The patchwork nature of abortion laws in the Midwest has made the procedure harder to obtain for pregnant women — and for health care providers. Telemedicine rules present particularly murky legal territory.
Allison Case, a family physician, spends much of her time working in a hospital where she gives birth and provides reproductive health services.
Case lives and works in Indiana, where abortion is now illegal with few exceptions. She is also licensed to practice in New Mexico, a state where abortion remains legal.
Before Indiana’s abortion ban went into effect, Case used her days off to provide reproductive health services, including abortion care, via telemedicine through a clinic that serves patients in New Mexico. Many of them come from neighboring Texas where abortion is prohibited.
Some travel alone, she says, others have their children with them.
“Some people buy hotels, some may have family or friends to stay with, some just sleep in their cars,” Case said. “It’s really awful.”
Since Roe was ousted, clinics that perform abortions have seen an increase in demand. Many clinics rely on the help of out-of-state doctors, like Case, who are able to ease some of the pressure and reduce wait times by providing services via telemedicine.
But as more states decide to restrict abortion, providers find themselves in an increasingly complicated legal landscape.
Is telemedicine abortion legal? Depends.
Medical abortions work for most women less than 11 weeks pregnant, and research suggests that medical abortion via telemedicine is safe and effective. Yet many states have passed laws to prohibit or limit access to telehealth abortions.
But it’s not always clear what that means for doctors like Case who are physically located in a state with abortion restrictions, but who have a license that allows them to provide telehealth care to patients in states where it is legal.
Case said she consulted several lawyers and none of them had a concrete answer for her.
“A lawyer said to me, ‘If someone tells you they think they know [or] they have certainties about this stuff, they are crazy,” she said.
State Abortion Telemedicine Laws:
- Iowa: It is legal for residents to request telemedicine services for abortions. It is also legal for doctors in Iowa to provide these services
- Kansas: Doctors in Kansas are not authorized to provide abortion care via telemedicine, but it is legal for residents to seek these services.
- Missouri: Telemedicine abortion is illegal for both patients and providers.
- Nebraska: Telemedicine abortion is illegal for both patients and providers.
In many states, patients seeking a telehealth abortion must be physically present in a state where telemedicine abortion is legal, even if it is just a matter of having a brief virtual consultation with a provider, who may be located in an entirely different state.
Telemedicine abortion providers find themselves in a murky legal gray area, having to weigh the risk they are willing to assume to care for their patients, or consider stopping that aspect of care altogether.
Katherine Watson, a law professor and medical ethicist at Northwestern University Feinberg School of Medicine in Chicago, said this is uncharted territory.
“The stakes are so high. We are talking about something that is a protected right in one state and a crime in a sister state,” Watson said. “And the map is a quilt. So it’s an absolutely radical change.
She said people need to understand the distinction between the letter of the law and the enforcement environment. Even though the law doesn’t explicitly criminalize what doctors like Case do, the enforcement environment may trap some of them in legal trouble, Watson said.
“In a draconian enforcement environment, you may not have violated the letter of the law. But creative prosecutors can look for a reason to persecute you,” she said.
There is no slam dunk argument prosecutors can use, she said, but in a charged political environment there is a real risk.
Look no further than Dr. Caitlin Bernard, an OB-GYN from Indiana who spoke about a legal abortion she performed earlier this summer to a 10-year-old rape victim from Ohio and told been vilified and publicly accused of wrongdoing by the state attorney general. .
Weigh the risks
Case works with Whole Woman’s Health, a reproductive health clinic that offers telemedicine abortions in five states: Illinois, Minnesota, New Mexico, Virginia and Maryland. The organization does not have physical clinics in some of these locations, but it works with providers who have medical licenses there to hold virtual appointments.
Whole Woman’s Health President and CEO Amy Hagstrom Miller said she speaks with providers about the risks they face working for the clinic. She suspects the lack of clarity in state laws is intentional, intended to “deter people from providing safe abortion care.”
The clinic has already stopped working with Texas-based providers because of the way abortion law allows anyone — even if not personally involved — to sue anyone who practices, helps, or has intent to assist with 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 follow the law doesn’t mean the anti-abortion people won’t come after you and try to vilify you and make your life harder,” Hagstrom Miller said.
On a day off from work caring for patients in Indiana in late August, Case sat at her laptop as one of her cats nestled quietly in her lap and her first patient aborted via telemedicine. logged in.
The woman was a pregnant college student from Texas who was sitting in her car. The camera only showed the upper half of her face. She had driven for hours in New Mexico looking for a prescription for abortion pills.
Case explained to her what to expect, explaining that abortion pills prevent the progression of pregnancy and prompt the body to eject the fetus within hours.
“It depends on the person, but a lot of people describe it as an abundant period,” Case told the young woman.
The patient wanted a medical note to excuse her from going to school, but requested that the note not mention that she had had an abortion.
It’s women like these who motivate Case to take on abortion cases through telemedicine.
But now that Indiana’s abortion ban has gone into effect, Case said she would likely stop those services. The risk is too high.
“It really left me feeling helpless, like I wasn’t able to help people. And that’s sad.”
Case of Dr. Allison
If providers in those states decide the risk is too high, Hagstrom Miller said, the clinic is prepared to divert the patient load 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 traveling to Illinois to provide those telemedicine services.
“I just think it’s a crazy thing to think that I’ll be driving an hour and a half to Illinois to use my license from New Mexico to help people who drive from Texas to New Mexico get abortions,” she said. “It’s like madness.”