Health Care
A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas
Emergency Rooms
by Lizzie Presser and Kavitha Surana
Nov. 1
Series: Life of the Mother: How Abortion Bans Lead to Preventable Deaths
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Reporting Highlights
Three Trips to the ER: At 6 months pregnant, Nevaeh Crain visited two Texas
ERs a total of three times in 20 hours, seeking care for troubling symptoms.
Fetal Tests Cost Time: On her third trip, a doctor insisted on two ultrasounds to
“confirm fetal demise” before moving her to intensive care. Hours later, Crain
died.
One of at Least Two Deaths: Crain is one of at least two Texas women who died
under the state abortion ban. Josseli Barnica died after a miscarriage in 2021.
These highlights were written by the reporters and editors who worked on this
story. Were they helpful?
Candace Fails screamed for someone in the Texas hospital to help her pregnant
daughter. “Do something,” she pleaded, on the morning of Oct. 29, 2023.
Nevaeh Crain was crying in pain, too weak to walk, blood staining her thighs.
Feverish and vomiting the day of her baby shower, the 18-year-old had gone to
two different emergency rooms within 12 hours, returning home each time
worse than before.
The first hospital diagnosed her with strep throat without investigating her
sharp abdominal cramps. At the second, she screened positive for sepsis, a
life-threatening and fast-moving reaction to an infection, medical records show.
But doctors said her six-month fetus had a heartbeat and that Crain was fine to
leave.
Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds
to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.
By then, more than two hours after her arrival, Crain’s blood pressure had
plummeted and a nurse had noted that her lips were “blue and dusky.” Her
organs began failing.
Hours later, she was dead.
Fails, who would have seen her daughter turn 20 this Friday, still cannot
understand why Crain’s emergency was not treated like an emergency.
But that is what many pregnant women are now facing in states with strict
abortion bans, doctors and lawyers have told ProPublica.
“Pregnant women have become essentially untouchables,” said Sara
Rosenbaum, a health law and policy professor emerita at George Washington
University.
Texas’s abortion ban threatens prison time for interventions that end a fetal
heartbeat, whether the pregnancy is wanted or not. It includes exceptions for
life-threatening conditions, but still, doctors told ProPublica that confusion and
fear about the potential legal repercussions are changing the way their
colleagues treat pregnant patients with complications.
In states with abortion bans, such patients are sometimes bounced between
hospitals like “hot potatoes,” with health care providers reluctant to participate
in treatment that could attract a prosecutor, doctors told ProPublica. In some
cases, medical teams are wasting precious time debating legalities and
creating documentation, preparing for the possibility that they’ll need to explain
their actions to a jury and judge.
Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston
University School of Medicine, said patients are left wondering: “Am I being
sent home because I really am OK? Or am I being sent home because they’re
afraid that the solution to what’s going on with my pregnancy would be ending
the pregnancy, and they’re not allowed to do that?”
There is a federal law to prevent emergency room doctors from withholding
lifesaving care.
Passed nearly four decades ago, it requires emergency rooms to stabilize
patients in medical crises. The Biden administration argues this mandate
applies even in cases where an abortion might be necessary.
No state has done more to fight this interpretation than Texas, which has
warned doctors that its abortion ban supersedes the administration’s guidance
on federal law, and that they can face up to 99 years in prison for violating it.
ProPublica condensed more than 800 pages of Crain’s medical records into a
four-page timeline in consultation with two maternal-fetal medicine specialists;
reporters reviewed it with nine doctors, including researchers at prestigious
universities, OB-GYNs who regularly handle miscarriages, and experts in
emergency medicine and maternal health.
Some said the first ER missed warning signs of infection that deserved
attention. All said that the doctor at the second hospital should never have sent
Crain home when her signs of sepsis hadn’t improved. And when she returned
for the third time, all said there was no medical reason to make her wait for two
ultrasounds before taking aggressive action to save her.
“This is how these restrictions kill women,” said Dr. Dara Kass, a former regional
director at the Department of Health and Human Services and an emergency
room physician in New York. “It is never just one decision, it’s never just one
doctor, it’s never just one nurse.”
