Telehealth providers navigate murky legal territory as abortion bans take effect | NPR . News

Alison Case, a family medicine physician, spends most of her time working in a hospital where she delivers children and provides reproductive health care services, including abortions.

Kiss lives and works in Indiana, where there is an abortion Banned now With a few exceptions. She is also licensed to practice in New Mexico, where abortion remains legal.

Before the abortion ban took effect in Indiana, Case was using her days off to provide reproductive health services, including abortion care, via telemedicine through a clinic serving patients in New Mexico. Many of them travel from neighboring Texas where abortion is prohibited.

She said some travel alone, others have children with them.

“Some people are buying hotels, some may have family or friends they can stay with, and some are sleeping in their cars,” Case said. “It’s really horrific.”

Since Roe was flipped, clinics offering abortions have seen an increase in demand. Many clinics rely on help from out-of-state doctors, such as Case, who are able to relieve some of the stress and keep waiting times by offering services via telemedicine.

But as more states move to restrict abortion, providers are finding themselves navigating an increasingly complex legal landscape.

Is abortion via telemedicine legal? It’s complicated

medical abortion It works for most people under 11 weeks of gestation, and research suggests medical abortion Via telemedicine Safe and effective. However, many countries have enacted legislation for Ban or restrict access to aborting telehealth services.

But it’s not always clear what that means for doctors like Case who are physically located in a state that has abortion restrictions, but who have a license that enables them to provide care via telehealth to patients in states where it is legal.

Case said she consulted several lawyers and none of them had a definitive answer for her.

One of the lawyers was like, ‘If anyone tells you they think they know [or] “They have a certainty about these things, it’s just out of their minds,” she said.

A woman is photographed from behind sitting at a desk and working on a laptop

Dr. Alison Case used to see telemedicine abortion patients in New Mexico on her days off from hospital work in Indiana. [Farah Yousry /  Side Effects Public Media]

In many states, patients who seek to perform a healthy, remote abortion must be physically present in a situation where a remote abortion is legal, even if it is just a short virtual consultation with the provider, who may be located in an entirely different situation.

Tele-abortion providers find themselves in an ambiguous legal gray area, where they must assess how much risk they are willing to take to care for their patients, or consider stopping this aspect of care altogether.

Kathryn WatsonThis is uncharted territory, said a law professor and medical ethics expert at Northwestern University Feinberg School of Medicine in Chicago.

“The stakes are very high. We are talking about something protected in one country and a felony in a sister country,” Watson said. The map is a mixture. So this is quite a drastic change.”

She said people should understand the difference between the rhetoric of the law and the environment for implementation. Even if the law does not explicitly criminalize what doctors like Kiss do, the enforcement environment can land some of them in legal trouble, Watson said.

“In a strict enforcement environment, you may not have violated the letter of the law. But creative prosecutors may be looking for a reason to persecute you,” she said.

She said there is no argument that prosecutors can use “slam dunk,” but that in a charged political environment, there is a real danger. Look no further than Dr. Caitlin Bernard, an Indiana gynecologist who spoke about the legal abortion she provided earlier this summer to a 10-year-old rape victim from Ohio who was reprehensible And the Publicly accused of wrongdoing by the state attorney general.

Service providers must weigh the risks

working d. Case with Whole Women’s Health, a reproductive health clinic that offers remote abortion in five states: Illinois, Minnesota, New Mexico, Virginia and Maryland. The organization does not have a brick-and-mortar clinic in some of these places, but it does work with providers who have medical licenses there to set default assignments to employees.

President and CEO of Whole Women’s Health Amy Hagstrom Miller She said she talks with providers about the risks they face while working in the clinic. She suspects the lack of clarity in state laws is intended to “scare people away from providing safe abortion care.”

The clinic has already stopped working with providers in Texas due to Abortion Law Method There anyone – even if not personally affected – is allowed to sue anyone who performs, assists or intends to assist in an abortion. This opens the door for political, cultural and even personal grievances to interfere with the work of health care providers.

“Just because you comply with the law does not mean that anti-abortion people will not go after you and try to discredit you and make your life difficult,” Hagstrom-Miller said.

On a day off Dr. Kiss from her job caring for Indiana patients in late August, she sat at her laptop as one of her cats quietly cradled on her lap and the first telemedicine miscarriage patient did telemedicine.

The woman was a pregnant student from Texas sitting in her car. The camera only showed the upper half of her face. She had driven hours in her car to New Mexico to get a prescription for abortion pills.

She told her condition what to expect, explaining that the abortion pill stops the pregnancy from progressing and prompts the body to expel the fetus within a few hours.

“It depends on the person, but a lot of people describe it as a heavy period,” Kiss told the young woman.

The patient requested a medical note to be excused from school, but requested that the note not mention that she had an abortion.

It is women like these who are motivating Kiss to take over abortions via telemedicine.

During a telemedicine appointment, doctors and nurses review a patient's medical history and confirm their eligibility for medical abortion.  They provide the patient with information about how the two pills work, how to take them, what to look for when the body expels the pregnancy, and when to seek medical attention in the rare case of complications.  The drugs are then sent to the patient, who must provide a mailing address in a situation where the abortion is legal.

But now that abortion is banned in Indiana entered into forceKiss said she would likely discontinue these services. The danger is too great.

“It really left me feeling helpless, like I can’t help people. And that’s sad,” she said.

Hagstrom-Miller said that if providers in these states determine the risk is too high, the clinic is prepared to shift the patient burden to providers in states where abortion remains legal and protected.

For her part, Case said, if the patient volume is high enough, she might consider driving to Illinois to offer these telemedicine services.

“I think it’s crazy to think I’m going to drive an hour and a half to Illinois to use my New Mexico license to help people who drive from Texas to New Mexico to get their abortions,” she said. “It’s like crazy.”

This story comes from a collaboration between Side effects of public media and the Midwest newsroom Collaboration in investigative journalism IPRAnd the KCUR 89.3And the Nebraska news and general mediaAnd the St. Louis Public Radio And the NPR. Contact Farah at fousry@wfyi.org. Follow on Twitter: @Farah Yosrim.

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