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Denied abortion for a doomed pregnancy, she tells Texas court: 'There was no mercy'

Samantha Casiano told a Texas courtroom that she should have been able to let her daughter, who had anencephaly, "go to rest sooner."
Danielle Villasana for NPR
Samantha Casiano told a Texas courtroom that she should have been able to let her daughter, who had anencephaly, "go to rest sooner."

Updated July 20, 2023 at 7:17 AM ET

AUSTIN, Texas – Samantha Casiano, who gave birth to a baby who lived just four hours, broke down and became physically ill on the witness stand as she told the story of her doomed pregnancy in an Austin, Texas, courtroom on Wednesday. Her husband, Luis Villasana, rushed to the front of the courtroom to help her, during a hearing in a case challenging the abortion bans in Texas.

Casiano was one of three women who gave dramatic testimony about their pregnancies in a hushed and spellbound courtroom in the case brought by the Center for Reproductive Rights. The case, on behalf of 13 patients and two doctors, argues that the medical exceptions to Texas' laws are unclear and unworkable for doctors in ways that harm patients. They also say that the state has done nothing to clarify its laws.

The case is thought to be the first time the experiences of women have been heard in open court since the Supreme Court ended the constitutional right to abortion last June.

In Wednesday's proceeding, which will continue on Thursday, lawyers for Casiano and the other plaintiffs asked the judge to temporarily suspend the bans for people who have medical complications in their pregnancies as the case proceeds. State Attorney General Ken Paxton's office is asking for the case to be dismissed.

The benches in the roomy, brand new courtroom at the Travis County Civil District Court were filled with reporters, plaintiffs, and their supporters, including several husbands. Members of the anti-abortion rights group Texas Alliance for Life were also in attendance.

Eight attorneys represented the patients and doctors challenging the law. On the other side of the room, two attorneys represented defendant Texas Attorney General Ken Paxton. Judge Jessica Mangrum, elected as a Democratic judicial candidate in 2020, presided.

Paxton, currently suspended, faces an impeachment trial in September over allegations of bribery and abuse of power.

During hours of emotional testimony, the courtroom felt tense and quiet. Casiano, who first told her story to NPR in April, was so overcome as she described her experiences she cried, coughed, and gagged in the witness box. The court was adjourned for a recess at that point.

When it was back in session, Casiano described what it was like to give birth to the daughter they named Halo. "She was gasping for air," Casiano said. "I just kept telling myself and my baby that I'm so sorry that this has happened to you. I felt so bad. She had no mercy. There was no mercy there for her."

People in the courtroom wept as Casiano spoke, including an attorney for the state of Texas.

The other women with complicated pregnancies who testified were Amanda Zurawski and Ashley Brandt. Both cried on the stand as they described extremely intimate details of their health and their ordeals losing wanted pregnancies.

Brandt was able to travel out of Texas to receive a selective reduction for a twin whose skull had not developedproperly. Zurawski's water broke too early, but she was denied induction or abortion. She went into septic shock and was in the intensive care unit for three days.

Amanda Zurawski speaks during a press conference outside the Travis County Courthouse on July 19, 2023. Ashley Brandt, Elizabeth Weller and Lauren Miller stand behind her.
AFP via Getty Images
Amanda Zurawski speaks during a press conference outside the Travis County Courthouse on July 19, 2023. Ashley Brandt, Elizabeth Weller and Lauren Miller stand behind her.

Assistant Attorney General Amy Pletscher, representing Paxton's office, objected frequently as the women described their experiences with pregnancy complications that were left untreated in Texas. She argued that it was not relevant to discuss past medical history, but the judge allowed the testimony to continue. Pletscher also asked each patient witness if Attorney General Ken Paxton had personally denied them an abortion. Each said no.

Molly Duane, the attorney for the Center for Reproductive Rights, attacked the defendant's arguments, laid out in a court filing in June, that none of the patient plaintiffs have the right to sue the state — the legal concept known as standing. In the document, the state argued that the women's past harm is the fault of the their doctors and their future harm — such as damage to their reproductive health — is hypothetical.

Duane countered: "Does the state think that the only person who would have standing to challenge an abortion law is a woman who comes to court with amniotic fluid or blood dripping down her leg?"

During her cross-examinations, Pletscher repeatedly asked the witnesses for the names of their doctors. Abortion bans in Texas carry civil and criminal penalties — up to life in prison — for doctors. The state laws do not penalize women.

The final witness who testified Wednesday was Dr. Damla Karsan, one of the physician plaintiffs in the lawsuit. She described the case of a patient whose fetus had a fatal condition who had to drive 14 hours to get an abortion out of state. "I feel like my hands are tied – I have the training, the skill, the experience, even the facilities to provide the care, and I'm unable to provide that care and it's – it's gut wrenching," Karsan testified.

Lawyers for Texas were especially aggressive in cross-examining Karsan. Attorney Jonathan Stone repeatedly questioned whether she was familiar with the exception language in Texas law prior to the current laws. He also questioned her about various policies of the hospitals where she works. In its June filing, the attorneys for Paxton's office referred to Karsan as an "abortionist" rather than a physician or OB-GYN.

In a press conference after the hearing adjourned, plaintiff Amanda Zurawski said she was shocked by the callousness of her cross-examination. "I survived sepsis and I don't think today was much less traumatic than that," she said.

The hearing continues for a full day on Thursday. After it concludes, Judge Mangrum could rule on the temporary injunction and motion to dismiss at any time.

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Selena Simmons-Duffin reports on health policy for NPR.