TEXAS – There came a point when the chills, fever and cramps were so intense that Lynn Callaway thought she might die.
Callaway was having a miscarriage, and had developed an infection. She wanted abortion-inducing medication or surgery to help empty her uterus and bring her suffering to an end. But, in a federal complaint filed Monday, Callaway says she’d already been refused that type of care at two Austin area emergency rooms, and felt she had no choice but to endure alone at home.
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Her husband, Mario, was unwilling to accept that his otherwise healthy 40-year-old wife was suddenly wan and bleeding on the floor, while their young son watched in alarm. He wanted to take her to New Mexico or Colorado to get the care they say they were wrongfully denied in Texas. But she was too weak to sustain the trip.
When they finally saw her doctor days later, Callaway was prescribed abortion-inducing drugs to pass the miscarriage. In an interview with The Texas Tribune, Callaway said when she pressed her doctor on why it had taken three medical facilities four days to treat her, she was told the emergency room would “have to be damned sure that it’s an actual miscarriage to be offering the pill.”
Four years after Texas banned nearly all abortions, Callaway is among women who say they are still being denied the full range of miscarriage care by doctors fearful of being accused of performing a prohibited abortion and spending life in prison or losing their medical licenses.
Last year, lawmakers passed a bill aimed at assuring doctors they wouldn’t be punished for treating miscarriages. The law went into effect last June. But months later, in October, Callaway found herself facing the same fear and uncertainty that has restricted pregnancy care in Texas since 2022.
Callaway’s complaint alleges that Baylor Scott and White Medical Center in Round Rock and St. David’s Round Rock Medical Center violated the Emergency Medical Treatment and Active Labor Act, a federal statute that requires hospitals to provide stabilizing treatment, including for miscarriages. She also asked the Texas Medical Board and Texas Board of Nursing to investigate the healthcare providers who she says failed to treat her.
A spokesperson for Baylor Scott & White Health said the hospital could not comment on the details of any specific case, but that medical decisions are “guided by the clinical judgment of our physicians and care teams who … determine appropriate treatment based on medical needs and applicable legal requirements.”
In a statement, St. David’s Round Rock Medical Center said it would address the complaint through the regulatory process.
“It is our practice to support and partner with licensed physicians who use their extensive training and experience to exercise their independent medical judgment to assess patients’ needs and determine the course of treatment within applicable laws and regulations,” the statement said.
Callaway’s lawyers say in the complaint that EMTALA investigations are being delayed by the Trump administration, in part due to a 2022 lawsuit brought by Texas Attorney General Ken Paxton. But it’s one of the few legal tools available to women like Callaway who want to challenge the impacts of the state’s abortion ban.
In the months since her miscarriage, Callaway says she struggles seeing pregnant women without imagining the worst case scenario.
“A lot of women don’t know — I didn’t — that it can go left really quickly,” she said. “And there are so many women where it did go left, and they’re not here to talk to us about this today.”
A hoped-for pregnancy interrupted
The Callaways have always lived an adventurous life. They met in ninth grade literature class in Athens, Georgia, and began dating in college. They’ve lived all over, including stretches in Michigan, New York City and Portugal, and served together in AmeriCorps. Callaway works in marketing, and started her own mushroom soda business on the side. They moved to Texas after their son was born eight years ago.
They’d been wanting to expand their family, and thought it might take time because they were a little older — but almost as soon as they started trying, they had a positive pregnancy test. They were both so ready for another exciting chapter in their lives.
“I immediately called the OB/GYN to let them know and get on the books for my first prenatal visit,” Callaway said. “We had already started to tell my son. We were just really happy. We were so looking forward to bringing this baby into our lives.”
Before her first appointment, when Callaway estimated she was seven weeks pregnant, she began spotting and experiencing pain. At her OB/GYN’s office, a nurse practitioner said she might have an ectopic pregnancy, a nonviable and potentially life-threatening condition in which a fertilized egg implants outside the uterus, according to the complaint.
Callaway began panicking, grief over losing the pregnancy mixed with alarm over the potential consequences to her health. She’d read about Kyleigh Thurman, an Austin-area woman who lost a fallopian tube after doctors delayed treating her ectopic pregnancy, in violation of federal law.
“I hadn’t heard of any good situations from this,” Callaway said. “It sounded like an emergency.”
The nurse ordered bloodwork to assess Callaway’s human chorionic gonadotropin, or hCG, levels. In early pregnancy, hCG, known as the “pregnancy hormone,” typically doubles every 48 to 72 hours. Declining numbers usually indicate a miscarriage.
Callaway was already home when she got the results — her hCG had dropped from 688 mIU/mL to 130 mIU/mL over the last 10 days, the complaint says. By that time, she was bleeding more, the cramping was increasing and she felt lethargic. She called the after-hours nurse, who said her hCG was still too high to offer more significant intervention, like a surgery or medication, according to the complaint.
