Cartoon: Electoral College Confessions


Let’s begin October with a little bit of meta!


I made a timelapse drawing video for this cartoon.


In 2019, Donald Trump tweeted about the idea of abolishing the electoral college:

….just the large States – the Cities would end up running the Country. Smaller States & the entire Midwest would end up losing all power – & we can’t let that happen. I used to like the idea of the Popular Vote, but now realize the Electoral College is far better for the U.S.A.

Although most people would say it with more coherent syntax, this is a vera popular argument in defense of the Electoral College: Without it, small states would lose all power.

Except the Electoral College really, really obviously doesn’t give small states power. It gives swing states power; the seven or so states that could go either way get an enormous amount of attention from Presidential candidates. But most small states aren’t swing states. Jamelle Bouie wrote:

Totaling the 2016 numbers, Sam Wang, a molecular biologist at Princeton who also runs a widely read election website, found that out of almost 400 campaign stops made after the conventions, neither Hillary Clinton nor Donald Trump made appearances in Arkansas, Oregon, Idaho, Wyoming, Montana, the Dakotas, Kansas, Oklahoma, Louisiana, Mississippi, New York, South Carolina, Tennessee, Kentucky, West Virginia or Vermont. It doesn’t matter that Trump won millions of votes in New Jersey or that Hillary Clinton won millions in Texas. If your state is reliably red or blue, you are ignored.

The actual reason Republicans support the Electoral College is obvious: Democrats have won the popular vote in seven of the last eight presidential elections. That is the only real reason – and it’s one they’re loathe to say aloud.

A lot of political cartoon humor comes from exactly this – people saying things aloud that they’d never say in real life.


The drawing in this cartoon is nothing special – two people walking through a park while arguing is something I’ve drawn a lot. But I really had fun drawing it. Sometimes I draw and it feels like I’ve forgotten how to draw. Not this time; I just had fun drawing every element of this, and I barely had to redraw anything. And the final results look good to me.

Panel three is the simplest panel, but also the one I’m happiest with. That face just looks good to me.


TRANSCRIPT OF CARTOON

This cartoon has four panels, plus an additional tiny “kicker” panel under the bottom of the cartoon. All four panels feature two characters who are walking through a park and talking.

The first character is a woman with dark hair pulled back in a ponytail, wearing a red tank top and jeans. Let’s call her TANKTOP. The second character is a businessman-looking man, wearing round glasses and a blue suit. Let’s call him SUIT.

PANEL 1

Tanktop and Suit are walking though a hilly park. Tanktop looks a little angry and is lecturing Suit, who seems calmer. Suit is walking in front of Tanktop, so he’s facing away from her.

TANKTOP: Conservatives say we need the Electoral College so small states won’t be ignored – but since the ten smallest states aren’t swing states, the Electoral
College guarantees they get ignored!

SUIT: I’m so sick of this argument.

PANEL 2

A close up of Suit, who is looking very annoyed.

SUIT: IT’s true our arguments for the Electoral College make zero sense! And they’re anti-Democracy! Who cares? It doesn’t matter if we make sense!

PANEL 3

An even closer close-up of Suit, who finally turns back to look at Tanktop as he speaks. His expression is angry and intense.

SUIT: With the Electoral College, we can lose the vote and still win the presidency! We will never let voters decide, because then we’d have less power, and power is all we care about! How do you not know that?

PANEL 4

Suit has turned away from Tanktop again and the two continue walking. Both of them have returned to speaking in ordinary tones, although Tanktop still looks annoyed.

TANKTOP: I did know, but I’m shocked you’re saying it aloud.

SUIT: Well, don’t forget this is a cartoon.

TINY KICKER PANEL UNDER THE BOTTOM OF THE CARTOON

Suit is talking to Barry the Cartoonist.

SUIT: I will never, ever, ever turn against the Electoral College! Unless Texas turns blue.

CHICKEN FAT WATCH

“Chicken fat” is an outdated cartoonists’ term for little details in a comic that don’t mean anything but are hopefully fun.

PANEL 1: Beaker from the Muppets is peeking out of a hole in a tree.

A sign in the background says “KEEP OFF THE GRASS (ink may smear).”

