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For one patient, doctors "had to wait for her creatinine to bump and her kidneys to be about to fail" before they could even offer her abortion care.
As new reporting on Amber Nicole Thurman's death highlights the dangers of Georgia Republicans' six-week abortion ban, a human rights group on Tuesday released a research brief about how a similar policy in a neighboring state "harms the health and safety of Florida patients while obstructing clinicians from providing basic reproductive and maternal medical care."
The Physicians for Human Rights (PHR) report, Delayed and Denied: How Florida's Abortion Ban Criminalizes Medical Care, focuses on the prohibition that was signed by Republican Gov. Ron DeSantis last year but didn't take effect until May, following a state Supreme Court ruling.
The PHR brief follows late May reporting on how wait times soared at abortion clinics in the states closest to Florida after its ban took effect and the Guttmacher Institute's findings from last week that the law led to a "substantial drop" in clinician-provided abortions across the state, in part because many people don't even know they are pregnant until after six weeks.
"Florida clinicians shared harrowing accounts of how routine medical care has been delayed, denied, and deviated from standards of care."
This summer, PHR interviewed 25 of Florida's reproductive healthcare providers about their experiences caring for pregnant patients under the six-week ban. Brief co-author Dr. Michele Heisler said in a Tuesday statement that "Florida clinicians shared harrowing accounts of how routine medical care has been delayed, denied, and deviated from standards of care."
"Not only abortion care but miscarriage and broader maternal healthcare have suffered gravely due to the state's ban," noted Heisler, PHR's medical director and a professor of internal medicine and public health at the University of Michigan.
"Our research brief sheds new light on the health and rights crisis fueled by Florida's abortion ban—on patients, providers, and the medical system as a whole," she said. "Under the state's abortion ban, Floridians have lost their reproductive autonomy."
One Florida doctor in private practice told PHR that "with the six-week ban, I would say it is more like the inability to really offer anything at all now. I mean, we see patients for their new obstetrician-gynecologist visits usually around eight weeks, and sometimes we see them earlier, if they are having bleeding or other issues where we end up scanning them earlier."
"But I do not think I have ever had a viable pregnancy that was less than six weeks that I could offer a termination," the OB-GYN said. "They are never less than six weeks, so it is essentially impossible. By the time we see them for their first visit, that option is already gone."
Florida's ban technically allows some abortions after six weeks—in cases of rape and incest, or to protect the health of the pregnant person—though medical professionals and reproductive rights advocates often point out that many patients are still denied legal care even with the limited "exceptions" in place.
Before the current law, Floridians were living under a 15-week ban, which took effect in the wake of the U.S. Supreme Court's right-wing supermajority reversing Roe v. Wade with its June 2022 Dobbs v. Jackson Women's Health Organization ruling.
One doctor who spoke with PHR recalled a story from that period: "I strongly remember a patient who had severe kidney disease and was admitted to the hospital and was teetering on the edge of that 15 weeks. I think she was 14 weeks or so, and she got admitted, and we were trying to figure out how best to help her. She was getting sicker and sicker."
"[We] had to bring it to the head people of the hospital and be like, 'What are we allowed to do?' And they were like, 'She is not sick enough yet.' And we had to wait for her to get sicker before we were even allowed to offer her termination. And she was past 15 weeks at that point," the OB-GYN explained.
"I think it took over two weeks for us to get an answer from the hospital administrators," the doctor added. "So that hit very strongly, because it was kind of insane that we had to wait for her to become sicker. We had to wait for her creatinine to bump and her kidneys to be about to fail before we were allowed to even offer her [termination]. Then we had to jump through so many hoops to be able to do it. It really changed everything that we did in our practice."
The report features several other stories of patient and provider frustrations and the dangers created by the six-week ban.
"The findings of PHR's research brief demonstrate the need to remove Florida's extreme abortion ban and restore access to comprehensive reproductive healthcare in the state," argued Payal Shah, brief co-author and the group's director of advocacy, legal, and research. "Both patients and providers are trapped in an unworkable legal landscape."
