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No bans. No barriers. JUST REPRODUCTIVE FREEDOM.
We're fighting for abortion access, for all, everywhere.
This groundbreaking case sought to clarify the scope of Texas’s medical emergency exception under its extreme abortion bans.
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Texas has three different abortion bans: a total ban, a six-week ban, and a pre-Roe criminal ban (unenforced but still on the books).
$100,000
Doctors who violate Texas’s abortion bans face fines of at least $100,000, up to 99 years in prison, and revocation of their state medical licenses.
22
This case originally had seven plaintiffs, but with an increasing number of Texans denied abortion care, that number later grew to 22.
Amanda Zurawski, from Austin, Texas, was 18 weeks pregnant when her water suddenly broke. At the doctor, Amanda received tragic news: her daughter would not survive.
But although staying pregnant put Amanda at risk of infection, hospital staff refused to give her an abortion for days because of Texas’s extreme abortion bans. Though the bans include an exception for the sake of the pregnant person’s life and health, they use confusing, non-medical language and threaten doctors with steep penalties that deter them from providing necessary, life-saving care.
Amanda was eventually able to have an abortion, but only after developing a life-threatening case of sepsis—permanently closing one of her fallopian tubes and compromising her ability to have children in the future.
The Center for Reproductive Rights filed this groundbreaking case March 6, 2023, seeking to clarify the scope of the “medical emergency” exception to Texas’s abortion bans. Originally filed on behalf of Amanda Zurawski, four other Texas women denied emergency abortion care, and two obstetrician-gynecologists, the case later grew to include 22 total plaintiffs.
On May 31, 2024, the Texas Supreme Court ruled in the case, refusing to clarify the abortion ban exceptions.
Currently, 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.
A pre-Roe criminal ban, which is not enforced and several courts have determined to be implicitly repealed.
These bans contain an exception to protect the pregnant person’s life and health. But thanks to Texas’s hostile abortion landscape, doctors are afraid to rely on that exception. If a doctor violates the ban, they face fines of at least $100,000, up to 99 years in prison, and revocation of their state medical license.
Combined with the bans’ unclear language, those legal risks deter Texas doctors from providing abortion care—a necessary, life-saving procedure crucial for treating many dangerous pregnancy conditions.
As a result, many pregnant patients in Texas have experienced severe physical harm and mental anguish, including the plaintiffs in this case.
Filed in state court in Austin on March 6, 2023, Zurawski v. State of Texas was 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.
In addition to the women denied abortion care, the case included two physician plaintiffs, both board-certified OB-GYNs. These doctors joined the lawsuit because the Texas bans prevented them from meeting their ethical obligations and providing necessary medical care.
The case asked the court to clarify Texas’s abortion bans by creating a binding interpretation of their “medical emergency” exception.
It argued that:
Texas’s bans contain conflicting language and non-medical terminology, making it unclear when the “medical emergency” exception applies. Despite repeated requests, the state failed to provide any guidance to doctors.
The court should allow doctors to use their good-faith judgment to determine which patients qualify under medical exceptions, rather than allowing politicians and state officials to make those decisions.
Threatening to enforce the bans against pregnant people suffering from dangerous medical conditions—and the physicians that treat them—violates the Texas
As a human being and a patient, I felt like I had no choice during this nightmare. What I needed most in that moment was the choice Texas lawmakers robbed me of—the choice to lose my child with dignity.
After plaintiffs testified at a state court hearing from July 19-20, 2023, a Texas district judge issued an injunction August 4, 2023, blocking Texas’s abortion bans as they apply to dangerous pregnancy complications.
The ruling clarified that doctors could use their own medical judgment to determine when to provide abortion care in emergency situations. It also denied the state’s request to throw out the case, and it found S.B. 8—Texas’s citizen-enforced abortion ban—unconstitutional.
The judge recognized in her ruling that the women who brought this case should have been given abortions.
But the state immediately appealed the ruling to the Texas Supreme Court, blocking it from taking effect.
After hearing oral arguments on November 28, 2023, the Texas Supreme Court ruled in this case on May 31, 2024, refusing to clarify the exceptions to the state’s abortion bans.
Largely ignoring the experiences of the plaintiffs denied abortion care, the ruling:
Said that abortions are not allowed when the fetus has a lethal condition and will not survive—unless the pregnant patient also has a life-threatening condition.
Dismissed claims that the bans violate patients’ constitutional rights to protect their lives and health.
