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Hope and Porsha Ngumezi pose together in a family photo. Credit: Danielle
Villasana for ProPublica
Health Care

A THIRD WOMAN DIED UNDER TEXAS’ ABORTION BAN. DOCTORS ARE AVOIDING D&CS AND
REACHING FOR RISKIER MISCARRIAGE TREATMENTS.

THIRTY-FIVE-YEAR-OLD PORSHA NGUMEZI’S CASE RAISES QUESTIONS ABOUT HOW ABORTION
BANS ARE PRESSURING DOCTORS TO AVOID STANDARD CARE EVEN IN STRAIGHTFORWARD
MISCARRIAGES.

by Lizzie Presser and Kavitha Surana Nov. 25, 6 a.m. EST
Share
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Republish

SERIES: LIFE OF THE MOTHER: HOW ABORTION BANS LEAD TO PREVENTABLE DEATHS

More in this series
Caret

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to
receive our biggest stories as soon as they’re published.

Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11
weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

Over the course of six hours on June 11, 2023, Porsha Ngumezi had bled so much
in the emergency department at Houston Methodist Sugar Land that she’d needed
two transfusions. She was anxious to get home to her young sons, but, according
to a nurse’s notes, she was still “passing large clots the size of grapefruit.”

Hope dialed his mother, a former physician, who was unequivocal. “You need a
D&C,” she told them, referring to dilation and curettage, a common procedure for
first-trimester miscarriages and abortions. If a doctor could remove the
remaining tissue from her uterus, the bleeding would end.

But when Dr. Andrew Ryan Davis, the obstetrician on duty, finally arrived, he
said it was the hospital’s “routine” to give a drug called misoprostol to help
the body pass the tissue, Hope recalled. Hope trusted the doctor. Porsha took
the pills, according to records, and the bleeding continued.

Three hours later, her heart stopped.

The 35-year-old’s death was preventable, according to more than a dozen doctors
who reviewed a detailed summary of her case for ProPublica. Some said it raises
serious questions about how abortion bans are pressuring doctors to diverge from
the standard of care and reach for less-effective options that could expose
their patients to more risks. Doctors and patients described similar decisions
they’ve witnessed across the state.

It was clear Porsha needed an emergency D&C, the medical experts said. She was
hemorrhaging and the doctors knew she had a blood-clotting disorder, which put
her at greater danger of excessive and prolonged bleeding. “Misoprostol at 11
weeks is not going to work fast enough,” said Dr. Amber Truehart, an OB-GYN at
the University of New Mexico Center for Reproductive Health. “The patient will
continue to bleed and have a higher risk of going into hemorrhagic shock.” The
medical examiner found the cause of death to be hemorrhage.

D&Cs — a staple of maternal health care — can be lifesaving. Doctors insert a
straw-like tube into the uterus and gently suction out any remaining pregnancy
tissue. Once the uterus is emptied, it can close, usually stopping the bleeding.

But because D&Cs are also used to end pregnancies, the procedure has become
tangled up in state legislation that restricts abortions. In Texas, any doctor
who violates the strict law risks up to 99 years in prison. Porsha’s is the
fifth case ProPublica has reported in which women died after they did not
receive a D&C or its second-trimester equivalent, a dilation and evacuation;
three of those deaths were in Texas.

ProPublica condensed 200 pages of medical records into a summary of the case in
consultation with two maternal-fetal medicine specialists and then reviewed it
with more than a dozen experts around the country, including researchers at
prestigious universities, OB-GYNs who regularly handle miscarriages, and experts
in maternal health.

Texas doctors told ProPublica the law has changed the way their colleagues see
the procedure; some no longer consider it a first-line treatment, fearing legal
repercussions or dissuaded by the extra legwork required to document the
miscarriage and get hospital approval to carry out a D&C. This has occurred,
ProPublica found, even in cases like Porsha’s where there isn’t a fetal
heartbeat or the circumstances should fall under an exception in the law. Some
doctors are transferring those patients to other hospitals, which delays their
care, or they’re defaulting to treatments that aren’t the medical standard.

