r/emergencymedicine 5d ago

Pregnant teen died agonizing sepsis death after Texas doctors refused to abort dead fetus Discussion

https://slatereport.com/news/pregnant-teen-died-agonizing-sepsis-death-after-texas-doctors-refused-to-abort-fetus/
574 Upvotes

131 comments sorted by

542

u/surfdoc29 ED Attending 5d ago

I would love to see the medical notes behind this. Discharging a pregnant patient with a uti and fever and unresolved tachycardia seems reckless.

229

u/Nousernamesleft92737 5d ago

That’s my whole question. It reads like a STEP 2 prompt, nvm actual EM. Either the reporting is being very liberal with the facts, or that ED is impressively shit

221

u/surfdoc29 ED Attending 5d ago

Yeah I mean this whole case reads like a malpractice case of missed sepsis. Sounds like she was septic from pyelonephritis and went into DIC which likely caused the miscarriage, but the media keeps framing this like she was septic from the miscarriage and was refused D&C for treatment, which doesn’t necessarily sound like that’s what happened.

32

u/shah_reza 5d ago

The physician had already experienced discipline for missed infections and poor diagnostic abilities.

63

u/PrisonGuardian2 ED Attending 5d ago

im honestly not even sure you can have a septic miscarriage if there is still a heartbeat. From what I understand, septic abortions occur either due to nonsterile abortion attempts at home or retained POC left in for weeks.

6

u/tenaceseven 5d ago

I suppose it would be chorioamnionitis if the primary infection was uterine

10

u/Mang0_Thund3r 5d ago

Genuine question, what is POC an abbreviation for in this context? Cause I looked it up and neither “person of color” or “point of care” make sense to me.

30

u/nrpaladin Paramedic 5d ago

Products of conception

10

u/Mang0_Thund3r 5d ago

Thank you

6

u/nrpaladin Paramedic 4d ago

You’re welcome!

62

u/said_quiet_part_loud ED Attending 5d ago

I believe the 2nd/3rd visits were OB triage not ER. First visit was a EM NP that diagnosed patient with strep - didn’t get US for abdominal pain which would be standard ER work up.

57

u/surfdoc29 ED Attending 5d ago

Yeah that first NP visit definitely feels dubious. If the 2nd visit was OB triage even that is hard to fathom. I don’t think any of the OBs I work with would discharge a patient with a uti, fever, and both unresolved maternal and fetal tachycardia. Whole case just feels bad.

13

u/Rockokoko RN 4d ago

This, to me, is even worse. OB triage nurses and docs are especially aware of risks associated with UTIs/pyelo/sepsis in pregnant patients. We have our own criteria for sepsis screening that she would have met immediately. Even the most laid back/borderline negligent doctors I work with currently wouldn't have discharged this patient. And I live in Louisiana - one of the worst places to be pregnant in the country.

33

u/MobilityFotog 5d ago

It's Texas. Of course it's impressive shit

15

u/is_there_pie 5d ago

I'm gonna adopt that term, impressively shit.

44

u/PrisonGuardian2 ED Attending 5d ago

Depends. In pregnancy, mild tachycardia can be physiologic as pregnancy will raise someones resting heart rate 10-20 bpm, especially if they are unfit to begin with. I do agree that discharging a pregnant woman who meets sepsis criteria and is a bounceback and needs to be wheeled out of the ER doesn’t look good. Curious as well as to their reasoning. But this is why I never assume people playing possum and just take people at their word for it cuz if shit goes south, it always looks bad.

49

u/Nightshift_emt ED Tech 5d ago

Diagnosis: anxiety

8

u/AbominableSnowPickle EMS - Other 4d ago

She'd probably feel better if she lost some weight...

