Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.
Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much in the emergency department at Houston Methodist Sugar Land that she’d needed two transfusions. She was anxious to get home to her young sons, but, according to a nurse’s notes, she was still “passing large clots the size of grapefruit.”
Hope dialed his mother, a former physician, who was unequivocal. “You need a D&C,” she told them, referring to dilation and curettage, a common procedure for first-trimester miscarriages and abortions. If a doctor could remove the remaining tissue from her uterus, the bleeding would end.
But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he said it was the hospital’s “routine” to give a drug called misoprostol to help the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took the pills, according to records, and the bleeding continued.
Three hours later, her heart stopped.
The 35-year-old’s death was preventable, according to more than a dozen doctors who reviewed a detailed summary of her case for ProPublica. Some said it raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks. Doctors and patients described similar decisions they’ve witnessed across the state.
It was clear Porsha needed an emergency D&C, the medical experts said. She was hemorrhaging and the doctors knew she had a blood-clotting disorder, which put her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11 weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at the University of New Mexico Center for Reproductive Health. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” The medical examiner found the cause of death to be hemorrhage.
D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a straw-like tube into the uterus and gently suction out any remaining pregnancy tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.
But because D&Cs are also used to end pregnancies, the procedure has become tangled up in state legislation that restricts abortions. In Texas, any doctor who violates the strict law risks up to 99 years in prison. Porsha’s is the fifth case ProPublica has reported in which women died after they did not receive a D&C or its second-trimester equivalent, a dilation and evacuation; three of those deaths were in Texas.
Texas doctors told ProPublica the law has changed the way their colleagues see the procedure; some no longer consider it a first-line treatment, fearing legal repercussions or dissuaded by the extra legwork required to document the miscarriage and get hospital approval to carry out a D&C. This has occurred, ProPublica found, even in cases like Porsha’s where there isn’t a fetal heartbeat or the circumstances should fall under an exception in the law. Some doctors are transferring those patients to other hospitals, which delays their care, or they’re defaulting to treatments that aren’t the medical standard.
Misoprostol, the medicine given to Porsha, is an effective method to complete low-risk miscarriages but is not recommended when a patient is unstable. The drug is also part of a two-pill regimen for abortions, yet administering it may draw less scrutiny than a D&C because it requires a smaller medical team and because the drug is commonly used to induce labor and treat postpartum hemorrhage. Since 2022, some Texas women who were bleeding heavily while miscarrying have gone public about only receiving medication when they asked for D&Cs. One later passed out in a pool of her own blood.
“Stigma and fear are there for D&Cs in a way that they are not for misoprostol,” said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is not standard in Texas anymore, even in cases where it should be recommended. People are afraid: They see D&C as abortion and abortion as illegal.”
Josseli Barnica, Nevaeh Crane, and now Porsha Ngumezi. There will be more. You should read the rest, but take care in doing so, it’s as sad and enraging as you think. Rest in peace, Porsha Ngumezi.
THE COMMENTS TO THIS ENTRY ARE CLOSED [AS USUAL]
KUFF REPORTS: Steve Vladeck describes getting ambushed at a legal forum.
Hyperbole, hyperbole! – [The chief judge of the Fifth Circuit is being accused of doing the “ambushing”, in consort with Judge Ho, the pro-life Korean, as identity-freaks might note, as if genetic ancestry were relevant to judicial performance]
Meanwhile, a like-minded scholar praises Prof. V. for his “admirable response”, but won’t allow any alternative views (“Comments closed”) on the erudiate law professor blawg run by Law Professor “Dissent-Not-Welcome” Howard Wasserman.
