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Mifepristone can now be offered at retail pharmacies

Jan 4th, 2023
by Charles Kuffner.
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Good news, for at least some of the country.

For the first time, retail pharmacies, from corner drugstores to major chains like CVS and Walgreens, will be allowed to offer abortion pills in the United States under a regulatory change made Tuesday by the Food and Drug Administration. The action could significantly expand access to abortion through medication.

Until now, mifepristone — the first pill used in the two-drug medication abortion regimen — could be dispensed only by a few mail-order pharmacies or by specially certified doctors or clinics. Under the new F.D.A. rules, patients will still need a prescription from a certified health care provider, but any pharmacy that agrees to accept those prescriptions and abide by certain other criteria can dispense the pills in its stores and by mail order.

The change comes as abortion pills, already used in more than half of pregnancy terminations in the U.S., are becoming even more sought after in the aftermath of last year’s Supreme Court decision overturning the federal right to abortion. With conservative states banning or sharply restricting abortion, the pills have increasingly become the focus of political and legal battles, which may influence a pharmacy’s decision about whether or not to dispense the medication.

The F.D.A. did not issue an announcement but planned to update its website to reflect the decision. The two makers of the pill, Danco Laboratories and GenBioPro, released statements saying the agency had informed them of the action.

The action is the latest step taken by the federal government to expand access to abortion pills by easing some of the restrictions that have applied to mifepristone since it was approved in 2000.

In December 2021, the F.D.A. said it would permanently lift the requirement that patients obtain mifepristone in person from a health provider, a step that paved the way for telemedicine abortion services which conduct medical consultations with patients by video, phone or online questionnaires and then arrange for them to receive the prescribed pills by mail.

On Tuesday, the F.D.A. officially removed the in-person requirement from its regulatory rule book for mifepristone, leaving in place the remaining two requirements: that health providers be certified to show they have the knowledge and ability to treat abortion patients and that patients complete a consent form.

See here for some background. My understanding of the action taken in 2021 was that it allowed mifepristone to be prescribed via telehealth. I’m a little fuzzy on how much of a difference-maker this announcement is, but whatever it is, every little bit helps. Just, you know, not everywhere.

Whether large pharmacy chains and local drugstores would opt to make the pills available was not immediately clear Tuesday. The steps for pharmacies to become certified to dispense mifepristone are not difficult, but they involve some administrative requirements that go beyond the process pharmacies use with most other medications, such as designating an employee to ensure compliance. Given the time and resources required by those steps, some pharmacies may not consider it worthwhile to offer a medication that only a small percentage of their customers may use.

But while abortion pills may constitute a small percentage of a pharmacy’s sales, they could have a big impact on its public profile. Calculations about public perception and the highly polarized political landscape are also likely to influence a pharmacy’s decision.

In about half the states, abortion bans or restrictions would make it illegal or very difficult for pharmacies to provide abortion pills.

In states where abortion remains legal, pharmacies may face customer demand for the medication or public pressure from abortion rights advocates and health providers. National chains could decide to offer the medication in those states while not providing it in their stores in restrictive states.

I can say with 100% certainty that you won’t be able to walk into your local CVS here in Texas and find any mifepristone. The real question is what the Lege will try to do to prevent people from going out of state to get any kind of abortion care, or to punish people not in Texas who provide that care; the corollary questions will be about what the courts will do with the resulting litigation. We’re still a few months out from that, but it’s coming. In the meantime, at least some people will get to benefit from this.

More on the targeting of medical abortion

Aug 28th, 2022
by Charles Kuffner.
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The end goal has always been a complete national ban on abortion. The “return it to the states” nonsense is a dodge to make you think it won’t be that bad and the people claiming it’s about a national ban are just fearmongering. The actions and words of the forced-birth fanatics make it clear what is really happening.

Two top antiabortion groups have crafted and successfully lobbied for state legislation to ban or further restrict the predominant way pregnancies are ended in the United States — via drugs taken at home, often facilitated by a network of abortion rights groups.

In the wake of the Supreme Court’s decision to overturn Roe v. Wade, 14 states now ban or partially ban the use of those drugs, mifepristone and misoprostol, which are used in more than half of all abortions.

But the drugs remain widely available, with multiple groups working to help provide them even to women in states with abortion bans. Students for Life of America and National Right to Life Committee, which have played leading roles in crafting antiabortion laws, hope to change that with new legislation.

The groups are pursuing a variety of tactics, from bills that would ban the abortion-inducing drugs altogether to others that would allow family members to sue medication providers or attempt to shut down the nonprofit groups that help women obtain and safely use the drugs.

Their strategy reflects the reality that abortion access today looks vastly different from that of the pre-Roe world, one without easy access to abortion medications from out-of-state or overseas pharmacies.

[…]

Students for Life is taking a different tack in efforts to limit or outlaw medication abortion — crafting and backing bills that restrict access to the drugs themselves.

Among the seven bills the group has successfully lobbied to pass, each requires women to see a physician in person to receive the medications rather than receiving them through the mail. The mandates vary from state-to-state, but most require a physical examination, a test to determine the blood type of the baby, an ultrasound to determine the stage of the pregnancy, a disclosure of safety risks and a follow-up examination after the procedure. In many of the states, the medications could only be used in a limited set of circumstances, like in Oklahoma where its use is restricted to ending early pregnancies that resulted from rape or incest — or if the woman’s life is in danger.

Telehealth appointments for the procedure are also prohibited under the bills.

In some cases, doctors are required to tell their patients that they can potentially reverse the effects of mifepristone and stop the abortion process — something that the American Medication Association has said is “a claim wholly unsupported by the best, most reliable scientific evidence.”

“So many states in the abortion arena have been playing with misinformation like this, relying on the antiabortion movement instead of medical professionals and what the science shows,” said Wendy E. Parmet, co-director of Northeastern University’s Center for Health Policy & Law. “Some states have required physicians say it causes breast cancer — which is also false.”

The ultimate goal of Students for Life is to block access to drugs entirely. The group is seeking criminal sanctions for the physicians and organizations that “manufacture, distribute, prescribe, dispense, sell or transfer” the drugs in the state.

If passed, the laws would be most effective in blocking prescriptions made by doctors in states where abortion is still legal — typically through telehealth appointments — to patients who reside in states where medication abortions are banned in all circumstances.

Experts say it is unlikely that law enforcement would be allowed to enter a state to arrest a doctor where they have no jurisdiction. However, state medical boards could penalize doctors — including revocation of their medical licenses — if they determined they are not licensed to practice medicine with someone who resides outside their state.

“It’s not as bad as going to prison, but it’s certainly something that no doctors want to have to do — be in a position where they are having to defend their license,” said Hearn, McCormack’s attorney, who is also a physician.

