AUSTIN (Nexstar) — On the second day in court over a lawsuit regarding exceptions to Texas’ near-total abortion ban, one doctor refuted other physicians’ claims that the law is confusing, saying doctors who do not provide abortions when a patient has severe pregnancy complications are misunderstanding the law.

The two-day hearing concluded Thursday, with mostly expert witnesses testifying on the second day in court.

The Center for Reproductive Rights filed the lawsuit in March on behalf of 15 Texas women who said the law put their lives in danger. Attorneys called two out-of-state physicians as witnesses Thursday, who both said they found the language about exceptions in Texas’ abortion law to be confusing.

Current Texas abortion laws

Once the U.S. Supreme Court overturned Roe v. Wade last summer, Texas was one of 13 states where abortion bans were automatically instated. Texas’ trigger law prohibits all abortions except under limited circumstances, such as a “life-threatening condition to the mother caused by the pregnancy.” Physicians who perform an abortion outside of these circumstances could be subject to a sentence of up to life in prison and at least a $100,000 fine for each offense.

Authors of the legislation said the state’s trigger law works in concert with Texas’ 2021 law, known as Senate Bill 8 — which allows private citizens to sue providers or anyone who aids and abets abortions that occur after six weeks.

The lawsuit does not seek to overturn the laws altogether. Instead, plaintiffs are asking the court to allow physicians to make exceptions to Texas laws and to clarify under what circumstances they can do so.

Physician testimony

The plaintiffs’ second witness, Dr. Ali Shahbizraja — an emergency physician at Massachusetts General Hospital — said there is a medical distinction between when a patient’s diagnosis presents an immediate threat to life and when a diagnosis could become life-threatening in the future.

“My opinion is that the laws as they’re currently written — the medical exceptions — they’re confusing. And that confusion and lack of clarity is keeping physicians from being able to exercise their good faith judgment in the treatment of patients,” he said. “It also is pretty evident that the fact is that the consequences of those laws are severe…as a consequence of that, they are going to, they’re going to and patients where there’s a gray zone, and there’s a lack of clarity, they’re going to err on the side of not treatment.”

Another expert the plaintiffs’ called, Dr. Aaron Caughey — a maternal fetal medicine specialist in Oregon — concurred with Shabizraja’s interpretation of the challenges Texas physicians are presented with.

“Risk of death, does that just mean above zero? Is there some threshold? How much risk? What is the timing of the risk? All these things matter and I think could really vary by interpretation by different clinicians,” Caughey said. “And I think that’s what makes this medical exception so challenging to interpret.”

The state’s expert witness, Dr. Ingrid Skop — a Texas OB-GYN, argued that “the law is clear,” and suggested physicians who are fearful of making a wrong decision “haven’t read the law carefully.”

“They should have known they could offer intervention in that situation, they did not need to wait until women were on the verge of dying and going to the ICU before they intervened,” she said — referring to the women’s testimony about being denied abortion care in Texas despite facing severe risks. added in reference to reports of women who have been in life-threatening situations after not being able to get an abortion in Texas.

Emotional testimony marks first day of hearing

The issue of exceptions to Texas’ near-total abortion ban are in state court for a second day, after a long day of testimony Wednesday from some of the women who are suing the state, saying the laws put their lives, and their babies, at risk.

During the often emotional testimony, the women shared stories of how they were unable to get a medical abortion during their pregnancies, despite having severe risks to their lives. At one point, the judge called a recess after one of the women got physically ill on the witness stand while recounting her experience of having to carry her baby to term — even though doctors told her halfway through her pregnancy that her daughter had no chance of survival.

Samantha Casiano testified that doctors diagnosed her baby with a rare birth defect called anencephaly — in which parts of the skull and brain are missing. Often in tears, Casiano said doctors told her they could not perform an abortion in Texas due to the state’s laws. She testified that once she finally gave birth to her daughter, she had to watch her “suffocate” for hours before dying.

“I just wanted to tell my baby I’m so sorry that I couldn’t help her and release her going to heaven sooner rather than later. I felt so bad. She had no mercy–there was no mercy for her and I couldn’t do anything,” she said.

State defense of its abortion laws

In court Wednesday, Amy Pletscher — assistant Texas attorney general — said that the law is already clear about what exceptions are allowed, saying physicians should not be afraid of prosecution if they follow the law.  

“Plaintiffs simply do not like Texas’s restrictions on abortion. Although as this Court well knows the purpose of the courts is not to legislate nor to issue advisory opinions,” she said during opening statements Wednesday.

Pletscher also argued the women are not suing the proper entity, asking women during their testimony if the attorney general or lawmakers directly told them they cannot get an abortion, suggesting instead the women should be suing physicians for not providing the care they needed.

After closing arguments, District Judge Jessica Mangrum said it could take “weeks” for her to rule on plaintiffs’ request for an injunction.