A Texas Woman Died After Waiting 40 Hours for Miscarriage Care
A Texas Woman Died After Waiting 40 Hours for Miscarriage Care
Josseli Barnica is one of at least two pregnant Texas women who died after doctors delayed emergency care. She’d told her husband that the medical team said it couldn’t act until the fetal heartbeat stopped.
Josseli Barnica grieved the news as she lay in a Houston hospital bed on Sept. 3, 2021: The sibling she’d dreamt of giving her daughter would not survive this pregnancy.
The fetus was on the verge of coming out, its head pressed against her dilated cervix; she was 17 weeks pregnant and a miscarriage was “in progress,” doctors noted in hospital records. At that point, they should have offered to speed up the delivery or empty her uterus to stave off a deadly infection, more than a dozen medical experts told ProPublica.
But when Barnica’s husband rushed to her side from his job on a construction site, she relayed what she said the medical team had told her: “They had to wait until there was no heartbeat,” he told ProPublica in Spanish. “It would be a crime to give her an abortion.”
For 40 hours, the anguished 28-year-old mother prayed for doctors to help her get home to her daughter; all the while, her uterus remained exposed to bacteria.
Three days after she delivered, Barnica died of an infection.
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Texas state law allows abortion in cases of medical emergencies. The hospital was absolutely in the wrong here.
The hospital knew that they had to protect themselves against the jagoffs who prosecute people who provide women with healthcare.
The law is what created this situation; if the doctors and hospital administration didn't have to worry about the fascists in the State government, this never would have been an issue.
Or do you just think the doctors didn't perform the procedure because they didn't feel like it?
I don't give a flying fuck why they didn't help her or what the law says.
They're monstrous torturers and murderers, regardless of their reasons or lack thereof.
You don't let someone suffer and die when you have the means to save them, regardless of the consequences, except possibly if those consequences would lead to greater suffering and death (trolley problem). Especially if you call yourself a doctor. (And no, the possibility of going to prison does not count as greater suffering and death, no matter how much of a sociopath you are).
Why dont you focus your rage against the people actually responsible?
It's easy to sacrifice someone else to the system. I'm not saying it was the right thing to do, but if these doctors have to stop practicing medicine then more women will die.
Point the blame at the right people.
but if these doctors have to stop practicing medicine then more women will die
Whatever these so called doctors are practicing is the opposite of medicine.
If they were to stop practicing it, at least they wouldn't have the opportunity to torture and murder more victims, and maybe some real doctors would get their jobs and be able to help.
There's no excuse for collaborating with a fascist regime. The ones obeying the orders are just as guilty as the ones giving them.
That's pretty easy to say when you're not on the hook and not one of the few doctors that didn't leave for blue states when the shit hit the fan.
Do you really think OB/GYN are lining up to be doctors in Texas?
Why are you not taking it into your own hands? You've not exhausted your own extralegal options, but you're calling on others to do it.
I'm lucky enough to live in a relatively civilised country (comparatively at least; everything can be improved), not some fascist hellhole like the USA.
Unlike the monsters who tortured and murdered this woman, however, I do use the opportunities and means I have to help people around me, but said people are lucky enough to not be anywhere near the USA.
The law is perfectly clear in allowing this. I'm not going to guess why they didn't do it, but your point is like arguing a cop watching a mass shooting happen right in front of him would be right to blame the law against excessive use of force if he chose not to kill the mass shooter even though there was an explicit clause saying it would have been permitted.
I'm not going to guess why they didn't do it
We all know why they didn't do it, and your willful ignorance is telling.
Alright, since you want me to say what it was, it sounds like a medical error to me.
Making an argument comparing doctors to cops may not have been the best move.
I'm not comparing them in terms of moral status, I'm comparing them in terms of what they can and can't do by law.
Hundreds of doctors and their lawyers disagree with you. Of course they could provide medical services, and see if local law enforcement decides to arrest them and lock them up. Or they could withhold medical services, because that's what their lawyers say is a reasonable interpretation of the law.
