An expectant teenager passed away after seeking help at three different emergency rooms in Texas.

Candace Fails desperately cried out for assistance from hospital staff for her pregnant daughter. 'Please, help her,' she begged on the morning of October 29, 2023.

Nevaeh Crain was writhing in agony, too frail to stand, blood soaking her legs. She was running a fever and vomiting on the day of her baby shower. Within 12 hours, the 18-year-old had visited two different emergency rooms, only to return home each time feeling more ill than before.

At the first hospital, doctors misdiagnosed her with strep throat, failing to investigate the cause of her severe abdominal pain. At the second, while medical records show she tested positive for sepsis, a deadly infection response, doctors reassured her that her unborn baby’s heartbeat was strong and sent her home, claiming she was fine.

On Crain's third visit to the hospital, an obstetrician ordered two ultrasounds to 'confirm fetal demise,' according to a nurse's report, before transferring her to intensive care.

By the time she arrived at the hospital, over two hours had passed. Crain’s blood pressure had dropped significantly, and a nurse noted her lips were 'blue and dusky.' Her organs were starting to fail.

A few hours later, Crain passed away.

Fails, who had hoped to celebrate her daughter's 20th birthday this Friday, is still struggling to understand why Crain’s condition wasn’t treated as an urgent medical emergency.

Doctors and lawyers have told ProPublica that many pregnant women in states with strict abortion bans are now facing similar life-threatening challenges.

'Pregnant women have essentially become untouchable,' said Sara Rosenbaum, a professor emerita of health law and policy at George Washington University.

Texas' abortion law threatens imprisonment for any intervention that ends a fetal heartbeat, regardless of whether the pregnancy is wanted. While it includes exceptions for life-threatening conditions, doctors told ProPublica that the fear and uncertainty surrounding potential legal consequences are influencing how their peers approach pregnant patients with complications.

In states with abortion bans, patients are sometimes passed between hospitals like 'hot potatoes,' with healthcare providers wary of being involved in treatments that could lead to criminal charges, according to doctors. Some medical teams are spending crucial time arguing over legal details and creating documentation, preparing for the possibility that their decisions might eventually be scrutinized by a jury or judge.

Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University, noted that patients are left wondering: 'Am I being sent home because I am truly fine? Or is it because they fear that the treatment I need would involve ending my pregnancy, which they are not allowed to do?'

There is a federal law that prohibits emergency room doctors from withholding lifesaving care.

Passed almost 40 years ago, this law mandates that emergency rooms must stabilize patients in medical emergencies. The Biden administration asserts that this requirement applies even when an abortion may be needed.

Texas has been the most aggressive in challenging this interpretation, warning doctors that its abortion ban takes precedence over federal guidance, with the threat of up to 99 years in prison for those who violate it.

ProPublica distilled over 800 pages of Crain’s medical records into a concise four-page timeline, working with two maternal-fetal medicine experts. Reporters then reviewed the timeline with nine doctors, including researchers from top universities, OB-GYNs specializing in miscarriages, and experts in emergency medicine and maternal health.

Some experts pointed out that the first ER failed to recognize early signs of infection that required attention. All agreed that the doctor at the second hospital should not have discharged Crain without addressing her worsening sepsis. When Crain returned for a third visit, all experts concurred that there was no justification for waiting on two ultrasounds before taking swift action to save her life.

'This is how these restrictions endanger women,' said Dr. Dara Kass, a former regional director at the Department of Health and Human Services and an emergency room doctor in New York. 'It’s never just one decision, one doctor, or one nurse.'

While the experts reviewing Crain’s medical records couldn't definitively say her death was preventable, they suggested that early hospitalization for close monitoring and ongoing treatment might have saved both her and her fetus.

They believed there was a possibility Crain could have carried the pregnancy longer. If an early delivery had been necessary, the hospital was equipped to care for a baby on the brink of viability. Alternatively, if the infection had progressed too far, terminating the pregnancy could have been the only option to save her life.

The doctors involved in Crain’s treatment did not respond to multiple requests for comment. Both Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth declined to answer specific questions about her care.

