

The Biden administration issued a directive to hospitals in 2022 that requires doctors to perform an abortion if they believe it is necessary to stabilize a patient’s emergency medical condition.

“If a state law prohibits abortion and does not provide an exception for the life of the pregnant person – or the exception is narrower than the definition of a medical emergency in EMTALA – then that state law is overridden,” the policy states.

Texas sued the Biden administration, arguing that the guidelines were an attempt to “force hospitals and doctors to commit crimes.” Trump-appointed U.S. District Judge Wesley Hendrix, who hears nearly all of the lawsuits filed in Lubbock, sided with the state, ruling that the guidelines “go far beyond the text of EMTALA.”

The 5th U.S. Circuit Court of Appeals in New Orleans agreed, ruling in effect that Texas hospitals cannot be required to perform life-saving abortions under EMTALA.

That ruling remains in effect even after the Supreme Court ruled in a separate EMTALA case involving Idaho’s abortion ban. In that case, the Supreme Court rejected Idaho’s arguments on procedural grounds, not on the merits.

These new complaints in federal court will likely re-open the question of whether hospitals can be held liable for failing to perform medically necessary abortions to stabilize a patient. Hospitals facing complaints under EMTALA will be investigated and may face disciplinary action ranging from citations to fines, up to and including loss of the ability to accept Medicare and Medicaid, which is effectively a death sentence for a hospital.

While Texas abortion laws allow doctors to terminate ectopic pregnancies, they are not legally required to do so.

“It is impossible to keep the patient’s best interests in mind when facing a life sentence,” said Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights, in a statement. “The Texas authorities have placed doctors in an impossible situation. It is clear that these exceptions are a travesty and that these laws put countless lives at risk.”