Hospitals Are Denying Lifesaving Treatment for Ectopic Pregnancies. Is That Legal?
Since the overturning of Roe v. Wade over two years ago, tensions have been higher than ever with state abortion laws. This is even more complicated when such laws run against federal emergency medical mandates.
Texan Kyleigh Thurman is one casualty. Last year, the 25-year-old had a near-death experience with a hospital that refused to treat her for an ectopic pregnancy until it was almost too late. Represented by the Center for Reproductive Rights, she’s now filed an administrative complaint with the U.S. Department of Health and Human Services (HHS) against the hospital. She alleges that the hospital violated the Emergency Medical Treatment and Active Labor Act (EMTALA) by failing to provide timely and necessary treatment.
Let’s take a look at the details of Thurman’s medical saga before we look at how cases like hers might be able to find justice.
Ectopic Pregnancies
You’ve probably heard of ectopic pregnancies, though hopefully none of your loved ones have had to suffer such an ordeal. An ectopic pregnancy is almost a misnomer, in the sense that it can never result in a viable gestation and birth. Ectopic pregnancies happen when a fertilized egg implants in a location other than in the uterine cavity and starts growing there. This can happen in the cervix, abdominal cavity, an ovary, or even the scar from a previous caesarian section.
Ectopic pregnancies are the leading cause of death of a pregnant woman in the first trimester. They also account for up to 10% of all pregnancy-related deaths. According to a 2022 report from the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Review Committee, the leading cause of pregnancy-related deaths in Texas was obstetric hemorrhage from a ruptured ectopic pregnancy.
In Kyleigh Thurman’s case, she specifically had what’s known as a tubal ectopic pregnancy. This is where the fertilized egg implants in one of the woman’s fallopian tubes instead of the uterus. Like any other ectopic pregnancy, such a situation is never viable for the fetus. Also like any other type of ectopic pregnancy, if it’s not treated in time, it can be deadly for the woman carrying it.
A Life-Threatening Condition
If a tubal ectopic pregnancy is left untreated the fallopian tube will rupture. This causes serious internal bleeding that can result in death for the pregnant woman. Once the tube is already ruptured, treatment usually requires the removal of the entire fallopian tube, which makes future fertility for the woman uncertain. If the woman is near rupture, she needs immediate medical intervention in order to not only keep her reproductive organs intact and functional for future pregnancies but also to preserve her life and health.
Ectopic pregnancies can be treated with either medication or surgery. The medication route is usually taken if the condition is detected early enough and if the mother’s vital signs are stable. In that case, a drug called methotrexate is often delivered via injection. This drug prevents cells in the embryo from growing, and the pregnancy is absorbed by the mother’s body.
The treatment with methotrexate is the safer route, but if the ectopic pregnancy is not detected early enough, then surgical intervention is required. In that case, if possible, the pregnancy may be able to be removed from the affected fallopian tube. But in other cases, part or all of the affected fallopian tube may have to be removed.
Kyleigh Thurman’s Case
Thurman was a resident of Burnet County in central Texas. She’d never been pregnant before and claims that she in fact had taken steps to prevent becoming pregnant. But despite these measures, in January 2023, she began noticing that something was wrong with her body: her menstrual cycle had been irregular that month, and she was getting the occasional cramps and dizzy spells. After she experienced continuous vaginal bleeding for almost a month and her symptoms worsened, she got in touch with her OBGYN, whose office was an hour away.
By mid-February, Thurman’s OBGYN had told her to take a pregnancy test. When she did, it came back positive. The doctor had allegedly already suspected an ectopic pregnancy based on Thurman’s symptoms. But because the doctor’s office had no more available appointments that day, and was rather far from Thurman, the doctor advised her to go to an ER in her hometown.
But when Thurman went to her local ER, the staff measured her pregnancy hormone levels and were unable to locate a pregnancy in her uterus. So, they discharged her. And when she returned two days later, the staff discharged her again and told her to come back in another two days.
