Crime Pregnant Texas teenager died after being denied emergency abortion care

[CatchnShoot]

Wait a second before you call people muppets (since you included me). The articles are saying missed diagnosis of sepsis. So if that’s true, then the right antibiotics given at the right time would have prevented the need for any type of medication induced abortion or surgical abortion.

I didn’t defend that law btw, but you did call me a muppet for blaming the docs. Sending someone home who meets SIRS criteria is often frowned upon when they come back and need an ICU admission.

lol... no, I wasn't referring to you, but if that's how you self-identify, muppet away frendo.

I was specifically referring to Madmick and Legion.

 

[Vampire life]

10+ year ER/ICU RN here.

The term "qualifies for sepsis" means next to nothing. It means you had a high heart rate and a fever (typical presentation), which is normal for everything from a low grade fever from a cold, strep, to monkey pox. PS the HR just needs to be above 90.

In terms of the bleeding and what not, an OB asking for an ultrasound in that scenario would be gold standard. Of course you need an US to rule out/in fetal demise as well as know what else may be going on. You do not need an ultrasound specifically for a fetal demise, but, if you suspect one, you want a clear picture. You can just do fetal heart tones on mom which is a bedside task for a nurse that takes 2 minutes. The physician can also do a bedside ultrasound. The physician can also order an US by an US tech that takes maybe 20-30 minutes and can be done in the room at bedside in emergent situations.

In terms of the low blood pressure, that could be from septic shock, or because she was bleeding. I would guess the latter based on available information. Two problems can occur at once, of course.

Pregnant patients that present to emergency departments > 16 weeks, in some places greater than 20, are cleared by E.D. if it is a non-OB related complaint, then evaluated by labor and delivery before discharge. Sometimes they are cleared in ED and sent to L&D for OB related complaints such as lower back pain, abd pain, vaginal bleeding, etc.

There's a lot of layman and litigation talk in these articles covering it. Not something you can rely on in context to an expiration in the emergency department. L&D patients are highly litigious, so suing parties usually get a head start on the release of information.

In addition to that, three ER visits could be an ER problem or it could be a patient problem. I've often had patients that come in for a sore throat like an asshole and come back 3 hours later with chest pain and whoops they have a pulmonary embolism or myocardial infarction, etc. -- there's a reason ER's discharge people with strict return precautions. Even if they weren't going to go in and therapeutically abort a soon to be demise for a septic mother, she would still be admitted on sepsis protocol (which she wasn't because she didn't meet the criteria)...or, for vaginal bleeding, she would be admitted for obs due to the bleeding up to and including transfusions and serial H&H labs. Those first two visits did not present the same as the 3rd. Period.

This poppycock about not addressing medical concerns because of the law are largely hogwash from the articles I've read about this case. People like this receive blood transfusions and sepsis therapy all the time and there is plenty of time to get an ultrasound in the midst of that, which again, would be absolute gold/platinum standard care to do in any state, legal abortions or not. There's a lot of missing puzzle pieces here that will only be found out through courts with a complete and comprehensive review of the medical record as to why the first two visits went the way they did.

They're out in front of their skis with this story as it currently stands, probably due to the election timing.

A sound voice of reason and experience chimes in
Thx
“Pre sepsis “
What’s the guidelines and symptoms for that- or to even check for it?
Fever?

 

[ColemanwastheGOAT]

There's no way of knowing whether the hospital did or didn't follow the CMS guidelines for sepsis at this point, that'll be figured out in court. Mostly because we don't know if she just had a couple SIRS criteria, or if she qualified for severe sepsis, or septic shock, etc. - certainly on the 3rd visit she would have even if the causative diagnosis wasn't actually sepsis but hemorrhaging. We also don't know her initial chief complaints/presentations the first two times, the triage notes/vitals, all the things that would allow us to objectively deconstruct the emergency visit and disposition. That's why I mentioned all this layman article silliness that's reported from one side is not very reliable or informative at this point. It seems axe grindy to me.

They may have very well done labs and a lactic and cultures (cultures take a few days) and everything came back unremarkable or minimally remarkable. She got diagnosed with strep, so she was likely given antibiotics for home. The hospital could also be shitty. The doctor could have been shitty. The fetal heart rate could have had an impact due to the new law. What I'd assert is that the timing of this reporting and the language is indicative that the people writing it are certainly rooting for that.