PANEL 2: A bird flying in the background has a cat head. (In the sense of its own head being feline, not in the sense that it’s carrying a decapitated cat’s head).

PANEL 4: An evil bunny smoking a cigarette is sticking its head out of a hole in the ground. In the foreground, a friendly looking pig wearing a fedora is glancing out towards the readers. On the path, a bored looking snail is on top of a tiny skateboard, and an ant is riding on top of the snail.

In panel one, Tanktop’s tattoo was a coffee mug with a smiley face on it. In this panel, the coffee mug has fallen on its side, spilling coffee, and the face on the mug is distressed.


Electoral College Confession! | Patreon

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33 Responses to Cartoon: Electoral College Confessions

  1. Avvaaa says:

    The place where small states really exercise outsize power is not the electoral college, but the Senate – it´s quite possible for a coalition of states representing 13% of the population to exercise an effective veto via filibuster. And given that those states are almost all republican aligned, it isn´t just possible, it happens quite a bit.

    But as weak as the move to reform the electoral college is, I´ve never heard any discussion of reforming the senate beyond the most pointy-headed academic exercises, so, I don´t even know why I am bringing this up, really.

    Here´s something that is a bit more relevant – does the Republican party as it currently exist, exist largely because it´s exactly the sort of party that can effectively game the electoral college? Given that the electoral college (and more generally, the American political system) gives an inbuilt bias to a certain set of actors, is it that surprising that those actors eventually coalesce around their shared opportunity to exploit the hack that was provided to them? In a sense the two main American parties may be regarded as the party that succeeds because of the biases of the electoral system, and the party that succeeds (sometimes) by overcoming those biases through popular mobilisation.

  2. Jacqueline+Squid+Onassis says:

    I agree but I’ll note that they don’t just game the Electoral College. As you’ve stated, they also have that inherent advantage in the Senate but their control of state government also allows them to gerrymander and game the House. It’s not a great way to structure a government.

  3. Avvaaa says:

    Yeah, really they are gaming the Electoral System, and the College is just one part of it, albeit a pretty important part.

  4. Avvaaa says:

    PS: It´s great to see a Republican represented as a white male. Very accurate.

  5. RonF says:

    With the Electoral College, we can lose the vote and still win the presidency!

    Except that we really don’t know what ‘the vote’ is.

    There’s a hidden presumption in all the arguments about the EC making it possible to lose the popular vote while still gaining the Presidency. It’s that the sum of the individual State popular votes equals a national popular vote that in summation represents the will of the American people. But the understanding that due to the EC your vote for President stops at your State line is likely to affect turnout in a way that can depress voter participation in certain States, especially one-party ones where the minority party figures “Why vote, what’s the use?”. The sum of the States’ individual popular votes simply cannot be presumed to fairly represent a result of a national vote for President.

  6. RonF says:

    The bottom line is that the Constitution is a compact among sovereign States whose concern was to protect their own sovereignty while surrendering only the minimum necessary to the Federal government. The States reserved the power over the Federal government to themselves as sovereign entities, not to the people of those States.

    Thus: the States, though the Electoral College, elect the President and thus the Executive Branch. The States elect the Senate, half of the Legislative Branch. The States, indirectly though the Senate and the President, nominate and confirm the Judicial Branch. The people directly only get one half of one branch of the Federal government, and the States have some control over those elections both as to how the districts are configured (with some control by the courts) and how the elections are held. The people were never intended to directly elect most of the government. The Federal government overall represents the States as entities, not the people. And it’s highly unlikely that fewer than 14 States will ever vote to maintain that structure.

  7. RonF says:

    Conservatives say we need the Electoral College so small states won’t be ignored – but since the ten smallest states aren’t swing states, the Electoral College guarantees they get ignored!

    But a small State could become a swing State at a future date. So while the EC isn’t currently helping them get more attention, I wouldn’t say it guarantees they get ignored.

    I also think that even if they’re being ignored, they still have an influence disproportionate to their population – which is closer to the actual argument I’ve seen made on the right-wing blogs. The specific argument I’ve seen is that without the ECs politicians wouldn’t bother campaigning anywhere that there isn’t one of the 6 or 10 major cities. On that basis, the EC means that the votes of rural areas are less drowned out by the urban centers.

  8. Avvaaa says:

    “But a small State could become a swing State at a future date.”