In other words, it doesn't really matter what you or I think. It matters what doctors and their lawyers believe is likely to occur. And we know what that is, because they're telling us out loud, and they're showing us through their actions.
Of course you're entitled to interpret the law however you want to. I think many of us have done that over time, and sometimes we realize that we got it wrong, because we see that lawyers and courts don't agree with us. Probably this is one of the times that you need to recognize what's actually happening, and realize that your wishful thinking is just that. I'm sure many people would be happier if reality matched your thoughts, but it doesn't.
Can you please tell me how this is confusing:
Sec. 171.002. DEFINITIONS. In this chapter:
(3) "Medical emergency" means a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.
...
Sec. 171.0124. EXCEPTION FOR MEDICAL EMERGENCY. A physician may perform an abortion without obtaining informed consent under this subchapter in a medical emergency. A physician who performs an abortion in a medical emergency shall:
(1) include in the patient's medical records a statement signed by the physician certifying the nature of the medical emergency; and
(2) not later than the 30th day after the date the abortion is performed, certify to the department the specific medical condition that constituted the emergency.
You do know that medical errors happens, right? People die from them all the time. This seems like a pretty clear-cut case of it.
It wasn't a "medical error."
It was the State of Texas intimidating doctors into not performing life-saving healthcare.
You can try to reframe it all you want, but this it the truth of the situation.
How is any of that legal text "intimidating"?
Yeah, they probably were just taking a long lunch instead of treating a patient.
Are you really asking how a law can be intimidating? That's like... The reason we have laws, man.
Laws can also be misread, and it's very likely that this was done somehow. The law explicitly allows abortions under these circumstances. Can you explain yourself what's confusing about it?
There's nothing confusing about it.
The law is set up to intimate doctors into not performing abortions. The doctors believe they will be second-guessed by Ken Paxton and his merry band of fascists.
You want to reframe it and blame the doctors instead of the draconian law that intimidates healthcare professionals.
There should never have been a restriction in the first place; women should be free to make their own healthcare decisions free from the constraints of theocratic virtue-signaling control freaks.
It's confusing because Ken Paxton doesn't actually care about the law. His goons will show up at your door and accuse you of violating the law whether you did the right thing or not.
That's worth watching an innocent person die? Besides, how likely is it that "even though she was literally dying of the infection and the hospital knew it, that didn't constitute a medical emergency" would hold up in court?
Read your own link.
The patient must have a life-threatening condition and be at risk of death or "substantial impairment of a major bodily function" if the abortion is not performed. "Substantial impairment of a major bodily function" is not defined in this chapter.
So, the words say that they can help, but because they (very intentionally) made the definitions of 'life threatening condition' and 'Substantial impairment of a major bodily function' undefined, there is no legal way for a doctor to bring harm to a fetus with a heartbeat without exposing themselves to the draconian Texas penalty laws https://guides.sll.texas.gov/abortion-laws/civil-penalties
The physician believed that a medical emergency had taken place, and therefore it would have been legal. And would you rather face legal consequences, or watch someone die in front of you because you could help them but didn't?
I hope all that doctor's other patients feel as morally superior as you do.
I hope the lawyers who gave the doctor this horrible advice get fired.
The woman died of sepsis. It’s extremely likely when you have a dead or dying fetus hemorrhagically working its way out of a uterus, but until you have it, you don’t. By the time people realize what’s going on, it’s often too late.
The law is disgusting because it is medically uninformed and constraining, and it assumes anyone considering abortion is just some gleefully slutty baby murderer.
From the article:
At that point, they should have offered to speed up the delivery or empty her uterus to stave off a deadly infection, more than a dozen medical experts told ProPublica.
This would mean it was legal to perform an abortion. They should have known about this risk.
I am trying to work on being less confrontational on here, but it really feels like you are being willfully obtuse. Playing devil's advocate for you, it seems like you are struggling with the gap between the text of the law and the enforcement context of the law. In this case there is a very wide gap between the two.