I’ve blogged about this in various forms before, and it’s important to keep in mind that this is where the forced birth fanatics want to go, and will go if they’re not stopped. Enforcing these kinds of laws will be extremely intrusive, wherever the exist. I have meant that in the past to mean that law enforcement will need to get all kinds of access to your mail, your phone logs, your browsing history, and so on, but there’s another way in which having such laws on the books will curtail everyone’s privacy. You will have to be extremely careful about what you say to whom, and you won’t be able to trust anyone you don’t know. That includes medical professionals and anyone who works for or with them.

If you are looking to end your own pregnancy, your own doctor may be your downfall.

Between 2000 and 2020, law enforcement in 26 states investigated or arrested at least 61 people for allegedly aborting their own pregnancy or helping someone else do so, according to a report released earlier this week by the legal advocacy group group If/When/How. And in 45 percent of those cases, it was healthcare providers or social workers who tipped off police.

In another 26 percent of the cases, people “entrusted with information”—like partners, parents, and friends—reported their ostensible loved one to police.

“The research really clearly confirms that the biggest threat to the privacy of abortion seekers is other people,” said Laura Huss, senior researcher for If/When/How. “That breakdown of trust and ethics and the patient-doctor relationship is really alarming.”

The report, which examined the criminalization of self-managed abortions while Roe v. Wade was still the law of the land, offers a stunning glimpse at how people who get abortions in this post-Roe era may be targeted and threatened by law enforcement. Although abortion opponents often insist that they do not want to punish pregnant people for abortions, abortion rights supporters have long pointed out that pregnant people have already faced criminal consequences—and there’s no way to ensure they’ll be kept out of an anti-abortion dragnet.

Gotta say, as a child of the 70s and 80s, all this gives me serious Soviet Union vibes. I’m old enough to remember when Republicans and conservatives thought that was a bad thing.

Of course we don’t do nearly enough for mental health

Jun 22nd, 2022
by Charles Kuffner.
1 comment

Because Republicans rush to talk about “mental health” every time there’s another mass shooting, it’s important to remember that their response to meeting the demand for mental health, in schools and elsewhere, has been completely inadequate.

Tucker’s was the kind of positive outcome state lawmakers pictured in 2019, when they worked to increase mental health resources for students after the mass shooting at Santa Fe High School that left eight students and two teachers dead.

Access to those services again is at the forefront as Republican leaders respond to last week’s massacre in Uvalde.

Mental health experts say the 2019 initiatives, including hundreds of millions of dollars more in funding, have only begun to address Texas’ mental health crisis, and that the state does little to track even their limited outcomes. Many school districts are left to fund their own interventions.

There is little evidence that mental illnesses cause mass shootings or that people diagnosed with them are more likely to commit violent crimes. Advocates also warn that scapegoating mental illness can stigmatize the wide spectrum of people living with psychological disorders.

“It’s absolutely something that should be addressed — but it’s not a panacea,” said Greg Hansch, executive director for the Texas chapter of the National Alliance on Mental Illness. “It’s more of a secondary or tertiary factor.”

Gov. Greg Abbott and other top Republicans have pointed to the shortage of mental health resources, especially in rural Texas, as a key factor in the Uvalde shooting, while rejecting calls for stricter gun laws.

The 18-year-old gunman, who killed 19 children and two adults, legally purchased the assault-style weapon he used in the shooting spree and had “no known mental health history,” Abbott said.

Even with the 2019 reforms, mental health care remains vastly underfunded in Texas. That largely is because of budget cuts two decades ago and years of stagnant funding to community mental health services. Today, Texas provides less access to care than any other state, and nearly three quarters of children and teenagers with major depression do not get treated, the highest rate in the country, according to the nonprofit group Mental Health America.

Without a direct source of state funding for mental health care, school districts in Texas are forced to rely on a patchwork of state and federal programs, most of which do not guarantee that money will flow to mental health services for students or training for teachers. As a result, only a tiny fraction of Texas’ roughly 1,200 public school and open-enrollment charter districts have enough counselors, social workers and psychologists to meet professionally recommended student-to-provider ratios, according to a recent Houston Chronicle analysis.

Central to lawmakers’ 2019 response was a new mental health consortium overseen by the University of Texas System, with a $99 million initial investment for programs focused on children and teens, including virtual visits between child psychologists and students referred by school staff. The Legislature also increased funding to Communities in Schools, which places staff directly on campuses and had employed Tucker’s social workers.

In addition, lawmakers required school officials to form “threat assessment teams” to identify students who may pose a risk of violence, and put forth another $100 million to school districts every two years that can be used to hire security personnel, provide mental health services and buy physical upgrades, such as metal detectors and bullet-resistant glass.

In the first year, however, just 12 percent of Texas school districts reported using any of the funds for mental health support, while 8 percent said the money was used for behavioral health services, according to a survey by the Texas School Safety Center at Texas State University.

A task force later found the Texas Education Agency was not collecting meaningful data on mental health programs in schools, including the number of students they serve or “any standard outcomes” they measure. The Legislature responded with a bill last year to bolster reporting, but the agency has yet to release any results.

Annalee Gulley, director of public policy and government affairs for Mental Health America of Greater Houston, said lawmakers have taken encouraging steps to support mental health but should have paired the funding with more direction for school officials on how to spend it.

“A critical lesson learned in the years following the Santa Fe High School shooting is funding alone is not enough,” Gulley said. “Instead, the state must connect financial resources to guidance on the most effective strategies to support the safety and well-being of educators and students following such a catastrophic event.”

Much of the focus since 2019 has been on the telehealth effort known as TCHATT, including more than $50 million in added pandemic funding last year. The program has been slow to expand, however, serving only about 6,000 students so far. By comparison, Communities in Schools serves 115,000 students annually on a $35 million budget. There are more than 5 million students in Texas.

So yeah, still a long way to go, and that’s before we get to things like the challenges of hiring all of the counselors that would be needed in Texas’ 1200 school districts and thousands of schools. And this story never mentions the need to expand Medicaid, which would be the single biggest thing that we could do in Texas to improve mental health care for everyone, not just for students. I started the draft of this post a couple of weeks ago, before the Cornyn/Murphy gang got what passes for traction on a bipartisan framework for a gun control bill (still no bill, and the framework remains under negotiation, but there’s an agreement to come to an agreement, and that’s the progress in question), and since then we’ve had that, more ridiculous talk about all of the non-gun things that actually cause mass shootings, the lunatics at the Texas GOP convention basically accusing Cornyn of treason, and a bunch more people getting shot and killed, but we haven’t had much talk about mental health. As with gun control itself, the Republicans and their gun enablers will be happy to just let that fade away, until the next time it has to be trotted out as an excuse for the latest mass casualty.

The coming fight over medical abortion

May 23rd, 2022
by Charles Kuffner.
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Sure is a good thing SCOTUS will leave this up to the states, isn’t it?

