Faraway doctors give abortion pills by video
Small Planned Parenthood clinics around Iowa are using a remote-control pill-dispensing system to make abortions available in areas where few doctors offer them.
The first-in-the-nation system allows a Planned Parenthood physician from Des Moines to visit with each patient by videoconference, then press a computer button to open a drawer in front of the patient, who could be seated up to 190 miles away. The patient then reaches into the drawer and withdraws the abortion pills.
The system is drawing interest from other abortion providers around the country. It's also bringing objections from anti-abortion activists.
Abortion opponents have filed a formal complaint with the Iowa Board of Medicine, which plans to investigate. The opponents point to a state law that says abortions must be performed by a physician.
Planned Parenthood says its doctors meet that requirement when they dispense the abortion drugs by remote control, then watch via a secure communications system as their patients take the first dose of medication.
Dr. Tom Ross, a Planned Parenthood physician who uses the system, said he fulfills his legal obligation to oversee the abortion process.
"I do. Yes, sir. Absolutely," he said. He's confident the state medical board will approve of the system, which private lawyers vetted.
Ross' contention is disputed by Operation Rescue, a national anti-abortion group that filed a complaint last month with the medical board.
"The 'telemed abortions' are being done without a licensed physician ever personally seeing or examining the patient," the complaint says. The letter calls the arrangement "apparently illegal and certainly dangerous," and it asks the state board to revoke the medical license of Dr. Susan Haskell, the Planned Parenthood chapter's medical director.
The abortion process in question involves two medications, both of which cause women to miscarry. The first is Mifeprex, a brand name for a pill also known by its chemical name, RU-486. The second drug is misoprostol, which women take at home after taking Mifeprex in the clinic.
About 1,500 Iowa patients have used Planned Parenthood of the Heartland's videoconferencing system to obtain abortion drugs in the past two years. The medication is available only to women in their first nine weeks of pregnancy.
How doctors, patients interact via network
The remote-control system uses a private communications network, separate from the Internet. It is used in 16 clinics operated by Planned Parenthood of the Heartland, the group's main Iowa chapter. The doctor usually is in Des Moines, but occasionally signs onto the system from one of the other clinics.
Planned Parenthood officials explained how the system works:
A patient who comes to a clinic and asks about abortion is given a pregnancy test. If the test comes up positive, a nurse performs an ultrasound, and the resulting images are sent electronically to the doctor. Local clinic staff members give the patient counseling, which includes information about the options of keeping a baby or giving it up for adoption. However, most women who come to the agency to talk about abortion have made up their minds already, Planned Parenthood officials said.
Patients are given printed information about the abortion pills, and they watch an eight-minute video about the process. The video talks about the effects of the drug, and possible side effects. The video says most women experience cramping and bleeding, similar to what they would experience during a heavy period.
The video says patients should feel normal within a day after taking the second medication at home. If not, they are instructed to call Planned Parenthood's 24-hour phone line to report complications.
Patients return to the clinic about two weeks later. They are checked to be sure they ended their pregnancies, which the video says happens for 98 percent of women who take the medications.
The video shows a re-enactment of a follow-up visit.
"Well, you're no longer pregnant," an actor in a white coat tells a woman portraying a patient.
"That's great," the woman says. "I really would like a baby sometime. But right now, we just can't afford it. I'm really glad we had this choice."
After watching the video, each patient is asked whether she wants to obtain the abortion drugs via the electronic conferencing system. If she says yes, she is seated in front of a computer monitor with a camera, which allows her to visit with a doctor. Such meetings usually last several minutes, Ross said.
The doctor goes over the woman's medical history, talks about how the drugs work, then asks whether the patient has any questions. When the doctor is satisfied, he or she enters a computer command that signals a drawer to open in front of the patient. The drawer contains two pill bottles. The patient is instructed to open one of them, remove the Mifeprex pill, then take it while the doctor watches.
The patient then is instructed to go home, where she will open the second bottle and withdraw four pills of misoprostol. She is to put the pills between her cheek and gum, where they will dissolve.
Debate over safety, effectiveness of drugs
Planned Parenthood tells patients the medications are safe and effective and have been used by hundreds of thousands of women. The agency says only about 2 percent of patients who use the drugs as instructed fail to abort their pregnancies. Most women then have traditional, surgical abortions.
The U.S. Food and Drug Administration says it has eight reports of women dying of infections after taking the pills, but it says there is no proof the pills caused the infections. Planned Parenthood officials say they have cut down on the chances of infection by giving antibiotics, changing the way the second drug is administered, and urging patients to call immediately if they have complications, including fever.
Operation Rescue said in its complaint that the failure rate of the medications can be up to 20 percent, and that continued pregnancies can lead to deformed fetuses and deadly infections. The group also contends that at least 13 women have died because of the drugs and that more than 1,100 have suffered serious complications.
Troy Newman, national president of Operation Rescue, said his group learned about the Planned Parenthood system via an anonymous tip. He said Operation Rescue receives many tips because it has offered a $25,000 reward leading to the arrest and conviction of abortion providers.
Newman said his objections to the system include that there is too little personal interaction between the physician and the woman.
"Clearly it's unsafe for the unborn baby, but I think it also puts the mother's life at risk," he said. "And it's illegal. That's the bottom line."
The group is trumpeting the fact that the Iowa Board of Medicine is investigating the matter. But the board's executive director, Mark Bowden, said his agency's response to Operation Rescue's concerns does not imply any wrongdoing by Planned Parenthood.
"The board sends out notices to anyone who files a complaint, telling them that we got the complaint and we're looking into it," he said. Only about 7 percent of complaints to the board result in formal sanctions, he said.
Bowden noted that other types of physicians, such as psychiatrists and radiologists, also have started using electronic means to interact with patients. The medical board wants to understand what methods are being used, and it wants to consider what is and is not appropriate, he said.
Doctor says he doubts complainant's motives
The Operation Rescue complaint centers on the state law requiring that all abortions be performed by a physician.
A national Planned Parenthood spokeswoman said 11 states allow other medical professionals, such as nurse practitioners or physician assistants, to provide abortion pills to patients, according to the most recent tally she has seen. The nearest such state is Illinois.
Ross, the Planned Parenthood physician, doesn't think Operation Rescue is really concerned about the quality of care provided to women. The group is just trying to throw up any possible roadblock to women who want access to abortions, he said.
Ross said he and other abortion rights supporters hoped more physicians would offer the abortion medications once federal regulators approved them in 2000. But few physicians want to wade into the controversial practice, Ross said, which is why Planned Parenthood is using the videoconferencing system to expand the reach of its Des Moines doctors.
"It's all about access, and the reality is that for many of our patients, they'd have to travel for hours to Des Moines" if the system wasn't available, he said.
An independent researcher hired by Planned Parenthood surveyed 200 patients who used the system and 200 patients who received abortion pills in face-to-face meetings with physicians.
The researcher found that 94 percent of women who used the teleconferencing system were "very satisfied" with their experience, compared with 88 percent in the standard group. The study found no serious complications in any of the 400 cases.
Newman, the Operation Rescue leader, said his group's complaint isn't just a ploy to limit access to abortion.
"We're anti-abortion. We make no bones about that," he said. "But we're also pro-woman, and we think all women should get the best health care possible."
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