Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her.
Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course” before discharging her without treatment for her ectopic pregnancy.
When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection intended to end the pregnancy. But it was too late. The fertilized egg growing on Thurman’s fallopian tube would rupture it, destroying part of her reproductive system.
That’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated a federal law when staff failed to treat her initially in February 2023.
“I was left to flail,” Thurman said. “It was nothing short of being misled.”
Even as the Biden administration has publicly warned hospitals to treat pregnant patients in emergencies, facilities continue to violate the federal law.
More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations has found.
Two women – one in Florida and one in Texas – were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting any treatment, including one California woman who needed a blood transfusion after she sat for nine hours in an emergency waiting room.
The White House says hospitals must offer abortions when needed to save a woman’s health, despite state bans. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.
Abortion bans complicate risky pregnancy care
In Texas, where doctors face up to 99 years of prison if convicted of performing an illegal abortion, medical and legal experts say the law is complicating decision-making around emergency pregnancy care.
Although the state law says termination of ectopic pregnancies is not considered abortion, the draconian penalties scare Texas doctors from treating those patients, the Center for Reproductive Rights argues.
“As fearful as hospitals and doctors are of running afoul of these state abortion bans, they also need to be concerned about running afoul of federal law,” said Marc Hearron, a center attorney. Hospitals face a federal investigation, hefty penalties and threats to their Medicare funding if they break the federal law.
The organization filed two complaints last week with the Centers for Medicare and Medicaid Service alleging that different Texas emergency rooms failed to treat two patients, including Thurman, with ectopic pregnancies.
Another complaint says Kelsie Norris-De La Cruz, 25, lost a fallopian tube and most of an ovary after an Arlington, Texas, hospital sent her home without treating her ectopic pregnancy, even after a doctor said discharge was “not in her best interest.”
“The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency healthcare,” she said in a statement. “I’m filing this complaint because women like me deserve justice and accountability from those that hurt us.”
Conclusively diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the pregnancy’s location on an ultrasound, three separate doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test and ultrasound of an empty uterus all indicate an ectopic pregnancy.
“You can’t be 100% — that’s the tricky part,” said Kate Arnold, an OB-GYN in Washington. “They’re literally time bombs. It’s a pregnancy growing in this thing that can only grow so much.”
Texas Right to Life Director Dr. John Seago said the state law clearly protects doctors from prosecution if they terminate ectopic pregnancies, even if a doctor “makes a mistake” in diagnosing it.
“Sending a woman back home is completely unnecessary, completely dangerous,” Seago said.
But the state law has “absolutely” made doctors afraid of treating pregnant patients, said Hannah Gordon, an emergency medicine physician who worked in a Dallas hospital until last year.
“It’s going to force doctors to start creating questionable scenarios for patients, even if it’s very dangerous,” said Gordon. She left Texas hoping to become pregnant and worried about the care she’d get there.
Gordon recalled a pregnant patient at her Dallas emergency room who had signs of an ectopic pregnancy. Because OB-GYNs said they couldn’t definitively diagnose the problem, they waited to end the pregnancy until she came back the next day.
“It left a bad taste in my mouth,” Gordon said.
“Oh my God, I’m dying.”
In Thurman’s case, when she returned to Ascension Seton Williamson a third time, her OB-GYN told her she’d need surgery to remove the fallopian tube, which had ruptured. Thurman, still heavily bleeding, balked. Losing the tube would jeopardize her fertility.
But her doctor told her she risked death if she waited any longer.
“She came in and she’s like, you’re either going to have to have a blood transfusion, or you’re going to have to have surgery or you’re going to bleed out,” Thurman said, through tears. “That’s when I just kind of was like, “oh my God, I’m, I’m dying.”
Ascension Seton Williamson declined to comment on Thurman’s case, but said in a statement the hospital “is committed to providing high-quality care to all who seek our services.”
In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in Broward Health Coral Springs’ emergency wait room, according to federal documents. An ultrasound revealed the patient had no amniotic fluid surrounding the fetus, a dangerous situation that can cause serious infection.
The woman miscarried in a public bathroom that day, after the emergency room doctor listed her condition as “improved” and discharged her, without consulting the hospital’s OB-GYN.
Emergency crews rushed her to another hospital, where she was placed on a ventilator and discharged after six days.