Republican-led states are moving swiftly to restrict access to medication abortion.

The efforts so far have focused on regulations around the pills, such as banning them from being shipped or prescribed. But can states ban the actual abortion pill itself, even though the Food and Drug Administration has approved it? That question could be the next frontier in the abortion wars.

The short answer comes down to this: The issue isn’t settled law and will likely be litigated in the courts. Some argue states may be hard-pressed to ban the federally approved medication, though antiabortion advocates disagree.

[…]

Some states have introduced bills focused on banning abortion pills, but they haven’t gotten a lot of traction, per Elizabeth Nash, an interim associate director at Guttmacher Institute, a research group that supports abortion rights. (A recent exception is Oklahoma, whose Republican governor is poised to sign legislation banning abortions – including medication abortions – from the moment of “fertilization.”)

Rather, states are banning the practice of medicine around the pills. For instance: At least 19 states ban the use of telehealth for medication abortion, and some states have additional restrictions, like prohibiting pills from being mailed.

Yet, if Roe v. Wade is overturned, some states may try to ban the actual medication. And states already have gestational limits and other abortion bans on the books that could kick in quickly if Roe is overturned — and those likely encompass limitations on the pills, experts said.

Can states ban a medication the FDA has signed off on?

There’s no clear precedent here.

Some states may argue they can ban medication abortion because states have the authority to regulate the practice of medicine. The FDA, on the other hand, is the acknowledged authority on medical products, such as the abortion pill. But the line between medical practice and medical products is not always clear.

And if a state squared off against the federal government over an FDA-approved drug … “We don’t know how the court would rule. It’s an open question,” Patti Zettler, an associate professor of law at Ohio State University and former associate chief counsel in the FDA’s Office of the Chief Counsel.

See here for some background. Reminder #1: The state of Texas has made it a felony to provide abortion medication after seven weeks, after having already banned anyone but doctors from dispensing such medication, and only via an in-person office visit – no telemedicine. You can be sure that Texas will take this to the next level in the next legislative session if it is in position to do so.

Reminder #2: The same medicine that is used for abortion is also used to treat miscarriages. Needless to say, women who are suffering through a miscarriage will face – and as that story notes, are already facing – barriers to medical care that could threaten their health, their future ability to get pregnant and carry a child to term, and even their lives. That’s our future, and if you think I’m being alarmist, go back and read all those soothing articles about how this Supreme Court was never ever going to overturn Roe v Wade because it would cause too much upheaval.

And more people are travelling for abortions

Mar 10th, 2022
by Charles Kuffner.
1 comment

The number of abortions performed in Texas has declined greatly since the passage of SB8. But the number of Texans seeking abortions has remained the same, which is what abortion advocates have always said would be the case.

The number of women leaving Texas to obtain abortions has grown tenfold since lawmakers here banned the procedure after early pregnancy, according to new research from The University of Texas at Austin.

The findings, coupled with a huge uptick in online orders for abortion pills, suggest that the state’s widespread crackdown has not yet led to a large decline in procedures. While abortions at Texas clinics did fall by about half after the new restrictions took effect in September, many women still sought out to end their unwanted pregnancies through other, often more challenging paths.

The law “has not reduced the need for abortion care in Texas. Rather it has reduced in-state access,” said Dr. Kari White, lead investigator at the university’s Texas Policy Evaluation Project.

More than 5,500 Texans traveled to abortion clinics in six surrounding states between September and December of last year, according to the study. That’s nearly 1,400 trips per month, up from about 130 per month in the same period in 2019. The latest tally is likely an undercount, since some clinics did not participate and the study did not include trips to states farther from Texas.

[…]

Abortion rights advocates are already preparing for states to cut access in more than two dozen states across the South and Midwest, and providers are rushing to build out clinic space in northern and coastal states more friendly to abortion rights.

The new findings from Texas may be an early picture of the scramble to come for women in other states. The vast majority of trips out of Texas were to Oklahoma and New Mexico, where clinics are on average several hundred miles from most Texans. Oklahoma has its own “trigger” abortion ban in place if the Supreme Court overturns Roe v. Wade, the 1973 decision protecting the right to abortion until about 23 weeks of pregnancy.

Women interviewed in the study said they faced heavy obstacles in seeking out abortions since the law took effect, including delays at clinics in and out of Texas. One in four said they had visited crisis pregnancy centers, which often discourage women from getting abortions. Researchers interviewed 65 women in total.

See here for the TexPEP news release, and here for the full report. You can consider this a bookend to the other recent report about the increase in demand for abortion-inducing medication. It may seem like a bit of comfort that there are still options available, but one is much more time consuming and expensive, not to mention about to get more so as states like Oklahoma and Louisiana follow in Texas’ cursed footsteps, and the other is also heavily restricted under state law, with the great likelihood of further restrictions coming in future legislative sessions if Republicans remain in control. It’s just a matter of time before the emphasis changes from “ways to make abortion more illegal” to “ways to increase enforcement of anti-abortion laws and increase the penalties for violating them”. Do not think for a minute that locking up people who seek abortions, and the people who help them, is off the table. I guarantee you, it is not.

In the “I hate it when I’m right” department, later the same day that I wrote this, I saw this on Twitter:

Don’t ask how that could be legal, or how it could possibly be enforced. The terror of it is the point. Scare people into thinking they can be locked up for seeking a legal abortion elsewhere, and you’re done.

And on that cheery note, we have this update about the largely futile efforts so far to stop this travesty in the courts.

In its 1973 ruling in Roe v. Wade, the U.S. Supreme Court created a constitutional protection for abortion through viability, the point at which a fetus could likely survive outside the womb, usually around 24 weeks.

Since then, states, including Texas, have been stopped by the federal courts when they’ve tried to ban abortions before that point in pregnancy.

But Texas’ law has so far managed to evade a similar fate. The U.S. Supreme Court declined to stop the law from going into effect before Sept. 1, instead allowing lawyers for the abortion providers to bring a pre-enforcement challenge, which was heard in November.

The U.S. Department of Justice also tried to challenge the law, and succeeded in getting it temporarily enjoined by a federal district judge. That ruling was swiftly overturned by a higher court and the U.S. Supreme Court eventually threw out the DOJ’s challenge.

In December, the Supreme Court also threw out the vast majority of the abortion providers’ legal challenge, allowing only one narrow aspect to proceed. That remaining challenge is slowly wending its way through the courts, but even if it is granted, it would not allow abortion providers to resume providing the procedure after six weeks of pregnancy.

Marc Hearron, senior counsel for the Center for Reproductive Rights, which is representing the abortion providers, said Thursday that their challenge in federal court “no longer stands a chance” of stopping these lawsuits from being filed.

“The Supreme Court greenlit this law’s unprecedented vigilante scheme and essentially said that federal courts are powerless to stop it,” he said. “There is no end in sight to this nightmare.”