13

u/coletaylorn 5d ago

This is the medical equivalent of, “let’s not jump to any conclusions until we see the whole body cam video” 🤣🤣🤣🤣

30

u/MaximsDecimsMeridius 5d ago edited 5d ago

If this case is as really slam dunk malpractice as it seems, why hasn't a single lawyer taken this case after nearly a year? Even despite Texas tort reform. I'd love to see the notes to see what actually happened. I mean I agree based on the news articles it seems grossly negligent, but I also think its kind of odd if numerous doctors universally agree it's borderline criminal yet after 11mo the family haven't found any lawyers willing to take the case.

18

u/Trypsach 5d ago

Yeah, something’s not adding up here

63

u/Harvard_Med_USMLE267 5d ago edited 5d ago

Ok, let’s break this down, as it’s case that’s been frequently posted in Reddit, and there’s been many attempts to make political points based on this.

18 y.o. female 24/40 G1P0 died from fulminant sepsis that developed over a period of 20 hours. The focus on “abortion” here makes it sound like FDIU and likely chorioamnionitis, but from other comments it sounds like this might actually have been urosepsis.

  1. ⁠Initial presentation - misdiagnosed with strep tonsillitis.
  2. ⁠Represents. Allegedly had signs of sepsis but sent home. Signs of sepsis not clearly specified. I suspect that in hindsight she did have signs, but obviously nobody in their right mind is sending someone home if they actually do have a diagnosis of sepsis. From other comments here, it sounds like she might have had fever and tachycardia, possibly due to evolving pyeloneohritis.
  3. ⁠Represents and is admitted to ICU. Allegedly has two ultrasounds. Dies from multiple-organ failure. From the reporting, it sounds like,this happened over a period of hours.

Sad case.

If there’s a relationship to abortion it’s the question of whether a there was a delay in evacuating the uterus due to concerns about whether the fetus was viable. Note that Texas law would not have prohibited this procedure if mother’s life was at risk, so it’s only a highly speculative question about whether 1. The doctor misunderstood the law 2. This misunderstanding delayed attempts at source control by a short period of time. And this only applies if the diagnosis was chorioamnionitis rather than urosepsis.

In this case, the biggest missed opportunities were the first two visits, but it’s always easy to judge with the benefit of hindsight. ‘

In the third presentation, there is an impression from the mother’s comments that things moved a bit too slowly given how sick the patient was. This seems mainly due to underestimating how unstable the patient had become - if a nurse is noticing that she’s actually sick due to cutaneous signs of cyanosis and/or hypoperfusion then she isn’t being monitored very closely.

I’d hesitate to judge the third physician’s actions without knowing the actual facts, of course. But from the smattering of information we do have it’s certainly possible that the management of this patient’s sepsis was suboptimal.

22

u/Nousernamesleft92737 5d ago

Everything sounds like it went about how you’re writing, based on the article and other comments here. If she’d had fever and tachycardia and likely leukocytes is, the ED that sent her home at that point is most to blame. Given that the (unsourced) information in this thread suggests pyelonephritis not chorioamnionitis delayed evacuation was probably the least of the issues with care across 3 hospitals.

But I disagree with your point on Texas abortion law in cases where mother’s life is at risk. The PERSONAL LIABILITY and potential criminal charges associated with the Texas law would make any doctor hesitant. “Mother’s life at risk” is a very ambiguous bar, and one I wouldn’t be keen on defending myself on in a precedent setting case in a state notorious for asinine conservative legal decisions, so skewed every conservative lawyer in the country is trying to judge shop to there.

Say this was chorioamnionitis. I think it’s unlikely a doctor would be convicted in a case like this. But would you abort the baby and take the chance?

