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would not survive to birth. She was advised that continuing her pregnancy put her at a higher risk
of developing preeclampsia, placental abruption, and deadly blood clots. Yet, she was denied an
abortion because the hospital said it was unsure whether her conditions satisfied Ohios abortion-
ban exceptions. She and her husband immediately scheduled an abortion at a hospital in Michigan.
But, soon after, a Michigan appeals court allowed the state’s 1931 abortion ban to go into effect
and, as a result, Tara was denied abortion care for the second time in under a week. After struggling
to find care in other states, she received a call from a doctor in Michigan who told her that they
could go ahead with the procedure as a judge had issued a temporary restraining order, blocking
the ban’s enforcement. That same day, she rushed to Michigan where she was finally able to
receive the care she needed.72

381. Beth Long, an Ohio resident, was around 17 weeks pregnant when she learned her
baby had limb body wall complex, a rare condition where the baby’s organs develop outside its
body. Beth, who had undergone extensive and expensive fertility treatment to get pregnant, was
told that the condition posed health risks for her too, including dangerous bleeding that could
necessitate a hysterectomy. Beth was advised to terminate the pregnancy as soon as possible. But
because her life was not “imminently in danger,” her state-issued insurance would not cover the
$20,000-$30,000 procedure in Ohio, and Beth was forced to delay abortion care for weeks and
ultimately travel to an out of state hospital that would do the procedure for a discounted rate. Beth
called it “the most dehumanizing experience of my life.”73

72 Abigail Abrams, ‘Never-Ending Nightmare.’ An Ohio Woman Was Forced to Travel Out of State for an
Abortion, Time (Aug. 29, 2022),
https://time.com/6208860/ohio-woman-forced-travel-abortion.
73 Elizabeth Cohen & Amanda Musa, Ohio Abortion Law Meant Weeks of “Anguish,” “Agony” for Couple
Whose Unborn Child Had Organs Outside Her Body, CNN (Feb. 8, 2023),
https://www.cnn.com/
2023/02/08/health/ohio-abortion-long/index.html
.

382. Kayla Smith, an Idaho resident, was 20 weeks pregnant when she learned her baby
had critical aortic stenosis and hypoplastic left heart syndrome, both serious heart defects. Kayla
had been diagnosed with preeclampsia when she was pregnant with her older child and worried
she would develop it again. Kayla ultimately decided to travel to Washington State for an induction
abortion.74

383. Jennifer Adkins, an Idaho resident, was 12 weeks pregnant when she learned that
her fetus had hydrops fetalis, a severe form of swelling, and likely had Turner syndrome. Jennifer
was told that her fetus was unlikely to survive but due to Idaho’s abortion bans, there was nothing
her doctors could do. Seeking abortion care in another state made Jennifer feel like a criminal and
a medical refugee, but she ultimately traveled to Oregon for an abortion.75

384. Carmen Broesder, an Idaho resident, was 6 weeks pregnant when she began
experiencing heavy bleeding and intense pain and cramps. Despite multiple trips to emergency
rooms at different hospitals, Carmen was repeatedly denied abortion care, with her physicians
citing trepidation regarding Idaho’s abortion ban. Carmen documented her 19-day miscarriage on
social media.76

385. Kelly Shannon, an Alabama resident, was midway through her pregnancy when she
learned her baby had Down syndrome and further testing revealed swelling in the baby’s head and
body wall, a heart defect, and a tumor in the baby’s abdomen. Kelly was told it was unlikely the

74 Abby Davis, ‘I Don’t Wish This on Anyone:’ Idaho Couple Travel Out of State for Abortion, KTVB7 (April
5, 2023),
https://www.ktvb.com/article/news/local/capitol-watch/idaho-couple-travels-out-of-state-for-abortion-
kayla-smith-james-smith-baby-brooks/277-f6d5cdca-7d1e-421b-8758-88495a1154d2
.
75 Kelcie Moseley-Morris, Her Fetus Had 1% Chance of Survival. Idaho’s Ban Forced Her to Travel for an
Abortion, Idaho Capital Sun (May 10, 2023),
https://idahocapitalsun.com/2023/05/10/her-fetus-had-1-chance-of-
survival-idahos-ban-forced-her-to-travel-for-an-abortion
.
76 Mary Kekatos, Idaho Woman Shares 19-Day Miscarriage on TikTok, Says State’s Abortion Laws
Prevented Her from Getting Care, ABC News (Jan. 21, 2023),
https://abcnews.go.com/Health/idaho-woman-shares-
19-day-miscarriage-tiktok-states/story?id=96363578

baby would survive to birth. Her doctors tried to get permission to perform her abortion, but while
one committee approved the procedure, a higher-level committee denied permission based on
Alabama’s laws. Kelly traveled to Virginia to access abortion care.77

386. Alyssa Gonzales, an Alabama resident, was heartbroken when her second baby was
diagnosed with trisomy 18. Yet in her words, “the worst was yet to come,” as Alabama’s trigger
law had taken effect weeks earlier and Alyssa was told she did not qualify for an exception. Alyssa
did not have the money to travel for an abortion, but after connecting with an abortion fund who
offered financial support, Alyssa loaded her infant son, her fiancé, and his parents in the car, and
they drove 11 hours to an abortion provider in Washington, D.C.78

387. Jill Hartle, a resident of South Carolina, was 22 weeks pregnant when her fetus was
diagnosed with hypoplastic left heart syndrome, a condition where the fetal heart does not properly
develop. But Jill was told there was nothing doctors could do for her at home because Roe v. Wade
had been overturned weeks earlier and South Carolina’s 6-week abortion ban was in effect. Jill
was ultimately able to get an appointment for an abortion in Washington, D.C. but had to wait two
weeks for an appointment due to the influx of patients.79

388. Mylissa Farmer, a Missouri resident, was nearly 18 weeks pregnant when her water
broke. Her doctor diagnosed her with PPROM and advised her to terminate the pregnancy to
protect her health. Due to Missouri’s abortion ban, however, she was advised that doctors could

77 Nadine El-Bawab, Alabama Mother Denied Abortion Despite Fetus’ ‘Negligible’ Chance of Survival, ABC
News (May 2, 2023),
https://abcnews.go.com/US/alabama-mother-denied-abortion-despite-fetus-negligible-
chance/story?id=98962378
.
78 Alyssa Gonzales, I Live in Alabama. Our Cruel New Abortion Law Has Made My Life Absolute Hell,
Huffpost Personal (Oct. 21, 2022),
https://www.huffpost.com/entry/supreme-court-roe-v-wade-
alabama_n_63486af5e4b0b7f89f546712
.
79 Andrea Michelson, Former Ms. South Carolina Says She Was Forced to Carry Her Fetus Until 25 Weeks
2 Months After Doctors Detected a Deadly Heart Defect, Insider (Nov. 14, 2022),
https://www.insider.com/former-
pageant-winner-describes-abortion-at-25-weeks-post-roe-2022-11
.

