Iowa physicians cannot be prohibited from using telemedicine to prescribe abortion-inducing medication to patients, according to a recent ruling by the state Supreme Court.
The Iowa Supreme Court overturned a lower court ruling that upheld a 2013 ban of the practice by the Iowa Board of Medicine. The ban places an “undue burden” on a woman’s right to an abortion and violates the state Constitution, the Supreme Court justices said.
Suzanna M. de Baca, president and CEO of Planned Parenthood of the Heartland, said the ruling protects women’s access to a safe, legal abortion.
“Medical experts opposed this law because it harms women by blocking access to safe medical care,” Ms. de Baca said in a statement . “When it comes to health care, politics should never trump medicine.”
Iowa Board of Medicine officials argued that a physical examination by a physician before the abortion and a follow-up examination after the abortion are essential, given the health risks associated with abortion-inducing drugs.
“The rule was adopted to address what the board saw as the unsafe practice of medicine, and not to place an undue burden on women who choose to terminate their pregnancies,” Mark Bowden, the board’s executive director, said in a statement . “The board will discuss the opinion at its meeting to determine its full application.”
The legal dispute began in 2013 when the Iowa Board of Medicine passed a rule that established standards of practice for physicians who prescribe or administer abortion-inducing drugs. The rules required that physicians personally perform a physical examination and be physically present when the abortion-inducing drug is provided. The regulation effectively prevented doctors from providing abortion treatment through telemedicine, a practice that Planned Parenthood clinics had used since 2008, according to court documents.
The rule immediately drew criticism, including from the Iowa Medical Society (IMS). In an October 2013 letter to the Board of Medicine, Jeanine Freeman, then-IMS legal counsel, wrote that board members failed to show that physicians – particularly those who care for pregnant women – agreed that the rule’s criteria were necessary and appropriate to assure patient safety and health. The board also made no effort to seek expertise, to consider other protocols, or to come to reasonable consensus on medical practice and patient safety, Ms. Freeman wrote.
And despite the Board of Medicine’s statement that the criteria in the rule would relate only to drug-induced telemedicine abortions, the medical society raised concerns about the impact of the rule on other areas of telemedicine.
“The criteria adopted here essentially eliminate telemedicine as a mechanism for the delivery of this medical service with little explanation and inadequate grounding in medical practice standards,” Ms. Freeman wrote.
Through its executive vice president, the Iowa Medical Society declined to comment for this article.
Planned Parenthood of the Heartland, which includes Iowa, sued over the rule in 2013. The regulation was temporarily halted pending the case’s outcome. In 2014, a district court ruled in favor of the Board of Medicine, and Planned Parenthood appealed. In the June 19 decision, the Iowa Supreme Court reversed the lower court decision, ruling that the burden placed on women seeking to terminate a pregnancy outweighed the Board of Medicine’s justification for its rule.
“An issue of equal protection of the laws is lurking in this case,” the justices wrote. “The board appears to hold abortion to a different medical standard than other procedures.”
Iowa is not the first state to institute a prohibition against medication abortions via telemedicine. At least 16 states require that a clinician providing a medication abortion be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely, according to a June 2015 report by the Guttmacher Institute, a nonprofit research and education group focused on advancing reproductive health.
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