Texas Senate Bill 31 looks to eliminate emergency abortion 'loopholes'
Texas lawmakers present a trio of abortion bills to strengthen abortion laws and clear up what is constituted as a medical emergency.
Senate Bill 31 is intended to protect doctors who perform abortions in cases of medical emergencies.
Lawmakers debate Senate Bill 33 and Senate Bill 28-80 to close any potential loopholes that cities have exploited by using public funds to support out-of-state abortion travel.
Texas lawmakers took up a trio of bills that aim at strengthening some of the strictest abortion laws in the nation.
But one bill is intended to clarify when doctors can perform an abortion during an emergency — a situation some doctors say has been murky.
What we know
When the Texas Heartbeat Act was established in 2021, medical professionals across the lone-star state claimed it muddied the waters on what constituted a medical emergency, allowing an abortion to be performed, legally, and without repercussions.
Senate Bill 31, dubbed the "Life of the Mother Act", seeks to get clinicians on the same page.
It also comes after the news outlet Propublica reported on three Texas women, including 28-year-old Josseli Barnica, who died after not receiving critical care during miscarriages.
Dig deeper
Also in committee on Thursday, was Senate Bill 33 and Senate Bill 28-80 were debated.
SB 33 is to close "loopholes" that supporters say some cities have exploited using public funds to support out-of-state abortion travel.
"SB 33 bans the logistical support, which includes child care, transportation to or from abortion providers, lodging and meals. Overall, Senate Bill 33 ensures that, local governments comply with Texas pro-life laws," said State Senator, Donna Campbell of Texas District 25.
This would implement criminal penalties for people and organizations who fund others' abortions. It also aims to crack down on those who mail abortion-inducing medications into the state.
What they're saying
"The intent of this bill is to remove any excuse from a doctor or a hospital treating a mom, for example, with an ectopic pregnancy, or a mom who's suffered a miscarriage or situations like that. To remove any question, any hesitation," said State Senator, Bryan Hughes of Texas District 1.
"This will protect doctors and civil suits. It will protect them in criminal prosecution as well as any discipline from the medical board," said Texas Right to Life President, Dr. John Seago.
The other side
Reaction to the bills are drawing swift criticism from many women's health advocacy groups.
"This is more about control than it is about protecting people or protecting their health or protecting life," said Denise Rodriguez of the Texas Equal Access fund.
Rodriguez works for Texas Equal Access Fund, an organization funded through private donors which helps Texas women get access to abortions in other states.
Under the new legislation, she and her group could be prosecuted.
"Anybody who is thought to have helped somebody access care… like somebody who gave somebody a ride to the airport, somebody who helped them pay for the procedure or facilitated in some way," said Rodriguez.
She accuses some lawmakers of intentionally "disguising" pieces of the legislation to avoid a bigger fuss.
"It is a political Trojan horse. It's being marketed as a way to provide clarity for physicians and hospitals to be able to provide emergency medical care for pregnant Texans who are facing emergencies. But it doesn't do that," said Rodriguez.
What's next
The timeline is unclear about when the trio of bills will be voted on or whether there's any indication they'd then pass the house.
The Source
Information in this article is provided by the Texas Senate Committee on State Affairs and previous FOX 4 coverage.
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CNN
2 days ago
- CNN
RFK Jr. wants to change a program that stopped vaccine makers from leaving the US market. They could flee again.
This story originally appeared on ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive their biggest stories as soon as they're published. Five months after taking over the federal agency responsible for the health of all Americans, Robert F. Kennedy Jr. wants to overhaul an obscure but vital program that underpins the nation's childhood immunization system. Depending on what he does, the results could be catastrophic. In his crosshairs is the Vaccine Injury Compensation Program, a system designed to provide fair and quick payouts for people who suffer rare but serious side effects from shots — without having to prove that drugmakers were negligent. Congress created the program in the 1980s when lawsuits drove vaccine makers from the market. A special tax on immunizations funds the awards, and manufacturers benefit from legal protections that make it harder to win big-money verdicts against them in civil courts. Kennedy, who founded an anti-vaccination group and previously accused the pharmaceutical industry of inflicting 'unnecessary and risky vaccines' on children for profits, has long argued that the program removes any incentive for the industry to make safe products. In a recent interview with Tucker Carlson, Kennedy condemned what he called corruption in the program and said he had assigned a team to overhaul it and expand who could seek compensation. He didn't detail his plans but did repeat the long-debunked claim that vaccines cause autism and suggested, without citing any evidence, that shots could also be responsible for a litany of chronic ailments, from diabetes to narcolepsy. There are a number of ways he could blow up the program and prompt vaccine makers to stop selling shots in the U.S., like they did in the 1980s. The trust fund that pays awards, for instance, could run out of money if the government made it easy for Kennedy's laundry list of common health problems to qualify for payments from the fund. Or he could pick away at the program one shot at a time. Right now, immunizations routinely recommended for children or pregnant women are covered by the program. Kennedy has the power to drop vaccines from the list, a move that would open up their manufacturers to the kinds of lawsuits that made them flee years ago. Dr. Eddy Bresnitz, who served as New Jersey's state epidemiologist and then spent a dozen years as a vaccine executive at Merck, is among those worried. 