AUSTIN, Texas (CN) — The Texas Supreme Court heard arguments Tuesday in a case brought by women and doctors seeking clarification as to when an abortion is permitted under medical exemptions to the state's various anti-abortion statutes.
Several plaintiffs in the case are women who believe the state's laws banning abortion put their lives at risk. Physicians in Texas refused to perform the procedure despite knowing the babies would not survive the pregnancy, putting them at risk of infection and impairment to their reproductive organs.
Other plaintiffs include physicians who feel the state’s laws have restrained them from providing what they believe to be necessary medical care to patients. The Center for Reproductive Rights brought the case on behalf of the plaintiffs.
Abortion has been effectively banned in the state since 2021 with the passage of Senate Bill 8, the state's six-week ban. After the U.S. Supreme Court ended the constitutional right to abortion in 2022, a separate law criminalizing abortion as a whole took effect. These laws do not provide exceptions in cases of rape or incest, but do however provide an exemption in cases where a "physician believes a medical emergency exists."
Physicians found to have violated these statutes face up to 99 years in prison, revocation of their medical license and a $100,000 fine. Additionally, any person who provided or helped provide an abortion may be sued under a civil statute by private citizens for a minimum of $10,000.
This legal landscape has led abortion providers and physicians to refuse to provide the procedure despite the exceptions in cases where the life of the mother is at risk, for fear of being targeted by prosecutors.
Tuesday’s oral arguments centered on whether a lower court’s temporary injunction in the case was proper.
On Aug. 4, Travis County District Court Judge Jessica Mangrum issued a temporary injunction, instituting a new standard for physicians to follow when considering the medical exemption. Furthermore, she denied the state’s motions to dismiss the case on the grounds that the plaintiffs lack standing and their claims are barred by sovereign immunity. The state immediately filed an accelerated appeal to the Texas Supreme Court, instantly staying the injunction.
Arguments began with Assistant Texas Attorney General Beth Klusmann outlining why the injunction should be overturned.
She told the nine-member, all-Republican, high court that the lower court “overstepped” its authority. Klusmann said that based on the statutes as they are written, “[doctors] are allowed to use reasonable medical judgment… in any given circumstance.”
She argued the injunction laid out a broad set of standards that would allow a doctor to provide an abortion even when a mother’s life is not at risk, flying in the face of the clear intent of the statutes. While the plaintiffs have argued the courts should allow doctors based on their “good faith judgment” to provide abortions to save the lives of patients, Klusmann said that the standard is and should remain based on the doctors’ reasonable medical judgment.
“When we are looking to reasonable medical judgment, you can look to what other doctors have said, you can look to what medical societies have said and what a hospital's policy is in order to determine what is objectively reasonable in that circumstance,” Klusmann told the justices.
Touching on the lack of standing and sovereign immunity claims made by the state, Justice Jeff Boyd asked Klusmann why she believes the plaintiffs' claims were improper. She explained that being denied an abortion is not an injury inflicted by the state attorney general or the Texas Medical Board — it is a decision made by the doctor.
“So she should have sued the doctor?" Boyd asked, to which Klussmann answered: “Another way to resolve some of this or bring clarity is through medical malpractice claims."
The question of who is to blame for the harm sustained by the plaintiffs continued as Molly Duane, senior staff attorney at the Center for Reproductive Rights, began fielding questions from the justices.
Justice Debra Lehrmann asked Duane whether doctors should be sued rather than the state.
“None of the plaintiffs blame their doctors,” Duane said. “Only the state or a court of this state can provide an interpretation of the statute that is actually enforceable. A hospital can tell its physicians what it thinks the statute means, but it cannot prevent the attorney general from going after a physician for violating the statute.”
Shifting to the injunction itself, Justice Jimmy Blacklock wondered whether it would open the door for people with common health conditions such as obesity and high blood pressure to get an abortion. Duane sought to distinguish between those health conditions and those that if left untreated may become emergent, life-threatening, and requiring intervention.
Justice Brett Busby asked why the injunction is necessary if the plaintiffs believed they were covered under the medical exemption. Duane answered the injunction is needed to the medical exemption into language they understand and clearly outlines what is and is not permissible.
Duane ended her time by asking the justices to “end the daily suffering of patients… and affirm that physicians can use their good faith judgment to provide abortions to their patients when it is medically necessary.”
The justices did not indicate when or how they would rule, though a ruling is expected no later than June.
When the lawsuit was initially filed in March, only five women and two physicians were named in the suit. As the case has progressed more women who shared a similar experience have come forward and joined in the case. Seven more women joined the suit earlier this month, bringing the total number of plaintiffs to 22.
The Center for Reproductive Rights has filed similar lawsuits in Idaho, Tennessee and Oklahoma, arguing that those states' abortion restrictions have also placed pregnant women at greater risk.
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