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OBGYNs Damla Karsan and Judy Levison in Karsan’s office on Fannin on Thursday, March 9, 2023. The doctors have joined a lawsuit brought by five women against the state of Texas as plaintiffs in hopes of clarifying when a physicians can end a pregnancy in emergency situations or if the fetus is not viable.
Annie Mulligan/Contributor
Last spring, Dr. Judy Levison started to give her routine answer when a patient, who was 15 weeks pregnant, asked why she should receive a blood test that picks up certain fetal defects.
Some women simply want to prepare themselves, the longtime Houston obstetrician-gynecologist explained. For others, she said, certain abnormalities may cause them to consider abortion.
“I suddenly get to the word abortion, and it was like ‘Oh, huh, I can’t really offer that in the state of Texas anymore,’” said Levison, noting that Texas already had implemented an abortion ban at six weeks. “And my patients generally didn’t have the means to go traveling to other states… I just realized I was in this quandary, and I couldn’t offer what I thought was right.”
THE LAWSUIT: 5 women sue Texas, saying its abortion ban put themselves or their fetuses at risk
That moment was part of what caused Levison to partially retire last year and join fellow Houston OB-GYN Dr. Damla Karsan in publicly pushing back against the state's abortion restrictions, at a time when most doctors fear speaking out could jeopardize their livelihoods. The two doctors signed onto a lawsuit brought by five women who say they were denied abortions despite having dangerous or nonviable pregnancies. The plaintiffs are not asking to overturn the law, but rather to clarify when abortions legally can be provided.
The Center for Reproductive Rights, which backed the suit, said it is the first time pregnant women have taken legal action against bans enacted by Texas and at least 12 other states since the U.S. Supreme Court overturned Roe v. Wade in June.
After working in Houston for more than two decades, Levison and Karsan see the case as a chance to fight for colleagues and patients caught between legal penalties and ethical treatment.
A ‘trailblazer’ in perinatal HIV treatment
A New Jersey native, Levison, 73, said the intense debate over women’s rights in the 1970s helped spark her interest in women’s health care.
She trained at Tufts University in Boston and for about 20 years practiced in Washington and California before joining the faculty at Baylor College of Medicine in 2000. She practiced as a general OB-GYN at the Harris Health System and largely treated patients in the system’s Women’s Program, which provides obstetric and gynecologic care for people living with HIV in the Houston area.
She did not know much about HIV when she chose the work, she said, but fell in love with the patients. She could learn about their diverse backgrounds — “HIV means different things to different cultures” — and it gave her a chance to speak Spanish most of the day.
Levison was promoted to the head of the Women’s Program in 2002, and over time became a national leader in perinatal HIV treatment. She serves on a state panel that examines babies born with congenital syphilis and HIV, as well as a national body that provides guidance for clinicians treating patients who live with the virus.
Part of Levison’s focus has been reducing the stigma around HIV. One of her successes at Harris Health was the organization of group prenatal care and education sessions, which gave pregnant patients with HIV a space to talk about contraception, postpartum depression, intimate partner violence and other common issues.
At the time, those group programs had not been widely adopted, said Dr. Anitra Beasley , an associate professor of obstetrics and gynecology at Baylor who trained under Levison.
“She was a trailblazer,” Beasley said. “When she started taking care of HIV pregnant patients, there were a few people here and there who were doing it, but not really. She was one of the early people who really said, ‘This population needs dedicated providers.’”
EARLY WARNINGS: Overturning Roe v. Wade poses risk to women with complicated pregnancies, Houston OB-GYN warns
As an educator, Levison gained the trust of her students, including Dr. Elizabeth Kravitz, a former Baylor College of Medicine student and resident at the University of Pennsylvania Health System.
Kravitz said she went to Levison around the time state lawmakers were considering the six-week abortion ban. She thought about leaving the state to continue her education as an OB-GYN, and Levison invited her over to her house to talk it through.
“She emulates exactly the kind of doctor I want to be,” Kravitz said. “She manages to juggle being a very personable clinician to her patients, and a teacher, and has her hand in advocacy and public health.”
