Telemed Abortion, Under Fire and Unique to Iowa

Jan 22, 2015

Today marks the 42nd anniversary of Roe v. Wade, the U.S.  Supreme Court ruling which over turned state laws banning abortion. But the issue of abortion is still hotly debated.  

Standing in an exam room I’m waiting to meet with Dr. Jill Meadows, a Planned Parenthood of the Heartland physician based in Iowa City. I’m in Des Moines, but really I could be at any of nine Planned Parenthood clinics in Iowa because I’ll be speaking with Meadows using a two-way video conference.

Iowa is one of a handful of states to expand abortion access in recent years thanks to telemedicine, which connects doctors and patients remotely. But the use of telemedicine for abortion is being challenged.

After speaking with the patient and examining test results conducted by Planned Parenthood employees, Meadows can prescribe Mifepristone. The drug, also known as RU-486, blocks of the action of progesterone thereby inducing miscarriage.

Meadows administers Mifepristone from her Iowa City office by pressing a button that remotely opens a drawer in Des Moines stocked with the medication. In Iowa only physicians can legally terminate pregnancies so telemedicine provides abortion access to patients hours away.

“And I’ll say it’s going to pop out at you,” says Meadows, “it opens up and I instruct her take the pill bottle out of the left side first. And have her go ahead and swallow with the water there whenever she’s ready with me watching, then we’re done.”

After taking the first pill at the clinic, patients take a second pill at home where they complete their abortion. Iowa’s method of telemed abortion is unique in the United States.

In 2013 the current Board of Medicine in Iowa ruled that abortion-inducing drugs could not be used in telemedicine. 16 other states ban telemed abortion.

Planned Parenthood challenged the board's decision in district court, the court sided with the board. Planned Parenthood appealed and the state Supreme Court will take up the case later this year. 

In the meantime telemed abortions in Iowa continue.

Iowa Board of Medicine Executive Director Mark Bowden says the board believes a doctor cannot determine if a patient is a suitable candidate for medical abortion using a video conference.

“Further the board is concerned that non-healthcare providers, with little or no training, were providing information to the doctor to make significant decisions on,” Bowden says.

After examining telemed abortions the American College of Obstetricians and Gynecologists found the procedure safe and effective. The 2010 incarnation of the Board of Medicine reached the same conclusion.

The 2010 board was appointed by Democratic Gov. Chet Culver, and the current board is comprised of appointees selected by Republican Gov. Terry Branstad.

Planned Parenthood’s attorney Mike Falkstrom says political ideology is now guiding the board’s decision on telemed abortion.

“It’s always strange to me, like in our case here, where you have the board very concerned about regulating one of the safest procedures in American medicine in this very tight way, when they have not banned telemedicine in any other context,” Falkstrom says.

In 2013 the board started investigating telemed abortion after community members and medical professionals submitted petitions saying the practice was unsafe.

An open records request by “The Des Moines Register” uncovered an email sent to Brenna Findley, a lawyer in the governor’s office, from Jenny Condon, the executive director of an anti-abortion crisis pregnancy center. 

In the June 2013 communication Condon inquires to Findley if the petition to the board needs more signatures. Jenifer Bowen of Iowa Right to Iowa and Tom Chapman of the Iowa Catholic Conference are copied on the email.

Though Findley says she did not know about the petition before Condon's email, Falkstrom says the email suggests coordination between the Branstad administration and anti-abortion activists.

“It was very much this, let’s all get together, let’s all make sure we’re all on the same to make the petition look right, and how to make the signatures look right," Falkstrom says.

Board of Medicine Executive Director Bowden declined to talk about the email. The board’s lawyers say since it was addressed to the governor’s office and not the board, there is no proof board members coordinated with anti-abortion groups to end telemed abortion.

Iowa Republican state Sen. David Johnson is also trying to stop telemed abortions in Iowa. Last week he filed a bill stipulating that abortions could only be induced in a clinic or hospital that are equipped with facilities to intervene surgically in cases of an incomplete abortion or severe bleeding.

Democrats control the state Senate, so the measure is unlikely to pass leaving the future of telemed abortions in Iowa in the hands of the state's Supreme Court justices.