The tragic death of Ciji Graham, a 34-year-old pregnant mother from North Carolina who did not receive the medical support she needed during her high-risk pregnancy, raises the question of whether state pro-life laws were at least partially to blame. While a January ProPublica report seems to suggest that the answer is “yes,” a doctor disagrees, saying the report appears to set up a false dichotomy.
“I sensed a sort of agenda behind this article to put this in a sense of ‘This is either the child or the mother,’” cardiovascular surgeon Dr. Gary Ott told WORLD News in a Feb. 10 article.
On Jan. 14, ProPublica published a report about Graham, a police officer with a 2-year-old son named SJ. It outlined how in 2023, Graham was suffering from atrial fibrillation, a rapid and irregular heartbeat, and was at risk of stroke or heart failure. Graham typically received treatment to regulate the heartbeat through a shock procedure called a cardioversion, but in November of that year, when she learned she was pregnant, the cardiologist she saw, Dr. Sabina Custovic, would not do the procedure due to the pregnancy. Graham was advised to consult three specialists and her primary care doctor and to return in a week.
Graham went home even though “her heart kept hammering,” ProPublica reported. According to several specialists ProPublica spoke with, there were multiple medical missteps that factored into Graham’s situation.
“The expert consensus is that cardioversion is safe during pregnancy, and ProPublica spoke with more than a dozen specialists who said they would have immediately admitted Graham to a hospital to get her heart rhythm under control,” the outlet reported. “They found fault, too, with a second cardiologist she saw the following day, who did not perform an electrocardiogram and also sent her home.” The second cardiologist, Dr. Will Camnitz at Cone Health, prescribed Graham a blood thinner in preparation for a cardioversion she could receive in three weeks, according to the outlet.
The doctors who refused to provide Graham with the medical help she needed did not reply to ProPublica’s inquiries about the situation.
Graham, who was about six weeks pregnant, decided an abortion would be the right next step in order to be able to secure the medical help she needed. ProPublica reported that “because of new abortion restrictions in North Carolina and nearby states, finding a doctor who could quickly perform a procedure would prove difficult,” and that abortion facilities are not designed “to treat certain medically complicated cases.”
Graham contacted A Woman’s Choice, the only abortion facility in Greensboro, and the wait line for an abortion would be about two weeks. She had an abortion scheduled for Nov. 28. However, a spokesperson for the facility told ProPublica in the report that because of Graham’s high heart rate, the facility did not have the resources she needed and thus would have been the wrong place for her to have the abortion. As she waited for the day of the scheduled abortion, she continued to suffer from chest pain and the rapid heartbeat.
On Nov. 19, 2024, Graham was found dead in her bedroom. Though an autopsy was not performed, a medical examiner listed Graham’s cause of death as “cardiac arrhythmia due to atrial fibrillation in the setting of recent pregnancy,” according to ProPublica.
ProPublica has reported on a number of tragic cases similar to Graham’s, to which pro-life advocates have often pointed out that it was misinformation, medical negligence or malpractice — not life-affirming legislation — that contributed to the death of a pregnant woman in a state with pro-life laws. ProPublica’s Jan. 14 report on Graham also spotlights a number of physicians’ commentary on where the actions of the doctors Graham saw fell short.
“High-risk pregnancy specialists and cardiologists who reviewed Graham’s case were taken aback by Custovic’s failure to act urgently,” ProPublica reported. “Many said her decisions reminded them of behaviors they’ve seen from other cardiologists when treating pregnant patients; they attribute this kind of hesitation to gaps in education. Although cardiovascular disease is the leading cause of death in pregnant women, a recent survey developed with the American College of Cardiology found that less than 30% of cardiologists reported formal training in managing heart conditions in pregnancy.”
Custovic did not comment to ProPublica about whether she thought “she had adequate training,” the outlet reported. A spokesperson at the hospital where Graham saw the second doctor commented that the hospital’s “treatment for pregnant women with underlying cardiac disease is consistent with accepted standards of care in our region.”
Graham’s death was preventable, according to several doctors who served on state maternal mortality review committees, according to the outlet.
Near the end of its report, ProPublica states, “Graham’s is the seventh case ProPublica has investigated in which a pregnant woman in a state that significantly restricted abortion died after she was unable to access standard care.”
Speaking to WORLD, Ott commented that it is standard medical practice to treat the mother with priority in situations when “it was truly mother or baby.” But in even the worst cases, when the woman is facing health problems that endanger her life, abortion isn’t necessary. An early delivery may be necessary, but even that is extreme. Ott said that the ProPublica report “[sets] up a false argument that, if we only had abortion, this wouldn’t have happened.”
Something Ott and his colleagues agreed with was that if a pregnant woman with Graham’s heart rate came to their practice, “they would quickly perform an echocardiogram to check for blood clots before moving on to stabilize her heart,” WORLD reported. He also explained that an abortion would have likely worsened the stress Graham’s was under, and that a cardioversion would not significantly put the baby at risk.
“It’s a false dichotomy,” Ott told WORLD. “It’s making a choice between two extremes that don’t have to exist because the obvious right thing to do here was to treat the mom properly, and mother and baby would both be healthy.”
Dr. Ingrid Skop, Texas-based OB-GYN and vice president and director of medical affairs at the Charlotte Lozier Institute, told WORLD that in extremely rare cases, an OB-GYN may determine that ending a woman’s pregnancy — such as by inducing labor before viability — will be a necessary but unintended effect of life-saving treatment for the mother. This would not constitute an abortion, she explained.
“The intent of the doctor is to protect the mother’s life. It’s not to end the child’s life,” she said.
Dr. Jeffrey Barrows, a retired OB-GYN from Ohio, told WORLD that most hospitals’ protocols for treating pregnant women with life-threatening complications are not obscure. He also said that as medicine becomes increasingly specialized, “some doctors are becoming less willing to treat patients with conditions that fall outside their standard practice,” due to fear of a lawsuit, WORLD reported.
Skop also commented to WORLD that in Texas, where life-affirming laws are very strict, some doctors may not have a full understanding of what protections they have in their practice, due to a lack of ongoing education from state and national medical boards.
“Unfortunately, many of the large mainstream medical organizations are pro-choice,” Skop added, “and they would like to see the laws fail. When they have weighed in on the issue, it has sometimes been in order to confuse the doctors more.”