The Texas Medical Board has disciplined three doctors ProPublica previously investigated whose patients died after receiving delayed or inappropriate pregnancy care under the state’s strict abortion ban.

Two of the doctors failed to properly intervene as a pregnant teenager repeatedly sought care for life-threatening complications, the board found. The third did not provide a dilation and curettage procedure to empty a miscarrying patient’s uterus, and she ultimately bled to death.

As ProPublica investigated those preventable deaths and five others across three states in the past few years, reporters found that abortion bans have influenced how doctors and hospitals respond to pregnancy complications. Facing risks of prison time and professional ruin, doctors have delayed key interventions until they can document that a fetus’ heart is no longer beating or that a case meets a narrow legal exception. Some physicians say their colleagues are discharging or transferring pregnant patients instead of taking responsibility for their care.

Doctors and lawyers have questioned why medical boards, which oversee physician licensing and investigate substandard care, have not played a more active role in guiding doctors on how to uphold medical standards within the constraints of the law. When asked by ProPublica in 2024 what recourse miscarrying patients had when a doctor denied them necessary treatment, the president of the Texas Medical Board said it had no say over criminal law but that patients could file a complaint and “vote with their feet” to seek care from another doctor.

Since then, the Texas board has taken more steps than those in other states, publishing guidance this year that provides case studies on how doctors can legally provide abortions to patients with certain medical complications. The state Legislature ordered the board to create the training materials as part of the Life of the Mother Act, which was passed after ProPublica’s reporting and made modest adjustments to the state’s abortion restrictions in an attempt to prevent additional maternal deaths.

Georgia, where Amber Thurman died after doctors did not try to empty her septic uterus for 20 hours, has not revisited its ban or disciplined key doctors involved.

Maternal care experts say health care providers will continue to hesitate to offer standard care as long as bans carry serious criminal consequences — Texas’ law can put a physician behind bars for 99 years. But those who spoke to ProPublica say that medical board sanctions are one of the few levers that can provide a counterweight, pushing hospitals and doctors to provide standard care despite uncertainty over vaguely written laws.

Michelle Maloney, who is representing the families of both Texas patients in malpractice lawsuits, said she was pleasantly surprised by the board’s recent actions. “Over the course of my career, I’ve had many horrific, horrific death cases. For someone to get disciplined by the medical board, especially while there’s ongoing litigation, is just extraordinarily rare,” she said.

In 2024, ProPublica reported on the case of 18-year-old Nevaeh Crain, who began experiencing severe pregnancy complications when she was six months pregnant in 2023. Although she exhibited clear signs of an infection, doctors at two hospitals sent her home. On her third visit, as Crain’s condition deteriorated, a doctor did not send Crain to the intensive care unit until he could confirm fetal demise with two ultrasounds. Texas law requires doctors to create extra documentation before performing procedures that could end a pregnancy. By the time the doctor had logged there was no fetal heartbeat, the medical record shows, Crain was too unstable for surgery. She died with her fetus still in her womb.

Dr. Ali Mohamed Osman, an emergency medicine doctor who saw Crain at Baptist Hospitals of Southeast Texas during her first emergency room visit, sent her home with a prescription for antibiotics for strep throat without investigating her stomach cramps, ProPublica reported. The medical board cited him for failing to appropriately treat her infection or check the health of the fetus.

Dr. William Noel Hawkins, an OB-GYN who saw Crain at Christus Southeast Texas St. Elizabeth hospital during her second ER visit hours later, was cited for discharging Crain even though she had a 103-degree fever, screened positive for sepsis and had a fetus with an abnormally high heart rate.

For both Osman and Hawkins, the board wrote, “this delay in care ultimately resulted in the death of both the patient and her unborn child due to complications of pregnancy.”

A board spokesperson would not say whether it investigated Dr. Marcelo Totorica, who saw Crain at her third visit to an ER, at Christus, and required two fetal ultrasounds, 90 minutes apart, before wheeling Crain into the ICU for an operation. The board does not disclose open investigations or cases when a doctor has been cleared of wrongdoing. Totorica did not respond to a request for comment.

ProPublica also investigated the case of Porsha Ngumezi, who died at Houston Methodist Sugar Land Hospital in 2023 after bleeding heavily during a miscarriage at 11 weeks. An OB-GYN overseeing her care, Dr. Andrew Ryan Davis, gave her misoprostol, a medication that can be used to complete low-risk miscarriages. More than a dozen experts who reviewed the case for ProPublica, however, said that this was a high-risk case and she should have immediately been given a D&C — a procedure that has become fraught in states with abortion bans. Clearing the uterus is standard care to stop hemorrhaging; misoprostol would only make the bleeding worse, they said.

The board investigation confirmed those findings, citing Davis for failing to quantify the volume of blood loss and choosing to monitor Ngumezi’s condition instead of immediately taking her for a D&C procedure. The board wrote, “This delay in care led to the patient’s death.” It added that it could not determine if Ngumezi would have survived if she received an emergency D&C.

The board has the power to levy fines up to $5,000 and, in the most extreme cases, suspend or revoke doctors’ licenses. In these cases, however, each doctor was ordered to take eight hours of continuing education courses within a year. While under the terms of the order, all must notify any employers of the board’s findings against them. Davis and Hawkins were disciplined in October, and Osman was disciplined in March. None of the doctors or hospitals responded to requests for comment. In the medical board orders, the doctors neither admit nor deny the board’s findings and agree to comply with the discipline.

Hope Ngumezi, Porsha Ngumezi’s husband, said the board’s order felt like “a slap in the face.”

“What kind of justice is this for Porsha?” he said. “I feel like the doctor shouldn’t be practicing anymore.”

Hawkins, who failed to meet the standard of care in Crain’s case, according to the board, had previously been disciplined by the board for improper care in several other cases, including failing to provide a tubal ligation and failing to diagnose a syphilis infection. The board issued an order to have Hawkins’ medical practice monitored in 2015; it was lifted two years later.

Reproductive rights advocates welcomed the Texas board’s recent actions but said that it and medical boards in other states should do more. None of the Texas discipline orders, for example, directly sanction a doctor for failing to offer or provide an abortion for a high-risk medical condition.

The board has disciplined some doctors in recent years for failing to provide D&Cs to patients after a confirmed miscarriage or for substandard care of pregnant patients experiencing emergencies, and the orders are typically released quietly. The board could be making public statements and sharing more robust guidance to remind doctors of the consequences, said Molly Duane, the litigation director of Amplify Legal, which is part of the reproductive rights advocacy group Abortion in America.

“They should be saying loudly: This is what can happen if you don’t provide care in these circumstances,” Duane said. At the Center for Reproductive Rights, Duane represented 20 Texas women in a case against the state who alleged doctors inappropriately denied them abortions during medical emergencies. The Texas Supreme Court sided with the state and blamed doctors for misinterpreting the law. Duane is not aware of any doctors in those cases who received discipline from the board.

ProPublica reported on the deaths of other Texas women, including Josseli Barnica and Tierra Walker, which experts said could have been prevented had the women been offered abortions for their high-risk medical conditions. And data analyses by ProPublica showed that sepsis rates and blood transfusions spiked among miscarrying women after the ban went into effect — an indicator of dangerous delays in care across the state.

The board would not say whether it has opened investigations into doctors involved in those cases or any others in which pregnant patients may have received substandard care due to abortion restrictions.