In case anyone is wondering why this sepsis thing is such a hang up, is because "qualifying for sepsis" is a very broad term. People without infectious process at all "qualify for sepsis" all the time every day, including during exercise (based on the symptoms, I mean). There are CMS recommended guidelines for treatment of the various stages of sepsis

2. Clinical Definitions of Sepsis | ATrain Education

Sepsis is a potentially fatal disease. For the best chance of treating it successfully, clinicians need to recognize it early and treat it quickly; however it can be difficult to diagnose, especially early in the course of the disease. Sepsis coexists with an infection, and often with other...

www.atrainceu.com

In addition to that, based on the above criteria, the treatment recommendations are as follows.

So the devil is in the details on the objective data upon each visit. I'd proceed with caution with reading layman articles where we only have half or less than half of the story. Believe it or not, too, mother's die from fetal demise in states where abortions are encouraged, too.

Great post.
l'll add calling these journalists 'laymen' is pretty charitable given they are making up their own narratives to fit their political agenda. The issue isn't a lack of knowledge, it's a lack of humanity.

They heard an 18 year old girl died from complications of a pregnancy jn an anti-abortion state and went 'FUCK YEAH! We can use this two days before the election!' and did a little victory dance around their studio apartments.

Fucking ghouls.

 

[LangfordBarrow]

Sad story and incredibly evil to try and politicize this.

The ban is political...

 

[PhitePhan]

The ban is political...

The “Ban” specifically allows for an abortion in this type of situation.

 

[Sinister]

Great post.
l'll add calling these journalists 'laymen' is pretty charitable given they are making up their own narratives to fit their political agenda. The issue isn't a lack of knowledge, it's a lack of humanity.

They heard an 18 year old girl died from complications of a pregnancy jn an anti-abortion state and went 'FUCK YEAH! We can use this two days before the election!' and did a little victory dance around their studio apartments.

Fucking ghouls.

The only one making up bullsh*t in here is you. Acting like you're brand new to the notion that every death or near death of a pregnant woman under similar circumstances in Texas hasn't had this same overtone. Like it's been JUST for the election.

And what are you gonna do if all evidence points to the 2nd Hospital for sure not acting, was a result of the legal climate of miscarriage treatment down there which has already been documented with other cases? Eat your crow? We gonna completely forget about Barnica's case where she was right in front of Doctors who had to wait for the fetal heartbeat to cease and she died of the subsequent infection? The similar deaths in other States? The fact that Texas' maternal mortality rate rose significantly after SB8?

But hey dont let increasingly dead women stop you from patting yourself on the back.

Study finds higher maternal mortality rates in states with more abortion restrictions | Celia Scott Weatherhead School of Public Health and Tropical Medicine

Figure 1. State abortion policy context in 2015 States with more restrictive abortion policy climate have higher total maternal mortality, measured as a death during pregnancy or within one year following the end of a pregnancy, a recent study conducted by a team of Tulane researchers finds.

sph.tulane.edu

 

[ColemanwastheGOAT]

The only one making up bullsh*t in here is you. Acting like you're brand new to the notion that every death or near death of a pregnant woman under similar circumstances in Texas hasn't had this same overtone. Like it's been JUST for the election.

And what are you gonna do if all evidence points to the 2nd Hospital for sure not acting, was a result of the legal climate of miscarriage treatment down there which has already been documented with other cases? Eat your crow? We gonna completely forget about Barnica's case where she was right in front of Doctors who had to wait for the fetal heartbeat to cease and she died of the subsequent infection? The similar deaths in other States? The fact that Texas' maternal mortality rate rose significantly after SB8?

But hey dont let increasingly dead women stop you from patting yourself on the back.

Study finds higher maternal mortality rates in states with more abortion restrictions | Celia Scott Weatherhead School of Public Health and Tropical Medicine

Figure 1. State abortion policy context in 2015 States with more restrictive abortion policy climate have higher total maternal mortality, measured as a death during pregnancy or within one year following the end of a pregnancy, a recent study conducted by a team of Tulane researchers finds.

sph.tulane.edu

And don't you stop dancing on those graves, creep.