Clarified that exceptions can be made for life-threatening conditions such as preterm premature rupture of membranes (PPROM)—but refused to say when, in the course of a patient’s deteriorating health situation, the exception would apply.
“This outrageous ruling clearly demonstrates that Texas’s ‘medical exceptions’ to its extreme abortion bans just don’t work,” said Molly Duane, senior staff attorney at the Center. “This ruling means that pregnant Texans will continue to suffer because they can’t access the medical care they desperately need.”
“We are enormously proud of the women in this case who stood up to Texas’ unjust law,” said Nancy Northup, the Center’s President and CEO. “We will continue to pursue every available legal avenue to address the suffering happening in Texas.”
We are the faces of women across the country who are standing up and demanding to be heard. It is not the last that you will be hearing from us in this fight for justice.
Plaintiffs: Patients Amanda Zurawski, Lauren Miller, Lauren Hall, Anna Zargarian, Ashley Brandt, Kylie Beaton, Jessica Bernardo, Samantha Casiano, Austin Dennard, D.O., Taylor Edwards, Kiersten Hogan, Lauren Van Vleet, Elizabeth Weller, Kristen Anaya, Kaitlyn Kash, D. Aylen, Kimberly Manzano, Danielle Mathisen, M.D., Cristina Nuñez, and Amy Coronado; and health care providers Damla Karsan, M.D. and Judy Levison, M.D., M.P.H. Center Attorneys: Molly Duane, Nicolas Kabat, Marc Hearron, Astrid Ackerman 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
Ahead of the oral arguments on November 28, 2023, a broad range of experts filed amicus (“friend of the court”) briefs with the Texas Supreme Court in support of the Center and its plaintiffs.
Lead plaintiff Amanda Zurawski, from Austin, experienced preterm pre-labor rupture of membranes (PPROM) at 18 weeks pregnant. For three days, doctors refused her an abortion, saying they could still detect fetal cardiac activity. After Amanda was diagnosed with sepsis and finally received abortion care, she spent the next three days in the ICU fighting for her life. The infection permanently closed one of her fallopian tubes, compromising her ability to have children.
Lauren Miller, from Dallas, learned she was pregnant with twins at eight weeks, after being hospitalized with hyperemesis gravidarum (severe morning sickness). 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. A fetal reduction abortion procedure would give both Lauren and the second fetus the best chance of survival, but doctors refused to provide it. After being hospitalized again for hyperemesis gravidarum at 15 weeks, she traveled out of state to Colorado for the procedure.
Lauren Hall, from outside of Dallas, discovered at 18 weeks pregnant that her fetus had anencephaly—a condition that 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. But although Lauren wanted an abortion, her doctors refused to help even with a referral. Lauren was forced to travel to Washington for abortion care.
Anna Zargarian, from Austin, Texas, was 19 weeks pregnant when her water broke. Emergency room doctors told Anna there was no chance that her baby would survive, and that without abortion care, she was at risk of infection, hemorrhage, and sepsis—but to get an abortion, she would need to leave the state. Anna was eventually forced to travel to Colorado for care, scared she would go into labor on the way.
Ashley Brandt, from Dallas, was 12 weeks pregnant with twins when she learned that one of the twins had acrania. The longer she stayed pregnant with both twins, the less likely it was that both would survive. Ashley’s doctors told her she would need to go out of state for a fetal reduction abortion procedure. She traveled to Colorado for the procedure, but even when she returned, her doctors didn’t want to acknowledge that she’d had an abortion. For the rest of her pregnancy, Ashley remained terrified for her life and her baby’s.
Physician Plaintiffs
Dr. Damla Karsan provides gynecological care, prenatal care, and obstetric care as part of her Houston-based practice. She has been unable to provide abortion care since Texas’s S.B. 8 law took effect in 2021. 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 about the scope of Texas’s abortion bans have caused a chilling effect on care. Dr. Levison partially retired from medicine after Roe v. Wade was overturned, feeling she could no longer practice medicine consistent with her training and ethical obligations
Dr. Austin Dennard is a board-certified OB-GYN who lives with her family in Dallas. When Dr. Dennard was 11 weeks pregnant, she found out that her baby had anencephaly, a lethal condition. Sadly, Dr. Dennard had been through this before when her first pregnancy was diagnosed with a rare genetic condition. But while she could previously get abortion care from a clinic at home, Texas’s new bans forced her to travel out of state. Dr. Dennard joined this case as a patient plaintiff after learning that her patient Lauren Miller went through the same experience she had.
