Along with the decision to have an abortion, Cox decided she wanted to have it done in Texas. She and her doctor felt she should reasonably fit into even the highly restrictive medical exemption for such a procedure in the state. She also knew she would need legal help, and she found that by contacting the Center for Reproductive Rights.
Cox had looked into other abortion-related cases in Texas and saw that the center was representing a group of women suing the state to clarify the scope of what the medical emergency exception is.
The key difference between her situation and that of the plaintiffs involved in the Zurawski case was that Cox was still pregnant, while they were not. Unlike Cox’s quickly litigated emergency case, Zurawski v. State of Texas has seen a few twists and turns over the span of 10 months.
On Aug. 4, a state district judge issued an injunction blocking Texas’ abortion bans as they apply to dangerous pregnancy complications. The court noted that doctors can use their own medical judgment to determine when to provide an emergency abortion procedure. The ruling also found Senate Bill 8, the so-called “Abortion Bounty Hunter Law,” unconstitutional. The law would allow virtually anyone to file lawsuits seeking $10,000 from anyone who performs abortions or otherwise aids in providing them to women more than six weeks pregnant.
The judge went so far as to state in her ruling that the women who brought this case should have been given abortions. The state quickly appealed that ruling to the Texas Supreme Court, effectively blocking it.
“As a direct result of Texas’s abortion bans, Texas is in the midst of a health care crisis,” reads the complaint. “Amanda Zurawski, Lauren Miller, Lauren Hall, Anna Zargarian, Ashley Brandt, and countless other pregnant people have been denied necessary and potentially life-saving obstetrical care because medical professionals throughout the state fear liability under Texas’s abortion bans.”
“Sadly, I think what we saw in the most urgent of circumstances is not a good foreshadowing of what’s to come from the highest court in Texas.” – Michelle Simpson Tuegel, attorney
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In August, D Magazine reported that seven of the plaintiffs listed are from North Texas, including Miller, Hall and Brandt. Currently, 22 women are listed as plaintiffs in the lawsuit against the state, with North Texas residents Kristen Anaya and Kimberley Manzano joining the suit in November.
According to the Center for Reproductive Rights, Manzano and her husband are devout Christians who eventually had to travel to New Mexico to have an abortion after they “learned at 10 weeks that her baby’s organs were growing outside the body and the baby had no chance of survival. By carrying the pregnancy, Kimberly’s health was at risk due to the likelihood of infection.”
The complaint lists other harrowing pregnancy scenarios for the original group of plaintiffs. The paperwork notes that Zurawski “was forced to wait until she was septic to receive abortion care, causing one of her fallopian tubes to become permanently closed." Also, according to the lawsuit, Brandt “had to travel out of state for an abortion to save the life of one of her twins, and afterwards, fearful of documenting [Brandt’s] abortion, her Texas physician instead described her condition as ‘vanishing twin syndrome.’”
A representative for the Center for Reproductive Rights told the Observer via email that the group is unsure of when the state Supreme Court will rule on the case and that it didn’t want to speculate on the potential outcome.
Since the U.S. Supreme Court ruled in 2022 that women have no constitutional right to an abortion, new cases and legal developments regarding abortions in Texas have become common. On Tuesday a federal appeals court ruled that federal regulations do not require emergency rooms to perform life-saving abortions if it conflicts with state law. Like the Cox case, it’s just another step in the wrong direction as far as abortion advocates are concerned.
“This ruling shows a complete disregard for the lives of pregnant people,” said Rabia Muqaddam, senior staff attorney for the Center for Reproductive Rights. “It suggests that everyone who goes to an emergency room in Texas is entitled to stabilizing care under EMTALA [Emergency Medical Treatment and Active Labor Act], unless they happen to be a pregnant person who needs an emergency abortion to be stabilized. This is a radical narrowing of EMTALA beyond any traditional understanding.”
The Tuesday decision is also another example of just how murky state abortion laws are when it comes to medical exemptions and the expectations that physicians and hospitals can face while being held legally liable under less-than-certain conditions.
“Things definitely seem unclear,” said Michelle Simpson Tuegel, a Dallas attorney who has challenged SB 8 in court. "I think the Cox case is important for the bigger picture. Politicians like to say that if there's a risk of death then abortions are allowed, but the reality of what doctors and women are faced with is that there are a lot of questions still, and frankly, doctors are afraid of facing decades in prison if their decision is evaluated later by a court as not being in line with the law, even if they made the decision based on their best medical judgement."
The lack of clarity might keep many Texas doctors from even trying to prove a medical exemption for an abortion is necessary, according to some experts.
As for what to expect from the Zurawski decision from the Texas Supreme Court, Simpson Tuegel thinks we’ve already seen an indication as to which way the court will go when it ruled in favor of the state in the Cox case.
“Sadly, I think what we saw in the most urgent of circumstances is not a good foreshadowing of what’s to come from the highest court in Texas,” she said. “They’re interpreting laws in a way that makes the health and freedom of choice for women who are in really risky and complicated situations where their doctors need to be able to decide what is best for them and not the Texas Supreme Court. The Supreme Court has shown with their decision in the Cox case and the language they used that they will substitute the opinions of judges in place of medical providers.”