Abortion providers have had more luck in Texas courts, where state District Judge David Peeples ruled in December that the law is unconstitutional. His judgment did not block lawsuits from being filed under the law, and is currently being appealed.

[…]

Immediately after Texas’ latest abortion restrictions went into effect Sept. 1, one San Antonio doctor, Alan Braid, announced in a Washington Post op-ed that he had provided an abortion after cardiac activity was detected.

“I fully understood that there could be legal consequences,” Braid wrote, “but I wanted to make sure that Texas didn’t get away with its bid to prevent this blatantly unconstitutional law from being tested.”

Three people sued Braid, including two disbarred attorneys who indicated they were more interested in seeing the law tested and getting the money than actually taking a stand against abortion.

Hearron, who is also representing Braid, said Thursday that they have filed a countersuit in federal court against the three claimants, seeking to have the law declared unconstitutional and the suits thrown out.

Beyond those initial three claims, no lawsuits have been brought against anyone for aiding or abetting in a prohibited abortion. But just last week, a group of anti-abortion lawyers asked a judge to allow them to depose the leaders of two abortion funding nonprofits to gather information for potential lawsuits.

So things are bad, and there’s no clear path to them being less bad. If you want something to happen at the federal level, we’re going to need to add at least two more Democratic Senators, which might give us enough to make changes to the filibuster, and we need to hold onto the House as well. If not, well, as the story says, there’s no end in sight.

More people are choosing the medical abortion option

Mar 5th, 2022
by Charles Kuffner.
1 comment

It’s not like there are good alternatives right now in Texas.

The demand for abortion-inducing medication spiked in the month after Texas significantly limited abortion access and has remained high since, according to new data from a researcher at the University of Texas at Austin.

The study reviewed requests for abortion-inducing medication made to Aid Access, an international nonprofit that provides the medication via the internet to people who cannot otherwise legally access the procedure. Prior to September 2021, the organization typically received an average of 10.8 requests a day from Texans.

Then, the Texas Legislature passed Senate Bill 8, which prohibits abortions after about six weeks of pregnancy, a point at which many people do not know they are pregnant. In the first week after the law went into effect on Sept. 1, Aid Access received an average of 137.7 daily requests from Texas, an increase of over 1000%.

“That big of a spike in requests shows us the uncertainty and chaos created by Senate Bill 8 going into effect,” said Abigail Aiken, the lead researcher on the study. “If it’s not certain that you can go to a clinic and get the care that you need, people will be looking around for what other options they have.”

The demand for the medication has remained higher than normal in the months since, Aiken found.

Medical abortion is typically a two-drug regimen of mifepristone and misoprostol that has been shown to be effective at terminating a pregnancy through the first 10 weeks of pregnancy. In December, the federal government lifted a requirement that the medication be dispensed in person, allowing it to be prescribed by telemedicine and sent through the mail.

But Texas law does not allow the medication to be prescribed through telemedicine or mailed and has limited its use to the first seven weeks of pregnancy.

[…]

Aiken, the researcher behind the study, said it’s impossible to know how and when patients use the medication they access through Aid Access — or how many patients are terminating pregnancies through other means.

But as the U.S. Supreme Court considers whether to overturn the constitutional protection for abortion, Aiken said this Texas data serves as a snapshot of what whole swaths of the country may be facing.

“It’s clear from this research and many studies that just because you make abortion harder to get, it doesn’t mean the need for abortion goes away,” she said. “And many people, they will look for other ways of doing that.”

See here and here for some background. The forced-birth contingent is of course not happy with this and murmuring about ways to pursue “legal action” against international and out of state groups like Aid Access. Not sure how they could do that without being extremely invasive, but I have no doubt that such a thought does not bother them at all. On the assumption that SCOTUS is going to gut Roe v Wade in some significant way, the main question is whether people will mostly still be able to get abortion pills freely, or whether they will have to rely on more evasive options. Both seem very much in play. The Chron has more.

FDA lifts restrictions on medical abortion

Dec 19th, 2021
by Charles Kuffner.
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Long overdue

The Biden administration on Thursday ended a long-standing restriction on a medication used to terminate early stage pregnancies, even as politicians across the United States intensified efforts that represent the most serious challenge to abortion rights in decades.

The elimination of the rule by the Food and Drug Administration means abortion pills can be prescribed through telehealth consultations with providers and mailed to patients in states where permitted by law. Previously, the pills could not be mailed, though that regulation had been temporarily suspended by the FDA.

In large swaths of the nation, however, strict state rules will dampen the impact. Several states ban sending abortion pills by mail and impose other restrictions.

The medication, mifepristone, was approved by the FDA in 2000 for what’s known as medication abortion. It is used with a second drug, misoprostol. The FDA required patients to pick up mifepristone in person at a hospital, clinic or medical office. There is no FDA requirement that the medication, also known as RU-486, be taken in a clinical setting, and most patients take it at home.

In April, the FDA waived the in-person dispensing requirement during the pandemic, saying research showed the action did not raise “serious safety concerns.” It then launched a scientific review to see whether restrictions on mifepristone should be lifted permanently, with Thursday as the deadline.

The agency, writing to a medical group that had sued the FDA over the rule, said it was dropping the in-person dispensing requirement “to minimize the burden on the health care delivery system” and “to ensure that the benefits of the drug outweigh the risks.” The FDA did not give an effective date for the change.

[…]

Loosening the federal restrictions will not change abortion access in many states with stricter regulations on the pills. Nineteen states have banned receiving the drugs through telehealth appointments, making the relaxed FDA rules irrelevant in places including Alabama, Arizona and Missouri. Some states impose other limitations on medication abortion, including allowing only physicians to prescribe the drug and mandating that patients take the pills under a doctor’s supervision rather than at home.

As federal officials have moved to ease restrictions on the drug, many states have tightened access. At least 16 states have proposed new restrictions on medication abortions this year, said Elizabeth Nash, state policy analyst for the Guttmacher Institute.

“State legislatures have been watching very carefully what happens at the federal level,” Nash said.

The highest-profile limitations were enacted in Texas, where lawmakers made it a felony to provide abortion pills after seven weeks of pregnancy and outlawed sending the drugs through the mail. Texas also banned nearly all abortion within the state by making any form of abortion illegal after about six weeks of pregnancy, though that law is being challenged in the courts.

The differing rules have the potential to widen disparities in abortion access, Nash said.

“Access looks very different depending on where you live,” Nash said. “Abortion access will continue to be very limited in states in the South, in the Plains and in the Midwest, and more accessible in states along the West Coast and the Northeast. … That’s problematic in and of itself, and could become an even bigger divide.”

Yeah, it sure is an issue here in Texas. The main question I have is how effectively will Texas be able to enforce its restrictions. It seems to me that there will be a lot of effort put into avoidance, and as such the only way to really make that law work as intended is to be pretty darned invasive. I don’t know how that will work.