only intervene if her vitals plummeted, infection set in, or the fetus’s cardiac activity stopped.
Mylissa worried that by the time there was an emergency, it would be too late for her, as she was
already at higher risk of maternal thrombosis, infection, and severe blood loss. After struggling to
find an abortion provider in three other states, she eventually found a clinic in Illinois and traveled
hundreds of miles to receive the care she needed.80 Upon information and belief, Mylissa is the
first patient since Roe was overturned to submit an EMTALA complaint based on being denied an
abortion for an emergent medical condition.81 The U.S. Department of Health and Human Services
recently cited hospitals in Kansas and Missouri for violating EMTALA by failing to provide
Mylissa with proper abortion care.82

389. “R,” a Missouri resident, found out she was pregnant a week after Roe v. Wade was
overturned. R had previously been diagnosed with a “bicornate uterus,” a congenital abnormality
that creates significant risks for carrying a child to term. R immediately knew that she wanted an
abortion. Missouri’s trigger ban had just taken effect, so R started calling clinics out of state, but
they were all booked up. It took seven weeks before she was able to get an appointment in Illinois.83

390. Deborah Dorbert, a Florida resident, was 24 weeks pregnant when her fetus was
diagnosed with Potter syndrome, a condition where the kidneys do not develop properly and do
not produce a sufficient amount of amniotic fluid. Deborah was told that the condition is

80 Susan Szuch, After Missouri Banned Abortions, She Was Left With a Baby Dying Inside. Doctors Said
They Could Do Nothing, Springfield News-Leader (Oct. 19, 2022),
https://www.news-leader.com/story/
news/local/ozarks/2022/10/19/missouri-laws-abortion-ban-left-her-with-a-baby-dying-inside-pprom/10366865002
.
81 Admin. Compl. (Mylissa Farmer), U.S. Dept of Health & Human Servs. (Nov. 8, 2022),
https://nwlc.org/wp-content/uploads/2022/11/2022.11.08-Mylissa-Farmer-EMTALA-complaint.pdf.
82 HHS Secretary Xavier Becerra Statement on EMTALA Enforcement (May 1, 2023),
https://www.hhs.gov/about/news/2023/05/01/hhs-secretary-xavier-becerra-statement-on-emtala-enforcement.html;
Press Release: NWLC Applauds CMS’ Action on Mylissa Farmer’s Emergency Abortion Complaint, Finding
Hospitals Violated Federal Law, Nat’l Women’s Law Ctr. (May 1, 2023),
https://nwlc.org/press-release/nwlc-
applauds-cms-action-on-mylissa-farmers-emergency-abortion-complaint-finding-hospitals-violated-federal-law
.
83 Carter Sherman, She Feared Giving Birth Would Kill Her. She Fled Her State for an Abortion., Vice (Oct.
26, 2022),
https://www.vice.com/en/article/m7gx4v/abortion-missouri

89
incompatible with life as babies born with Potter syndrome are both unable to breathe and go into
renal failure at birth, and that the risks to Deborah will increase as her pregnancy continues.
Deborah and her husband decided that they wanted an abortion as soon as possible due to concern
for Deborah’s physical and mental health, worries about the baby suffering, and their desire to
begin the grieving process. But because no one in Florida would perform the abortion under the
state’s medical exception, and it was too difficult to leave the state, Deborah carried the pregnancy
to term. Her baby lived for only 99 minutes. Florida has a 15-week abortion ban that has been in
effect since shortly after Roe was overturnedit has been challenged but is in effect while appeals
continue.84

391. Anya Cook and Shanae Smith-Cunningham, two close friends in Florida, were both
pregnant at the same time when they experienced the same pregnancy complication just days apart.
Anya was around 16 weeks pregnant when her water broke and Shanae was 19 weeks pregnant.
Anya was diagnosed with PPROM at an emergency room then sent home to wait. She ultimately
gave birth in the bathroom of a hair salon, started bleeding profusely, and was rushed to the hospital
for emergency surgery. Shanae was in Jamaica when her water broke and took the risk to fly back
to Florida, thinking she would get better care at home. But Shanae was sent home from the hospital
multiple times before she eventually went into labor on her own. Both women are now suffering
from fertility problems.85

84 Frances Stead Sellers, Thomas Simonetti, & Maggie Penman, The Short Life of Baby Milo (May 19, 2023),
https://www.washingtonpost.com/health/interactive/2023/florida-abortion-law-deborah-dorbert; Frances Stead
Sellers, Her Baby Has a Deadly Diagnosis. Her Florida Doctors Refused an Abortion, Washington Post (Feb. 18,
2023),
https://www.washingtonpost.com/health/2023/02/18/florida-abortion-ban-unviable-pregnancy-potter-
syndrome
; Maya Yang, Florida Couple Unable to Get Abortion Will See Baby Die After Delivery, The Guardian (Feb.
18, 2023),
https://www.theguardian.com/world/2023/feb/18/florida-abortion-law-couple-birth.
85 Caroline Kitchener, Two Friends Were Denied Care After Florida Banned Abortion. One Almost Died,
Washington Post (April 10, 2023),
https://www.washingtonpost.com/politics/2023/04/10/pprom-florida-abortion-
ban
392. Anabely Lopes, a Florida resident, was 15 weeks pregnant when her fetus was
diagnosed with trisomy 18. Florida’s 15-week ban had gone into effect just days earlier, and
Anabely was forced to travel to Washington, D.C. for an abortion. The experience was so painful
and devastating that Anabely had thoughts of suicide.86

393. Heather Maberry, a Kentucky resident, was 20 weeks pregnant when she learned
her baby had anencephaly. Heather was already struggling with hyperemesis gravidarum and on
bedrest. Now she must decide if she will travel out of state for an abortion or give birth to a child
who will not survive. She is currently trying to raise the funds she needs on GoFundMe to travel
for an abortion.87

394. Amy English, a Kentucky resident, was 20 weeks pregnant when she learned her
baby had acrania and anencephaly and would not survive to birth. Amy wanted an abortion but
erupted into sobs when her doctor told her that it was illegal in Kentucky and she should call
hospitals in Illinois. Amy remembers thinking, “Am I just supposed to Google the number, call
the front desk and ask, ‘How do I get an abortion at your hospital?’” Amy, her husband, and her
sister-in-law called multiple clinics, but due to abortion laws in Indiana and Ohio, she had trouble
finding a provider who could do a D&E. Eventually, she found a hospital 400 miles away in Illinois
that agreed to give her an induction abortion.88

86 Timothy Bella, Fla. Woman Forced to Fly to D.C. for Abortion Returns for State of the Union, Washington
Post (Feb. 7, 2023),
https://www.washingtonpost.com/politics/2023/02/07/state-of-union-abortion-florida-anabely-
lopes
.
87 Kelsey Souto, Powell Co. Woman Forced to Travel out of State for Abortion, WKYT (May 8, 2023),
https://www.wkyt.com/2023/05/08/powell-co-woman-forced-travel-out-state-abortion.
88 Alex Acquisto, A ‘Twisted’ Experience: How KY’s Abortion Bans Are Depriving Pregnant Patients of
Health Care, Lexington Herald Leader (Feb. 22, 2023),
https://www.kentucky.com/news/politics-
government/article271925592.html
395. Leah Martin, a Kentucky resident, was 12 weeks pregnant when she learned her
fetus had triploidy and she was diagnosed with a partial molar pregnancy. She was told that her
pregnancy could give her cancer if she did not get an abortion. But Kentucky’s abortion bans had
taken effect two weeks earlier and the hospital told Leah that they could not perform the abortion
while litigation of the abortion bans continued. But Leah got lucky. Shortly after her diagnosis, a
Kentucky judge temporarily enjoined the abortion bans, and Leah got an appointment at
Kentucky’s sole abortion clinic. The injunction was lifted just days after her procedure and the
abortion bans remain in effect today.89

