Texas Tribune
Texas averages five abortions a month after Dobbs
by By Eleanor Klibanoff, The Texas Tribune – 2024-06-24 05:00:00
SUMMARY: Since the Dobbs ruling overturned Roe v. Wade in June 2022, Texas has seen a drastic decrease in abortions, from 4,400 to an average of five per month. Legal, medical, and personal challenges have arisen due to the stringent abortion laws. While some women have successfully sought abortions out of state or through telehealth and international providers, many face severe hurdles and delays, sometimes resulting in severe complications. The laws allow abortions to save a woman's life, but vague language and fear of penalties leave doctors hesitant. Anti-abortion activists continue efforts to restrict abortion access further.
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In the last two years, Texas abortion clinics closed, legal challenges raced through the court system, towns tried to ban out-of-state travel, conservative activists made abortion pills and emergency rooms into battlegrounds, and woman after woman after woman came forward with stories of medical care delayed or denied because of confusion over Texas' abortion laws.
And five women were able to get an abortion, on average, each month.
Texas, with 30 million residents and 10% of the women of reproductive age in the nation, used to see about 4,400 abortions a month.
Now, five.
State data, which is available only through January 2024, shows some months, no abortions were performed at all; there were never more than 10 in one month.
The drop in abortions in Texas is so large it's difficult to visualize in numbers: a 99.89% decline, a sheer cliff face on a line graph. But the meaning behind the metrics is perhaps even more difficult to discern.
For abortion-rights advocates, each missing number represents an individual in turmoil — a life derailed by an unintended pregnancy or a heartbreaking pregnancy complication worsened by delayed medical care.
Across the aisle, this number represents a dream achieved and evidence that the laws are working, both in banning elective abortions and ensuring women who need to terminate for medical reasons are able to. If some women have been able to get an abortion — the laws can't be that restrictive, can they?
Of course, these numbers don't tell the whole story. They don't capture the frantic trips out of state, the pills secreted in a bathroom, the forays over the border, all the ways Texans are managing to terminate their pregnancies despite the laws.
But two years after the June 2022 Dobbs ruling overturned Roe v. Wade, those abortions tell us a lot about how Texas' laws are working — exactly as designed.
Who has an abortion
Before Texas banned nearly all abortions, people sought to terminate their pregnancies for all sorts of reasons. They couldn't afford another child; they felt they were too young; they were in an unstable, or even abusive, home; they were sexually assaulted; they just weren't ready.
These people, and their reasons, still exist, and they face enormous challenges in either seeking abortions elsewhere or carrying these pregnancies to term. But since the Dobbs decision, much of the focus of the courts, the legislature, the media and advocates has narrowed in on one aspect — abortions for medically complicated pregnancies.
Performing an abortion in Texas is punishable by up to life in prison, unless, “in the exercise of reasonable medical judgment,” a doctor believes the pregnant patient is at risk of death or “substantial impairment of a major bodily function.”
This “life of the mother” exception, as it is often called, is supposed to allow doctors to perform an abortion when medically necessary. In practice, many doctors say the vagueness of the language and the extreme penalties leave them paralyzed.
“You sometimes feel like you're damned if you do, damned if you don't,” Dr. Todd Ivey, a Houston OB-GYN, told the Texas Tribune in April. “Patients are in very difficult situations … and then you have the threat from the other side of civil penalties in addition to criminal penalties, along with the loss of your license and prison time. It's incredibly frightening.”
The fact that some women are getting abortions under this exception is proof enough for many anti-abortion groups that it is working.
“We can see that there are doctors in Texas who clearly understand that the law allows them to intervene to save a woman's life,” said Amy O'Donnell with Texas Alliance for Life. “Not a single woman has lost their life, and no doctor has faced any kind of prosecution, lost their medical license or faced any penalties.”
The numbers, however, don't shed light on the process a woman goes through to get that abortion. Amanda Zurawski's membrane ruptured when she was 18 weeks pregnant, guaranteeing she would miscarry. Her doctors repeatedly refused to perform an abortion because they could still detect a fetal heartbeat. It wasn't until she went into sepsis, eventually spending three days in the intensive care unit, that they acted.
Zurawski led a lawsuit that challenged Texas' abortion laws on the grounds that they resulted in delayed or denied care for medically complicated pregnancies. Ultimately, 19 other women and two doctors signed on to the suit with their own stories
“The preventable harm inflicted on me will, medically, make it harder than it already was for me to get pregnant again,” Zurawski said at a news conference announcing the lawsuit last March. “The barbaric restrictions our lawmakers have passed are having real- life implications on real people. I may have been one of the first who was affected by the overturning of Roe in Texas, but I'm certainly not the last.”
The state and anti-abortion activists have argued that the laws are clear — it is the doctors who are being overly timid or, perhaps, intentionally obstinate.
“Our law allowed that doctor to intervene sooner, and so that's not an issue with the law,” O'Donnell said. “Her story is heartbreaking, but it is not an outcome that's based on Texas law, but just a doctor who didn't perform the life-saving abortion.”
During a hearing in which Zurawski and other plaintiffs testified against the laws, lawyers for the state encouraged them to file complaints or bring medical malpractice suits against their doctors for failing to act.
“Given the nature of plaintiffs' past experiences, it is understandable that they are seeking to place blame,” assistant attorney general Amy Pletscher said at the hearing. “But the blame directed at defendants is misplaced. Rather, plaintiffs sustained their alleged injuries as a direct result of their own medical providers failing them.”