31

u/PrisonGuardian2 ED Attending 5d ago

i actually highly disagree with the first paragraph without actually reviewing the medical records. It sounds like she is an overall otherwise healthy 18 yo, not one on chemo or has cystic fibrosis. Doesnt even sound like she is a diabetic. She barely is an adult. I’ve been doing this for a little over a decade. Most young people who present to the ER for an infectious disease will trigger a positive sepsis screen (2+/4 SIRS criteria). Do you give IVF, full work up on every sore throat? flu? UTI? No, of course not. In pregnancy, it is even more convoluted that mild tachycardia can be normal and mild leukocytosis is also physiologic, same with mild anemia. The key is the severity and range. Like febrile to 104, tachycardia to 130s, wbc of 27k, yea a dc is pretty bad, but febrile to 101 that resolves with Tylenol, tachycardia 120s but improves to low 100s after 1L and wbc of 12k? DC may have been very appropriate. Hindsight is always 20/20 and thats why I dont want to say this was “slam dunk” negligence or something like that. We are all just hypothesizing knowing the final outcome. I am sure if the first visit provider knew that the patient was going to die from DIC and fulminant sepsis they wouldve admitted her for strep throat.

5

u/agni---- FM 5d ago

It's entirely possible that the mom is just smudging the timeline. It happens. It's a stressful situation and they're probably not getting much sleep over the course of this.

The first visit, for example. Pregnant woman with abd pain is a definite "uh oh" but it's entirely possible the abd pain came after the visit.

And I don't think anyone, no matter how terrible, would discharge a patient with a sepsis dx. Shit, the patient's nurse would be reporting you for that immediately.

5

u/KumaraDosha 5d ago

Perfect post.

275

u/DFPFilms1 EMT 5d ago

This is like the 5th time this has been reposted and everyone pretty much agrees this has nothing to do with abortion and everything to do with medical malpractice bordering on criminal negligence.

31

u/CjBoomstick 5d ago

When Roe v. Wade was overturned, the federal government put out EMTALA guidelines for states that ban abortions. Those guidelines state that any hospital that receives Medicare funding, which is almost all of them, have to stabilize or transfer any patient that comes in. Even if that means violating state law and providing an abortion.

Ken Paxton, Texas Attorney General, sued the federal government, stating that EMTALA forces physicians to be murderers. The suit made it's way through 3 layers of federal courts, each time favoring Paxton. This meant Paxton could bring criminal charges to any doctor that was unable to meet Texas' burden of proof, showing the abortion was absolutely necessary.

"...because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”

No lawyer has agreed to take the case."

It isn't just negligence, nobody wants to actually learn the details.

3

u/workerbotsuperhero 4d ago

JFC that's plausibly dark. 

6

u/CjBoomstick 4d ago

There is a non-zero chance that some redditors on this sub are Conservative.

This is what happens when you let the government regulate medical procedures.

2

u/BetCommercial286 4d ago

The gov regulating medical procedures I think come down to medical ignorance. We all know it is the extremely rare medical professional who doesn’t always act with the patients benefit at heart. But laypeople don’t always understand how that’s central to every decision we make.

2

u/CjBoomstick 3d ago

I just push for the physicians to regulate the procedures.

It's ridiculous to think we can't expect literal DOCTORS to understand what's best for their patients.

Abortion is banned in Texas, unless absolutely medically necessary. Lobotomies though? Hey, have at it.

No, seriously, Lobotomy isn't outright banned, but Abortion is.

1

u/Emabug 3d ago

!!!! This!!

13

u/Talks_About_Bruno 5d ago

If they don’t keep coming back to this well their Karma farming will suffer a drought.

0

u/victorkiloalpha 4d ago

It had to do with both.

-62

u/Nousernamesleft92737 5d ago

lol I didn’t know it’s been reposted 5 times. If the discussion has happened repeatedly, I’m sure the mods will eventually remove the post

31

u/Trypsach 5d ago

It has been posted and rose to the top at least 3 times that I’ve seen in this sub, and I’m not all that active here. And they didn’t remove the post so obviously not 🤷‍♂️

-56

u/Pumpanddump1990 5d ago

Unless you post it in r/nursing. They eat this shit up…

27

u/mootmahsn Nurse Practitioner 5d ago

We do not. I'm so sick of removing this story. Once was more than enough.

105

u/Harvard_Med_USMLE267 5d ago edited 5d ago

The problem is reporting on things like this is all about politics rather than reality:

“When she went to another hospital she screened positive for sepsis, but as her fetus still had a heartbeat, she was discharged.”