396. Chloe, an Arizona resident, was 23 weeks pregnant when she learned her baby had
holoprosencephaly. She was told her baby would only survive for days, if at all, but that due to the
state’s 15-week abortion ban, she could not receive an abortion in Arizona. Chloe considered
traveling out of state, but the clinic where she was scheduled to receive care canceled her
appointment after they received threats to the clinic and to her safety based on a story regarding
her experience that she had shared on social media. Chloe was forced to carry the pregnancy to
term and her daughter lived for only 2 days.90 Chloe continues to suffer mental health effects from
the experience.

397. Jaci Statton, an Oklahoma resident, was in her first trimester when she learned she
had a partial molar pregnancy. Heavy bleeding and severe nausea first sent her to the emergency
room. She was told that continuing the pregnancy was extremely dangerous to her health and could
lead to cancer. But three different hospitals turned her away, saying that due to Oklahoma’s

89 Id.
90 Katie Kindelan, Woman Has 44 Hours with her Baby Born After a Nonviable Pregnancy, Good Morning
America (May 11, 2023),
https://www.goodmorningamerica.com/wellness/story/44-hours-baby-carried-nonviable-
pregnancy-term-after-97451344
.
abortion laws, they could not provide her with abortion care. One hospital told her to wait in the
parking lot of the hospital to see if she got worse. Jaci eventually traveled to Kansas for an abortion.
She continues to suffer negative health effects form the pregnancy.91 A study and associated
commentary published in the Lancet shows that Jaci’s experience is not unique: confusion about
the state’s abortions laws is widespread at the hospitals throughout Oklahoma.92

398. Additional stories of pregnant people not publicly named have appeared constantly
in the news since Roe v. Wade was overturned. For example: a Texas woman whose fetus was
diagnosed with acrania spent six weeks putting together the resources to travel out of state for an
abortion, and she ended up needing a hysterectomy that likely would not have been necessary if
she had been able to get an abortion sooner;93 a Tennessee woman whose fetus was diagnosed with
a genetic condition putting her at risk of preeclampsia was forced to take a 6-hour ambulance ride
to North Carolina where, on arrival, her blood pressure was dangerously high and she was showing
signs of kidney failure;94 a Tennessee woman was diagnosed with a cesarean scar ectopic
pregnancy and traveled to Georgia which, though it has its own abortion ban, at least has an explicit
exception for ectopic pregnancies, unlike Tennessee;95 a Florida woman pregnant with twins was

91 Selena Simmons-Duffin, In Oklahoma, a Woman was Told to Wait Until She’s ‘Crashing’ for Abortion
Care, NPR (April 25, 2023),
https://www.npr.org/sections/health-shots/2023/04/25/1171851775/oklahoma-woman-
abortion-ban-study-shows-confusion-at-hospitals
.
92 Michele Heisler et al., US Abortion Bans Violate Patients’ Right to Information and to Health, Lancet
(April 25, 2023),
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00808-5/fulltext; Physicians
for Human Rights, the Oklahoma Call for Reproductive Justice, and the Center for Reproductive Rights, No One
Could Say: Assessing Emergency Obstetrics Information as a Prospective Prenatal Patient in Post-Roe Oklahoma
(April 2023),
https://phr.org/wp-content/uploads/2023/04/Oklahoma-Abortion-Ban-Report-2023.pdf.
93 Selena Simmons-Duffin, 3 Abortion Bans in Texas Leave Doctors ‘Talking in Code’ to Pregnant Patients,
NPR (March 1, 2023),
https://www.npr.org/sections/health-shots/2023/03/01/1158364163/3-abortion-bans-in-texas-
leave-doctors-talking-in-code-to-pregnant-patients
.
94 Susan Rinkunas, A Tennessee Woman Had to Take a 6-Hour Ambulance Ride to Get an Abortion, Jezebel
(Oct. 17, 2022),
https://jezebel.com/a-tennessee-woman-had-to-take-a-6-hour-ambulance-ride-t-1849668907.
95 Poppy Noor, ‘I Cried With Her’: The Diary of a Doctor Navigating a Total Abortion Ban, The Guardian
(Feb. 22, 2023),
https://www.theguardian.com/world/2023/feb/22/diary-doctor-navigating-total-abortion-ban-
tennessee
.
20 weeks pregnant when her water broke and she partially delivered one of the fetuses, but she
was forced to wait a week until both fetuses’ hearts stopped to receive medical care;96 people
whose fetuses were diagnosed with fatal conditions like anencephaly, some of whom were able to
travel out of state for abortion care, while others were forced to carry the pregnancies to term and
suffer through the emotional trauma of a stillbirth;97 and people who have been denied or delayed
in receiving treatment for ectopic pregnancies or miscarriage despite intense pain and bleeding.98

B. Confusion and Fear Throughout the Medical Community Regarding Texas’s
Abortion Bans and Similar Bans Around the Country

399. The stories of pregnant people described above reflect the widespread confusion
among the medical community regarding the proper application of the Emergent Medical
Condition Exception, combined with fear that a physician’s good faith reliance on the exception
could nonetheless result in disciplinary sanctions, civil penalties, and/or a lengthy prison sentence.

400. After S.B. 8 took effect, researchers from Texas Policy Evaluation Project, the
University of Texas at Austin, Baylor College of Medicine, and the Pegasus Health Justice Center
interviewed 25 clinicians in general obstetrics and gynecology, maternal and fetal medicine, and
genetic counseling regarding the impact S.B. 8 has had on their practice. The results of these

96 Rachel Rapkin, Here’s the Harrowing Story of One of My Patients After Florida’s 15-Week Abortion Ban,
Tampa Bay Times (Jan. 21, 2023),
https://www.tampabay.com/opinion/2023/01/21/heres-harrowing-story-one-my-
patients-after-floridas-15-week-abortion-ban-column
.
97 Nilo Tabrizy et al., “Do No Harm”: OB-GYNs Weigh the Legal Impact of Abortion Bans, N.Y. Times
(Sept. 10, 2022),
https://www.nytimes.com/video/us/100000008489880/abortion-bans-maternal-health.html?
searchResultPosition=14
; Noor, supra n.95.
98 Confusion Post-Roe Spurs Delays, Denials for Some Lifesaving Pregnancy Care, Washington Post (July
16, 2022),
https://www.washingtonpost.com/health/2022/07/16/abortion-miscarriage-ectopic-pregnancy-care;
Stephanie Wenger, Tennessee Doctor Details Patient's Experience Being Unable to Get Pills to Complete Her
Miscarriage, People (July 8, 2022),
https://people.com/health/tenn-doctor-details-patients-experience-being-unable-
to-get-pills-to-complete-her-miscarriage
interviews were published in the New England Journal of Medicine99 and show that fear and
confusion among the medical profession regarding abortion bans is widespread:

401. There is no consensus view among physicians on the meaning of the Emergent
Medical Condition Exception, leading to significant chilling in the provision of pregnancy-related
care that involves abortion.