"Despite state health agency statements to the contrary, the state's abortion ban is an egregious intrusion on patient autonomy that is causing medical harm," Shah added. "The ban's criminal penalties and narrow, vague exceptions have compelled clinicians to deviate from established standards of care and medical ethics. These impacts constitute violations of Floridians' human rights."
Florida voters will soon have an opportunity to restore much broader access to abortion care. This November, they can vote "yes" on Amendment 4, a state constitutional amendment backed by Floridians Protecting Freedom that would enshrine the right to abortion before viability in Florida.
Former President Donald Trump, a Florida resident and the Republican nominee facing Democratic Vice President Kamala Harris in the battle for the White House, confirmed last month that he plans to vote "no" on the ballot measure. In response, Harris said that "I trust women to make their own healthcare decisions and believe the government should never come between a woman and her doctor... The choice in this election is clear."
Amber Nicole Thurman's death "is the logical outcome of the Georgia abortion ban working exactly as intended by horrifically punishing women who try to access abortion care," said one advocate.
Reproductive rights advocates have warned for years that abortion bans and restrictions like those now in place in 22 U.S. states would kill pregnant people, and have been dismissed as "hyperbolic" by right-wing lawmakers and activists.
On Monday, new reporting shed light for the first time on the case of one woman whose "preventable" death was the result of an abortion ban—and as ProPublica reported, "there are almost certainly others."
The outlet reported on the story of Amber Nicole Thurman, a 28-year-old mother of a six-year-old son in Georgia, who realized she was pregnant in July 2022—weeks after the right-wing majority on the U.S. Supreme Court overturned Roe v. Wade and just as the state's six-week abortion ban was going into effect.
Thurman had just passed the six-week mark in her pregnancy as the ban took effect on July 20, with "exceptions" that Republicans claimed would allow doctors to provide care to pregnant people who were facing life-threatening complications.
Unable to get an abortion in her home state, the medical assistant, who was planning to attend nursing school and had recently been able to move out of her family's home into an apartment with her son, scheduled a dilation and curettage (D&C)—a surgical abortion procedure—at a clinic in North Carolina, about four hours away. Scheduling the appointment required taking the day off work, finding childcare, and borrowing a relative's car.
Thurman hit heavy traffic on the way to the clinic and missed her appointment; with abortion bans going into effect across the Southeast, the facility was overwhelmed with out-of-state patients and was unable to schedule another D&C for her.
Instead, she was prescribed the abortion pills misoprostol and mifepristone, and took the first pill before heading back home with plans to take the second in Georgia.
After taking the second pill, however, Thurman experienced a rare complication, with some of the fetal tissue remaining in her uterus.
Before Georgia's abortion ban went into effect, she would have been able to obtain a D&C, with doctors removing the remaining tissue—a fairly routine procedure, and part of the standard care for a miscarriage.
As ProPublica reported, the year after the Supreme Court handed down the Roe v. Wade ruling in 1973, affirming that abortion care was a constitutional right in the U.S., the new availability of D&Cs for abortion and miscarriages slashed the maternal mortality rate for women of color by up to 40%.
But when Thurman arrived at Piedmont Henry Hospital in the Atlanta suburb of Stockbridge—having experienced increasing pain and heavy bleeding before vomiting blood and fainting—she encountered a medical team that delayed providing her the standard care for roughly 20 hours.
ProPublica noted that the "supposed lifesaving exceptions" in Georgia's six-week abortion ban prohibit doctors from using medical instruments "with the purpose of terminating a pregnancy," and specify that procedures such as a D&C can only be used if fetal tissue needs to be removed due to a "spontaneous abortion"—the medical term for a miscarriage.
Thurman had told the doctors that she had had a medication abortion, which Republican state lawmakers hadn't included in the exceptions—suggesting she shouldn't be provided care since she'd chosen to terminate her pregnancy. Violating the law could result in prosecution and a prison sentence of up to a decade for a doctor.