'If his unstated goal is to basically destroy the vaccine industry, that could do it,' said Bresnitz, who retired from Merck and has consulted for vaccine manufacturers. 'I still believe, having worked in the industry, that they care about protecting American health, but they are also for-profit companies with shareholders, and anything that detracts from the bottom line that can be avoided, they will avoid.' A spokesperson for PhRMA, a U.S. trade group for pharmaceutical companies, told ProPublica in a written statement that upending the Vaccine Injury Compensation Program 'would threaten continued patient access to FDA approved vaccines.' The spokesperson, Andrew Powaleny, said the program 'has compensated thousands of claims while helping ensure the continued availability of a safe and effective vaccine supply. It remains a vital safeguard for public health and importantly doesn't shield manufacturers from liability.' Since its inception, the compensation fund has paid about $4.8 billion in awards for harm from serious side effects, such as life-threatening allergic reactions and Guillain-Barré syndrome, an autoimmune condition that can cause paralysis. The federal agency that oversees the program found that for every 1 million doses of vaccine distributed between 2006 and 2023, about one person was compensated for an injury. Since becoming Health and Human Services secretary, Kennedy has turned the staid world of immunizations on its ear. He reneged on the U.S. government's pledge to fund vaccinations for the world's poorest kids. He fired every member of the federal advisory group that recommends which shots Americans get, and his new slate vowed to scrutinize the U.S. childhood immunization schedule. Measles, a vaccine-preventable disease eliminated here in 2000, roared back and hit a grim record — more cases than the U.S. has seen in 33 years, including three deaths. When a U.S. senator asked Kennedy if he recommended measles shots, Kennedy answered, 'Senator, if I advised you to swim in a lake that I knew there to be alligators in, wouldn't you want me to tell you there were alligators in it?' Fed up, the American Academy of Pediatrics and other medical societies sued Kennedy last week, accusing him of dismantling 'the longstanding, Congressionally-authorized, science- and evidence-based vaccine infrastructure that has prevented the deaths of untold millions of Americans.' (The federal government has yet to respond to the suit.) Just about all drugs have side effects. What's unusual about vaccines is that they're given to healthy people — even newborns on their first day of life. And many shots protect not just the individuals receiving them but also the broader community by making it harder for deadly scourges to spread. The Centers for Disease Control and Prevention estimates that routine childhood immunizations have prevented more than 1.1 million deaths and 32 million hospitalizations among the generation of Americans born between 1994 and 2023. To most people, the nation's vaccine system feels like a solid, reliable fact of life, doling out shots to children like clockwork. But in reality it is surprisingly fragile. There are only a handful of companies that make nearly all of the shots children receive. Only one manufacturer makes chickenpox vaccines. And just two or three make the shots that protect against more than a dozen diseases, including polio and measles. If any were to drop out, the country could find itself in the same crisis that led President Ronald Reagan to sign the law creating the Vaccine Injury Compensation Program in 1986. Back then, pharmaceutical companies faced hundreds of lawsuits alleging that the vaccine protecting kids from whooping cough, diphtheria and tetanus caused unrelenting seizures that led to severe disabilities. (Today's version of this shot is different.) One vaccine maker after another left the U.S. market. At one point, pediatricians could only buy whooping cough vaccines from a single company. Shortages were so bad that the CDC recommended doctors stop giving booster shots to preserve supplies for the most vulnerable babies. While Congress debated what to do, public health clinics' cost per dose jumped 5,000% in five years. 'We were really concerned that we would lose all vaccines, and we would get major resurgences of vaccine-preventable diseases,' recalled Dr. Walter Orenstein, a vaccine expert who worked in the CDC's immunization division at the time. A Forbes headline captured the anxiety of parents, pediatricians and public health workers: 'Scared Shotless.' So a bipartisan group in Congress hammered out the no-fault system. Today, the program covers vaccines routinely recommended for children or pregnant women once Congress approves the special tax that funds awards. (COVID-19 shots are part of a separate, often-maligned system for handling claims of harm, though Kennedy has said he's looking at ways to add them to the Vaccine Injury Compensation Program.) Under program rules, people who say they are harmed by covered vaccines can't head straight to civil court to sue manufacturers. First, they have to go through the no-fault system. The law established a table of injuries and the time frame for when those conditions must have appeared in order to be considered for quicker payouts. A tax on those vaccines — now 75 cents for every disease that a shot protects against — flows into a trust fund that pays those approved for awards. Win or lose, the program, for the most part, pays attorney fees and forbids lawyers from taking a cut of the money paid to the injured. The law set up a dedicated vaccine court where government officials known as special masters, who operate like judges, rule on cases without juries. People can ask for compensation for health problems not listed on the injury table, and they don't have to prove that the vaccine maker was negligent or failed to warn them about the medical condition they wound up with. At the same time, they can't claim punitive damages, which drive up payouts in civil courts, and pain and suffering payments are capped at $250,000. Plaintiffs who aren't satisfied