Dozens of pregnant women, some bleeding or in labor, are turned away from ERs despite federal law

WASHINGTON (AP) — Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her.

Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course" before discharging her without treatment for her ectopic pregnancy.

When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection to end the pregnancy. It was too late. The fertilized egg growing on Thurman’s fallopian tube ruptured it, destroying part of her reproductive system.

That’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated federal law when staff failed to treat her initially in February 2023.

“I was left to flail," Thurman said. “It was nothing short of being misled.”

The Biden administration says hospitals must offer abortions when needed to save a woman's life, despite state bans enacted after the Supreme Court overturned the constitutional right to an abortion more than two years ago. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.

More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations found.

Two women — one in Florida and one in Texas — were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting treatment, including one in California who needed a blood transfusion after she sat for nine hours in an emergency waiting room.

In Texas, where doctors face up to 99 years of prison if convicted of performing an illegal abortion, medical and legal experts say the law is complicating decision-making around emergency pregnancy care.

Although the state law says termination of ectopic pregnancies isn't considered abortion, the draconian penalties scare Texas doctors from treating those patients, the Center for Reproductive Rights argues.

“As fearful as hospitals and doctors are of running afoul of these state abortion bans, they also need to be concerned about running afoul of federal law,” said Marc Hearron, a center attorney. Hospitals face a federal investigation, hefty penalties and threats to their Medicare funding if they violate the federal law.

The organization filed complaints last week with the Centers for Medicare and Medicaid Service alleging that different Texas emergency rooms failed to treat two patients, including Thurman, with ectopic pregnancies.

One complaint says Kelsie Norris-De La Cruz, 25, lost a fallopian tube and most of an ovary after an Arlington, Texas, hospital sent her home without treating her ectopic pregnancy, even after a doctor said discharge was “not in her best interest.”

“The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency healthcare,” she said in a statement. “I’m filing this complaint because women like me deserve justice and accountability from those that hurt us.”

Conclusively diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the pregnancy’s location on an ultrasound, three doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test and an ultrasound of an empty uterus all indicate an ectopic pregnancy.

“You can't be 100% — that's the tricky part," said Kate Arnold, an OB-GYN in Washington. “They're literally time bombs. It's a pregnancy growing in this thing that can only grow so much."

Texas Right to Life Director John Seago said state law protects doctors from prosecution for terminating ectopic pregnancies, even if a doctor “makes a mistake” in diagnosing it.

“Sending a woman back home is completely unnecessary, completely dangerous," Seago said.

But the state law has “absolutely” made doctors afraid of treating pregnant patients, said Hannah Gordon, an emergency medicine physician who worked in a Dallas hospital until last year.

She recalled a patient with signs of an ectopic pregnancy at her Dallas emergency room. Because OB-GYNs said they couldn't definitively diagnose the problem, they waited to end the pregnancy until she came back the next day.

“It left a bad taste in my mouth," said Gordon, who left Texas hoping to become pregnant and worried about the care she'd receive there.

When Thurman returned to Ascension Seton Williamson a third time, her OB-GYN told her she'd need surgery to remove the fallopian tube, which had ruptured. Thurman, still heavily bleeding, balked. Losing the tube would jeopardize her fertility.

Her doctor told her she risked death if she waited any longer.

“She came in and she’s like, you're either going to have to have a blood transfusion, or you’re going to have to have surgery or you’re going to bleed out,” Thurman said, through tears. “That’s when I just kind of was like, ‘Oh my God, I’m, I’m dying.’”

The hospital declined to comment on Thurman’s case, but said in a statement it “is committed to providing high-quality care to all who seek our services.”

In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in Broward Health Coral Springs' emergency wait room, according to federal documents. An ultrasound revealed the patient had no amniotic fluid surrounding the fetus, a dangerous situation that can cause serious infection.

The woman miscarried in a public bathroom that day, after the emergency room doctor listed her condition as “improved” and discharged her, without consulting the hospital's OB-GYN.

Emergency crews rushed her to another hospital, where she was placed on a ventilator and discharged after six days.

Abortions after 15 weeks were banned in Florida at the time. Broward Health Coral Springs’ obstetrics medical director told an investigator that inducing labor for anyone who presents with pre-viable premature rupture of membranes is "the standard of care, has been a while, regardless of heartbeat, due to the risk to the mother.”

The hospital declined comment.

In another Florida case, a doctor admitted state law had complicated emergency pregnancy care.

“Because of the new laws ... staff cannot intervene unless there is a danger to the patient's health," a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator who was probing the hospital's failure to offer an abortion to a woman whose water broke at 15 weeks, well before the fetus could survive.

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

Two short-staffed hospitals — in Idaho and Washington — admitted to investigators they routinely directed pregnant patients to other hospitals.

A pregnant patient at a Bakersfield, California, emergency room was quickly triaged, but staff failed to realize the urgency of her condition, a uterine rupture. The delay, an investigator concluded, may have contributed to the baby's death.

Doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for fetal heartbeats or discharged patients who were in active labor, leaving them to deliver at home or in ambulances, according to the documents.

Nursing and doctor shortages, trouble staffing ultrasounds around-the-clock and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official.

“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” she said.

