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ARLINGTON, Tex. — Kelsie Norris-De La Cruz tried not to cry as the doctor in the emergency room delivered one of the most frightening diagnoses a pregnant woman can receive.

The 25-year-old college senior was told she likely had an ectopic pregnancy, a highly dangerous condition where the embryo implants outside of the uterus. Without immediate treatment, the fallopian tube can rupture — and the patient can die.

The law that has prohibited <a href="https://www.washingtonpost.com/abortion/" target="_blank" class="contextual_link">abortion</a>s in Texas since Roe v. Wade was overturned now explicitly allows doctors to treat ectopic pregnancies. But when doctors at Texas Health Arlington Memorial Hospital evaluated Norris-De La Cruz last week, they refused to terminate the pregnancy, saying there was some chance the pregnancy was still viable, Norris-De La Cruz recalled. Instead, they advised her and her mother to go home and wait, according to medical records reviewed by The Washington Post.

Norris-De La Cruz ultimately received emergency surgery about 24 hours later at a different hospital in the area, at which point her ectopic pregnancy had already started to rupture. The OB/GYN who performed the procedure said that, if Norris-De La Cruz had waited much longer, she would have been “in extreme danger of losing her life.”

“I was scared I was going to ... lose my entire reproductive system if they waited too long,” Norris-De La Cruz said in an interview two days after her surgery. “I knew it could happen at any moment.”

Her case highlights a chilling reality of post-Roe America: Medical exceptions to abortion bans have not stopped doctors from turning away patients with significant pregnancy complications, often with harrowing consequences. Their stories underscore the messy collision between abortion laws and medical diagnoses — and the struggles of doctors and hospitals to navigate what many say are inadequate legal protections to treat women with life-threatening conditions.

In the nearly two years since Roe fell, <a href="https://www.washingtonpost.com/politics/2023/07/20/texas-abortion-ban-hearing/" target=_blank>dozens of women</a> have come forward with stories of medical care denied because of abortion bans, with the changes in treatment bringing some <a href="https://www.washingtonpost.com/politics/2023/04/10/pprom-florida-abortion-ban/" target=_blank>close to death</a> or affecting patients’ future fertility. Several dozen women across the country who experienced pregnancy complications have challenged their state abortion bans in court.

Two friends were denied care after Florida banned abortion. One almost died.

The Post learned of Norris-De La Cruz’s case when her mother, seeking advice, called a Houston reproductive health clinic when a reporter was present. To corroborate Norris-De La Cruz’s account, The Post reviewed dozens of pages of medical records, sonogram images, photos and text messages, and conducted interviews with many of the people involved in the case.

Four OB/GYNs who reviewed Norris-De La Cruz’s medical records for The Post, with Norris-De La Cruz’s permission, said she should have been offered emergency surgery. They said they suspected Texas’s abortion ban played a role in how she was advised.

“That should have been a bread and butter slam dunk diagnosis,” said Clayton Alfonso, an OB/GYN at Duke University. “It doesn’t make sense to me that they would send her away, unless they had a fear that the surgery … could be perceived as causing an abortion.”

Kimberly Walton, the director of media relations for Texas Health, said the hospital’s top priority is “providing our patients with safe, high-quality care.”

“Treatment decisions are individualized based on a patient’s clinical condition and we believe the care provided to the patient in this case was appropriate,” she wrote in a statement.

Walton did not answer a written question about whether the delay in Norris’s care was related to the abortion law. The doctors who sent Norris home did not respond to requests for comment.

A Republican state senator who has spearheaded much of Texas’s antiabortion legislation said he was surprised and frustrated to hear about Norris-De La Cruz’s case.

“I don’t know what the excuse would be for a Texas doctor not treating an ectopic pregnancy, because that’s not the law,” said Sen. Bryan Hughes, who sponsored a law last year specifying that Texas doctors are permitted to treat ectopic pregnancies, a follow-up to Texas’s abortion ban meant to prevent cases like this one.

But many doctors consider even Hughes’s follow-up law, which took effect in September, to be an inadequate tool for treating patients like Norris-De La Cruz amid a complicated post-Roe landscape. Ectopic pregnancies in the fallopian tube, which never survive to term, can be hard to diagnose on an ultrasound with 100 percent certainty, several doctors said — and if the diagnosis is wrong, a doctor might fear potential legal repercussions for terminating a viable pregnancy.

Faced with abortion bans, doctors beg hospitals for help with key decisions

After the first of two OB/GYNs at Arlington Memorial refused to treat Norris-De La Cruz, her mother, Stephanie Lloyd, immediately thought about Texas’s abortion ban.

“Does this have anything to do with the abortion law?” she remembered asking the doctor.

When he didn’t answer, Lloyd recalled, she had to restrain Norris-De La Cruz as her daughter tried to launch herself at him.

“Whenever I f---ing rupture,” Norris-De La Cruz said, “I’m giving my lawyers your f---ing name.”

Desiree Rios

Norris-De La Cruz had not wanted to lose her pregnancy.

When she got a positive test in early January, she said, she and her boyfriend immediately started to imagine who their child might become.

“We made jokes all the time like, ‘Maybe he’ll be a competitive chess player,’” Norris-De La Cruz said. “We thought the possibility of creating something that was a unity of us was really beautiful."

It was just one week later that Norris-De La Cruz started to cramp and bleed.

She went straight to the emergency room on Jan. 14, where doctors measured her pregnancy hormone levels, performed an ultrasound and told her to return in 48 hours. By her second appointment two days later, her pregnancy hormone levels had dropped precipitously, according to medical records — leading the doctors to suspect a “failed early pregnancy,” although they acknowledged in the records that they could not entirely rule out the possibility of an ectopic.