with the outcome or whose cases drag on too long can exit the program and file their cases in traditional civil courts. There they can pursue punitive damages, contingency-fee agreements with lawyers and the usual evidence gathering that plaintiffs use to hold companies accountable for wrongdoing. But a Supreme Court ruling, interpreting the law that created the Vaccine Injury Compensation Program, limited the kinds of claims that can prevail in civil court. So while the program isn't a full liability shield for vaccine makers, its very existence significantly narrows the cases trial lawyers can file. Kennedy has been involved in such civil litigation. In his federal disclosures, he revealed that he referred plaintiffs to a law firm filing cases against Merck over its HPV shot in exchange for a 10% cut of the fees if they win. After a heated exchange with Sen. Elizabeth Warren during his confirmation proceedings, Kennedy said his share of any money from those cases would instead go to one of his adult sons, who he later said is a lawyer in California. His son Conor works as an attorney at the Los Angeles law firm benefiting from his referrals. When ProPublica asked about this arrangement, Conor Kennedy wrote, 'I don't work on those cases and I'm not receiving any money from them.' In March, a North Carolina federal judge overseeing hundreds of cases that alleged Merck failed to warn patients about serious side effects from its HPV vaccine ruled in favor of Merck; an appeal is pending. The Vaccine Injury Compensation Program succeeded in stabilizing the business of childhood vaccines, with many more shots developed and approved in the decades since it was established. But even ardent supporters acknowledge there are problems. The program's staff levels haven't kept up with the caseload. The law capped the number of special masters at eight, and congressional bills to increase that have failed. An influx of adult claims swamped the system after adverse reactions to flu shots became eligible for compensation in 2005 and serious shoulder problems were added to the injury table in 2017. The quick and smooth system of payouts originally envisioned has evolved into a more adversarial one with lawyers for the Department of Justice duking it out with plaintiffs' attorneys, which Kennedy says runs counter to the program's intent. Many cases drag on for years. In his recent interview with Carlson, he described 'the lawyers of the Department of Justice, the leaders of it' working on the cases as corrupt. 'They saw their job as protecting the trust fund rather than taking care of people who made this national sacrifice, and we're going to change all that,' he said. 'And I've brought in a team this week that is starting to work on that.' The system is 'supposed to be generous and fast and gives a tie to the runner,' he told Carlson. 'In other words, if there's doubts about, you know, whether somebody's injury came from a vaccine or not, you're going to assume they got it and compensate them.' Kennedy didn't identify who is on the team reviewing the program. At one point in the interview, he said, 'We just brought a guy in this week who's going to be revolutionizing the Vaccine Injury Compensation Program.' The HHS employee directory now lists Andrew Downing as a counselor working in Kennedy's office. Downing for many years has filed claims with the program and suits in civil courts on behalf of clients alleging harm from shots. Last month, HHS awarded a contract for 'Vaccine Injury Compensation Program expertise' to Downing's firm, as NOTUS has reported. Downing did not respond to a voicemail left at his law office. HHS didn't reply to a request to make him and Kennedy available for an interview and declined to answer detailed questions about its plans for the Vaccine Injury Compensation Program. In the past, an HHS spokesperson has said that Kennedy is 'not anti-vaccine — he is pro-safety.' While it's not clear what changes Downing and Kennedy have in mind, Kennedy's interview with Carlson offered some insights. Kennedy said he was working to expand the program's three-year statute of limitations so that more people can be compensated. Downing has complained that patients who have certain autoimmune disorders don't realize their ailments were caused by a vaccine until it's too late to file. Congress would have to change the law to allow this, experts said. A key issue is whether Kennedy will try to add new ailments to the list of injuries that qualify for quicker awards. In the Carlson interview, Kennedy dismissed the many studies and scientific consensus that shots don't cause autism as nothing more than statistical trickery. 'We're going to do real science,' Kennedy said. The vaccine court spent years in the 2000s trying cases that alleged autism was caused by the vaccine ingredient thimerosal and the shot that protects people from measles, mumps and rubella. Facing more than 5,000 claims, the court asked a committee of attorneys representing children with autism to pick test cases that represented themes common in the broader group. In the cases that went to trial, the special masters considered more than 900 medical articles and heard testimony from dozens of experts. In each of those cases, the special masters found that the shots didn't cause autism. In at least two subsequent cases, children with autism were granted compensation because they met the criteria listed in the program's injury table, according to a vaccine court decision. That table, for instance, lists certain forms of encephalopathy — a type of brain dysfunction — as a rare side effect of shots that protect people from whooping cough, measles, mumps and rubella. In a 2016 vaccine court ruling, Special Master George L. Hastings Jr. explained, 'The compensation of these two cases, thus does not afford any support to the notion that vaccinations can contribute to the causation of autism.' Hastings noted that when Congress set up the injury table, the lawmakers acknowledged that people would get compensated for 'some injuries that were not, in fact, truly vaccine-caused.' Many disabling neurological disorders in children become apparent around the time kids get their shots. Figuring out whether the timing was coincidental or an indication that the vaccines caused the problem has been a huge challenge. Devastating seizures in young children were the impetus for the compensation program. But in the mid-1990s, after a yearslong review of the evidence, HHS removed seizure disorder from the injury table and narrowed the type of encephalopathy that would automatically qualify for compensation. Scientists subsequently have discovered genetic mutations that cause some of the most severe forms of epilepsy. What's different now, though, is that Kennedy, as HHS secretary, has the power to add autism or other disorders to that injury table. Experts say he'd have to go through the federal government's cumbersome rulemaking process to do so. He could also lean on federal employees to green-light more claims. In addition, Kennedy has made it clear he's thinking about illnesses beyond autism. 