Last month, the Texas Supreme Court rejected Zurawski v. Texas, and further endorsed this view.
“A physician who tells a patient, ‘Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,' and in the same breath states ‘but the law won't allow me to provide an abortion in these circumstances' is simply wrong in that legal assessment,” the court wrote in its May 31 opinion.
The Texas Supreme Court has ruled, in this case but more explicitly in an earlier case, that the law doesn't require doctors to wait until a pregnant patient is “within an inch of death or her bodily impairment is fully manifest or practically irreversible.” A doctor can act before the harm to the mother is imminent, the court ruled.
But state data shows that 88 of the 90 abortions performed in the 18 months for which data is available happened because there was a medical emergency, as well as being necessary to preserve the health of the patient. And while no doctor has been prosecuted, there is a three-year statute of limitations and both state and private attorneys have shown their willingness to bring long-shot cases to test the limits of the law.
When an Austin district judge ruled 31-year-old Kate Cox could terminate her nonviable pregnancy, Attorney General Ken Paxton sent letters to Houston hospitals telling them he would pursue legal action if they allowed Cox to have an abortion on their premises. The Texas Supreme Court later ruled Cox did not qualify for an abortion.
“A physician thought that abortion was necessary, but the court came right behind and said, ‘No, we don't think so. We disagree,'” said Dr. Ivey, the Houston obstetrician, who is also an officer in the Texas chapter of the American College of Obstetricians and Gynecologists. “How can a physician feel protected enough to provide good medical care when the ultimate decision is going to be made by the court, and they may not support the physician?”
Paxton also sued the federal government for reminding emergency rooms of their obligation to stabilize patients experiencing a medical emergency, even if stabilization requires an abortion. The 5th U.S. Circuit Court of Appeals sided with Texas; the U.S. Supreme Court is expected to rule any day on a related case out of Idaho that could impact that ruling.
Even while it upheld the state law on abortions as it applied to complicated pregnancies, the Texas Supreme Court conceded that more clarity is needed. Late last year, justices asked the Texas Medical Board, the state licensing agency, to issue clearer guidance to doctors to help them interpret the laws and feel more confident performing medically necessary abortions.
The board's initial attempt at guidance focused mostly on listing paperwork doctors should prepare if they've performed a medically necessary abortion. At a stakeholder meeting last month, doctors, lawyers and women who had experienced complicated pregnancies said this wasn't enough to clear up the confusion and get Texans the care they need.
“We need clarity. Women's maternal health and fertility are dependent on the state getting this right,” said Dr. Joseph Valenti, a north Texas OB-GYN and chair of the Texas Medical Association's Board of Trustees.
On Friday, the board adopted a slightly modified version of their proposed rule.
How many more
While the plight of women with complicated pregnancies has moved into the foreground, Texans continue to seek abortions for a wide-range of reasons. What we don't know — and likely will never know — is just how many have found ways to terminate their pregnancies post-Dobbs, and how they did so.
#WeCount, a research project from the Society of Family Planning, has found the number of abortions nationally has stayed pretty consistent from before Dobbs, even as 14 states have banned abortion. They attribute this to other states expanding access to abortion and the wider access to telehealth.
Texans are a big part of this out-of-state abortion travel. More than 35,000 Texans went to another state to get an abortion in 2023, compared to just 2,400 in 2019, according to a study from the Guttmacher Institute. They primarily traveled to New Mexico, the only state bordering Texas that still allows abortion. Almost three-quarters of abortions there in 2023 were provided to out-of-state residents. Several clinics that used to operate in Texas have set up shop over the border in New Mexico.
And a countless number of Texans have ended pregnancies without ever leaving the state, thanks to widespread access to medication abortions, pills that induce abortion and are often obtained through telehealth appointments with out-of-state providers.
While prescribing and mailing abortion-inducing drugs is illegal in Texas, at least half a dozen states have passed so-called “shield laws” that aim to protect health care providers who prescribe abortion pills to patients in Texas and other restrictive states. The laws have not yet been tested in court.
Other women use international providers, like AidAccess, a European nonprofit that saw demand spike after the Dobbs decision, make quiet trips to pharmacies over the U.S.-Mexico border, or obtain the pills through an ever-growing whisper network.
Frustrated by this workaround, anti-abortion activists have focused on restricting out-of-state travel and access to abortion-inducing medications.
Several small towns, as well as Lubbock County, have passed a legally dubious ordinance that tries to prevent people from using local roads to transport anyone out-of-state for an abortion. The ordinance, which is enforced through private civil lawsuits, recently hit resistance in Amarillo, the largest city to consider it.
Jonathan Mitchell, the former Texas solicitor general responsible for many of the most aggressive conservative legal arguments in recent years, has taken things a step further. Mitchell has filed legal petitions seeking to depose women who terminated their pregnancies outside of Texas, as well as groups that fund out-of-state abortions for Texans. None of those petitions has yet resulted in depositions.
Mitchell has also filed a wrongful death lawsuit against three women who he says helped a friend obtain and take abortion-inducing drugs. The women have countersued Mitchell's client, the ex-husband of the woman who had been pregnant. That case is slowly moving through the court system.
