Are abortion bans preventing women from receiving treatment for ectopic pregnancies?

Over 100 pregnant women in the US have been denied emergency care in the last two years, according to the AP. Are abortion bans to blame?

Aug 16, 2024

What’s going on with pregnant women being denied life-saving care?

Kelsie Norris-De La Cruz was turned away by 3 different doctors before finally finding someone to treat her ectopic pregnancy. Kyleigh Thurman was denied the medication methotrexate for her suspected ectopic pregnancy, leading to her almost losing her life after her fallopian tube ruptured. These are two of the recent cases that the Center for Reproductive Rights has taken on to help achieve their mission of making sure reproductive rights (such as abortion, IVF, birth control, etc.) are legally protected.

What do these two cases have in common? They both occurred in a state with a strict abortion ban - specifically, Texas. According to the Center for Reproductive Rights, abortion bans like Texas’ directly lead to delays in care for women suffering serious and life-threatening pregnancy complications.

But is this really true? What evidence do we have to suggest that this is the case, and what evidence do we have against it? Let’s take a look at everything we know about these specific cases, and then zoom out a little bit and get a glimpse of the bigger picture.

A closer look at these cases

Kelsie Norris-De La Cruz

Kelsie Norris-De La Cruz’s story is all over the internet. You can find various accounts of it with a quick google search of her name, and I’ve read through many of them. This one published by the Washington Post is the one I found to be most detailed. I also like it because the Post had multiple doctors review Kelsie’s medical records and give their opinion on the case as well, which provides additional insight into the facts of the case. I highly recommend giving the article a read, but here is a quick overview of the main points of the case.

Kelsie went to the emergency room early in her pregnancy with concerning symptoms. She was diagnosed with an impending miscarriage and sent home to let the pregnancy pass on its own. The ER did not rule out the possibility of an ectopic pregnancy,
Weeks later, Kelsie returned to the ER again with worsening symptoms. There she saw an OBGYN who determined she didn’t need treatment and discharged her.
She then spoke to an on-call doctor who specialized in emergency medicine. He did not feel comfortable discharging her, and admitted her, but did not have the authority to provide her with the treatment he felt she needed.
The next morning, Kelsie spoke with a different OBGYN who determined “no operation warranted” and discharged her with instructions to return in 48 hours for a follow up.
She left the hospital and was able to see a different OBGYN that afternoon (private practice), who immediately diagnosed the ectopic pregnancy and booked her for surgery.
As a result of the surgery, Kelsie lost one of her fallopian tubes.

Kyleigh Thurman

Kyleigh Thurman’s story is a little bit harder to find details on, but the complaint filed by the Center for Reproductive Rights has most of the pertinent information (scroll down to page 8, point B under “Factual Allegations”). Here is an overview of her case:

Kyleigh Thurman experienced concerning symptoms for a month before reaching out to her OBGYN, who instructed her to take a pregnancy test. It was positive, and the OBGYN suspected an ectopic pregnancy based on her symptoms.
Because the OBGYN’s office was over an hour away and booked for the day, Kyleigh went to the emergency room where she was discharged. Two days later she returned to the emergency room and was once again discharged.
Her OBGYN reviewed test results performed at the emergency room and once again said she was likely experiencing an ectopic pregnancy. She needed the medication methotrexate to treat the pregnancy, but neither the OBGYN’s office nor Kyleigh’s local hospital stocked it. So, Kyleigh drove an hour away to a larger hospital.
Kyleigh’s OBGYN contacted the on-call physician at this hospital and advised that she needed treatment for an ectopic pregnancy. However, Kyleigh was reportedly denied any treatment, discharged, and told to return in two days.
She returned a few days later with worsening symptoms but was once again not offered any treatment. It wasn’t until Kyleigh’s OBGYN drove to the hospital and talked to the medical staff herself that they eventually agreed to treat her with methotrexate.
The methotrexate injection came too late, and several days later her ectopic pregnancy ruptured. Because of this, Kyleigh’s right fallopian tube had to be removed in order to save her life.

Are abortion bans to blame for these delays in care?

While these cases are the two more recent ones you might see being shared around social media, these are certainly not the only stories of their kind that have gained significant media attention since Roe v. Wade was overturned in June of 2022. And, with each new, tragic story comes a familiar finger-pointing to the abortion bans of the states in which many of these situations occur.

The Center for Reproductive Rights, among other abortion advocacy groups, are quick to blame abortion bans for women not receiving appropriate care and treatment at hospitals.

But, to their credit, these groups do acknowledge that treatment for ectopic pregnancies is not illegal in Texas (or any state for that matter). Texas state law specifically excludes the treatment of ectopic pregnancies from its legal definition of abortion.