'We have now this epidemic of immune dysregulation in our country, and there's no way to rule out vaccines as one of the key culprits,' he told Carlson. Kennedy mentioned diabetes, rheumatoid arthritis, seizure disorders, ADHD, speech delay, language delay, tics, Tourette syndrome, narcolepsy, peanut allergies and eczema. President Donald Trump's budget estimated that the value of the investments in the Vaccine Injury Compensation Program trust fund could reach $4.8 billion this year. While that's a lot of money, a life-care plan for a child with severe autism can cost tens of millions of dollars, and the CDC reported in April that 1 in 31 children is diagnosed with autism by their 8th birthday. The other illnesses Kennedy mentioned also affect a wide swath of the U.S. population. Dr. Paul Offit, a co-inventor of a rotavirus vaccine and director of the Vaccine Education Center at Children's Hospital of Philadelphia, for years has sparred with Kennedy over vaccines. Offit fears that Kennedy will use flawed studies to justify adding autism and other common medical problems to the injury table, no matter how much they conflict with robust scientific research. 'You can do that, and you will bankrupt the program,' he said. 'These are ways to end vaccine manufacturing in this country.' If the trust fund were to run out of money, Congress would have to act, said Dorit Reiss, a law professor at University of California Law San Francisco who has studied the Vaccine Injury Compensation Program. Congress could increase the excise tax on vaccines, she said, or pass a law limiting what's on the injury table. Or Congress could abolish the program, and the vaccine makers would find themselves back in the situation they faced in the 1980s. 'That's not unrealistic,' Reiss said. Rep. Paul Gosar, an Arizona Republican, last year proposed the End the Vaccine Carveout Act, which would have allowed people to bypass the no-fault system and head straight to civil court. His press release for the bill — written in September, before Kennedy's ascension to HHS secretary — quoted Kennedy saying, 'If we want safe and effective vaccines, we need to end the liability shield.' The legislation never came up for a vote. A spokesperson for the congressman said he expects to introduce it again 'in the very near future.' Renée Gentry, director of the George Washington University Law School's Vaccine Injury Litigation Clinic, thinks it's unlikely Congress will blow up the no-fault program. But Gentry, who represents people filing claims for injuries, said it's hard to predict what Congress, faced with a doomsday scenario, would do. 'Normally Democrats are friends of plaintiffs' lawyers,' she said. 'But talking about vaccines on the Hill is like walking on a razor blade that's on fire.'
CNN
02-07-2025
- CNN
A ‘striking' trend: After Texas banned abortion, more women nearly bled to death during miscarriage
Maternal health Women's health Abortion rightsFacebookTweetLink Follow This story was originally published by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive its biggest stories as soon as they're published. Before states banned abortion, one of the gravest outcomes of early miscarriage could easily be avoided: Doctors could offer a dilation and curettage procedure, which quickly empties the uterus and allows it to close, protecting against a life-threatening hemorrhage. But because the procedures, known as D&Cs, are also used to end pregnancies, they have gotten tangled up in state legislation that restricts abortion. Reports now abound of doctors hesitating to provide them and women who are bleeding heavily being discharged from emergency rooms without care, only to return in such dire condition that they need blood transfusions to survive. As ProPublica reported last year, one woman died of hemorrhage after 10 hours in a Houston hospital that didn't perform the procedure. Now, a new ProPublica data analysis adds empirical weight to the mounting evidence that abortion bans have made the common experience of miscarriage — which occurs in up to 30% of pregnancies — far more dangerous. It is based on hospital discharge data from Texas, the largest state to ban abortion, and captures emergency department visits from 2017 to 2023, the most recent year available. After Texas made performing abortions a felony in August 2022, ProPublica found, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%. The number of emergency room visits for early miscarriage also rose, by 25%, compared with the three years before the COVID-19 pandemic — a sign that women who didn't receive D&Cs initially may be returning to hospitals in worse condition, more than a dozen experts told ProPublica. While that phenomenon can't be confirmed by the discharge data, which tracks visits rather than individuals, doctors and researchers who reviewed ProPublica's findings say these spikes, along with the stories patients have shared, paint a troubling picture of the harm that results from unnecessary delays in care. 'This is striking,' said Dr. Elliott Main, a hemorrhage expert and former medical director for the California Maternal Quality Care Collaborative. 