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WASHINGTON (AP) — A Texas hospital that repeatedly sent a woman who was bleeding and in pain home without ending her nonviable, life-threatening pregnancy violated the law, according to a newly released federal investigation.

The government’s findings, which have not been previously reported, were a small victory for 36-year-old Kyleigh Thurman, who ultimately lost part of her reproductive system after being discharged without any help from her hometown emergency room for her dangerous ectopic pregnancy.

But a new policy the Trump administration announced on Tuesday has thrown into doubt the federal government’s oversight of hospitals that deny women emergency abortions, even when they are at risk for serious infection, organ loss or severe hemorrhaging.

Thurman had hoped the federal government’s investigation, which issued a report in April after concluding its inquiry last year, would send a clear message that ectopic pregnancies must be treated by hospitals in Texas, which has one of the nation’s strictest abortion bans.

“I didn’t want anyone else to have to go through this,” Thurman said in an interview with the Associated Press from her Texas home this week. “I put a lot of the responsibility on the state of Texas and policy makers and the legislators that set this chain of events off.”

Uncertainty regarding emergency abortion access

Women around the country have been denied emergency abortions for their life-threatening pregnancies after states swiftly enacted abortion restrictions in response to a 2022 ruling from the U.S. Supreme Court, which includes three appointees of President Donald Trump.

The guidance issued by the Biden administration in 2022 was an effort to preserve access to emergency abortions for extreme cases in which women were experiencing medical emergencies. It directed hospitals — even ones in states with severe restrictions — to provide abortions in those emergency cases. If hospitals did not comply, they would be in violation of a federal law and risk losing some federal funds.

The Centers for Medicare and Medicaid Services, the federal agency responsible for enforcing the law and inspecting hospitals, announced on Tuesday it would revoke the Biden-era guidance around emergency abortions. CMS administrator Dr. Mehmet Oz said in a social media post on Wednesday that the revocation of the policy would not prevent pregnant women from getting treatment in medical emergencies.

“The Biden Administration created confusion, but EMTALA is clear and the law has not changed: women will receive care for miscarriage, ectopic pregnancy, and medical emergencies in all fifty states—this has not and will never change in the Trump Administration,” Oz wrote, using the acronyms for the Emergency Medical Treatment and Labor Act.

The law, which remains intact and requires doctors to provide stabilizing treatment, was one of the few ways that Thurman was able to hold the emergency room accountable after she didn’t receive any help from staff at Ascension Seton Williamson in Round Rock, Texas in February of 2023, a few months after Texas enacted its strict abortion ban.

An ectopic pregnancy left untreated

Emergency room staff observed that Thurman’s hormone levels had dropped, a pregnancy was not visible in her uterus and a structure was blocking her fallopian tube — all telltale signs of an ectopic pregnancy, when a fetus implants outside of the uterus and has no room to grow. If left untreated, ectopic pregnancies can rupture, causing organ damage, hemorrhage or even death.

Thurman, however, was sent home and given a pamphlet on miscarriage for her first pregnancy. She returned three days later, still bleeding, and was given an injected drug intended to end the pregnancy, but it was too late. Days later, she showed up again at the emergency room, bleeding out because the fertilized egg growing on Thurman’s fallopian tube ruptured it. She underwent an emergency surgery that removed part of her reproductive system.

CMS launched its investigation of how Ascension Seton Williamson handled Thurman’s case late last year, shortly after she filed a complaint. Investigators concluded the hospital failed to give her a proper medical screening exam, including an evaluation with an OB-GYN. The hospital violated the federal Emergency Medical Treatment and Labor Act, which requires emergency rooms to provide stabilizing treatment to all patients. Thurman was “at risk for deterioration of her health and wellbeing as a result of an untreated medical condition,” the investigation said in its report, which was publicly released last month.

Ascension, a vast hospital system that has facilities across multiple states, did not respond to questions about Thurman’s case, saying only that it “is committed to providing high-quality care to all who seek our services.”

Penalties for doctors, hospital staff

Doctors and legal experts have warned abortion restrictions like the one Texas enacted have discouraged emergency room staff from aborting dangerous and nonviable pregnancies, even when a woman’s life is imperiled. The stakes are especially high in Texas, where doctors face up to 99 years in prison if convicted of performing an illegal abortion. Lawmakers in the state are weighing a law that would remove criminal penalties for doctors who provide abortions in certain medical emergencies.

“We see patients with miscarriages being denied care, bleeding out in parking lots. We see patients with nonviable pregnancies being told to continue those to term,” said Molly Duane, an attorney at the Center for Reproductive Rights that represented Thurman. “This is not, maybe, what some people thought abortion bans would look like, but this is the reality.”

The Biden administration routinely warned hospitals that they need to provide abortions when a woman’s health was in jeopardy, even suing Idaho over its state law that initially prohibited nearly all abortions, unless a woman’s life was on the line.

Questions remain about hospital investigations

But CMS’ announcement on Tuesday raises questions about whether such investigations will continue if hospitals do not provide abortions for women in medical emergencies.

The agency said it will still enforce the law, “including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy.”

While states like Texas have clarified that ectopic pregnancies can legally be treated with abortions, the laws do not provide for every complication that might arise during a pregnancy. Several women in Texas have sued the state for its law, which has prevented women from terminating pregnancies in cases where their fetuses had deadly fetal anomalies or they went into labor too early for the fetus to survive.

Thurman worries pregnant patients with serious complications still won’t be able to get the help they may need in Texas emergency rooms.

“You cannot predict the ways a pregnancy can go,” Thurman said. “It can happen to anyone, still. There’s still so many ways in which pregnancies that aren’t ectopic can be deadly.”

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