The definition of abortion in Texas law can be found in section 245.002 of the Health and Safety Code. It states:

(1)  "Abortion" means the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means with the intent to cause the death of an unborn child of a woman known to be pregnant.  The term does not include birth control devices or oral contraceptives.  An act is not an abortion if the act is done with the intent to:
(A)  save the life or preserve the health of an unborn child;
(B)  remove a dead, unborn child whose death was caused by spontaneous abortion; or
(C)  remove an ectopic pregnancy.

As you can see, the removal of an ectopic pregnancy is an explicit exception to what the state of Texas considers an abortion. But this alone wasn’t enough for abortion advocates, so last year the 88th Texas legislature passed HB 3058 which provided further protection for physicians treating an ectopic pregnancy.

Sec. 74.552.  AFFIRMATIVE DEFENSE IN CERTAIN ACTIONS ARISING  FROM CERTAIN PREGNANCY COMPLICATIONS. 
(a) It is an affirmative  defense to liability in a civil action brought against a physician  or health care provider for a violation of Section 170A.002, Health  and Safety Code, including an action to recover a civil penalty  under Section 170A.005, Health and Safety Code, that the physician  or health care provider exercised reasonable medical judgment in  providing medical treatment to a pregnant woman in response to:               (1)  an ectopic pregnancy at any location; or              
(2)  a previable premature rupture of membranes.

Abortion advocates cannot claim that the laws aren’t clear, yet they still claim that the laws are deterring doctors from providing appropriate medical care. Apparently, doctors are too afraid being sued for providing legal and necessary treatment to their patients.

This claim comes despite the fact that in most of these stories, the doctors themselves are not usually blaming the laws for the delay in care. In fact, we rarely get the doctor’s side at all - HIPPA laws would keep the doctors from freely speaking out regarding the details of any case. Because of this, we must keep in mind that any allegations of a doctor’s motives in delaying care are simply speculation. Without testimony from the doctor himself, we cannot assume motive.

Could it just be simply…negligence?

Just for fun, let’s say that the laws are NOT deterring doctors from providing care. Let’s just completely eliminate that possibility. What other possibility is there?

Quite simply, negligence.

Is it outside of the realm of possibility that sometimes doctors are negligent? That sometimes they make mistakes, or miss something, or are just simply too busy to give every patient the time and quality of care that they deserve?

Two years ago I think the answer would be a resounding NO. Of course doctors can make mistakes! But ever since Roe v. Wade was overturned, it seems that doctors must never be to blame when it comes to issues of reproductive rights. Abortion advocates are avoiding holding doctors accountable for malpractice via the scapegoat of abortion bans.

According to Forbes, medical malpractice is the third most common cause of death, making up 9.5% of all deaths in the US annually. One in three care providers in the US is sued for medical malpractice during their care, and misdiagnosis is one of the most common types of malpractice.

In addition, according to this study, obstetrics and gynecology is one of the most sued medical specialties, with nearly 83% of OBGYNs being sued at least once in their careers. The same study also noted that a study involving residents from 2001-2015 found OBGYNs to have the highest number of claims (17%).

From this data I have two takeaways:

Given the clear laws that allow for treatment of ectopic pregnancy, and the prevalence of medical malpractice in the US (and particularly in the OBGYN specialty), there is ample evidence to suggest that the delays in care happening with preganant women around the US are not due to abortion bans but malpractice; and
The likelihood of being sued as a doctor is so high that you should not choose that profession if you are afraid of being sued. If doctors are actually failing to treat patients because of this fear, then they are in the wrong profession.

By the way, the study mentioned above was published in 2022 just weeks after the Dobbs v. Jackson ruling, but compiled data from many other earlier studies. This means that the findings of that study do not take into account any recent malpractice suits since the overturning of Roe v. Wade.

Can an ectopic pregnancy be misdiagnosed?

Misdiagnosis is one of the leading causes of medical malpractice. In Kelsie’s case detailed above, not a single account of her story indicated that she ever received a diagnosis of ectopic pregnancy before the final OBGYN who treated her. This leads me to believe that Kelsie may have been misdiagnosed; the doctors she saw, for whatever reason, did not believe her to be experiencing an ectopic pregnancy but a miscarriage. Because of this, they did not treat her.

It is not uncommon for an ectopic pregnancy to be misdiagnosed. According to this study, between 40-50% of ectopic pregnancies are misdiagnosed upon the first visit to the emergency room. According to the NHS - the UK’s National Health Service:

“It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.”

