FACT CHECK: ProPublica admits truth but still blames 'abortion bans' for woman's death

The pro-abortion ProPublica media outlet is once again attempting to blame state abortion restrictions for a pregnant woman's death — and this attempt is even more baffling than those that came before.

North Carolina mother Ciji Graham's 2023 death was both tragic and preventable; it is also unlikely to be related to state abortion restrictions.

Key Takeaways:

• North Carolina mother Ciji Graham, who was not quite halfway through her first trimester of pregnancy, visited a cardiologist complaining of a rapid heartbeat — a pre-existing condition for Graham that had successfully been treated before.

• The cardiologist reportedly refused to perform the same procedure (cardioversion) because Graham was pregnant, despite research showing cardioversion can safely be performed during pregnancy. ProPublica's experts stated she should have been admitted to a hospital and treated based on the standard of care.

• Graham's condition grew worse, and she visited a second cardiologist who prescribed medication and scheduled cardioversion for three weeks later.

• Eventually, Graham became convinced she needed an abortion, which is legal in North Carolina up to 12 weeks for any reason (she was six weeks), as well as legal for medical emergency at any point in pregnancy. Before the abortion appointment, scheduled for two weeks into the future, Graham died.

• ProPublica attempted to blame state abortion restrictions for Graham's death, despite the allowances in North Carolina's law and despite acknowledging a nationwide education gap regarding pregnant women with cardiovascular issues.

• Graham could have been saved, but not by having an abortion; she needed the proper treatment required for her condition, which was both safe and available. She was failed by doctors who made "inexplicable" decisions, according to ProPublica's own experts, and North Carolina's abortion restrictions would have been irrelevant.

The Details:

ProPublica published a report on the death of Ciji Graham, a Black police officer in North Carolina. Graham was raising a young child and had a chronic heart condition which caused atrial fibrillation, or AFib, a rapid and irregular heart rhythm. It isn't necessarily life-threatening, but it does require treatment with medicine or sometimes a procedure known as cardioversion.

Cardioversion is a procedure in which the heart is shocked to reset its normal rhythm; this can be done during a scheduled appointment or as part of emergency treatment. Graham had undergone successful cardioversion procedures in the past.

North Carolina's abortion law wasn't likely a factor

ProPublica's article states, "Like hundreds of thousands of women each year who enter pregnancy with chronic conditions, Graham was left to navigate care in a country where medical options have significantly narrowed."

It also states (emphases added):

... because of new abortion restrictions in North Carolina and nearby states, finding a doctor who could quickly perform a procedure would prove difficult. Many physicians and hospitals now hesitate to discuss abortion, even when women ask about it. And abortion clinics are not set up to treat certain medically complicated cases. As a result, sick pregnant women like Graham are often on their own....

In a region that had legislated its commitment to life, she would spend her final days struggling to find anyone to save hers. 

But this dramatic narrative isn't quite in line with reality.

QUICK HIT: It would make little sense for North Carolina doctors to "hesitate" in discussing first-trimester abortion in a state where first-trimester abortion is completely legal.

In North Carolina, abortion isn't restricted at all in the first trimester, and it allows for exceptions in the second and third trimesters based on the circumstances of a child's conception as well as the health of the child (arguably not the most stringent or protective law for preborn children). And for medical necessity, the law contains no limits at all. It states (emphasis added):

Under the new law, abortion is permitted through the first 12 weeks of pregnancy for any reason, through the 20th week of pregnancy if the pregnancy resulted from rape or incest, through the 24th week of pregnancy if there is a life-limiting anomaly in the unborn child, and at any time if there is a medical emergency for the pregnant woman.

If abortion is allowed for any reason throughout the first trimester and well after for medical emergencies, rape/incest, and anomalies, it is clear that abortions must be occurring in North Carolina — even in hospital settings.

These allowances aren't exactly "narrow" as ProPublica claims; they certainly weren't narrow for Graham, who was six weeks pregnant — well within the law's allowances, even if she had not had a medical condition. Even in states with the most stringent pro-life laws (like Texas, which ProPublica has attacked multiple times), induced abortion is allowed for situations deemed by physicians to be medical emergencies.

Despite ProPublica's insistence that the law is to blame, Graham:

• apparently interacted with more than one physician, yet does not appear to have asked about referrals to an OBGYN.

