Latest news with #MassachusettsMedicationAbortionAccessProject
Associated Press
2 days ago
- Health
- Associated Press
Inside the legal fight over the telehealth clinics that help women defy abortion bans
Every month, thousands of women thwart abortion bans in their home states by turning to telehealth clinics willing to prescribe pregnancy-ending drugs online and ship them anywhere in the country. Whether this is legal, though, is a matter of debate. Two legal cases involving a New York doctor could wind up testing the shield laws some states have passed to protect telehealth providers who ship abortion pills nationwide. Dr. Margaret Carpenter faces a felony charge in Louisiana for supplying abortion medication through the mail to a pregnant teen in that state. The patient's mother also faces criminal charges. A Texas judge fined the same physician $100,000 after the state accused her of prescribing abortion medication for a woman near Dallas. So far, the prosecution hasn't progressed thanks to New York's shield law, which has protected Carpenter from extradition to Louisiana. But other telehealth centers operating in states with similar legal protections for abortion providers are watching closely. 'We have great legal counsel who have advised us that what we are doing is legal,' said Dr. Angel Foster, co-founder of The Massachusetts Medication Abortion Access Project, which is among a handful of telehealth providers that facilitate abortions from afar in states with bans. As more states consider enacting shield laws or expanding existing ones, whether one state can shield providers from liability for breaking another state's laws around abortion is still an unsettled area of law. Erik Baptist, senior counsel for the Alliance Defending Freedom, which opposes abortion, said shield laws violate a constitutional requirement that states respect the laws and legal judgments of other states. 'What these shield law states are doing are undermining the prerogative of these pro-life states to implement and enforce pro-life laws,' said Baptist, director of the group's Center for Life. 'And so I think the Supreme Court ultimately will want to take this.' 'That is inherently a challenge with shield laws and telehealth,' said Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School. 'At a certain point, for the purposes of abortion bans, the courts will need to decide: Do we treat a telehealth abortion as happening within the state of the provider or within the state of the patient?' Abortion pills sent to your home Decades ago, the FDA approved the use of two prescription medicines — mifepristone and misoprostol — to terminate pregnancies. But it wasn't until 2023 that telehealth abortions across states became more popular, after the U.S. Supreme Court overturned Roe v. Wade in 2022. The Society of Family Planning, which supports abortion rights, said that between April and June 2024 there were an average of 7,700 telehealth abortions performed each month in states that either ban abortion totally or after six weeks of pregnancy. The prescribing process at telehealth clinics varies by provider, but usually takes place entirely online, with the patient answering a series of health-related questions and consent forms. At some telehealth clinics, medical providers don't come face-to-face with patients, even via videoconferencing, and patients don't necessarily know the prescriber's name unless requested. For instance, when Foster's clinic, also known as The MAP, puts pills in the mail, only the name of the practice appears on the label, as allowed under the Massachusetts shield law. If patients have follow-up questions, they can talk or text the doctor working that day, but may not know that doctor's name either. Pills can arrive in a less than a week. 'This has been the safety net, post-Dobbs, of allowing people who don't have the ability to travel out of state to get abortion care,' said Greer Donley, a University of Pittsburgh law professor and abortion law expert. When dealing with medications not related to abortion, doctors are often able to write prescriptions for patients in other states. However, in most states, if the patient is located within its borders, the doctor must have a license issued by that state, according to Mei Wa Kwong, executive director of the The Center for Connected Health Policy. States with shield laws Twenty three states and Washington, D.C., currently have shield laws protecting abortion providers. Of those, eight have specific provisions protecting them from criminal prosecution or civil lawsuits even if the patient is in another state, according to the nonprofit research organization KFF. They include California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington. Louisiana's request to extradite Carpenter hit a roadblock when New York Gov. Kathy Hochul rejected it, citing the state's shield law. (A county clerk also cited the shield law as he refused to file the civil judgment from Texas.) 'These are not doctors providing health care. They are drug dealers,' Republican Louisiana Attorney General Liz Murrill told state lawmakers as she promoted a bill that would expand who can sue and be sued in abortion medication cases. 'They are violating our laws. They are sending illegal medications for purposes of procuring abortions that are illegal in our state.' Clinics say they will keep prescribing Julie Kay, the executive director of the Abortion Coalition for Telemedicine, the nationwide organization co-founded by Carpenter, said providers won't be 'bullied and intimidated' into ceasing operations. Other telehealth abortion providers said they also won't be deterred by legal threats. 'I have been working in this field for 25 years and this is part of the work,' said Dr. Rebecca Gomperts, founder and director of Aid Access, an abortion pill supplier. 'It's something that we all anticipated would happen,' she said of the legal challenges. A doctor who is part of A Safe Choice, a network of California-based physicians that prescribes abortion pills to women in all 50 states, told The Associated Press he believes he is protected by the state's shield law, but is also taking precautions. 'I'm not going to be traveling outside of California for a very long time,' said the doctor, who spoke with The Associated Press on condition of anonymity because he wanted to protect his identity for safety reasons. ___ Associated Press writer Sara Cline in Baton Rouge, Louisiana, contributed to this report.