So, being blocked like all others outside Wasserman’s academic coccoon ecosystem I wrote to Profs. Lubet and Vladeck directly (forgoing the public forum to test alternative takes on the matter, which would make it worthwhile to waste remaining life time). Neither responded. Let’s see whether Kuff is committed to allow counterspeech that discomforts him even if the lordly legal professoriate does not. I haven’t given up hope yet, and that’s why you see my comments on KUFF’s blog. In short: I haven’t given up on the possibility of productive discourse on contentious issues, and KUFF hasn’t shut me down yet, which he has every right to do, since he owns this blog and the First Amendment doesn’t apply
Here is my missive to Lubet and Vladeck, with a quote from the post as the lead:
“Those who begin coercive elimination of dissent soon find themselves exterminating dissenters. Compulsory unification of opinion achieves only the unanimity of the graveyard.”
Posted by Steve Lubet on November 19, 2024 at 09:18 AM | Permalink
Comments
The comments to this entry are closed.
Dear Professor:
I complained about judicial nonrecusals two decades ago, and have been persona non grata in the Southern District of Texas ever since. See link to Fifth Circuit opinion below.
So, some of what Prof. V. is saying resonates with me.
That said, I feel Professor V. needs to work on growing a thicker skin himself. The gravamen of his complaint is that he got verbally “attacked”. He squeals about the form and severity of the criticisms. In essence, Judge Jones wasn’t nice and polite enough with him. Even turned down the offer of a beer summit (harkening back to Pres. Obama).
My response: If you can dish it out (criticize public officials, not to mention judges), you gotta be able to take the response to it, polite or otherwise.
Bottom line: It’s all just talk and about being miffed about unexpected ego-damaging counterspeech.
Let’s acknowledge the obvious here: Judge Jones didn’t RULE against the famous professor and judiciary critic or hold him in CONTEMPT, or issue an order to show cause why his LICENSE TO PRACTICE LAW (if any) should be suspended for “impugning the integrity of the court”. Mr. V. is indeed privileged, as he admits, in his tenured academic post and NOT subject to adverse rulings as long as he stays out of court as an actual litigant or practicing attorney. Practicing attorneys, by contrast, must be obedient and tow the line if they want to survive professionally. And pro-se litigants, of course, get crushed if they get too cheeky.
Further, thanks to Chief Jones, Professor V. got an excellent opportunity to air out his grievances about the Fifth Circuit and conservative judge shopping to the academic choir, i.e., his fellow left-leaning intellectuals. Even the general media picked up on the “drama”.
Unsurprisingly, most feedback that he attests to receiving comes from fellow academic bubble dwellers. Who would have any incentive to criticize such an eminent scholar? I would, but I am something of an oddball, and can make time for discourse activities that no longer imperil my job or career. Call it a luxury if you will.
Truth is, I am myself a shut-down critic of judge behavior and I have suffered the consequences that are not merely rhetorical or merely ego-diminishing in tenor.
As such I would have something meaningful to say on “judicial independence” and how it is defended through suppression (or rather punishment) of dissent, but you closed the comments and won’t allow it. You too, insulate privileged speakers from criticism, just like Blogmeister Wasserman.
Sad.
Sincerely,
Wolfgang P. Hirczy de Mino, PhD (Political Science is my field, so I am very comfortable conceptualizing judges as political actors and analyzing their official conduct accordingly)
WOLFGANG P. HIRCZY DE MINO – Google Scholar
Faculty Judges Should Recuse in University Cases
On August 18, 2005, the Faculty Rights Coalition, led by Dr. Wolfgang Hirczy de Mino, addressed the University of Houston Board about the recusal of faculty judges from cases in which the university or a university official is a party. His presentation is reprinted below.
[If interested, you can find the remainder online or google Faculty Rights Coalition v. Hank or Hirczy v. Hamilton, No. 05-20213 (5th Cir. 2006)
[Dona Glimm Hamilton n/k/a Dona Cornell)]
Disclosure: I was the Plaintiff in the USDC Southern District of Texas, where I got sanctioned for making a stink by way of preclusion order, the Appellant in the Fifth Circuit, and the petitioner in the SCOTUS. The latter graced me with a denial . Some day I am going to put my pro-se petition for cert online. It was, of course, denied, but I am still proud of it.
And the non-recusal issue hasn’t gone away.