'The trend is very clear.' The data mirrors a sharp rise in cases of sepsis — a life-threatening reaction to infection — ProPublica previously identified during second-trimester miscarriage in Texas. Blood loss is expected during early miscarriage, which usually ends without complication. Some cases, however, can turn deadly very quickly. Main said ProPublica's analysis suggested to him that 'physicians are sitting on nonviable pregnancies longer and longer before they're doing a D&C — until patients are really bleeding.' That's what happened to Sarah De Pablos Velez in Austin last summer. As she was miscarrying and bleeding profusely, she said physicians didn't explain that she had options for care. Sent home from the emergency room without a D&C two times, she ultimately needed blood transfusions so that she wouldn't die, according to medical records. 'What happened to me was just so wrong,' she told ProPublica. 'Doctors need to be providing care to pregnant women — that needs to be a baseline.' After ProPublica exposed preventable deaths following delays in care, the Texas Legislature passed a bill this year to clarify that doctors can provide abortions when a patient is facing a life-threatening emergency, even if it is not imminent. But many Texas doctors say the reform does not address the difficulty of treating women experiencing early miscarriages, which almost always involve blood loss; they say it's hard to know when the expected bleeding might evolve into a life-threatening emergency — one that could have been prevented with a D&C. Women can bleed and remain stable for a long time, until they crash. Texas forbids abortion at all stages of pregnancy — even before there is cardiac activity or a visible embryo. And while the law allows doctors to 'remove a dead, unborn child,' it can be difficult to determine what that means during early miscarriage, when an array of factors can signal that a pregnancy is not progressing. An embryo might fail to develop. Cardiac activity may not emerge when it should. Hormone levels might dip or bleeding might increase. Even if a doctor strongly suspects a miscarriage is underway, it can take weeks to conclusively document that a pregnancy has ended, and all the while, a patient might be losing blood. Some OB-GYNs and emergency room physicians have long been advising patients to complete their miscarriage at home, especially at Catholic hospitals, even if that is not the standard of care. But now, physicians across the state are faced with a law that threatens up to 99 years in prison, and more are making a new calculus around whether to intervene or even tell patients they are likely miscarrying, said Dr. Anitra Beasley, an OB-GYN in Houston. 'What ends up happening is patients have to present multiple times before a diagnosis can be made,' she added, and some of those patients wind up needing blood transfusions. While they can be lifesaving, transfusions do not stop the bleeding, experts told ProPublica, and they can introduce complications, such as severe allergic reactions, autoimmune disorders or, in rare events, blood cancer. The dangers of hemorrhage are far greater, from organ failure to kidney damage to loss of sensation in the fingers and toes. 'There's a finite amount of blood,' said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. 'And when it all comes out, you're dead.' ProPublica's findings about the rise in blood transfusions make clear that women who experience early miscarriages in abortion ban states are living in a more dangerous medical climate than many believe, said Amanda Nagle, a doctoral student investigating the same blood transfusion data for a forthcoming paper in the American Journal of Public Health. 'If people are seeking care at an emergency department,' Nagle said, 'there are serious health risks to delaying that care.' Waiting for certainty In some clinics and hospitals across Texas, the pressure to definitively diagnose a miscarriage has led to delays in offering D&Cs. Considering the chance of criminal prosecution, some doctors now default to what many pregnancy loss experts view as an overly cautious method for diagnosing miscarriage: ultrasound images alone, using criteria from the Society of Radiologists in Ultrasound. Relying only on images to diagnose — and discounting other factors, like lab results or clinical symptoms — can take days or even weeks. Dr. Gabrielle Taper was a resident at a Catholic hospital in Austin when the ban was enacted, and a culture of fear took hold among her colleagues, she told ProPublica. 'We started asking, 'Are we certain that we can document that we've met the radiology guidelines?' as opposed to just treating the patient in front of us,' she said. If they couldn't show that the likely miscarriage met the criteria, they often felt they had to discharge patients without offering a D&C. 'People are already in distress, and you are giving them confusion, a false sense of hope,' she told ProPublica. 'Having to send a patient home knowing they may bleed so much they would need a blood transfusion — when I know there are procedures I could do or medicine I could offer — is just excruciating.' The hospital where she worked did not respond to ProPublica's request for comment. The American College of Obstetricians and Gynecologists does not recommend this approach, advising doctors instead to review the ultrasound as one piece of information among many and counsel patients on all their options. The Society of Radiologists in Ultrasound said that the guidelines 'are not meant to apply in the setting of a life-threatening situation, such as heavy bleeding,' but did not respond to a question about whether it agreed with ACOG that doctors should use a combination of ultrasound images and clinical judgment to assess a pregnancy loss. Dr. Courtney A. Schreiber, an obstetrics and gynecology professor and expert in early pregnancy care, said that even if a patient wants to let a likely miscarriage complete at home, the medical team should still explain different management options, including medication to speed up the process or a D&C, should symptoms like bleeding get worse. 