Abortion Coalition for Telemedicine
We are a start up advocacy group working to pass and implement state laws that can enable licensed clinicians to provide medication abortion through telemedicine to patients in states where access is banned or restricted. Access in these states is dire, with many patients finally getting pills from overseas or through underground networks. This access is often later in pregnancy than the FDA approved 10 weeks, resulting in a traumatizing experience and sometimes medical complications which can place them at risk of legal issues as well. Telemedicine access in the restricted states is urgently needed.
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​The founders of this organization are two physicians and a lawyer with combined decades of providing cutting-edge abortion access and advocacy: Dr. Linda Prine, Dr. Maggie Carpenter, and Julie F. Kay.
INTRODUCTION
We work directly in New York and nearby states to advocate for telemedicine shield laws while simultaneously setting up the tools needed for implementation. We are also supporting health care providers and attorneys interested in learning more and/or advocating for passage or implementation in other states. While there are many abortion-support organizations, at the moment, there is no organization that is helping to implement telemedicine shield laws and assist those who provide these vital services.
OUR WORK IS PRIMARILY TO BUILD SUPPORT FOR TELEMEDICINE SHIELD LEGISLATION
Last year, following the Dobbs decision, a flurry of legislation was passed to protect patients traveling from abortion restrictive states and the providers who treat them. These 7 states currently provide protections to providers when patients travel to an abortion-friendly state. Now we need to go further as the majority of abortion care seekers can’t travel. The telemedicine shield laws can protect providers serving patients across state lines without requiring any travel, and thereby significantly reducing costs, delay and stigma. Telemedicine shield laws offer providers protection from criminal and civil liability and from licensing sanctions. With a shield law in place, telemedicine can provide a safe, affordable way for patients to receive care from a licensed clinician, with US distributed, FDA-approved medications.
Nonetheless, in New York and elsewhere, we witnessed some initial hesitation and “risk-aversion” from our abortion rights allies and elected officials. In response, we have been working to successfully organize and rally mission-driven abortion providers and medical organizations, as well as community organizations who work directly with pregnant people in abortion ban states and who recognize the urgency to provide direct services in a timely fashion. This requires legal research, medical expertise, community outreach and careful oversight to make sure the proposed laws are as good as they could possibly be. Since the passage of the first telemedicine abortion shield law in Massachusetts in July 2022, we are learning and improving on the essential elements of these laws and their implementation.
We have been building support for the passage of the laws with as many community groups as possible so that the legislators feel the pressure. We have been able to help persuade the traditional reproductive health organizations (NYCLU, ACOG, NIRH and PP) to support the legislation in New York, although they have unfortunately resisted making passage a top priority for their organizations. Nonetheless, through our educational meetings with legislators and their aides, petition writing and circulating, gathering memos of support, writing op eds and extensive communications with media we have made enormous progress and are optimistic about the NYS bill passing this term. Bills in Washington, Vermont, Maryland and New Jersey are also in the works.
OUR WORK HELPING PROVIDERS LAUNCH SHIELDED PRACTICES
Once these bills are passed, several barriers to implementation will still need to be overcome. Thus, our work includes support for solo practitioners or small group practices dedicated to providing telemedicine abortion. (Large abortion providing organizations are averse to interstate telemedicine abortion services in an uncertain political and legal climate.) Dedicated clinicians need assistance with establishing a separate business or LLC, electronic medical records, obtaining malpractice insurance, contracts with Mifepristone and misoprostol distributors as well as other nuts and bolts activities. Medical malpractice coverage for telemedicine-only abortion practices is either non-existent or prohibitively expensive because of the bias against abortion coverage. We have been working to identify investors interested in establishing a “risk management pool” to create independent coverage by working with non-biased insurance agents. Finally, the actual distribution of the pills is a challenge because the existing mail order pharmacies are reluctant to mail from their businesses into restricted states. We are exploring alternatives, including systems for clinicians who may need to organize self-mailing from their work sites. Our organization is working in several states to make connections, raise funds, and mentor clinicians so that these barriers can be overcome.
CONCLUSION
We are happy to provide additional information on the legalities of telemedicine abortion as well as detailed information about the increasing need for these services from physicians directly providing advice and care on abortion and miscarriage management.
Dr. Linda Prine — lindaprine@mac.com
Dr. Maggie Carpenter — magscarpenter@gmail.com
Julie F. Kay, JD — msjuliefkay@gmail.com