July 24, 2012 -- The family of a Chicago woman who died after hemorrhaging during an abortion at a Planned Parenthood clinic has hired a lawyer to help them decide whether to take legal action.
"We're just trying to get all the facts from the incident and determine what the best course of action is," Corey Meyer, the family's lawyer, said. "We're still getting information."
Tonya Reaves, 24, died after hemorrhaging during cervical dilation and evacuation -- a kind of second-trimester abortion -- and an intrauterine pregnancy late Friday night, Cook County medical examiners said.
Reaves was transported via ambulance from a Chicago Planned Parenthood clinic to Northwestern Memorial Hospital at about 11:00 a.m. Friday, medical examiners said. She was pronounced dead about 12 hours later, at 11:20 p.m.
Medical examiners have ruled her death an accident.
Meyer said Reaves experienced a complication during the procedure at the reproductive health clinic.
He said the family is looking to determine whether the actions of Planned Parenthood or Northwestern Memorial contributed to her death.
Reaves' autopsy report will not be available for at least a month, the medical examiners said.
Planned Parenthood of Illinois' president and CEO Carole Brite said in a statement, "While legal abortion services in the United States have a very high safety record, a tragedy such as this is devastating to loved ones and we offer our deepest sympathies."
Unlike a first-trimester abortion, in which suction is used to remove uterine contents small enough to go through tubing, the cervical dilation and evacuation requires instruments to help remove the fetus, said Dr. Stephen Weiss, an assistant professor at Emory University in Atlanta.
Proving malpractice generally requires proof that a patient's negative outcome resulted from treatment below the standard of care.
"If the patient had a clear history of having a bleeding disorder and [Planned Parenthood] never asked those kinds of questions preoperatively, then that would be bad," said Weiss, who had not treated Reaves. "If she didn't know about it and she said no when they asked those questions, then that's within the standard of care."
Weiss said it is rare for patients to die as a result of a cervical dilation and evacuation. "It probably happens less often than people dying just having full-term child birth," he said.
Dr. Mitchell Rosen, director of the University of California-San Francisco fertility preservation center and the director of the University of California-San Francisco reproduction laboratories, said, "There could have been a million things that could have gone wrong. To have the cause of death be cervical dilation and evaluation, it may be somewhat of a stretch."
Rosen said that while the procedure is common, Reaves' uncontrolled bleeding might highlight that something abnormal occurred.
"This is what we consider to be a sentinel event," said Rosen, who had not treated Reaves. "It's like somebody giving birth. You can always have a severe complication, but it's not supposed to happen."
Reaves might have had a preexisting medical condition that required more scrutiny prior to the procedure, Rosen said.
"Hemorrhages tend to happen with later pregnancies," Rosen said. "It's not uncommon when there have been retained products of conception within the uterus. But in the absence of any sound medical evidence or medical information, it's tough.
"There is no procedure that is 100 percent safe," Rosen said. "We tell every single patient that, whatever it is."
Weiss said the causes of hemorrhaging for full-term pregnancies and abortions often overlap.
"One in 100 patients will have a postpartum hemorrhage following childbirth," he said. "A much lower number will have a late-postpartum hemorrhage, and days or weeks later, will come back after heavy bleeding."
Weiss said hemorrhaging can be caused by any number of factors, including blood vessel spasms, underlying problems with clotting and placenta tissue left behind in the uterus after an abortion.
He said that in Reaves' case, she could have experienced two different kinds of hemorrhaging.
She could have either bled out through the vagina, or there might have been damage to the arteries that feed into the uterus, which could have caused blood to collect on the abdominal side of the uterus, he said.
"That could form a big bruise that could burst," he said. "Then all of a sudden, [the patient] would bleed briskly internally."