Iowa Board of Medicine considering new rules governing web-cam abortions

By Randall K. O’Bannon, Ph.D.

Editor’s note. In an earlier version of this article, published Friday, August 9, 2013, we mistakenly left the impression that the petition signed by 14 medical professionals and the public petition gathered by Iowa Right to Life and submitted to the Iowa Medical Board with some 20,000 signatures were one and the same. The expanded version below corrects that error and offers additional detail about the impact of those petitions and the new rules being considered by the Iowa board.

Dr. Tom Ross, who works for Planned Parenthood, demonstrates the agency's telemedicine system from an office near downtown Des Moines.   Tony Leys/The Register

Dr. Tom Ross, who works for Planned Parenthood, demonstrates the agency’s telemedicine system from an office near downtown Des Moines.
Tony Leys/The Register

Is a “web-cam abortion” – where an abortionist safely ensconced behind a desk at a big city clinic simply clicks a computer mouse to remotely unlock a drawer with a dose of dangerous abortifacient pills for a woman he’s never personally examined at a location maybe hundreds of miles away – a legitimate application of what has come to be called telemedicine?

It’s a question a medical board in Iowa is going to be examining over the next several months. The outcome could have an impact not only on the women and unborn children of Iowa, but also across America.

Iowa Right to Life, National Right to Life’s state affiliate, began a campaign three years ago to collect signatures exposing and opposing the dangerous practice in Iowa. That petition, along with one presented by 14 medical professionals raising questions about the safety of the chemical abortions in a web-cam setting helped to prod the Iowa Board of Medicine to consider new rules that would effectively halt such abortions in Iowa. As we will see below the Board of Medicine has responded.

Iowa—the birthplace of webcam abortions

The “birth” of the web-cam abortion came in July of 2008, when Planned Parenthood’s behemoth Midwestern affiliate Planned Parenthood of the Heartland (PPH) began offering them at 16 of their smaller clinics scattered around Iowa. Women go to their local Planned Parenthood clinic, talk with a counselor, have some blood work, an ultrasound, maybe an exam by a “trained staffer,” and if allowed to proceed, teleconference with an abortionist back in Des Moines, where PPH is headquartered.

If he is satisfied after a brief consultation, the abortionist remotely releases the abortion pills to the woman. She first takes the mifepristone (RU-486)at the abortion clinic. She takes misoprostol, a prostaglandin, later at home to initiate powerful contractions to expel the tiny corpse. She is given the number of a 24 hour hotline to call if she has problems.

Even under normal, non-web-cam circumstances, the chemical abortion process is generally painful, bloody, and protracted. Women taking these drugs have been hospitalized for hemorrhage, ruptured ectopic pregnancies, and infections, some of which have proven fatal. A number of women end up in surgery when the chemical method fails.

In just its first year offering web-cam abortions, the number of chemical abortions performed at PPH grew to exceed the number of surgical abortions by 2,582 to 2,210. Many of the new web-cam abortions were surely a part of that sad statistic.

In 2010, with Democrats holding both houses of the Iowa legislature and the state under control of pro-abortion Democratic governor Chet Culver, the Iowa Board of Medicine rejected challenges and ruled that PPH’s web-cam abortions could continue.

Since that time, Republicans have taken over the Iowa House and pulled nearly even in the Senate. All 10 members of the medical board have been replaced by pro-life Republican Terry Branstad who took over the governor’s mansion in 2011.

In June the new medical board met and reviewed issues raised by petitions from Iowa Right to Life and from a group of medical professionals expressing concerns about the safety of web-cam abortions.

The petition from Iowa Right to Life, signed by some 20,000 Iowans, called on legislators and members of the Iowa Board of Medicine to “STOP Webcam Abortions in Iowa!” and called the practice a “perversion” of “Telemedicine” technology that puts women in danger. The petition noted that while these abortions might be more profitable for Planned Parenthood, they would be traumatic for women, “who will have to deal with the body of the dead baby at home.”

The petition filed by 14 doctors, nurses, and other health care professionals from across the state pointed out that webcam procedure was inconsistent with protocol approved by the U.S. Food and Drug Administration (FDA) and agreed to by the manufacturer, and explicitly told the Iowa Board of Medicine that “Webcam abortions are not consistent with the standards of practice for medicine.”

While offering no statement on their individual or corporate views on abortion in general in the petition, the medical professionals simply put forward the case as to why basic medical standards require the physician be physically present to do “a preliminary in-person physical examination” before administering a chemical abortion. The petition said that a physical exam is necessary to rule out the possibility of ectopic pregnancy, whose symptoms (e.g., bleeding, severe pain, etc.) are similar to the expected side effects of a such abortions. The petition goes on to note that a physician needs to schedule a follow up “to ensure that the woman’s health recovers after the chemical abortion.”