 

[Sinister]

The “Ban” specifically allows for an abortion in this type of situation.

No it doesnt. It's not clear on when it allows for an abortion, or what any criteria are. Vaguely saying "to save the life of the Mother" means virtually nothing without context. The Cox decision sent a clear message that even knowing a woman is at risk of death isnt enough for them to allow the exception, so that means she had to actually BE dying...and then who determines at what stage of dying she needs to be at? The Doctors face prosecution. The woman also faces being dragged through Court and prosecuted if they determine she want dying the correct amount.

 

[Sinister]

And don't you stop dancing on those graves, creep.

No one is trying to dance except you and a couple of expected others after Poatan posted. Nothing I'm saying is at all celebratory.

 

[PhitePhan]

No it doesnt. It's not clear on when it allows for an abortion, or what any criteria are. Vaguely saying "to save the life of the Mother" means virtually nothing without context. The Cox decision sent a clear message that even knowing a woman is at risk of death isnt enough for them to allow the exception, so that means she had to actually BE dying...and then who determines at what stage of dying she needs to be at? The Doctors face prosecution. The woman also faces being dragged through Court and prosecuted if they determine she want dying the correct amount.

The Cox decision was ENTIRELY different than this woman dying due to medical emergency/error/negligence… to try and use the Cox case as a rationale for the doctors not doing their job here is disengenuous, at best.

“Kate Cox, a mother of two who is around 20 weeks pregnant, found out just after Thanksgiving that her developing fetus has trisomy 18, a fatal diagnosis.”

 

[GreatSaintGuillotine]

I actually had a kid tell me in middle school that our texts books were wrong about civil war, it was over states rights not slavery. Still makes me chuckle

Yeah my whole class tore into my AP history teacher about that. He was very Adamant it was an "economic dispute " between states

 

[iwannabeadored]

Yeah my whole class tore into my AP history teacher about that. He was very Adamant it was an "economic dispute " between states

I hear that’s actually how they teach the civil war in the south.


When you argue what the “economic dispute” was about or what’s”state right” was violated then theirs usually silence

 

[Poatan Power]

The only one making up bullsh*t in here is you. Acting like you're brand new to the notion that every death or near death of a pregnant woman under similar circumstances in Texas hasn't had this same overtone. Like it's been JUST for the election.

And what are you gonna do if all evidence points to the 2nd Hospital for sure not acting, was a result of the legal climate of miscarriage treatment down there which has already been documented with other cases? Eat your crow? We gonna completely forget about Barnica's case where she was right in front of Doctors who had to wait for the fetal heartbeat to cease and she died of the subsequent infection? The similar deaths in other States? The fact that Texas' maternal mortality rate rose significantly after SB8?

But hey dont let increasingly dead women stop you from patting yourself on the back.

Study finds higher maternal mortality rates in states with more abortion restrictions | Celia Scott Weatherhead School of Public Health and Tropical Medicine

Figure 1. State abortion policy context in 2015 States with more restrictive abortion policy climate have higher total maternal mortality, measured as a death during pregnancy or within one year following the end of a pregnancy, a recent study conducted by a team of Tulane researchers finds.

sph.tulane.edu

If hospitals are not following evidence based practice because of this law, it's appalling. In California I've worked in Catholic hospitals that regulate this with policy and physicians here all the time tie tubes, etc. based on "the life of the mother" because it is such a broad term even when it would have been in violation of said policy. That being said, there are plenty of EBP treatment protocols for sepsis, etc. that can be implemented while getting fetal heart tones and what not that would be the correct treatment in this case from a broadly speaking idea of what may have happened. If any treatment was withheld due to the wording of this law then as a health care professional I'd have to say that obviously this law is unethical (to me), and I'm not supportive of abortion in general other than keeping the govt out of folks' uteruses. As someone who's broadly pro-life I'm still glad I work in California because even if we fuck a lot of shit up out here, we approach maternity correctly at a state funding level and have some of the best neonatal intensive care units in the country. When I was a hospital supervisor I was always amazed at seeing NICU nurses taking care of 24, 26, even a couple 22 weekers I saw that made it to discharge. As the years have gone on the level of recovery and normalcy these kids have made it to is absolutely amazing.