402. Some physicians believe that “[p]eople have to be on death’s door to qualify for
maternal exemptions to SB8.” Accordingly, some clinicians force patients with “pregnancy
complications or preexisting medical conditions that may be exacerbated by pregnancy” to “delay
an abortion until their conditions become life-threatening,” i.e., until the patient is in crisis, and
thus “qualify as medical emergencies.”100 In other words, instead of being offered expectant
management or termination of pregnancy when the emergent conditions present themselves,
pregnant people are given one option: wait to miscarry without medical intervention or until the
emergent conditions have made them so horribly ill that they are at risk of imminent death.

403. For example, “[s]ome clinicians believe that patients with rupture of membranes
before fetal viability are eligible for a medical exemption under SB8, while others believe these
patients cannot receive an abortion so long as there is fetal cardiac activity. Physicians who
believe they cannot intervene before a patient falls sick with infection will send patients home,

99 Whitney Arey et al., A Preview of the Dangerous Future of Abortion Bans Texas Senate Bill 8, 387 N.
Engl. J. Med. 388, 388-89 (Aug. 4, 2022); see also Charlotte Huff, In Texas, Abortion Laws Inhibit Care for
Miscarriages, NPR (May 10, 2022),
https://www.npr.org/sections/health-shots/2022/05/10/1097734167/in-texas-
abortion-laws-inhibit-care-for-miscarriages
; María Méndez, Texas Laws Say Treatments for Miscarriages, Ectopic
Pregnancies Remain Legal But Leave Lots of Space for Confusion, Tex. Tribune (July 20, 2022),

https://www.texastribune.org/2022/07/20/texas-abortion-law-miscarriages-ectopic-pregnancies.
100 Arey et al., supra n.99 at 389
95
“only to see them return with signs of sepsis.” Another patient received an abortion only after her
“severe cardiac condition” caused her to be admitted to the ICU.101

404. All of the hospitals where the interviewees practice prohibited fetal reduction,
“even though in some cases (e.g., complications of monochorionic twins) failure to perform the
procedure could result in the loss of both twins.”102 This reflects Lauren M. and Ashley’s personal
experiences.

405. Some of the interviewed clinicians reported that, based on legal guidance, they do
not believe they can even counsel patients regarding “the availability of abortion in cases of
increased maternal risks or poor fetal prognosis, although before SB8 they would have done so.”103
Again, this reflects the experiences of Amanda, Lauren M., Lauren H., Anna, Ashley, Kylie,
Jessica, Samantha, Dr. Dennard, Taylor, Kiersten, Lauren V., and Elizabeth, who sensed that their
medical providers felt muzzled.

406. Fear of liability under the abortion bans is so great that some physicians have even
changed their standard treatment methods from D&E to induction or hysterotomy (a procedure
similar to caesarean).104

407. The confusion extends to physicians who do not perform abortions but are involved
in advising on the appropriate treatment or in providing sedation, such as anesthesiologists who
place epidurals during labor inductions. These physicians reportedly worry about potential liability
for “aiding and abetting” an illegal abortion and thus decline to participate
408. Confusion over the Emergent Medical Condition Exception extends to ectopic
pregnancies as well. At least one Texas hospital no longer treats patients with ectopic pregnancies
implanted in cesarean scars, even though ectopic pregnancies are excluded from Texas’s definition
of abortion and leading experts at the Society for Maternal-Fetal Medicine recommend treating
these “life-threatening pregnancies” with “surgical or medical” termination.106

409. Because of the law’s severe restrictions on maternal health and wellbeing, some
doctors have departed Texas for states without equally strict abortion bans. The result is fewer
doctors who are fully equipped to treat patients suffering from serious pregnancy complications
and challenges with training the next generation of doctors.107

410. Another study was conducted at two large hospitals in Dallas County, Parkland
Hospital and the William P. Clements Jr. University Hospital after S.B. 8 took effect. The study
documented a significant increase in maternal morbidity among patients with preterm labor who
would have been promptly offered induction abortions before the law but, due to fear regarding
S.B. 8, were not offered such treatment until their physicians determined that an emergent
condition posed an immediate threat to maternal life. The study followed 28 patients (26 with
PPROM, 2 with pregnancy tissue prolapsed into the vagina). Among these patients, 43% (12 of
28) experienced infection or hemorrhage and one patient required a hysterectomy. Other maternal
morbidities included ICU admissions, blood transfusions, postpartum emergency room visits, and
postpartum readmission.108

106 Id. at 389 (citing Russell Miller et al., Society for Maternal-Fetal Medicine (SMFM) Consult Series #49:
Cesarean Scar Pregnancy, 222 Am. J. Obstetrics & Gynecology B2-B14 (May 2020); see also Patricia Santiago-
Munoz, M.D., Cesarean Scar Ectopic Pregnancy: Facts and Treatment Options, U.T. Sw. Med. Ctr. (Aug. 23, 2022),

https://utswmed.org/medblog/cesarean-scar-ectopic-pregnancy (explaining that a CSEP “may result in hemorrhage”
and “potentially lead[] to a hysterectomy, damage to surrounding organs, or death of the pregnant patient”).

107 Arey et al., supra n.99 at 390.
108 Anjali Nambiar, et al., Maternal Morbidity and Fetal Outcomes Among Pregnant Women at 22 Week
411. The Dallas hospitals study concluded that “state-mandated expectant management”
is associated with “significant maternal morbidity.109

412. State-mandated expectant management under Texas’s abortion bans resulted in a
lapse of nine days on average between first diagnosis and the development of “complications that
qualified as an immediate threat to maternal life.”110

413. The Dallas hospitals study examined practices prior to the overturning of Roe and
the triggering of Texas’s complete ban on abortion. It also examined practices at level IV
designated maternal care facilities in large urban centers. On information and belief, delays and
maternal morbidities are worse for patients who first present to non-level IV designated maternal
care facilities, for patients who live far from large urban centers, and for patients after the Trigger
Ban sprung into effect.

414. An additional study focused on patients with lethal or life-limiting fetal diagnoses
in Texas after S.B. 8 took effect. The study documented self-censoring among health care
providers regarding abortion because of a fear of potential liability under S.B. 8, and a resulting
lack of information for patients about their pregnancy options, including abortion. The study
followed 16 patients who received lethal or life-limiting fetal diagnoses in Texas after S.B. 8 took
effect and ultimately pursued an abortion out of state. Patients reported feeling isolated after
receiving their diagnoses as their health care providers were unable to speak openly with them
about their options, including abortion. Instead, the study documented that patients were forced to
rely on Google and their own knowledge about abortion, all the while stating that they would have

Gestation or Less with Complications in Two Texas Hospitals After Legislation on Abortion, 227 Am. J. Obstetrics &
Gynecology 648 (2022),
https://doi.org/10.1016/j.ajog.2022.06.060.
preferred to receive information straight from their Texas doctor. The study concluded that
restrictions like S.B. 8 “erode the patientphysician relationship, evoke fear and safety concerns,
and create a significant burden on patients to understand pregnancy options and navigate the
process of abortion alone.”111

415. The patients study concluded that restrictions like S.B. 8 “erode the patient
physician relationship, evoke fear and safety concerns, and create a significant burden on patients
to understand pregnancy options and navigate the process of abortion alone.”

