Abortion

goofy · January 5, 2024, 10:55pm

This is another EMTALA case like the Fifth Circuit one CN posted above:

The Ninth Circuit had blocked Idaho’s law, so SCOTUS is explicitly reinstating it for months until it hears arguments.

goofy · January 5, 2024, 10:59pm

MJS on the EMTALA stuff:

When the Supreme Court overturned Roe v. Wade, it claimed to be removing the judiciary from the abortion debate. In reality, it simply gave the courts a macabre new task: deciding how far states can push a patient toward death before allowing her to undergo an emergency abortion. On Tuesday, the U.S. Court of Appeals for the 5th Circuit offered its own answer, declaring that Texas may prohibit hospitals from providing “stabilizing treatment” to pregnant patients by performing an abortion—withholding the procedure until their condition deteriorates to the point of grievous injury or near-certain death. The ruling proves what we already know: Roe’s demise has transformed the judiciary into a kind of death panel that holds the power to elevate the potential life of a fetus over the actual life of a patient.

If that description seems hyperbolic, consider the facts of Tuesday’s decision, Texas v. Becerra. It involves a clash between a federal law and Texas’ stringent abortion ban. Texas law reflects the anti-abortion movement’s fundamental hostility toward any health exceptions; it permits emergency abortions only when a patient is “at risk of death” or “substantial impairment of a major bodily function.” Any doctor who terminates a pregnancy before this point is subject to a 99-year prison term. The Texas Supreme Court affirmed the narrow scope of this exception last month when it forbade Kate Cox from terminating her pregnancy. Cox suffered “severe cramps, leaking fluid and elevated vital signs” due to an abnormality that rendered the fetus incompatible with life. Yet the court unanimously decreed that, until her symptoms grew considerably more dire, Cox was legally obligated to continue the failing pregnancy.

This draconian ban, and others like it, conflicts with a federal statute, the Emergency Medical Treatment and Active Labor Act, or EMTALA. That law compels federally funded hospitals to provide “necessary stabilizing treatment” to any patient experiencing an “emergency medical condition.” It defines the term as any condition that “could reasonably be expected” to seriously jeopardize a patient’s health, bodily functions, or organs. In July 2022, President Joe Biden’s Department of Health and Human Services issued guidance noting that EMTALA applies when a pregnant patient requires an abortion for “stabilizing” care. It clarified that any stricter abortion laws must yield to EMTALA, granting red-state doctors permission to terminate a pregnancy well before a patient is dying.

Texas promptly attacked the Biden administration’s guidance, filing a lawsuit in a division that ensured the case would land in front of one of conservatives’ favorite judges: James Wesley Hendrix, a far-right Trump appointee. The state argued that it has the right to force patients into more extreme medical distress before allowing them to terminate a pregnancy, and that EMTALA’s “stabilizing” standard does not apply to abortion. Predictably, Hendrix agreed, blocking the federal government from “enforcing the guidance” in Texas, or against a group of anti-abortion doctors who joined the lawsuit. Biden’s Department of Justice appealed, but now the 5th Circuit has sided with Hendrix.

SensiblePerson · January 6, 2024, 12:25am

Fucking awful

goofy · January 8, 2024, 7:51pm

non-paywall link

A tragic and difficult read. I wouldn’t say Texas’s abortion ban is the only thing that killed this woman - a lot of this story is just about the difficulty of receiving medical care without money or particularly (in this case) U.S. citizenship - and saving her life would have required her consenting to an abortion, and who knows if she would have wanted that even knowing the dangers her pregnancy presented. But the fact it was never even given to her as an option is dire.

CaffeineNeeded · January 14, 2024, 8:32pm

Thoughts as I read:

“Anything that fails in society, anything that’s broken, ends up being the emergency room’s problem,” one of the employees told me.

Yuuuupppp

Diabetic, severely obese (guessing she’s short), history of heart failure in her 20s and pregnant… not a good idea.