The Independent
2 days ago
- Health
- The Independent
Inside the legal fight over the telehealth clinics that help women defy abortion bans
Every month, thousands of women thwart abortion bans in their home states by turning to telehealth clinics willing to prescribe pregnancy-ending drugs online and ship them anywhere in the country. Whether this is legal, though, is a matter of debate. Two legal cases involving a New York doctor could wind up testing the shield laws some states have passed to protect telehealth providers who ship abortion pills nationwide. Dr. Margaret Carpenter faces a felony charge in Louisiana for supplying abortion medication through the mail to a pregnant teen in that state. The patient's mother also faces criminal charges. A Texas judge fined the same physician $100,000 after the state accused her of prescribing abortion medication for a woman near Dallas. So far, the prosecution hasn't progressed thanks to New York's shield law, which has protected Carpenter from extradition to Louisiana. But other telehealth centers operating in states with similar legal protections for abortion providers are watching closely. "We have great legal counsel who have advised us that what we are doing is legal,' said Dr. Angel Foster, co-founder of The Massachusetts Medication Abortion Access Project, which is among a handful of telehealth providers that facilitate abortions from afar in states with bans. As more states consider enacting shield laws or expanding existing ones, whether one state can shield providers from liability for breaking another state's laws around abortion is still an unsettled area of law. Erik Baptist, senior counsel for the Alliance Defending Freedom, which opposes abortion, said shield laws violate a constitutional requirement that states respect the laws and legal judgments of other states. "What these shield law states are doing are undermining the prerogative of these pro-life states to implement and enforce pro-life laws,' said Baptist, director of the group's Center for Life. 'And so I think the Supreme Court ultimately will want to take this.' 'That is inherently a challenge with shield laws and telehealth,' said Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School. 'At a certain point, for the purposes of abortion bans, the courts will need to decide: Do we treat a telehealth abortion as happening within the state of the provider or within the state of the patient?' Abortion pills sent to your home Decades ago, the FDA approved the use of two prescription medicines — mifepristone and misoprostol — to terminate pregnancies. But it wasn't until 2023 that telehealth abortions across states became more popular, after the U.S. Supreme Court overturned Roe v. Wade in 2022. The Society of Family Planning, which supports abortion rights, said that between April and June 2024 there were an average of 7,700 telehealth abortions performed each month in states that either ban abortion totally or after six weeks of pregnancy. The prescribing process at telehealth clinics varies by provider, but usually takes place entirely online, with the patient answering a series of health-related questions and consent forms. At some telehealth clinics, medical providers don't come face-to-face with patients, even via videoconferencing, and patients don't necessarily know the prescriber's name unless requested. For instance, when Foster's clinic, also known as The MAP, puts pills in the mail, only the name of the practice appears on the label, as allowed under the Massachusetts shield law. If patients have follow-up questions, they can talk or text the doctor working that day, but may not know that doctor's name either. Pills can arrive in a less than a week. 'This has been the safety net, post-Dobbs, of allowing people who don't have the ability to travel out of state to get abortion care,' said Greer Donley, a University of Pittsburgh law professor and abortion law expert. When dealing with medications not related to abortion, doctors are often able to write prescriptions for patients in other states. However, in most states, if the patient is located within its borders, the doctor must have a license issued by that state, according to Mei Wa Kwong, executive director of the The Center for Connected Health Policy. States with shield laws Twenty three states and Washington, D.C., currently have shield laws protecting abortion providers. Of those, eight have specific provisions protecting them from criminal prosecution or civil lawsuits even if the patient is in another state, according to the nonprofit research organization KFF. They include California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington. Louisiana's request to extradite Carpenter hit a roadblock when New York Gov. Kathy Hochul rejected it, citing the state's shield law. (A county clerk also cited the shield law as he refused to file the civil judgment from Texas.) 