• does not appear to have asked any doctor about (legally) aborting her high-risk pregnancy.

Given the information provided by ProPublica, it is unknown why these discussions between physician and patient did not occur.

"Inexplicable" responses from cardiologists

In 2023, Graham again was experiencing AFib, with her heart reaching 192 beats per minute. This time, however, she was newly pregnant, and her cardiologist, Dr. Sabina Custovic, refused to perform the cardioversion.

ProPublica's consulted experts presented this refusal as "inexplicable," noting that cardioversion is considered safe during pregnancy. Pregnancy can exacerbate existing heart conditions, and cardioversion is often the preferred treatment because it is seen as safer for the preborn child than taking medication.

Clearly, if this treatment is safe during pregnancy, there would have been no reason for Graham's cardiologist to decline to perform the cardioversion — which is likely why ProPublica's experts called the response "inexplicable."

QUICK HIT: The cardiologist would have had no legitimate legal or medical reason to refuse to provide the treatment; abortion restrictions had nothing to do with this refusal.

Instead of receiving the medical care she needed, Graham was sent home and was encouraged to consult with other specialists. Experts who spoke to ProPublica reportedly all agreed that Graham should have been admitted to the hospital.

A second cardiologist, Dr. Will Camnitz at Cone Health, confirmed that an EKG on Graham from the day prior showed AFib, and then he sent Graham home (with a normal pulse rate at the time of the visit), with a prescription for blood thinners and an appointment for cardioversion three weeks later "if by then she hadn’t returned to a regular heart rhythm on her own," wrote ProPublica.

While ProPublica's experts said this was a reasonable course of action, Camnitz also didn't order a follow-up EKG to confirm that her heart rate was not still dangerously high. “He’s an electrophysiologist and he didn’t do that, which is insane,” Dr. Kayle Shapero, a cardio-obstetrics specialist at Brown University, told ProPublica.

QUICK HIT: There was no reason related to any abortion restriction that would have prevented Camnitz from ordering another EKG.

In addition to the rapid heartbeat, Graham was also having trouble breathing, meaning there were significant risks.

“I can’t think of any situation where I would feel comfortable sending anyone home with a heart rate of 192,” Dr. Jenna Skowronski, a cardiologist at the University of North Carolina, told ProPublica. Rhode Island cardiologist Dr. Daniel Levine agreed, and said a cardioversion should have been performed, even if it posed a risk to the preborn child. As he correctly pointed out, “No mother, no baby.”

QUICK HIT: There was no law and no circumstance preventing Graham's cardiologists from taking whatever action was necessary to treat her heart condition. There was also no law preventing Graham from obtaining an abortion.

Zoom In:

Again, ProPublica never makes note of Graham asking her cardiologists about seeking a legal abortion or about being referred to an OBGYN. If any discussion on the topic had occurred, there is a chance that Graham might have learned that her health condition made her high risk — too high risk to seek an abortion at a clinic.

The article simply states that Graham "came to believe" that abortion was the best way to "protect her health" — not that she was encouraged to seek one. And nowhere does ProPublica state that Graham sought help from an obstetrician/gynecologist.

Instead, Graham reached out to A Woman's Choice, an abortion facility in Greensboro, at six weeks pregnant. There was a two-week wait for her abortion appointment, which ProPublica claimed was the fault of abortion restrictions in surrounding states:

[T]here was a long line ahead of her. Women were flooding the state from Tennessee, Georgia and South Carolina, where new abortion bans were even stricter. On top of that, a recent change in North Carolina law required an in-person consent visit three days before a termination. The same number of patients were now filling twice as many appointment slots. 

In the case of a medical emergency, an abortion is immediately allowed, with no waiting period.

The law notes that medical emergency is defined as, "A condition which, in reasonable medical judgment, so complicates the medical condition of the pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible physical impairment of a major bodily function, not including any psychological or emotional conditions." 

A Woman's Choice told ProPublica they didn't keep appointment forms, so it's not known if Graham told them about her health issues; however, someone from the facility told ProPublica that it wouldn't have been equipped for a high-risk situation like Graham's. It is possible that the abortion business didn't ask about health risks, and Graham didn't mention any — indicating another breakdown in communication.

ProPublica admitted that hospitals affiliated with Duke University and the University of North Carolina would have committed an abortion on Graham with a doctor's referral.