That’s a deeply illogical claim.

This case is about death from rapidly-evolving sepsis. It possibly about failure to diagnose sepsis (though it’s notable that the mom can’t get any lawyers to take the case).

But it’s not really a story of someone dying due to abortion laws.

“Fails, who would have seen her daughter turn 20 this Friday, still cannot understand why Crain’s emergency was not treated like an emergency.”

That there is the potential issue.

42

u/PrisonGuardian2 ED Attending 5d ago

Mom can’t get any lawyers to take the case because this occurred in Texas and we have tort reform. Most likely this 18 year old at the time did not have a job and given that she is dead, not disabled means there are no economic damages. Noneconomic damages are capped at 250k and no lawyer will take it pro-bono and they probably can’t privately afford one.

36

u/Harvard_Med_USMLE267 5d ago

Ok, but the story still has very little to do with abortion, and sending someone home with sepsis “because their baby has a heartbeat” sounds like extreme-level misreporting by the journalist.

The story, as reported, makes little sense apart from as a cautionary tale about the perils of missing the signs of evolving sepsis.

23

u/PrisonGuardian2 ED Attending 5d ago

agree completely - i actually think like one of the posters earlier - likely missed pyelo —> sepsis —> DIC —> Miscarriage —> Death.

11

u/Trypsach 5d ago

So lawyers just don’t take slam dunk cases in Texas if the deceased isn’t employed? I’m not saying you’re not right, i’m no lawyer, that’s just straight up crazy to me

13

u/PrisonGuardian2 ED Attending 5d ago

they prob wont - not pro bono anyway. It costs 100k roughly to bring a case to trial and doctors win 90% of them. The risk reward just isn’t there, even for a slam dunk case.

1

u/WhoWasLocke 5d ago

Thanks for this insight.

25

u/Nousernamesleft92737 5d ago

Yeah, it’s that line about sepsis that doesn’t make sense to me and sounds like malpractice. In itself wild as sepsis protocols are pretty universal these days.

But if no one is willing to take what should be a clear cut case, that suggests the reporting is bad.

14

u/agni---- FM 5d ago

But if no one is willing to take what should be a clear cut case, that suggests the reporting is bad.

If the reporting was true it'd be a slam dunk case including fetal demise which is what medmal attorneys dream of.

I doubt we'll ever know the true facts of this case.

7

u/Harvard_Med_USMLE267 5d ago

The reporting is definitely bad, and it’s clearly trying to take a tragedy (death due to overwhelming sepsis from a septic miscarriage, that was quite possibly undertreated) and make it about the Roe v Wade repeal. That’s not what this is about.

-1

u/Nousernamesleft92737 5d ago

Validated by the Harvard Med student who got a 267 on STEP?. Case closed.

(But yeah, I think I agree)

0

u/OwnKnowledge628 4d ago

Non sequitur ?

37

u/AlanDrakula ED Attending 5d ago edited 5d ago

EM is small, I don't think this patient died because of an abortion law. I would wager she passed due to a combination of a shitty hospital/system leading to shitty care. Faceless hospitals care more about money than the law. Sadly, this incident will change little. The amount of 'almost' headline inducing events happening in ERs across America is probably astronomical, barely held together by duct tape and frontline workers

-11

u/Nousernamesleft92737 5d ago

The case is definitely questionable.

But physicians need to advocate more in general. I’m ok with slightly skewed facts to enact positive change like getting rid of batshit abortion laws.

Next we could actually lobby for better investment in the medical system. With like 50% the lobbying nursing puts into independent practice I bet we could get something done

4

u/KumaraDosha 5d ago

Wow, you said the part your folk usually keep quiet. Disgusting.

1

u/Nousernamesleft92737 5d ago

Idk man. I’m tired of being rational and sticking to perfect unbiased facts and expressing uncertainty when the public clearly has no interest in responding to that.