416. In the months since Roe v. Wade was overturned and other state bans have taken
effect, confusion over the scope of exceptions to abortion bans has extended beyond Texas. For
example, another article in the New England Journal of Medicine explained that physicians and
other medical professionals nationwide have struggled to translate legislative exceptions to
abortion bans into actionable clinical guidelines, with disastrous impacts on patient care. Without
further explanation, physicians do not know if, for example, a patient with pulmonary
hypertension, for whom we cite a 30-to-50% chance of dying with ongoing pregnancy,” is
sufficiently at risk of death or substantial impairment of a major bodily function to permit
abortion.112

417. Other studies of the impact on the medical profession of reversing Roe v. Wade are
ongoing, including a study out of the University of California San Francisco designed to examine
how making abortion illegal is forcing clinical care for pregnant patients to deviate from the usual

111 Courtney C. Baker et al., Texas Senate Bill 8 and Abortion Experiences in Patients with Fetal Diagnoses,
141 Obstetrics & Gynecology 602 (2023),
https://pubmed.ncbi.nlm.nih.gov/36735418.
112 Lisa H. Harris, Navigating Loss of Abortion ServicesA Large Academic Medical Center Prepares for
the Overturn of Roe v. Wade, 386 N. Engl. J. Med. 2061, 2061 (June 2, 2022) (describing a Michigan hospital’s efforts
to interpret a state law permitting abortions to “preserve the life” of the pregnant person).
standard of care.113 Preliminary findings of this study document horrifying outcomes for patients
with emergent medical conditions that, like the Plaintiffs here, were denied or delayed abortion
care due to confusion in the medical profession regarding the exceptions to abortion bans
nationwide.114

418. In legal challenges to state abortion bans since Roe was overturned, medical
professionals around the country have testified about the challenges of complying with state
abortion bans, telling harrowing stories about their patients. These include: a 16-year-old girl who
had such debilitating hyperemesis that she lost over 20 pounds and was forced to travel out of state
twice to receive the care she needed after being denied an abortion; a patient with stage III
melanoma who could not receive treatment until her pregnancy was terminated but was told she
would have to travel out of state to receive an abortion, causing her to break down and cry
inconsolably; and multiple patients diagnosed with PPROM but denied abortion care.115 In one
case, a PPROM patient was forced to endure an excruciating, hours-long delivery of a non-viable
fetus that eventually caused her to hemorrhage.116 Physicians have also testified about patients
with mental health conditions that necessitated abortion care, including attempted suicide.117

419. These physicians have also testified about patients they treated before Roe was
113 Dobbs Impact Study, Univ. Cal. S.F., https://carepostroe.ucsf.edu.
114 Daniel Grossman et al., Preliminary Findings: Care Post-Roe: Documenting Cases of Poor-Quality Care
Since the Dobbs Decision, Advancing New Standards in Reproductive Health (ANSIRH) (May 2023),

https://www.ansirh.org/sites/default/files/2023-05/Care%20Post-Roe%20Preliminary%20Findings.pdf.
115 Aff. of Aeran Trick ¶¶ 6, 9, 11, Preterm Cleveland v. Yost, No. A2203203, 2022 WL 4279758 (Ohio Ct.
Com. Pl. Sept. 2, 2022); Aff. of Valerie Williams, M.D. 10-11, June Med. Servs., LLC v. Landry, No. C-720988,
2022 WL 2902625 (La. Dist. Ct. July 13, 2022) (hereinafter Williams Aff.).

116 Williams Aff. 11.
117 See, e.g., Aff. of Dr. Sharon Liner ¶ 11, Preterm Cleveland v. Yost, No. A2203203 (Ohio Ct. Com. Pl.
Sept. 2, 2022) (“We have had at least 3 patients threaten to commit suicide. Another patient stated that she would
attempt to terminate her pregnancy by drinking bleach.”); Aff. of David Burkons, M.D. 9, Preterm Cleveland v.
Yost, No. A2203203, 2022 WL 4279758 (Ohio Ct. Com. Pl. Sept. 2, 2022).
overturned who they may not be able to help under the new state abortion bans if the same patient
presented for care today. For example: patients whose fetuses were diagnosed with triploidy,
causing some to develop HELLP syndrome and others preeclampsia with severe features; a patient
who developed disseminated intravascular coagulation (“DIC”)a condition that causes pregnant
patients to lose large volumes of blooddue to placental abruption; a patient with preeclampsia
with severe features that caused fluid to accumulate between the tissues lining her lungs and chest;
a patient with preeclampsia with severe features caused by a partial molar pregnancy; a patient
who experienced a septic abortion; a patient who went into hypovolemic shock after experiencing
uncontrollable vaginal bleeding at 19 weeks of pregnancy; a patient with bipolar disorder at risk
of developing postpartum psychosis; and patients with panic disorders that lead to attempted
suicide.118

420. Physicians have also provided compelling hypotheticals in their testimony that
highlight the practical ramifications of unclear abortion ban exceptions. For instance, one
physician asked: “If a pregnant patient is experiencing renal failure, does she have to be on dialysis
before a physician may perform an abortion that would otherwise be prohibited by the Ban? If a
pregnant patient has a cardiac lesion, does a physician have to wait until she experiences heart

118 Decl. of Kylie Cooper, M.D. 6-12, United States v. Idaho, No. 1:22-cv-00329 (D. Idaho Aug. 8, 2022),
ECF No. 17-7; Decl. of Dr. Emily Corrigan ¶¶ 20-30, United States v. Idaho, No. 1:22-cv-00329 (D. Idaho Aug. 8,
2022), ECF No. 17-6; Decl. of Stacy T. Seyb, M.D. ¶¶ 7-14, United States v. Idaho, No. 1:22-cv-00329 (D. Idaho
Aug. 8, 2022), ECF No. 17-8; Aff. of Samantha Meltzer-Brody, M.D. ¶¶ 40-41, SisterSong Women of Color Reprod.
Just. Collective v. Georgia, No. 2022CV367796, 2022 WL 3335938 (Ga. Super. Ct. July 23, 2022) (“I recall one
patient who came to me with debilitating postpartum psychosis, a condition related to bipolar disorder that is often
characterized by delusional thinking, typically focused on the infant. . . . The symptoms are excruciating . . . and there
is a strong association between postpartum psychosis and maternal suicide. This patient was still in my treatment
no longer experiencing postpartum psychosis but still navigating her bipolar disorderwhen she learned of an
accidental pregnancy. She was gravely concerned about either stopping her medication during pregnancy and
experiencing a worsening of her bipolar disorder, or continuing her medication and exposing the fetus to serious
teratogenic risks. But even more than that, she was terrified at the thought of experiencing postpartum psychosis again
and potentially hurting her child or herself. This patient told me repeatedly that she felt such overwhelming distress at
the thought of continuing the pregnancy that she would rather die than go on.”).
failure to intervene? If a pregnant patient has a clogged blood vessel, does a physician have to wait
until she experiences chest pain before terminating the pregnancy to prevent pulmonary
embolism?” Aff. of Martina Badell, M.D. ¶ 30, SisterSong Women of Color Reprod. Just.
Collective v. Georgia, No. 2022CV367796, 2022 WL 3335933 (Ga. Super. Ct. July 25, 2022).
Another physician queried: “[I]f I and another physician judge that a woman’s neurological
condition is so complicated by pregnancy that she might lose entirely the ability to breathe, and I
perform a procedure, could another physician look at the patient’s chart after the fact and think
that we overestimated the danger, or that we should have delayed the abortion to see whether the
patient’s condition deteriorated?” Decl. of Nikki Zite, M.D., M.P.H. 21, Memphis Ctr. for
Reprod. Health v. Slatery, No. 3:20-cv-00501 (M.D. Tenn. June 22, 2020), ECF No. 8-3.