Abortions after 15 weeks were banned in Florida at the time. Broward Health Coral Springs’ obstetrics medical director told an investigator that inducing labor for anyone who presents with pre-viable premature rupture of membranes is “the standard of care, has been a while, regardless of heartbeat, due to the risk to the mother.”
The hospital declined to comment or share its policies with the AP.
In another Florida case, a doctor admitted state law had complicated emergency pregnancy care.
“Because of the new laws … staff cannot intervene unless there is a danger to the patient’s health,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator who was probing the hospital’s failure to offer an abortion to a pregnant woman whose water broke at 15 weeks, well before the fetus could survive.
Troubles extend beyond abortion ban states
Serious violations that jeopardized a mother or her fetus’ health occurred in states with and without abortion bans, the AP’s review found.
In interviews with investigators, two short-staffed hospitals – in Idaho and Washington – admitted to routinely directing pregnant patients to drive to other hospitals.
A pregnant patient at a Bakersfield, California, emergency room was quickly triaged, but staff failed to realize the urgency of her condition, a uterine rupture. The delay, an investigator concluded, may have contributed to the baby’s death.
Doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for fetal heartbeats or discharged patients who were in active labor, leaving them to deliver at home or in ambulances, according to the documents.
Nursing and doctor shortages that have plagued hospitals since the onset of COVID-19, trouble staffing ultrasounds around-the-clock, and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official.
“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” she said.
Noah Lyles said he tested positive for COVID two days before he finished third in the 200-meter final at the Paris Olympics on Thursday night.
Here’s what we know about the timeline of Lyles’ illness:
When did Lyles know he had COVID?
Lyles says he quickly got into quarantine after he had tested positive Tuesday morning. He participated in the 200-meter semifinal on Wednesday, where he finished second. Lyles’ coach afterward said the sprinter was “fine.”
Lyles, who usually always takes an opportunity to talk, did not speak to reporters after the semifinal.
The 100-meter champion said he was feeling better as the 200 final approached. He estimated he was about 90-95 percent when the starting gun went off.
“I still wanted to run,” he said after Thursday night’s race. “They said it was possible.”
What happened in his 200-meter race?
Lyles was trailing 200-meter champion Botswana’s Letsile Tebogo as they headed into the homestretch, which is usually where the American puts on a trademark closing finish that has always been the best part of his race. Before this week, he hadn’t lost a 200 since his third-place finish in Tokyo three years ago.
This time, Lyles could not close. Only a desperate push to the line then a collapse onto the purple track.
“To be honest, I knew if I wanted to come out here and win, I had to give everything I had from the get-go,” he said. “I didn’t have any time to save energy. So that was kind of the strategy for today.”
After crossing the line third for the second straight Olympics, Lyles fell to his back and writhed on the ground trying to catch his breath. He got to one knee and stayed there for nearly 30 seconds before getting up, asking for water and getting to the wheelchair.
Why was he allowed to run?
The U.S. track federation released a statement saying it and the U.S. Olympic and Paralympic Committee adhered to all Olympic and Centers for Disease Control guidelines.
“After a thorough medical evaluation, Noah chose to compete tonight,” the statement said. “We respect his decision and will continue to monitor his condition closely.”
Three years ago, at the Tokyo Olympics, a positive COVID test would have put an athlete in immediate isolation, forcing them to a special hotel with no contact with other Olympic participants. Even in 2022 at the Winter Games in China, daily tests and strict isolation measures were automatic. COVID rules have been changed in much of society, including sports, school and work. The USATF says they followed current policies.
France, which once had tight COVID restrictions, no longer has rules for people with the virus, just recommendations to those who test positive to self-isolate.
The World Health Organization said Tuesday that 40 athletes at the Olympics had tested positive for the virus amid growing cases worldwide.
What races does Lyles have left?
Lyles was expected to run the anchor leg of the 4×100 on Friday in what many thought would be a quest for a third gold medal in Paris. He said he would talk to his relay teammates and come to a decision.
“I want to be very honest and transparent, and I’m going to let them make the decision,” Lyles said, describing himself as being at around 90 or 95%.
The medical-cannabis company Trulieve has contributed another $5 million to a campaign to allow recreational marijuana in Florida, according to a newly filed finance report.
