‘Gray area’ of life or death: The horrible scenario that faces many pregnant women rushed to Florida’s ERs

Derick and Anya Cook of Margate can’t shake their memories of the horrific scene that unraveled in the bathroom of a Hollywood hair salon, and the devastation that followed.

Anya had been only 16 weeks’ pregnant when her water broke unexpectedly. She rushed to a Coral Springs hospital in distress. Although the doctor providing emergency care told her that her amniotic sac had ruptured, he gave Anya antibiotics and sent her home. Anything more would violate Florida’s 15-week abortion ban in effect at the time, he told the Cooks.

“Even though she was carrying a baby that would not survive and was at risk for infection or hemorrhaging, we were sent home,” Derick said.

Distraught, Anya went to the Hollywood salon, telling her husband that if she died she wanted her hair to be funeral-ready.

Shortly after arriving, Anya went into the bathroom and delivered the stillborn baby alone, blood hemorrhaging from her body onto the floor and the umbilical cord dangling and still attached to her daughter. She called Derick in a panic to help her.

“I followed what I had seen on medical shows to cut my daughter’s umbilical cord and help my wife deliver the placenta,” Derick said. Paramedics rushed Anya to Memorial Regional Hospital, where she went into surgery for 12 hours with a medical team trying to save her life. At some point, Derick said, a doctor asked him how badly he wanted to save his wife’s uterus, unsure whether the medical team could save both.

“I know she should have never been in a life-or-death situation trying to have our child,” Derick said.

Florida’s emergency physicians and obstetricians had already been grappling with scenarios like Anya’s, when the state’s more restrictive law went into place.

On May 1, a new six-week abortion law went into effect in Florida with exceptions to allow doctors to perform an abortion in life-threatening situations, including an ectopic pregnancy, a woman’s water breaking early, or a trophoblastic tumor that forms in the uterus. With those exceptions, which Florida doctors say are common scenarios in emergency departments, doctors must interpret how soon they can intervene to end a pregnancy.

“That’s the gray area,” said Dr. Daniel Christie, a South Florida fertility and IVF physician. “How close to death does a woman need to be to say, ‘Now we can do something to save the life of the mother?'”

While Florida hospitals are trying to come up with policies and protocols for how to protect a mother’s life, and address emergency abortion care, attention has shifted to the U.S. Supreme Court.

A U.S. Supreme Court decision expected this month will determine whether women can receive emergency abortion care or whether state abortion bans prevent it.

A nearly 40-year old federal law called the Emergency Medical Treatment and Labor Act (EMTALA) requires Medicare hospitals to provide stabilizing care to all patients experiencing a medical emergency. Until now, hospitals have defined “stabilizing care” to include emergency abortion.

In Idaho, when a pregnant patient has complications, abortion is only legal to prevent the woman’s death, not to help stabilize her. The Biden administration sees that as a direct conflict, and the Justice Department sued Idaho, asserting the federal emergency care law preempts the state’s abortion ban.

In a court filing, Idaho physicians warned the court that patients are being harmed by the state’s total abortion ban. They described cases in which women facing serious pregnancy complications were either sent home from the hospital or transferred out of state for care.

“What is going on now in Idaho could easily happen in Florida,” said Dr. Leonardo Alonso, an emergency medicine specialist in Jacksonville.

If the Supreme Court sides with Idaho, Florida doctors  — like others around the country — will be forced to wait until a patient is at the brink of death before intervening.

“What this means is a pregnant woman in an emergency situation may be able to get to the ED, but when she gets there, she may not necessarily get the care she needs,” said Dr. Cecilia Grande, a Miami gynecologist.

Most emergency doctors practicing in Florida at this time have done so only while EMTALA has been the guiding law, said Dr. Damian Caraballo, a Tampa emergency phyisican and past president of the Florida College of Emergency Physicians.

“The ruling could change the way people practice,” he said. “If they get rid of EMTALA, it becomes a whole new wild west in practicing emergency medicine.”

If the Supreme Court rules that EMTALA doesn’t apply to abortion care, a pregant woman suffering a life-threatening complication could be told in an emergency room that there’s nothing that the doctors legally can do, even when medically there is, Caraballo said. The doctors would have to stand by and wait for patients to decline.

“When people who make laws who don’t practice medicine, it creates a huge conundrum that could harm patients through unintended consequences,” Caraballo said.

Ultimately, emergency physicians call in hospital obstetricians to decide treatment for pregnant patients in pain, bleeding, or who might have a dangerous infection.

Dr. Shavonne Ramsey-Coleman, an obstetrician with the Ob Hospitalist Group, works on staff for hospitals in Boynton Beach, Miami and South Miami. When she treats a pregnant women in distress, she says she puts the mother’s life first. “If we see women who are in situations where they’re hemorrhaging, or they’re dying actively, we are going to take care of those patients — period.”

But Ramsey-Coleman acknowledges wiith Florida’s abortion ban, navigating when and how aggressively she intervenes is tricky.  If obsetricians wait too long, the patient can lose a massive amount of blood, end up with sepsis, or develop lasting damage to her organs and her future fertility.

“The law now in Florida is decently clear, but there are always some gray areas. Each hospital has a legal team, and we take it to them and the ethics committee to help us suss it out,” she said. “Every hospital is a little bit different in how they are handling it.”

Some women will be asked to wait, she said.  “Unfortunately, there are patients having to leave the state for some of the treatments and therapies if they are unwilling to wait a day or two or three.”

Christie, the IVF doctor, said he helped Anya Cook after her uterus surgery and expects to see more women in her situation if EMTALA no longer exists as the guiiding federal law.

“Fertile couples who were hamstrug because they had appropriate care withheld will now be coming to see me because they need my service, and things internally in the woman have become so wrecked I may or may not be able to correct what damage has been done,” he said. “The law needs to recognize it’s not just saving a life — it’s about what you are jeopardizing when a pregnant woman is left untreated.”

Derick Cook says nearly 18 months after his tragedy, he is watching for the Supreme Court ruling, hoping it will ensure a family’s right to emergency abortion care. He wants men to know this issue affects them too, as fathers.

“It’s very scary when your wife is bleeding and you don’t know what to do,” he said. “When you want your wife to get the help she needs and instead get turned away, that’s scary, and that’s gonna be scary for a lot of families across this nation.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.