Misoprostol, the medicine given to Porsha, is an effective method to complete
low-risk miscarriages but is not recommended when a patient is unstable. The
drug is also part of a two-pill regimen for abortions, yet administering it may
draw less scrutiny than a D&C because it requires a smaller medical team and
because the drug is commonly used to induce labor and treat postpartum
hemorrhage. Since 2022, some Texas women who were bleeding heavily while
miscarrying have gone public about only receiving medication when they asked for
D&Cs. One later passed out in a pool of her own blood.

“Stigma and fear are there for D&Cs in a way that they are not for misoprostol,”
said Dr. Alison Goulding, an OB-GYN in Houston. “Doctors assume that a D&C is
not standard in Texas anymore, even in cases where it should be recommended.
People are afraid: They see D&C as abortion and abortion as illegal.”

Hope visits his wife’s gravesite in Pearland, Texas. Credit: Danielle Villasana
for ProPublica

Doctors and nurses involved in Porsha’s care did not respond to multiple
requests for comment.

Several physicians who reviewed the summary of her case pointed out that Davis’
post-mortem notes did not reflect nurses’ documented concerns about Porsha’s
“heavy bleeding.” After Porsha died, Davis wrote instead that the nurses and
other providers described the bleeding as “minimal,” though no nurses wrote this
in the records. ProPublica tried to ask Davis about this discrepancy. He did not
respond to emails, texts or calls.

Houston Methodist officials declined to answer a detailed list of questions
about Porsha’s treatment. They did not comment when asked whether Davis’
approach was the hospital’s “routine.” A spokesperson said that “each patient’s
care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson added,
“including the abortion law in place in Texas.”

“WE NEED TO SEE THE DOCTOR”

Hope and his two sons outside their home in Houston Credit: Danielle Villasana
for ProPublica

Hope marveled at the energy Porsha had for their two sons, ages 5 and 3.
Whenever she wasn’t working, she was chasing them through the house or dancing
with them in the living room. As a finance manager at a charter school system,
she was in charge of the household budget. As an engineer for an airline, Hope
took them on flights around the world — to Chile, Bali, Guam, Singapore,
Argentina.

The two had met at Lamar University in Beaumont, Texas. “When Porsha and I began
dating,” Hope said, “I already knew I was going to love her.” She was magnetic
and driven, going on to earn an MBA, but she was also gentle with him, always
protecting his feelings. Both were raised in big families and they wanted to
build one of their own.

When he learned Porsha was pregnant again in the spring of 2023, Hope wished for
a girl. Porsha found a new OB-GYN who said she could see her after 11 weeks. Ten
weeks in, though, Porsha noticed she was spotting. Over the phone, the
obstetrician told her to go to the emergency room if it got worse.

To celebrate the end of the school year, Porsha and Hope took their boys to a
water park in Austin, and as they headed back, on June 11, Porsha told Hope that
the bleeding was heavier. They decided Hope would stay with the boys at home
until a relative could take over; Porsha would drive to the emergency room at
Houston Methodist Sugar Land, one of seven community hospitals that are part of
the Houston Methodist system.

At 6:30 p.m, three hours after Porsha arrived at the hospital, she saw huge
clots in the toilet. “Significant bleeding,” the emergency physician wrote. “I’m
starting to feel a lot of pain,” Porsha texted Hope. Around 7:30 p.m., she
wrote: “She said I might need surgery if I don’t stop bleeding,” referring to
the nurse. At 7:50 p.m., after a nurse changed her second diaper in an hour:
“Come now.”

Still, the doctor didn’t mention a D&C at this point, records show. Medical
experts told ProPublica that this wait-and-see approach has become more common
under abortion bans. Unless there is “overt information indicating that the
patient is at significant risk,” hospital administrators have told physicians to
simply monitor them, said Dr. Robert Carpenter, a maternal-fetal medicine
specialist who works in several hospital systems in Houston. Methodist declined
to share its miscarriage protocols with ProPublica or explain how it is guiding
doctors under the abortion ban.

As Porsha waited for Hope, a radiologist completed an ultrasound and noted that
she had “a pregnancy of unknown location.” The scan detected a “sac-like
structure” but no fetus or cardiac activity. This report, combined with her
symptoms, indicated she was miscarrying.