Throughout Levison’s career, she has managed patients, directly or indirectly, who experienced dangerous pregnancy complications, including premature rupture of membranes, in which a patient’s water breaks before labor begins, and conditions arising from high blood pressure or other pre-existing illnesses.
After Texas in September 2021 banned abortions after the presence of a fetal heartbeat, which usually starts around six weeks of pregnancy, Levison started hearing stories from colleagues at Texas Medical Center hospitals about how the laws were affecting treatment. In some cases, patients whose fetuses were not likely to survive had been forced to wait until the pregnancy ended on its own, rather than receive immediate care, she said.
Later, as the Supreme Court decision on Roe v. Wade loomed , Levison penned a letter to Baylor leaders on behalf of herself and several colleagues, asking for more guidance on how to handle complex cases. Soon, she became part of a group of physicians that began sharing information and advising each other on treating pregnant patients in difficult situations.
She already had considered stepping away from clinical work for a variety of reasons, but the fear that had spread throughout the profession had become “just one more reason,” she said.
“I said, I can't do it this way anymore.”
Standing up for those who can’t
It was a colleague who first asked Dr. Damla Karsan if she would be willing to be a plaintiff in this case. The person was not able to participate because she had ties to a public institution.
As a physician in private practice, Karsan, 52, knows she has more freedom to speak out than others.
“My patients come first,” Karsan said. “I’m not employed by a hospital or larger entity that’s going to tell me I can’t do this as an employee because it’s going to reflect on them. So, I think, one, it’s my character; two, it’s my situation.”
Karsan, a Houston native, received her bachelor’s degree from Rice University, then completed medical school at Washington University and her residency at Duke University. She has been in private practice in Houston for almost 22 years, and opened her own practice, Comprehensive Women’s Healthcare in southwest Houston, about five years ago.
She had known she wanted to be a doctor since she was 4 years old, inquiring as a kindergartner about their instruments and how they work. It was not until middle school when she hit puberty that she discovered an interest in women’s health. In medical school, she started a program for reproductive health education in a school with one of the highest teen pregnancy rates in the city of St. Louis.
“From the very beginning, women’s health and reproductive health has been a very central focus for me,” Karsan said.
RIPPLE EFFECTS: Pregnant with cancer in a post-Roe world: ‘This is a baby we want. … But I don’t want to die’
Decades later, Karsan is a veteran health care provider in the community. Just the other day, she confirmed a pregnancy in a patient whom she delivered as a newborn, which her staff joked now makes her a “granddoctor.”
As the name of her practice says, Karsan takes a comprehensive approach in treating patients, and that always has included abortion care. The vagueness of the state’s emergency exception “impacts me on a regular basis,” she said.
“These cases are so nuanced,” Karsan said. “I think the legislature is very ill-equipped to spell out these things because they don’t have the experience, the medical knowledge, and there’s no way you could spell out every single situation.”
In one recent case, Karsan had a patient in her second trimester come into the emergency room with bleeding and blood clots with a high risk of hemorrhage. An ultrasound revealed the fetus had anencephaly, a birth defect in which parts of the brain and skull are missing — the same situation as two of the women joining Karsan in suing the state. Karsan's hands were tied, she said, because the patient had not started hemorrhaging.
“She might choose, had the fetus been potentially viable long-term, to take the risk and watch and wait, but, you know, she's taking a risk for no potential benefit here,” Karsan said.
In a similar case, another of Karsan’s patients, also in her second trimester, had a fetus with body-stalk anomaly , a rare and severe defect that is considered to be fatal. That patient did not have the means to fly somewhere to get an abortion, so the family ended up driving 14 hours to another state.
“I mean, it’s just a tragic situation from the get-go, and now we’re abusing this family by making them jump through these hoops to get the care they need,” she said. “Those that don’t have the wherewithal or the means to travel are going to end up carrying these pregnancies with the risk of diabetes and preeclampsia and hemorrhage, hysterectomy” and possibly even death.
“It’s making women second-class citizens,” she added. “It boggles my mind that we’re at this point in 2023.”
taylor.goldenstein@houstonchronicle.com
julian.gill@houstonchronicle.com