Other conservative groups filed a lawsuit seeking to revoke the Food and Drug Administration's approval for mifepristone, one of two drugs taken together to terminate a pregnancy. While U.S. District Judge Matthew Kacsmaryk, the only federal judge in Amarillo, granted their petition, the Supreme Court recently overturned it, ruling that the doctors did not have standing to bring the suit.
Mifepristone remains approved, but the case may not be over.
Even further out of the spotlight are the Texans who did not get an abortion, but might have if laws were different. Maybe they lacked the resources to travel out of state, the information on how to get the medication, or the willingness to wade into these uncertain legal waters.
The clearest picture about who and how many people carried pregnancies to term as a result of the new abortion laws will eventually come from birth data. Early fertility data for Texas shows Hispanic women are seeing the greatest increase in births, and teen pregnancy has ticked up for the first time in decades. Some may turn to adoption, but the vast majority will likely parent children they did not intend to have.
Last legislative session, in a moment of bipartisan agreement motivated by the overturn of Roe v. Wade, the state extended health care coverage for poor mothers to one year postpartum, and eliminated the sales tax on diapers. It has invested in crisis pregnancy centers to give supplies to new moms.
Whether that commitment will be equally front of mind in the upcoming session will be determined when the legislature convenes in January. While lawmakers in other states have paid for their anti-abortion stances at the ballot box, Texas has continued to march steadily to the right, helped by voters who are more focused on issues like the border and the economy.
Two years after the overturn of Roe v. Wade, Texas voters say abortion is only the sixth most important issue facing the state.
Disclosure: Texas Medical Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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Texas Tribune
How Houston ISD’s takeover could change U.S. schools
by By Asher Lehrer-Small and Danya Pérez, Houston Landing, The Texas Tribune – 2024-07-03 16:43:08
SUMMARY: Houston ISD saw major changes this school year under state-appointed superintendent Mike Miles. New policies included rapid teaching methods, daily student quizzes, and hallway silence. These transformations resulted from a historic state takeover aimed at reshaping the district. The overhaul focused on tying teacher pay to test scores and resulted in notable test score improvements and higher teacher salaries but also sparked controversy and high teacher turnover. The long-term success of these measures remains debated, with some seeing potential for broader implementation and others viewing them as unsustainable. Miles' approach has faced mixed reactions, with ongoing observations and concerns about its future impact.
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Todo cambió. Everything changed.
That's how Arturo Monsiváis described life this year for his fifth-grade son, who attends Houston ISD's Raul Martinez Elementary School. Teachers raced through rapid-fire lessons. Students plugged away at daily quizzes. Administrators banned children from chatting in the hallways.
Sitting in the parent pickup line on the last day of school, Monsiváis said his son often complained that the new assignments were too difficult. But Monsiváis, a construction worker, wouldn't accept any excuses: Study hard, he advised.
“I tell my son, ‘Look, do you want to be working out here in the sun like me, or do you want to be in an office one day? Think about it,'” Monsiváis said.
The seismic changes seen by Monsiváis' son and the 180,000-plus students throughout HISD this school year are the result of the most dramatic state takeover of a school district in American history, a grand experiment that could reshape public education across Texas and the nation.
In stunningly swift fashion, HISD's state-appointed superintendent and school board have redesigned teaching and learning across the district, sought to tie teacher pay more closely to student test scores, boosted some teacher salaries by tens of thousands of dollars and slashed spending on many non-classroom expenses.
First: Demonstrators rally in front of Hattie Mae White Educational Support Center in opposition to a possible takeover of the HISD's elected board by the TEA. Last: From left, Jaelauryn Brown, 8, Jaedis Brown, 13, and Jaeson Brown, 4, walk through the front rotunda of Houston ISD's Wheatley High School in Houston's Greater Fifth Ward on June 1, 2023.
Credit:
Houston Landing file photo / Marie D. De Jesús | Houston Landing file photo / Antranik Tavitian
The changes in HISD rival some of the most significant shakeups to a public school system ever, yet they've received minimal national media attention to date.
Still, district leaders, citing private conversations with researchers and superintendents, said education leaders throughout the U.S. are following the HISD efforts to see whether they may be worth replicating. Adding to the intrigue: Texas lawmakers have looked in recent years to policies used by HISD's new superintendent, former Dallas Independent School District chief Mike Miles, as inspiration for statewide legislation.
“I think people are watching and waiting,” HISD Board Secretary Angela Lemond Flowers said. “We're stepping out there big, and it's important because we are a big district and we have lots of students that we need to make sure we're serving better. Not in the next generation. Not in five years. Like, immediately.”
Houston ISD Superintendent Mike Miles.
Credit:
Antranik Tavitian/Houston Landing
Miles, the chief architect of HISD's new blueprint, has pointed to early successes — including strong improvement in state test scores this year — as evidence that his model works where others have failed. For decades, Black and Latino children in urban school districts like Houston have trailed well behind wealthier and white students in school.
Miles' critics, however, have blasted his approach as an unproven, unwanted siege on the district orchestrated by Texas Republicans. They cite high teacher turnover headed into the next school year and long-term questions about the affordability of Miles' plans as indicators the effort may be doomed.
Regardless of whether the HISD intervention becomes a shining success, a historic failure or something in between, it could help answer one of the most pressing questions in education: Can a large, urban public school district dramatically raise student achievement and shrink decades-old performance gaps, ultimately helping to close America's class divide?
