By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research
Editor’s note. This first ran September 5. It explores in detail all the many questions raised by Planned Parenthood of the Heartland’s use of web-cam abortions.
On August 30, 2013, two days after a contentious hearing, the Iowa Board of Medicine voted 8-2 to implement rules that will effectively spell the end of web-cam abortions in the state. The Iowa legislature could still act to overturn or delay the decision and lawyers from Planned Parenthood may go to court to block it. But if not, the new standards could be in place as early as November 6.
The new rules mandate that physicians prescribing the abortion pill conduct a physical examination of the patient, be physically present when the drug is provided, and schedule a follow up to confirm completion of the abortion and evaluate the woman’s medical condition. This is decidedly not how web-cam abortions are currently performed in Iowa.
Planned Parenthood’s sprawling Midwest affiliate, today known as Planned Parenthood of the Heartland (PPH), introduced the web-cam abortion to Iowa in 2008, connecting 16 of its smaller offices to a larger clinic back in Des Moines.
An abortionist there teleconferences with a patient, reviews her case, and asks a couple of questions. If satisfied, he clicks a mouse which remotely unlocks a drawer at the location where the woman is which contains the abortion pills which make up the two-drug abortion technique (RU-486 and a prostaglandin). She takes the first pill there and takes the rest home to administer to herself later.
If things go as planned, she will endure painful cramps and substantial bleeding and abort her child sometime in the next several days.
Notably, in the Planned Parenthood model, the abortionist is never in the same room as the woman, and thus never actually physically examines her. He is not there when she receives the abortion drugs and also nowhere close by if and when she encounters serious problems over the next several days.
Why is it important that the abortionist is in the same room? Women using RU-486 and a prostaglandin to abort their babies have hemorrhaged and required emergency surgery. They have had their fallopian tubes rupture from an undetected ectopic pregnancies, which these pills do not treat. They have contracted rare but deadly infections.
Thousands of women have been injured and over a dozen women have died after taking these abortifacient drugs. And those numbers are as of 2011.
These are the sort of facts the board considered in making its decision.
The spin of Planned Parenthood and those that follow their lead in the media is that politics, not science, controlled the decision of the Iowa Board of Medicine on webcam abortions. The board’s August 28 hearing clearly showed that Planned Parenthood was right—not about the current board but about the decision the previous board made in 2011.
Information on risks and injuries associated with use of the abortion drugs was shared with the Iowa Board of Medicine back in 2011. However that board, serving at the pleasure of pro-abortion Democratic governor Chet Culver, never seriously considered the data and chose to allow the practice to continue.
A new board, appointed by pro-life Republican governor Terry Branstad, sees its responsibilities differently.
Responding to public concerns expressed in an Iowa Right to Life petition signed by 20,000 Iowans and a formal petition presented by 14 Iowa medical professionals challenging the safety of web-cam abortions, the Iowa Board of Medicine met June 28, 2013 to consider new rules to govern the practice (see “Iowa Board of Medicine considering new rules governing web-cam abortions”). The August 28 meeting was to give the public the opportunity to comment on the proposed new rules.
Representatives of Planned Parenthood argued that the web-cam system was safe and effective and called the new rules “unwarranted, unnecessary,” and “restrictive.” But the more the board probed, the more they found evidence of troubling practices with regard to chemical abortions, web-cam and otherwise, at Planned Parenthood of the Heartland.
Tom Ross, a doctor from Planned Parenthood who is the abortionist on the other side of the computer screen in Des Moines during many of the affiliate’s web-cam abortions, told the board that he gets calls “on a fairly regular basis” from the nurse who mans the affiliate’s hotline set up to handle patient enquiries and concerns.
Ross says he discusses the situation with the nurse, determines the course of action to recommend and has the nurse call back or may even call the patient back himself. If he feels the situation warrants, he sends the patient to the nearest emergency room and he will try to follow up with someone in the E.R. about his patient. Ross admits, however, that he may have patients seeking emergency care without informing or involving him.
These admissions are critical, and did not escape the board’s attention. Despite Ross’s reassurances and his stated willingness to diagnose and suggest treatment over the phone, in practice, the upshot is that none of the web-cam abortionists back in Des Moines is really that available to handle incomplete abortions or treat complications. It means serious problems end up being dumped on local emergency rooms, which one doctor, speaking in favor of the new regulations, noted may already be burdened with events such as car crash victims or other emergency cases.
Ross’s statement is also an admission that some patients may be lost to follow up, raising new questions about how certain Planned Parenthood can be that their web-cam abortion patients had complication-free medical outcomes.
Todd Buchacker, an RN who worked with PPH and helped to develop the web-cam protocol, gave his assurances to the Board that “the delivery system used is safe and effective and it complies with accepted standard of care in the United States.”
Buchacker and Robert Shaw, a pediatrician on the PPH board, ignited somewhat of a firestorm, though, by admitting that physical exams may be minimal and may be conducted not by doctors or nurses but by certified medical assistants (CMA).