It was a Friday night, so if her condition worsened, the nurse said she should go to the emergency room, Callaway said.
“I was just totally confused,” Callaway said. “And then things took a turn for the worse.”
Hospital uncertainty
That night, with her husband and son in the car, a shaking, sick Callaway walked into the emergency room at Baylor Scott & White in Round Rock. She told the nurse that she was in pain and bleeding, and based on her declining hCG levels, was having a miscarriage or ectopic pregnancy.
The emergency room physician asked her to consent to an STD test, she said.
“I don’t need an STD test, I’m having a miscarriage,” Callaway remembers thinking. But to expedite the process, she agreed to a painful pelvic exam.
The doctor confirmed her pregnancy was not ectopic, but she was miscarrying. There was no fetal cardiac activity, so Callaway expected to receive medications, likely misoprostol and mifepristone, which is the standard procedure for treating early pregnancy loss. The abortion-inducing drugs help accelerate the body’s passage of the fetal tissue to reduce the risk of infection, retained tissue or other complications.
Instead, she says she was told to go home and wait for the pregnancy to pass. She was told it would be like a bad period, and she could take Tylenol for the pain. The doctor told her everything with her blood work looked fine, according to the complaint. But Callaway said her blood specimen was still in the room, not yet tested.
“So I’m not really believing it,” she said. “I don’t think there was any intention on addressing the issue. It was a passing the buck situation.”
Back at home, the chills and pain increased. She thought about the women who had died from delayed miscarriage care. She was well aware of the disproportionate risk she faced as a Black woman. She started talking with her husband about what they would do if she didn’t survive — how he would raise their son, how he could access the life insurance policy.
He was aghast. He’d always thought he’d be able to protect his wife against anything that came their way, but this wasn’t a bear or a rattlesnake, he said.
“I just felt helpless in a way that I’ve never felt in this relationship, in this marriage,” he said. “It did something to me where I felt like I had to still be present for my son and be level-headed, but then on the inside I’m freaking out.”
He wanted to go out to the car, close the door and scream. Instead, he frantically Googled health care facilities in other states, calling around, looking at flights, even as his wife told him she wasn’t well enough to travel.
Callaway’s bloodwork came back in the morning showing several abnormal metrics, the complaint says. She called the hospital back, where she recalled a nurse telling her that while the labs weren’t normal, her condition was “not necessarily life or limb threatening.” She was told, once again, to follow up with her OB/GYN.
“No one’s here to help me,” Callaway remembers thinking. “I just felt like I was on my own, and that these people didn’t care. And if the hospital isn’t going to treat you, what are you going to do?”
A nurse Callaway knew through her cousin reviewed her records and advised her on how to know if she was hemorrhaging or if the infection was worsening. On Sunday, she decided to try another hospital. At St. David’s Round Rock, a physician assistant determined her hCG was now 50 mIU/mL and she had developed an infection, the complaint says. She was given pain meds and antibiotics, but the physician assistant said the emergency room didn’t offer mifepristone and misoprostol, or surgical treatments for miscarriages, according to the complaint.
The next day, she finally got in to see her OB/GYN, who Callaway said was immediately concerned by the signs of infection and blood loss. The doctor found retained fetal tissue, which can lead to infection, and offered her the treatment she’d been denied all weekend — abortion-inducing medication to pass the pregnancy.
“She made the right call,” Callaway said. “I just wish the call was made sooner.”
Life of the mother
When the U.S. Supreme Court overturned Roe v. Wade in 2022, Texas banned all abortions from the moment of conception, except to save the life of the pregnant patient. Doctors who perform prohibited abortions can face up to life in prison, as well as tens of thousands of dollars in fines and the loss of their medical license.
Doctors warned that the strict penalties, and the unpredictable nature of pregnancy, would inevitably incentivize healthcare providers to hesitate before they provided medically necessary miscarriage care. Almost immediately, their predictions came true. Dozens of women came forward with stories of medical care delayed or denied by doctors, nurses and hospital administrators who wanted to wait until they were “damned sure” the law allowed them to intervene, as Callaway said her doctor put it.
Many of these women sued, seeking to overturn the law or widen the medical exemption. The lawsuits failed to amend the law. But after ProPublica revealed that at least four Texas women had died due to delayed treatment, lawmakers agreed to take a second look at the restrictions.
Senate Bill 31, known as the Life of the Mother Act, passed with overwhelming support in both chambers last session and was signed by Gov. Greg Abbott, who said at the time that it would “protect both mothers and babies while giving medical professionals the legal security and clinical clarity they desire.”