Restrictive state laws are spurring an increase in some areas of what’s known as “self-managed abortions” in which patients buy illegal medication on the Internet and terminate pregnancies without interacting with the health-care system.

While some see this as a dangerous trend, others say the situation is sharply improved from decades earlier — because of the abortion pills.

Abigail Aiken, assistant professor of public affairs at the University of Texas at Austin, said she is often asked whether the country is headed to “back-alley abortions and infections” if Roe v. Wade is struck down.

“One of the things we have that we didn’t have in the ’60s and ’70s is access to abortion pills that are very safe, very effective if you have the right instructions,” Aiken said. “Self management is a safety net. And it’s also an ability to take your health care into your own hands when the state legislature is trying to block access.”

That sounds logical to me. And it should be known, this way around the law has been in use for some time. Again, the question to me is how vigorously Texas will try to crack down on that, and how heavy-handed such enforcement will be. I feel very confident saying that the zealots who pushed the bounty hunter law will not be satisfied by anything other than an all-out crackdown, whatever the consequences. If you think I’m being alarmist, look at where we are now and tell me honestly it’s not far worse than you thought it would be. The 19th and Mother Jones have more.

Expanding telemedicine

Apr 2nd, 2021
by Charles Kuffner.
Comments are off for this post

Seems like a good idea.

Last year, rules temporarily changed in Texas allowing for additional types of doctor appointments to happen virtually.

As the state returns to more normalcy, there are questions about whether that broader use of telemedicine will continue.

Patterson said he hopes so but was recently surprised to find out he couldn’t schedule a virtual appointment with Advanced Pain Care.

“When Gov. Greg Abbott lifted his emergency order in early March, it was widely thought that the Medical Board also rescinded their rule on telemedicine, but it turns out there was a separate rule allowing us to continue with telemedicine,” said Dr. Mark Malone, president of Advanced Pain Care.

Malone explained they stopped telemedicine for about two weeks, because there was some confusion but offered curbside appointments as another option to patients concerned about COVID-19.

[…]

According to a spokesperson with the Texas Medical Board (TMB), the board’s emergency rule expanding the use of telemedicine is still in effect.

The board’s emergency rule regarding prescriptions was renewed earlier this month and will continue until May 1.

“The emergency rule continues to allow for telephone refill of certain prescriptions to established chronic pain patients as long as the patient has been seen by the prescribing physician, or health professional… in the last 90 days either in-person or via telemedicine using audio and video two-way communication,” said the rule on TMB’s website.

Abbott said during his State of the State address last month that he wants to permanently expand access to telemedicine services.

A number of bills have been introduced this legislative session regarding telemedicine. Several have already been heard in committee hearings.

Those bills would include a pilot project to provide emergency telemedicine medical services in rural areas and reimbursement and payment of claims for telemedicine medical services and telehealth services under certain health benefit plans.

A recent study showed that as many physician offices closed last February to April, the use of telehealth quickly escalated.

This makes sense, in the same way that lifting the rules about drinks to go made sense. And as is often the case, Texas had been a laggard compared to other states. Telemedicine was only legalized by the Legislature in 2017, following a federal anti-trust lawsuit that forced the issue. I wouldn’t want telemedicine to become the default, but that’s not what’s on the table here. Having it be part of the mix is valuable, and allowing it to grow and change as the needs of the patients demand it is what should happen. If one of those bills can be passed it would be a good thing.

Sid Miller and the unqualified creep

Apr 14th, 2018
by Charles Kuffner.
4 comments

I missed this when it came out last Friday, and now that I’ve seen it I wish I was still blissfully ignorant of it.

Sid Miller

Sid Miller

Texas Agriculture Commissioner Sid Miller in late 2016 appointed to the state’s Rural Health Task Force a former physician and Miller campaign donor who had his medical license revoked or suspended in three states.

In Iowa, Rick Ray Redalen’s medical license was first suspended when he was convicted of perjury in a case involving his marriage to his 15-year-old former stepdaughter. The license was later revoked for good for failure to report a malpractice suit, medical board records show.

Redalen, who calls himself “the Maverick Doctor,” said he was introduced to Miller several years ago by Todd M. Smith, a lobbyist who has reported making hundreds of thousands of dollars from Redalen’s company and is Miller’s longtime political strategist.

Redalen, who donated heavily to Miller’s campaign months before his appointment, said he has used the unpaid task force position to advocate for expanded access to telemedicine — a service offered by one of his companies. Redalen said he never expected any favors in exchange for his contributions to Miller.

Miller “is one of the first actual political people that I have met that talks constantly about improving health care in rural Texas and among rural Texans. Most people aren’t interested in that,” Redalen, 75, said.

[…]

Redalen has not practiced medicine for years but hit it big in the medical business nonetheless. In 1996, he founded a company called QuestRx, which now goes by ExitCare and was sold to Elsevier in 2012. The company provides a widely used tool that provides information to patients as they are discharged from medical facilities.

As a doctor, Redalen worked in emergency rooms and as a primary care doctor and has had his license suspended or revoked in Minnesota, Iowa and Louisiana.

The disciplinary action against Redalen by Minnesota’s medical board was due to “psychiatric and drug problems,” according to a 1995 Des Moines Register article.

Redalen’s legal troubles in Iowa stemmed from his relationship with his stepdaughter, whom he married in Tarrant County while on a trip to Texas in September 1988. He had been married to her mother, who committed suicide in 1987. In 1986, Redalen pleaded guilty to assault after authorities said he struck his wife with a rifle butt and pointed a gun at sheriff’s deputies, according to the Register article.

Emphasis mine. There’s more, mostly about Redalen’s financial contributions to Miller, so go read it. I highlighted the bits I did because I want to focus on the fact that in 1988, when he was 45 years old, this man married his 15-year-old former stepdaughter, whose mother had committed suicide the year before, when she was 14. One can debate, as some experts do in the Statesman story, whether these financial arrangements constitute a violation of campaign finance regulations, and one can discuss, as Erica Greider does, Miller’s long history of not caring about his mostly rural consituents, if one wants. I can’t get past the fact that Rick Ray Redalen was a 45-year-old man who married a 15-year-old girl, a 15-year-old girl who used to be his STEPDAUGHTER. I’m unable to think of a good reason why a decent person would want to form a relationship with such a man, whether political or financial or otherwise. Sid Miller is quite infamous for questioning on social media the morals of people who are not like him. Frankly, anyone whose morals are different than Sid Miller’s should be happy about that.

Telemedicine set to expand in Texas

Jun 19th, 2017
by Charles Kuffner.
Comments are off for this post

Coming to a video screen near you, thanks to a bill signed in May by Greg Abbott.

