Despite growing use of remote consultations during the COVID-19 outbreak, doctors aren’t allowed to prescribe abortion medications
As a primary care physician working through the coronavirus pandemic, Julia Oat-Judge, of Asheville, has embraced telemedicine.
New to the virtual practice when COVID-19 arrived, she estimated she now treats 60% of her patients through video chats, during which she consults, refers and prescribes without people ever entering her office.
Yet Oat-Judge works a second job, on Saturdays, as a physician at the Planned Parenthood Asheville Health Center. At this clinic, she cannot by law virtually prescribe the abortion medication some patients seek.
"Health care has been on this tremendous transformation, since March, in terms of teleheath and meeting people's needs in different ways," Oat-Judge said. "It seems that the whole system has been transformed in this direction, and it feels like an unfair situation to not be able to offer it uniformly."
North Carolina is one of 18 states to ban telemedicine abortions, requiring patients meet physicians in-person to receive abortion pill prescriptions. While pro-life advocates defend this ban as best for women’s health, abortion providers decry the law as an unneeded obstacle to access. The health care industry’s shift towards telemedicine during the pandemic has some providers questioning why North Carolina residents can’t skip physical visits to obtain abortions.
Question of trust
In 2008, Planned Parenthood of the Heartland in Iowa became the nation’s first abortion clinic to offer medical abortions through telemedicine. While surgical abortions inherently require hands-on interaction between physicians and patients, medical abortions are performed by ingesting two pills - Mifepristone and Misoprostol. A recent report found 60 percent of women eligible for medical abortions – at or less than 10 weeks pregnant – elected pills over surgery.
In 2013, North Carolina barred physicians from prescribing Mifepristone, the pill patients take first, without an in-person visit. North Carolina and several states grouped in the South and Midwest continue to forbid physicians from prescribing abortions from a distance.
Despite the telemedicine ban, every year sees a greater percentage of North Carolina residents choosing medical abortions over surgeries. A decade ago, less than 20% of all abortions in the state were medical. The most recent state North Carolina Department of Health and Human Services data in 2018 shows nearly half of the 23,000 abortions performed on North Carolina residents were medical abortions.
Tami Fitzgerald, executive director of the N.C. Values Coalition, argued there was a simple rationale for this ban.
"It’s an easy answer: for the safety of the woman seeking the abortion," she said. "These are drugs that actually cause the death of the unborn child in the woman."
Fitzgerald, whose organization advocates for pro-life issues, said the abortion pill demanded a higher degree of supervision from physicians than other medicines. If a pregnant person incorrectly estimated their gestation period, taking abortion pills after 10 weeks could be dangerous.
Providers acknowledged telemedicine abortions do put more responsibility on patients to provide accurate information.
"To actually trust women is something that in the United States we're not very comfortable doing, said Terry Sallas Merritt, an executive team member at A Woman’s Choice Inc., which operates abortion clinics in Greensboro, Raleigh, and Charlotte. "So, we have to be willing to say that we trust someone to be able to tell us how far along in the pregnancy they think they are."
Sallas Merritt pointed out that under telemedicine, physicians could still order tests to supplement and verify patients’ information. While doctors don’t physically meet patients, they can direct people to have ultrasounds or blood work taken at health clinics closer to their homes., which would save many from coordinating trips to faraway clinics.
North Carolina’s 14 abortion clinics are clustered in larger cities, leaving hundreds of miles between many providers.
Flexibility or patient safety?
The Asheville Planned Parenthood is the state’s only abortion clinic west of Charlotte. Western North Carolina’s geography – with expansive counties jutting close to South Carolina, Georgia, Tennessee, and Virginia – means in-state and out-of-state residents venture long distances to see doctors.
Oat-Judge admitted she didn’t regularly consider the state’s telemedicine abortion ban until COVID-19 pushed many of her other physician duties into virtual spaces. In March, the federal government expanded telemedicine services for Medicare and eased HIPAA, federal standards to shield personal patient information, and allowed doctors to consult with patients via video apps like FaceTime and Skype.
"Now I can see how easy it is," Oat-Judge said. "We have the technology. It's treating flexibility in accessing care from a time standpoint that is really helpful for people who are working."
She asserted medical abortions can be performed functionally the same through telemedicine as through a physical visit. And as with other health care services, Oat-Judge said telemedicine possesses additional benefits for abortion patients during COVID-19.
"We could cater to more people who are concerned about the pandemic and leaving their home," she said.
Sallas Merritt contended women facing greater child care responsibilities and tighter finances during the pandemic would also benefit from abortion services that didn’t require them to travel away from home.
Fitzgerald downplayed any barriers to access during the pandemic.
"Abortion clinics were open, and still are open, and there's no reason a woman cannot visit one of those clinics and obtain drugs under the supervision of a physician person," she said.
Neither the offices of Gov. Roy Cooper nor N.C. House Speaker Tim Moore responded to requests for their views on the telemedicine abortion ban during the pandemic.
Sallas Merritt and Oat-Judge have not seen noticeable drops in patient levels at their respective clinics since mid-March. For these providers, the issue isn’t absolute abortion access, but rather what they view as a lack of logic behind the state’s telemedicine ban.
"What the pandemic has done is to illuminate the many innovative uses of quality patient care through telemedicine, in areas that we wouldn't normally suspect that you would be able to provide medical care," Sallas Merrit said. "So, when we see that this is happening everywhere it calls attention more to the idea of why can't it happen in abortion medication care."
Reporter Brian Gordon can be reached at email@example.com.