“Back to the future”
The HISD intervention represents “by far the most bizarre state takeover that we've ever seen,” said Jonathan Collins, a Columbia University Teachers College associate professor who has worked with another takeover district, Providence Public Schools.
Texas Education Commissioner Mike Morath.
Credit:
Houston Landing file photo/Sergio Flores
Typically, states take the reins of districts following major academic or financial scandals. HISD, by comparison, has scored at a “B” level in recent years under Texas' A-through-F rating system and kept its financial house in order.
But in 2019, HISD allowed one campus, Wheatley High School in Greater Fifth Ward, to receive a seventh straight failing grade from the state. Wheatley's scores triggered a Texas law — authored in 2015 by a Houston-area Democrat fed up with years of poor outcomes at some HISD schools — that gave Texas Education Commissioner Mike Morath the right to replace the district's school board.
After three years of legal battles with HISD trustees, who tried to halt the takeover, Morath emerged victorious. He appointed Miles and nine local residents to run the district in June 2023.
Rather than focusing on the handful of HISD schools with the most flagrant academic underperformance, Miles overhauled a huge swath of the district — 85 out of roughly 270 schools — in his first year.
In doing so, Miles relied heavily on practices pioneered in the 2000s and 2010s by the so-called “education reform” movement, a loose collection of politicians, charter school organizers and district chiefs.
The group argued that instilling a “no-excuses” attitude toward student achievement and partially tying teacher pay to test score growth could dramatically improve American education. Miles implemented a similar playbook during his three-year stint leading Dallas ISD, an approach that helped improve student test scores but contributed to a near-doubling of the district's teacher turnover rate.
In recent years, the reform movement that inspired Miles' policies has largely fallen out of favor. The changes haven't consistently moved the needle on exam results nationwide, while high-stakes testing has become less popular.
But to Miles, the movement fell short for one main reason: It didn't go big enough.
So Miles required over 1,000 HISD teachers at over two dozen campuses to reapply for their jobs, ultimately replacing about half of them. He rearranged how educators teach students, requiring them to use an approach that mandates students must participate in class roughly every four minutes. And he rolled out new lesson plans for about a third of the district's schools that included short, daily quizzes in nearly all subjects.
Thomas Toch, the director of Georgetown University's FutureEd think tank, said Miles' approach “feels like sort of a ‘back to the future' moment.” The HISD overhaul currently represents “the largest effort to implement school improvement at scale,” Toch said.
While major public school reforms aren't new, the scope and speed of HISD's overhaul stand out.
Former District of Columbia Public Schools chancellor Michelle Rhee famously fought in the late 2000s to partially tie pay to exam score growth, but she didn't dictate classroom instruction techniques and school staffing models. New Orleans turned its 45,000-student district into an all-charter school system post-Hurricane Katrina, but fewer children saw big changes than in HISD. Even Miles' most ambitious reforms in Dallas targeted a fraction of the students as HISD.
“This is an effort, the largest in the country, to turn around a traditional, urban district,” Miles said. “That's what we're engaged in.”
First: A student works at a team center, Aug. 31, 2023, at Houston ISD's Sugar Grove Academy in Houston. Last: David Espinoza, at right, looks over his students' work during an Art of Thinking class at Houston Math, Science, and Technology Center High School in Houston on Jan. 25, 2024.
Credit:
Houston Landing file photo/Antranik Tavitian
A teacher helps a student in one of the team centers at Sugar Grove Academy in Houston on Aug. 31, 2023.
Credit:
Antranik Tavitian/Houston Landing
Wider model?
One year in, Miles' administration has scored some key victories.
The elementary and middle schools Miles targeted for changes saw, on average, a 7 percentage point increase in the share of students scoring at or above grade level on statewide reading and math tests, commonly known as the STAAR exams. Other HISD schools saw a 1 percentage point increase, while state averages slid in math and remained flat in reading.
“I think you can say pretty clearly that [the transformation model] has been working well,” Miles said when the scores came out.
HISD also has made some progress in meeting legal requirements for serving students with disabilities, an area in which the district has struggled for more than a decade, according to state-appointed conservators monitoring the district.
But other indicators could spell trouble for Miles' administration in year two and beyond.
As of early June, four weeks before educators' deadline to resign without penalty, roughly one-quarter of HISD's 11,000-plus teachers had left their positions ahead of the upcoming school year, district administrators said. Historically, HISD's teacher turnover rate has hovered around 15% to 20%.
The departures follow widespread complaints that, under Miles' leadership, district administrators micromanage teachers by frequently observing classroom instruction and providing feedback. David Berry, a former journalism teacher at Wisdom High School, recalled a fall meeting where district administrators scolded teachers for using student engagement strategies too infrequently.
“They proceeded to rip us apart,” said Berry, who plans to teach in a neighboring district next year. “I've never been talked to like that as a teacher, really, as a grownup.”
The financial viability of Miles' plans also remains in question. HISD ran a nearly $200 million deficit on a roughly $2.2 billion budget in Miles' first year, with much of the shortfall tied to dramatic increases in staffing and pay at overhauled schools. The district is budgeting a similar deficit next year, though it plans to use $80 million in unspecified property sales to lessen the blow.
Still, if HISD can continue to post strong test scores, history suggests Miles' model could soon spread beyond Houston.