Fails and Crain held the belief that abortion was morally wrong. The teenager would only have considered it in cases of rape or life-threatening illness, she told her mother. They didn't concern themselves with whether the government banned abortion, focusing instead on how their Christian faith shaped their personal decisions.

When they found out Crain was expecting a baby girl, the two spent countless hours imagining the little dresses they could buy and speculating on what kind of mother she would become. Crain decided on the name Lillian. Fails eagerly anticipated meeting her.

But when her daughter fell ill, Fails believed doctors had a duty to do everything they could to prevent a life-threatening situation, even if it meant losing Lillian. In her eyes, the doctors seemed more focused on monitoring the fetal heartbeat than on caring for Crain.

'I know it sounds selfish, and God knows I would have wanted both of them to survive, but if I had to choose,' Fails said, 'I would have chosen my daughter.'

'I’m in a lot of pain,' Crain said.

Crain had just graduated from high school in her hometown of Vidor, Texas, in May 2023, when she found out she was pregnant.

She and her boyfriend of two years, Randall Broussard, were inseparable, often playfully fighting over vapes or cuddling on the couch watching vampire movies. Crain was captivated by his gentleness, while he admired her ability to make friends effortlessly and her knack for making people laugh. Although they were young, they had already dreamed of starting a family. Broussard, who came from a large family with eight siblings, wanted many children. Crain, on the other hand, hoped for a daughter and the close bond she had with her own mother. Earlier that year, Broussard gave Crain a small diamond ring — a 'promise,' he told her, 'that I will always love you.'

On the morning of their baby shower, October 28, 2023, Crain woke up with a headache. Her mom had decorated the house with pink balloons, and Crain set out Halloween-themed platters. Soon, nausea overtook her, and she began vomiting and running a fever. As guests arrived, Broussard opened gifts — onesies, diapers, and bows — while Crain kept drifting in and out of sleep, her eyes closing.

Around 3 p.m., her family insisted she needed to go to the hospital.

Broussard drove Crain to Baptist Hospitals of Southeast Texas, where they waited in the emergency room for four hours. During that time, Crain began vomiting, and the staff gave her a plastic pan. When she wasn’t vomiting, she rested her head on her boyfriend's lap.

A nurse practitioner ordered a strep test, which came back positive. However, physicians told ProPublica that in pregnant patients, abdominal pain and vomiting should not be immediately linked to strep throat without further investigation, and the pregnancy should have also been assessed.

Instead, Baptist Hospitals discharged her with a prescription for antibiotics. Crain returned home by 9 p.m. and quickly fell asleep. But a few hours later, she woke her mother in the middle of the night. 'Mom, my stomach still hurts,' she said from the dark bedroom at 3 a.m. 'I’m in a lot of pain.'

Fails drove Crain and Broussard to another hospital, Christus Southeast Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins noted Crain had a fever of 102.8 and an elevated pulse, according to medical records. A nurse also recorded that Crain rated her abdominal pain as seven out of ten.

Her vital signs suggested the possibility of sepsis, according to medical records. Experts told ProPublica that when a patient shows signs of sepsis, immediate treatment is crucial, as it can rapidly lead to death. These patients must be closely monitored until their condition stabilizes. Tests and scans are used to identify the infection's source, and if it’s in the uterus, surgery may be required to remove the fetus.

In the obstetric emergency room, a nurse attached a sensor belt around Crain’s abdomen to monitor the fetal heart rate. 'The baby’s fine,' Broussard reassured Fails, who was waiting outside in the hallway.

After two hours of IV fluids, a dose of antibiotics, and some Tylenol, Crain’s fever persisted, her pulse remained elevated, and the fetal heart rate was unusually rapid, according to medical records. Despite this, Hawkins diagnosed her with strep throat and a urinary tract infection, prescribed medication, and sent her home.

Hawkins had a history of missed diagnoses. Eight years earlier, the Texas Medical Board found that he had failed to identify appendicitis in one patient and syphilis in another. In the latter case, the board noted that his oversight 'may have contributed to the fetal demise of one of her twins.' The board placed Hawkins under supervision for two years, though the monitoring order was later lifted. (Hawkins did not respond to multiple attempts for comment.)

