An Iowa Board of Medicine rules review instigated by anti-choice activists has the potential to shutter the country’s first telemedicine abortion program. A legislative committee had the opportunity to end the review, which was initiated despite any documented complaints from patients or providers, but chose to let the process move forward. As a result, a public hearing on August 28 may be the last hurdle before telemed abortions are banned in the state—an outcome the local arm of Planned Parenthood is working hard to avoid.
Since the program began in 2008, a number of Iowa Planned Parenthood clinics have offered telemedicine abortions, which allow patients to take medication abortion pills while videoconferencing with a physician. For clinics in rural areas, where it is more difficult to find doctors locally to perform abortions, telemed abortions allow many patients to receive abortion care more quickly and conveniently than if they had to travel to a different part of the state.
The Des Moines Register reported in June that more than 3,000 patients had received telemed abortion care in the state and that the Iowa medical board had not received any complaints from patients who have had a telemed abortion, nor had it received any complaints from doctors or medical professionals who have participated in the process. And a survey of the state’s women found that there is a high rate of satisfaction with the program as well as a low rate of complications.
Anti-choice activists began lobbying against telemed abortions in 2010, arguing that the program violates the law, which states that only a doctor can perform abortions. Lobbyists at that meeting included representatives from Operation Rescue, Americans United for Life, and Silent No More, as well as local anti-choice advocates from Iowa Right to Life and the Iowa Catholic Conference. After a year-long investigation into the telemed abortion practice, the Iowa Board of Medicine determined there was no wrongdoing, and the program continued.
But the landscape in the state has changed since 2010. Republican and abortion opponent Terry Branstad has since become governor of Iowa, and since entering office he has replaced all ten members of the state’s board of medicine. Gov. Branstad has made it no secret he wants to end telemed abortions in the state, and said in a recent press conference that “the Board of Medical Examiners is indeed moving in a direction that will protect the health and well-being of Iowa women.”
The board considered reviewing the rules and potentially banning the process in June after Iowa Right to Life approached it with a petition. The Branstad administration was reportedly tipped off in advance about the effort. “We didn’t even know that this was going to be on the agenda until 48 hours before the meeting. We were very surprised and taken off guard,” Planned Parenthood of the Heartland CEO Jill June told RH Reality Check. “[Branstad's office] certainly had notice that this was underway. We did not.”
Unlike the 2010 review, this current query is about whether the process of telemed abortions, and medication abortion itself, is dangerous to patients—a talking point being used by Iowa anti-choice activists and promoted in the local media. Writing about the dangers of the medication abortion pill RU-486, conservative columnist Tom Quiner wrote in the Des Moines Register about the death of Holly Patterson following a medication abortion. But he did not include in his column several pertinent facts: that her death occurred nearly ten years ago, and that although “14 have died from [taking RU-486],” those deaths span 11 years. The 2,207 “adverse results” Quiner cites are from a pool of 1.52 million patients who have used the pill in the United States through the end of April 2011, and less than one-third of them required hospitalization.
“They are claiming it is unsafe,” said June. “And without the benefit of any evidence, of any testimony, any facts, or any investigation the board took action to end the practice.”
“During the meeting itself it seemed like the staff of the board of medicine and even their own legal counsel was not fully apprised. They were advising the board not to take action. But the governor’s attorney [Brenna Findley] was there. That was a very unusual matter. Typically she does not attend those meetings,” June said. Findley advised the board that it was fine to immediately start the review process—an opinion not shared by some board members and attorneys, who had raised concerns that the process was moving too quickly.
A representative for Americans United for Life was one of just three people to testify at the meeting. “There were a lot of things that were really very unusual, and that’s why you didn’t see the kind of local involvement or comments at that meeting. People simply weren’t aware of what was taking place,” June said.
The state’s Administrative Rules Review Committee was the only legislative means of ending the board review once it was underway, but the group ruled, on Tuesday, in a 4 to 4 party-line vote to let the process continue. It would have required a two-thirds majority vote to delay or stop the board from moving ahead.
So far, the individuals trying to quickly shutter the program have heard little publicly from individuals who have participated in the program or who support it. Those individuals have one chance to weigh in, and many are preparing to do so. The August 28 public hearing has been moved to a larger auditorium to accommodate the expected audience and will last most of the afternoon to provide time for public testimony. But because it is not an official board meeting, no action will occur. Instead, the board members will be allowed to meet as early as the following day to put their intentions into a finalized form. Once that form is published, either the program will stay in place, or it could end as early as October.
If the board enacts a ban, the country’s first and most successful telemed abortion program may be gone for good, without a single patient complaint ever being filed against it.
“We are doing our utmost to ensure that people are well aware of what is taking place,” June told RH Reality Check. “We’ve published some op-eds in newspapers and seen that there are letters to the editor from supporters being generated. We are going to hold a demonstration the day of the public hearing and are encouraging health experts and people who know that public policy should be predicated on evidence and not opinions to speak to the board of medicine.”