The law says a medical crisis need not be “imminent” before healthcare providers can act, and that a doctor can only be charged if the state can prove “no reasonable doctor” would have made the same call. It also required the Texas Medical Board to create training for doctors who perform obstetrics care.
That training, finalized in early 2026, lays out a hypothetical scenario in which a woman is experiencing early pregnancy loss. The training materials ask whether managing a miscarriage counts as an abortion and must be reported to the state.
“NO. Management of first-trimester incomplete early pregnancy loss is not an abortion under Texas law,” the slide says, before noting that it is legal to provide both misoprostol and mifepristone in a case like this.
Molly Duane, Callaway’s attorney through Amplify Legal, said she’s not surprised that women are still coming forward with these stories, even after the clarifying law went into effect.
“People don’t walk into emergency rooms with signs on their forehead saying this is a miscarriage, this is an ectopic pregnancy,” she said. “Pregnancy is complicated and that’s why abortion bans cannot and do not work, because once you ban one type of care, you effectively ban everything.”
Legal avenues
Callaway filed a complaint Monday against the hospitals under EMTALA, the Emergency Medical Treatment and Labor Act. This 40-year-old federal law, born out of a Texas statute designed to stop patient dumping, says emergency rooms must stabilize anyone who shows up.
Before the overturn of Roe v. Wade, courts long held that abortion can be a necessary stabilizing treatment for a pregnant woman having a medical emergency. When Texas and other states banned the procedure, the Biden administration issued guidance saying EMTALA overrode state abortion bans.
Texas Attorney General Ken Paxton sued, saying Biden was trying to “transform every emergency room in the country into a walk-in abortion clinic.” A district court and the 5th U.S. Circuit Court of Appeals agreed, putting the guidance on ice for Texans. The Biden administration appealed to the U.S. Supreme Court, which declined to hear the case.
When President Donald Trump took office last year, he revoked the guidance nationwide. Centers for Medicare and Medicaid Services administrator Mehmet Oz said in a statement that “women will receive care for miscarriage, ectopic pregnancy, and medical emergencies in all fifty states — this has not and will never change in the Trump Administration.”
Some patients in abortion ban states have found accountability through the law. Last year, federal investigators concluded that Ascension Seton, in the Austin area, violated EMTALA when it denied Thurman treatment for her ectopic pregnancy. She ultimately lost a fallopian tube.
While Thurman’s case was resolved quickly, Duane said others are being slow-rolled. She said CMS officials told her that Texas cases are being reviewed by the Department of Justice to ensure they comply with the 5th Circuit’s order in Paxton’s case, delaying final adjudication for an “interminable” period. CMS did not respond to a request for comment.
“The law is still there and you don’t get things you don’t ask for, so we’re going to continue to push for EMTALA to be enforced in Texas,” Duane said. “But I think people should be really concerned about … how the behavior of politicians in the state of Texas is impeding investigations into substandard care.”
Callaway also filed complaints with the Texas Medical Board and Texas Board of Nursing, asking for investigations into the doctors and nurse practitioners who did not provide her with medications or surgical options. The medical board recently sanctioned three doctors for delaying miscarriage care, resulting in the death of two women.
Duane, who has litigated on behalf of doctors, said she is sympathetic to the predicament facing healthcare providers because of the law. But patients should not be silent when their needs are being pushed aside due to fear, she said.
“What I will not accept is that patient care has just drastically changed, and that this is a new normal,” she said. “It’s not normal. It’s not normal to send someone home in significant pain and bleeding with instructions to take over the counter Tylenol.”
Months after that traumatizing weekend, Callaway saw firsthand how different care can be elsewhere.
While on a family trip in the Portuguese countryside, she suddenly started bleeding heavily, soaking through her clothes and the rental car seat. Mario rushed them to a hospital, where she navigated a language barrier to explain that she’d recently had a miscarriage. She was ushered into the dedicated obstetrics emergency room, where the doctor immediately took her seriously. They discovered more retained fetal tissue that her doctors in the U.S. had missed.
“I just remember the bedside manner of the doctor there. I just immediately felt like everything was going to be okay,” she said. “When I explained to her what I had already gone through, it was confusing to her that anyone would wait or have you go to a specialist. My understanding was that common sense trumped everything in this setting.”
Since returning to Texas, Callaway had to leave her marketing job, where she worked with both hospitals. Mario has gone to counseling, and they had to help their son through a period where he was unusually withdrawn and sad.
Callaway hopes to still expand their family one day, but knowing what she knows now, it’s hard to imagine feeling safe enough to do so.
“It wasn’t just grieving the loss of a pregnancy, but grieving a system you thought would protect you,” she said.
Disclosure: Ascension/Seton and Baylor Scott & White Health have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.