    LOL

  9. Ampersand says:

    The specific argument I’ve seen is that without the ECs politicians wouldn’t bother campaigning anywhere that there isn’t one of the 6 or 10 major cities. On that basis, the EC means that the votes of rural areas are less drowned out by the urban centers.

    Okay, so your theory here is that, given a nationwide election rather than one limited to seven or eight states, candidates wouldn’t campaign anywhere but the 6-10 largest cities (i.e., the places with the greatest density of voters).

    Two questions:

    1) Why do Governors commonly do things like make a big public deal of visiting every county in their state, if the best strategy for their re-election would be to only visit the ten biggest cities?

    2) Why don’t candidates only visit the ten largest cities in the swing states? Instead, they generally do stops in many places across the swing states.

    There’s no evidence at all that candidates act in the way you describe, and quite a bit that they don’t. Of course candidates will visit big cities, and you shouldn’t want them not to. But the fact is, they don’t visit only the largest cities. Votes are votes, events are events, and there’s no logical reason, given campaigns that are half a year long or longer, for candidates to not visit a large number of places.

    Oh, and a third question:

    If you were right about how candidates act, which you’re not, why would having candidates visit only the ten largest cities in swing states be better than them visiting the ten largest cities across the country? What makes swing state cities and voters so much more deserving than voters in places like NYC and Houston?

  10. Megalodon says:

    Elie Mystal posted an article at The Nation and noted what “rural” and “urban” and “mob rule” probably mean to EC apologists.

    The idea that the Electoral College protects small states and rural voters is the biggest modern lie about what the system does. The EC doesn’t force politicians to give a damn about whether or not a state is “rural”; it forces them to care about whether the margin of victory is close enough in the state to make it worthwhile to campaign there.

    We can clearly see this by looking at where the presidential candidates are spending their money and campaign time. An NPR analysis from May showed that the two presidential candidates were spending most of their money in just a few states: Pennsylvania, Michigan, Arizona, Georgia, North Carolina, and Wisconsin. All of those rank in the top 15 states, by population, except for Wisconsin, which is 20th (meaning it’s still in the top half of states by population). The Electoral College does not direct candidates’ campaign time and attention to small states but to big states where the race happens to be tight.

    And that doesn’t even tell the full story in terms of the true urban-rural divide. First of all, the idea of a “rural” state is largely a myth. According to the 2020 Census, 80 percent of Americans live in “urban” areas. In only four states—Maine, Mississippi, Vermont, and West Virginia—does a majority of the population live outside of urban areas, and nobody with a straight face would argue that the Electoral College encourages presidential candidates to spend a lot of time and resources in those places.

    Of the states that are Electoral College “battlegrounds,” Wisconsin and North Carolina are the only ones where as much as a third of their populations live in rural areas. In all the other battleground states, more than 70 percent of the population lives in urban areas.

    We are an urbanized nation. That’s why, even when politicians go to slightly more rural states like Georgia or Michigan, they go to the major cities in those states. They go to where people actually live. Major cities, in relatively populous states, have an outsize share of political power in the Electoral College system as long as those states are close.

    So what’s really going on here? Why do so many people believe the Electoral College protects “rural” interests when it demonstrably does not? I believe what’s happening is that these people are using “rural” as a euphemism for “white,” and “urban” as a euphemism for “Black.” The Electoral College protects white interests and sensibilities from being overrun by the emerging non-white majority in this country, and the people who defend the EC are desperate to keep it that way. The “mob rule” these people claim to be afraid of is not, say, mobs of angry whites attacking the Capitol to install the government of the losing presidential candidate; they’re worried about “mobs” of Black people, living in cities, voting for the candidate of their choice, and having their votes count just as much as those of white folks who are spread out around the country.

    https://www.thenation.com/article/politics/the-electoral-college-is-bad/

  11. RonF says:

    Okay, so your theory here ….

    I said “The specific argument I’ve seen is ….”, not “My theory is ….”.

    Why do Governors commonly do things like make a big public deal of visiting every county in their state, if the best strategy for their re-election would be to only visit the ten biggest cities?