Kylie Beaton, who lives in Fort Worth with her family, learned at her 20-week scan that her baby had a fatal condition, alobar holoprosencephaly, in which the brain does not develop normally and the head grows abnormally quickly. She tried to get an abortion in New Mexico, but the clinic turned her away because the baby’s head was already measuring close to 24 weeks. At 28 weeks, she begged to be induced before the baby’s head grew too large to deliver vaginally, but her doctors refused due to Texas’s abortion bans. She had an emergency Cesarean at 35 weeks, and her baby died four days later. Kylie said that having to go through the birth and death of her son made losing him much harder.
Jessica Bernardo, from Frisco, learned at 14 weeks pregnant that her daughter had several fatal medical conditions, including fetal anasarca. If Jessica continued the pregnancy, she would risk developing a fatal condition herself. After the hospital ethics committee denied her doctor’s request to provide an abortion, Jessica told her doctor that her family had a residence in Colorado and asked if they should go there, using what felt like coded language. Her doctor agreed, but the clinics in Colorado were all booked, and Jessica was eventually forced to get care in Seattle. Jessica describes this experience as the worst trauma of her life.
Samantha Casiano, who lives in East Texas with her family, learned at her 20-week scan that her baby had anencephaly and would not survive. Since she lacked the time, finances, or resources to travel out of state, her doctor said she had no option but to continue with the pregnancy. For months, she faced the pain of strangers’ congratulations and worried about how to afford a funeral for her daughter. Samantha’s daughter died four hours after birth. She wished she had been able to put her daughter to rest earlier, since she was going to have to rest either way.
Taylor Edwards, from Austin, learned at 17 weeks pregnant that her daughter had a fatal condition called encephalocele. Continuing the pregnancy posed risks to Taylor, too. Despite the daunting logistics and cost, Taylor decided to travel to New Mexico for abortion care—but three hours before her flight, the clinic canceled her appointment. Unable to find other appointments in New Mexico, Taylor grew terrified that she would soon be too far along for an abortion. Eventually, she was able to get care at a Colorado clinic. She returned home feeling she was back at square one with IVF, and she fears being pregnant again in Texas.
Kiersten Hogan, of the Dallas-Fort Worth area, had just left her abusive boyfriend and moved to Texas when her water suddenly broke. Diagnosed with cervical insufficiency, she was forced to stay in the hospital against her will, where religious counselors repeatedly came to visit her and staff told her that if she tried to leave, it could be used as evidence that she was trying to kill her baby. Four days later, Kiersten delivered her son stillborn. She says being detained against her will made her feel like a criminal during the biggest medical emergency of her life.
Lauren Van Vleet learned at 22 weeks pregnant that her son had anencephaly and would not survive. Due to Texas’ laws, her doctor said there was nothing she could do but wait for the baby’s heart to stop beating or carry the pregnancy to term. When she began searching for out-of-state abortion appointments, Lauren was 23 weeks pregnant, concerned she was already too far along, and terrified of legal liability. Thanks to support from family members, she was able to have an abortion in Maryland at 24 weeks. She still wants children but is afraid to be pregnant again in Texas.
Elizabeth Weller, of Kingwood, Texas, was 19 weeks pregnant when her water broke. Her baby would not survive, and continuing the pregnancy would risk her fertility and life—but hospital staff refused her an abortion because she had already been prescribed antibiotics, which they said put her in a “legal gray area.” Her only options were to stop taking the antibiotics and stay in the hospital—or go home, watch for signs of worsening infection, and wait for her baby to die inside her. After she developed an infection called chorioamnionitus, a medical board finally approved an abortion. Elizabeth’s experience made her feel like she was being punished by the state of Texas for losing a wanted pregnancy.
Kristen Anaya, of the Dallas-Fort Worth area, was 16½ weeks pregnant when her water broke. At the hospital, she developed a fever and uncontrollable shaking—early signs of sepsis—but was denied abortion care because her daughter still had a heartbeat. Over the next 22 hours, her condition worsened until the hospital finally granted her doctor permission to provide an abortion. Kristen’s symptoms began to subside immediately after the procedure, and she spent five days in the hospital recovering.
