Zurawski v. State of Texas
This case seeks to clarify the scope of Texas's “medical emergency” exception under its state abortion bans.
On March 6, 2023, the Center for Reproductive Rights filed a groundbreaking lawsuit asking the state of Texas to clarify the scope of their abortion bans’ “medical emergency” exception. The Center is representing five women who were denied abortion care in Texas after facing severe and dangerous pregnancy complications, as well as two obstetrician-gynecologists who have been unable to provide care to their patients because of Texas’s bans.
The case, filed in state court in Austin, is the first lawsuit brought on behalf of women denied abortions since the U.S. Supreme Court eliminated the constitutional right to abortion in June 2022.
Texas has three state laws banning abortion:
- A trigger ban, which outlaws abortion entirely;
- S.B. 8, the “vigilante” ban that prohibits abortion after about six weeks of pregnancy; and
- A pre-Roe criminal ban that several courts have determined to be implicitly repealed.
While the laws contain an exception for the life and health of the pregnant person, Texas’s hostile abortion landscape has made physicians afraid to rely on the exception. These extreme bans criminalizing abortion have stoked fear and confusion among pregnant people and doctors throughout the state.
The Center argues that Texas’s abortion bans contain conflicting language and non-medical terminology, making it unclear when physicians are permitted to provide care under the laws’ “medical emergency” exception. The state has also failed to provide any guidance to doctors on this issue, despite repeated requests.
Physicians found to have violated Texas’s abortion laws face fines of at least $100,000, up to 99 years in prison, and revocation of their state medical licenses. Such legal risks, combined with the bans’ unclear language, are deterring Texas physicians from providing their patients with abortion care— a necessary, life-saving procedure crucial for treating many dangerous pregnancy conditions to their patients. As a result, patients in Texas have experienced severe physical harm and mental anguish.
The two physician plaintiffs in the case—both board-certified ob-gyns—joined the lawsuit because the Texas bans prevent them from meeting their ethical obligations as physicians and providing the medical care their patients need.
The Center’s lawsuit asks the court to clarify Texas’s abortion bans by creating a binding interpretation of the laws’ “medical emergency” exception. The Center argues that the court’s interpretation should allow physicians to exercise their good-faith judgment regarding what patients qualify under medical exceptions, rather than allowing politicians and state officials to make those decisions.
The Center also argues that the threatened enforcement of Texas’s bans against pregnant people suffering from dangerous medical conditions and the physicians that treat them violates the Texas Constitution’s guarantees to life, liberty, and equality.
About the Plaintiffs: Texas Women Facing Severe Pregnancy Complications
The stories of these five women denied abortion care in the case exemplify the threats Texas’s bans pose to pregnant people’s lives and make clear that Texans in obstetrical emergencies are not getting the care they need:
- Amanda Zurawski, from Austin, lead plaintiff in the case, was denied abortion care after she experienced preterm pre-labor rupture of membranes (PPROM) at 18 weeks of pregnancy. She was seen at a Catholic hospital in Austin, where she was denied an abortion because her doctors could still detect fetal cardiac activity. Three days later, she showed signs of infection and was diagnosed with sepsis, a life-threatening condition. Although doctors then performed an emergency induction abortion, she spent the next three days in the ICU fighting for her life. She ultimately survived, but the infection caused one of her fallopian tubes to become permanently closed, compromising her future ability to have children. She has been forced to turn to in vitro fertilization (IVF) in attempt to start a family.
- Lauren Miller, from Dallas, was hospitalized at eight weeks of pregnancy for severe nausea, vomiting, and dehydration, and was diagnosed with hyperemesis gravidarum—a condition posing significant risks to the patient and her pregnancy. She also learned at that time she was pregnant with twins. But at 12 weeks, Lauren learned that one of her twins had trisomy 18—a condition that causes multiple structural abnormalities and makes the fetus unlikely to survive to birth. Due to Texas’s abortion bans, doctors denied Lauren a fetal reduction abortion procedure, despite it being necessary to give Lauren and the second fetus the best chance of survival. After being again hospitalized for hyperemesis gravidarum at 15 weeks, she traveled out of state to Colorado to obtain the fetal reduction abortion. Lauren has recovered and is expecting to give birth this month.
- Lauren Hall, from outside of Dallas, discovered at 18 weeks pregnant that her fetus had anencephaly, a condition which prevents fetuses from developing a skull. Her fetus had no chance of survival and continuing the pregnancy posed severe risks to her, including hemorrhage and pre-term birth. Although Lauren wanted an abortion, her obstetrician refused to provide one or to help in any way. In addition, her medical specialist was afraid to give her a referral for an abortion out of state and refused to even send her medical records. Lauren was forced to travel out of state to obtain an abortion at a clinic outside of Seattle. She is now pregnant again, due in September but scared to be pregnant under the state’s laws.
- Anna Zargarian, from Austin, Texas, was 19 weeks pregnant when her water broke and she began cramping. In the emergency room, doctors told Anna there was no chance that her baby would survive and that based on her condition, she was at risk of infection, hemorrhage, and sepsis. Anna was told that she needed an abortion but could not get one in Texas and would need to leave the state. Anna decided to fly to Colorado for an abortion, despite her fear of going into labor on the way. While she still wants to have children, she is afraid to go through pregnancy again in Texas.
- Ashley Brandt, from Dallas, was pregnant with twins but at 12 weeks, learned that one of the twins had acrania—and the longer she stayed pregnant with both twins, the less likely it was that both would survive the pregnancy. Ashley’s doctors told her that because of S.B. 8, she would need to go out of state to obtain a fetal reduction abortion procedure, which she traveled to Colorado to obtain. Back in Texas after her procedure, her doctors were reluctant to acknowledge that she’d had an abortion. For the remainder of her pregnancy, until she gave birth to a full term, healthy baby, Ashley remained terrified for her life and that of her baby.
About the Plaintiffs: Physicians
- Dr. Damla Karsan provides gynecological care, prenatal care, and obstetric care as part of her Houston-based practice. Before Texas’s S.B. 8 law, she provided abortions to her patients in need of such care, but since the law took effect in 2021, she has been unable to provide the care they need. Dr. Karson joined this lawsuit to speak on behalf of other physicians who she knows are afraid to speak out for fear of retaliation.
- Dr. Judy Levison is a faculty member at a medical school in the Houston area. Since S.B. 8 took effect, she has seen how widespread fear and confusion regarding the scope of Texas’s abortion bans have chilled the provision of necessary obstetric care, including abortion care. Dr. Levison partially retired from the practice of medicine in 2022 following the overturning of Roe v. Wade, feeling she could no longer practice medicine the way she was trained and consistent with her ethical obligations as a physician.
Plaintiffs: Amanda Zurawski; Lauren Miller; Lauren Hall; Anna Zargarian; Ashley Brandt; Damla Karsan, M.D.; Judy Levison, M.D., M.P.H.
Center Attorneys: Molly Duane, Nicolas Kabat, Marc Hearron
Co-Counsel/Cooperating Attorneys: Jamie A. Levitt, J. Alexander Lawrence, and Aditya V. Kamdar of Morrison & Foerster LLP, and Austin Kaplan of Kaplan Law Firm
- Complaint, 03.06.23