Texas lawmakers, inspired by Miles' work, passed legislation in 2019 that allocated money to school districts that adopted teacher evaluation systems like the one he used in Dallas. Texas districts received nearly $140 million in 2022-23 under the law.
They also passed a law that allowed long-struggling campuses to skirt closure by replicating a turnaround plan Miles implemented in Dallas. Participating schools have to provide high levels of feedback on instruction, extend school hours and offer incentives for top-rated teachers and principals.
Miles last fall said his Houston work is “not a test case” for statewide policy. More recently, however, he alluded to the possibility of his model being implemented more widely.
“There's a lot of interest across the country, mostly from people who are educators, of what's happening here,” Miles said in a May interview. “This actually could be a proof point for others if it can be done.”
Harvard Graduate School of Education economist Thomas Kane, who has researched students struggling to rebound from the pandemic nationwide, said he believes HISD's overhaul could interest many district leaders.
“If there have been substantial improvements in student achievement gains simultaneously with improvements in student attendance, I think that will grab a lot of attention nationally and will make people curious about the Houston reforms,” Kane said.
Kourtney Revels, at center, the mother of a third-grade student at Houston ISD's Elmore Elementary School, confronts district staff limiting public access to a June 2023 school board meeting at HISD headquarters in northwest Houston.
Credit:
Annie Mulligan for Houston Landi
Community appetite
Even if HISD produces remarkable gains in the coming years, many elected school boards — which answer directly to local voters, unlike Miles and the state-appointed board — might not stomach upheaval on the level of Houston.
Miles' policies, coupled with his bulldozer style of leadership, have prompted family protests and student walkouts throughout his first year. Typically, more than 100 community members criticize his administration during school board meetings. In one particularly heated exchange from June, a district administrator repeatedly yelled “scoreboard” at a group of jeering audience members while pointing to a screen displaying student test scores.
Even some families that approached Miles' arrival with hopefulness have turned against the district's leadership. Tish Ochoa, the mother of an HISD middle schooler, said she began the school year “cautiously optimistic” but soured on Miles' plans as she heard reports of stressed-out teachers and changes to high-performing schools.
“I wouldn't say that I was like, ‘Rah-rah takeover,' but I was also like, ‘I hope this works.' I was supportive of the new administration coming in,” Ochoa said. “I don't feel that way anymore.”
Houston ISD Superintendent Mike Miles observes a classroom on Aug. 11, 2023, at Sugar Grove Academy in Houston's Sharpstown neighborhood.
Credit:
Houston Landing file photo/Antranik Tavitian
Miles has argued that many families quietly back his administration. However, few community members have spoken out in support of his efforts, save for a handful of nonprofits and civic groups largely backed by big-dollar philanthropy or business organizations.
At HISD's overhauled schools, many parents said they're open to timers ticking in classroom corners and rapid-fire quizzes — so long as their children aren't left behind.
“I don't care about the changes,” McReynolds Middle School mother Christina Balderas said. “The only thing I care about is when my daughter gets home and she tells me, ‘This is what I learned today, mom.' They can have all the changes in the world that they need.”
In the next few years, Morath likely will begin gradually bringing some of HISD's elected trustees back onto the school board, as outlined in state law. From there, they will decide which Miles policies to keep or dismantle.
Three of HISD's nine elected trustees responded to interview requests for this story: Sue Deigaard, Plácido Gómez and Dani Hernandez. They said they want to see multiple years of data on the impact of Miles' approach before solidifying their impressions.
Most said they would reverse unpopular details of Miles' plan, such as requiring some children to carry a traffic cone to the bathroom as a hall pass, but they found early evidence of the academic impact promising.
“If I had to make a decision right now of whether to continue [the overhaul model], I would,” said Gómez, who represents parts of eastern and central HISD. “There isn't enough data to say, ‘This definitely works,' but there's enough for me to want to continue on this path.”
Just in: Former U.S. Rep. Liz Cheney, R-Wyoming; U.S. Sen. John Fetterman, D-Pennsylvania; and Oklahoma Gov. Kevin Stitt will take the stage at The Texas Tribune Festival, Sept. 5–7 in downtown Austin. Buy tickets today!
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Texas Tribune
Fight over trans medical care is at center of leaked Houston health records case
by By Dante Motley, The Texas Tribune – 2024-07-03 15:56:06
SUMMARY: Dr. Eithan Haim, formerly of Texas Children's Hospital, faced charges for allegedly breaching patient privacy laws by leaking confidential information about trans children's treatments to a conservative activist. The activist publicized the information, inciting conservative outrage and prompting Attorney General Ken Paxton's investigation. Haim, now charged federally, denies wrongdoing, claiming his actions aimed to expose the hospital's practices. His supporters, including Republican politicians and conservative media, view him as a whistleblower and martyr against transgender care. Critics argue his leak endangered families and fueled misleading conservative rhetoric. Haim is defended by Ryan Patrick, ex-U.S. attorney and son of Lt. Gov. Dan Patrick.
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As the Texas Legislature considered banning the use of puberty blockers and hormone treatment for trans kids last year, a Houston doctor breached the record system of Texas Children's Hospital in Houston — the largest pediatric hospital in the country.
Dr. Eithan Haim, a former employee of the hospital, retrieved the personal information of underage patients who were not under his care, and illegally leaked them to a conservative activist, court documents allege.
The activist published them, and conservative outrage followed. Attorney General Ken Paxton opened an investigation. The Legislature passed the ban within days.