    That depends on the State. Here in Illinois you can be sure that J. B. Pritzger did no such thing. Sure, he showed up in some Downstate counties, but all 103? No way. Cook County (Chicago and close-in suburbs), the collar counties (farther out suburbs), Springfield (State capital) and some Downstate counties, but that’s it.

  12. Ampersand says:

    Yes, but “the specific argument” is that politicians would definitely act like that, when we can see that usually they don’t.

    You know how much of the US population lives in the 10 biggest cities combined? About 35 million (going by 2023 estimates). The current population of the US is about 345 million. Why would any candidate choose to ignore 90% of the population?

    I mean, right now, they DO ignore over 90% of the population, but that’s because Republicans fear that they can’t remain as extreme as they want to and still win the White House if they had to win a popular vote. But if candidates had to appeal to the whole country to win, then that’s what they’d try to do.

    It’s weird how you talk as if you oppose candidates ignoring most of the population, when in fact you argue in favor of the Electoral College, which is a law designed to allow presidential candidates to ignore voters.

    By the way, you said earlier that Republicans wouldn’t necessarily lose the popular vote if we had a popular vote system for choosing Presidents. And you’re right about that. Republicans would probably do what any rational party would do in that circumstance – they’d moderate as necessary to be able to win. There’s no way to test this, but without the EC, I don’t think the GOP would have chosen Trump as their presidential candidate three times in a row. You only choose someone like Trump if you know you’re not going to be answerable to a popular vote.

  13. Avvaaa says:

    “Here in Illinois…”

    Would you support an electoral college style voting system being used inside Illinois?

  14. nobody.really says:

    …nobody with a straight face would argue that the Electoral College encourages presidential candidates to spend a lot of time and resources in those places.

    So if I had a gay face, would you think I would make a different argument about the Electoral College?

    We are an urbanized nation. That’s why, even when politicians go to slightly more rural states like Georgia or Michigan, they go to the major cities in those states. They go to where people actually live. Major cities, in relatively populous states, have an outsize share of political power in the Electoral College system as long as those states are close.

    Oddly, Donald Trump goes to the major cities—and then disparage those cities, arguably as a strategy to pander to the outstate voters who resent being overshadowed by the major cities in their state. Kinda clever, really.

    If there’s one thing I have yet to hear Trump say, it would be Happy Birthday.

  15. Ampersand says:

    If there’s one thing I have yet to hear Trump say, it would be Happy Birthday.

    I see what you did there! :-p

  16. Dianne says:

    Welp, we’re done here. We’ll never have to vote again, electoral college or not.

  17. Ampersand says:

    I don’t think that’s true. We’re strong on the road to fascism and autocracy, but we’re not all the way there yet.

  18. RonF says:

    Avvaaa:

    “Would you support an electoral college style voting system being used inside Illinois?”

    If there was such – say, with Electoral votes based on the counties – the GOP would likely win the governorship a lot more often than they do. But no, not really.

    What I would like to see is a return to the multi-representative districts the Illinois House used to have. Illinois has 59 Senatorial districts, each of which is divided in half to have 118 House members. But what it used to do was elect 3 members of the House for each of the 59 districts. Your option was to vote for one, two or 3 members in each district, with 3, 1.5, or 1 vote given to each candidate. The result was that in districts with a strong but not overwhelming majority for one party, the voters for the other party would cast a “bullet” ballot for one candidate, resulting in 2 representatives from the majority party and 1 from the minority party being elected to the House. That way everyone in the district felt fairly represented.

    nobody.really:

    “… disparage those cities, arguably as a strategy to pander to the outstate voters who resent being overshadowed by the major cities in their state.”

    Don’t discount the number of people actually in those cities who are looking around, seeing a gross degradation of their city over the last 20 years or so, and find themselves agreeing with him.

  19. RonF says:

    Dianne:

    “We’ll never have to vote again, electoral college or not.”

    Amp:

    “I don’t think that’s true.”

    You’re right, and it never was. Trump was telling some people that he’d fix things so well that they’d never need to vote again, not that he’d end democracy (which few people outside the extreme left believed, anyway) and stop allowing people to vote. The press, as usual, seized on a phrase out of context for partisan purposes.

    “We’re strong on the road to fascism and autocracy, but we’re not all the way there yet.”