But the ultrasound record alone was less definitive from a legal perspective,
several doctors explained to ProPublica. Since Porsha had not had a prenatal
visit, there was no documentation to prove she was 11 weeks along. On paper,
this “pregnancy of unknown location” diagnosis could also suggest that she was
only a few weeks into a normally developing pregnancy, when cardiac activity
wouldn’t be detected. Texas outlaws abortion from the moment of fertilization; a
record showing there is no cardiac activity isn’t enough to give physicians
cover to intervene, experts said.

Dr. Gabrielle Taper, who recently worked as an OB-GYN resident in Austin, said
that she regularly witnessed delays after ultrasound reports like these. “If
it’s a pregnancy of unknown location, if we do something to manage it, is that
considered an abortion or not?” she said, adding that this was one of the key
problems she encountered. After the abortion ban went into effect, she said,
“there was much more hesitation about: When can we intervene, do we have enough
evidence to say this is a miscarriage, how long are we going to wait, what will
we use to feel definitive?”

At Methodist, the emergency room doctor reached Davis, the on-call OB-GYN, to
discuss the ultrasound, according to records. They agreed on a plan of
“observation in the hospital to monitor bleeding.”

A sonogram of Porsha’s firstborn on the fridge in the family home. She was
excited to have a third child. Credit: Danielle Villasana for ProPublica

Around 8:30 p.m., just after Hope arrived, Porsha passed out. Terrified, he took
her head in his hands and tried to bring her back to consciousness. “Babe, look
at me,” he told her. “Focus.” Her blood pressure was dipping dangerously low.
She had held off on accepting a blood transfusion until he got there. Now, as
she came to, she agreed to receive one and then another.

By this point, it was clear that she needed a D&C, more than a dozen OB-GYNs who
reviewed her case told ProPublica. She was hemorrhaging, and the standard of
care is to vacuum out the residual tissue so the uterus can clamp down,
physicians told ProPublica.

“Complete the miscarriage and the bleeding will stop,” said Dr. Lauren Thaxton,
an OB-GYN who recently left Texas.

“At every point, it’s kind of shocking,” said Dr. Daniel Grossman, a professor
of obstetrics and gynecology at the University of California, San Francisco who
reviewed Porsha’s case. “She is having significant blood loss and the physician
didn’t move toward aspiration.”

All Porsha talked about was her devastation of losing the pregnancy. She was
cold, crying and in extreme pain. She wanted to be at home with her boys. Unsure
what to say, Hope leaned his chest over the cot, passing his body heat to her.

At 9:45 p.m., Esmeralda Acosta, a nurse, wrote that Porsha was “continuing to
pass large clots the size of grapefruit.” Fifteen minutes later, when the nurse
learned Davis planned to send Porsha to a floor with fewer nurses, she “voiced
concern” that he wanted to take her out of the emergency room, given her
condition, according to medical records.

At 10:20 p.m., seven hours after Porsha arrived, Davis came to see her. Hope
remembered what his mother had told him on the phone earlier that night: “She
needs a D&C.” The doctor seemed confident about a different approach:
misoprostol. If that didn’t work, Hope remembers him saying, they would move on
to the procedure.

A pill sounded good to Porsha because the idea of surgery scared her. Davis did
not explain that a D&C involved no incisions, just suction, according to Hope,
or tell them that it would stop the bleeding faster. The Ngumezis followed his
recommendation without question. “I’m thinking, ‘He’s the OB, he’s probably seen
this a thousand times, he probably knows what’s right,’” Hope said.

But more than a dozen doctors who reviewed Porsha’s case were concerned by this
recommendation. Many said it was dangerous to give misoprostol to a woman who’s
bleeding heavily, especially one with a blood clotting disorder. “That’s not
what you do,” said Dr. Elliott Main, the former medical director for the
California Maternal Quality Care Collaborative and an expert in hemorrhage,
after reviewing the case. “She needed to go to the operating room.” Main and
others said doctors are obliged to counsel patients on the risks and benefits of
all their options, including a D&C.

Performing a D&C, though, attracts more attention from colleagues, creating a
higher barrier in a state where abortion is illegal, explained Goulding, the
OB-GYN in Houston. Staff are familiar with misoprostol because it’s used for
labor, and it only requires a doctor and a nurse to administer it. To do a
procedure, on the other hand, a doctor would need to find an operating room, an
anesthesiologist and a nursing team. “You have to convince everyone that it is
legal and won’t put them at risk,” said Goulding. “Many people may be afraid and
misinformed and refuse to participate — even if it’s for a miscarriage.”