Over the next few weeks, Norris-De La Cruz said, she still didn’t feel well — experiencing bouts of abdominal pain so severe that she struggled to stand. Thinking she might have appendicitis or a urinary tract infection, she went to the health center on her campus at the University of Texas at Arlington, around noon on Feb. 12, where a nurse told her to go straight to the emergency room.

Then came the frightening diagnosis at the Arlington Memorial ER.

After her confrontation that day with the OB/GYN, Norris-De La Cruz spoke with a different doctor on call who specialized in emergency medicine and had also reviewed her tests and ultrasound scans. He disagreed with the OB/GYN’s decision to discharge her, according to medical records. While he said he was not permitted to do the surgery himself — that required an OB/GYN — he recommended she remain in the hospital overnight.

“I do not feel comfortable discharging her home and do not think that is in her best interest,” the emergency room doctor wrote in her records.

The following morning, Norris-De La Cruz was turned away by a second OB/GYN, who determined that there was “no operation warranted,” according to records. The OB/GYN discharged her and told her to follow up in 48 hours.

As Norris-De La Cruz prepared to leave the hospital around 10 a.m. on Feb. 13, her mother was standing outside in the parking lot, begging a woman at a New Mexico abortion clinic over the phone to help terminate her daughter’s ectopic pregnancy.

“Texas should be able to help you,” Lloyd recalled the clinic staff member saying. “Why do you want to come here?”

She gave Lloyd the number for another office — a former abortion clinic in Houston that provides ultrasounds and out-of-state referrals. But they didn’t know what to say, either.

“You could come to a Houston hospital but they might tell you the same thing,” Marjorie Eisen, a patient advocate at Houston Women’s Reproductive Services, told Lloyd when she called, in an exchange observed by The Post. “We’ve had luck with our county hospitals sometimes and sometimes not.”

Houston Women’s Reproductive Services has consulted with three other patients in similar situations since Jan. 1, said Kathy Kleinfeld, the clinic’s administrator — all women who she said have been turned away from hospitals with ectopic pregnancies.

Eisen suggested Lloyd talk to a doctor she knew in Dallas.

“I’m so sorry you’re dealing with this,” Eisen said. “It’s a nightmare.”

Lloyd started to panic, pacing back and forth as she tried to figure out what to do next. Her daughter was going to die, she recalled thinking to herself: Why wouldn’t anyone help her?

Back inside the hospital, Norris-De La Cruz got a call from her best friend, Monica Perez, whom she’d been texting with updates throughout the night.

“I’m on my way to my OB/GYN,” Perez recalled saying as she drove to one of her regular appointments. “Do you want me to tell the nurses and see if they can squeeze you in?”

Norris-De La Cruz immediately texted her friend a picture of her sonogram, hoping the image would be enough to convince them.

“They can see you at 2 o’clock,” she said.

As soon as Perez’s OB/GYN, Jeffery Morgan, reviewed Norris-De La Cruz’s ultrasound scans, he immediately identified an ectopic pregnancy.

All the textbook signs were there, he said in an interview a week after the consultation: A large mass on the right side of her pelvis. Elevated levels of pregnancy hormone with no visible pregnancy inside the uterus. Fluid in the abdomen.

“There are times when it’s really early in the process when it can be hard to know if it’s ectopic — but that honestly would have been weeks before where she was in the pregnancy,” Morgan said, adding that he was 98 percent sure Norris-De La Cruz had an ectopic when he initially examined her.

At his clinic, Morgan told Norris-De La Cruz and her mother that he recommended surgery as soon as possible.

As soon as they heard that, they both started to sob.

“Wow,” Norris-De La Cruz recalled thinking as she looked up at the doctor. “I don’t have to make my case. You see it. You understand that this is an emergency.”

Norris-De La Cruz was scheduled for surgery at Medical City hospital in Arlington three hours later.

Morgan was able to remove the ectopic pregnancy, according to records.

But the mass had grown so large he also had to take most of her right fallopian tube, a loss that could affect her future fertility.

That outcome was likely inevitable, according to most of the OB/GYNs consulted for this story. Norris-De La Cruz probably would have lost her tube even if she had been treated immediately at Arlington Memorial, they said.

Morgan said he never considered delaying or withholding treatment because of the abortion ban, which he says clearly allows Texas doctors to treat ectopic pregnancies. He said he was shocked to learn that Norris-De La Cruz had been turned away.

“Honestly, it baffles me,” Morgan said. “Any kind of ectopic, anything like that is excluded.”

In the days since the surgery, Norris-De La Cruz and Lloyd have thought a lot about Texas’s abortion law, which they both believe factored into the delay in Norris-De La Cruz’s care.

When Roe v. Wade was overturned in 2022, the two had argued fiercely about what a near-total abortion ban would mean for women in the state — with Norris-De La Cruz fearing a loss of personal freedoms, and Lloyd welcoming new protections for babies who couldn’t speak up for themselves.

Initially, Lloyd said, she thought the Texas abortion law would only affect people who decided they didn’t want to be pregnant — never imagining it could prevent women from accessing lifesaving care. Now, she said, she has completely changed her mind about abortion bans.

“I didn’t realize how far it had gone,” she said. “But it has happened to my life now, with my daughter."

“Her life has been in danger and affected by someone who was too afraid to help.”

Post Grad: Five Women and Their First Year Out of College 

Princeton University, BA in History 

Caroline Kitchener is a reporter covering abortion at The Washington Post. She won the 2023 Pulitzer Prize for National Reporting. 

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An ectopic pregnancy put her life at risk. A Texas hospital refused to treat her.

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