'It's our obligation to share information, help manage expectations and keep women safe,' she said. What happened to Porsha Ngumezi shows how dangerous it can be to delay care, according to more than a dozen doctors who previously reviewed a detailed summary of her case for ProPublica. When the mother of two showed up bleeding at Houston Methodist Sugar Land in June 2023, at 11 weeks pregnant, her sonogram suggested an 'ongoing miscarriage' was 'likely,' her doctor noted. She had no previous ultrasounds to compare it with, and the radiologist did not locate an embryo or fetus — which Ngumezi said she thought she had passed in a toilet; her doctors did not make a definitive diagnosis, calling it a pregnancy of 'unknown location.' After hours bleeding, passing 'clots the size of grapefruit,' according to a nurse's notes, she received two blood transfusions — a short-term remedy. But she did not get a procedure to empty her uterus, which medical experts agree is the most effective way to stop the bleeding. Hours later, she died of hemorrhage, leaving behind her husband and young sons. Doctors and nurses involved in Ngumezi's care did not respond to multiple requests for comment for ProPublica's story last fall, and the hospital did not answer questions about her care when asked about it again for this story. A spokesperson from Methodist Hospital said its OB-GYNs follow ACOG's miscarriage diagnosis guidelines, which recommend considering clinical factors in addition to ultrasounds. Visit after visit Even in circumstances in which the abortion ban allows a doctor to intervene — to treat a life-threatening emergency, for example, or to 'remove a dead, unborn baby' — there's plenty of evidence, detailed in lawsuits and federal investigations, that doctors in Texas still aren't offering procedures. As soon as Sarah De Pablos Velez, a 30-year-old media director, learned she was pregnant last summer, she began attending regular checkups at St. David's Women's Care, in Austin. During her third appointment at about nine weeks, a resident, Dr. Carla Vilardo, and her supervisor, Dr. Cynthia Mingea, reviewed the ultrasound, according to medical records, which indicated her pregnancy wasn't viable. Instead of being offered treatment for a miscarriage, De Pablos Velez says she was advised to hold out hope and come back for the next checkup. Five maternal health experts and practicing OB-GYNs who reviewed the records for ProPublica said by that ultrasound visit, doctors would have had enough information to determine that the pregnancy wasn't viable, even under the most conservative guidelines. If they wanted to be extra sure, they could have done blood work or one more ultrasound during that visit. Instead, De Pablos Velez was told to come back in two weeks, according to medical records. During a visit when she should have been nearly 11 weeks pregnant, Mingea wrote in her chart she was 'not optimistic' about the pregnancy's viability. Still, De Pablos Velez was advised to return in another week to be sure. Within a few days, when the cramping got so bad she could barely walk, De Pablos Velez went to the emergency room at St. David's Medical Center, unaware that a D&C could stop the pain and the bleeding. 'I've never researched what it looks like for women who have a miscarriage,' she told ProPublica. 'I always thought you go to the bathroom and have a little bit of blood.' Over two visits to the emergency room, doctors told her that she could complete the miscarriage at home, even as she reported filling up three toilet bowls with blood and a nurse remarked that they needed a janitor to clean the floor, De Pablos Velez and her husband recalled. No obstetrician ever came to assess her condition, according to medical records, and while her hospital chart says 'all management options have been discussed with the patient and her husband,' De Pablos Velez and her husband both told ProPublica no one offered her a D&C. She was told to follow up with her OB at her next appointment in three days. Six hours after discharge, though, she was trying to ride out the pain at home when her husband heard her muttering 'lightheaded' in the bathroom and ran to her in time to catch her as she collapsed. 'She was pale as a ghost, sweating, convulsing,' said her husband, Sergio De Pablos Velez. 'There was blood on the toilet, the trash can — like a scene out of a horror movie.' An ambulance rushed her to the hospital, where doctors realized she no longer had enough blood flowing to her organs. She received two blood transfusions. Without them, several doctors who reviewed her records told ProPublica, she would have soon lost her life. Vilardo and the doctors who saw De Pablos Velez in the emergency room did not respond to requests to speak with ProPublica or declined to be interviewed. St. David's Medical Center, which is owned by HCA, the largest for-profit hospital chain in America, said it could not discuss her case unless she signed privacy waivers. The hospital did not respond to ProPublica's questions even after she submitted them. The De Pablos Velezes say that a hospital patient liaison told them after the ordeal that the hospital would conduct an internal investigation, educate the emergency department on best practices and share the results. It never shared anything. When ProPublica asked about the status of the investigation, neither the liaison nor the hospital responded. Mingea, who supervised Vilardo's care during checkups, reviewed the clinic's records with ProPublica and agreed that De Pablos Velez should have been counseled about miscarriage management options at the clinic, weeks before she ended up in the ER. She said she did not know why she wasn't but pointed ProPublica to the Society of Radiologists in Ultrasound criteria, which is hanging on the clinic's wall and is used to teach residents. She was adamant that her clinic, which she described as 'very pro-choice — about as much as we can be in Texas,' regularly provides D&Cs for miscarrying patients. 'I feel badly that Sarah had this experience, I really do,' she said. 'Everybody deserves to be counseled about all their options.' Doctors had five opportunities to counsel De Pablos Velez about her options and offer her a D&C, said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed case records. If they had, the life-or-death risks could have been avoided. De Pablos Velez 'basically received the same care Porsha Ngumezi did, only Porsha died and she survived,' said Abbott. 'She was lucky.' Sophie Chou contributed data reporting, and Mariam Elba contributed research.