Davis moved Porsha to a less-intensive unit, according to records. Hope wondered
why they were leaving the emergency room if the nurse seemed so worried. But
instead of pushing back, he rubbed Porsha’s arms, trying to comfort her. The
hospital was reputable. “Since we were at Methodist, I felt I could trust the
doctors.”

On their way to the other ward, Porsha complained of chest pain. She kept
remarking on it when they got to the new room. From this point forward, there
are no nurse’s notes recording how much she continued to bleed. “My wife says
she doesn’t feel right, and last time she said that, she passed out,” Hope told
a nurse. Furious, he tried to hold it together so as not to alarm Porsha. “We
need to see the doctor,” he insisted.

Her vital signs looked fine. But many physicians told ProPublica that when
healthy pregnant patients are hemorrhaging, their bodies can compensate for a
long time, until they crash. Any sign of distress, such as chest pain, could be
a red flag; the symptom warranted investigation with tests, like an
electrocardiogram or X-ray, experts said. To them, Porsha’s case underscored how
important it is that doctors be able to intervene before there are signs of a
life-threatening emergency.

But Davis didn’t order any tests, according to records.

Around 1:30 a.m., Hope was sitting by Porsha’s bed, his hands on her chest,
telling her, “We are going to figure this out.” They were talking about what she
might like for breakfast when she began gasping for air.

“Help, I need help!” he shouted to the nurses through the intercom. “She can’t
breathe.”

“ALL SHE NEEDED”

Hope with his son Credit: Danielle Villasana for ProPublica

Hours later, Hope returned home in a daze. “Is mommy still at the hospital?” one
of his sons asked. Hope nodded; he couldn’t find the words to tell the boys
they’d lost their mother. He dressed them and drove them to school, like the
previous day had been a bad dream. He reached for his phone to call Porsha, as
he did every morning that he dropped the kids off. But then he remembered that
he couldn’t.

Friends kept reaching out. Most of his family’s network worked in medicine, and
after they said how sorry they were, one after another repeated the same
message. All she needed was a D&C, said one. They shouldn’t have given her that
medication, said another. It’s a simple procedure, the callers continued. We do
this all the time in Nigeria.

Since Porsha died, several families in Texas have spoken publicly about similar
circumstances. This May, when Ryan Hamilton’s wife was bleeding while
miscarrying at 13 weeks, the first doctor they saw at Surepoint Emergency Center
Stephenville noted no fetal cardiac activity and ordered misoprostol, according
to medical records. When they returned because the bleeding got worse, an
emergency doctor on call, Kyle Demler, said he couldn’t do anything considering
“the current stance” in Texas, according to Hamilton, who recorded his
recollection of the conversation shortly after speaking with Demler. (Neither
Surepoint Emergency Center Stephenville nor Demler responded to several requests
for comment.)

They drove an hour to another hospital asking for a D&C to stop the bleeding,
but there, too, the physician would only prescribe misoprostol, medical records
indicate. Back home, Hamilton’s wife continued bleeding until he found her
passed out on the bathroom floor. “You don’t think it can really happen like
that,” said Hamilton. “It feels like you’re living in some sort of movie, it’s
so unbelievable.”

Across Texas, physicians say they blame the law for interfering with medical
care. After ProPublica reported last month on two women who died after delays in
miscarriage care, 111 OB-GYNs sent a letter to Texas policymakers, saying that
“the law does not allow Texas women to get the lifesaving care they need.”

ProPublica

A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas
Emergency Rooms

A Woman Died After Being Told It Would Be a “Crime” to Intervene in Her
Miscarriage at a Texas Hospital

Dr. Austin Dennard, an OB-GYN in Dallas, told ProPublica that if one person on a
medical team doubts the doctor’s choice to proceed with a D&C, the physician
might back down. “You constantly feel like you have someone looking over your
shoulder in a punitive, vigilante type of way.”