The company made the contribution July 15 to the Smart & Safe Florida political committee, which is leading efforts to pass a recreational-marijuana initiative on the November ballot.
In all, Trulieve had contributed about $60.39 million to the committee as of July 19, according to a state Division of Elections database.
The committee had raised a total of $66.475 million in cash and nearly $129,000 in in-kind contributions. It had spent $53.963 million.
The initiative, which will appear on the ballot as Amendment 3, says, in part, that it would allow “adults 21 years or older to possess, purchase, or use marijuana products and marijuana accessories for non-medical personal consumption by smoking, ingestion, or otherwise.”
Voters in 2016 passed a constitutional amendment that allowed medical marijuana.
President Joe Biden did not wear a face mask in public a couple of times after the White House announced he had tested positive for COVID-19. The White House said the Democratic incumbent was experiencing “mild” symptoms while the president’s physician said Biden would self-isolate “in accordance with CDC guidance for symptomatic individuals.”
What does the CDC guidance say? What does the White House say?
After the announcement on Wednesday, Biden emerged bare-faced from the motorcade after he arrived at the airport in Las Vegas, where he had made several appearances, and boarded Air Force One. He also was not wearing a mask, which medicals professionals have said can help slow the spread of disease, as he stepped off the plane hours later at Dover Air Force Base in Delaware. Biden was surrounded by Secret Service agents and aides on both ends of the trip.
White House press secretary Karine Jean-Pierre said in Wednesday’s announcement that Biden, 81, was experiencing “mild” symptoms and would stick to prearranged plans to travel to his home in Rehoboth Beach, where he would isolate.
Biden’s physician, Dr. Kevin O’Connor, said in a separate statement that Biden had a runny nose, dry cough and a feeling of “general malaise.” He said Biden was being treated with the drug Paxlovid “and will be self-isolating in accordance with CDC guidance for symptomatic individuals.”
The CDC recommends that people “stay home and away from others” if they’re feeling sick. They say people can resume normal activities when symptoms have started to improve and the person no longer has a fever.
The CDC describes masks as an “additional strategy” for preventing disease spread, but it generally leaves it up to individuals to decide whether to use them. It calls masks “especially helpful” when someone is sick and suggests they be used as a precaution during recovery.
What the White House says
The White House has not responded to an emailed request for comment about why Biden chose not to wear a mask.
How is Biden doing?
O’Connor said Thursday that Biden is still experiencing mild upper respiratory symptoms from COVID-19,. The president does not have a fever and his vital signs remained normal. He’s being treated with the drug Paxlovid.
Quentin Fulks, the principal deputy manager of Biden’s reelection campaign, said Thursday that Biden was “feeling fine” and was making calls and doing work. Fulks spoke at a news conference on the sidelines of the Republican National Convention in Milwaukee.
White House national security spokesperson John Kirby told reporters during a separate Zoom briefing that Biden was “being kept up to speed as appropriate by his leadership team, and certainly that includes on the national security front.”
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Associated Press writers Mike Stobbe in New York and Will Weissert in Washington contributed to this report.
Retired judge Heather Hallett, who is leading the ongoing inquiry, said the government wrongly believed in 2019 that it was one of the best-prepared countries in the world for an outbreak and it anticipated the wrong pandemic — influenza.
“This belief was dangerously mistaken,” Hallett said in releasing her first report. “In reality, the U.K. was ill-prepared for dealing with the whole-system civil emergency of a pandemic, let alone the coronavirus pandemic that actually struck.”
The COVID-19 pandemic has been blamed for more than 235,000 deaths in the U.K. through the end of 2023 — one of the highest death tolls in the world.
“Today’s report confirms what many have always believed — that the U.K. was under-prepared for COVID-19, and that process, planning and policy across all four nations failed U.K. citizens,” Prime Minister Keir Starmer said, referring to England, Northern Ireland, Scotland and Wales.
“The safety and security of the country should always be the first priority, and this government is committed to learning the lessons from the inquiry and putting better measures in place to protect and prepare us from the impact of any future pandemic,” he said.
The first report from the inquiry, based on hearings that began in June 2023, was focused only on pandemic preparedness and didn’t place blame on any individual.