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

Kyleigh Thurman, one of the patients who is filing a federal complaint against an emergency room for not treating her ectopic pregnancy, talks about her experience at her studio, Wednesday, Aug. 7, 2024, in Burnet County, Texas. (AP Photo/Eric Gay)

BEIRUT (AP) — An Israeli strike on Beirut on Friday killed at least three people and wounded more than a dozen others, Lebanese health officials said, the first Israeli attack on the Lebanese capital in months that came after Hezbollah pounded northern Israel with rockets.

Israel announced the strike, but didn't immediately specify the target in Beirut's crowded southern suburbs, where Lebanon's Hezbollah militant group holds sway.

Lebanon's Health Ministry reported that at least three people were killed and 17 others wounded as local networks broadcast footage of wounded people being pulled from the ruins of a flattened building and ambulances rushing to the scene of the strike.

The strike in Dahiyeh, just kilometers from downtown Beirut, hit during rush hour, as people were leaving work and students headed home from school.

The escalation came as the region awaited the revenge promised by the militant group’s leader, Hassan Nasrallah, for this week’s mass bombing attack on pagers and walkie-talkies belonging to Hezbollah members.

Israel's rare strike on the Beirut suburbs came after Hezbollah pounded Israel with 140 rockets, which the Israeli military said came in three waves targeting sites along the ravaged border with Lebanon.

Following the attacks, the Israeli military said that it had struck areas across southern Lebanon targeting Hezbollah infrastructure, but didn’t provide details of damage.

Hezbollah said that its attacks had targeted several sites along the border with Katyusha rockets, including multiple air defense bases as well as the headquarters of an Israeli armored brigade they said they’d struck for the first time.

The Israeli military said that 120 missiles were launched at areas of the Golan Heights, Safed and the Upper Galilee, some of which were intercepted. Fire crews were working to extinguish blazes caused by pieces of debris that fell to the ground in several areas, the military said.

The military didn’t say whether any missiles had hit targets or caused any casualties.

Another 20 missiles were shot at the areas of Meron and Netua, and most fell in open areas, the military said, adding that no injuries were reported.

Hezbollah said that the rockets were in retaliation for Israeli strikes on villages and homes in southern Lebanon, not two days of attacks widely blamed on Israel that set off explosives in thousands of Hezbollah pagers and walkie-talkies.

On Thursday, Israel said its military had struck “hundreds of rocket launcher barrels” in southern Lebanon, saying that they “were ready to be used in the immediate future to fire toward Israeli territory.”

The army also ordered residents in parts of the Golan Heights and northern Israel to avoid public gatherings, minimize movements and stay close to shelters in anticipation of the rocket fire that eventually came Friday.

Hezbollah and Israel have exchanged near-daily fire since Oct. 8, a day after the Israel-Hamas war’s opening salvo, but Friday’s rocket barrages were heavier than normal.

Nasrallah on Thursday vowed to keep up daily strikes on Israel despite this week’s deadly sabotage of its members’ communication devices, which he described as a “severe blow.”

At least 20 were killed in the attacks and thousands were wounded when pagers, walkie-talkies and other devices exploded in Lebanon on Tuesday and Wednesday.

The sophisticated attacks have heightened fears that the cross-border exchanges of fire will escalate into all-out war. Israel has neither confirmed nor denied involvement in the attacks.

In recent days, Israel has moved a powerful fighting force up to the northern border, officials have escalated their rhetoric, and the country’s security Cabinet has designated the return of tens of thousands of displaced residents to their homes in northern Israel an official war goal.

Fighting in Gaza has slowed, but casualties continue to rise.

Overnight, Palestinian authorities said that 15 people were killed in multiple Israeli attacks in the Gaza Strip.

Those included six people, including an unknown number of children, in an airstrike early Friday morning in Gaza City that hit a family home, Gaza’s Civil Defense said. Another person was killed in Gaza City when a strike hit a group of people on a street.

Israel maintains that it only targets militants, and accuses Hamas and other armed groups of endangering civilians by operating in residential areas. The military, which rarely comments on individual strikes, had no immediate comment.

Gaza’s Health Ministry says that more than 41,000 Palestinians have been killed in the territory since Hamas’ Oct. 7 attack. The ministry doesn’t differentiate between fighters and civilians in its count, but says a little over half of those killed were women and children.

Israel says it has killed more than 17,000 militants, without providing evidence.

More than 95,000 people have also been wounded in Gaza since Oct. 7, the Health Ministry said.

The war has caused vast destruction and displaced about 90% of Gaza’s population of 2.3 million.

Ambulances arrive at the scene of an Israeli missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Hassan Ammar)

People stand on top of a damaged car at the scene of a missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Bilal Hussein)

People and rescuers gather at the scene of an Israeli missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Bilal Hussein)

People gather near a damaged building at the scene of an Israeli missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Bilal Hussein)

People gather at the scene of an Israeli missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Bilal Hussein)

People gather at the scene of an Israeli missile strike in the southern suburbs of Beirut, Friday, Sept. 20, 2024. (AP Photo/Bilal Hussein)

Israeli Iron Dome air defense system fires to intercept a rocket fired from Lebanon, in northern Israel, Friday, Sept. 20, 2024. (AP Photo/Leo Correa)