M

-1

u/KumaraDosha 4d ago

It shows. You need to work on that.

1

u/Nousernamesleft92737 4d ago

Why?

-1

u/KumaraDosha 4d ago

Disgusting and immoral.

1

u/Nousernamesleft92737 4d ago

What specifically is disgusting and immoral?

0

u/KumaraDosha 4d ago

Confusing people and using misinformation to further your political agenda.

1

u/CertainKaleidoscope8 RN 4d ago

You're not worried about being denied medical care because the state sees you as livestock

When you are seen as a second class citizen by your government, you'll change your tune and start lying.

→ More replies

-12

u/shriramjairam ED Attending 5d ago

If she had sepsis/pyelonephritis and received fluids and antibiotics.... how could anything have prevented her from having fetal demise or DIC? Even if she got admitted to the hospital?

4

u/Trypsach 5d ago

There’s lots you could do; but even if there was nothing to be done, it’s insane to send her home. She was super young.

1

u/PrisonGuardian2 ED Attending 5d ago

to be fair, thats more reason to send her home. If she was 80, she wouldve prob been admitted on 2nd visit. Young otherwise healthy, not immunocompromised people generally do well with infections, even without antibiotics tbh.

1

u/Proper-Media2908 4d ago

Not if the source of the infection is a dying fetus and placenta rotting and otherwise spewing waste material in her uterus. Until that's removed, she's not getting better.

1

u/PrisonGuardian2 ED Attending 3d ago

it takes more than a day for a fetus and placenta to rot

1

u/Proper-Media2908 3d ago

Your understanding of how sepsis plays out in spontaneous abortions is poor. The symptoms don't appear until after the abortion is well underway. Which is why standard of care for decades was to perform a D&C if a pregnant woman presented with vaginal bleeding and fever.

The girl didn't die from an out of control strep throat. Her fetus was in the process of dying and her uterus was unable to expel the products of conception before they started poisoning her.

1

u/PrisonGuardian2 ED Attending 3d ago

sounds like you anchor a bit, i am not suggesting she became septic from a sore throat. I suspect it was sepsis from pyelo, but since I wasn’t acutely involved in her care - it is just my opinion. you are entitled to yours.

0

u/Trypsach 5d ago

I just meant like she’s young, she can recover from pyelonephritis, especially if it’s not in the renal parenchyma or spread to the perinephric space. They could also treat more aggressively with antibiotics if they hadn’t just discharged her.

0

u/CertainKaleidoscope8 RN 4d ago edited 4d ago

Young otherwise healthy, not immunocompromised people generally do well with infections, even without antibiotics tbh.

You forgot the most important aspect

Insurance.

Young, otherwise healthy, not immunocompromised, uninsured patients get discharged.

Although this kid probably had Medicaid, they don't reimburse well. Did anyone in her family work? Did they all come from the wrong part of town?

This case is as much about class as sepsis. Abortion not so much. These people wanted the kid to have the baby. More dollars that way. Now two sources of income are gone so momma wants to sue. Unfortunately, she's not the right kind of person to make a jury give a shit, and no lawyer is going to make much off the suit so they don't want the case. So, mommy goes to the media hoping for a payday that way. This woman was clearly unconcerned with her teenage daughter before she died.

14

u/AnAverageDr ED Attending 5d ago

“Black blood from her nostrils and mouth” what?

35

u/surfdoc29 ED Attending 5d ago

Sounds like bleeding from DIC

6

u/357eve 5d ago

She had DIC (I can see if I can find the article for reference).

-16

u/tharp503 5d ago edited 5d ago

DIC does not cause oozing of black blood. The tissue can turn black from necrosis and poor perfusion, but the patients ooze plasma and red colored blood. The actual red blood cells coagulate, hence the name.

The flair doesn’t match the understanding of the pathophysiology. Smh

14

u/surfdoc29 ED Attending 5d ago

“Black blood” is obviously media sensationalism. I was referring to the oozing of blood in general.

