By Allie Kelly
Dr. Judy Levison had been practicing medicine for over 40 years. She’s a board-certified OB-GYN and current faculty member at a Texas medical school.
Last summer, she decided to stop seeing patients.
“I can no longer provide the kind of counseling that I was trained to do,” Levison said.
Levison is a plaintiff in Zurawski vs. State of Texas, an ongoing lawsuit filed in March by the Center for Reproductive Rights. The plaintiff list now includes two medical professionals and thirteen women who say their health was put at risk when they were unable to receive care under the state’s abortion bans.
The case aims to clarify the scope of the medical emergency under Texas bans. Vague exception language leaves doctors asking tough legal questions, Levison said, and patients facing barriers to care.
‘You can’t practice ethical medicine in that context’
Saturday marks a year since the U.S. Supreme Court voted to uphold the decision in Dobbs vs. Jackson Women’s Health Organization, a case that centered on a Mississippi abortion ban.
The decision resulted in Roe vs. Wade being overturned, a landmark decision that protected the constitutional right to abortion for over five decades. Abortion legislation was then left up to individual states.
Trigger laws — previously unenforceable heartbeat bills and restrictions on second and third trimester abortions — were enacted in 13 states. Other states passed legislation to protect a person’s right to the procedure in all or most cases.
Texas’ abortion ban was put in place nearly a year before Roe was overturned.
Senate Bill 8 went into effect in September 2021. It states that abortions cannot legally be performed in Texas beyond six weeks gestation, a window before some people find out they are pregnant, per Cleveland Clinic.
Under a subsequent trigger ban, it is a felony to perform an abortion unless the pregnant person is facing a “life-threatening physical condition” or “a serious risk of substantial impairment of a major bodily function.” Texas medical professionals who carry out the procedure can be faced with up to a $100,000 fine and life in prison. There are no stated exceptions for cases of incest, rape or fetal anomaly.
Medication abortion, like mifepristone and misoprostol pills, are also illegal to dispense, but are approved by the Federal Food and Drug Administration.
And, because any abortion-related criminal charges would be directed toward health care providers, many Texas doctors are hesitant to discuss abortion with their patients. Some fear legal retribution.
“You can’t practice ethical medicine in that context,” Levison said.
Carolyn Cline is the CEO of Woman to Woman Health Center, a pregnancy center in Dallas. She said the organization offers reproductive health services and information about abortion alternatives.
Cline said she has seen confusion from women and their doctors in the last year, and her organization looks to “educate women about what the actual law says.”
However, Cline said there needs to be more clarity in the law about reproductive health so doctors and patients can be well-informed.
“I think there needs to be clarity on exactly what the law says. We all need to understand it for the sake of the women, for the sake of those that are providing medical services as well,” she said.
Even if doctors do what they think is medically right, Levison asked, “What is the risk?” She said a court could decide that a health care provider made the wrong decision, that a patient’s condition wasn’t life-threatening.
“One of the reasons I’m speaking out is that my colleagues are younger than I am,” she said. “Many are in their 30s, have young families and are starting their career. One of the possible penalties after Dobbs is 99 years in prison. And you’re going to put your family first.”
Trust needs to be given to the pregnant people and their physicians, Levison said.
‘Texas law doesn’t have to do this’
Last August, Amanda Zurawski contacted her obstetrician about some strange pregnancy symptoms she was experiencing. Her doctor told her to come to the office for an exam.
Zurawski was told by her medical provider that her cervix had dilated prematurely, and soon after, her membranes ruptured. Because her pregnancy was still so many weeks before viability, Zurawski was told that her baby would not survive.
There was little doctors could do to help Zurawski. In testimony before the Senate Judiciary Committee last April, she said that, while her health care providers knew she would lose her baby, they did not feel comfortable performing a medically-necessary abortion due to the language in Texas abortion laws.
In order to receive the procedure, Zurawski’s condition would have to deteriorate enough for the hospital’s ethics board to consider it life threatening.
She had to wait.
Three days later, Zurawski was in the intensive care unit with sepsis, fighting to stay alive.