You aren't going to change any minds here by arguing that the law technically allows abortions in this case. The issue is the enforcement and underlying context of the law.
I think the text of the law is quite plain. It's not a huge reach to imagine that this is yet another terrible instance of a medial error. Hundreds of thousands of people die every year because of them. If you want to talk about enforcement, then we have at least one case of a doctor having a lawsuit against him dismissed after he was accused of providing an abortion. Also, as of 2023, nobody had been arrested for providing an abortion.
I appreciate you trying to see things from my perspective, but the facts of the case seem pretty clear to me. Arguing that this is because of the abortion law doesn't make a whole lot of sense. If the law says "you can shoot someone if they invade your home," much the same as this law does, it's not the legislators' fault if I freeze up when my home is invaded and die. Medical error, either because of bad legal advice or a poor understanding of medicine, is more reasonable as an explanation.
If the facts of the case are clear to you but they aren't clear to doctors who actually live and work in the state, and are risking getting locked up for years or decades, and large hospitals that are part of gigantic corporations that have expensive lawyers working for them, maybe it's because they know more than you, or maybe it's because they are more worried about being cautious, because they know that the cops and the DAs down there are eager to arrest people.
All of which is to say, we don't even have to look at the text of the law, because people are telling us the actual effect of the law. You're pounding the statute but the statute's not the problem. The enforcement of the statute is the problem. So you can keep on pounding it, but your energies are misdirected.
If the law is being interpreted in court in such a way that the text of the law is being ignored for the sake of scoring more convictions, the state of Texas is begging to be smacked down for doing so. And that smackdown would be perfectly justified. The longer this obviously incorrect interpretation of the law goes unchallenged, the longer it will cause a chilling effect on the medical community that is truly trying to save lives. No, it is not easy to be the tip of the spear, but the state of Texas would owe them a great debt.
Yes they should have but didn't because of a vague law that does not lay out exactly when the mothers life is in danger. Does she have to be in pain? Conscious? Bleeding? Irregular heartbeat? Does the fetus have to viable? The law does not allow for interpretation so hospitals literally have to wait until the women is in cardiac arrest to act. So yes if this women was in any normal state with normal defined laws that don't restrict how doctors decide what their patients need. So yes they should have acted but couldn't.
The 2017 law allowed abortions in emergencies as defined in Section 171.002, Health and Safety Code. This is what it says:
"As certified by a physician" means the physician can decide whether this is a life-threatening emergency.
Hmmmmm it's like the religious right nut jobs don't trust science and doctors.
Please see my reply to your other comment. I don't see how this has anything to do with science and doctors rather than some idiot giving fatally bad legal advice.
Did you read the article?
I did. Here's how I replied:
That threat was because she could have sought a C-section. If I'm understanding this page correctly, one's fertility is reduced by about 13% after a C-section. If I'm not, feel free to show me how I got it wrong. Did that guy ever end up prosecuting anyone involved, though? Why would a judge side with the prosecution after a court literally gave her an order permitting her to do that?
Elaborating further, though the odds of the baby surviving past the first year are only 5-10%, its life should still be preserved if possible. People can and do elect to have surgery despite a low chance of survival.
The patient must have a life-threatening condition and be at risk of death or "substantial impairment of a major bodily function" if the abortion is not performed.
The problem is that legal jargon and medical jargon are very different animals. The legal is deliberately ambiguous, and the medical is hyper-specific... so doctors are left scratching their heads about things like "is the white blood cell count high enough for a lawyer to call this life threatening?" "Is the blood pressure low enough?" meanwhile the mother waits and dies.
"During a medical emergency" or "life threatening" are copouts that don't actually mean shit, and no doctor is going to risk going to prison to find out.
There's already been at least one doctor in Texas who risked legal consequences for performing an abortion, and he won out. And given that twelve other physicians stated a premature delivery should have been done, it's plain that something should have been done. Now she's dead, because apparently the hospital staff misunderstood a rather clearly-written law.