In Iowa, CMAs may have done as little three semesters of college study, performed just a ten week practicum, and passed an exam.
Shaw was repeatedly questioned by medical board member and physician Bob Bender. Bender “asked Shaw whether he had ever relied on a certified medical assistant to perform an initial patient examination – something another Planned Parenthood representative had suggested sometimes occurred in telemedicine abortion situations,” according to the August 29 Des Moines Register..
“Shaw refused to answer the question, however, arguing that his personal medical experience was irrelevant to questions over the standard of care provided in telemedicine abortions,” The Register’s Tony Leys reported. In other words Shaw evaded the question.
Sean Kenney, a maternal-fetal specialist from Lincoln, Nebraska, another area covered by the giant PPH affiliate, seriously questioned the idea that a CMA could conduct an appropriate physical exam. He said that a pelvic exam, not just a cursory ultrasound by a nurse trained in a weekend course, was necessary to rule out ectopic pregnancy when the pregnancy was less than five weeks.
Buchacker tried to tell the board that, except for the doctor’s conferencing via the video camera, the web-cam abortion and the chemical abortion mediated by an on-site abortionist were virtually the same. Here’s a direct quote:
“In both types of medical encounters, the patient is in the health center staffed by trained medical professionals, the woman talks at great length with a specially trained educator or health care professional and reviews all of her options that she faces being that she is pregnant. She is given factual and medical accurate [sic] and unbiased information regarding all of those options, a medical history is taken, hemoglobin or hematocrit labs are performed to check for contraindications, Rh blood typing is done to permit the detection and prevention of potential future complications. An ultrasound is performed by a qualified medical professional who provides gestational age of the pregnancy and any existence of an ectopic pregnancy. The records are then transmitted to the physician to review the client’s medical history, the ultrasound and lab results and vital signs and any other sorts of physical exam information.”
Buchacker then argued that whether the doctor [abortionist] meets with the woman in person or over the webcam, he reviews her records, goes over the procedure, and answers any question. The only difference is whether he hands her the drugs in person or delivers the drugs via the “telemedicine technology.”
Far from reassuring people, this answer raises a number of serious questions.
Who exactly are these “trained medical professionals” and what is the nature and depth of their training? Note that Buchacker contrasts the “specially trained educator” with a “health care professional”; if they aren’t a “health care professional” then what does this special training involve?
Is it merely a title given to someone who has gone through a Planned Parenthood marketing program or weekend medical seminar? What does Planned Parenthood think “qualifies” the “qualified medical professional” conducting the ultrasound?
Sean Kenney, the maternal fetal specialist cited above, notes that the quality of an ultrasound image depends on the quality of the equipment and the level of training of the ultrasonagrapher. “Garbage in, garbage out,” Dr. Kenny told the board.
Sonographers working for him undergo four years of training, but he grants that there are two-year programs. However it is unclear whether Planned Parenthood even goes that far, much less whether they even any medical “qualifications” at all.
Perhaps most revealing was how it wasn’t just the abortionist who used teleconferencing who failed to do the physical examination. This was typical for the onsite Planned Parenthood abortionist too!
In both cases, the screening, the testing, most of the counseling are done by staffers, medically trained or not, with the abortionist merely swooping in at the end to review the records, give a few instructions, answer questions, and give out the powerful chemical abortifacients. And if there are serious problems, she doesn’t return to the clinic, but is sent to the local E.R., whether she met her abortionist in person or via the webcam.
The board has yet to release a statement indicating the full reasoning behind their decision to impose the new rules. But given concerns and questions raised by board, issues surrounding staff training and roles, physician responsibility to examine, track, and treat patients, the inherent risk of risk of the chemical abortion procedure, and all too real potential of medical crises could and may easily be cited as more than adequate justification for reining in a reckless practice board chair Greg Hoversen said amounted to “experimentation” on Iowa patients.
Worth noting is that early on, Planned Parenthood tried to portray opposition to its web-cam abortion system as opposition to telemedicine, which is widely practiced and widely accepted. But Jonathan Linkous, CEO of the American Telemedical Association, told USA Today (8/11/13) that remote consultations were not threatened by Iowa’s efforts to try and deal with these abortions.
It is one thing to try to conduct a consultation over an x-ray or hold a counseling session over a video conference or even to try to perform some emergency life saving procedure when medical professionals aren’t around. But it quite another thing entirely to use a video teleconferencing system to sell more abortion pills to women in rural areas for whom you don’t want to train or hire or send the staff to adequately treat.
It might be overly optimistic to think that Planned Parenthood won’t challenge and delay the new rules in court. But thanks to the hearings and the new rules at least we now know that when an objective medical board actually took a look at Planned Parenthood’s web-cam practices, they saw what pro-lifers have been pointing out all along. And that is a billion dollar national corporation and a powerful regional affiliate that shows nearly as little regard for the lives of mothers as it does for the lives of their children, one more committed to expanding their abortion empire and making money from “medical” abortion than practicing sound medicine.