Allison Case is a family medicine physician licensed to practice in both Indiana and New Mexico. Through telehealth appointments, she has previously used her dual degree to help some women who have driven from Texas to New Mexico, where abortions are legal, get their abortion prescriptions. Then came Indiana’s abortion ban.
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Allison Case, a family medicine doctor, spends most of her time working at a hospital where she gives birth and provides reproductive health services, including abortions.
Case lives and works in Indiana, where ban on most abortions valid for one week at the end of September until a judge temporarily stops the restraining order. The state has since appealed the judge’s order and asked Indiana’s high court to hear the case. Meanwhile, Case is also licensed to practice in New Mexico, a state where abortion is still legal.
Before Indiana’s abortion ban took effect, Case would use her days off to provide reproductive health services, including abortion care, through telemedicine through a clinic. patient care in New Mexico. Many of them are from neighboring Texas, where abortion is banned.
Some people travel alone, she said, and others have their children with them.
“Many people are [staying in] Hotel, others may have family or friends they can stay with, some are just sleeping in their cars,” Case said. That is really terrible. “
During the telemedicine appointment, the doctor, nurse, or other qualified health professional will review the patient’s medical history and ensure eligibility for a medical abortion. They provide patients with information on how the two pills work, how to take them, what to watch out for when a pregnancy is out of the body, and when to seek medical attention in the rare event of complications. proof. The drugs are then sent to the patient, who must provide a mailing address in the state where abortion is legal.
United States, More than a dozen states severely restrict access to abortionand most people have such laws at work. Nationwide, since Roe v. Wade has been debunked, clinics that offer abortion services have seen an increase in demand. Many clinics rely on help from out-of-state doctors, like Case, who can relieve some of the pressure and reduce wait times by providing services through telemedicine.
But as more states move to restrict abortion, these providers are having to navigate an increasingly complex legal landscape.
Is telemedicine abortion legal? Various experts
Medical abortion works for most people less than 11 weeks pregnant and research shows medical abortion through telemedicine is safe and effective. However, many states have enacted laws to prohibit or restrict access for remote abortion.
But it’s not always clear what that means for doctors like Case, who practically live in states with abortion restrictions but have licenses that allow them to provide care. via telehealth to patients in legal states.
Case said she consulted several attorneys about legality, and none of them had a specific answer for her.
“A lawyer said, ‘If someone tells you, they think they know [or] they’re sure about these things, they’re not on their minds,’ she said.
In many states, patients seeking a remote abortion must be physically present in a state where telemedicine abortion is legal, even if only for a brief virtual consultation with a provider who may be in a completely different state.
These providers are finding themselves in a legal gray area, having to consider how much risk they are willing to take to care for their patients or consider pausing altogether. this aspect of care.
Katherine WatsonThis is uncharted territory, says a law professor and medical ethicist at Northwestern University Feinberg School of Medicine in Chicago.
“The stakes are high,” said Watson. “We’re talking about something that’s protected in one state and felony in the sister state.” “And the map is a patchwork. So this is a radical change. “
People have to understand the difference between the text of the law and the enforcement environment, she said. Even if the law doesn’t explicitly criminalize what doctors like Case do, the enforcement environment could land some of them in legal trouble.
“In a draconian enforcement environment, you may not be breaking the law,” said Watson. “But creative prosecutors can find excuses to mistreat you.”
There is no argument that prosecutors can use, she said, but in an charged political environment, there is a real risk. Look no further than Dr Caitlin Bernard, an Obstetrician and Gynecologist in Indiana who spoke out about the legal abortion she provided earlier this summer to a 10-year-old rape victim from Ohio. ; Bernard is libel and publicly accused of misconduct by the state attorney general.
Suppliers must weigh the risks
Case partners 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 doesn’t have a traditional clinic in some places, but it works with licensed medical providers there to make virtual appointments for employees.
President and CEO of Whole Woman’s Health, Amy Hagstrom Miller, she tells service providers about the risks they face when working for the clinic. She suspects the lack of clarity in the state law is by design, which is intended to “turn people away from providing safe abortion care.”
Now, with Indiana’s recent abortion ban on hold, Case said she’s looking to continue offering telemedicine abortions. But if the ban goes into effect again, she said, she will be reluctant to stop those services. The risk is too high.
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Now, with Indiana’s recent abortion ban on hold, Case said she’s looking to continue offering telemedicine abortions. But if the ban goes into effect again, she said, she will be reluctant to stop those services. The risk is too high.
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The clinic stopped working with Texas-based providers because abortion law there allows anyone – even someone who is not personally affected – to sue anyone who performs, assists or intends to assist with an abortion. That opens the door for political, cultural, and even personal grievances to interfere with healthcare providers’ work.
“Just because you’re abiding by the law doesn’t mean anti-abortionists won’t go after you and try to defame you and make life difficult for you,” Hagstrom Miller said.
In late August, on a day off Case from caring for patients in Indiana, she sat by her laptop as one of her cats quietly nestled in her lap and the patient aborted. by her first telemedicine login.
This woman is a pregnant student from Texas sitting in her car. The camera only shows the top half of her face. She drove for hours to New Mexico looking for an abortion prescription.
Case instructs her on what to expect, explaining that the abortion pill stops pregnancy and prompts the body to push the embryo out within a few hours.
“It depends on the person, but many people describe it as a difficult period,” Case told the young woman.
The patient requested a medical note to excuse her from going to school, but the request did not mention that she had an abortion.
It’s women like this that motivate Case to perform telemedicine abortions.
With Indiana’s abortion ban now in place, Case said she’s looking to continue offering telemedicine abortions. But if the ban goes into effect again, she said, she will stop those services. The risk is too high.
If more providers in these states decide the risk is too high, Hagstrom Miller says, the clinic is willing to shift patient numbers to providers in states where abortion is still legal. and protected.
For her part, Case said, if the number of patients is large enough, she might consider driving across the state border, to neighboring Illinois, so that she can continue to provide these telemedicine services.
“I just thought it was a crazy thing to think I was going to drive an hour and a half to Illinois to use my New Mexico. [medical] “She said” driver’s license to help people who drive from Texas to New Mexico have abortions. It’s like a madness. “
This story comes from NPR’s health reporting partnership with Side effects Public communication, Midwest Newspaper Office and Kaiser Health News (KHN).
