totalyNOTaPIRATE [none/use name]

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Cake day: April 1st, 2024

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  • Wtf

    Democrats eye Harris 2028 presidential run as they devise political comeback Party aides are confident in US vice-president’s ability to bounce back, including a bid for California governor emocratic party aides have begun to float ideas for a Kamala Harris political comeback, reportedly eyeing another run at the US’s highest office even as the party continues to grapple with the electoral messages contained in the vice-president’s decisive defeat in November’s White House race against Donald Trump.

    Harris, who has reportedly not ruled out a second run for the presidency, is now reported to be considering a run for the California governorship, currently held until 2027 by Gavin Newsom. Newsom was a rumoured presidential contender during the chaotic summer that saw Joe Biden step down from a rematch with Trump – whom he defeated in the 2020 election – and then endorse Harris as his replacement.

    According to the Washington Post on Monday, some Democratic party aides believe Trump – who, among other things, overcame a criminal conviction and other such charges to win – has sufficiently overturned the norms of losing White House candidates’ not attempting a second bite at the proverbial apple to give Harris the opportunity of a repeat bid in 2028, this time for the full cycle.

    “Since Donald Trump has rewritten the rules – the norms – I don’t believe Kamala Harris or anyone should try to go with precedent, ever,” said Donna Brazile, a Harris ally, Al Gore 2000 presidential campaign manager and political commentator. “There are no rule books.”

    Molly Murphy, a pollster who worked on the both the Biden and Harris campaigns, told the outlet: “The rules potentially don’t apply this time, and she still absolutely could have a mulligan because of the unique circumstances of this race and the candidate switch.

    “But I don’t think it will be a given.”

    The sentiment that Harris could make another bid for the White House comes as the Democratic party is sculpting an argument that her loss to Trump was not as comprehensive as has been popularly portrayed. She emerged from her three-month, $1.5bn campaign with higher approval ratings than she entered it, according to the political website 538, though she lost the electoral college 312-226 and became the first of three candidates to lose the popular vote to Trump.

    “She is ending this race in a very different place than other nominees that have lost,” one Harris adviser told the outlet. “Her approval is higher. People were very happy with the race that she ran.”

    Supporters further point to unequal political consequences for male and female candidates following a ballot box loss. Hillary Clinton did not attempt another run after losing to Trump in 2016, handing the Democratic torch to one-term president Biden.

    Debbie Walsh, director of the center for American women and politics at Rutgers University, told the Post, “landing in general has kind of been harder for women”, noting that women who served at state level positions “don’t get the soft landing of a position in a law firm that allows them to regroup and earn some money and maybe run for something else. They struggle a bit.”

    But as Harris considers her future – husband Doug Emhoff is returning to entertainment law – donors and supporters in California, where she served as a US senator and state attorney general, are pushing for a run for governor in 2026 to replace who would then be the outgoing, term-limited Newsom.

    “The people that drove that conversation – within 18 minutes of the election being called – was the finance team,” one Harris confidante told the outlet.

    If Harris, who beat Trump by 20 points in California, runs for and wins the governorship, she would become the nation’s first Black female governor, a considerable consolation prize.

    But other Democrats are also considering both races. For president, Newsom as well as fellow governors JB Pritzker of Illinois and Gretchen Whitmer of Michigan are said to be getting into position.

    Harris campaign aides acknowledge the competition but say her name recognition, coupled with donors and experience as well as a conviction that she was dragged by Biden’s unpopularity, opens the starting gate for a comeback.

    It’s almost Shakespearean that Joe Biden didn’t just kill his own campaign – he killed hers, too,” a Harris campaign adviser told the Post.

    Meanwhile, California congresswoman Katie Porter, a potential state governor candidate, diplomatically told the outlet: “I am certain that everyone will want to support Kamala Harris in continuing to serve this country.”

    Harris herself has not revealed her thinking but is said to be “processing” her loss and plans to “stay in the fight”.

    “The fight that fueled our campaign – a fight for freedom and opportunity – that did not end on November 5,” Harris said on a call with donors and supporters in November.

    Harris ultimately used the word “fight” 19 times during that call.

    That last sentence killed me inside. My day is ruined.










  • Time is a flat circle

    "The US Central Command said its forces conducted dozens of airstrikes on Islamic State targets in central Syria on Sunday

    In a statement, the Centcom said its strikes were aimed to ensure that the Islamic State does not take advantage of the current situation in Syria.

    “Battle damage assessments are underway, and there are no indications of civilian casualties,” reads a statement by Centcom posted on X.