The sad thing about all of this is that Roe v. Wade was about as good as we were going to get other than fetal protections at a certain week. It wasn't based on a good case (in my layman opinion) but the issue is almost too complex for litigation. In a dream land we could have fetal protections starting at, let's say, 16 weeks so that viable life was protected with a buffer but medical decision making was also protected for 16 weeks for rape, incest, etc. and then qualifiers including mother's life and well being could be protected after that fact... and then we can tell both sides to suck it up and accept the concessions to their all or nothing wants.

I think the worst possible thing for this issue nationally was for it to become a state by state issue. It effectively becomes just like firearms where one state can be overwhelmingly draconian (California, Mass, etc.) and set new paltry standards. The standard for this, in whatever form it comes down, needs to be a constitutional amendment.

 

[Sinister]

The Cox decision was ENTIRELY different than this woman dying due to medical emergency/error/negligence… to try and use the Cox case as a rationale for the doctors not doing their job here is disengenuous, at best.

“Kate Cox, a mother of two who is around 20 weeks pregnant, found out just after Thanksgiving that her developing fetus has trisomy 18, a fatal diagnosis.”

Neat how you take a quote line out of the Cox decision and think you have a point, demonstrating that you didnt actually look into the case much or the arguments made. Nothing disingenuous about pointing out the fact that the Texas Supreme Court just entirely ignored Cox's Doctors about her risk of death, saying she doesn't meet the requirements to allow abortion even though there are no clearly stated requirements, and then pretending like you can't fathom what kind of effect that decision would have on the medical community.

"
Cox’s lawyers say the problem is the laws — they’re too vague, and the stakes too high, for doctors to implement them with confidence.

The state says the problem is with the way doctors are interpreting the law, not the law itself. When several women testified in July that they had been denied medically necessary abortions, an assistant attorney general asked why they were suing the state instead of their doctors. Again and again, the state’s lawyer asked the women: Did Attorney General Ken Paxton tell you you couldn’t get an abortion? Did anyone, working in any capacity for the state, tell you you couldn’t get an abortion?

But when Cox got a court order allowing her doctor to terminate her non-viable pregnancy, Paxton channeled the full power of the state to stop her, threatening hospitals, appealing to the state’s highest court and ultimately getting the order blocked."

That's the position of the State. They tell women to blame the Doctors, then when the women call their bluff, the State steps in and interferes.

"The amniocentesis confirmed her fetus was developing with full trisomy 18, an extreme chromosomal abnormality. If her child was born alive at all, they would survive only minutes, hours or days outside of the womb.

Cox’s pregnancy was going to end in heartbreak. The only question was when. Cox and her husband wanted to end “the pain and suffering that has plagued this pregnancy,” she said in a statement.

“I do not want to put my body through the risks of continuing this pregnancy,” she said. “I do not want to continue until my baby dies in my belly or I have to deliver a stillborn baby or one where life will be measured in hours or days.”

Before the overturn of Roe v. Wade in June 2022, Texas law would have allowed Cox to have an abortion at her doctor’s office or hospital. But now, her doctors told her they could not perform the procedure, and there was likely no one in Texas who would."

Doctors dont want to risk this. Because of the vague wording of the laws.

"While Cox was inside a doctor’s office in Dallas, receiving this devastating diagnosis, the Texas Supreme Court was considering this exact question, of when and whether doctors can terminate a pregnancy, in another case, Zurawski v. Texas.

Twenty women had signed onto this suit, saying they had been unable to access medically necessary abortions because of the state’s abortion laws.

Texas laws ban all abortions unless, “in the exercise of a reasonable medical judgment,” a doctor determines that the patient is experiencing “a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function.”

The Center for Reproductive Rights, which filed the Zurawski suit, argued doctors are unclear on what qualifies as “reasonable medical judgment,” and should be allowed to act based on their “good faith belief” that an abortion is necessary.

"
At the Zoom hearing, Jonathan Stone, a lawyer for the Texas attorney general’s office argued that Cox “does not meet all of the elements” to qualify for a medical exemption, and granting the order would require “changing the medical exemption in Texas and then saying that the plaintiffs meet this changed newly rewritten standard.”

