Ensuring Texas Hospitals Provide Emergency Care for Ectopic Pregnancies
This case ensures Texas hospitals provide emergency abortion care as mandated under the Emergency Medical Treatment and Active Labor Act (EMTALA).
Update: In May 2025, the Department of Health and Human Services notified Kyleigh Thurman that it had cited the Texas hospital for violating EMTALA.
SummaryOn 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.
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].   
What is EMTALA?What is EMTALA?
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.
Ectopic pregnancyEctopic pregnancy
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.
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.
About the plaintiffsAbout the plaintiffs
About the case
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.
About the ruling
On May 8, 2025, the Department of Health and Human Services notified Kyleigh Thurman that it had cited the Ascension Seton Williamson Hospital for violating EMTALA when it refused to provide her care for her ectopic pregnancy.
The complaint filed for Kelsie Norris-De La Cruz is still pending.
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