    Trump makes it a point to transfer authority and responsibility from the central government to the States and to protect civil rights such as free speech and the right to keep and bear arms. Fascists concentrate authority and responsibility into a central government and restrict free speech and the right to keep and bear arms. Trump’s no fascist.

  20. Jacqueline+Squid+Onassis says:

    RonF forgets about SCOTUS granting immunity to POTUS for almost any criminal act committed while POTUS. That takes authority and responsibility away from the States.

    RonF clearly didn’t see Dollar Store Mussolini saying that you’d never have to vote again if he won because to those of us not in the cult, it’s clear that RonF’s interpretation is bullshit to tell those not in the cult.

    Based on the long history of RonF’s comments, I think it’s safe to say that he is a committed pro-fascist and I will continue to treat his apologies and obfuscations in that light.

  21. RonF says:

    SCOTUS stated that the President had immunity for acts executed pursuant to his constitutional powers, not for almost any criminal act.

    Fascism is a system of government that is authoritarian and is nationalistic in that it seeks to concentrate power over industry, commerce, education, the media, etc. in a central government and subordinate individual rights to what the person/people running it see as the interests of the state. During Trump’s first administration you saw individual rights (such as those guaranteed by the 1st and 2nd Amendment) gain protection and the power of the Federal government reduced by cutting regulations and moving issues at law such as abortion to the States. I figure that will continue in his second administration (i.e., perhaps a serious effort to eliminate or limit the Dept. of Education). He’s an a$$hole from a personal viewpoint but he’s not a fascist.

  22. Ampersand says:

    Ron, the net result of Dobbs is that people are less free. People who used to be able to control their own reproduction have now had their freedom taken away from them. Trump freeing the states to take away individual rights is not an increase in “individual rights,” and it’s Orwellian to suggest it is.

    In Texas, a teenager named Nevaeh Crain died because Trump’s Supreme Court freed Texas to ban abortions. If Clinton had won, it is likely that Crain would be alive today. So how is Crain more free?

  23. Avvaaa says:

    “Based on the long history of RonF’s comments, I think it’s safe to say that he is a committed pro-fascist”

    I mean, I think we can remove the prefix and say that Ron is a fascist.

    He may not have the courage of his convictions to actually implement fascist policies himself, but his ideology is clearly fascist in and of itself, as opposed to “merely” being supportive of, or tending towards, fascism.

    Enjoy being a fascist, Ron.

  24. Ampersand says:

    Avvaaa, the more this forum includes personal attacks by participants on other participants, the worse this place is for me, and it’s not like I can leave. (At least, not without shutting the place down). Please try to avoid personal attacks.

  25. RonF says:

    I had not heard of this case. From CNN

    The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.

    Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.

    ProPublica condensed more than 800 pages of Crain’s medical records into a four-page timeline in consultation with two maternal-fetal medicine specialists; reporters reviewed it with nine doctors, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in emergency medicine and maternal health.

    Some said the first ER missed warning signs of infection that deserved attention. All said that the doctor at the second hospital should never have sent Crain home when her signs of sepsis hadn’t improved. And when she returned for the third time, all said there was no medical reason to make her wait for two ultrasounds before taking aggressive action to save her.

    This looks like medical malpractice to me. The first visit was a blown diagnosis. The second visit was a blatant failure to provide treatment for her sepsis. Neither had a damn thing to do with abortion. The third visit’s initial check on the status of the fetus makes sense to me, as whether or not it was alive is normal healthcare for a pregnant woman in a medical crisis. But by then her grossly neglected sepsis had her spiraling towards death, and as noted even on her 3rd visit the doctors didn’t follow protocol for her treatment. She died of sepsis that went untreated because of malpractice, not because she didn’t get an abortion. Nowhere in the article does it say “If she had gotten an abortion she would have lived”. Claiming that the laws in Texas restricting abortion led to her death is projection.

  26. RonF says:

    Amp:

    Ron, the net result of Dobbs is that people are less free. People who used to be able to control their own reproduction have now had their freedom taken away from them.

    There are LOTS of ways for people to control their own reproduction. What Dobbs did was to enable States to pass laws that keep people from killing a child in the womb once they did reproduce. That leaves that child the ultimate individual freedom; the freedom to live.

