The Texas Medical Board has taken disciplinary action against three physicians whose delayed or inappropriate care contributed to the deaths of two pregnant women in 2023, according to board records reviewed by multiple news organizations. The sanctions follow investigations into cases that drew national attention amid ongoing debate over how state abortion restrictions affect emergency maternal care.
The board found that two doctors failed to adequately respond when an 18-year-old patient, Nevaeh Crain, repeatedly sought treatment for life-threatening complications during her pregnancy. A third physician was cited for not performing a dilation and curettage (D&C) procedure on a patient experiencing a high-risk miscarriage, which medical experts say could have prevented fatal hemorrhaging. In both cases, the board determined that delays in care directly contributed to maternal deaths.
These actions represent some of the few instances in which a state medical board has penalized physicians for care delays linked to abortion bans, a development that reproductive health advocates say underscores the need for clearer clinical guidance amid legal uncertainty. While the penalties imposed—primarily mandatory continuing education—are relatively modest, experts note that any board sanction carries professional weight and may influence hospital protocols moving forward.
Board Findings Cite Specific Failures in Patient Monitoring and Intervention
In the case of Nevaeh Crain, who was six months pregnant when she first sought care in September 2023, the Texas Medical Board determined that Dr. Ali Mohamed Osman, an emergency medicine physician at Baptist Hospitals of Southeast Texas, failed to properly evaluate her symptoms during an initial ER visit. Board records indicate he discharged her with a diagnosis of strep throat without assessing abdominal pain or fetal wellbeing, despite her reporting severe cramping.
Hours later, Crain returned to a different facility—Christus Southeast Texas St. Elizabeth Hospital—where she was seen by Dr. William Noel Hawkins, an OB-GYN. According to the board’s findings, Hawkins discharged her despite documented signs of sepsis, including a 103-degree fever and abnormal fetal heart rate. The board concluded that this failure to admit and treat her condition constituted a deviation from the standard of care.
On her third visit, Crain was again seen by Hawkins, who ordered two fetal ultrasounds 90 minutes apart before transferring her to intensive care. By the time fetal demise was confirmed, her condition had deteriorated to the point where surgery was no longer viable. She died with the fetus still in utero. The board stated that “this delay in care ultimately resulted in the death of both the patient and her unborn child due to complications of pregnancy” for both Osman and Hawkins.
In a separate case, Dr. Andrew Ryan Davis, an OB-GYN at Houston Methodist Sugar Land Hospital, was found to have deviated from standard practice when treating Porsha Ngumezi, who experienced a miscarriage at 11 weeks gestation in April 2023. Although Davis administered misoprostol—a medication appropriate for low-risk pregnancy loss—the board determined that Ngumezi’s case involved significant hemorrhaging requiring immediate surgical intervention. Board records show he did not quantify blood loss or proceed with a D&C, instead opting for observation. The patient died from excessive bleeding.
The board wrote that “this delay in care led to the patient’s death,” though it noted it could not definitively conclude whether survival would have been possible with earlier intervention. Davis was ordered to complete eight hours of continuing education within one year and notify his employer of the sanction.
Disciplinary Actions Reflect Limited Scope of Board Authority Amid Legal Constraints
All three physicians received identical sanctions: mandatory completion of eight hours of continuing medical education within 12 months and a requirement to inform current and future employers of the board’s findings. The orders, issued in March 2024 for Osman and October 2024 for Hawkins and Davis, do not include fines, license suspensions, or revocations. The physicians neither admitted nor denied the allegations but agreed to comply with the terms.
Under Texas Occupations Code § 164.052, the medical board may impose penalties including fines up to $5,000, probation, practice restrictions, or license suspension or revocation for unprofessional conduct. However, in these cases, the board opted for educational remediation, a choice that has drawn criticism from patient advocates who argue the response does not match the severity of the outcomes.
Hope Ngumezi, Porsha’s husband, publicly criticized the sanction as inadequate, stating in interviews with news outlets that the order felt like “a slap in the face” and expressing belief that Davis should no longer be permitted to practice medicine. Similar sentiments were echoed by legal representatives for the families, who noted that medical board sanctions during active litigation are exceptionally rare.
The board’s actions come amid broader scrutiny of how Texas’ abortion ban—enacted under Senate Bill 8 in 2021 and later reinforced by trigger laws following the overturning of Roe v. Wade—affects clinical decision-making. Physicians have reported delaying interventions until they can confirm fetal demise or navigate narrow legal exceptions, fearing criminal prosecution under statutes that permit sentences of up to life imprisonment for providing an abortion.
Guidance Issued After Criticism, But Gaps Remain in Clinical Direction
In response to criticism that medical boards have not done enough to clarify physicians’ obligations under conflicting state and federal mandates, the Texas Medical Board published training materials in early 2024 on managing pregnancy complications within legal boundaries. The guidance, developed under legislative direction from the Life of the Mother Act (Senate Bill 24, 88th Legislature), includes case studies intended to illustrate when interventions such as D&C or abortion-inducing medications are permissible.
The Life of the Mother Act, signed into law in June 2023, amended existing abortion restrictions to clarify exceptions for conditions posing a risk of death or “substantial impairment of major bodily function.” However, critics argue the language remains vague, particularly around what constitutes an imminent threat, leaving physicians to interpret standards without clear clinical thresholds.
Reproductive rights legal advocates, including representatives from the Center for Reproductive Rights and Amplify Legal, have acknowledged the board’s guidance as a step forward but stressed that it does not proceed far enough. They note that the materials do not explicitly address scenarios where terminating a pregnancy is medically indicated to preserve maternal health—a gap they say leaves doctors vulnerable to legal risk even when following accepted medical practice.
Molly Duane, litigation director at Amplify Legal, stated that medical boards should issue stronger public statements reinforcing that failure to provide standard emergency care—such as timely D&C for hemorrhaging or antibiotics for sepsis—can result in disciplinary action, regardless of abortion-related legal concerns. She emphasized that boards have a duty to uphold medical standards independent of criminal statutes.
National Patterns Emerge in Maternal Morbidity Data Post-Ban Implementation
Analysis of hospital discharge data by researchers and journalists has shown increases in sepsis diagnoses and blood transfusions among pregnant patients experiencing miscarriage in Texas since the near-total abortion ban took effect in September 2021. These trends, observed across multiple studies, suggest systemic delays in care that may be contributing to preventable morbidity.
Similar patterns have been documented in other states with restrictive abortion laws, including Georgia, where Amber Thurman died in 2022 after a septic miscarriage went untreated for over 20 hours. Despite public outcry, the Georgia Composite Medical Board has not taken disciplinary action against the physicians involved in her case, according to board records and reporting from investigative outlets.
Experts in maternal-fetal medicine warn that without clearer protections for physicians acting in quality faith to stabilize patients, hospitals may continue to see avoidable complications arising from delayed intervention. They recommend that state medical boards strengthen oversight, increase transparency in investigations, and collaborate with clinical experts to develop evidence-based guidelines that align with both safety standards and legal requirements.
As of now, the Texas Medical Board has not announced whether it has opened investigations into other cases involving maternal deaths linked to delayed care under the abortion ban. The board maintains a policy of not disclosing open investigations or cases where no wrongdoing is found, limiting public visibility into its enforcement activities.
For updates on ongoing investigations or future guidance from the Texas Medical Board, the public can consult the board’s official website and meeting agendas, which are posted in accordance with state open meetings laws. Individuals seeking to file a complaint against a physician may do so through the board’s online portal.
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