She is now the primary name on the Zurawski vs. State of Texas case, joined by women who experienced severe preventable infections, dangerous journeys to get an abortion out of state or the pain of carrying a baby with a fatal condition. Most cited emotional trauma as one of their reasons for joining the case.
“As you read the stories, and as you begin to talk to patients — and they tell you what they were going through, how afraid they were, how afraid their doctors are — it’s heartbreaking and it’s infuriating,” Center for Reproductive Rights Senior Counsel Marc Hearron said. “None of this had to happen, and what’s happening right now is happening by design. Texas law doesn’t have to do this.”
Last month, the Center for Reproductive Rights requested an injunction to block Texas abortion bans in the event of pregnancy complications.
The state filed a plea to the jurisdiction on June 15, a document that could get the Zurawski case thrown out.
A hearing on the motion will take place in July.
Attorney General Ken Paxton and Texas Medical Board Executive Director Stephen Brint Carlton are named defendants in the case. The offices of Paxton and Brint Carlton did not respond to a request for comment.
Paxton has previously said he will continue to defend “the pro-life laws of Texas and the lives of all unborn children.”
The Texas Alliance for Life, a statewide anti-abortion organization, responded to the Zurawski case when it was filed in March via a public statement.
The organization said Texas law is “carefully crafted” to allow doctors to treat pregnant people with life-threatening conditions without risk of criminal or civil liability.
“Texas Alliance for Life supports clarification of the medical emergency exception language within Texas’ pro-life laws,” the Alliance for Life said in the statement. “That clarification needs to come in the same way doctors are educated about other legislation affecting their practice in Texas.”
‘Too many mountains to climb’
With near total abortion bans, Hearron said reproductive care access is a key concern. He said low-resourced pregnant people are getting trapped in a health care crisis — and it’s important not to lose sight of them.
Many Texans faced with a situation where abortion is the medically-recommended option are unable to access care due to the high costs of out-of-state travel, transportation, child care, taking time off of work and the procedure itself.
And, in the event of an immediate medical situation, the time it takes to travel by plane or car to another state is risky.
These are the people that abortion bans are hitting the hardest, Hearron said.
“For my patients who were primarily low-income, abortion really wasn’t an option because they don’t have the means to travel out of state or take time off from their jobs,” Levison said. “They risk being fired. They would have to obtain child care. There were too many mountains to climb.”
As of last summer, women’s clinics and Planned Parenthood-affiliates can no longer provide abortions in the state. Many closed, others refocused their efforts to advocacy or other support. For many Texas residents, clinics were there only avenue to affordable reproductive health and abortion care.
Marsha Jones is the co-founder and executive director of the Afiya Center, a North Texas-based organization that centers on reproductive justice. The organization primarily provides HIV education and health care access support to Black pregnant people.
“At the end of the day, it all starts and ends with access,” Jones said. “There’s never been equitable access ever. And now, with the Dobbs decision and the overturning of Roe, that makes access even harder.”
Abortion bans have the greatest impact on people with the least access to resources, she said. And Black women additionally face a significant amount of stigma for their sexual and reproductive choices.
“It will just be more complicated even for a Black woman with resources to access an abortion in times like this than it will be for a white one without resources.”
From a future policy perspective, Jones hopes to see health care that reflects reproductive justice and expanded access. People’s entire living experience includes their reproductive experience, she said.
The Woman to Woman Health Center provides services for free, Cline said. She feels that her center provides people, regardless of their financial situation, with the services they need outside of abortion care.
“We care greatly about women, and we want them to be well educated, we want them to be empowered and we want them to have good health care,” she said.
Cline said her center doesn’t believe abortion is in a woman’s best interest or in the best interest of the baby she’s carrying.
Levison said the state’s limits on abortion access and the incongruity of what is considered a medical emergency puts pregnant people’s lives at risk. Obstetric complications, she said, can happen to anyone.
“I wish that the general public would understand it,” Levison said. “That abortion is a part of health care.”
This story, originally published in The Dallas Morning News, is reprinted as part of a collaborative partnership between The Dallas Morning News and Texas Metro News. The partnership seeks to boost coverage of Dallas’ communities of color, particularly in southern Dallas.