III. THE TEXAS CONSTITUTION PROTECTS PREGNANT PEOPLE WITH
EMERGENT MEDICIAL CONDITIONS AND THEIR PHYSICIANS FROM
STATE DEPRIVATION OF THEIR RIGHTS

A. Pregnant People Have Fundamental and Equal Rights Under the Texas Constitution
421. The Supreme Court may have stripped pregnant people of their federal
constitutional right to abortion, Dobbs v. Jackson Women’s Health Organization, 142 S. Ct. 2228
(2022), but that does not mean that Plaintiffs are without Constitutional Rights.

422. The Texas Constitution guarantees its citizens certain fundamental rights,
specifically: “[n]o citizen of this State shall be deprived of life, liberty, property, privileges, or
immunities, or in any manner disfranchised, except by the due course of the law of the land.” Tex.
Const. art. I, § 19. People do not lose these rights simply because they are pregnant. Moreover,
Texas law cannot demand that a pregnant person sacrifice their life, their fertility, or their health
for any reason, let alone in service of “unborn life,” particularly where a pregnancy will not or is
unlikely to result in the birth of a living child with sustained life
102
423. The Texas Constitution also prohibits Texas law from excluding pregnant people
with certain kinds of emergent conditionsfor example, pregnant people whose health risks are
not imminently “life-threatening”from receiving appropriate and/or life-saving medical care.

424. The Texas Constitution also guarantees “equal rights” under the law and prohibits
the law from “den[ying] or abridg[ing rights] because of sex.” Tex. Const. art. I, §§ 3, 3a. To deny
a “woman known to be pregnant” equal access to life-saving and health-preserving medical care,
simply because she is pregnant, would violate this foundational premise of equality under Texas
law.

425. To the extent Texas’s abortion bans bar the provision of abortion to pregnant people
to treat medical conditions that pose a risk to the pregnant person’s life or a significant risk to their
health, the bans violate pregnant people’s fundamental rights under § 19 and their rights to equality
under the law under §§ 3, 3a.

426. Indeed, Texas’s abortion bans fail any level of constitutional review when applied
to such pregnant people. “If the Texas [pre-Roe ban] statute were to prohibit an abortion even
where the mother’s life is in jeopardy, I have little doubt that such a statute would lack a rational
relation to a valid state objective under the test stated in Williamson . . . .” Roe v. Wade, 410 U.S.
113, 173 (1973) (Rehnquist, J., dissenting). Because the abortion bans force pregnant people with
emergent medical conditions to surrender their lives, health, and/or fertility, they have no rational
relationship to protecting life, health, or any other legitimate state interest.

B. Texas-Licensed Physicians Have Liberty and Property Rights to Provide Care to
Pregnant People with Emergent Conditions

427. The Texas Constitution guarantees that “[n]o citizen of this State shall be deprived
of life, liberty, property, privileges, or immunities, or in any manner disfranchised, except by the
due course of the law of the land.” Tex. Const. art. I, § 19. The threatened enforcement of the
abortion bans against physicians who in good faith provide abortions for pregnant people suffering
emergent medical conditions infringes this constitutional guarantee.

428. Section 19 guarantees Texas-licensed physicians the right to practice their
profession by providing abortion to their pregnant patients to treat emergent medical conditions
that the physician determines poses a risk to the patient’s life or health.

429. To fulfill this guarantee, physicians must be able to exercise their good faith
judgment in the care of their patients with emergent conditions without threat that the state will
take their license and/or liberty if a prosecutor or jury second guesses their medical judgment.

430. Texas law authorizes Defendant TMB to institute disciplinary and licensing
proceedings against any physician who performs an abortion that the TMB determines did not
meet the Emergent Medical Condition Exception. See, e.g., Tex. Occ. Code §§ 165.001,
164.052(a)(5), 164.053(a), 164.055; Tex. Health & Safety Code § 170A.007. These proceedings
may result in a provider losing their license to practice medicine. See, e.g., Tex. Health & Safety
Code § 170A.007.

431. Disciplinary actions are reported to the National Practitioner Data Bank119 and can
have collateral consequences on a physician’s ability to practice in other U.S. states.120 Defendant
TMB, for example, requires physicians to make timely reports of any disciplinary actions taken by
other jurisdictions against the physician, 22 Tex. Admin. Code § 173.3, and has taken disciplinary

119 See 42 U.S.C. § 11132 (requiring state medical boards to report all revocations or suspensions of physician
licenses); see also Nat’l Practitioner Data Bank, Guidebook, at Ch. E: Reports, Table E-1 (Oct. 2018),

https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp (explaining state medical boards and hospitals have
mandatory reporting obligations).

120 See, e.g., Tex. Admin. Code § 173.3(d) (requiring reporting within 30 days of any actions issued by
another state); Tex. Med. Bd. Press Release at 4-5, TMB Disciplines 27 Physicians at June Meeting, Adopts Rule
Changes (June 30, 2022),
https://www.tmb.state.tx.us/dl/2B28AF92-02B2-0425-2295-86E2DEAD1C51 (describing
“other states’ [disciplinary] actions”).
action against physicians based on conduct occurring in other states.121 Upon information and
belief, disciplinary sanctions may also result in loss of employment.

432. Physicians must make a substantial investment to obtain a medical license in Texas.
433. According to the TMB, to be eligible for a physician’s license in Texas, individuals
must: graduate from an accredited medical school, having gained admission through a highly
competitive application process which often necessitates incurring significant amounts of debt (in
2019, an average of between $94,399 and $142,797 for students at medical schools in Texas);122
complete at least one continuous year of graduate medical training or a fellowship; pass rigorous
state examinations; practice medicine full-time for one year; and, inter alia, have no relevant
disciplinary or criminal history. 22 Tex. Admin Code § 163.2.

