Sign up for The Brief, The Texas Tribune's daily newsletter keeping readers up to date on Texas' most important news.

A group of 111 gynecologists in Texas released a letter to elected state leaders on Sunday urging them to change abortion laws that they say have prevented them from providing life-saving care to pregnant women.

The doctors pointed to ProPublica's recent reporting on two pregnant Texas women who died after medical staff delayed emergency care.

Josseli Barnica, 28, died of an infection in 2021, three days after suffering a miscarriage. More than a dozen medical experts said Barnica's death was preventable. However, the state's abortion laws prevented doctors from intervening until they could not detect a fetal heartbeat, which did not happen until about 40 hours after the miscarriage began.

Nevaeh Crain, 18, died last year after developing a dangerous complication of sepsis that doctors refused to treat while her six-month-old fetus still had a heartbeat. Two emergency rooms failed to treat her and a third delayed treatment, leading Crain to be transferred to the intensive care unit only after she experienced organ failure. Medical experts said that if hospital staff had treated her early, they could have either helped Crain have an early delivery or saved her life by terminating the pregnancy if the infection had progressed too far.

“Josseli Barnica and Nevaeh Crain should be alive today,” the doctors wrote in their letter. “As gynecologists in Texas, we know firsthand how much these laws limit our ability to provide high-quality, evidence-based care to our patients.”

In 2021, Texas lawmakers passed a law banning doctors from performing abortions after six weeks. The law allows the public to sue doctors or anyone who assists in an abortion for $10,000.

After Roe vs. Wade was overturned in Dobbs vs. Jackson, Texas banned almost all abortions – including in cases of rape and incest. The law provides an exemption for a doctor to perform an abortion if he or she believes it is necessary to save the pregnant patient's life. Doctors who violate state abortion laws risk losing their medical license and possibly life in prison.

Doctors have said confusion over what constitutes a life-threatening condition has changed the way pregnant patients with complications are treated. The Texas Medical Board has provided guidance on interpreting the law's medical exception, and the Texas Supreme Court has ruled that doctors do not have to wait until there is imminent risk to the patient to intervene. But some doctors say the guidelines are vague and that hospitals will evaluate each situation on a case-by-case basis.

ProPublica's reporting on Crain and Barnica comes as U.S. Sen. Ted Cruz and U.S. Rep. Colin Allred of Dallas face off in a heated battle for one of Texas' two U.S. Senate seats. Their differing views on abortion have been a central issue in the race, and both candidates have spoken out about the deaths of Crain and Barnica.

“Texas doctors can’t do their jobs because of Ted Cruz’s cruel abortion ban,” Allred wrote on X, linking to the story on Crain. “Cruz even lobbied SCOTUS to allow states to ban life-saving emergency abortions.”

In 2021, Cruz supported a 20-week federal abortion ban. He also co-sponsored a bill that would allow states to exclude medical providers who perform abortions from Medicaid funding. After the U.S. Supreme Court ruled Roe v. Wade overturned, Cruz celebrated the decision as a “massive victory.”

Cruz had previously said he believed Texas' exemption to save the pregnant mother's life worked. This week he reiterated that stance. In an interview with The Houston Chronicle, he called the deaths of Crain and Barnica “heartbreaking” and said the procedures necessary to save the pregnant mother's life were legal in Texas.

Dozens of women have come forward to say they were unable to receive the medical care they needed for their medically complex pregnancies after the state's abortion ban went into effect.

Last year, state lawmakers passed a law allowing abortions for people with ectopic pregnancies, a nonviable form of pregnancy in which the embryo implants outside the uterus, and when a patient's amniotic sac ruptures before the fetus is viable.

The doctors who signed the letter expressed their desire to see a change in state law.

“Texas needs a change. A change in the law. A change in the way we govern medical decisions that should be made between a patient, their family and their doctor.”