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Two women have filed complaints with the federal government alleging that Texas hospitals denied them abortion care necessary to treat their ectopic pregnancies.

The complaints were filed August 6 by Kelsie Norris-De La Cruz and Kyleigh Thurman against Texas Health Arlington Memorial Hospital and Round Rock-based Ascension Seton Williamson Hospital, respectively. Both women are represented by the Center for Reproductive Rights.

Both say the hospitals denied them appropriate stabilizing medical care, which hospitals that accept federal Medicare funding are required to do under the Emergency Medical Treatment and Labor Act, also known as EMTALA. 

Ectopic pregnancies, which happen when a fertilized egg implants outside the pregnant person’s uterus, can be fatal to them and cannot result in birth. Both women had ectopic pregnancies that implanted in their fallopian tubes, which connect ovaries to the uterus.

The women say that they were initially sent home without receiving appropriate care, which in this case should have been terminating the pregnancy. The women say they continued to seek follow-up care: Norris-De LaCruz sought a second opinion hours later with a different doctor who diagnosed her ectopic pregnancy and had her brought in for surgery. Thurman returned days later after experiencing continued vaginal bleeding. But by the time both could receive abortions, their pregnancies had ruptured. Both women had to have their affected fallopian tube removed.

A spokesperson for Ascension wrote that, “while we cannot speak to specifics of this case, Ascension is committed to providing high-quality care to all who seek our services.” Texas Health did not immediately respond to an emailed request for comment.

In theory, Texas law, which bans almost all abortions, allows termination for patients with ectopic pregnancies. But the physicians still have to prove in court that any abortion they provide is protected by law. As a result, doctors in the state have said offering abortions still carries immense legal risks, even for ectopic pregnancies.

“Texas law clearly allows for abortions to treat ectopic pregnancies, and federal law requires it. Yet, Kelsie and Kyleigh were denied absolutely urgent care,” Beth Brinkmann, Senior Director of U.S. Litigation at the Center for Reproductive Rights, said in a statement. 

“As long as these bans are in place, doctors will be terrified to provide abortions of any kind,” she continued, referring to the state’s near-total abortion ban.

“”Pregnancy is not straightforward, and I now have to live with the consequences of these extreme laws every day,” Thurman said in a statement. “None of this should have happened to me, and I want to make sure this doesn’t happen to anyone else.”

These complaints mark the second round of legal action by the Center for Reproductive Rights regarding Texas’ abortion laws. In 2023, the organization filed suit on behalf of a group of women who were denied abortions for medically complex pregnancies, arguing that those patients were unable to get health care because of confusion over the state’s narrow medical emergency exception, which allows abortions to save the life of the pregnant person or to prevent “substantial impairment of major bodily function.” The women lost that case, Zurawski v. State of Texas, in a decision issued May 31.

Typically, EMTALA complaints are investigated by the state. But in this case, the women’s attorneys are asking the federal Department of Health and Human Services’ Center for Medicare and Medicaid Services to handle these complaints instead. 

The federal government has argued that EMTALA protects abortions under emergency circumstances, trumping state bans. Idaho, another state with strict abortion laws, has challenged the federal government’s enforcement of EMTALA, arguing that the state cannot protect the right to an abortion that is in conflict with its own near-total ban. This June, the Supreme Court sent that case back to lower courts for continued litigation.

Texas has also challenged the federal government; an appeals court has said that while this question is litigated, emergency rooms in the state are not required to give abortions in medical emergencies. 

Molly Duane, a senior staff attorney at Center for Reproductive Rights, argued that even in that context, the federal law should protect care for ectopic pregnancies, given Texas’ explicit carveout for this medical situation.

“The State agrees that terminating ectopic pregnancies is not ‘an abortion’ under Texas’s legal definition of the term. So the 5th Circuit’s ruling is irrelevant because that case only addresses places where Texas’s abortion ban and EMTALA potentially conflict,” Duane said. “Here there is no conflict, so it is clear that the federal government can and should enforce EMTALA.”