The morning after Thurman arrived at the hospital at around 9:30 pm on August 18, 2022, with an ultrasound showing fetal tissue remaining in Thurman's body, a doctor diagnosed "acute severe sepsis," but it was still hours before the staff provided care to remove the tissue.
According to ProPublica:
By 5:14 a.m., Thurman was breathing rapidly and at risk of bleeding out, according to her vital signs. Even five liters of IV fluid had not moved her blood pressure out of the danger zone. Doctors escalated the antibiotics.
[...]
At 6:45 a.m., Thurman’s blood pressure continued to dip, and she was taken to the intensive care unit.
At 7:14 a.m., doctors discussed initiating a D&C. But it still didn’t happen. Two hours later, lab work indicated her organs were failing, according to experts who read her vital signs.
At 12:05 p.m., more than 17 hours after Thurman had arrived, a doctor who specializes in intensive care notified the OB-GYN that her condition was deteriorating.
Thurman was finally taken to an operating room at 2 p.m.
By then, the situation was so dire that doctors started with open abdominal surgery. They found that her bowel needed to be removed, but it was too risky to operate because not enough blood was flowing to the area—a possible complication from the blood pressure medication, an expert explained to ProPublica. The OB performed the D&C but immediately continued with a hysterectomy.
During surgery, Thurman's heart stopped.
The state's maternal mortality review board, which includes 10 physicians, determined that the hospital's decision to delay providing care for nearly an entire day had a "large" impact on Thurman's "preventable" death.
ProPublica identified one other Georgia woman whose death was caused by delayed abortion care resulting from the state's ban, and plans to report on her story in the coming days.
"This is what abortion bans do," said writer and activist Jessica Valenti.
At The New York Times, columnist Michelle Goldberg wrote that "it was only a matter of time" before Americans would learn that an abortion ban had killed a pregnant person.
"The shattering fallout from abortion prohibition was entirely predictable for anyone who has paid attention to such bans in other countries," Goldberg wrote, citing the 2012 case in Ireland of Savita Halappanavar, who died of septicemia after doctors refused to treat her for a miscarriage because her fetus still had a heartbeat.
"In Ireland, the name Savita became a rallying cry" that led voters to overwhelmingly approve a referendum making abortion legal, wrote Goldberg. "The name Amber should be one here."
On Tuesday, Vice President Kamala Harris, the Democratic presidential candidate, addressed Thurman's story, saying her death is "exactly what we feared when Roe was struck down."
"This young mother should be alive, raising her son, and pursuing her dream of attending nursing school," said Harris. "Women are bleeding out in parking lots, turned away from emergency rooms, losing their ability to ever have children again... And now women are dying. These are the consequences of [Republican candidate] Donald Trump's actions."
A spokesperson for Republican Georgia Gov. Brian Kemp's office dismissed the medical board's finding that Thurman's death could have been prevented if not for the state's abortion ban, telling ProPublica that the law allows doctors to provide care in medical emergencies and calling the outlet's reporting a "fear-mongering campaign."
But Leah Greenberg, co-executive director of progressive advocacy group Indivisible, said Thurman death "was not a tragic mistake."
"It is the logical outcome of the Georgia abortion ban working exactly as intended," said Greenberg, "by horrifically punishing women who try to access abortion care."
The president of the AFL-CIO called the November election a "fundamental choice," slamming Trump as "an unhinged serial union buster who betrays working people."
The 2024 U.S. presidential debate in Philadelphia Tuesday night presented what progressive organizers and labor leaders described as a stark choice between a former president dedicated to slashing taxes for the rich and assailing fundmental freedoms and a vice president committed to protecting abortion rights, combating corporate abuses, and alleviating the nation's housing crisis.
Over the course of the 90-minute debate, Republican nominee Donald Trump repeated well-worn lies about the 2020 election, regurgitated racist falsehoods about immigrants, bragged about the conservative-dominated Supreme Court's decision revoking the constitutional right to abortion care and refused to say he would veto a national abortion ban, and doubled down on his plan to "cut taxes very substantially."
