Episode Transcript
[00:00:00] Before we begin. This episode contains content that some listeners may find sensitive. Listener discretion is advised.
[00:00:27] In our last episode, I stated that we would begin looking into the stories of women who have been impacted firsthand by the bans on abortion.
[00:00:37] However, within the past several weeks, a New York doctor was indicted by a Louisiana jury for prescribing and mailing abortion pills to a patient who lives in the abortion ban state.
[00:00:52] I wanted to take a deeper look into this issue to understand how these new revelations with abortion bans, the law and telehealth will be impacted as we move forward.
[00:01:07] Telehealth is the delivery of healthcare services remotely using technology such as video conferencing, smartphones and computers. It allows patients to receive care from the comfort of their own homes or other convenient locations without needing to travel to a doctor's office or hospital.
[00:01:30] Telehealth can encompass a wide range of services including virtual doctor's appointments, tracking patients, vital signs, and health data. Remotely therapy sessions can be conducted via video conference.
[00:01:47] It can provide prescription refills through online platforms. Telehealth can also help support and educate people on how to manage conditions like diabetes or heart disease.
[00:02:03] There are many benefits to telehealth. The first benefit is is it allows increased access to care.
[00:02:11] Telehealth makes health care more accessible for people who live in rural areas, have mobility issues, or face other barriers to in person care.
[00:02:22] There is a level of convenience with telehealth because it eliminates the need to travel to appointments, which helps save time and money.
[00:02:32] Telehealth can potentially reduce health care costs for both patients and providers. Lastly, telehealth can make it easier for patients to stay connected with their healthcare providers and manage their health.
[00:02:48] With the benefits of telehealth. There are also challenges and considerations.
[00:02:54] Not everyone has access to the necessary technology or Internet connection for telehealth. Another consideration is how to protect patient privacy and ensure the security of health information.
[00:03:08] This is a crucial element in telehealth.
[00:03:12] Also, insurance coverage and reimbursement for telehealth services can vary. Finally, laws and regulations regarding telehealth vary by state, which can create challenges for providers and patients.
[00:03:30] Telehealth has become increasingly popular, especially since the COVID 19 pandemic. It has the potential to transform healthcare delivery, making it more accessible, convenient, and patient centered.
[00:03:49] Since the overturn of Roe v. Wade, telehealth has emerged as a significant factor in abortion access, particularly in the context of increasing restrictions in many states.
[00:04:02] Here is how it works and its implications.
[00:04:06] Telehealth Abortion involves receiving abortion care remotely, typically through a video consultation with a healthcare provider. If deemed eligible, the patient receives abortion pills mufapristone and misoprostol by mail or picks them up from a designated location. This method is generally available for early stage pregnancies. The US Food and Drug Administration approved the drugs for abortion use more than two decades ago and the regimen is approved for use up to 10 weeks gestation.
[00:04:43] Research has long found that medication abortion is safe and effective. Recent studies have shown that to be true even when the patient gets the medicine through a telehealth appointment. According to cnn, there are many benefits to telehealth abortion. It can improve access to abortion care, especially for those in rural areas, those who face logistical barriers like transportation or child care, or those who live in states with restrictive abortion laws. It offers a more convenient and private option for those who prefer to receive care at home.
[00:05:23] Some of the challenges and considerations we need to be aware of are as many states have enacted laws specifically targeting telehealth abortion.
[00:05:36] These laws may require in person visits, impose restrictions on providers, or even ban telehealth abortion altogether.
[00:05:45] This creates a complex patchwork of regulations making it difficult for some to access this option.
[00:05:53] Not all health care providers offer telehealth abortion services.
[00:05:58] Finding a provider license to practice in your state can be a challenge.
[00:06:03] Some states have laws that restrict or ban the mailing of abortion pills, further limiting access to telehealth abortion. While studies have shown telehealth abortion to be safe and effective, it's important to have access to appropriate follow up care if needed.
[00:06:22] Telehealth abortion has become an increasingly important means of accessing abortion care, especially in the post Roe era. However, its availability and legality are subject to ongoing legal and political battles.
[00:06:40] The future of telehealth abortion will depend on the evolving legal landscape and the efforts of advocates and policymakers on both sides of the issue.
[00:06:52] According to the Guttmacher Institute, since post Dobbs, the importance of self managed medication abortion has also increased as more people have been obtaining medication, abortion and other novel ways.