While they were not certain from looking at the records provided that Crain’s
death could have been prevented, they said it may have been possible to save
both the teenager and her fetus if she had been admitted earlier for close
monitoring and continuous treatment.
There was a chance Crain could have remained pregnant, they said. If she had
needed an early delivery, the hospital was well-equipped to care for a baby on
the edge of viability. In another scenario, if the infection had gone too far,
ending the pregnancy might have been necessary to save Crain.
Doctors involved in Crain’s care did not respond to several requests for
comment. The two hospitals, Baptist Hospitals of Southeast Texas and Christus
Southeast Texas St. Elizabeth, declined to answer detailed lists of questions
about her treatment.
Fails and Crain believed abortion was morally wrong. The teen could only
support it in the context of rape or life-threatening illness, she used to tell her
mother. They didn’t care whether the government banned it, just how their
Christian faith guided their own actions.
When they discovered Crain was pregnant with a girl, the two talked endlessly
about the little dresses they could buy, what kind of mother she would be. Crain
landed on the name Lillian. Fails could not wait to meet her.
But when her daughter got sick, Fails expected that doctors had an obligation
to do everything in their power to stave off a potentially deadly emergency,
even if that meant losing Lillian. In her view, they were more concerned with
checking the fetal heartbeat than attending to Crain.
“I know it sounds selfish, and God knows I would rather have both of them, but
if I had to choose,” Fails said, “I would have chosen my daughter.”
Fails says that Crain, shown here as a child with her mother, was “the gravity” in
her life. “She would put her arms around me like she was the adult and I was the
kid and tell me I was strong.” Credit: Danielle Villasana for ProPublica
“I’m in a Lot of Pain”
Crain had just graduated from high school in her hometown of Vidor, Texas, in
May of 2023 when she learned that she was pregnant.
She and her boyfriend of two years, Randall Broussard, were always hip to hip,
wrestling over vapes or snuggling on the couch watching vampire movies. Crain
was drawn to how gentle he was. He admired how easily she built friendships
and how quickly she could make people laugh. Though they were young, they’d
already imagined starting a family. Broussard, who has eight siblings, wanted
many kids; Crain wanted a daughter and the kind of relationship she had with
her mom. Earlier that year, Broussard had given Crain a small diamond ring — “a
promise,” he told her, “that I will always love you.”
On the morning of their baby shower, Oct. 28, 2023, Crain woke with a
headache. Her mom decorated the house with pink balloons and Crain laid out
Halloween-themed platters. Soon, nausea set in. Crain started vomiting and
was running a fever. When guests arrived, Broussard opened gifts — onesies
and diapers and bows — while Crain kept closing her eyes.
Around 3 p.m., her family told her she needed to go to the hospital.
Broussard drove Crain to Baptist Hospitals of Southeast Texas. They sat in the
waiting room for four hours. When Crain started vomiting, staff brought her a
plastic pan. When she wasn’t retching, she lay her head in her boyfriend’s lap.
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A nurse practitioner ordered a test for strep throat, which came back positive,
medical records show. But in a pregnant patient, abdominal pain and vomiting
should not be quickly attributed to strep, physicians told ProPublica; a doctor
should have also evaluated her pregnancy.
Instead, Baptist Hospitals discharged her with a prescription for antibiotics. She
was home at 9 p.m. and quickly dozed off, but within hours, she woke her
mother up. “Mom, my stomach is still hurting,” she said into the dark bedroom
at 3 a.m. “I’m in a lot of pain.”
Fails drove Broussard and Crain to another hospital in town, Christus Southeast
Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins saw that Crain
had a temperature of 102.8 and an abnormally high pulse, according to records;
a nurse noted that Crain rated her abdominal pain as a seven out of 10.
Her vital signs pointed to possible sepsis, records show. It’s standard medical
practice to immediately treat patients who show signs of sepsis, which can
overtake and kill a person quickly, medical experts told ProPublica. These
patients should be watched until their vitals improve. Through tests and scans,
the goal is to find the source of the infection. If the infection was in Crain’s
uterus, the fetus would likely need to be removed with a surgery.