Travis County District Judge Maya Guerra Gamble disagreed and granted the motion.

“The idea that Ms. Cox wants desperately to be a parent, and this law might actually cause her to lose that ability is shocking and would be a genuine miscarriage of justice,” she said."

That's when Paxton stepped in. And what was his first act? He sent a threatening letter TO THE HOSPITAL.

"
Within hours, Paxton sent a threatening letter to Methodist Hospital, The Women’s Hospital of Texas and Texas Children’s Hospital, where Karsan has admitting privileges, reminding them of the “potential long-term implications if you permit such an abortion to occur at your facility.”

Paxton said the hospitals were not protected from felony prosecution nor private lawsuit if they allowed the abortion to occur on their property, and said they should not rely on Guerra Gamble’s ruling as she “is not medically qualified to make this determination.”

“We remind you that the TRO will expire long before the statute of limitations for violating Texas’ abortion laws expires,” Paxton wrote."

And quite frankly, I'm disappointed in you because I'd expect someone who goes on about medical freedom as much as you do when it comes to vaccines to at least realize the implications here. But I guess that's only where it benefits you. Women who face infertility and death from carrying non-viable fetuses, miscarriages, ectopic pregnancies, they can get f*cked, property of the State.

 

[Sinister]

If hospitals are not following evidence based practice because of this law, it's appalling. In California I've worked in Catholic hospitals that regulate this with policy and physicians here all the time tie tubes, etc. based on "the life of the mother" because it is such a broad term even when it would have been in violation of said policy. That being said, there are plenty of EBP treatment protocols for sepsis, etc. that can be implemented while getting fetal heart tones and what not that would be the correct treatment in this case from a broadly speaking idea of what may have happened. If any treatment was withheld due to the wording of this law then as a health care professional I'd have to say that obviously this law is unethical (to me), and I'm not supportive of abortion in general other than keeping the govt out of folks' uteruses. As someone who's broadly pro-life I'm still glad I work in California because even if we fuck a lot of shit up out here, we approach maternity correctly at a state funding level and have some of the best neonatal intensive care units in the country. When I was a hospital supervisor I was always amazed at seeing NICU nurses taking care of 24, 26, even a couple 22 weekers I saw that made it to discharge. As the years have gone on the level of recovery and normalcy these kids have made it to is absolutely amazing.

The sad thing about all of this is that Roe v. Wade was about as good as we were going to get other than fetal protections at a certain week. It wasn't based on a good case (in my layman opinion) but the issue is almost too complex for litigation. In a dream land we could have fetal protections starting at, let's say, 16 weeks so that viable life was protected with a buffer but medical decision making was also protected for 16 weeks for rape, incest, etc. and then qualifiers including mother's life and well being could be protected after that fact... and then we can tell both sides to suck it up and accept the concessions to their all or nothing wants.

I think the worst possible thing for this issue nationally was for it to become a state by state issue. It effectively becomes just like firearms where one state can be overwhelmingly draconian (California, Mass, etc.) and set new paltry standards. The standard for this, in whatever form it comes down, needs to be a constitutional amendment.

See my above post for evidence that the Cox decision shook up the medical community in Texas. Paxton is unhinged and their Supreme Court gave him their stamp of approval.

 

[GreatSaintGuillotine]

I hear that’s actually how they teach the civil war in the south.


When you argue what the “economic dispute” was about or what’s”state right” was violated then theirs usually silence

We legitimately hijacked a whole class period arguing with this man lol. The civics teacher (and Army vet, hilarious guy) came in, overhead and respectfully told him he was wrong and to stfu. Good times

 

[iNoScopedJFK]

See my above post for evidence that the Cox decision shook up the medical community in Texas. Paxton is unhinged and their Supreme Court gave him their stamp of approval.

Paxton threatened a doctor that performed an abortion on a woman in Dallas even when the doctor got court approval for that abortion. Think of how unhinged that is. The doctor determined this abortion was an emergency and had to be performed ASAP, but still had to get approval from a court in the middle of this process of trying to perform an emergency abortion in order to not face potential life in prison and even after getting approval for that emergency abortion was still threatened with potential legal action.

