An Iowa Supreme Court case about medical abortions performed through telemedicine could have broader implications for the power of state medical boards to restrict telehealth services.
The court last week heard oral arguments in Planned Parenthood of the Heartland Inc. et al v. Iowa Board of Medicine, a challenge to the state medical board's 2013 decision to require that a physician be physically present when an abortion-inducing drug is given to a patient. The state now allows women to receive medical abortions through teleconferencing with physicians, assisted by on-site nurses or certified medical assistants. The doctor reviews the patient's information and remotely unlocks a drawer at the clinic where the patient is sitting that contains the pregnancy-ending medication, which the doctor and other staff then watch the patient ingest.
The state medical board, whose members were appointed by anti-abortion Republican Gov. Terry Branstad, cited patient safety as the reason for its rule. But Planned Parenthood argues that it was meant to limit women's access to abortions. Planned Parenthood and the American College of Obstetricians and Gynecologists warn that the case could have serious implications for women's health and abortion access, especially in rural areas.
But it also could have a ripple effect on the growing field of telehealth. Nathaniel Lacktman, the leader of Foley & Lardner's telemedicine law practice, said it could foreshadow state medical boards restricting or controlling services offered through telemedicine. “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. “No other healthcare tool has proved itself as powerful and capable to reach critically underserved patients in rural and urban areas alike.”
Also, the case could encourage abortion foes around the country to try to limit access to medical abortions via their state medical boards rather than seeking legislative action, he said.
Dr. Joseph McMenamin, who practices telemedicine law in Richmond, Va., said the Iowa case could be significant if the court rules that a proper physician-patient relationship cannot be established or a proper diagnosis made without the doctor's physical presence.
But Rene Quashie, senior counsel with law firm Epstein Becker Green, pointed to the Iowa Board of Medicine's proposed rule to expand the practice of telemedicine. “This case is much more about abortion politics than it is about telemedicine,” he said.
Sixteen states require that clinicians providing a drug-induced abortion be physically present during the procedure, according to the Guttmacher Institute.