Every doctor who reviewed Crain’s vital signs for ProPublica agreed she should have been admitted to the hospital. 'She should have never been sent home,' said Elise Boos, an OB-GYN from Tennessee.

Kass, the emergency physician from New York, described it more bluntly: by discharging her, they were 'pushing her down the path of no return.'

'This is bullshit,' Fails said as Broussard wheeled Crain out of the hospital; she was too weak to walk on her own. Fails had assumed they would keep her daughter overnight. Crain was breathing heavily, hunched in pain, her face pale. Usually chatty, the teen was eerily quiet.

Back home around 7 a.m., Fails tried to make her daughter as comfortable as possible as Crain cried out in pain. When Crain said she needed to use the bathroom, Fails helped her to the toilet. 'Mom, come here,' Crain called from the bathroom, blood staining her underwear.

The blood confirmed what Fails had feared: her daughter was experiencing a miscarriage.

At 9 a.m., a full day after the nausea started, they returned to Christus St. Elizabeth. Crain's lips were pale, and she kept insisting she was about to faint. The staff began administering IV antibiotics and performed an ultrasound at her bedside.

Around 9:30 a.m., Dr. Marcelo Totorica, the OB-GYN on duty, could not detect a fetal heartbeat, according to the records. He expressed his condolences to the family, saying he was sorry for their loss.

Medical protocol dictates that critically ill patients who miscarry should be stabilized and, in many cases, rushed to surgery for delivery, particularly in the case of a spreading infection. However, at Christus St. Elizabeth, the OB-GYN opted to continue with antibiotic treatment. About 30 minutes later, as nurses inserted a catheter, Fails noticed blood covering her daughter's thighs.

At 10 a.m., Melissa McIntosh, a nurse specializing in labor and delivery, discussed Crain’s condition with Dr. Totorica. By then, Crain was experiencing contractions. 'Dr. Totorica says not to move the patient,' McIntosh wrote after their conversation. 'He mentions there’s a small chance Crain may need ICU care, and insists on another bedside ultrasound before transferring her to a room.'

Although Dr. Totorica had already performed an ultrasound, he requested another one.

The first ultrasound had not saved an image of Crain’s uterus in the medical record. 'Bedside ultrasounds aren’t always equipped to save permanent images,' explained Dr. Abbott, the Boston-based OB-GYN.

Under Texas’s abortion laws, doctors must document the absence of a fetal heartbeat before performing any procedure that could end a pregnancy. In emergencies, doctors are required to justify their decisions in writing. 'Doctors are often caught in a dilemma,' said Dr. Tony Ogburn, an OB-GYN in San Antonio. 'Until we can be absolutely sure this isn’t a normal pregnancy, we can’t act, because there’s a fear of being accused of performing an abortion.'

By 10:40 a.m., Crain’s blood pressure began to fall. Moments later, Dr. Totorica was paging for an emergency response team over the hospital loudspeakers.

Around 11 a.m., two hours after Crain's arrival at the hospital, a second ultrasound was conducted. A nurse recorded: 'Bedside ultrasound at this time to confirm fetal demise, as ordered by Dr. Totorica.'

At 11:20 a.m., doctors moved Crain into the ICU, with Fails remaining by her side, gently rubbing her head as her daughter drifted in and out of consciousness. Crain was unable to sign consent forms for her care due to 'extreme pain,' so Fails signed the release for an 'unplanned dilation and curettage' or 'unplanned cesarean section,' according to the records.

However, the medical team quickly determined that operating had become too dangerous. They suspected Crain had developed disseminated intravascular coagulation, a severe complication of sepsis, which meant she was internally bleeding.

Desperate and in tears, Fails locked eyes with her daughter. 'You’re strong, Nevaeh,' she said. 'God made us strong.'

Crain sat upright in the bed, and black, congealed blood poured from her nostrils and mouth.

'The law is on their side.'

Crain is one of at least two pregnant women in Texas who tragically died after doctors delayed treating their miscarriages, according to ProPublica’s findings.