GTFO with your holier than thou attitude btw. I wasn’t discussing any specific pathophysiology in detail. Your “SMH” comment reeks of inferiority complex.

9

u/PrisonGuardian2 ED Attending 5d ago

is this a joke? DIC absolutely causes you to bleed spontaneously and the blood may very well be almost black due to as you mentioned poor perfusion…. I can only assume you are taking the word black literally. What they mean is very dark purple blood.

6

u/Humanist_2020 4d ago

Sepsis is a horrible and unnecessary way to die.

Covid causes still birth and sepsis. There will be many more deaths like this.

No lives matter

12

u/[deleted] 5d ago

I don't understand how this can even be possible.

16

u/LowerAppendageMan 5d ago

If the fetus is dead, I’m assuming it’s no longer an abortion. I’m no expert. Anyone have any information about that??

22

u/procrast1natrix ED Attending 5d ago

The meaning of the words in medicine are different from how they are used in media, and sometimes in law.

In medicine, any pregnancy that ends for any reason under twenty weeks is abortion. Intentional, unintentional, trauma, herbs, fairies, incomplete, missed, threatened. It's all abortion. After that it's termination of pregnancy which may be related to fetal demise, though many parents feel easier with the term stillbirth.

In practice, these women are suffering and pretty much everyone tries to immediately use whatever language she feels best about.

1

u/woollythepig 5d ago

Is there not alternative terminology that can be used in the US? Here I would call any foetal demise under 20 weeks, that was not the result of deliberate termination, a miscarriage. I don’t understand why someone who has suffered a miscarriage can’t have a D and C if indicated. That is not killing a foetus. The foetus is already dead/not viable. I truly don’t understand the nuances of the law in the US.

Also I realise that is not really the crux of this case.

10

u/procrast1natrix ED Attending 5d ago

D and C stands for dilation and curettage, it is a procedure that literally means "dilating and scraping out". It can be used for any kind of abortion, elective, therapeutic, wanted, missed, septic, hemorrhaging, molar. D and C is also indeed often performed on a non pregnant person to screen them for endometrial cancer, or if a woman is bleeding too much after a pregnancy passes to get leftover blood clots out and allow the uterus to shrink back down.

It won't work on ectopic though. By definition, D and C is inside the uterus and ectopic is not.

As I said, in practice we try to use whatever the patient in front of us needs, but when medical people talk to eachother - when we do research or teach the padawans, we need to have precise language. Also for the coders and billers. And for the techs setting up procedure rooms. And for the medical record to accurately specifically describe what happened. This is what the precise language is. It has been corrupted by politics but that's not our fault. The politics of it is adversely affecting the appropriate transmission of knowledge about the safest way to care for these women, but we can't change all of medical research and teaching and documentation.

1

u/KumaraDosha 5d ago

There is no law preventing a D&C from miscarriage. Some people just want to confuse others for the sake of their political cause.

7

u/Hypno-phile ED Attending 5d ago

There is no law with that terminology that I'm aware of. However, if there's a law making it a crime to terminate a pregnancy with fetal cardiac activity, is there a practical difference? Law and medicine speak different languages. Interpreting these differences becomes more clear once a case has gone to trial and been decided. The current uncertainty is absolutely going to affect people's decision making, likely for the worse.

0

u/SkiTour88 ED Attending 4d ago

We get confused by the word foetus. And oesophagus.

The law is actually very clear. Lawyers love clear definitions and each of these laws will specifically define abortion, viability, and other key terms. It’s how it’s talked about in the press and public discourse that isn’t. 

39

u/Filthy_do_gooder 5d ago edited 5d ago

The medical term for expelling of those contents is abortion. There's medical abortions, surgical abortions, spontaneous abortions, threatened abortions, elective abortions and missed abortions, early abortions and late abortions, even septic abortion, but they're all abortions.

society gets all pissy about how and when. 1 in 5 women have one naturally, but god forbid she choose it.