'These are not doctors providing health care. They are drug dealers,' Republican Louisiana Attorney General Liz Murrill told state lawmakers as she promoted a bill that would expand who can sue and be sued in abortion medication cases. 'They are violating our laws. They are sending illegal medications for purposes of procuring abortions that are illegal in our state.' Clinics say they will keep prescribing Julie Kay, the executive director of the Abortion Coalition for Telemedicine, the nationwide organization co-founded by Carpenter, said providers won't be 'bullied and intimidated' into ceasing operations. Other telehealth abortion providers said they also won't be deterred by legal threats. 'I have been working in this field for 25 years and this is part of the work," said Dr. Rebecca Gomperts, founder and director of Aid Access, an abortion pill supplier. 'It's something that we all anticipated would happen," she said of the legal challenges. A doctor who is part of A Safe Choice, a network of California-based physicians that prescribes abortion pills to women in all 50 states, told The Associated Press he believes he is protected by the state's shield law, but is also taking precautions. 'I'm not going to be traveling outside of California for a very long time,' said the doctor, who spoke with The Associated Press on condition of anonymity because he wanted to protect his identity for safety reasons. ___
Miami Herald
08-05-2025
- Health
- Miami Herald
Despite historic indictment, doctors will keep mailing abortion pills across state lines
When the news broke on Jan. 31 that a New York physician had been indicted for shipping abortion medications to a woman in Louisiana, it stoked fear across the network of doctors and medical clinics who engage in similar work. "It's scary. It's frustrating," said Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, a clinic near Boston that mails mifepristone and misoprostol pills to patients in states with abortion bans. But, Foster added, "it's not entirely surprising." Ever since the Supreme Court overturned Roe v. Wade in 2022, abortion providers like her had been expecting prosecution or another kind of legal challenge from states with abortion bans, she said. "It was unclear when those tests would come, and would it be against an individual provider or a practice or organization?" she said. "Would it be a criminal indictment, or would it be a civil lawsuit," or even an attack on licensure? she wondered. "All of that was kind of unknown, and we're starting to see some of this play out." The indictment also sparked worry among abortion providers like Kohar Der Simonian, medical director for Maine Family Planning. The clinic doesn't mail pills into states with bans, but it does treat patients who travel from those states to Maine for abortion care. "It just hit home that this is real, like this could happen to anybody, at any time now, which is scary," Der Simonian said. Der Simonian and Foster both know the indicted doctor, Margaret Carpenter. "I feel for her. I very much support her," Foster said. "I feel very sad for her that she has to go through all of this." On Jan. 31, Carpenter became the first U.S. doctor criminally charged for providing abortion pills across state lines - a medical practice that grew after the U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022, which overturned Roe. Since Dobbs, 12 states have enacted near-total abortion bans, and an additional 10 have outlawed the procedure after a certain point in pregnancy, but before a fetus is viable. Carpenter was indicted alongside a Louisiana mother who allegedly received the mailed package and gave the pills prescribed by Carpenter to her minor daughter. The teen wanted to keep the pregnancy and called 911 after taking the pills, according to an NPR and KFF Health News interview with Tony Clayton, the Louisiana local district attorney prosecuting the case. When police responded, they learned about the medication, which carried the prescribing doctor's name, Clayton said. On Feb. 