The ER they describe is terrifying to me. Delivering babies is one of those things I’m trained to do but don’t do enough to feel remotely qualified to do. Last did it in 2018, with an OBGYN holding my hand the entire time. It’s been such a HALO (High acuity low occurance) event where I work that I’ve only done sims of it since.

Her BP being high isn’t a big deal. She never needed to be admitted for HTN, her doctors are morons or, more likely, there’s something else going on.

I’d say what actually killed her was social determinants of health and obesity (see previous) more than anything else. If she isn’t so obese, she doesn’t get DM and HTN. If her HTN is controlled with medications (which she clearly wasn’t taking regularly), she doesn’t get heart failure (which is the cause of the pulmonary edema). This is very much a ‘this is america’ type problem.

The management of the patient is also fucking wrong on that last visit. The ER doctor flat fucked up. She shouldn’t have gotten ativan, fentanyl and labetalol. All those things do is decrease the drive to breathe and decrease cardiac output. She needed to be on a high dose nitroglycerin drip with BiPAP. The ER doctor misdiagnosed pre-eclampsia for what was acute pulmonary edema.

Not doing the resuscitative hysterotomy (technical term for doing c-section while cpr is ongoing right away) is a mistake too, but as a single provider I get it. Those rarely work anyways. I’m trained to do those, and it’s one of those procedures I dwell on but have never had to do.

I stopped there… it’s a ‘too close to home’ situation for me. If I’m being honest, this type of case walking through the ER is my worst nightmare.

goofy · January 22, 2024, 7:38pm

For nearly five hours I alternate between lying in a fetal position on our bathroom floor and curling up against the wall, shivering uncontrollably one moment, and burning up the next.

I vomit three times on the floor. I rock back and forth in tears, repeating out loud, to myself, to God, to my husband and my dog on the other side of the door, to please, please make this stop. The pain is so blinding that I think I’m hallucinating.

It goes on so long, I don’t have the energy to scream, at what feels like every single bone in my body crumbling, my body breaking apart, collapsing into itself. Between each new wave of pain that comes, I try to focus on the broken grout between the floor tiles.

I pass out twice. I am terrified that I will die.

No one should have to fear they may die because of a miscarriage. And yet, for women like me in the United States, in Texas, that fear is very real.

goofy · January 25, 2024, 6:44am

Jesus, this is a much higher number than I would have guessed:

https://twitter.com/HoustonChron/status/1750249481071697965

non-paywall link

Texas saw an estimated 26,313 rape-related pregnancies during the 16 months after the state outlawed all abortions, with no exceptions for survivors of rape or incest, according to a study published Wednesday in the Journal of the American Medical Association.

Following the June 2022 Supreme Court ruling that overturned Roe v. Wade, the researchers estimated there were 519,981 rapes associated with 64,565 pregnancies during the four to 18 months after states implemented total abortion bans. Of those pregnancies, an estimated 5,586 occurred in states with exceptions for rape and 58,979 in states with no exceptions.

Danspartan · January 25, 2024, 1:18pm

In before the RWNJs say most of the rapes were actually false claims.

boredsocial · January 25, 2024, 6:52pm

And every one of those women has an entire family network who are, regardless of normal personal politics, appalled. If there’s one thing history has shown time and time again it’s that conservatives change their views permanently when something actually reaches out and touches them (only on the one thing obviously if they had normal amounts of empathy they wouldn’t be conservatives). Bob Dole is the reason why the ADA is a real thing and not totally watered down.

This abortion thing is really really stupid, and you know this to be true because the stats say it’s really stupid, your eyes tell you it’s really stupid, and your intuition tells you it’s really stupid. The only way you can even disagree is if you are deeply (and intentionally) ignorant of the real consequences of any meaningful restriction on reproductive healthcare.