    The fundamental question here is whether or not a fetus developing in the womb is an individual human life that the state has the obligation to protect against those who would kill it as much as it would protect the life of a child once it is out of the womb. At the end of the day it’s a philosophical or moral question, not a scientific one. If you don’t think it is, then abortion is not an issue that a government should get involved in. If you do think it is, then abortion is an issue that merits a government intervention. Does abortion involve one person? Or two?

  27. Jacqueline+Squid+Onassis says:

    … enable States to pass laws that keep people from killing a child in the womb…

    By definition, there is no such thing as a child in the womb. But you know this.

  28. Dianne says:

    The second visit was a blatant failure to provide treatment for her sepsis. Neither had a damn thing to do with abortion.

    Do you know what the treatment for sepsis in the presence of a nidus of infection is?

    Yep, you guessed it, removal of the source of the infection. Antibiotics and supportive care can temporize briefly, but the only treatment that will end with a live person is removal of the source of infection, aka, in this case, an abortion. So yes, you’re right. It was a blatant failure to treat the sepsis due to Dobbs and resultant laws that force malpractice.

  29. Dianne says:

    The fundamental question here is whether or not a fetus developing in the womb is an individual human life

    There’s a fundamental problem with this framing: It disregards the rights of the involved entity that is definitely, unquestionably an individual human: The pregnant person. Again, since I’ve never seen any anti-choicer give a straight answer to this question: If you and only you are able to save someone’s life via blood, tissue, or organ donation, should you be legally forced to do so, regardless of the risk to your own health? If you don’t agree that it is fine and should be legal for the state to forcibly seize people and remove blood, bone marrow, a kidney, etc, then you can’t, consistently, be anti-choice, regardless of the status of the fetus. (Which, incidentally, is not an individual human in any meaningful sense.)

  30. RonF says:

    Dianne:

    … the source of infection, aka, in this case, an abortion.

    I don’t recall that the fetus was identified as the source of the infection. And in any case, the first doctor didn’t even look for sepsis and the second doctor saw it but didn’t try to treat it at all. Again, neither of those had anything to do with abortion laws.

    If you and only you are able to save someone’s life via blood, tissue, or organ donation, should you be legally forced to do so, regardless of the risk to your own health?

    Here’s a straight-up answer for you, then. No, you should not. But then, that’s not an equivalent case to pregnancy.

  31. Dianne says:

    I don’t recall that the fetus was identified as the source of the infection.

    The article didn’t provide every medical detail so I suppose you are technically correct that it was not explicitly stated that the fetus (or more likely the membranes and amniotic fluid) was the source of the infection. However, the clues certainly point that direction. The patient had sharp abdominal pains consistent with labor. She had blood running down her legs, consistent with breakage of the membranes. Certainly, the second doctor thought the fetus and/or fetal environment (amniotic fluid, placenta, etc) were the source of the infection or they wouldn’t have mentioned fetal heartbeat as a reason not to treat. (I suppose it is possible that they simply refused to give any medication at all to a pregnant person with a doomed but not yet dead fetus, but that seems unlikely. Far more likely, they knew that an abortion was the only way to effectively treat the infection and refused to do so due to fear of the legal consequences.)

    Again, neither of those had anything to do with abortion laws.

    It has everything to do with abortion: Abortion was the only treatment that could have saved the patient and it was refused. I agree that the first doctor probably missed the diagnosis, but the second and third certainly knew that they were letting the patient die, but were too afraid of the legal risk to do anything about it.

    But then, that’s not an equivalent case to pregnancy.

    Okay, I’ll bite. Let’s hear your convoluted explanation of why it isn’t the same as pregnancy. Or you could just give up and admit that the difference is that cis men are not at risk of pregnancy.

  32. Megalodon says:

    I don’t recall that the fetus was identified as the source of the infection.

    And if the infection was in her uterus, that would have required surgical removal of the fetus (i.e. an abortion).

    Her vital signs pointed to possible sepsis, records show. It’s standard medical practice to immediately treat patients who show signs of sepsis, which can overtake and kill a person quickly, medical experts told ProPublica. These patients should be watched until their vitals improve. Through tests and scans, the goal is to find the source of the infection. If the infection was in Crain’s uterus, the fetus would likely need to be removed with a surgery.