Any doctor that performs an abortion in Texas is risking a minimum $100,000 fine and permanently losing there license to practice medicine if lawyers, who are not medical professionals, decide it was medically necessary yet.
As a result, doctors in TX have been advised by their lawyers not to perform abortions unless the mother is literally minutes away from death, because otherwise you can’t prove that it was medically necessary.
In the case, the patient died of sepsis. Doctors couldn’t perform the abortion when she needed it because they couldn’t prove that it was medically necessary yet.
They knew that not performing the abortion would put mom at a much high risk of dying later. But they couldn’t legally prove that risk exists because all pregnancies involve some degree of risk.
If you want doctors to perform medical procedures when it’s medically necessary, you need doctors making that decision, not lawyers, not the state. That’s what Texas had before this law went into effect.
It’s literally created a trolly problem, it’s now better for the doctors to let some women die so they can save more lives later.
But we have "over a dozen" medical experts who say it would have been the correct decision, and the law explicitly allows it. If it's so obvious that over a dozen experts who never spoke to the patient could know it was the right decision, then how does a competent doctor actually interacting with the patient not know that?
Yes.
That’s the problem with this law.
It takes the decision away from the medical experts, and puts in the hands of lawyers and judges who may or may not have a different agenda.
The lawyers/judges would want to throw physicians in prison? And as of 2023, no doctors had actually been arrested for doing this. Actually, at least one got a case dismissed after the fact.
I can see you’re clearly not interested in understanding the situation the physician was in or discussing solutions that would have saved this patient’s life.
I’m not going to debate you further.
The article says what would have saved her life, so I didn't think that was at issue here. But alright. It was good talking to you, and I hope you have a good day.
Sure sure. Perfectly legal to do an abortion in Texas in a case of a medical emergency.
And then the case gets reviewed by a board of religious zealots who believe unwanted pregnancies (and by extension, pregnancy related deaths) are part of their god's divine plan. They determine if this was an abortion, or a murder. In Texas, a state where the only thing liberal is their application of the death penalty.
Can you see why what the law says and what the law does can be very different?
The definition of emergency is absurdly specific though. The corpse inside you can't just be dead, it can't just be decomposing, the fragments of putrefying corpse matter must be coursing through your blood at a sufficient concentration before anything can legally be done.
If she dies, then it was an emergency and you should have saved her. Jail.
If she doesn't die, then it wasn't an emergency and you shouldn't have done the abortion. Jail.
The patient must have a life-threatening condition and be at risk of death or "substantial impairment of a major bodily function" if the abortion is not performed.
So, therein lies the problem.
They couldn't take action before her life was in danger even though they knew it would be. So they have to wait until it's an "emergency" which is far more risky. And this woman died was a result.
This law greatly increased the risk of the situation needlessly.
She died, so that's an emergency. If someone is having a stroke and somehow doesn't die until three days later, that doesn't make it any less an emergency.
Do you hear yourself?
It was an emergency because she died?
She died days after it was too late for an abortion to save her.
If they performed the abortion when it would have saved her life, she wouldn’t have died, by your own logic it would’n’ve been an emergency.
And you’d be here arguing that the doctor should lose his license for performing an abortion when it wasn’t an emergency.
Yes. If someone is going to die soon after the problem is discovered, it's an emergency. I don't think this is a controversial claim. If someone gets hit by a car or has a stroke and has days to live, that doesn't mean we hold off on providing healthcare so they survive the incident.
It’s designed to be legal minefield. If I were a doctor I certainly wouldn’t do one. I don’t want to go to prison or be accused of murder for saving somebody’s life. It’s not worth it.
Can you please tell me how this is a legal minefield:
Sec. 171.002. DEFINITIONS. In this chapter:
(3) "Medical emergency" means a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.
...
Sec. 171.0124. EXCEPTION FOR MEDICAL EMERGENCY. A physician may perform an abortion without obtaining informed consent under this subchapter in a medical emergency. A physician who performs an abortion in a medical emergency shall:
(1) include in the patient's medical records a statement signed by the physician certifying the nature of the medical emergency; and
(2) not later than the 30th day after the date the abortion is performed, certify to the department the specific medical condition that constituted the emergency.