One of the most important rules for GOP politicians has long been to never do anything that directly negatively impacts the base in any substantial way that can be directly tied to them. They do plenty that is bad for the base at a macro level but the GOP base is nowhere near smart enough to analyze macro policy (Dave Ramsey is the right financial advisor for these people ffs) so you can boil them like the frogs they are all you want… but you probably shouldn’t pass a law that forces their niece/daughter/granddaughter/etc to carry a rapists baby to term or causes them serious health problems.

akm · January 26, 2024, 12:56pm

…or else they will have no choice but to crinkle their foreheads and vote for Donald J. Trump and every other republican on the ballot.

boredsocial · January 26, 2024, 2:42pm

Nah man one of the most annoying things about conservatives is how fast they change their tune when it’s their turn to get their face eaten. Their fundamental hypocrisy is one of the things I like the least about them. If they were willing to take one for the team that would actually be a bit noble, but they absolutely aren’t. They just don’t have much if any empathy which is why they’re conservative.

And this is why the GOP since 2016 has been fucking up so badly… instead of only hurting poor people and brown people they’ve accidentally hurt an awful lot of people who probably would have voted for them.

akm · January 26, 2024, 3:02pm

I hear you. But on the other hand they are about to fuck up into controlling all levers of federal government with lockdown control over the Supreme Court for a generation, so I suppose we need some more faces eaten asap.

Danspartan · January 26, 2024, 8:21pm

It’s their ever expanding definition of “other”. You find more people to be outraged pretty soon you big tent is a lean-to off the side of 1970s Winnebago back by the dumpsters at a rural Walmart.

goofy · January 28, 2024, 5:30am

This story is enraging. The medical system failed her when she needed care at a traumatic time

On Sept. 19, Watts was 21 weeks and five days pregnant when she noticed an “uncomfortable” fluid leaking from her, she said. Her OB-GYN told Watts that her pregnancy was nonviable, according to a report by the Trumbull County Coroner’s Office. Watts was then transported by ambulance to Mercy Health St. Joseph Warren Hospital in Warren, Ohio, where she waited hours “for the doctor to come in or call,” she said during the interview.

“I kept asking whoever would come in to check my vitals — I said, ‘Have you heard anything?’ and they were like, ‘Oh, well, we’re still waiting. We’re still waiting.’”

Watts waited at least eight hours before deciding to leave the hospital “against medical advice,” according to medical records. The hospital report also states that Watts understood her risk of complications, including hemorrhage, sepsis or death.

Watts returned to the hospital the next day to get a labor induction; she waited for 11 hours, she said, but was never induced and opted to go home.

“I felt frustrated,” Watts said. “I felt ignored.”

But boy did they spring into fucking action when she said the A-word and they found a fucking crime they could report her for

Watts’ case was referred to Mercy Health’s ethics committee that day, after staff reported concerns with Watts using the word “abortion” when discussing the next steps to her care, according to medical records shown by CBS News. In Ohio, abortions after 22 weeks into a pregnancy are banned with exceptions to life-saving care, according to the state’s law.
…
While waiting on a decision about an induction on Sept. 20, Watts said she was worried about her own health. She miscarried two days after leaving the hospital for a second time.

Upon arriving at the hospital a third time in the middle of her miscarriage, Watts said a nurse reassured her that “everything’s going to be OK.” Meanwhile, that nurse, whom the hospital has not identified, called the police, Watts said. In a call with a 911 dispatcher shared by CBS News, the nurse said Watts “didn’t want to look” at the fetus. She also alleged Watts “didn’t want the baby and she didn’t look,” according to the 911 audio. Watts said, however, this was not true.

“I said I did not want to look,” Watts said Friday. “I have never said I didn’t want my baby. I would have never said something like that. It just makes me angry that somebody would put those type of words in my mouth to make me seem so callous and so — so hateful.”

Police arrested her days later on charges of abusing a corpse, under a state law that punishes those who treat a human corpse in a “way that the person knows would outrage reasonable family sensibilities” or “community sensibilities.” The fifth-degree felony charge is punishable by up to one year in prison and a fine of up to $2,500.

Grand jury told the cops to fuck off, thank god.

Melkerson · January 28, 2024, 6:20am

Can someone explain this part to me

If the prosecutor determined that she did not violate the Ohio criminal statute, then why is it even getting to the grand gury in the first place.

He must have thought it did in order to get an indictment. Now he has decided that it isn’t a violation. Did the group of laypeople in the grand jury just remind him of something that he should have known?

