Ectopic pregnancies, in which a fertilized egg implants itself outside the pregnant woman’s uterus, can be fatal and do not result in delivery. Both women had ectopic pregnancies, in which the egg implants itself in their fallopian tubes, which connect the ovaries to the uterus.

The women say they were initially sent home without receiving the appropriate care, which in this case would have been an abortion. They say they continued to seek follow-up care: Norris-De LaCruz sought a second opinion from another doctor hours later, who diagnosed her as an ectopic pregnancy and had her admitted for surgery. Thurman returned days later after continuing to suffer vaginal bleeding. But by the time both were able to have abortions, their pregnancies had already ended. Both women had to have the affected fallopian tube removed.

An Ascension spokesperson wrote: “While we cannot speak to the specifics of this case, Ascension is committed to providing quality care to all who use our services.” Texas Health did not immediately respond to an emailed request for comment.

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

“Texas law clearly allows abortion to treat ectopic pregnancies, and federal law requires it. Yet Kelsie and Kyleigh were denied absolutely essential treatment,” Beth Brinkmann, senior director of U.S. litigation at the Center for Reproductive Rights, said in a statement.

“As long as these bans are in place, doctors will be afraid to perform any type of abortion,” she continued, referring to the state’s virtually total ban on abortion.

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

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

Normally, EMTALA complaints are investigated by the state, but in this case, the women’s attorneys are asking the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Services to handle the complaints instead.

The federal government argues that EMTALA protects emergency abortions, thereby overriding state bans. Idaho, another state with strict abortion laws, has challenged the federal government’s enforcement of EMTALA, arguing that the state cannot protect the right to an abortion when it conflicts with its own near-total ban. In June of this year, the Supreme Court sent the case back to the lower courts for further proceedings.

Texas has also challenged the federal government, with an appeals court saying that while the issue is being litigated, the state’s emergency rooms are not required to provide abortions in medical emergencies.

Molly Duane, a senior staff attorney at the Center for Reproductive Rights, argued that even in this context, federal law should protect care for ectopic pregnancies because Texas has provided an explicit exception for this medical case.

“The state agrees that terminating an ectopic pregnancy is not an ‘abortion’ under the Texas legal definition of the term. Therefore, the 5th Circuit’s ruling is irrelevant because this case only addresses areas where the Texas abortion ban and EMTALA may conflict,” Duane said. “There is no conflict here, so it is clear that the federal government can and should enforce EMTALA.”