“This is a huge step forward, a real positive for Texas,” said Dr. Nancy Dickey, executive director of the Rural and Community Health Institute at Texas A&M University. She recently co-authored a report about the health crisis facing rural Texans amid hospital closings and other barriers to access.

Texas was one of the last holdouts in the rapidly evolving world of virtual medicine by requiring an in-person visit between doctor and patient in most cases before allowing diagnosis.

That requirement was at the heart of a bitter, six-year legal battle between the Texas Medical Board, which cited concerns of insufficient patient care, and Teladoc, a national leader in telemedicine.

Teladoc, headquartered in Lewisville, has more than 20 million customers nationwide, including 3 million in Texas. Previously in Texas the company used phones and high-resolution photos for diagnoses, as did other telemedicine companies in the state.

Teladoc has spent about $13 million in legal fees alone in the fight. The new state law presumably renders the fight moot.

The Texas Medical Board, made up of 19 regulators, declined to comment directly on the new law.

“The litigation, although abated, is still pending,” a spokesman said in an emailed statement.

“The need in Texas carried the day,” said Jason Gorevic, CEO of Teladoc. “This paves the way to expand.”

Or at least catch up with the rest of the country.

Texas currently dwells near the bottom of the nation in per-capita access to a physician, ranking usually between 46th and 48th, Dickey said.

In fact, 158 of Texas’ 254 counties do not have a single surgeon. In 185 counties, representing more than 3 million people, there is not a single psychiatrist. Eighty counties have five or less physicians.

While the traditional picture of telemedicine is one of linking a doctor to a patient in some isolated dot on the map, Dickey said it is equally useful for those in small towns who might be 30- to 45-minute drive from a specialist in a larger city.

Those patients, often older and poorer, may not have the time or energy to make a drive on rural roads, said Dickey.

“It is a way to take very specialized medical skills out to towns of 10,000 to 20,000 people,” she said.

See here and here for more on the lawsuit, and here for more on the bill that was signed that basically removed the barriers to telemedicine in Texas. I had been wondering about the status of the litigation since the compromise bill was announced. A little Googling yielded some more specific information than what is in this story.

Teladoc, which is based in Dallas, began operating in the state in 2005. But around 2010 the Texas Medical Board began restricting the practice of telemedicine, especially telemedicine by video, through a prescribing rule revision that required physicians to establish their patient relationship with an in-person visit.

This is where there are two different versions of the story. Teladoc and MDLive, which have operated continuously in Texas with their phone-only services, maintain that medical board rules have always permitted phone calls, even when they restricted the use of video telemedicine. The Medical Board, conversely, has maintained that this is essentially a loophole created by a drafting error and that the intent of the rule is clear: to forbid all telemedicine without an establishing in-person visit.

When Teladoc continued to use telemedicine by phone, the Texas Medical Board sent them a public letter telling asking them to stop, then issued an emergency rule clearing up any ambiguity between phone and video visits. Teladoc sued over the rule, saying that the interpretation of the law in the letter constituted a rule in and of itelf and that the making of that rule didn’t follow the proper procedures for rulemaking.

To make a long story short, that lawsuit beget a much bigger lawsuit in April 2015, one which might have gone all the way up to the Supreme Court. Teladoc sued the medical board under antitrust laws, saying that as a group of practicing physicians with a financial interest in the restriction of telemedicine, the medical board couldn’t pass rules designed to muscle out its competition.

“Unfortunately we had to go to bat for our clients’ right to avail themselves of our services,” Gorevic said. “But it was worth the effort, and we see that as our responsibility as a leader in the space. We never ceased operating in the state and in fact we were reluctant to go to court, but ultimately the reason we went to court was to protect our right to continue to operate and the right of our clients to operate our services. … We stepped up and took a stand and we didn’t see any of our competitors doing the same thing.”

That lawsuit dragged on for two years with a number of twists and turns and cost Teladoc $7 million in a single quarter, according to a public earnings call. Indications were looking positive for the company (the FTC, the federal government’s primary antitrust actor, even filed a friend-of-the-court brief on Teladoc’s behalf), but ultimately the two sides realized they would rather reach a compromise than take the case any further up the ladder. Last fall they requested a stay in the case and a settlement seemed likely to follow.

Gorevic confirmed to MobiHealthNews that if Abbott signs the bill, it will essentially end the long legal battle.

“We expect that the legislation, if signed by the governor, will end the lawsuit,” he said. “It will obviate the need for the lawsuit.”

That story was published May 26, and an update to it at the top confirms the bill’s signing. I didn’t find anything more recent than this in Google News, so I presume the details of the settlement are still being worked out. As I said before, telemedicine isn’t a panacea – it will be of limited use to people who still don’t have insurance, for example – but it’s a good option to have. We’ll see how much it takes root in the state.

A telemedicine breakthrough

Feb 14th, 2017
by Charles Kuffner.
1 comment

This is good to see.

Sen. Charles Schwertner

A years-long fight over the use of telemedicine in Texas appears to have been resolved, with medical and industry groups agreeing to compromise legislation that, if it passes, could benefit patients, especially those in rural areas.

Senate Health and Human Services Committee Chairman Charles Schwertner, a Georgetown Republican and orthopedic surgeon, confirmed the deal on Wednesday and said he will sponsor the legislation to resolve the longstanding feud over rules to allow doctors to see patients electronically.

“I think we will have a bill very soon,” he said, noting there could be “considerable benefits” to patients if the legislation is approved by lawmakers — as well as possible benefits to taxpayers if the electronic doctor visits can help curb spiraling costs for some state-funded healthcare programs.

Ironically, despite the heated controversy over telemedicine for most Texans, the concept of electronic visits was adopted successfully two decades ago in the Texas prison system in a program that is now credited for saving hundreds of millions of dollars.

While the announced agreement clears the way for Schwertner’s bill to move forward in the Legislature to passage, opposition could still materialize that could delay — or perhaps derail — it. Last session, well over a dozen bills were filed to allow telemedicine in Texas, but none became law, officials said.

[…]

While providing few details on the settlement, Schwertner said Wednesday he believes the issues of disagreement have been addressed. Others familiar with the talks agreed.

They said doctors wanted to ensure proper patient care was maintained and that they would receive payment for services provided remotely. Health insurance providers who had supported use of new technologies to improve care and cut costs wanted to ensure proper payments would be permitted. And companies that offer telemedicine services wanted to ensure they could operate without onerous restrictions.

“This is significant, and will be a winner for everyone,” said Nora Belcher, executive director of the Texas e-Healthcare Alliance, a telemedicine trade group. “This is going to get us a fair and open market for telemedicine in Texas.”