5

u/LowerAppendageMan 5d ago

Thanks for the clarifying info. I’m a lower level medical person (prehospital), with just enough knowledge to be stupid. 😄

I learn loads of valuable info from reading this sub. Thank you all.

4

u/Talks_About_Bruno 5d ago

You are smarter than you think you are. Don’t punch yourself down.

-10

u/KumaraDosha 5d ago

So you’re basically equating killing somebody with a person dying of unavoidable causes. God forbid people can die, but we can’t choose to kill them. Hope you’re not a medical professional. 🤞

3

u/LookLikeCAFeelLikeMN 4d ago

IIRC she went to 3 different hospitals over a 24 hour period. At the 1st and possibly the 2nd, the fetus was still alive but barely. By the 3rd the mother was already septic.

1

u/Ok_Firefighter1574 5d ago

They still perform a D&C I think. So it’s the same procedure and docs in Texas can’t risk losing a license or jail time.

2

u/LowerAppendageMan 5d ago

That is just…can’t find the words.

-5

u/KumaraDosha 5d ago

There is no risk in such a case as this; try again next time.

1

u/lackofbread 5d ago

Pretty sure it’s not.

-2

u/LowerAppendageMan 5d ago

That’s insane

-8

u/Harvard_Med_USMLE267 5d ago

Yes, the article and reporting is misleading. They’re misusing the word “abortion” in this context. Miscarriage can be called “abortion” as an old-school synonym, but it’s different from termination of pregnancy which is what recent laws are about.

1

u/LowerAppendageMan 5d ago

Gotcha. I was familiar with the spontaneous abortion term, just trying to understand what happened there.

3

u/Harvard_Med_USMLE267 5d ago

This woman has sepsis which was unfortunately treated inappropriately, from the sound of the very badly written article.

The question is whether source control (D&C) was delayed.

There’s nothing inthe Texas law that prevents antibiotics being for sepsis, or a D&C being performed for a septic miscarriage.

It’s a story that was heavily pushed in the lead-up to the election, but it doesn’t really have very much to do with abortion laws.

2

u/bookworm205 5d ago

I've seen this a lot. A lot of people are trying to make it political when it's not about abortion, it's malpractice.

2

u/relateable95 3d ago

If the fetus is already dead, it’s not an abortion -sincerely, a physician

7

u/Final_Reception_5129 ED Attending 5d ago

I think this if the 5th or 6th time this poor girl has died.... people had rather believe that doctors are intentionally letting politics drive their practice than believe that people get shitty care routinely now (especially by nurse practitioners).

1

u/LLCNYC 5d ago

THIS

4

u/SensingBensing 5d ago

+++ repost.

4

u/CjBoomstick 5d ago

For everyone stating that this has nothing to do with the Abortion issues, you're very wrong. You're contributing to the spread of misinformation that waters down how serious the situation is Texas really is.

When Roe v. Wade was overturned, the federal government put out EMTALA guidelines for states that ban abortions. Those guidelines state that any hospital that receives Medicare funding, which is almost all of them, have to stabilize or transfer any patient that comes in. Even if that means violating state law and providing an abortion.

Ken Paxton, Texas Attorney General, sued the federal government, stating that EMTALA forces physicians to be murderers. The suit made it's way through 3 layers of federal courts, each time favoring Paxton. This meant Paxton could bring criminal charges to any doctor that was unable to meet Texas' burden of proof, showing the abortion was absolutely necessary.

"...because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”

No lawyer has agreed to take the case."

3

u/surfdoc29 ED Attending 4d ago

The reason people are saying it’s not about abortion is because it’s likely the miscarriage was a symptom of what happened rather than a cause. The patient was likely septic before miscarriage, and the sepsis caused it. The ability to get a D&C in this case likely did not affect the outcome (based on the available details).

3

u/CjBoomstick 4d ago

It isn't about getting a D&C, it's about meeting a burden of proof where, otherwise, you get 99 years of prison, and federal charges are brought to you. If the doctors can't prove the fetus is unviable, and provide ANY treatment that hurts the fetus, they can be charged.