In the UK, expectant management is often used in the case of suspected ectopic pregnancy. This is because ectopic pregnancies sometimes resolve on their own. Expectant management involves close monitoring of the pregnancy with regular testing to reassess the risk and if further treatment is needed. In the US, we often jump straight to treatment, but this article from American Family Physician notes that at least 14 studies have found that 68-77% of ectopic pregnancies resolve on their own.

If the doctors on Kelsie’s case did suspect ectopic pregnancy, it’s possible they decided to take a more conservative expectant management approach. After all, a 2002 study did find that roughly 40% of pregnancies initially diagnosed as ectopic turn out to be completely normal, viable, intrauterine pregnancies. If this is in fact the case, then taking an expectant management approach in cases where symptoms do not immediately indicate a medical emergency makes sense.

Kyleigh’s case is more confusing, since her doctor immediately suspected an ectopic pregnancy and her symptoms were fairly severe, yet the hospital still refused to treat her. Whatever the reason for the hospital’s delay in care, it seems evident that this is a case of medical malpractice.

How prevalent are these types of cases in the US?

The Associated Press recently came out with an article regarding their own analysis of federal hospital investigations. Their analysis found that over 100 pregnant women experiencing complications had been turned away from emergency rooms since 2022.

Let’s put that in perspective a bit. The analysis said “over 100 pregnant women” - this number is likely higher, since they only analyzed the data from hospitals that had been federally investigated. But it’s the number we have to go off of, so let’s just say 150 to be conservative.

150 pregnant women over a period of two years. A quick google search tells me that there are roughly 5 million pregnancies a year in the US (again, this is a rough, but conservative, estimate). So, 10 million pregnancies over a course of two years. Of those, about 2% are ectopic and up to 20% will end in miscarriage. Most of the complications being referred to are in relation to ectopic pregnancies and miscarriages, so we’ll just say these 150 women fall into a subcategory of about 25% of women (again - rough but conservative estimate).

25% of 10,000,000 = 2,500,000 pregnancies ending in miscarriage or ectopic

150/2,500,000 = .006% of all pregnant women experiencing a miscarriage or ectopic pregnancy are being turned away from emergency rooms.

Don’t get me wrong, I hate that this is happening at all. Pregnant women absolutely deserve top-notch care. But, “over 100 women” doesn’t sound nearly as astronomical when you put it into the context of the millions of pregnancies that occur in the US each year.

Is the problem exclusive to states with abortion bans?

Furthermore, the same Associated Press article goes on to state,

“Serious violations that jeopardized a mother or her fetus’ health occurred in states with and without abortion bans, the AP’s review found.”

Specifically noted in the article are 3 cases that occurred in states with lax abortion laws. California and Washington both allow for unrestricted abortion until viability, yet doctors in those states are compromising pregnant patients’ care, too. Emergency medicine doctor and former US Health and Human Services official Dara Krass warned that this is due to nursing and doctor shortages and trouble staffing ultrasounds, though she also attributed some of the blame to abortion bans.

But the point remains - if abortion bans are to blame for negligent doctors, then why are we seeing these same issues in abortion-friendly states? Clearly abortion bans cannot solely be to blame. In all the cases the AP reviewed, the women sought care from emergency rooms. It seems maybe we have an emergency medicine crisis in the US - and it isn’t because of abortion bans.

Do abortion bans play any role in the delay in care?

While it’s possible that in some cases, abortion bans may be causing doctors to take a more conservative approach, this is nearly impossible to prove. In order to establish a correlation, we would have to compare data showing the prevalence of this issue before Roe was overturned against the data showing the prevalence after Roe was overturned. To my knowledge, this data does not currently exist.

However, even if the laws are playing a role in some cases, the issue cannot be exclusively attributed to abortion bans for all of the reasons stated above. Instead, it appears that the more likely culprit is a lack of appropriate staff and resources in emergency departments as well as medical negligence.

It is also true that this issue is still relatively rare - given the small percentage of pregnancies in which these cases occur, there is no reason to believe it is happening at a greater rate now than before Roe was overturned.

If a doctor is being negligent and not providing appropriate care, then by all means, that doctor should be sued. Why are we trying to make excuses for a person who literally has lives in their hands and isn’t taking that responsibility seriously?

I support doctors and think they are amazing. But I also recognize that doctors are humans and capable of error, and that not all doctors are good doctors. Let’s be realistic in our expectations of doctors, and let them take responsibility when they mess up.

The reality is, no matter how you spin it, this is medical malpractice. When the law clearly states it is legal to treat ectopic pregnancy, and you refuse to provide that treatment when it is needed, that is malpractice. Blame the laws all you want, but ultimately it is the DOCTOR standing in the way of the treatment, not the law.