Branstad, Culver spar on telemedicine abortion debate

Former Gov. Terry Branstad says he believes using telemedicine to prescribe and dispense abortion-inducing pills is inappropriate and the practice should be discontinued in Iowa.

“I think it's a violation of the law,” Branstad said in an interview Thursday. “I think it's wrong and I think a lot of Iowans feel it's wrong and I don't think it should continue.”

At issue is a practice by Planned Parenthood of the Heartland whereby licensed physicians use a remote-controlled system to conduct medical assessments with patients in rural Iowa clinics via a two-way, closed circuit audio-video hookup in real time and dispense Mifepristone, also known as RU-486, in the early stages of a pregnancy.

However, Gov. Chet Culver, Branstad's opponent in the Nov. 2 election, said such a move would “pull the plug on progress” by curtailing all telemedicine activities that pose great potential for reducing costs and delivering services to rural Iowa.

“What Terry Branstad is proposing is to shut down all telemedicine. You can't just very narrowly pick and choose who is allowed to use telemedicine. This shouldn't be about ideology. This should be about health care and providing services, including family-planning services,” Culver said “He's over-simplifying a very complex issue.”

Branstad, a former governor from 1983 to 1999 who also was president of the Des Moines University osteopathic medical college, said there is a benefit to be derived from telemedicine in reading X-rays or scans from a distance or for certain consultations, but he questioned whether the patient examinations conducted by teleconferencing meet the standard for appropriate medical care.

“They are claiming that this amounts to an examination, but that's not the way that I would interpret an examination. An examination is when you really see the patient,” he said. “But an issue as significant as a pregnancy and abortion and doing that over telemedicine without ever seeing the patient, I don't think it's right.”

National and Iowa abortion-rights opponents have asked the Iowa Board of Medicine to use their administrative powers to immediately cease the practice and they filed complaints in 10 Iowa counties where clinics are providing what they call “webcam abortions,” seeking criminal prosecution after the Iowa Attorney General's Office declined to tackle what was viewed as a local jurisdiction issue.

Jenifer Bowen, executive director of Iowa Right to Life, said her group's members have not heard back from any of the county attorneys they contacted.

Bowen said Iowa law requires that an abortion must be performed by a physician or osteopath licensed to practice medicine and surgery and, if a doctor is not present in person, “then who is considered the abortionist?” She also noted that Iowa law does not have rules for “abortion by webcam.”

“Obviously, we don't want any abortions, but we certainly see a significant danger with no doctor present,” she said.

According to 707.7 of the Iowa code, “any person who terminates a human pregnancy, with the knowledge and voluntary consent of the pregnant person, who is not a person licensed to practice medicine and surgery or osteopathic medicine and surgery under the provisions of chapter 148, commits a class C felony.

Two other sections deal with pregnancies terminated after the end of the second trimester, and the code says the feticide law “shall not apply to the termination of a human pregnancy performed by a physician licensed in this state to practice medicine or surgery or osteopathic medicine or surgery when in the best clinical judgment of the physician the termination is performed to preserve the life or health of the pregnant person or of the fetus and every reasonable medical effort not inconsistent with preserving the life of the pregnant person is made to preserve the life of a viable fetus.”

An ad-hoc committee of the Board of Medicine was established in August to study telemedicine issues. It met last month and is expected to present a report or update to the board members at the Oct. 22 meeting, said executive director Mark Bowden. Much of Iowa's telemedicine policy was implemented in 1996 before many technological advances were developed.

“I think it should be discontinued. Legally, I'm not sure what role the governor has in that. But I certainly don't think that's appropriate,” Branstad said. He also said Planned Parenthood should not be receiving any state funding for health-care services, which topped $7 million in the current budget year.

“I think people will be surprised to learn that that's the way he thinks. This is a preview of coming attractions,” said Jill June of Planned Parenthood of the Heartland, the largest provider of reproductive health care to low-income women in Iowa, serving more than 62,000 clients. “He would shut us down in order to get votes.”

June said the telemedicine program her agency implemented two years ago was thoroughly researched to ensure it was in full compliance with Iowa law and the requirements in the use of Mifepristone in the early stages (the first 62 days) of a pregnancy. The pill is given in a medical clinic by a physician using the telemedicine network in real time after the patient has received services – including an ultrasound -- from medical staff on site at the clinic.

The procedure is similar to other medical services delivered between doctors and patients via secure electronic communications, June added. Nearly 1,900 Iowa patients have used the videoconferencing system to obtain abortion drugs from July 1, 2008, to Sept. 1 of this year, she said.