The issue of abortion may be grabbing the attention in a case argued Wednesday before the Iowa Supreme Court, but the case could have broader implications for telehealth practices and state boards of medicine, experts said.
The Iowa Supreme Court heard oral arguments in Planned Parenthood of the Heartland Inc. and Dr. Jill Meadows v. Iowa Board of Medicine, a case that focuses on the question of whether abortions should be allowed through telemedicine in Iowa.
The procedure involves doctors talking with patients via videoconferencing. Nurses or certified medical assistants then perform physical exams, take blood for lab work and conduct ultrasounds. Physicians examine the information and, by computer, release a remote-controlled drawer containing the medications.
The state's board of medicine, however, voted in 2013 to impose a rule requiring doctors to be physically present when an abortion-inducing drug is provided. The board cited patient safety in approving the rule. But Planned Parenthood argues that the rule was meant to limit women's access to abortions.
Planned Parenthood and the American College of Obstetricians and Gynecologists, among others, say the case could have serious implications for the health of women, especially those in rural areas, forcing them to seek riskier alternatives.
But the case also could have ripple effects on the growing field of telehealth and potentially the compositions of state boards of medicine.
Nathaniel Lacktman, a partner with Foley & Lardner and the leader of the firm's telemedicine practice, said boards of medicine have been at the forefront of regulating telemedicine. The Iowa case could foreshadow the ability of those boards to restrict or control telemedicine services in the future.
“Unfortunately, what all this Iowa activity fails to recognize is that telemedicine is simply a conduit technology through which the services are provided,” Lacktman said. Doctors can perform high-quality examinations via real-time video and “no other healthcare tool has proved itself as powerful and capable to reach critically underserved patients in rural and urban areas, alike,” he said.
“What we like to typically see are more permissive policies that help advance these types of policies so more patients can receive the care they need,” he said.
Joseph McMenamin, a lawyer in Richmond, Va., who focuses much of his work on telemedicine, also said the Iowa court's ruling could have implications for the field, specifically if the court rules that a proper physician-patient relationship cannot be established or a proper diagnosis cannot be made without the doctor's physical presence.
“Were they to so rule, that would tend to impede the progress of telehealth in the state of Iowa,” said McMenamin, also a former practicing emergency physician.
It's also possible the case could lead to more abortion foes seeking to limit access to medical abortions via their state boards of medicine rather than their legislatures, some say.
The Iowa Legislature attempted to pass legislation limiting tele-abortions, but was unsuccessful, Lacktman said. The state's board of medicine, however, is appointed by the governor, and once its membership turned over in a way that was aligned against the use of telemedicine technology for abortion, the board passed the rule prohibiting it, he said.
“If the court rules against Planned Parenthood, it may cause other states to look at their state boards of medicine as the vehicle for greater influence on telemedicine, especially for (using) it for abortions,” Lacktman said. “It could open the door to people exploring it as an opportunity to achieve some of their political ends in a way that may be quicker or easier than the full-on legislative process of their state.”
McMenamin hopes the heated politics of abortion don't seep into the issue of telehealth.
“I very much hope that those who evaluate the usefulness of telemedicine and its ability to provide access to care will not be forming those judgments around their no-doubt deep-seated and sincere convictions about abortion,” McMenamin said.
But Rene Quashie, senior counsel with law firm Epstein Becker Green, thinks there's little to fear. He doesn't believe the case will have any impact on telehealth in Iowa or elsewhere—precisely because it's so closely linked to the politics of abortion. Quashie pointed to a rule the Iowa Board of Medicine is set to finalize in April—a rule that seems to further open up the practice of telemedicine in Iowa— as proof that the board's attitude toward telehealth abortion doesn't seem to mirror its attitude toward the rest of the field.
“I think this case is much more about abortion politics than it is about telemedicine, especially given the fact the state of Iowa saw fit to really expand their telemedicine regulations,” Quashie said.
Across the country, 16 states require that clinicians be physically present when prescribing abortion-inducing drugs, according to the Guttmacher Institute, which said it seeks to advance sexual and reproductive health and rights.
The Iowa Supreme Court justices Wednesday focused their questions on a number of key issues in the case such as the safety of telemedicine abortions versus medical abortions where a doctor is physically present. They also discussed issues such as how much deference to give the board in its decisionmaking and whether the board's rule violates the state's constitution.
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