Interview with Dr. Christina Francis regarding the case of Tierra Walker

On November 19, 2025, ProPublica published ““Ticking Time Bomb”: A Pregnant Mother Kept Getting Sicker. She Died After She Couldn’t Get an Abortion in Texas.” This is the case of Tierra Walker, a pregnant woman with multiple chronic health conditions who died during pregnancy.

I have some significant skepticism over ProPublica’s objectivity (See “ProPublica identifies their medical experts a little too subtly“) and the accuracy with which they frame medical malpractice stories (See “Nevaeh Crain’s family says her death is being used for politics“).

But if ProPublica’s depiction of the case of Tierra Walker is reasonably accurate, the story gave me more pause than some of their other articles. So I reached out to Dr. Christina Francis of AAPLOG to ask if we could talk about the case in more detail. You can listen to the full conversation here or read a summary below.

Key Takeaways

1. Tierra Walker’s death reflects repeated failures in basic medical care and coordination.
2. Standard protocols for managing severe hypertension and preeclampsia exist and should have prevented discharge at 20 weeks.
3. Improving maternal outcomes should be a shared goal across abortion disagreements, with many avenues for common ground.

Summary

“This story gave me more pause than other denial-of-care cases.”

I began the conversation with Dr. Francis by reviewing the facts of Walker’s case. She entered pregnancy with severe risk factors, including chronic hypertension, diabetes, kidney dysfunction, and a prior twin pregnancy complicated by preeclampsia that resulted in both babies stillborn. From the start, Walker qualified as a high-risk patient who should have received coordinated care from maternal–fetal medicine specialists.

ProPublica reports Walker saw dozens of clinicians across multiple hospitalizations, suggesting a breakdown in continuity of care. It appears doctors who were not OBGYNs made key decisions about Walker’s treatment. Aggressive blood pressure control, inpatient monitoring, and early specialist involvement appear inconsistent or absent.

Dr. Francis noted she could provide a better analysis if she had access to the medical records. When reading about Walker’s case, Dr. Francis had several assessment questions:

1. Did Walker have a primary physician as an outpatient who was trying to coordinate care? If not, why not?
2. Why did she go to multiple hospitals? Was she told to do this?
3. What did doctors do to try to control Walker’s blood pressure early in pregnancy?
4. Was Walker receiving blood pressure medication on a regular basis?
5. Which kind of doctors (OBGYNs vs internal medicine, for example) were deciding the approach to controlling blood pressure?
6. Did doctors recommend Walker take daily aspirin (as someone with her medical history should be taking)?

ProPublica focuses on whether and when doctors should suggest abortion, but is less detailed about non-abortion standards of care.

“How do we assess, when a woman is facing a high risk condition, whether abortion is something we need to talk about?”

Dr. Francis explained that with chronic medical conditions, physicians should first exhaust evidence-based treatments. But when serious risk persists despite proper care, ending a pregnancy becomes ethically and medically appropriate. Dr. Francis emphasized the standard should leave room for physician judgment and patient consent, and Texas law allows intervention in those circumstances.

“This behavior is not explained by people being afraid of abortion laws.”

At roughly 20 weeks, Walker was diagnosed with preeclampsia, prescribed blood pressure medication, and discharged. Dr. Francis called this “frankly malpractice,” explaining that previable preeclampsia [which is rare] is severe preeclampsia, and requires hospitalization. In hospital the medical team could have put Walker on a drip (a constant dose) of blood pressure medication until her blood pressure was under control. It’s unclear based on the article why they discharged her instead. Fear of abortion restrictions wouldn’t explain failing to aggressively manage Walker’s blood pressure either early in pregnancy or after diagnosing her with preeclampsia.

“There should be common ground on righteous indignation at this lack of even reasonable care.”

Dr. Francis and I considered several aspects of U.S. obstetric care that need significant improvement:

• Care coordination and continuity, especially for complex patients
• Preeclampsia prevention and treatment, especially for patients with known risk factors
• Evidence-based protocols for hypertensive disorders in pregnancy, specifically seeing broader adoption of known successful methods
• Expansion of the obstetric workforce, including OBGYNs, maternal-fetal medicine specialists, and midwives
• Training of the existing workforce for managing complex conditions
• Improvements in pre-pregnancy health, including chronic disease management and earlier counseling on risk reduction for patient who may get pregnant
• Data collection and transparency, specifically having the CDC consistently track maternal deaths by pregnancy outcome

I argued that, even as the pro-choice and pro-life sides continue to fight about abortion laws, we should be able to work together on these less controversial elements to decrease maternal mortality and improve reproductive healthcare in other areas.

---

If you appreciate our work and would like to help, one of the most effective ways to do so is to become a monthly donor. You can also give a one time donation here or volunteer with us here.