The original filing said "It is also Dr. Karsan’s good faith belief and medical recommendation that that the Emergent Medical Condition Exception to Texas’s abortion bans and laws permits an abortion in Ms. Cox’s circumstances, as Ms. Cox has a life-threatening physical condition aggravated by, caused by, or arising from her current pregnancy that places her at risk of death or poses a serious risk of substantial impairment of her reproductive functions if a D&E abortion is not performed. Dr. Karsan is unsure how close to death her patients need to be before abortion is permitted under Texas law. As has been the case with prior patients over the last two years, Dr. Karsan is unsure if Ms. Cox’s current medical condition counts as close enough to death under Texas law for the Emergent Medical Condition Exception to apply." (clauses 139,140)
The Texas Supreme Court said "The pleadings state that Ms. Cox's doctor believes Ms. Cox qualifies for an abortion based on the medical-necessity exception. But when she sued seeking a court's pre-authorization, Dr. Karsan did not assert that Ms. Cox has a 'life-threatening physical condition' or that, in Dr. Karsan's reasonable medical judgement, an abortion is necessary because Ms. Cox has the type of condition the exception requires."
In short, the court decided that Dr. Karsan described the statute, and that Dr. Karsan stated that the statute applied, but Dr. Karsan did not actually say "the patient had a life-threatening physical condition," but only that the patient WOULD have a life-threatening condition if an abortion were not performed. Or at least that's probably the argument; it's not explained very well. Therefore, the Court cannot not rule on whether the abortion is legal or not. After all, only a doctor could make that determination, not a court (you can read the smirk).
Truly an amazing decision, and if there's an award in Hell for achievements in pedantry, that court would have a real shot. Sadly, the Court would probably be disqualified for such an award as they technically lied (Dr. Karsan did in fact say "Ms. Cox has a life-threatening physical condition"), and one presumes Hell's Pedantry Awards interpret such rules quite strictly.