Texas Attorney General Ken Paxton has successfully made his state the only one in the nation that does not have to comply with the Biden administration’s directive to ensure emergency departments provide care to patients like Crain.

Following the U.S. Supreme Court's decision to overturn the constitutional right to abortion, the Biden administration issued new guidance for states with abortion bans on how to adhere to the Emergency Medical Treatment and Labor Act. This federal law mandates that hospitals receiving Medicare funding — which includes nearly all hospitals — must stabilize or transfer anyone who seeks emergency care, including pregnant patients. The guidance asserts that this applies even if it requires violating state law to provide an abortion.

In response, Paxton filed a lawsuit in 2022, arguing that the federal guidance 'forces hospitals and doctors to commit crimes' and that it was an attempt to turn every emergency room into an abortion clinic.

A key issue in the legal battle has been the definition of who qualifies for an abortion. The federal EMTALA guidelines apply when a pregnant patient’s health is in 'serious jeopardy,' a broader standard than Texas' abortion restrictions, which only allow exceptions in cases where there is a 'risk of death' or 'serious risk of substantial impairment of a major bodily function.'

The lawsuit worked its way through three levels of federal courts, each time encountering judges appointed by former President Donald Trump, whose appointments played a key role in the overturning of Roe v. Wade.

After U.S. District Judge James Wesley Hendrix, appointed by Trump, swiftly ruled in favor of Texas, Paxton celebrated the victory over what he described as 'left-wing bureaucrats in Washington.'

'The decision last night confirms what we have known all along,' Paxton remarked. 'The law is on our side.'

This year, the U.S. Court of Appeals for the 5th Circuit upheld the order, with the ruling written by Kurt D. Engelhardt, another judge appointed by Trump.

The Biden administration appealed to the U.S. Supreme Court, asking the justices to clarify that certain emergency abortions should be permitted.

Despite reports of preventable deaths linked to abortion bans, the Supreme Court refused to intervene last month.

Paxton hailed this as 'a major victory' for the state's abortion restrictions.

He has made it clear that he will pursue charges against doctors performing abortions, should he determine the cases don't meet the strict medical exceptions outlined by Texas law.

Last year, he issued a warning to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. Paxton argued that neither the doctor nor the patient had sufficiently demonstrated the life-threatening nature of the woman's condition.

Many healthcare providers claim this type of threat has led them to 'pass the buck,' opting to refer patients rather than provide direct care.

Since the implementation of the abortion bans, an OB-GYN in San Antonio has reported an increase in patients being transferred from across Southern Texas, many of whom could have been treated locally for complications that are now escalating.

The hospital, which is well-funded, is seen as having greater institutional support for providing abortions and managing miscarriages, according to the doctor. Other providers, he noted, are sending patients to their facility because, frankly, they prefer not to handle these cases themselves.

After Crain’s death, Fails couldn’t stop thinking about how Christus Southeast Hospital failed to address her daughter’s condition. 'She was bleeding,' Fails recalled. 'Why didn’t they take action to address it, instead of waiting for another ultrasound to confirm that the baby was gone?'

Sign up for Dinogo Health's weekly newsletter.

It was the medical examiner, not the hospital staff, who eventually removed Lillian from Crain’s womb. The autopsy did little to answer Fails' persistent questions about the hospital’s negligence. The examiner labeled the death as 'natural' and blamed it on 'complications of pregnancy.' However, he did acknowledge that Crain had been seeking medical care for a worsening illness in the days leading up to her death.

In November, Fails contacted medical malpractice attorneys to explore her options for seeking justice in court. However, she soon encountered a new legal hurdle that made her path forward more difficult.

Had Crain been admitted as an inpatient, Fails would have only needed to prove that the hospital failed to meet medical standards, something she believed she could demonstrate. However, since the delays and discharges took place in the emergency room, Texas law required a much higher standard of proof: 'willful and wanton negligence,' according to legal experts.

No attorney has agreed to take on the case.

Research by Mariam Elba, reporting by Cassandra Jaramillo, and data reporting by Andrea Suozzo contributed to this article.