Panel needs more time to review telemed abortions

A state panel that oversees and regulates physicians and medical practices in Iowa will need more time to review issues pertaining to the use of telemedicine – including Planned Parenthood's procedure whereby doctors prescribe and dispense abortion-inducing pills to patients in rural Iowa clinics, board officials said Friday.

Kent Nebel, director of legal affairs for the Iowa Board of Medicine, said members of an ad hoc group plan to review various national standards and gather other information and report back to the full board at its next meeting slated for mid-December. Board members are reviewing a 1996 policy statement on telemedicine in light of changing technological capabilities and monitoring a parallel national study that is expected to be completed in 2011.

“It's a very complex issue,” he told board members.

The telemedicine update came during a meeting where a dozen people urged the state regulators to halt abortion-related uses of telemedicine.

“I implore you to stop this grisly practice,” said Dan Holman, an abortion opponent from Keokuk.

Two women told board members about the harmful, traumatic effects they suffered after undergoing medical abortions conducted by doctors in traditional clinical settings – problems that Maggie DeWitte, executive director of Iowans For Life, said will be exacerbated by a “vending machine attitude toward gynecological care” where doctors do not directly examine women seeking to terminate a pregnancy.

N. Tre' Critelli, a Des Moines attorney, raised concerns about the legal implications of medical assessments conducted via online or teleconferencing hookups where the location of the supervising physician is uncertain. He questioned whether current Iowa law allows for the practice as a standard for appropriate medical care.

“I suggest that you punt and let the Legislature decide,” Critelli said. “I suggest you put a stop to this right now – a halt and let lawmakers address it.”

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.

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 – has said the telemedicine program in place for two years 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 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, she 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, June said.

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.

Pro-life groups held a rally later in the day that focused on the telemedicine issue.

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.”