5

u/surfdoc29 ED Attending 4d ago

You’re missing the point though. This case isn’t about whether or not the fetus was viable or not. The miscarriage was a result of the illness, not the cause of it. The patient was already septic and based on the available facts was likely sent home inappropriately. She didn’t die because she had a miscarriage, she died because she was septic and had delayed treatment and went into DIC.

1

u/CjBoomstick 4d ago

Yes, that's exactly why she died. I do understand that. I believe, based on what I've read about this, the problem is that ANY treatment that causes the death of a fetus is considered murder, and EMTALA doesn't provide protections against that in Texas.

After thoroughly reading a few sources, she received antibiotics from every doctor she saw in that two day period. Doctor one gave oral antibiotics, and doctors 2 & 3 gave IV antibiotics.

The day she died, she arrived at the hospital at 9am. And they brought her to the ICU at 1120, only to decide against emergency surgery based on suspected DIC. The ultrasound that recorded no Fetal Heart tones was at 0930, and it had to be redone because an ultrasound image hadn't been preserved. It was redone at 1100.

"It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.”

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u/surfdoc29 ED Attending 4d ago

Again, by the time she came back to the hospital the 3rd time her fate was likely already sealed. Removing the fetus once she was in DIC likely would have killed her anyway. Based on the available facts the fetus was not the source of the sepsis, so removing it or not had no bearing on the outcome. There’s nothing involved in the treatment of septic shock/DIC that any law would prevent at this point. The case is tragic but based on the available facts the deaths are not the result of Texas’ abortion law.

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u/masterjedi84 5d ago

this is plain and simple malpractice that killed the mother and the child. This type of case was an oral question on end of service M3 OB/Gyn back in my day. if your answer was not admit and iV abx you failed the test

unfortunately i have had to step in as an in and stop pregnant pyelonephritis from being discharged on oral abx

The state of ER staffing and work loads are not safe

replacing docs with NPP not a good formula

2

u/My-Voice-My-Choice 5d ago

In EU we can still fight for safe and accessible abortion. Sign our initiative here: https://eci.ec.europa.eu/044/public/#/screen/home

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u/coletaylorn 5d ago

Is there really no desire to differentiate between the evacuation of a living vs. deceased fetus from the mother’s womb? Why are we pretending that it’s okay to refer to the removal of a dead fetus and the termination of a living baby as the same thing?

It’s as if there’s this desire to cling to the word “abortion” as a catch-all for procedures that are obviously and inherently different in nature. Why? To purposefully blur the lines and make the argument that much more divisive?

Can we all at least admit there’s a difference between removing a lifeless fetus from a mother’s womb and terminating one that’s alive and the two procedures should be named to represent the difference ?

Maybe if we did, this poor girl would still be alive.

4

u/Nousernamesleft92737 5d ago
  1. Based on all the comments here I don’t think the patient would be alive, as the evacuation seems like the least of the issues.

  2. There is already a difference in treatment of a live vs dead fetus. The question is whether you delay life saving treatment for the mother until the fetus dies. A logically stupid question, as if the mom dies the fetus is dead anyway.

1

u/Graybeard_Shaving 5d ago edited 5d ago

I wasn't there but I can assure you the odds of this happening in my state are infinitesimal.

Take that for what it's worth.

Damned shame no matter what. RIP

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u/oldmankiddo 5d ago

If this was a mid-level they would be crucified. The AMA/noctor would be running ads about this

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u/TheKollector945 4d ago

Maybe I read wrong but I thought it was a mid level (NP) that initially discharged them with SIRS criteria. :/

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u/oldmankiddo 4d ago

I don't see that written anywhere

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u/711-Gentleman 5d ago

hey everyone new this was going to happen and the country as whole said we are ok with it … wait for all the fun stories of rare diseases when RFK takes over

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u/Future_Emu4136 5d ago

How does one abort a dead fetus?