CNN
02-07-2025
- CNN
A ‘striking' trend: After Texas banned abortion, more women nearly bled to death during miscarriage
This story was originally published by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive its biggest stories as soon as they're published. Before states banned abortion, one of the gravest outcomes of early miscarriage could easily be avoided: Doctors could offer a dilation and curettage procedure, which quickly empties the uterus and allows it to close, protecting against a life-threatening hemorrhage. But because the procedures, known as D&Cs, are also used to end pregnancies, they have gotten tangled up in state legislation that restricts abortion. Reports now abound of doctors hesitating to provide them and women who are bleeding heavily being discharged from emergency rooms without care, only to return in such dire condition that they need blood transfusions to survive. As ProPublica reported last year, one woman died of hemorrhage after 10 hours in a Houston hospital that didn't perform the procedure. Now, a new ProPublica data analysis adds empirical weight to the mounting evidence that abortion bans have made the common experience of miscarriage — which occurs in up to 30% of pregnancies — far more dangerous. It is based on hospital discharge data from Texas, the largest state to ban abortion, and captures emergency department visits from 2017 to 2023, the most recent year available. After Texas made performing abortions a felony in August 2022, ProPublica found, the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%. The number of emergency room visits for early miscarriage also rose, by 25%, compared with the three years before the COVID-19 pandemic — a sign that women who didn't receive D&Cs initially may be returning to hospitals in worse condition, more than a dozen experts told ProPublica. While that phenomenon can't be confirmed by the discharge data, which tracks visits rather than individuals, doctors and researchers who reviewed ProPublica's findings say these spikes, along with the stories patients have shared, paint a troubling picture of the harm that results from unnecessary delays in care. 'This is striking,' said Dr. Elliott Main, a hemorrhage expert and former medical director for the California Maternal Quality Care Collaborative. 'The trend is very clear.' The data mirrors a sharp rise in cases of sepsis — a life-threatening reaction to infection — ProPublica previously identified during second-trimester miscarriage in Texas. Blood loss is expected during early miscarriage, which usually ends without complication. Some cases, however, can turn deadly very quickly. Main said ProPublica's analysis suggested to him that 'physicians are sitting on nonviable pregnancies longer and longer before they're doing a D&C — until patients are really bleeding.' That's what happened to Sarah De Pablos Velez in Austin last summer. As she was miscarrying and bleeding profusely, she said physicians didn't explain that she had options for care. Sent home from the emergency room without a D&C two times, she ultimately needed blood transfusions so that she wouldn't die, according to medical records. 'What happened to me was just so wrong,' she told ProPublica. 'Doctors need to be providing care to pregnant women — that needs to be a baseline.' After ProPublica exposed preventable deaths following delays in care, the Texas Legislature passed a bill this year to clarify that doctors can provide abortions when a patient is facing a life-threatening emergency, even if it is not imminent. But many Texas doctors say the reform does not address the difficulty of treating women experiencing early miscarriages, which almost always involve blood loss; they say it's hard to know when the expected bleeding might evolve into a life-threatening emergency — one that could have been prevented with a D&C. Women can bleed and remain stable for a long time, until they crash. Texas forbids abortion at all stages of pregnancy — even before there is cardiac activity or a visible embryo. And while the law allows doctors to 'remove a dead, unborn child,' it can be difficult to determine what that means during early miscarriage, when an array of factors can signal that a pregnancy is not progressing. An embryo might fail to develop. Cardiac activity may not emerge when it should. Hormone levels might dip or bleeding might increase. Even if a doctor strongly suspects a miscarriage is underway, it can take weeks to conclusively document that a pregnancy has ended, and all the while, a patient might be losing blood. Some OB-GYNs and emergency room physicians have long been advising patients to complete their miscarriage at home, especially at Catholic hospitals, even if that is not the standard of care. But now, physicians across the state are faced with a law that threatens up to 99 years in prison, and more are making a new calculus around whether to intervene or even tell patients they are likely miscarrying, said Dr. Anitra Beasley, an OB-GYN in Houston. 'What ends up happening is patients have to present multiple times before a diagnosis can be made,' she added, and some of those patients wind up needing blood transfusions. While they can be lifesaving, transfusions do not stop the bleeding, experts told ProPublica, and they can introduce complications, such as severe allergic reactions, autoimmune disorders or, in rare events, blood cancer. The dangers of hemorrhage are far greater, from organ failure to kidney damage to loss of sensation in the fingers and toes. 'There's a finite amount of blood,' said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington. 'And when it all comes out, you're dead.' ProPublica's findings about the rise in blood transfusions make clear that women who experience early miscarriages in abortion ban states are living in a more dangerous medical climate than many believe, said Amanda Nagle, a doctoral student investigating the same blood transfusion data for a forthcoming paper in the American Journal of Public Health. 'If people are seeking care at an emergency department,' Nagle said, 'there are serious health risks to delaying that care.' Waiting for certainty In some clinics and hospitals across Texas, the pressure to definitively diagnose a miscarriage has led to delays in offering D&Cs. Considering the chance of criminal prosecution, some doctors now default to what many pregnancy loss experts view as an overly cautious method for diagnosing miscarriage: ultrasound images alone, using criteria from the Society of Radiologists in Ultrasound. Relying only on images to diagnose — and discounting other factors, like lab results or clinical symptoms — can take days or even weeks. Dr. Gabrielle Taper was a resident at a Catholic hospital in Austin when the ban was enacted, and a culture of fear took hold among her colleagues, she told ProPublica. 'We started asking, 'Are we certain that we can document that we've met the radiology guidelines?' as opposed to just treating the patient in front of us,' she said. If they couldn't show that the likely miscarriage met the criteria, they often felt they had to discharge patients without offering a D&C. 'People are already in distress, and you are giving them confusion, a false sense of hope,' she told ProPublica. 