    “There should be no doubt – we will not allow Isis to reconstitute and take advantage of the current situation in Syria,” said Gen Michael Erik Kurilla.

    “All organizations in Syria should know that we will hold them accountable if they partner with or support Isis in any way,” Kurilla added."


  • Nazi Germany Amnesty International says: "Treblinka,Sobibor? Never heard of"

    Amnesty International’s Israel branch has distanced itself from the rights group’s allegation that Israel was committing “genocide” in Gaza, but said “serious crimes” were potentially taking place that needed investigation.

    The local branch, which operates as a separate charity from the international organisation, said in a statement: “While the Israeli section of Amnesty International does not accept the accusation that Israel is committing genocide, based on the information available to us, we are concerned that serious crimes are being committed in Gaza, that must be investigated.” Israeli soldiers in the southern Gaza Strip Israel’s war in Gaza amounts to genocide, Amnesty International report finds Read more

    The 296-page report, examining events in Gaza between October 2023 to July 2024, found that Israel had “brazenly, continuously and with total impunity … unleashed hell” on the strip’s 2.3 million population, noting that the “atrocity crimes” against Israelis by Hamas on 7 October 2023, which triggered the war, “do not justify genocide”.

    While its publication was largely welcomed by Palestinians and humanitarian groups, it was met with fury in Israel. “The deplorable and fanatical organisation Amnesty International has produced a fabricated report that is entirely false and based on lies,” Israel’s foreign ministry said in a statement.

    The United States said it disagreed with the conclusions of the report. “We have said previously and continue to find that the allegations of genocide are unfounded,” State Department spokesman Vedant Patel told reporters.

    Multiple attempts to broker a ceasefire and hostage release deal in the war in Gaza, now raging for 14 months, have failed, although mediator Qatar said on Thursday it would resume its role, raising tentative hopes that progress could be made in fresh negotiations.

    Egypt, another major mediator, has put forward a proposal involving a temporary ceasefire lasting 45-60 days, with a staged hostage release and prisoner swap. A Hamas delegation met with Egyptian negotiators in Cairo earlier this week, and Israel is considering sending its own delegation in the next few days – the most movement on talks since the last round collapsed in August.

    The Egyptian proposal also suggests that the West Bank-based Palestinian Authority take control of the Rafah crossing between Gaza and Egypt, which Israel seized in May, and a substantial increase in the supply of aid. An average of 50 trucks entered Gaza through the Kerem Shalom crossing with Israel in November, UN data shows. Aid agencies say at least 500 are needed to meet the population’s needs amid a dire humanitarian crisis and the approach of winter.

    In Gaza, at least 39 people were killed by Israeli fire in the preceding 24 hours, according to medics, including at least 20 who died when an overnight airstrike set alight cooking gas canisters and tents tents housing displaced families in what Israel has dubbed a “humanitarian zone”. Israel said the strike targeted senior Hamas operatives, whom it did not identify.

    Other Israeli strikes reported on Thursday hit Gaza City, where medics said an airstrike destroyed a house where an extended family had taken shelter and damaged two nearby homes, killing at least three people.

    Residents searched for loved ones and belongings among the charred wreckage in Mawasi, a coastal area in the south of the strip, where hundreds of thousands of people have been forced to seek shelter.

    At a funeral for those killed in Mawasi in nearby Khan Younis, Abu Anas Mustafa told Reuters that the Amnesty report was “a victory for Palestinian diplomacy”, although he said it “came late”.

    “It is the 430th day of the war today, and Israel has been carrying out massacres and a genocide from the first 10 days of the war,” he said.


  • Amnesty late as aways

    A report from Amnesty International alleges that Israel’s war against Hamas in the Gaza Strip constitutes the crime of genocide under international law, the first such determination by a major human rights organisation in the 14-month-old conflict.

    The 32-page report examining events in Gaza between October 2023 to July 2024, published on Thursday, found that Israel had “brazenly, continuously and with total impunity … unleashed hell” on the strip’s 2.3 million population, noting that the “atrocity crimes” against Israelis by Hamas on 7 October 2023, which triggered the war, “do not justify genocide”.

    Israel has “committed prohibited acts under the Genocide Convention, namely killing, causing serious bodily or mental harm, and deliberately inflicting on Palestinians in Gaza conditions of life calculated to bring about their physical destruction” with the “specific intent to destroy Palestinians” in the territory, the report said.

    It marks the first time Amnesty has alleged the crime of genocide during an ongoing conflict, and builds on a March report by the UN special rapporteur for Palestine that concluded “there are reasonable grounds to believe” Israel was committing genocide against Palestinians.