The criminal penalties are so chilling that even women with diagnoses included
in the law’s exceptions are facing delays and denials. Last year, for example,
legislators added an update to the ban for patients diagnosed with previable
premature rupture of membranes, in which a patient’s water breaks before a fetus
can survive. Doctors can still face prosecution for providing abortions in those
cases, but they are offered the chance to justify themselves with what’s called
an “affirmative defense,” not unlike a murder suspect arguing self defense. This
modest change has not stopped some doctors from transferring those patients
instead of treating them; Dr. Allison Gilbert, an OB-GYN in Dallas, said doctors
send them to her from other hospitals. “They didn’t feel like other staff
members would be comfortable proceeding with the abortion,” she said. “It’s
frustrating that places still feel like they can’t act on some of these cases
that are clearly emergencies.” Women denied treatment for ectopic pregnancies,
another exception in the law, have filed federal complaints.

In response to ProPublica’s questions about Houston Methodist’s guidance on
miscarriage management, a spokesperson, Gale Smith, said that the hospital has
an ethics committee, which can usually respond within hours to help physicians
and patients make “appropriate decisions” in compliance with state laws.

After Porsha died, Davis described in the medical record a patient who looked
stable: He was tracking her vital signs, her bleeding was “mild” and she was
“said not to be in distress.” He ordered bloodwork “to ensure patient wasn’t
having concerning bleeding.” Medical experts who reviewed Porsha’s case couldn’t
understand why Davis noted that a nurse and other providers reported “decreasing
bleeding” in the emergency department when the record indicated otherwise. “He
doesn’t document the heavy bleeding that the nurse clearly documented, including
the significant bleeding that prompted the blood transfusion, which is
surprising,” Grossman, the UCSF professor, said.

Patients who are miscarrying still don’t know what to expect from Houston
Methodist.

This past May, Marlena Stell, a patient with symptoms nearly identical to
Porsha’s, arrived at another hospital in the system, Houston Methodist The
Woodlands. According to medical records, she, too, was 11 weeks along and
bleeding heavily. An ultrasound confirmed there was no fetal heartbeat and
indicated the miscarriage wasn’t complete. “I assumed they would do whatever to
get the bleeding to stop,” Stell said.

Instead, she bled for hours at the hospital. She wanted a D&C to clear out the
rest of the tissue, but the doctor gave her methergine, a medication that’s
typically used after childbirth to stop bleeding but that isn’t standard care in
the middle of a miscarriage, doctors told ProPublica. "She had heavy bleeding,
and she had an ultrasound that's consistent with retained products of
conception." said Dr. Jodi Abbott, an associate professor of obstetrics and
gynecology at Boston University School of Medicine, who reviewed the records.
"The standard of care would be a D&C."

Stell says that instead, she was sent home and told to “let the miscarriage take
its course.” She completed her miscarriage later that night, but doctors who
reviewed her case, so similar to Porsha’s, said it showed how much of a gamble
physicians take when they don’t follow the standard of care. “She got lucky —
she could have died,” Abbott said. (Houston Methodist did not respond to a
request for comment on Stell’s care.)

It hadn’t occurred to Hope that the laws governing abortion could have any
effect on his wife’s miscarriage. Now it’s the only explanation that makes sense
to him. “We all know pregnancies can come out beautifully or horribly,” Hope
told ProPublica. “Instead of putting laws in place to make pregnancies safer, we
created laws that put them back in danger.”

For months, Hope’s youngest son didn’t understand that his mom was gone.
Porsha’s long hair had been braided, and anytime the toddler saw a woman with
braids from afar, he would take off after her, shouting, “That’s mommy!”

A couple weeks ago, Hope flew to Amsterdam to quiet his mind. It was his first
trip without Porsha, but as he walked the city, he didn’t know how to experience
it without her. He kept thinking about how she would love the Christmas lights
and want to try all the pastries. How she would have teased him when he fell
asleep on a boat tour of the canals. “I thought getting away would help,” he
wrote in his journal. “But all I’ve done is imagine her beside me.”

First image: Hope now wears his and Porsha’s wedding rings around his neck.
Second image: Porsha’s son plays with cards capturing memories of his mother.
Credit: Danielle Villasana for ProPublica

Mariam Elba and Lexi Churchill contributed research.

Filed under —

* Health Care
* Abortion

Lizzie Presser

Lizzie Presser covers health, inequality and how policy is experienced for
ProPublica.

* Mail Lizzie.Presser@propublica.org

Kavitha Surana

Kavitha Surana is a reporter at ProPublica.

* Mail Kavitha.Surana@propublica.org

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