'Having to send a patient home knowing they may bleed so much they would need a blood transfusion — when I know there are procedures I could do or medicine I could offer — is just excruciating.' The hospital where she worked did not respond to ProPublica's request for comment. The American College of Obstetricians and Gynecologists does not recommend this approach, advising doctors instead to review the ultrasound as one piece of information among many and counsel patients on all their options. The Society of Radiologists in Ultrasound said that the guidelines 'are not meant to apply in the setting of a life-threatening situation, such as heavy bleeding,' but did not respond to a question about whether it agreed with ACOG that doctors should use a combination of ultrasound images and clinical judgment to assess a pregnancy loss. Dr. Courtney A. Schreiber, an obstetrics and gynecology professor and expert in early pregnancy care, said that even if a patient wants to let a likely miscarriage complete at home, the medical team should still explain different management options, including medication to speed up the process or a D&C, should symptoms like bleeding get worse. 'It's our obligation to share information, help manage expectations and keep women safe,' she said. What happened to Porsha Ngumezi shows how dangerous it can be to delay care, according to more than a dozen doctors who previously reviewed a detailed summary of her case for ProPublica. When the mother of two showed up bleeding at Houston Methodist Sugar Land in June 2023, at 11 weeks pregnant, her sonogram suggested an 'ongoing miscarriage' was 'likely,' her doctor noted. She had no previous ultrasounds to compare it with, and the radiologist did not locate an embryo or fetus — which Ngumezi said she thought she had passed in a toilet; her doctors did not make a definitive diagnosis, calling it a pregnancy of 'unknown location.' After hours bleeding, passing 'clots the size of grapefruit,' according to a nurse's notes, she received two blood transfusions — a short-term remedy. But she did not get a procedure to empty her uterus, which medical experts agree is the most effective way to stop the bleeding. Hours later, she died of hemorrhage, leaving behind her husband and young sons. Doctors and nurses involved in Ngumezi's care did not respond to multiple requests for comment for ProPublica's story last fall, and the hospital did not answer questions about her care when asked about it again for this story. A spokesperson from Methodist Hospital said its OB-GYNs follow ACOG's miscarriage diagnosis guidelines, which recommend considering clinical factors in addition to ultrasounds. Visit after visit Even in circumstances in which the abortion ban allows a doctor to intervene — to treat a life-threatening emergency, for example, or to 'remove a dead, unborn baby' — there's plenty of evidence, detailed in lawsuits and federal investigations, that doctors in Texas still aren't offering procedures. As soon as Sarah De Pablos Velez, a 30-year-old media director, learned she was pregnant last summer, she began attending regular checkups at St. David's Women's Care, in Austin. During her third appointment at about nine weeks, a resident, Dr. Carla Vilardo, and her supervisor, Dr. Cynthia Mingea, reviewed the ultrasound, according to medical records, which indicated her pregnancy wasn't viable. Instead of being offered treatment for a miscarriage, De Pablos Velez says she was advised to hold out hope and come back for the next checkup. Five maternal health experts and practicing OB-GYNs who reviewed the records for ProPublica said by that ultrasound visit, doctors would have had enough information to determine that the pregnancy wasn't viable, even under the most conservative guidelines. If they wanted to be extra sure, they could have done blood work or one more ultrasound during that visit. Instead, De Pablos Velez was told to come back in two weeks, according to medical records. During a visit when she should have been nearly 11 weeks pregnant, Mingea wrote in her chart she was 'not optimistic' about the pregnancy's viability. Still, De Pablos Velez was advised to return in another week to be sure. Within a few days, when the cramping got so bad she could barely walk, De Pablos Velez went to the emergency room at St. David's Medical Center, unaware that a D&C could stop the pain and the bleeding. 'I've never researched what it looks like for women who have a miscarriage,' she told ProPublica. 'I always thought you go to the bathroom and have a little bit of blood.' Over two visits to the emergency room, doctors told her that she could complete the miscarriage at home, even as she reported filling up three toilet bowls with blood and a nurse remarked that they needed a janitor to clean the floor, De Pablos Velez and her husband recalled. No obstetrician ever came to assess her condition, according to medical records, and while her hospital chart says 'all management options have been discussed with the patient and her husband,' De Pablos Velez and her husband both told ProPublica no one offered her a D&C. She was told to follow up with her OB at her next appointment in three days. Six hours after discharge, though, she was trying to ride out the pain at home when her husband heard her muttering 'lightheaded' in the bathroom and ran to her in time to catch her as she collapsed. 'She was pale as a ghost, sweating, convulsing,' said her husband, Sergio De Pablos Velez. 'There was blood on the toilet, the trash can — like a scene out of a horror movie.' An ambulance rushed her to the hospital, where doctors realized she no longer had enough blood flowing to her organs. She received two blood transfusions. Without them, several doctors who reviewed her records told ProPublica, she would have soon lost her life. Vilardo and the doctors who saw De Pablos Velez in the emergency room did not respond to requests to speak with ProPublica or declined to be interviewed. St. David's Medical Center, which is owned by HCA, the largest for-profit hospital chain in America, said it could not discuss her case unless she signed privacy waivers. The hospital did not respond to ProPublica's questions even after she submitted them. The De Pablos Velezes say that a hospital patient liaison told them after the ordeal that the hospital would conduct an internal investigation, educate the emergency department on best practices and share the results. It never shared anything. When ProPublica asked about the status of the investigation, neither the liaison nor the hospital responded. Mingea, who supervised Vilardo's care during checkups, reviewed the clinic's records with ProPublica and agreed that De Pablos Velez should have been counseled about miscarriage management options at the clinic, weeks before she ended up in the ER. She said she did not know why she wasn't but pointed ProPublica to the Society of Radiologists in Ultrasound criteria, which is hanging on the clinic's wall and is used to teach residents. She was adamant that her clinic, which she described as 'very pro-choice — about as much as we can be in Texas,' regularly provides D&Cs for miscarrying patients. 'I feel badly that Sarah had this experience, I really do,' she said. 'Everybody deserves to be counseled about all their options.' Doctors had five opportunities to counsel De Pablos Velez about her options and offer her a D&C, said Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, who reviewed case records. If they had, the life-or-death risks could have been avoided. De Pablos Velez 'basically received the same care Porsha Ngumezi did, only Porsha died and she survived,' said Abbott. 'She was lucky.' Sophie Chou contributed data reporting, and Mariam Elba contributed research.
