The Iowa Supreme Court on Friday struck down a rule prohibiting doctors from administering abortion-inducing drugs remotely via technology, a decision with potential implications for telemedicine nationwide.
In a unanimous decision, the court said the rule, which requires doctors to be physically present when an abortion-inducing drug is provided, is unconstitutional at the state and federal levels.
Planned Parenthood has been performing the telemedicine abortions in Iowa since 2008. Under the procedure, a trained staff member takes a patient's medical history, checks vital signs, collects blood for testing and performs an ultrasound. A doctor in a different location then reviews the information and, via videoconferencing, talks with the patient and remotely releases a drawer in the same room as the patient with the medications. The physician and staff member then watch the woman take the drug.
The Iowa Board of Medicine, however, passed its rule in August 2013, citing patient safety.
Planned Parenthood has argued the rule's true purpose was to limit women's access to abortions.
The Iowa Medical Board's executive director, Mark Bowden, said in a statement Friday the board adopted the rule to address what it saw as “the unsafe practice of medicine, and not to place an undue burden on women who choose to terminate their pregnancies." The board had said it was concerned about the “quality and sufficiency” of the physical exam being performed before a medical abortion.
Bowden said the board will discuss the ruling at its meeting in July to fully determine how to apply it. A spokesman for Iowa Gov. Terry Branstad said Friday the governor was disappointed by the ruling but it was too early to speculate as to whether there will be an appeal.
“After receiving petitions from medical professionals from all across Iowa that raised concerns about the quality of care women were receiving under these webcam procedures, the Iowa Board of Medicine provided a standard of care for webcam abortions,” Jimmy Centers, a spokesman for Branstad, said in a statement. “Although the Court upheld parental notification, the governor is extremely disappointed that the Iowa Board of Medicine's action, which ensured women received the high standard of care that they deserve, was reversed by the Iowa Supreme Court.”
Suzanna de Baca, CEO of Planned Parenthood of the Heartland, applauded the court for protecting “women's access to safe, legal abortion.”
“Medical experts opposed this law because it harms women by blocking access to safe medical care,” de Baca said in a statement Friday. “When it comes to healthcare, politics should never trump medicine.”
In its opinion, the court said the rule places an undue burden on a woman's right to terminate her pregnancy.
Also, the court said, the medical board didn't seem consistent in its views over telemedicine abortions versus other telemedicine activities.
“Whenever telemedicine occurs, the physician at the remote location does not perform a physical examination of the patient,” the court wrote. “It is difficult to avoid the conclusion that the Board's medical concerns about telemedicine are selectively limited to abortion.”
The case has potential ramifications for telemedicine abortions, and the broader, growing field of telemedicine in general, across the country.
Nathaniel Lacktman, a partner at law firm Foley & Lardner in Chicago, said the ruling may send a message to other states, particularly because the court found the "undue burden" test established by the U.S. Supreme Court.
He also noted that the ruling cited studies showing that telemedicine abortions don't pose any more risk of complications than those done in person.
“This is a great win in support of telemedicine services,” Lacktman wrote in an e-mail.
Joseph McMenamin, a lawyer in Richmond, Va., who focuses much of his work on telemedicine, said the fact that the Iowa Supreme Court saw no problem with telemedicine abortions may suggest a level of acceptance of telemedicine that advocates couldn't necessarily claim five or 10 years ago.
“What's perhaps most helpful about it is the Supreme Court of Iowa seemed to make pretty clear telemedicine is a standard way of providing healthcare, which advocates of telemedicine have argued for a long time,” McMenamin said.
McMenamin noted, however, that the national implications might still be somewhat modest given that the American College of Obstetricians and Gynecologists already has a position that telemedicine is a safe and effective means over which to carry out a medical abortion.
In fact, ACOG president Dr. Mark DeFrancesco released his own statement Friday saying that abortion via telemedicine can be particularly helpful to rural women who otherwise might have to travel hundreds of miles to receive care.
“Telemedicine is widely regarded as an important and promising technology in medical care, and its potential benefit to American patients' access to care is significant,” DeFrancesco said. “Singling out and restricting one particular use of telemedicine care is wrong, and we are pleased that the Iowa Supreme Court has recognized that.”
Sixteen states require that clinicians be physically present when prescribing abortion-inducing drugs, according to the Guttmacher Institute, which works to advance sexual and reproductive health and rights. Minnesota is the only other state where telemedicine abortions are allowed, according to Planned Parenthood of the Heartland.