434. If physicians meet these requirements and incur the substantial associated costs,
they are eligible for full licensure in Texas for which they must apply. 22 Tex. Admin Code
§§ 163.2, 163.4. Once granted, a physician may practice medicine within Texas and has a vested
property interest in their license.

435. Revoking or suspending a physician’s license based on a flawed interpretation of
the Emergent Medical Condition Exception is improper interference with the physician’s vested
property interest in their license.

436. Further, sending a physician to prison for up to 99 years for providing timely and
appropriate medical care to a pregnant person with an emergent medical condition is improper
interference with the physician’s liberty.

121 Tex. Med. Bd. Press Release at 4-5, TMB Disciplines 27 Physicians at June Meeting, Adopts Rule Changes
(June 30, 2022),
https://www.tmb.state.tx.us/dl/2B28AF92-02B2-0425-2295-86E2DEAD1C51.
122 See, e.g., Medical School Debt Keeps Climbing, Tex. Med. Ass’n (April 2020), https://app.texmed.org/
tma.archive.search/files/53049/april_20_tm_educationinfographic.pdf
.
105
437. Physicians have constitutional rights under § 19 of the Texas Constitution including
rights to liberty, property, and substantive due course of law. Even for laws that only touch on
economic rights, § 19 requires a rational relationship to the purpose of the law.

438. As applied to pregnant people with emergent medical conditions and the physicians
treating them, Texas’s abortion bans fail to comply with the Texas Constitution. They do not serve
a proper legislative purpose because far from furthering life, they harm pregnant people’s lives,
and the lives of their children, without furthering potential life at all. Texas law also demands that
there be a real and substantial connection between a legislative purpose and the language of the
law as it functions in practice. For pregnant people with emergent medical conditions, there is
none. Further, for patients with emergent conditions, Texas’s abortion bans work an excessive
burden on physicians treating such patients relative to their purported purpose. See, e.g., Patel v.
Tex. Dept of Licensing & Reg., 469 S.W.3d 69, 80-81 (Tex. 2015).

CLAIMS
CLAIM I: DECLARATORY JUDGMENT
439. The allegations in paragraphs 1 through 438 above are incorporated as if fully set
forth herein.

440. Plaintiffs hereby petition the Court pursuant to the UDJA.
441. Section 37.002 of the UDJA provides that it is remedial and its purpose is to settle
and to afford relief from uncertainty and insecurity with respect to rights, status, and other legal
relations; and it is to be liberally construed and administered.

442. Under Section 37.003 of the UDJA, a court of proper jurisdiction has the power to
declare rights, status, and other legal relations, whether or not further relief is or could be claimed.
The declaration may be either affirmative or negative in form and effect and the declaration has
the force and effect of a final judgment or decree
443. Plaintiffs thus seek a declaratory judgment that the exception to Texas’s abortion
bans, codified at Tex. Health & Safety Code §§ 170A.001-002, 171.002(3), 171.203-205, permits
physicians to provide a pregnant person with abortion care when the physician determines, in their
good faith judgment and in consultation with the pregnant person, that the pregnant person has a
physical emergent medical condition that poses a risk of death or a risk to their health (including
their fertility).

444. Plaintiffs also seek a declaratory judgment that, at a minimum, Texas’s abortion
bans do not preclude a physician from providing abortion care where, in the physician’s good faith
judgment and in consultation with the pregnant person, a pregnant person has: a physical medical
condition or complication of pregnancy that poses a risk of infection, bleeding, or otherwise makes
continuing a pregnancy unsafe for the pregnant person; a physical medical condition that is
exacerbated by pregnancy, cannot be effectively treated during pregnancy, or requires recurrent
invasive intervention; and/or a fetal condition where the fetus is unlikely to survive the pregnancy
and sustain life after birth.

445. Plaintiffs have sued the State and the relevant state agencies, and that they seek to
have this Court determine the validity of Texas’s abortion bans as applied in circumstances arising
from emergent medical conditions. Therefore, the State and its agencies are necessary parties to
this suit and governmental immunity does not apply.

CLAIM II: ULTRA VIRES
446. The allegations in paragraphs 1 through 445 above are incorporated as if fully set
forth herein.

447. A state office may not act without legal authority. See, e.g., City of El Paso v.
Heinrich, 284 S.W.3d 366, 372 (Tex. 2009)
448. Any official’s enforcement of Texas’s abortion bans against any physician who
provides an abortion to a pregnant person after determining that, in the physician’s medical
judgment, the pregnant person has a physical emergent medical condition for which abortion
would prevent or alleviate a risk of death or risk to their health (including their fertility) would be
inconsistent with the Emergent Medical Condition Exception to Texas’s abortion bans and
therefore would be ultra vires.

449. Plaintiffs have sued the Defendant state officials in their official capacities, and
they seek prospective relief other than the recovery of monetary damages. Therefore,
governmental immunity does not apply.

CLAIM III: SECTION 19 RIGHTS OF PREGNANT PEOPLE
450. The allegations in paragraphs 1 through 449 above are incorporated as if fully set
forth herein.

451. Under the Texas Constitution, “[n]o citizen of this State shall be deprived of life,
liberty, property, privileges, or immunities, or in any manner disfranchised, except by the due
course of the law of the land.” Tex. Const. art. I, § 19.

452. To the extent Texas’s abortion bans bar the provision of abortion to pregnant people
to treat emergent medical conditions that pose a risk to pregnant people’s lives or health (including
their fertility), the bans violate pregnant people’s fundamental rights under Article I, § 19 of the
Texas Constitution.

453. Thus applied, Texas’s abortion bans do not serve a compelling or important state
interest and are not sufficiently tailored to serve any compelling interest.

454. Thus applied, Texas’s abortion bans also lack any rational relationship to protecting
life, health, or any other legitimate state interest
455. Plaintiffs seek a declaratory judgment that Article I, § 19 of the Texas Constitution
guarantees a pregnant person the right to an abortion where the pregnant person has an emergent
medical condition that poses a risk of death or risk to their health (including their fertility), and an
abortion would prevent or alleviate such risk.

456. Any official’s enforcement of Texas’s abortion bans as applied to a pregnant person
with an emergent medical condition for whom an abortion would prevent or alleviate a risk of
death or risk to their health (including their fertility) would be inconsistent with Article I, § 19 of
the Texas Constitution and therefore would be ultra vires.

CLAIM IV: EQUAL RIGHTS OF PREGNANT PEOPLE
457. The allegations in paragraphs 1 through 456 above are incorporated as if fully set
forth herein.

458. Under the Texas Constitution, “[a]ll freemen, when they form a social compact,
have equal rights, and no man, or set of men, is entitled to exclusive separate public emoluments,
or privileges, but in consideration of public services.” Tex. Const. art. I, § 3.

459. Texas does not prevent non-pregnant people or people unable to get pregnant from
accessing critical medical treatment nor force them to unnecessarily suffer severe illnesses and
injuries and undergo mental anguish.

460. To the extent Texas’s abortion bans bar or delay the provision of abortion to a
pregnant person with an emergent medical condition that poses a risk of death or risk to their health
(including their fertility), while allowing non-pregnant people and people unable to get pregnant
to access medical treatment for emergent medical conditions, Texas’s abortion bans violate
pregnant people’s right to equal rights.