Telemedicine isn’t a panacea, but it’s a worthwhile tool to have in the bag, and it should be regulated in a reasonable fashion that allows access while still prioritizing level of care and patient safety. I appreciate the work that Sen. Schwertner has done here to bring the stakeholders together and work something out. I was curious about one thing, because as we know there is an ongoing lawsuit by a telemedicine company called Teladoc against the state of Texas over its current regulations. The story did not mention this litigation, so I sent a query to Sen. Schwertner’s office to ask if one intent of his bill was to resolve that lawsuit. The response I received was “It is our hope that by passing an agreed-to bill between the various stakeholders, this legislation will eliminate much of the legal ambiguity currently surrounding telemedicine and create a clear, fair, and consistent regulatory environment that will allow for the provision of telemedical services while ensuring the safety of Texas patients.” My interpretation of this is that they hope the bill will allow for that dispute to be resolved, but they can’t make it happen on their own. Anyway, this will be worth watching both during the session and (if the bill passes) afterwards.

More on the Texas telemedicine lawsuit

Nov 1st, 2016
by Charles Kuffner.
Comments are off for this post

Texas Monthly has a nice overview.

Imagine you’re sick, or you think you might be sick, and you want to talk to a doctor. Instead of waiting a week or two to see your primary care physician, you just open an app on your phone or computer and within minutes you’re video-chatting with a doctor or nurse. Maybe you even have a medical device, like a blood pressure monitor, that connects your computer and transmits images and data to your doctor in real time while you’re talking.

That’s not science fiction. It’s called telemedicine, an $18 billion worldwide industry and one of the fastest-growing sectors in health care. In many ways, telemedicine represents the future of health care, promising to do for medicine what Uber and Lyft have done for transportation. Across the country, the use of telemedicine is expanding as consumers realize how much more convenient it is to talk to a doctor when and where they choose. It’s also a lot cheaper. The average telemedicine visit costs between $40 and $50, compared to the average in-person doctor’s visit, which is about $100 more—not counting the cost of the time and effort it takes to travel to and from a brick-and-mortar doctor’s office.

But here in Texas, where we have an infamous shortage of doctors and nurses, telemedicine has hit a snag. New rules promulgated by the Texas Medical Board last year prompted Dallas-based Teladoc, the largest telemedicine firm in the country, to file a federal antitrust lawsuit against the board. Specifically, the medical board’s new rules (PDF), approved in April 2015 but blocked by a federal judge’s preliminary injunction just days before they were set to take effect, stipulate how physicians in Texas can establish a “doctor-patient relationship” with new patients before engaging in telemedicine. A patient must either visit the doctor in person or meet “face-to-face” over video conference. But the video conference must be at an approved medical site like a hospital, clinic, or a fire station, and there must be a “patient site presenter” on hand, like a nurse or a physician’s assistant. In other words, you can’t just turn on your computer at home, login to a telemedicine app and be connected with a doctor. Put another way, in Texas you have to go to a medical clinic to be seen by a doctor, even if the doctor isn’t there.

This presents a substantial obstacle for Texans who are interested in using telemedicine. Many people, especially younger folks, simply won’t go to a doctor’s office, either because they don’t have what doctors and policymakers call “a medical home,” or because they don’t have health insurance.

So in Texas, which has the highest uninsured rate in the nation, on-demand telemedicine could be a game-changer. It holds the promise that, instead of forgoing medical care, more people might actually seek out a doctor when they’re sick.

All of this is why the antitrust lawsuit Teledoc filed has sparked so much debate—and confusion. Teladoc, which says Texas was already among the most restrictive states in the country for telemedicine, claims the new rules will hamstring telemedicine firms and limit patients’ access to healthcare. The medical board claims just the opposite. It views its new regulations as an expansion of telemedicine, not a restriction of it. Meanwhile, as the case wends its way through federal courts, a consortium of health care and tech groups is calling on the Texas Legislature to step in and settle the matter when lawmakers convene in Austin early next year.

[…]

The Legislature seems at least somewhat aware that it needs to step in. Last session, both the Senate and House issued interim charges to study telemedicine and give recommendations about how to improve it. To date, most of these hearings have steered clear of the lawsuit and spent considerable time hearing testimony about how great telemedicine is in Texas. To be fair, Texas was one of the first states to invest in telemedicine technology in the 1990s, and since then has tried to encourage its use in rural areas where medical specialists are scarce. One pilot program, supported by state funds and run by the Texas Tech University Health Sciences Center in Lubbock, will equip ambulances in rural West Texas with technology that allows first responders to communicate with physicians at regional trauma centers on a secure internet connection and transmit patient data in real-time while en route to a trauma center or an emergency room.

Those are real advances, and will likely save some lives in rural communities. But the big gains from telemedicine will come from hundreds of thousands of consumers using the services for routine care—and doing so on their own initiative from their homes and offices. To make that possible in Texas, lawmakers might need to act. During the 2015 session, Representative Jodie Laubenberg filed several telemedicine bills, including one that would have prevented the medical board from issuing the rule requiring a face-to-face consultation if the physician had never seen the patient. The bill was introduced and referred to the House Public Health Committee, but after the board published its new rules in April and Teladoc sued, Laubenberg, pulled it. “If something’s going to court, we stand back,” she said—a line that’s since been repeated in interim hearings on telemedicine.

But Laubenberg, along with Teladoc and many other Texas-based healthcare firms, thinks the legislature should step in once the court case is settled. They think this is about something much larger than a single antitrust suit. “Over the last five to ten years, telemedicine changed from a promise to a reality,” says Gorevic. “Now we’re starting to see the benefits. Today it’s becoming part of the fabric of the healthcare delivery system.” Just how much a part of the fabric it becomes in Texas depends not only on the Fifth Circuit Court, but how well lawmakers can work with regulators once the dust settles. Right now, the tide seems to be turning in telemedicine’s favor. In September, Robinson, the medical board’s executive director since 2001, announced she’s leaving the board to direct the telemedicine program at University of Texas Medical Branch in Galveston.

For lawmakers like Laubenberg, the issue is about something yet greater than healthcare: the degree to which regulatory boards should make up rules for their industries. “I’ve never been a big fan of agency rulemaking. They tend to go rogue,” she said. “I think the medical board thought they could get ahead of it, but the issue’s too big, and they couldn’t do it.”

See here for the background, and be sure to read the whole thing. It seems likely that Teladoc will prevail in court, though one never knows for sure, and it won’t surprise me if the Lege decides to step in and attempt to settle the matter themselves. There is of course an irony in Jodie Laubenberg being so involved with this, since the omnibus anti-abortion HB2 from 2013 prohibits dispensing abortion-inducing drugs (mifepristone-misoprostol regimen) by anyone other than a physician and requires that the physician dispensing the drug first examine the pregnant woman, which is interpreted to mean “in person”, thus making HB2 itself a telemedicine ban. That provision wasn’t part of the lawsuit that led to much (but not all!) of HB2 being struck down, though it may well come later. Point being, Laubenberg considers regulating doctors to be her job, not the Medical Board’s. We’ll see who gets to make the next move, the Fifth Circuit or the Lege. Texas Association of Business President Bill Hammond, opining in the Chron, has more.