[00:07:09] Within six months after the Dobbs decision, distributors of medical abortion medication reported that over 27,000 orders of this prescription were mailed, according to the Society of Family Planning's We Count project. In the 18 months following the Supreme Court's decision that ended federal protection for abortion, the number of abortions in the United States has continued to grow from this report. In 2023, there were on average 86,000 abortions per month compared to 2022 where there were about 82,000 per month. The researchers were expecting a decline in this number. Florida, California and Illinois saw the largest surges in abortions, which is especially interesting given Florida's recent six week ban that started in May of 2024. Dr. Allison Norris, who is a co chair of the We Count Project and professor at Ohio State University's College of Public Health, said in a statement, Even as the total number of abortions nationally has increased, we can't lose sight of the fact that access to in person abortion care has virtually disappeared in states where abortion is banned. The loss of clinic based care, which makes up more than 80% of abortion care, is a devastating loss to access for people across wide swathes of the country.
[00:08:48] Medication abortion, including telehealth abortion, has become a common option since the Dobbs decision.
[00:08:56] There are a lot of barriers that are removed from the process by using telehealth abortion. The process is easy and available for access while also delivering abortion at a much lower cost.
[00:09:10] Telehealth has filled in some of the gaps that have been created by abortion bans. However, there is a need for broader awareness and the trust in telehealth abortion.
[00:09:23] Telehealth has filled in some of the gaps that have been created by abortion bans. However, there is a need for broader awareness of and trust in telehealth abortion.
[00:09:35] According to an editorial that was published in jam, a Internal Medicine, which is a peer reviewed medical journal, states that telehealth abortion is especially important for individuals living outside metropolitan areas, in low income communities or where high quality reproductive and maternity care services are lacking because of legislative restrictions.
[00:10:03] A major factor in the increase of abortions nationwide is is the rise of telehealth. This was made possible in part by regulations loosening during the coronavirus pandemic. According to CNN, the FDA provided regulatory flexibilities during the COVID 19 pandemic for broader access to medication abortions through telehealth. The use of mail order pharmacies became more widely available in 202021 last reported, telehealth abortions now make up 19% of all abortions in the United States.
[00:10:45] Although telehealth abortions are safe and widely used within the state of Louisiana, lawmakers have added mufapristone and misoprostol to the list of controlled dangerous substances in the state, creating penalties of up to 10 years of prison time for anyone caught with the drugs.
[00:11:06] This was the latest move by anti abortion politicians to control access to abortion pills, which people are ordering online and getting them shipped to their state through telehealth Abortion Care this law passed in May of 2024 and is the first of its kind.
[00:11:26] This law, Senate Bill 276, looks to target people who might obtain abortion medications to distribute them to pregnant people.
[00:11:38] This makes it harder for people who need these prescriptions to treat miscarriages or for other reproductive healthcare. These two drugs are widely used for miscarriage treatment. The drugs are still allowed, however. However, medical personnel have to go through extra steps to access them.
[00:11:57] Some doctors are concerned this change could cause delays in administering these drugs in medical emergencies, such as when a woman is hemorrhaging after giving birth.
[00:12:08] Additional states are also considering ways to restrict abortion pills in their 2025 legislation. Since Louisiana banned nearly all abortions, some patients who have miscarried have had trouble filling prescriptions for misoprostol at pharmacies because of the concern that the drugs would be used for abortions.
[00:12:33] This drug is often prescribed to women who are miscarrying because the treatment can potentially ward off weeks of waiting, worrying and bleeding. But when trying to pass all of the fetal material from the body, misoprostol mimics the natural hormones produced in the body during a natural miscarriage.
[00:12:55] According to Dr. Jamila Perit, an OBGYN in Washington, D.C. if this medication is restricted or banned completely, no one will be able to get access to it with any ease. We use this medication in lots of different ways and for lots of different care, including miscarriage and pregnancy loss.
[00:13:19] Dr. Jane Martin, an OB GYN in New Orleans whose hospital sees up to 5,000 births per year, stated that misoprostol is administered at least once a day in labor and delivery to manage dangerous postpartum hemorrhages.
[00:13:37] Misoprostol is usually stored in an OBGYN unit, in a hemorrhage box, in the room, on the delivery table or in a nurse's pocket. With the new law, there will be more red tape to access the drugs. For example, the medication may be down the hall in a locked container or potentially an in house pharmacy. At Smith smaller hospitals, up to 5% of obstetric patients will experience postpartum hemorrhages, which cause 11% of maternal deaths in the U.S. according to the Joint Commission, patients can lose a large amount of blood in a very short period of time, so in these situations, the seconds and minutes count.