More than a year later, federal prosecutors have charged Haim with violating patient privacy laws.
Those actions and the indictment that followed have thrust him into the center of one of the most emotional and divisive issues in Texas politics. Prosecutors are accusing him of feeding the public misleading information to damage his old hospital's reputation and “promote his own personal agenda.” The Texas GOP is backing him.
Advocates for trans rights say the case is an example of how often misleading conservative rhetoric has only made it more dangerous for Texas families with trans children. They cast the recent legislation targeting gay and trans people as part of a broader effort in Texas and across many states dominated by conservative politicians to stigmatize and punish queer people in ways that profoundly upend the lives of tens of thousands of families.
Meanwhile, Haim is being hailed as a martyr by conservatives in Texas and beyond who assert he is a victim of political persecution. On the conversative podcast circuit and elsewhere, they call transition-related care for kids child abuse and describe the doctors and parents that provide it as abusers.
Members of Congress have written in support of him. Supporters have raised nearly $1 million for his defense. He's being represented in court by Ryan Patrick, a prominent former U.S. attorney during the Trump administration who is the son of Lt. Gov. Dan Patrick.
Haim has pleaded not guilty. He has said that his actions were intended to expose the hospital's transgender care program.
“I maintained from day one that I have done nothing wrong,” Haim said last week outside the courthouse, The Houston Chronicle reported. “We're going to fight this tooth and nail to stand up for whistleblowers everywhere.”
Haim was released on a $10,000 bond and now faces 10 years in federal prison and a maximum fine of $250,000. On his fundraising site, Haim said he did not break the law since the documents were redacted and “no personally identifiable patient health information was disclosed.”
Transition-related care covers a wide range of treatments. It can include such social steps as adopting new pronouns or changing one's style of dress. It can also mean medical interventions such as puberty blockers, hormone therapy and surgeries, though those are rarer for children. These treatments are for gender dysphoria, the distress that arises when a person's gender identity does not align with their birth-assigned sex. The American Medical Association has defended such care, arguing that such treatments are essential for the well-being of transgender youth.
Concerns about transition-related health care for kids started to gain steam in Texas in February 2022, when Gov. Greg Abbott directed the Texas Department of Family and Protective Services to investigate instances of transition-related care for transgender children as child abuse.
In response, Texas Children's Hospital announced that it would pause the prescription of hormone therapies for transgender kids. The hospital said the decision was made to “safeguard our health care professionals and impacted families from potential legal ramifications.”
Months later, a state supreme court ruling stated that while DFPS was allowed to conduct such investigations, the governor's directive was not a legally binding instruction and they did not have to.
Haim said that the hospital continued these practices in secret. In the charges against him, prosecutors noted that Haim received training on health privacy regulations and attended “numerous trainings related to anonymous reporting of any instances of misconduct, ethic violations or child abuse.” But, they said, Haim did not report concerns to any supervisors, anonymous hotlines or Child Protective Services.
Instead, he turned over redacted versions of the medical records to conservative activist Christopher F. Rufo, who published an article in May 2023 reporting that the hospital continued administering puberty blockers and cross-sex hormones to minors and linking to the documents. In the report, Rufo names physicians and details the types of procedures they were conducting. The leaked documents are no longer available though that article. The hospital did not respond to a request for comment, but has said in the past that the care it provides meets legal requirements.
At the time of the leak, such treatments had not yet been made illegal in Texas.
There is no situation in which a doctor should publicly disclose any patient's medical information without consent, said Johnathan Gooch, a spokesperson for an LGBT-rights group, Equality Texas. This release of information puts families at risk, Gooch said.
“In an age where people make a game of figuring out where a random pin is on Google Maps, people are very good at searching the internet,” Gooch said. “Doxxing people has become very popular in radical circles. So it definitely puts the health and well being of these families and their children at risk to be exposed, especially when that exposure is in a hyperpolarized environment.”
But Haim and his supporters argue that he took a brave stand to expose misconduct.
In a letter to the prosecutor, U.S. Sen. Ted Cruz, R-Texas, denounced what he called “selective prosecution and the weaponization of the Department of Justice against political opponents.”
U.S. Rep. Chip Roy, R-Austin, sent a letter to U.S. Attorney General Merrick Garland similarly suggesting misuse of law enforcement to ideologically target detractors and requesting information for the House Judiciary Committee. U.S. Rep. Dan Crenshaw, R-Houston, supported Hiam in a news conference last Wednesday where he said that Haim did nothing wrong.
And two Republican state lawmakers, Rep. Brian Harrison of Midlothian and Sen. Mayes Middleton of Galveston, have written to the state Health and Human Services Commission criticizing the alleged use of Medicaid funds to cover these treatments. In their letter, they laud Haim and say that the hospital committed child abuse.
Harrison told The Texas Tribune that the support for Haim is indicative of the ways Texas is “trying to protect children.” Propelled by similar statements about “protecting children,” anti-LGBTQ+ legislation has received significant attention in the Texas legislature over the past few years — a sentiment that has inspired actions like Haim's.
After his indictment, Haim was celebrated by various far-right websites and forums. Rufo described him as a “whistleblower.”
“If Haim prevails, other courageous doctors and medical professionals will follow his lead and speak out,” Rufo wrote in a City Journal article.
