Allison Case, a family physician, spends much of her time working in a hospital where she gives birth and provides reproductive health services, including abortions.
Case lives and works in Indiana, where a ban on most abortions took effect for one week at the end of September until a judge temporarily suspended the ban — a reprieve that the State is sure to appeal. Case 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, and others are accompanied by their children.
“Some people are [staying in] hotels, some might have family or friends to stay with, some just sleep in their cars,” Case says. “It’s really awful.
During a telemedicine appointment, doctors, nurses or other qualified medical professionals review the patient’s medical history and ensure that she is eligible for medical abortion. They give the patient information on how the two pills work, how to take them, what to watch out for when the body expels the pregnancy, and when to seek medical attention in the rare case of complications. The drugs are then mailed to the patient, who must provide a mailing address in a state where abortion is legal.
In the USA, more than a dozen states severely restrict access to abortionand almost as many have such laws in the works. across the country, from Roe vs. Wade was reversed, clinics that perform abortions saw 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 act to restrict abortion, these providers find themselves in an increasingly complicated legal landscape.
Is telemedicine abortion legal? Experts differ
Medical abortions work for most women less than 11 weeks pregnant, and research suggests medical abortion by telemedicine is safe and effective. Yet many states have enacted laws to prohibit or limit access 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 does. is legal.
Case says she consulted several attorneys about the legalities, 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.
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.
These providers find themselves in a gray gray area legally, having to weigh the risk they are willing to take on to care for their patients, or consider stopping that aspect of care altogether.
Catherine Watsona law professor and medical ethicist at Northwestern University Feinberg School of Medicine in Chicago, says this is uncharted territory.
“The stakes are so high. We’re talking about something that’s 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.”
People need to understand the distinction between the letter of the law and the enforcement environment, she says. Even though the law doesn’t explicitly criminalize what doctors like Case do, the enforcement environment may trap some of them in legal trouble.
“In a draconian enforcement environment, you may not have violated the letter of the law. But creative prosecutors may look for a reason to persecute you,” Watson says.
There’s no slam dunk argument prosecutors can use, she says, but in a charged political environment there’s 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; Bernard was reviled and publicly accused of wrongdoing by the state attorney general.
Suppliers must 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.
President and CEO of Whole Woman’s Health, Amy Hagstrom Miller, says 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.”
Farah Yousry / Side Effects Public Media
The clinic has already stopped working with Texas-based providers due to the abortion law way it allows anyone – even someone not personally involved – to sue anyone who performs, assists, or intends 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 difficult,” Hagstrom Miller said.
In late August, one of the days Case took time off from work to care for patients in Indiana, she sat in front of her laptop as one of her cats nestled quietly in her lap. and that his first telemedicine abortion patient went online.
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 embryo 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 requested a medical note excusing her from school, but requested that the note not mention that she had an abortion.
It’s women like these who motivate Case to take on abortion cases through telemedicine.
With Indiana’s abortion ban now suspended, Case says she plans to continue offering telemedicine abortions. But if the ban takes effect again, she says, it will shut down those services. The risk is too high.
If more providers in those states decide the risk is too high, Hagstrom Miller says, the clinic is prepared to divert the patient load to providers in states where abortion remains legal and protected.
For her part, Case says, if the volume of patients is high enough, she might consider crossing the state line, into neighboring Illinois, so she can continue to provide those telemedicine services.
“I just think it’s crazy to think I’ll drive 1:30 to Illinois to use my New Mexico [medical] license to help people who drive from Texas to New Mexico get abortions,” she says. “It’s just, like, madness.
This story comes from NPR’s health reporting partnership with Public media on side effects, Midwest Newsroom and Kaiser Health News (KHN).