[00:14:25] Two alternative medications can be used for hemorrhaging. However, they have more side effects and can't be used on patients with certain medical problems These other medications also have to be refrigerated, which means they need to be stored somewhere and it may be harder to access in a state of emergency.
[00:14:45] Misoprostol is one of the drugs most commonly used by OBGYNs and is routinely used in pregnancy care. It can also be used to soften and dilate the cervix for other gynecological procedures, such as inserting an IUD or endometrial biopsies.
[00:15:07] Louisiana's current abortion bans make it a crime to provide an abortion, including giving someone abortion pills. This law makes it illegal for anyone to even possess the ability these pills without a prescription under the state's Uniform Controlled Dangerous Substances Law.
[00:15:28] It also adds stiff criminal penalties for anyone who orders abortion pills online as a precaution in advance of pregnancy, which is called advance provision, which has become popular in states with abortion bans.
[00:15:44] Penalties for this quote unquote crime can result in a prison sentence of one to five years and a fine of $5,000 for the possession of either of these drugs. Louisiana classified these two drugs alongside Valium and Xanax. A Schedule 4 drug states that a drug must be found to cause some level of physical or psychological dependence and to have the potential to be abused in order to be added to the list of controlled substances.
[00:16:18] Misoprostol and mufapristone are not considered to be addictive in the traditional sense, and it does not create physical or psychological dependence.
[00:16:29] The legal challenges surrounding misoprostol and mufapristone haven't directly resulted in them being classified as Schedule 4 controlled substances that that type of scheduling is handled by the Drug Enforcement Administration, not typically through individual court rulings.
[00:16:50] However, judicial actions have attempted to restrict access to these medications based on arguments that diverge from the standard criteria used for scheduling controlled substances.
[00:17:04] Louisiana has changed both of these medications to a Schedule 4 drugs only at the state level, not federally.
[00:17:12] The Republican Center Thomas Presley, who was the bill's author, stated that he wanted to create a bill that would punish coerced criminal abortion where someone knowingly gives abortion pills to a pregnant woman to cause or attempt to cause an abortion without her knowledge or consent.
[00:17:31] Currently, I could not locate any legitimate statistics on on the amount of women who have had this crime committed against them. Of the quote unquote articles that were found discussing coerced criminal abortions, none offered research or proof of their findings. The question has to be asked, does this bill truly help women who are victims of being tricked into taking these pills, or is it yet another way politicians can control women's bodies and their reproductive health.
[00:18:04] Passing this law continues to isolate pregnant people who have decided to end their pregnancy because they do not want to involve friends or family members out of fear they could be criminally charged for helping at the end of January 2025, a grand jury issued an indictment against Dr. Margaret Carpenter for criminal abortion, a felony in the state which had a near total ban on the procedure. Carpenter was charged with criminal abortion by means of abortion inducing drugs. Louisiana requested Dr. Maggie Carpenter be extradited from New York to Louisiana.
[00:18:48] This request was denied by New York's Governor Kathy Hochul, stating, I will not be signing an extradition order that came from the Governor of Louisiana. Not now, not ever.
[00:19:02] She also instructed law enforcement in New York not to cooperate with out of state warrants for such charges.
[00:19:10] This is the first instance in which charges have been brought against a doctor accused of prescribing abortion pills to another state.
[00:19:19] Since the Roe v. WADE decision in 2022, Louisiana has enacted a near total abortion ban with no exceptions for rape or incest.
[00:19:31] Physicians convicted of performing abortions, including one with pills, can be sentenced up to 15 years in prison.
[00:19:42] According to the Louisiana District Attorney to Tony Clayton, the minor child was home alone, felt she had to take the pill because of what her mother told her.
[00:19:52] Authorities have stated that the minor child experienced a medical emergency and had to be transported to the hospital after taking the alleged medication prescribed by Dr. Carpenter.
[00:20:05] An indictment was also issued against the teenager's mother who Ascends turned herself in to the police.
[00:20:13] Dr. Carpenter has also been in trouble with the State of Texas. In 2024 she allegedly prescribed abortion pills to a woman in Dallas.
[00:20:25] Texas is another state that does not allow for exceptions in cases of rape or incest.
[00:20:31] It has been alleged that the 20 year old woman who was prescribed the medication ended up in the hospital.
[00:20:39] It was only after she was hospitalized that the man described as the biological father of the unborn child learned of the pregnancy and abortion.
[00:20:50] Attorney General Ken Paxton filed a civil lawsuit against the doctor. Texas State District Judge Brian Gant ordered Dr. Carpenter to pay a $100,000 penalty as well as attorney fees for allegedly breaking a Texas law by prescribing abortion meds via telemedicine.