However, prosecutors have questioned Haim's motives. The indictment argues, Haim committed “malicious harm” to the hospital and its patients. The hospital faced “financial loss, medical delays … as well as threats and harm to its patients and esteemed physicians.”
And opponents of the state's crackdown on translation-related care are concerned about the politicians backing Haim.
To Gooch, of Equality Texas, the rhetoric and actions of state officials are worrying. He says there is a “direct connection” between the words of Texas politicians and the experiences of trans people in the state.
“We've seen many families moving away in order to keep providing health care to their young people,” Gooch said. “And then those who had to stay in Texas, if they didn't have the means to leave, have been forced to spend massive amounts of money to travel across state lines in order to get regular checkups.“
Disclosure: Equality Texas and Texas Children's Hospital have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
Texas Tribune
Gov. Abbott’s border wall will take around 30 years, $20B
by By Jasper Scherer, The Texas Tribune – 2024-07-03 05:00:00
SUMMARY: Governor Greg Abbott announced a state-funded border wall along Texas' Mexico border three years ago, resulting in 34 miles of steel bollards so far, at a cost of $25 million per mile. The fragmented wall faces challenges like securing land rights, with plans to cover 100 miles by 2026. Critics, including Democrats and some Republicans, argue the wall is costly and ineffective, while Abbott claims it helps combat illegal immigration. The project is part of Abbott's $11 billion border security initiative, but acquiring private land remains a significant hurdle. The wall's projected full completion could take 30 years and $20 billion.
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Three years after Gov. Greg Abbott announced Texas would take the extraordinary step of building a state-funded wall along the Mexico border, he has 34 miles of steel bollards to show for it.
That infrastructure — which has so far run up a price tag of some $25 million per mile — isn't yet a contiguous wall. It has gone up in bits and pieces spread across at least six counties on Texas' 1,254-mile southern border. Progress has been hampered by the state's struggles to secure land access, one of myriad challenges signaling a long and enormously expensive slog ahead for Abbott.
Nonetheless, state contractors have already propped up more wall mileage than former President Donald Trump's administration managed to build in Texas, and Abbott's wall project is plowing ahead at a quickened pace. State officials hope to erect a total of 100 miles by the end of 2026, at a rate of about half a mile per week. The governor frequently shares video of wall construction on social media and has credited the project with helping combat immigration flows. To date, though, steel barriers cover just 4% of the more than 800 miles identified by state officials as “in need of some kind of a barrier.” And at its current rate — assuming officials somehow persuade all private landowners along the way to turn their property over to the state — construction would take around 30 years and upwards of $20 billion to finish.
Under Abbott's direction, state lawmakers have approved more than $3 billion for the wall since 2021, making it one of the biggest items under the GOP governor's $11 billion border crackdown known as Operation Lone Star. The rest of the money is being used for items like flooding the border with state police and National Guard soldiers and transporting migrants to Democrat-controlled cities outside Texas, all of which Abbott and other Republicans say is needed to stem the historic number of migrants trying to enter the country.
Democrats and immigration advocates have cast the wall project as a taxpayer-funded pipe dream that will do nothing to address the root causes driving the immigration crisis. And they say the governor, in reviving what was once a hallmark of Trump's agenda, is using public money to boost his political stock.
Even some immigration-hawk Republicans are showing unease about the mounting costs of the wall.
“I am, too, concerned that we're spending a whole lot of money to give the appearance of doing something rather than taking the problem on to actually solve it, and until we do that, I don't expect to see much happen,” state Sen. Bob Hall, R-Edgewood, said last fall before voting in committee to spend another $1.5 billion in wall funding.
Abbott's office did not respond to a request for comment for this story.
Acquiring land
The construction pace has largely hinged on the state's success securing rights to build the wall through privately owned borderland. Early on, the project showed little signs of life as state contractors struggled to obtain the needed easements. But things picked up last year as the state began working out more agreements covering larger tracts. Through mid-June, officials had secured 79 easements covering about 59 miles of the border, according to Mike Novak, executive director of the Texas Facilities Commission, which is overseeing the effort.
At a facilities commission meeting last month, Novak said state officials were in various stages of negotiation with landowners over another 113 miles.
“We knew from the beginning that this was going to be the choke point, you know, one of the most challenging parts of this program,” Novak said of land acquisition. “And it proved true. But we've remained steadfast.”
Officials had built 33.5 miles of wall through June 14, a facilities commission spokesperson said.
The state's ability to secure land rights has also dictated the wall's location, though officials say they have focused on areas pinpointed by the Department of Public Safety as the “highest priority.” TFC officials have declined to share exactly where the wall is being built, citing security concerns, though Novak recently said construction was underway on wall segments in Cameron, Maverick, Starr, Val Verde, Webb and Zapata counties.
Though the Texas-Mexico border spans more than 1,200 miles, Abbott's budget director, Sarah Hicks, told a Senate panel in 2022 that DPS had identified 805 miles “as vulnerable, or [that] is in need of some kind of a barrier.” Another 180 miles are covered by natural barriers, mostly in the Big Bend region of West Texas, while existing barriers already cover another 140 miles, according to state officials.
Novak has said the pace of building about half a mile of wall per week is expected to continue for the “foreseeable future.” At that rate, about 100 miles would go up every four years, with the full 805 miles covered sometime after 2050, when Abbott would be in his 90s.