You do know that medical errors happens, right? People die from them all the time. This seems like a pretty clear-cut case of it.
What happens if they thought it was an emergency but other physicians might not agree, or after the fact when more information is available it turns out not to be?
So what happens is you wait and wait until your patient is going to die without a doubt… because you have to be sure, thus putting their life at risk.
Emergencies are often not so easy to characterize in the real world. Sometimes you have to make assumptions. Those assumptions aren’t always correct.
Or you could save your patient's life. The laws state if the physician believes there's a medical emergency.
I don’t think that’s what it says. Why include the medical records in the statement if we are meant to rely on the doctor’s belief at the time based on the information that was available? Shouldn’t it be enough to trust the expert? It rather looks like making sure there’s documentation for possible criminal prosecution (for murder!) if they’re wrong.
Sure, I can accept there’s a theory of exceptions, but I think it’s liable to scare away providers. However, I suppose I’m not a medical expert. I can point to the well lack of care situation as my example of this concern and the chilling effect the law has on providers doing their jobs.
I'm not a medical expert either, but I rely very heavily on physicians to remain alive. You and I both have a vested interest in our doctors treating us well. This looks like a tragic case of a medical error. This was, in 2018, the leading cause of death in America. It's not a huge stretch of the imagination. Even given the requirement to document it, with over a dozen people saying it would have been correct, it seems like it would be a very simple matter to prove in before a judge that it was necessary. The law also seems more geared towards collecting anonymous statistics as well.
Notice how that law is vague on the medical emergency aspects. When exactly is a women with an nonviable pregnancy a danger to the mother?
"Life-threatening condition" is a fairly wide umbrella. Given the number of people who die of sepsis every year, that sounds like a life-threatening condition to me. A substantial impairment is defined under federal law. Sepsis would likely also count there, too - it messes you up real badly, after all.
That threat was because she could have sought a C-section. If I'm understanding this page correctly, one's fertility is reduced by about 13% after a C-section. If I'm not, feel free to show me how I got it wrong. Did that guy ever end up prosecuting anyone involved, though? Why would a judge side with the prosecution after a court literally gave her an order permitting her to do that?
This happened prior to the version of the law you posted.
[Can you point to which law before this happened prohibits abortions in cases of medical emergency?(https://guides.sll.texas.gov/abortion-laws/history-of-abortion-laws#s-lg-box-wrapper-34155545) Let's go through the list:
- The 1925 laws were found unconstitutional.
- Roe v. Wade happened in 1973.
- In 1992, the "viability" standard was introduced. This baby was clearly unviable.
- The 1999 law is specific to minors, and the victim here wasn't a minor.
- The Woman's Right to Know Act didn't prohibit abortions.
- The 2011 law stated that a sonogram must be performed. Because the baby was suffering from an irreversible medical condition, though, this wouldn't apply.
- The only part of the 2013 law that was upheld was the ban after 20 weeks "with some exceptions." The rest were overtuned in 2016, and this event occurred before the 20th week.
- The 2017 law was found unconstitutional in 2018, well before this happened.
- The 2021 law went into effect on September 1, 2021. However, in Sec. 171.205, it states that the prohibition of abortions on a fetus with a detectable heartbeat "do[es] not apply if a physician believes a medical emergency exists that prevents compliance with this subchapter." This was a medical emergency.
It's been the fucking wild west here in Texas due to new laws being pushed out then shot down so quickly, no one can keep track. Even the ones passed are written so badly, they can't be interpreted correctly. The following is from an article from ProPublica
Although US abortion bans – which more than a dozen states have enacted in the two years since the supreme court overturned Roe v Wade – technically permit the procedure in medical emergencies, doctors across the country have said that the laws are worded so vaguely that they don’t know when they can legally intervene.
This has been repeated ad nauseum by doctors on local outlets. It's meant to be vague and confusing.