Danspartan · January 28, 2024, 7:28am

Just covering his ass from the anti abortion crowd. I would have indicted but the GJ returned no bill.

Jman220 · January 28, 2024, 1:35pm

A grand jury can be used as a screening/investigative tool by the prosecutor. There were times that I did this as a prosecutor. You can have the following three scenarios:

You have a case where you believe you can prove the defendant’s guilt beyond a reasonable doubt, but you’re not sure how a jury is going to treat the evidence (you’re concerned your witnesses are shitty, the evidence is really complicated, etc.). Maybe people in the office disagree/aren’t sure if the case is provable. In that situation, I’d put all evidence possible in front of the grand jury, including what I thought the defense would put in, and see what they said. It’s a decent test for what a random assortment of 12 citizens later on will think of the case; or
You have a shitshow case that maybe shouldn’t be prosecuted but you don’t know what you don’t know, maybe it needs more investigation, maybe there are more witnesses but you want to see what the witnesses are going to testify to, and they’re not cooperating or speaking with you. In that case, you put it in front of the grand jury, and see what shakes out (generally as far as the testimony of incalcitrant witnesses). Sometimes you need to put it in front of the grand jury because you need the grand jury subpoena power to get records that you can’t otherwise get and may either prove or disprove an element of the crime. I’ve had situations where, after presenting a case, I instructed the grand jury that the elements of a crime had not been established and that no charges were being submitted for their consideration. The one that springs to mind most was an armored truck robbery where we thought we had the right defendant (nobody had been charged yet), and I needed to get some out of state financial records to see if they matched our theory of the crime. I started the presentation, used the subpoena power to get the records, discovered that they did not match our theory of the crime, and instructed the grand jury that no crime had been established; or
You have a high-profile case that you know shouldn’t be prosecuted, but you don’t want to be the one to make the call. You put the case in and intentionally tank it so that the “grand jury is the one that made the decision.” Maybe you coordinate with the defense attorney to have the defendant testify and don’t bother cross-examining the defendant, etc. I never did this and it was a shitty practice by cowards.

I suspect Option 3 is what happened here…

kerowo · January 28, 2024, 1:57pm

I hope someone is going to get her to sue the hospital for being general fuckwits.

Melkerson · January 28, 2024, 6:46pm

If option 3 is what happened, then it seems to me that the prosecutor wouldn’t say “Watts did not violate the Ohio criminal statute”, because the kayfabe requires that he ostensibly thought that Watts did. So he would have to say something like “The GJ didn’t indict” or “The GJ didn’t believe the statute was violated”. The way he said it makes it sounds like his opinion. I guess he could have changed his mind (like in your option 2).

goofy · February 8, 2024, 2:30am

Could also go in GOP Insanity:

https://talkingpointsmemo.com/news/florida-chief-justice-fetal-personhood-abortion-amendment

During Wednesday’s arguments over the language of a proposed ballot initiative to protect abortion rights, Florida Supreme Court Chief Justice Carlos Muñiz kept returning to a well neither side had briefed.

“It talks about ‘all natural persons are equal before the law and have unalienable rights’ — I don’t know that I could affirmatively say that the term ‘natural person,’ as a matter of just ordinary meaning, doesn’t include the unborn,” Muñiz said. “We certainly talk about the unborn that way.”

Muñiz was quoting from one of the earliest passages in Florida’s constitution that says that all natural persons “are equal before the law and have inalienable rights, among which are the right to enjoy and defend life and liberty, to pursue happiness, to be rewarded for industry, and to acquire, possess and protect property.” If this passage applied to “the unborn” — or in non-anti-abortion political speak, embryos and fetuses — abortion at every stage would be murder. This is a state-level version of fetal personhood, the anti-abortion white whale.

While Muñiz was eager to promote his radical interpretation of the state constitution, Florida, even under its hard-right regime, does not presently embrace it. The state currently has a 15-week abortion ban, with a six-week one tangled up in court. If the state was operating under his preferred approach, abortion would likely be banned completely.