[00:21:13] The New York shield law includes a provision that allows a prescriber who is sued to countersue the plaintiff to recover damages.
[00:21:24] The Attorney General Paxton has issued an injunction barring Dr. Carpenter from prescribing abortion medication to Texas residents.
[00:21:33] The Abortion Coalition for Telemedicine commented the Ken Paxton is prioritizing his anti abortion agenda over the health and well being of women by attempting to shut down telemedicine abortion nationwide. By threatening access to safe and effective reproductive health care, he is putting women directly in home harm's way.
[00:22:00] The Abortion Coalition for Telemedicine, which was co founded by Dr. Carpenter, called the indictment against her the latest in a series of threats that jeopardize women's access to reproductive health care throughout the country. The medication is approved by the US Regulators and has been proven safe and effective for decades.
[00:22:23] The Abortion Abortion Coalition for Telemedicine was created in 2022 after the US Supreme Court overruled Roe v. Wade, which opened the doors for states to ban abortion. This is a non profit website with medical and legal expertise to meet this moment in our history.
[00:22:44] The nonprofit provides technical and legal support for telemedicine providers.
[00:22:50] New York Governor Kathy Hochul called the case outrageous and stated that it is an attempt by Republicans to stop the access to reproductive care not just in conservative states but across the US she is quoted saying, I will do everything I can to protect this doctor and allow her to continue the work that she is doing that is so essential.
[00:23:16] The New York Attorney General, Leticia James, also has commented on this indictment, stating that it is a cowardly attempt to weaponize the law against out of state providers.
[00:23:29] On February 3, 2025, Governor Kathy Hochul signed a new law in New York just days after a Louisiana grand jury indicted Dr. Carpenter.
[00:23:42] This new law helps strengthen the telehealth shield law that providers prescribing abortion medication can request that a dispensing pharmacy print their practice's name on the prescription bottle label instead of their name. This law will make it more difficult for hostile states to target New York doctors serving patients in states lacking access to abortion care.
[00:24:08] Six states California, Colorado, Massachusetts, New York, Vermont and Washington have shield laws in effect to ensure that abortion providers can offer said care regardless of the patient's location.
[00:24:24] This statute says that medical professionals cannot be prosecuted or held liable for providing abortion care to people from other states.
[00:24:35] These laws are further expanding the role of telehealth by allowing residents needing care to access it, even in states where abortion is banned.
[00:24:47] Between July and December 2023, more than 40,000 people in states with abortion bans and telehealth restrictions received medication abortion through providers in states protected by shield laws.
[00:25:03] Telehealth abortions have become a great way for those who live in abortion ban states to access care. However, some things need to be considered with the inequalities in telehealth abortion care.
[00:25:17] Some virtual clinics had minimum age requirements that are not legally mandated in the states they serve. These restrictions limit abortion access for adolescents who face even greater barriers to abortion and stand to benefit from the privacy and ability to avoid travel that telehealth offers.
[00:25:39] Few virtual clinics accept private insurance or Medicaid.
[00:25:44] There are a variety of ways that can address some of these inequalities. At the state level, policy changes that could help would include improving equitable access to telehealth medical care more broadly through actions such as increasing coverage for asynchronous telehealth and promoting equitable access to reliable Internet connection.
[00:26:09] Another way to promote access would be to improve Medicaid and insurance reimbursement.
[00:26:17] The last way to help with inequalities in telehealth abortion is to remove in person counseling, ultrasound, and other requirements that are not based on medical evidence.
[00:26:33] As we continue to see the challenges and benefits of telehealth abortions, we need to be aware that this form of care is in jeopardy.
[00:26:43] Legal threats challenge the future potential of telehealth abortion. Since mail service is managed by the federal government, and with the change in administration, this avenue of delivery could threaten mail order delivery of abortion pills and patients who receive them. The new Secretary of Health and Human Services, Robert F. Kennedy, Jr. Suggested in his confirmation hearings he was open to significantly limiting access to abortion medication and refused to say whether emergency rooms should have to provide emergency abortion care to save the lives of pregnant patients.
[00:27:25] State laws and restrictions pose significant challenges to the availability of telehealth abortion, but we are continuing to see virtual clinics emerging as key providers in the United States abortion landscape face dire restrictions on abortion access.
[00:27:46] Next week we will be focusing on some of the lawsuits that have been filed against abortion bans and abortion ban states SA.
