Complaints Against Texas Hospitals for Denying Emergency Care for Ectopic Pregnancies

On August 6, 2024, the Center for Reproductive Rights filed administrative complaints with the U.S. Department of Health and Human Services (HHS) against two Texas hospitals—Texas Health Arlington Memorial Hospital and Ascension Seton Williamson Hospital—on behalf of two woman denied abortion care despite experiencing life-threatening ectopic pregnancies.

The Center’s complaints allege that in refusing to provide the care the patients needed, the hospitals violated the Emergency Medical Treatment and Active Labor Act (“EMTALA”), a federal law requiring hospital emergency departments to provide “stabilizing treatment” to patients experiencing an emergency health condition.

The filings seek to ensure that Texas hospitals provide emergency abortion care for pregnant people in such dire situations. 

EMTALA mandates that hospitals conduct an examination to determine whether an emergency medical condition exists, and if so, “provide treatment as may be required to stabilize the medical condition” or transfer the individual to another medical facility after the patient is stabilized. If the individual is not stabilized, EMTALA notes, the hospital may only transfer the patient if the individual requests the transfer or if the medical benefits of the transfer outweigh the risks.

HHS issued guidance on July 11, 2023, emphasizing that even in states with abortion bans, hospitals are legally required to meet their obligations under EMTALA. Under the law, HHS can levy fines, withdraw federal funding and require remedial action by the hospital.

In an ectopic pregnancy, a fertilized egg implants in a location other than inside the uterus, leaving the pregnancy with no chance of survival. If not treated promptly, an ectopic pregnancy can be deadly for the pregnant patient.  

The Center’s clients, Kelsie Norris-De La Cruz and Kyleigh Thurman, nearly died and suffered permanent damage to their reproductive organs after they were refused emergency treatment for their ectopic pregnancies.

Although abortion is illegal in Texas, providing an abortion in cases of ectopic pregnancies is explicitly allowed under state law. But even when patients’ lives and health are endangered, doctors and hospitals have been fearful of providing abortion care because of the risk of serious criminal and civil penalties. Under the state’s abortion bans, doctors face up to 99 years in prison, loss of medical license, and at least $100,000 in fines for providing care.  

Both Thurman and Norris-De La Cruz had tubal ectopic pregnancies—in which a fertilized egg implants in a fallopian tube instead of the uterus.  The condition—which leaves the pregnancy with no chance of survival—can cause the fallopian tube to rupture, which can cause major internal bleeding and even death. A patient who is near rupture needs immediate treatment to preserve reproductive organs and protect the life and health of the patient.

Kelsie Norris-De La Cruz, of the Dallas-Fort Worth area, sought treatment at Texas Health Arlington Memorial Hospital.  Against the recommendation of an emergency room physician, and with the explicit acknowledgement that Norris-De La Cruz’s fallopian tube may rupture, the hospital discharged her without treating her condition or transferring her to another facility.

Hours later, Norris-De La Cruz sought a second opinion from another OB-GYN who easily diagnosed the ectopic pregnancy and rushed her into emergency surgery to save her life. She lost one of her fallopian tubes, leaving her future fertility compromised.

Read more about Kelsie Norris-De La Cruz’s story here.

Kyleigh Thurman, of Burnet, Texas, sought treatment at Ascension Seton Williamson Hospital. It discharged her without treating her ectopic pregnancy or transferring her to another facility. Days later, she returned to the hospital because she continued to experience vaginal bleeding. Even though her OB-GYN concluded she had an ectopic pregnancy, and an attending hospital physician concluded her symptoms were those of an ectopic pregnancy, the hospital again refused to treat her. Not until her OB-GYN pleaded to hospital staff to give her care did the hospital finally treat her to save her life.

But the care came too late, and Thurman’s ectopic pregnancy ruptured. She, too, lost one of her fallopian tubes, leaving her future fertility compromised.  

Read more about Kyleigh Thurman’s story here. 

Relief Requested

Kelsie Norris-De La Cruz and Kyleigh Thurman, in separate complaints, request that the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) and/or HHS Office of Inspector General (OIG):

• Conduct an independent investigation of the hospital for EMTALA violations arising from their refusal to provide her with necessary stabilizing treatment to preserve her life, health, bodily functions, and bodily organs;
• Take all necessary steps to remedy all unlawful conduct identified in its investigation, including by imposing all appropriate penalties;
• Monitor any resulting agreements between CMS and the hospital to ensure compliance with EMTALA; and
• Provide other appropriate equitable relief.

Ectopic Pregnancy Is the Leading Cause of Maternal Deaths in the First Trimester   

Since the U.S. Supreme Court eliminated the constitutional right to abortion in 2022, there have been numerous reports of delays and denials of pregnancy-related care in emergency rooms in states with abortion bans, even for care that is technically legal under state law.  

Due to fear of prosecution, in cases of ectopic pregnancies, doctors are delaying care, forcing patients to wait days or weeks and to undergo additional testing to confirm and reconfirm the diagnosis to ensure the treatment would not be considered a prohibited abortion. Such delays in care can threaten patients’ lives, since ectopic pregnancy is life-threatening and requires immediate treatment.  

Nationwide, ectopic pregnancy is the leading cause of maternal mortality in the first trimester, accounting for up to 10% of all pregnancy-related deaths. In 2022, most pregnancy-related deaths in Texas were due to hemorrhage, and the most common cause of hemorrhage was ruptured ectopic pregnancy.

Center Attorneys: Molly Duane, Astrid Marisela Ackerman

Documents:

• Administrative Complaint Against Texas Health Arlington Memorial Hospital, 08.06.24
• Administrative Complaint Against Ascension Seton Williamson Hospital, 08.06.24

August 06, 2024

The Center files administrative complaints with the U.S. Department of Health and Human Services alleging that Texas Health Arlington Memorial Hospital and Ascension Seton Williamson Hospital violated the Emergency Medical Treatment and Active Labor Act (“EMTALA”).

• “Center Files Complaints Against Texas Hospitals for Denying Women Emergency Care for Life-Threatening Ectopic Pregnancies,” 08.12.24
• “Dozens of pregnant women being turned away from ERs despite law,” AP News, 08.12.24

The Center for Reproductive Rights is dedicated to helping all people access abortion. If you have been denied care while facing pregnancy complications and want to speak to a lawyer about your options, please reach out to [email protected].