“Given the risks associated with inducing an abortion with an abortion-inducing drug,” the medical petitioners declare, “it is inappropriate for a physician to provide such a drug remotely by use of a webcam or other telemedicine device.”

Meeting on June 28, 2013, the Iowa Board of Medicine voted 8-2 to begin the process of writing new state rules on the web-cam abortion procedure.

Taking recommendations offered by the medical petition, the board is considering amending the “Standards of Practice and Principles of Medical Ethics” of Iowa’s Administrative Code that would govern such practices. Under the proposals that the board is looking at, the abortionist chemically inducing the abortion would be required conduct a physical exam to determine and document gestational age and the location of child in the uterus, to require that the physician be physically present with the woman when the abortion-inducing drug is provided, and that the physician schedule a follow up appointment with the woman 12-18 days after she uses the abortion drugs in order to confirm the abortion and to evaluate the woman’s medical condition.

The Board also recommends the adoption of a rule specifying that physician dispensing these abortifacient drugs be in compliance with Iowa rules related to parental notification regarding pregnant minors.

The medical board’s rule-making process was allowed to move forward when a joint legislative Administrative Rules Review Committee failed, by a 4-4 tie vote, to pass a motion by Democrats to delay the Board’s proposed rule process 70 days.

The Iowa Board of Medicine will hold a public hearing on the issue on August 28 and then, once again, review the proposal. A final decision and the new rules could be in place as early as October 23.

Whether the proposed rules will survive intact or be modified is unknown at this point. Several other states have passed laws, similar to the proposed Iowa rules, mandating that the abortionist be physically present in the same room as the patient to whom he is giving the abortion pills. This alone would effectively end the web-cam program, as his presence renders the whole arrangement and apparatus moot.

Supporters of web-cam abortions argue that it benefits women in rural areas, enabling them to obtain abortions without having to travel long distances to far away big city clinics. But it seems that the convenience of the abortionist would really be the greater factor, rather than the woman’s, who would obviously be better served by the physician’s presence, conducting an actual physical exam, monitoring her progress, ready to step in if there is some medical emergency.

The web-cam system enables the abortionist to avoid all the travel. He simply scrolls from one abortion patient to another on his computer screen all the while raking in money at a faster rate than he ever could physically going from one rural clinic to another.

Planned Parenthood and defenders of web-cam abortions try to make it seem as if this is an attack on telemedicine itself, which has proven itself a useful tool in modern medicine. Such bogus allegations ignore both the purpose and place of telemedicine and the all too real risks of chemical abortion.

Telemedicine can be traced back to the days of the space program as a way to treat astronauts far from any doctor’s office. Used properly it offers a real benefit to those needing immediate emergency medical care that can’t get to the hospital right away or to location bound people whose chronic conditions can be treated remotely.

In such cases, there is risk involved, and ideally these patients would actually be physically examined and treated by a doctor. But the risk of employing a telemedical doctor is outweighed by more pressing risk of the serious medical crisis at hand (or the risk of mistreatment so small to as to be of no consequence).

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None of this applies in the situation of web-cam abortions. The pregnant woman is in no immediate danger before taking the pills. It is the process itself that will expose her to danger. If a abortionist is hundreds of miles away, there is nothing he can do to treat her if she begins to hemorrhage, has an allergic reaction and goes into convulsions, or contracts some deadly fast multiplying bacteria.

In recent articles on the possible rule change, PPH tells reporters it has had no complaints among the 3,000 plus women who used the web-cam system since the program began in 2008. However this does not tell us much about the number or nature of the problems women faced. (The same affiliate had a patient who nearly bled to death in tests of the abortion pill back in the mid-1990s, but told the press that the trial had ended with “no complications” among the 238 women participating.)

An April 30, 2011, FDA “Mifepristone U.S. Postmarketing Adverse Events Summary” found more than 2,200 “adverse events” associated with use of the abortion drugs, including 14 women in the U.S. who died. Women taking the drug were hospitalized with ruptured ectopic pregnancies, blood loss requiring transfusions, and infections that proved deadly in at least seven cases. This is much more serious than simply taking an aspirin suggested by a nurse over the phone.

Given what we know about the all too real dangers of chemical abortions for both their intended and unintended victims, no one should be doing them, but least of all, some video doctor from hundreds of miles away who has never physically examined his patient and won’t be anywhere near if something goes wrong.

Added NRLC director of state legislation, Mary Spaulding Balch, JD, “It is encouraging that the Board of Medicine has decided to re-visit this important issue of providing abortions via video conferencing. The State of Iowa will be better served if the Board recognizes that web-cam abortions are not good for mothers or their unborn children.”

Telemedicine should be used to save lives, not to end them.

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