STOKING FIRE: Expanding Options Through Telemedicine


The scene sounds like something from a science fiction playbook:

“An abortionist in another town pushes a button on a computer screen and out pops the abortion pill. A licensed physician never examines the woman.”

A warning, written by members of Operation Rescue, follows: If anti-abortionists don’t act, Planned Parenthood will bring “push-button abortions” to a town or city near you.

Be afraid, the notice on OR’s website suggests, be very afraid. Oh, but not so afraid that you think all is lost, for OR is fighting Planned Parenthood of the Heartland’s utilization of telemedicine to expand abortion availability in Iowa and has filed a complaint with the state Board of Medicine to get it stopped.

Russell Bardin, Chief Investigator of Iowa’s medical oversight agency, wrote complainant Cheryl Sullenger a letter in April, assuring her “that this matter will be investigated as soon as possible.”  And Sullenger? She is none other than OR’s second in command. Her anti-choice creds include two years in prison—1988 to 1990—for attempting to bomb San Diego’s Alvarado Medical Clinic in 1987. After moving to Wichita post-incarceration, she assumed a perch alongside OR head Troy Newman and proceeded to harass Dr. George Tiller, his staff and patients. Worse, immediately after Tiller’s murder, police found a slip of paper with Sullenger’s name and number in the getaway car used by assassin Scott Roeder.

For its part, Planned Parenthood of the Heartland became involved in providing medical abortions in the 1990s as part of the original FDA trial of the drugs. At that point a two-drug combo, called RU 486, allowed women to abort without surgery during the first seven–now extended to nine–weeks of pregnancy. The FDA approved the pills in December 2003; the Alan Guttmacher Institute estimates that 20 percent of women having early abortions now use them.

Planned Parenthood of the Heartland began Iowa’s telemedicine program in June 2008. According to Regional Director Todd Buchacker:

“We wanted to expand medical services to rural areas so women wouldn’t need to travel so far for care. Planned Parenthood of the Heartland runs 24 clinics throughout Iowa and Nebraska; 18 provide abortion services.”

“Iowa is unique,” he continues. “Its medical code is written in a way to allow telemedicine.  In fact, psychiatric care has relied on telemedicine consultations for about 15 years.”

Buchacker, an RN, describes Planned Parenthood’s telemedicine program and—big shocker—it’s nothing like the description on OR’s website. A patient comes into the Center, he begins, sees a nurse, and takes a pregnancy test. If the test is positive, she is given a sonogram and the image is either read on-site or is electronically sent to an off-site physician. In-person counseling with a trained staffer comes next. If the woman wants to terminate, she is told about both surgical and medical abortion. She is then shown an eight-minute video about medical abortion that describes the process and includes data about possible side effects, from severe cramping, to infection, to incomplete fetal expulsion. She is also told—by the counselor—about post-abortion follow-up and the availability of a 24-hour-a-day hotline should  complications or questions arise. If the woman opts for a medical abortion she ultimately goes into a room where she speaks, via teleconference, with a physician.

“By this point,” Buchacker adds, “the woman has already been counseled and the doctor has looked at the ultrasound and reviewed her medical history. The doctor is now there to answer any additional questions she might have. Once she says that she wants the medication, the doctor initiates the abortion by opening a drawer that is hooked up to a secure Internet connection. This gives her access to the first pill, mifeprex, which she takes in front of the doctor and the staffer who is in the room with her. The woman is then told to take the second drug, misoprostol, between 24 and 28 hours later, at home.”

To date, more than 1500 women have used Planned Parenthood of the Heartland’s telemedicine program for medical abortions; while it’s currently the only state to offer this service, Dr. Vanessa Cullins, Vice President for Medical Affairs at the Planned Parenthood Federation of America, says that PPFA is open to using telemedicine in other locales.

“There is the potential for telemedicine practices to expand,” she wrote in an email. “But there are many factors that each affiliate would have to consider, including the needs of the local population and state and local laws.”

Still, Cullins continues, “we’re encouraged by the response this service has received in Iowa. An independent researcher surveyed 200 patients who used the telemedicine system and 200 who were given the abortion pills in person from a physician. Ninety-four percent of women who received their pills through telemedicine were ‘very satisfied’ with their experience.”

What’s more, less than 0.5 percent of women using medication experience serious complications.  And, since the pills are widely and successfully used in other parts of the world—80 percent of early abortions in France and 43 percent in England are terminated with mifeprex and misoprostol—the potential expansion of medical abortion throughout the U.S. is undoubtedly causing OR a great deal of angst.

In their end-of-the-world-as-we-know-it projection, the landscape is teeming with dead fetuses. “If abortionists are allowed to dispense abortion drugs at the push of a button,” OR howls, “an abortionist sitting in an office miles away could kill hundreds of babies before lunch time.”

Let’s hope the Iowa Board of Medicine sees it differently.

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