 

[Sinister]

We legitimately hijacked a whole class period arguing with this man lol. The civics teacher (and Army vet, hilarious guy) came in, overhead and respectfully told him he was wrong and to stfu. Good times

Hey but there's no such thing as systemic racism in the US and CRT is evil...according to all the racists.

 

[Sinister]

Paxton threatened a doctor that performed an abortion on a woman in Dallas even when the doctor got court approval for that abortion. Think of how unhinged that is. The doctor determined this abortion was an emergency and had to be performed ASAP, but still had to get approval from a court in the middle of this process of trying to perform an emergency abortion in order to not face potential life in prison and even after getting approval for that emergency abortion was still threatened with potential legal action.

If you actually read the arguments of those 2 cases, they're f*ckin disgusting. In the first case the Texas AG officr argued that a woman MUST be pregnant and seeking an abortion in order to even file a lawsuit to challenge the law. Imagine that, in the US, where plenty of corporate entities engage in egregious SLAPP lawsuits all the time, and where the GOP is actively suing to stymie democracy itself in multiple States, and a failed former President can sue 60 times to subdue the will of the people, suddenly there are conditions on who can even BEGIN to challenge the law. This made it a requirement for a woman experiencing a threatening pregnant to come before Courts first. Lolwut?

So here comes Cox, a woman seeking an abortion in Texas with a legitimate challenge and a Court agrees. Immediately Paxton has a f*ckin aneurism and goes on a tirade against multiple medical institutions. There is seriously no way that anyone can determine that the legal climate down there ISN'T having an effect on the medical community.

 

[Islam Imamate]

The Cox decision was ENTIRELY different than this woman dying due to medical emergency/error/negligence… to try and use the Cox case as a rationale for the doctors not doing their job here is disengenuous, at best.

“Kate Cox, a mother of two who is around 20 weeks pregnant, found out just after Thanksgiving that her developing fetus has trisomy 18, a fatal diagnosis.”

You say its entirely different but Kate Cox ran into the same issue.

Duane believed Kate's case fell under that exception: "Yes, and so did her doctor. The problem is, no one knows what that means. Major bodily function? What about a minor bodily function? Surely fertility would count as a major bodily function. But there's no clarity about this."

Oh and what happened to Kate Cox?

So far, no private citizen has successfully sued another for aiding an abortion. But the Coxes, and their doctor, didn't want to risk prosecution. So, in December, when Kate was 20 weeks pregnant, they sued the state of Texas. "We were asking for a court order to say Kate can get an abortion in Texas, and her doctor and her husband would be protected by that court order," Duane said.

The District Court granted their restraining order. But the Texas attorney general sent a letter to doctors and hospitals warning they could still be prosecuted if they helped Kate get an abortion – and he filed an appeal with the State Supreme Court.

Smith asked, "As the Texas Supreme Court is debating this, what are you going through?"

"I mean, I didn't hardly get out of bed – stressed, you know? I had a timeline. I couldn't wait," Kate said.

They decided they had to go out of state. The Coxes had the abortion in New Mexico, and said goodbye to a future they'd already been grieving.

So even though her pregnancy was DOA and she successfully sued the state to get a court order allowing her to get an abortion she was still threatened by the Texas attorney General and was fearful enough as a result to get the abortion out of state. This is the system Republicans want, one where women with nonviable pregnancies are so fearful of prosecution that even with a court order they have to flee the state to perform abortions and even then some are trying to criminalize so called "abortion tourism" to prevent even that.

Paxton threatened a doctor that performed an abortion on a woman in Dallas even when the doctor got court approval for that abortion. Think of how unhinged that is. The doctor determined this abortion was an emergency and had to be performed ASAP, but still had to get approval from a court in the middle of this process of trying to perform an emergency abortion in order to not face potential life in prison and even after getting approval for that emergency abortion was still threatened with potential legal action.

If you're talking about Kate Cox then you're wrong, that doctor didn't even perform the abortion despite having the court order due to Paxton's threat so Kate Cox had to leave the state to get an abortion. And remember that some Republicans want to criminalize even that.