But Graham likely would not have felt driven to seek an abortion had she received the medical treatment she needed from her cardiologists.

Unfortunately, Graham was found dead on November 19, 2023, just five days after attempting to seek help. The cause of death was “cardiac arrhythmia due to atrial fibrillation in the setting of recent pregnancy.”

Reality Check:

Pattern of misplaced blame

The overarching message in the ProPublica article is that Graham died because she was not able to access an abortion; it ties into their recent "Life of the Mother" series which claimed laws in pro-life states were causing numerous women to die. Yet that series, as well as the article about Graham, put blame for these tragic deaths in the wrong place. In virtually every scenario, the woman in question didn't need abortion, but had been denied proper and timely medical care.

Glossing over "gaps in education"

This is especially clear with Graham's case. ProPublica quoted its experts, who laid blame on "gaps in education" for cardiologists regarding pregnant women with heart conditions. And yet, even with this acknowledgment of existing educational gaps and a failure to act across the country, ProPublica still insisted on blaming abortion restrictions (emphases added):

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. “A large proportion of the cardiology workforce feels uncomfortable providing care to these patients,” the authors concluded in the Journal of the American Heart Association. The legal threats attached to abortion bans, many doctors have told ProPublica, have made some cardiologists even more conservative.

There is no evidence to back up this last claim, which is particularly galling considering the mentioned survey showed that the vast majority (upwards of 70%) of cardiologists are not properly trained to treat pregnant women.

This is an astounding admission; yet it seems to have barely fazed ProPublica's authors, still hell-bent on blaming abortion restrictions for Graham's death.

The study ProPublica referenced from the Journal of the American Heart Association cited hundreds of doctors across the entire country. This is, therefore, a widespread issue not solely found in states where abortion is restricted. That fact should disturb people, but it is not a crisis created by abortion restrictions.

The Big Picture:

Another major issue ProPublica failed to discuss in relation to Graham's death is the disproportionate treatment for minority women often observed in health care.

Black women are significantly more likely to die of pregnancy-related, or childbirth-related causes, regardless of where they live. According to the CDC, these deaths are very often preventable. Investigations from both ProPublica and NPR have stated that Black women have three times the risk of death while giving birth compared to white women. Accordingly, Black women who give birth at hospitals primarily serving minorities face serious complications (infections, birth-related embolisms, and emergency hysterectomies) at much higher rates.

Additionally, a study from Dr. Elizabeth Howell, a professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai Hospital, found that the rate of death or injury for Black women would likely fall by as much as 50 percent if they delivered at hospitals which primarily serve white patients.

And yet, Black women from wealthy neighborhoods still fared worse than white, Hispanic, and Asian women from impoverished neighborhoods. Obese women of all races even fared better than Black women of healthy weight. 

Maternal mortality rates are dropping overall — but among Black women, this isn't the case.

And for all women, there are issues that persist:

• Maternity care deserts, defined as a county without a hospital or birth center offering obstetric care, is becoming a bigger and bigger problem, and it isn't because of abortion; hospitals began shutting down maternity wards as a cost-cutting measure before Roe v. Wade was overturned. As birth rates decrease, hospitals located in less populous areas have begun making cuts to obstetric services.

• While deaths from obstetrics-related causes (like hemorrhage or pre-eclampsia) have decreased, deaths from indirect, pre-existing causes (like hypertension) have increased.

All of this information, combined with existing knowledge about the lack of education cardiologists receive regarding treating heart problems during pregnancy, explains a great deal about what led to Graham's tragic and preventable death.

These issues exist outside of the debate regarding abortion restrictions — but ProPublica had a narrative and an agenda to promulgate, and these issues weren't included.

The Bottom Line:

ProPublica has already unintentionally proven that abortion restrictions are not leading to the deaths of pregnant women. Yet the outlet chooses only to examine deaths in states with abortion restrictions instead of including those without, and continually pushes the same narrative.

This doesn't help to protect women like Ciji Graham. It's only meant to protect and promote abortion.

Go Deeper:

Read more about ProPublica's chosen narrative, and the disservice it does to women:

• ProPublica’s long-planned agenda is clear: Whatever the problem, blame pro-life laws

• ProPublica’s Pulitzer award proves that poor journalism can win if it has the preferred agenda

• ProPublica blames pro-life laws for miscarriage complications, but admits data can’t prove it