Texas v. the Feds: Telemedicine edition

Sep 19th, 2016
by Charles Kuffner.
1 comment

Here’s a new one.

Teladoc, the Dallas-based company that sued Texas over its telemedicine regulations, has a new ally in the Federal Trade Commission.

In a letter sent to the U.S. 5th Circuit Court late Friday, the federal antitrust agency sided with Teladoc in the company’s legal battle, criticizing the Texas Medical Board for allegedly misinterpreting case law.

The telehealth company sued last year to block board rules that in most cases require face-to-face contact between a patient and a physician before a physician can issue a prescription.

That threatened Teladoc’s business model, which virtually connects Texas patients to remote, Texas-licensed doctors, some of whom are based out-of-state. The company says its physicians consult patients over the phone for routine medical issues, and patients can upload photos or other information describing their symptoms and medical history.

Teladoc filed an antitrust lawsuit against the regulatory Texas Medical Board in federal court last year, alleging that the 19-member board made up mostly of doctors had behaved like a cartel by passing rules intended to limit competition.

The state has asked the appeals court to throw out Teladoc’s lawsuit, and federal regulators on Friday urged the court not to.

The Texas Medical Board failed to show that “any disinterested state official ever substantively reviewed” the telemedicine rules “to determine whether the rules promote a clearly articulated state policy to displace competition rather than the private interests of active market participants,” federal regulators wrote.

I hadn’t noticed this before now, and I don’t know much about this, though on the surface it sounds like Teladoc has a good argument. I was hoping to find an analysis of this via Google, but the best I could do was this by the hacks at the TPPF that was just boilerplate business/free market rah-rah. Here’s an interview with Teladoc’s CEO from January about the lawsuit, if you’re interested. The suit was filed by Teladoc, the AG’s office is defending the Texas Medical Board, and the feds have only just gotten involved, so this isn’t a typical Texas-versus-feds situation. It is a reminder that not all such cases fall into the usual narrative.

There’s an app for birth control

Oct 25th, 2014
by Charles Kuffner.
Comments are off for this post

I’m sure this won’t controversial at all.

“Isn’t there an app for that?”

Turns out there is, if what you’re after is birth control or a test for a sexually transmitted infection.

In the latest example of fast-growing “telemedicine,” video conferencing that virtually extends medical expertise, Planned Parenthood is rolling out a pilot project for real-time “office visits” that bring patient and medical provider face to face on a smartphone, tablet or personal computer.

Fueling the Planned Parenthood Care project, under way in Washington and Minnesota, is a “horrible statistic,” says Chris Charbonneau, president and CEO of Planned Parenthood of the Great Northwest: “People are sexually active for six to nine months before they get a really reliable birth-control method.”

One result: an estimated 52,500 unintended pregnancies in Washington in 2010, according to the state Department of Health.

Combine that with the prevalence of chlamydia, the most commonly reported sexually transmitted infection (STI) in the U.S., and gonorrhea — both primarily affecting people ages 15 to 24 — and Planned Parenthood hatched a plan to meet young people where they live: on their phones and mobile devices.

For now, the virtual visits create a streamlined process for getting mail-order birth control — and soon, test kits for two common sexually transmitted infections.

Along with convenience, the virtual visits provide a technological answer to this question, Charbonneau says: “How do we see people who either can’t or have difficulty walking into bricks-and-mortar sites, to at least get them started on birth control” or begin investigating a potential sexually transmitted infection?

The national Planned Parenthood organization chose Washington as one of the first states for the project because of its long history of support for women’s reproductive rights and its strong local chapter, according to the local organization.

Planned Parenthood hopes the project will expand next to Alaska and eventually go nationwide. Obstacles include state laws — and possibly some controversy in the wake of a telemedicine controversy in Iowa.

[…]

Some [anti-abortion] activists also worry that webcam visits, though solely for birth control, may ultimately lead to more abortions.

“We know how these things start,” says Dan Kennedy, CEO of Human Life of Washington. “Who is honestly going to believe that’s as far as it goes?”

I’m sure you can imagine how the “argument” will go from there. I’m posting this partly because it’s a great idea, and partly so we’re all familiar with the background when someone in the Lege inevitably files a bill to ban this. In the name of women’s health, of course. Tech Times has more.

Dan Patrick wants to play doctor

Nov 21st, 2012
by Charles Kuffner.
Comments are off for this post

Clearly, the man missed his calling.

Before Texas’ abortion sonogram law passed last legislative session, some women seeking to end pregnancies in rural communities relied on telemedicine, with physicians — working in partnership with medical technicians or nurses — administering prescription drugs via videoconference to induce early-stage abortions.

If new legislation filed by Sen. Dan Patrick, R-Houston, passes in 2013, women in remote corners of the state may have even fewer options to get the procedure.

2011’s abortion sonogram law — another measure Patrick championed — requires that a physician, as opposed to a technician or nurse, perform a sonogram on a woman seeking an abortion at least 24 hours ahead of the procedure. That in effect prohibits the use of telemedicine for drug-induced abortions, which opponents of the procedure call a welcome consequence for a little-discussed practice.

SB 97, Patrick’s latest measure, would further increase the in-person requirements for physicians. In addition to the in-person sonogram 24 hours ahead of the abortion, doctors would have to personally administer both of the two medications used for drug-induced abortions, and see the patient again for a follow-up appointment within 14 days, a particular challenge for the roving doctors who treat women in the state’s rural counties.

Amy Hagstrom Miller, CEO of the abortion provider Whole Women’s Health, said that before last session’s sonogram law took effect in February, her clinics in Beaumont, McAllen and Fort Worth relied on telemedicine. A technician would perform the sonogram and a physician based in Austin would review the patient’s medical records, then videoconference with the patient to answer any questions.

“Through telemedicine we were able to serve women in communities, mainly more rural communities, where access to abortion was much more difficult,” she said.

Silly woman. Don’t know you know Dan Patrick knows what’s best for you and your patients? Don’t make him have to pass a bill requiring his express written consent for anyone to get an abortion in this state, because he will if you make him mad enough. This would be a good time for those of you whose Senators are Eddie Lucio, Judith Zaffirini, or Carlos Uresti to start calling their offices and telling them not to vote to bring this travesty to the floor, like they did in 2011 with the sonogram bill. With the defeat of Jeff Wentworth, the last pro-choice Republican in the state, we’ll need at least two and possibly all three of them to stand with their fellow Democrats in opposing this, depending on when the election to succeed the late Mario Gallegos is concluded. This would also be a good time for so-called “moderates” like Sarah Davis to do something to earn that designation and actively oppose this ridiculous intrusion into the doctor-patient relationship, instead of waiting till the bill comes to the floor of the House and casting a token vote against it.