461. Thus applied, Texas’s abortion bans do not serve a compelling or important state
interest and are not sufficiently tailored to serve any compelling interest.
462. Thus applied, Texas’s abortion bans also lack any rational relationship to protecting
life, health, or any other legitimate state interest.

463. Plaintiffs seek a declaratory judgment that Article I, § 3 of the Texas Constitution
guarantees a pregnant person the right to an abortion where the pregnant person has an emergent
medical condition that poses a risk of death or risk to their health (including their fertility), and an
abortion would prevent or alleviate such risk.

464. Any official’s enforcement of Texas’s abortion bans as applied to a pregnant person
with an emergent medical condition for whom an abortion would prevent or alleviate a risk of
death or risk to their health (including their fertility) would be inconsistent with Article I, § 3 of
the Texas Constitution and therefore would be ultra vires.

CLAIM V: EQUALITY BASED ON SEX FOR PREGNANT PEOPLE
465. The allegations in paragraphs 1 through 464 above are incorporated as if fully set
forth herein.

466. Under the Texas Constitution, “[e]quality under the law shall not be denied or
abridged because of sex, race, color, creed, or national origin.” Tex. Const. art. I, § 3a.

467. To the extent Texas’s abortion bans bar or delay the provision of abortion to a
“woman known to be pregnant to treat an emergent medical condition that poses a risk of death
or risk to their health (including their fertility), while allowing other people to access medical
treatment for emergent medical conditions, Texas’s abortion bans deny pregnant women equality
because of sex.

468. To the extent the Texass abortion bans are based on gender stereotypes that a
womans primary role is to birth children and be a mother, they constitute discrimination because
of sex.
469. Thus applied, Texas’s abortion bans do not serve a compelling or important state
interest and are not sufficiently tailored to serve any compelling interest.

470. Thus applied, Texas’s abortion bans also lack any rational relationship to protecting
life, health, or any other legitimate state interest.

471. Plaintiffs seek a declaratory judgment that Article I, § 3a of the Texas Constitution
guarantees a pregnant person the right to an abortion where the pregnant person has an emergent
medical condition that poses a risk of death or risk to their health (including their fertility), and an
abortion would prevent or alleviate such risk.

472. Any official’s enforcement of Texas’s abortion bans as applied to a pregnant person
with an emergent medical condition for whom an abortion would prevent or alleviate a risk of
death or risk to their health (including their fertility) would be inconsistent with Article I, § 3a of
the Texas Constitution and therefore would be ultra vires.

CLAIM VI: SECTION 19 RIGHTS OF PHYSICIANS
473. The allegations in paragraphs 1 through 472 above are incorporated as if fully set
forth herein.

474. Under the Texas Constitution, “[n]o citizen of this State shall be deprived of life,
liberty, property, privileges, or immunities, or in any manner disfranchised, except by the due
course of the law of the land.” Tex. Const. art. I, § 19.

475. Section 19 guarantees Texas-licensed physicians the right to practice their
profession by providing abortion to their pregnant patients to treat emergent medical conditions
that the physician determines pose a risk to the pregnant person’s life or health (including their
fertility).

476. To the extent Texas’s abortions bans bar or delay physicians from providing
abortion to treat emergent medical conditions that pose a risk to a pregnant person’s life or health
111
(including their fertility), Texas’s abortion bans violate Texas-licensed physicians’ rights under
Section 19.

477. Thus applied, Texas’s abortion bans do not serve a proper legislative purpose, there
is no real and substantial connection between a legislative purpose and the language of the abortion
bans as those bans function in practice for patients with emergent medical conditions, and Texas’s
abortion bans work an excessive burden on Texas-licensed physicians treating such patients
relative to their purpose.

478. Thus applied, Texas’s abortion bans also lack any rational basis.
479. Plaintiffs seek a declaratory judgment that Article I, § 19 of the Texas Constitution
guarantees Texas-licensed physicians the right to provide an abortion to a pregnant person to treat
an emergent medical condition that the physician determines poses a risk to the pregnant person’s
life or health (including their fertility).

480. Any official’s enforcement of Texas’s abortion bans as applied to a Texas-licensed
physician who provides an abortion to a pregnant person to treat an emergent medical condition
that the physician determines poses a risk to the pregnant person’s life or health (including their
fertility) would be inconsistent with Article I, § 19 of the Texas Constitution and therefore would
be ultra vires.

CLAIM VII: APPLICATION FOR TEMPORARY INJUNCTION
481. The allegations in paragraphs 1 through 480 above are incorporated as if fully set
forth herein.

482. Pursuant to Texas Civil Practice and Remedies Code Section 65.011 et seq.,
Plaintiffs are entitled to temporary injunctive relief against Defendants pending the full resolution
of the merits.
483. Defendants’ threatened enforcement of Texas’s abortion bans is causing imminent,
irreparable injury to Plaintiffs.

484. Plaintiffs are likely to prevail on the merits of this case and receive the requested
declaratory judgment, as well as equitable relief.

485. Plaintiffs also have no adequate remedy at law for Defendants’ threatened actions.
Specifically, money damages are insufficient to redress the threatened injury to Plaintiffs.

486. The threatened injury to Plaintiffs far outweighs any possible damages to
Defendants. Plaintiffs include women who are currently pregnant and physicians who treat
pregnant patients every day. There is no state interest that can outweigh the harm caused to patients
by being denied or delayed in accessing abortion care that could save their lives, their fertility, or
the health.

487. Accordingly, in order to preserve the status quo, Plaintiffs request that Defendants
be cited to appear, and, after a full hearing, further request that the Court enter a temporary
injunction pursuant to Texas Rule of Civil Procedure 680 et seq. and Texas Civil Practice and
Remedies Code Section 65.011 et seq.

488. Plaintiffs are willing to post a bond for any temporary injunction if ordered to do
so by the Court, but request that the bond be minimal because Defendants are acting in a
governmental capacity, have no pecuniary interest in the suit, and no monetary damages can be
shown. Tex. R. Civ. P. 684.

PRAYER FOR RELIEF
WHEREFORE, Plaintiffs ask this Court:
A. To enter a judgment against Defendants granting appropriate declaratory relief to
clarify the scope of the exception to Texas’s abortion bans consistent with the Texas
Constitution
113
B. To enter a judgment against the Defendant state officials that enforcing Texas’s
abortion bans contrary to the Court’s declaration regarding their scope would be
ultra vires;

C. To enter a judgment that Texas’s abortion bans, as applied to pregnant people with
emergent medical conditions and Texas-licensed physicians treating such patients,
violate the Texas Constitution;

D. To issue temporary and permanent injunctive relief that restrains Defendants, their
agents, servants, employees, attorneys, and any persons in active concert or
participation with Defendants, from enforcing Texas’s abortion bans or instituting
disciplinary actions related to alleged violations of the abortion bans in a manner
violating the court’s judgment;

E. To retain jurisdiction after judgment for the purposes of issuing further appropriate
injunctive relief if the Courts declaratory judgment is violated; and

F. To such other and further relief as the Court deems just and proper.
 
 
 
 
 
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