In a room at the obstetric emergency department, a nurse wrapped a sensor
belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard
told Fails, who was sitting in the hallway.
After two hours of IV fluids, one dose of antibiotics, and some Tylenol, Crain’s
fever didn’t go down, her pulse remained high, and the fetal heart rate was
abnormally fast, medical records show. Hawkins noted that Crain had strep and
a urinary tract infection, wrote up a prescription and discharged her.
Hawkins had missed infections before. Eight years earlier, the Texas Medical
Board found that he had failed to diagnose appendicitis in one patient and
syphilis in another. In the latter case, the board noted that his error “may have
contributed to the fetal demise of one of her twins.” The board issued an order
to have Hawkins’ medical practice monitored; the order was lifted two years
later. (Hawkins did not respond to several attempts to reach him.)
All of the doctors who reviewed Crain’s vital signs for ProPublica said she
should have been admitted. “She should have never left, never left,” said Elise
Boos, an OB-GYN in Tennessee.
Kass, the New York emergency physician, put it in starker terms: When they
discharged her, they were “pushing her down the path of no return.”
“It’s bullshit,” Fails said as Broussard rolled Crain out in a wheelchair; she was
unable to walk on her own. Fails had expected the hospital to keep her
overnight. Her daughter was breathing heavily, hunched over in pain, pale in the
face. Normally talkative, the teen was quiet.
Crain’s boyfriend, Randall Broussard, and mother at Fails’ home in Vidor, Texas
Credit: Danielle Villasana for ProPublica
Back home, around 7 a.m., Fails tried to get her daughter comfortable as she
cried and moaned. She told Fails she needed to pee, and her mother helped her
into the bathroom. “Mom, come here,” she said from the toilet. Blood stained
her underwear.
The blood confirmed Fails’ instinct: This was a miscarriage.
At 9 a.m, a full day after the nausea began, they were back at Christus St.
Elizabeth. Crain’s lips were drained of color and she kept saying she was going
to pass out. Staff started her on IV antibiotics and performed a bedside
ultrasound.
Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal
heart rate, according to records; he told the family he was sorry for their loss.
Standard protocol when a critically ill patient experiences a miscarriage is to
stabilize her and, in most cases, hurry to the operating room for delivery,
medical experts said. This is especially urgent with a spreading infection. But at
Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour
later, as nurses placed a catheter, Fails noticed her daughter’s thighs were
covered in blood.
At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica
about Crain’s condition. The teen was now having contractions. “Dr. Totorica
states to not move patient,” she wrote after talking with him. “Dr. Totorica states
there is a slight chance patient may need to go to ICU and he wants the
bedside ultrasound to be done stat for sure before admitting to room.”
Though he had already performed an ultrasound, he was asking for a second.
The first hadn’t preserved an image of Crain’s womb in the medical record.
“Bedside ultrasounds aren’t always set up to save images permanently,” said
Abbott, the Boston OB-GYN.
The state’s laws banning abortion require that doctors record the absence of a
fetal heartbeat before intervening with a procedure that could end a pregnancy.
Exceptions for medical emergencies demand physicians document their
reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain
this isn’t a normal pregnancy, we can’t do anything, because it could be alleged
that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San
Antonio.
At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was
paging for an emergency team over the loudspeakers.
Around 11 a.m., two hours after Crain had arrived at the hospital, a second
ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to
confirm fetal demise per Dr. Totorica’s orders.”
When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side,
rubbing her head, as her daughter dipped in and out of consciousness. Crain
couldn’t sign consent forms for her care because of “extreme pain,” according
to the records, so Fails signed a release for “unplanned dilation and curettage”
or “unplanned cesarean section.”
But the doctors quickly decided it was now too risky to operate, according to
records. They suspected that she had developed a dangerous complication of
sepsis known as disseminated intravascular coagulation; she was bleeding
internally.
Frantic and crying, Fails locked eyes with her daughter. “You’re strong, Nevaeh,”
she said. “God made us strong.”
Crain sat up in the cot. Old, black blood gushed from her nostrils and mouth.
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