A second phase looking at the government’s response, including the “partygate” scandal in which then Prime Minister Boris Johnson and his staff broke their own rules by hosting work parties, is due later. A third phase will look into what lessons can be learned from how the nation handled the crisis. The inquiry is due to hold hearings until 2026.
Hallett found that an outdated 2011 pandemic strategy for flu wasn’t flexible enough to adapt to a crisis nearly a decade later and was abandoned almost immediately.
“There were fatal strategic flaws underpinning the assessment of the risks faced by the U.K., how those risks and their consequences could be managed and prevented from worsening and how the state should respond,” Hallett said.
There also was a lack of focus on what was needed to deal with a rapidly transmissible disease, and not enough done to build up a system to test, trace and isolate infected patients.
Hallett said in her 217-page report that the U.K. needs to be better prepared for the next pandemic — one that could be even deadlier.
“The U.K. will again face a pandemic that, unless we are better prepared, will bring with it immense suffering and huge financial cost and the most vulnerable in society will suffer the most,” she said.
Hallett recommended that a new pandemic strategy be developed and tested every three years, and that government and political leaders should be accountable for having preparedness and resilience systems in place. She also said that outside experts should be used to prevent “the known problem of groupthink.”
“Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic,” Hallett said. “Never again can a disease be allowed to lead to so many deaths and so much suffering.”
Elkan Abrahamson, who represents the nearly 7,000 members of the COVID-19 Bereaved Families for Justice, applauded Hallett for adopting most of its recommendations to prevent a repeat disaster.
“However, it is extremely disappointing that the vulnerable were ignored in the recommendations and there were no proposals for dealing with racial inequality, health inequalities or the effects of austerity,” Abrahamson said.
More than 5 million American adults were receiving mental health treatment at a state-monitored mental health facility in 2022, according to a report from the Department of Health and Human Services released in April, an increase from last year.
However, access to treatment can largely depend on where someone lives or what kind of insurance they have. More than half of adults receiving treatment lived in just 10 states, as many Americans lack access to mental health care.
This year, as the Biden administration works to combat the mental health crisis spurred by the COVID-19 pandemic, the Centers for Medicare & Medicaid Services expanded Medicare access to behavioral health services.
Wysa analyzed data compiled by the Substance Abuse and Mental Health Services Administration to find which states had the highest rates of adults receiving mental health treatment. Each state’s mental health administration reports the data individually. Maine did not report sufficient data and was excluded from this report.
Wysa
States and communities take a patchwork approach to treatment
Nationwide, 15 out of every 1,000 people were receiving mental health treatment in 2022. However, disparities between states vary widely. In Florida, 13 out of every 1,000 residents are receiving mental health treatment, totaling 289,664 people. They make up 5.7% of all people receiving mental health treatment in the United States. Read the national analysis to see which states had the highest rates of people receiving mental health treatment.
People who live in rural states have high rates of people receiving mental health services at state-monitored facilities. Isolation, diminishing economic prospects, and the stigmatization of mental health conditions can lead to higher rates of depression in rural communities. In Iowa, where about one-third of its population lives in rural areas, an estimated 473,000 people have a mental health condition. However, the state ranked last in terms of psychiatric bed availability, with only 2 available beds per 100,000 residents.
Beyond access to care, each state runs its own mental health administration differently, including the types of facilities each state monitors. In Wisconsin, for instance, private facilities and individual practitioners are regulated, while Connecticut only regulates mental health treatments at what are known as private intermediate treatment facilities, or dedicated institutions for mental health treatments that don’t require hospital-level care. Vast differences in the quality of treatment, with some facilities receiving more oversight than others, further stratify mental health care across the nation.
No matter how you measure it, the mental health crisis is impacting millions of Americans. Along with federal grants and initiatives, states and community organizations are taking individual steps to increase access to treatment.
In Montana, where 5 out of every 100 residents are receiving mental health treatments, Gov. Greg Gianforte signed a bill last year allocating $300 million to improve and expand access to behavioral care. Last month, the state’s behavioral health commission presented recommendations to divide the funds, including improving case management, expanding services, and recruiting and retaining mental health care specialists.
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This story features data reporting and writing by Elena Cox and is part of a series utilizing data automation across 49 states and Washington D.C.
This story originally appeared on Wysa and was produced and distributed in partnership with Stacker Studio.