    “Our damning findings must serve as a wake-up call: this is genocide and it must stop now,” Agnès Callamard, the group’s secretary general, said in a news conference on Wednesday.

    Amnesty cited the deliberate obstruction of aid and power supplies together with “massive damage, destruction and displacement”, leading to the collapse of water, sanitation, food and healthcare systems, in what it called a “pattern of conduct” within the context of the occupation and blockade of Gaza.

    “We did not necessarily start out thinking we would come to this conclusion. We knew there was a risk of genocide, as the international court of justice said,” Budour Hassan, Amnesty’s Israel and occupied Palestinian territories researcher, told the Guardian. “When you join the dots together, the totality of the evidence, it is not just violations of international law. This is something deeper.”

    The main allegations in the report are:

    The unprecedented scale and magnitude of the military offensive, which has caused death and destruction at a speed and level unmatched in any other 21st-century conflict;
    
    Intent to destroy, after considering and discounting arguments such as Israeli recklessness and callous disregard for civilian life in the pursuit of Hamas;
    
    Killing and causing serious bodily or mental harm in repeated direct attacks on civilians and civilian infrastructure, or deliberately indiscriminate attacks; and
    
    Inflicting conditions of life calculated to bring about physical destruction, such as destroying medical infrastructure, the obstruction of aid, and repeated use of arbitrary and sweeping “evacuation orders” for 90% of the population to unsuitable areas.
    

    As an occupying power, Israel is legally obliged to provide for the needs of the occupied population, Kristine Beckerle, an adviser to Amnesty’s Middle East and North Africa team, said on Wednesday. She described Israel’s May offensive on Rafah, until then the last place of relative safety in the strip, as a major turning point when it came to establishing intent.

    “[Israel] had made Rafah the main aid point, and it knew civilians would go there. The ICJ ordered them to stop and they went ahead anyway,” she said. “Rafah was key.”

    At least 47 people including four children were killed in air strikes across Gaza on Tuesday, according to health officials in the territory, including at least 21 who were sheltering in tent camp housing displaced people near the city of Khan Younis. The Israeli military said it had targeted Hamas militants.

    Amnesty has called on the UN to enforce a ceasefire, impose targeted sanctions on Israeli and top Hamas officials, and for western governments such as the US, the UK and Germany to stop providing security assistance and selling arms to Israel.

    The rights group has also urged the international criminal court, which last month issued arrest warrants for the Israeli prime minister, Benjamin Netanyahu, and the former defence minister Yoav Gallant, to add genocide to the list of war crimes it is investigating.

    Finally, it called for the unconditional release of civilian hostages and for “Hamas and other Palestinian armed groups responsible for the crimes committed on 7 October to be held to account”.

    The report, You Feel Like You Are Subhuman’: Israel’s Genocide Against Palestinians in Gaza, is likely to be met with outrage in Israel and generate accusations of antisemitism. Several legal experts and genocide studies scholars contend that the 7 October attack was also genocidal.

    The Holocaust led to the creation of the Jewish state and the Geneva conventions, which codified and outlawed genocide as a punishable crime. Both initiatives were the international community’s “never again” response to the horrors inflicted on European Jews by the Nazis in world war two.

    In its conclusion, the report says that Amnesty “recognises that there is resistance and hesitancy among many in finding genocidal intent when it comes to Israel’s conduct in Gaza”, which has “impeded justice and accountability”.

    “Amnesty International concedes that identifying genocide in armed conflict is complex and challenging, because of the multiple objectives that may exist simultaneously. Nonetheless, it is critical to recognise genocide, and to insist that war can never excuse it,” it states.

    Amnesty said the report was based on fieldwork, interviews with 212 people, including victims, witnesses and healthcare workers in Gaza, analysis of extensive visual and digital evidence, and more than 100 statements from Israeli government and military actors it said amounted to “dehumanising discourse”. It also used video and photo evidence of soldiers committing or celebrating war crimes.

    Israel’s acts in Gaza were examined “in their totality, taking into account their recurrence and simultaneous occurrence, and both their immediate impact and their cumulative and mutually reinforcing consequences”, it said. Findings were shared “extensively” on multiple occasions with Israeli authorities, the group added, but were not met with responses.

    Thursday’s publication builds on the London-based rights group’s previous bold positions on Israel’s occupation of the Palestinian territories. In 2022, Amnesty joined Human Rights Watch and the respected Israeli NGO B’Tselem in issuing a major report accusing Israel of apartheid, as part of a growing movement to redefine the Israeli-Palestinian conflict as a struggle for equal rights rather than a territorial dispute. Israeli politicians called for the report to be withdrawn, alleging antisemitism.