    In a room at the obstetric emergency department, a nurse wrapped a sensor belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard told Fails, who was sitting in the hallway.

    https://www.propublica.org/article/nevaeh-crain-death-texas-abortion-ban-emtala

    But whatever the source of the infection, Nevaeh Crain subsequently started suffering a bleeding miscarriage, and she needed emergency surgery to remove the fetus to stop her from bleeding to death. But the doctors delayed that procedure to confirm and document “fetal demise.”

    Back home, around 7 a.m., Fails tried to get her daughter comfortable as she cried and moaned. She told Fails she needed to pee, and her mother helped her into the bathroom. “Mom, come here,” she said from the toilet. Blood stained her underwear.

    The blood confirmed Fails’ instinct: This was a miscarriage.

    At 9 a.m, a full day after the nausea began, they were back at Christus St. Elizabeth. Crain’s lips were drained of color and she kept saying she was going to pass out. Staff started her on IV antibiotics and performed a bedside ultrasound.

    Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal heart rate, according to records; he told the family he was sorry for their loss.

    Standard protocol when a critically ill patient experiences a miscarriage is to stabilize her and, in most cases, hurry to the operating room for delivery, medical experts said. This is especially urgent with a spreading infection. But at Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour later, as nurses placed a catheter, Fails noticed her daughter’s thighs were covered in blood.

    At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica about Crain’s condition. The teen was now having contractions. “Dr. Totorica states to not move patient,” she wrote after talking with him. “Dr. Totorica states there is a slight chance patient may need to go to ICU and he wants the bedside ultrasound to be done stat for sure before admitting to room.”

    Though he had already performed an ultrasound, he was asking for a second.

    The first hadn’t preserved an image of Crain’s womb in the medical record. “Bedside ultrasounds aren’t always set up to save images permanently,” said Abbott, the Boston OB-GYN.

    The state’s laws banning abortion require that doctors record the absence of a fetal heartbeat before intervening with a procedure that could end a pregnancy. Exceptions for medical emergencies demand physicians document their reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain this isn’t a normal pregnancy, we can’t do anything, because it could be alleged that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San Antonio.

    At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was paging for an emergency team over the loudspeakers.

    Around 11 a.m., two hours after Crain had arrived at the hospital, a second ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to confirm fetal demise per Dr. Totorica’s orders.”

    When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side, rubbing her head, as her daughter dipped in and out of consciousness. Crain couldn’t sign consent forms for her care because of “extreme pain,” according to the records, so Fails signed a release for “unplanned dilation and curettage” or “unplanned cesarean section.”

    Officially, Nevaeh Crain’s death was attributed to “complications of pregnancy.”

    It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.” He did note, however, that Crain was “repeatedly seeking medical care for a progressive illness” just before she died.

    Now, malpractice may indeed be involved in this case. However, because of Texas’s abortion ban, the cascading harm of that initial malpractice was not stopped or remedied even when it may still have been possible to save Nevaeh Crain’s life because the doctors were afraid to undertake any procedure that would have resulted in killing a possibly still living fetus.

    Doctors cannot and will not trust their discretion about saving a patient’s life while under the threat of criminal prosecution. Even when doctors take the precaution of getting advanced court approval for an abortion to save a patient’s life, Ken Paxton has threatened to prosecute them anyway if he personally disagrees about the necessity of an abortion. So intimidated physicians often pass the buck.

    He has also made clear that he will bring charges against physicians for performing abortions if he decides that the cases don’t fall within Texas’ narrow medical exceptions.

    Last year, he sent a letter threatening to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. He insisted that the doctor and her patient had not proven how, precisely, the patient’s condition threatened her life.

    Many doctors say this kind of message has encouraged doctors to “punt” patients instead of treating them.

    https://www.propublica.org/article/nevaeh-crain-death-texas-abortion-ban-emtala

    As for you trying to deflect this case as solely a matter of medical malpractice that does not involve abortion at all, the law in Texas also screws over patients in that regard.

    Last November, Fails reached out to medical malpractice lawyers to see about getting justice through the courts. A different legal barrier now stood in her way.

    If Crain had experienced these same delays as an inpatient, Fails would have needed to establish that the hospital violated medical standards. That, she believed, she could do. But because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”

    No lawyer has agreed to take the case.

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