Kamala Harris, who is leading the Democratic ticket, repeatedly took aim at Trump's economic agenda, saying that "it's all about tax breaks for the richest people" and accusing the former president of being "more interested in defending himself than he is in looking out for you." Harris also touted her endorsement from the United Auto Workers and decried the offshoring of manufacturing jobs during Trump's first term.
On reproductive rights, Harris noted that Trump "hand-selected three members of the United States Supreme Court with the intention that they would undo the protections of Roe v. Wade, and they did exactly as he intended."
"Now in over 20 states there are Trump abortion bans which make it criminal for a doctor or nurse to provide healthcare," said Harris. "In one state it provides prison for life. Trump abortion bans that make no exception even for rape and incest."
"Understand what that means," Harris continued. "A survivor of a crime, a violation to their body, does not have the right to make a decision about what happens to their body next. That is immoral. And one does not have to abandon their faith or deeply held beliefs to agree the government, and Donald Trump certainly, should not be telling a woman what to do with her body."
Kamala Harris’ full response on abortion pic.twitter.com/QEVkM5WjkR
— Acyn (@Acyn) September 11, 2024
Swing Left, a progressive advocacy group, said following Tuesday's debate that "there is only one candidate who will protect and expand our freedoms," adding that "the choice couldn't be clearer."
"Harris has a clear plan for her presidency: Building an opportunity economy, securing reproductive freedom, making housing more affordable, and protecting access to healthcare for millions of Americans," the group said. "Donald Trump wants to tax the middle class while giving tax cuts to his billionaire buddies, further strip away reproductive rights—including abortion, IVF, and birth control—and implement Project 2025 on day one. But rather than present his vision, he struggled to communicate a single coherent point."
On housing, said the co-executive directors of the Center for Popular Democracy Action, Harris "did what no other presidential candidate or elected president has done."
"Harris laid out a future to boost first-time homeowners and demonstrated her commitment to America's working people," said Analilia Mejia and DaMareo Cooper. "Trump is a racist slumlord. The contrast couldn't be more stark and for the Center for Popular Democracy Action, the choice is clear."
Liz Shuler, president of the AFL-CIO, similarly described the 2024 contest as a "fundamental choice," characterizing Harris as a "principled, tough fighter who'll work to create opportunity for all of us" and Trump as "an unhinged serial union buster who betrays working people."
"As tonight's debate reminded us, a second Trump term would be a corporate CEO's dream and a worker's nightmare," Shuler said in a statement late Tuesday. "Trump and Vance are ready to make their Project 2025 agenda a terrifying reality: eviscerating unions, slashing millions of union jobs, and making it nearly impossible for workers to organize, while cutting wages and benefits and threatening health and safety on the job. They're running a campaign based on division and fear to cover up the fact that they are in this for themselves and their rich donor friends—not the workers who make this country run."
"Harris' comments on Gaza continue to offend voters appalled by Netanyahu's U.S.-funded killing campaign."
But it wasn't all praise for Harris following her debate performance.
Climate groups voiced outrage over her expressed support for fracking and touting of "the largest increase in domestic oil production in history" under the Biden administration.
"Tonight, Harris spent more time promoting fracking than laying out a bold vision for a clean energy future," said the youth-led Sunrise Movement. "That's a big missed opportunity. With an election this close, every young climate voter we turn out matters."
Harris' response to the lone question about Israel's assault on Gaza also sparked anger from progressives who have been pushing the vice president to support an arms embargo against the Israeli military—a position that, according to recent polling, would boost her support among U.S. voters.
On the debate stage Tuesday night, Harris reiterated her support for a cease-fire while emphasizing that "Israel has a right to defend itself."
"Harris' comments on Gaza continue to offend voters appalled by Netanyahu's U.S.-funded killing campaign," said Abbas Alawieh, co-founder of the Uncommitted National Movement. "They offer nothing new and perpetuate the murderous status quo. It's simple: To stop the war, our government must stop sending the weapons fueling the war."