  • South korea update

    • The Yonhap News Agency is reporting that members of the national assembly have been banned from entering the building, with the South Korean military having reportedly announced the suspension of all parliamentary activity. We have not yet independently verified this information. The parliament speaker is traveling to parliament and plans to convene a session, according to local broadcaster YTN TV.

    -The US, south Korea’s most powerful ally, has not yet commented on the martial law declaration. About 28,500 American troops are stationed in south Korea to guard against north Korea, led by Kim Jong Un.

    • Here is a statement from martial law commander Park An-su.

    He said:

    All political activities are banned in South Korea following the imposition of martial law on Tuesday and all media will be subject to government monitoring.
    
    All political activities, including those of the national assembly, local councils, political parties, and political associations, as well as assemblies and demonstrations, are strictly prohibited.
    
    All media and publications shall be subject to the control of the martial law command.
    

    With martial law imposed, all military units in the south, which remains technically at war with the nuclear-armed north, have been ordered to strengthen their emergency alert and readiness postures, Yonhap news agency reported. Under south Korean law, lawmakers cannot be arrested by the martial law command and the government has to lift martial law if the majority of the national assembly demands it in a vote. The leader of the prime minister’s own conservative party, Han Dong-hoon, has vowed to stop the imposition of the law “with the people” and Lee Jae-myung, the leader of the opposition Democratic party, which has a majority in parliament, has also expressed opposition to it.

    A taxi driver in Seoul who asked to remain anonymous for fear of reprisal said: “They’re using exactly the same methods they used in the Park Chung-hee and Chun Doo-hwan eras … Whenever their regime is in crisis, they use war-mongering and martial law to cover it up.”

    Park and Chun were military dictators in South Korea between 1961 and 1988. “I never imagined this would happen again,” the taxi driver said.

    -South Korean markets started reacting to the news. The won tumbled to the lowest level against the dollar in two years: 1,443 won per dollar.

    -The Chinese Embassy in Korea told Chinese citizens in the country to remain calm and pay attention to political changes. It asked them to “strengthen safety awareness, reduce unnecessary outings, express political opinions with caution and abide by the official decrees issued by Korea.”

    -Live video broadcast by state news media shows soldiers pushing against citizens who are trying to enter the National Assembly building.



  • Reuters and guardian algo are reporting:

    Israeli tanks fire on southern Lebanon as officials says ceasefire with Hezbollah violated

    Israeli tank fire hit six areas in southern Lebanon on Thursday and the Israeli military said its ceasefire with Hezbollah was breached after what it called suspects, some in vehicles, arrived at several areas in the southern zone, reports Reuters.

    A ceasefire between Israel and Lebanese armed group Hezbollah took effect on Wednesday under a deal brokered by the US and France, intended to allow people in both countries to start returning to homes in border areas.

    The Israeli military had urged residents of towns along the border strip not to return yet for their own safety.

    On Thursday morning, Israeli tank fire hit six areas within that border strip, state media and Lebanese security sources said. The rounds struck Markaba, Wazzani and Kfarchouba, Khiyam, Taybe and the agricultural plains around Marjayoun, all of which lie within two kilometres of the blue line demarcating the border between Lebanon and Israel. One of the security sources said two people were injured in Markaba.

    Reuters reports that Lebanese families displaced from their homes near the southern border have tried to return to check on their properties. But Israeli troops remain stationed within Lebanese territory in towns along the border and Reuters reporters heard surveillance drones flying over parts of southern Lebanon.

    There was no immediate comment on the tank rounds from Hezbollah or Israel, said Reuters.

    Hezbollah has said its fighters “remain fully equipped to deal with the aspirations and assaults of the Israeli enemy.” Its forces will monitor Israel’s withdrawal from Lebanon “with their hands on the trigger”, Reuters reports.


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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


  • A Third Woman Died Under Texas’ Abortion Ban. Doctors Are Avoiding D&Cs and Reaching for Riskier Miscarriage Treatments. Thirty-five-year-old Porsha Ngumezi’s case raises questions about how abortion bans are pressuring doctors to avoid standard care even in straightforward miscarriages. by Lizzie Presser and Kavitha Surana. PROPUBLICA Wrapping his wife in a blanket as she mourned the loss of her pregnancy at 11 weeks, Hope Ngumezi wondered why no obstetrician was coming to see her.

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

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

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

    Three hours later, her heart stopped.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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