The earliest wall construction has cost roughly $25 million to $30 million per mile, according to TFC officials. That would amount to $20 billion to $24 billion for the entire 805-mile span, or about three times the cost of paying every Texas public university student's tuition last year. The estimate does not account for the cost of maintaining the wall once it is built, which TFC estimates will cost around $500,000 per mile each year.
Lubbock state Sen. Charles Perry, who last year carried Texas' new immigration law that allows state police to arrest people for illegally crossing the Mexico border, is another Republican who has expressed concern about the wall's cost.
“I am for border security. I am not against a wall. But to me, at least from what I can tell, it is a perpetual circle. We're on the hamster wheel,” Perry said last fall as he prepared to vote for the $1.5 billion wall funding bill. “[At some point] the response has not to be more money for infrastructure. At some point this state must draw the line in the sand.”
Still, no Texas Republican has voted against border wall funding. Lawmakers approved nearly $2.5 billion for the effort in the state's current two-year budget — more than was allotted in state funds to all but a handful of state agencies, and more than twice what Texas spends on its court and juvenile justice systems.
State Rep. Christina Morales, D-Houston, said she doesn't think Texas' GOP leadership “really understands why people are crossing in the first place.”
“Spending billions of dollars on a wall really does not address the root causes of the migration that's happening,” said Morales, who is vice chair of the House's Mexican American Legislative Caucus. “What we should be investing in is our education, our health care, real solutions for problems that are happening right now in Texas.”
Since 2021, federal officials have recorded an average of about 2 million illegal border crossings a year, a record that Abbott has attributed to President Joe Biden for rolling back some of Trump's border policies. The governor has touted the wall construction as a way for Texas to “address the border crisis while President Biden has sat idly by.” Biden and other Democrats have blamed Republicans for shooting down a sweeping bipartisan border deal earlier this year.
The scope of Texas' wall construction — and Abbott's broader border security efforts — are unprecedented in nature, as the federal government is generally responsible for immigration enforcement and the costs associated with it.
Even with the state's improved pace securing easements, Novak has said land access remains the biggest challenge for the project, and “it'll probably remain that way through most of the program.” The Trump administration encountered the same issue after the former president famously said he would build the wall and make Mexico pay for it. Even using the federal government's power to seize some borderland, Trump's administration built just 21 miles of new wall along the Texas-Mexico border.
The painstaking negotiations are required for Texas' wall because lawmakers barred the use of eminent domain to gain land access.
Last year, state Sen. Brandon Creighton, R-Conroe, filed legislation to change that, arguing TFC officials could only build a complete wall if they were authorized to use eminent domain powers. The proposal failed to make it through the Senate, though Creighton said he plans to file it again for the session that starts next January.
“Of course, we can continue to negotiate with ranchers, but that is a very slow process,” Creighton said. “And it's an incomplete process, because there will always be holdouts for different reasons.”
Creighton, one of the upper chamber's more conservative members, said he still supports using state funds to build a border wall, even as some of his GOP colleagues have raised objections.
“I say no to waste, inefficiencies, potential fraud and unreasonable spending as much as any member,” Creighton said. “But … there are times, with all of that fiscal conservatism, that we have to use the money that we save efficiently to protect Texans and Texas.”
“A difficult and complex task”
Most border wall advocates acknowledge barriers alone will not deter people from trying to enter the country illegally. But they say a wall would work if paired with more law enforcement officers and technology, arguing it would slow down attempted crossers to give border agents more time to apprehend them and encourage migrants to seek asylum via ports of entry.
But smuggling gangs have used ordinary power tools to saw through parts of Trump's wall and scaled it using disposable ladders. Some immigration experts say border walls fail to solve the underlying factors driving people to migrate, such as the poverty, violence and political upheaval in Central America, Haiti and Venezuela that is driving millions to flee and straining U.S. resources at the border.
“Walls do not achieve the objectives for which they are said to be erected; they have limited effects in stemming insurgencies and do not block unwanted [migrant] flows, but rather lead to a re-routing of migrants to other paths,” wrote Élisabeth Vallet of the nonpartisan Migration Policy Institute in a 2022 report.
Those sorts of objections have done nothing to deter Abbott and GOP lawmakers, who are armed with a huge budget surplus and polling that shows a majority of Texas voters support the state's wall effort and overall border spending. More than 90% of Republican voters support the wall, with 74% voicing “strong” support, according to an April poll by the Texas Politics Project.
With construction plunging ahead, Novak has projected confidence about the wall's status, pointing to the recent progress after an initial slow start, which saw officials build less than 2 miles in the 12 months after Abbott announced the effort.
It's not just land access that complicates wall construction, Novak said at the June TFC meeting, where he ticked off a list of other factors: changing soil conditions that require “complicated engineering solutions”; steering clear of irrigation systems when building on agricultural land; weather; and “sensitivity” to cattle, oil and gas and hunting operations.
“It's a difficult and complex task, at best,” Novak said. “But with that said, we're whipping it. The latest stats reflect what I like to call just steadfast progress.”
Just in: Former U.S. Rep. Liz Cheney, R-Wyoming; U.S. Sen. John Fetterman, D-Pennsylvania; and Oklahoma Gov. Kevin Stitt will take the stage at The Texas Tribune Festival, Sept. 5–7 in downtown Austin. Buy tickets today!
The post Gov. Abbott's border wall will take around 30 years, $20B appeared first on TexasTribune.org.
The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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