Thurman had her own OBGYN review her blood tests and ultrasounds from the ER. After doing so, the OBGYN informed Thurman over the phone that she likely had an ectopic pregnancy. The doctor recommended an injection of methotrexate to terminate it but did not have the drug in her office. She told Thurman to go to the ER for the medication. But when Thurman’s hometown hospital didn’t have the drug either, she had to find another hospital that did.
Hospital Denies Thurman Treatment
That was how, on February 21, Thurman found herself an hour away from home at Ascension Williamson Hospital in Round Rock, Texas. Her OBGYN had called the physician on call at Ascension, advising her that Thurman had an ectopic pregnancy and needed methotrexate as soon as possible. Again, an ultrasound showed no pregnancy in the uterus, but rather a 2-cm growth on her right fallopian tube. That, combined with decreased levels of pregnancy hormones, were all signs of a tubal ectopic pregnancy.
Yet, instead of treating Thurman with methotrexate or anything else, they sent her home with instructions to return in two days. Thurman continued to experience her bleeding over the next few days, and her OBGYN again told her to return to the ER at Ascension Williamson. So on February 24, Thurman again drove to Ascension and explained to them the same diagnosis. The medics observed that her pregnancy hormone levels had “plateaued which is concerning for a possible ectopic pregnancy.,” but again did not offer her treatment.
Intervention Almost Too Late
Thurman was at a loss of what to do and called her OBGYN once again for advice. This time, the doctor was so infuriated that she personally showed up at Ascension Williamson to convince the medical staff to give Thurman the methotrexate. The hospital staff eventually agreed to do so – but it was too late. Even after the injection, a few days later, Thurman experienced a sudden, “blinding” pain and began bleeding to the point of passing out. Her ectopic pregnancy was rupturing.
Thurman’s hometown ER did not have the resources to treat her condition when she arrived. She was transferred to Ascension Williamson as she was bleeding out. Fortunately, they were able to remove her right fallopian tube in time to save her life.
Though she survived, it’s understandable that Thurman did not come out of the ordeal unscathed. She claimed that she was “overwhelmed by the horror of the ordeal.” In addition to the physical toll that the condition and the intervention took, she claims that she suffered significant psychological harm. On top of that, her future ability to have children will be significantly affected by the removal of her fallopian tube.
Thurman Takes Action
Thurman has brought a legal action under EMTALA. Enacted by Congress in 1986, the federal law covers any hospital that has an emergency department and receives Medicare funds — this includes Ascension Williamson.
The law requires covered hospitals to provide whatever treatment is required to stabilize an emergency medical condition that is within their capabilities. If the hospital can’t do so, it must transfer the patient to another facility.
Since ectopic pregnancies are considered emergency medical conditions requiring stabilization under EMTALA, Thurman claims that Ascension Williamson’s staff violated federal law. Thurman’s action against Ascension is not a lawsuit because it was not filed in court – as it would be if she’d instead brought a claim for medical malpractice. Rather, it’s a complaint that’s filed with HHS, and will be reviewed by the agency rather than the judiciary.
Many Similarly Situated Women
Thurman is just one case sample of many women going through similar denial of treatment. Fellow Texan Kelsie Norris-De La Cruz was similarly discharged from Texas Health Arlington without treatment for her ectopic pregnancy and suffered similar consequences. She too has filed a similar complaint with HHS.
These Texans are not alone in their fight for lifesaving care. Women in other states like Kansas and Idaho are similarly challenging their state laws and the decisions of their hospitals in denying treatment for ectopic pregnancies, which can result in death and infertility. Some of these are agency complaints, but some of them are lawsuits filed in court.
Will this growing snowball of legal action bring about any greater change in legislation?
Related Resources:
- Is Health Care a Right? (FindLaw’s Learn About the Law)
- Arizona Supreme Court Revives 1864 Law Banning Abortion (FindLaw’s Courtside)
- Emergency Room Malpractice: When Can You Sue? (FindLaw’s Learn About the Law)