Kaitlyn Kash, of Austin, discovered at 13 weeks pregnant that her baby had severe skeletal dysplasia and would not survive. Her doctor advised her to seek care outside Texas, so she traveled to Kansas for an abortion, where she was harassed by protestors. During a subsequent pregnancy, Kaitlyn had a miscarriage, but she struggled to access the medication her doctor prescribed to manage it because the drug is also used in medication abortion. After she gave birth to her daughter in 2023, she needed a dilation and curettage (D&C) procedure to remove placental tissue, but the hospital couldn’t find equipment and staff in time—landing Kaitlyn in the ICU. She was later told she was lucky she hadn’t lost her uterus.
D. Aylen, of San Antonio, learned at 19 weeks pregnant that her baby had anencephaly. Hoping to prevent more suffering for herself and her baby, D. called out-of-state abortion clinics—most of which had four- to eight-week wait times—and eventually had an abortion in San Diego. Losing her child and being forced to travel to California to obtain health care was one of the worst moments of D.’s life.
Kimberly Manzano, of the Dallas-Fort Worth area, learned at 10 weeks pregnant that many of her baby’s organs were not developing properly and that the baby had little to no chance of survival. Her doctor warned that continuing the pregnancy could put her at risk of infection and urged her to seek abortion care out of state. At 18 weeks, Kimberly traveled to New Mexico for an abortion. Though she and her husband are devout Christians who always considered themselves anti-abortion, it was clear to them that abortion was their only option. Kimberly now believes it is not her place to judge someone else’s decision about their pregnancy.
Dr. Danielle Mathisen, formerly of the Fort Worth area, was 18 weeks pregnant when she received several lethal fetal diagnoses. Dr. Mathisen’s doctor—who is also her aunt—said she couldn’t help her and advised her to go on a “vacation” out of state. Shocked that she couldn’t openly discuss abortion with her own family member due to Texas’s bans, Dr. Mathisen traveled to New Mexico for abortion care. She has since moved to Hawai’i, where abortion is legal.
Cristina Nuñez, of El Paso, has several medical conditions—including diabetes, cardiovascular issues, and end-stage renal disease—and was advised by doctors never to become pregnant. But when Cristina discovered she was six weeks pregnant and asked her OB-GYN for an abortion, she never heard back. A New Mexico clinic also refused to help, saying Cristina’s medical conditions made her ineligible for medication abortion but that she was too early in pregnancy for a surgical abortion. Cristina’s health rapidly deteriorated and her arm turned black due to blood clotting issues, but the emergency room again refused her care. Cristina had to wait 11 days and contact an organization for legal support and translation services (since she does not speak English) before she was finally able to get a life-saving abortion.
Amy Coronado, of Houston, was several months pregnant when she learned that her daughter had a brain condition, alobar holoprosencephaly, and would likely not survive. If Amy continued the pregnancy, she would face risks to her own health. Because Amy received her fetal diagnosis the same day Texas’s trigger ban took effect, her doctor couldn’t refer her for an abortion, forcing her to travel out of state to New Mexico. Her insurance would not cover the out-of-state abortion and she had to pay out of pocket for the procedure and travel expenses. She fears for her health and safety if she gets pregnant again in Texas.
The Center files a groundbreaking lawsuit asking the state of Texas to clarify the scope of the “medical emergency” exceptions under its abortion bans. Women denied abortions sue Texas
March 22, 2023
Center files amended complaint
The Center files an amended complaint in the case, adding eight new plaintiffs and requesting the court grant a temporary injunction to block Texas’s abortion bans as they apply to pregnancy complications while the case proceeds. Center files amended complaint
July 12, 2023
Texas files motion to dismiss case
The state of Texas files a motion to dismiss the case.
July 19, 2023
State Court hearing begins
Two-day hearing begins in a Texas state court in Austin on the plaintiffs’ request to temporarily block the bans and on the state’s request to dismiss the case. Five plaintiffs testify, along with two experts in obstetrics and emergency medicine. State Court hearing begins
August 4, 2023
District Court clarifies exceptions; Texas appeals
A Texas district judge issues an injunction blocking Texas’s abortion bans as they apply to dangerous pregnancy complications, clarifying that doctors can use their own medical judgment to provide emergency abortions. The ruling also denies the state’s request to throw out the case and finds S.B. 8—Texas’s citizen-enforced abortion ban—unconstitutional. The state of Texas immediately appeals the ruling. District Court clarifies exceptions; Texas appeals
The Texas Supreme Court rules in the case, refusing to clarify the exceptions to the state’s abortion bans and rejecting claims brought by the plaintiffs denied abortions. Texas Supreme Court rules against plaintiffs
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