11, Louisiana's Republican governor, Jeff Landry, signed an extradition warrant for Carpenter. He later posted a video arguing she "must face extradition to Louisiana, where she can stand trial and justice will be served." New York's Democratic governor, Kathy Hochul, countered by releasing her own video, confirming she was refusing to extradite Carpenter. The charges carry a possible five-year prison sentence. "Louisiana has changed their laws, but that has no bearing on the laws here in the state of New York," Hochul said. Eight states - New York, Maine, California, Colorado, Massachusetts, Rhode Island, Vermont, and Washington - have passed laws since 2022 to protect doctors who mail abortion pills out of state, and thereby block or "shield" them from extradition in such cases. But this is the first criminal test of these relatively new "shield laws." The telemedicine practice of consulting with remote patients and prescribing them medication abortion via the mail has grown in recent years - and is now playing a critical role in keeping abortion somewhat accessible in states with strict abortion laws, according to research from the Society of Family Planning, a group that supports abortion access. Doctors who prescribe abortion pills across state lines describe facing a new reality in which the criminal risk is no longer hypothetical. The doctors say that if they stop, tens of thousands of patients would no longer be able to end early pregnancies safely at home, under the care of a U.S. physician. But the doctors could end up in the crosshairs of a legal clash over the interstate practice of medicine when two states disagree on whether people have a right to end a pregnancy. Doctors on Alert but Remain Defiant Maine Family Planning, a network of clinics across 19 locations, offers abortions, birth control, gender-affirming care, and other services. One patient recently drove over 17 hours from South Carolina, a state with a six-week abortion ban, Der Simonian said. For Der Simonian, that case illustrates how desperate some of the practice's patients are for abortion access. It's why she supported Maine's 2024 shield law, she said. Maine Family Planning has discussed whether to start mailing abortion medication to patients in states with bans, but it has decided against it for now, according to Kat Mavengere, a clinic spokesperson. Reflecting on Carpenter's indictment, Der Simonian said it underscored the stakes for herself - and her clinic - of providing any abortion care to out-of-state patients. Shield laws were written to protect against the possibility that a state with an abortion ban charges and tries to extradite a doctor who performed a legal, in-person procedure on someone who had traveled there from another state, according to a review of shield laws by the Center on Reproductive Health, Law, and Policy at the UCLA School of Law. "It is a fearful time to do this line of work in the United States right now," Der Simonian said. "There will be a next case." And even though Maine's shield law protects abortion providers, she said, "you just don't know what's going to happen." Data shows that in states with total or six-week abortion bans, an average of 7,700 people a month were prescribed and took mifepristone and misoprostol to end their pregnancies by out-of-state doctors practicing in states with shield laws. The data, covering the second quarter of 2024, is part of a #WeCount report estimating the volume and types of abortions in the U.S., conducted by the Society of Family Planning. Among Louisiana residents, nearly 60% of abortions took place via telemedicine in the second half of 2023 (the most recent period for which estimates are available), giving Louisiana the highest rate of telemedicine abortions among states that passed strict bans after Dobbs, according to the #WeCount survey. Organizations like the Massachusetts Medication Abortion Access Project, known as the MAP, are responding to the demand for remote care. The MAP was launched after the Dobbs ruling, with the mission of writing prescriptions for patients in other states. During 2024, the MAP says, it was mailing abortion medications to about 500 patients a month. In the new year, the monthly average has grown to 3,000 prescriptions a month, said Foster, the group's co-founder. The majority of the MAP's patients - 80% - live in Texas or states in the Southeast, a region blanketed with near-total abortion restrictions, Foster said. But the recent indictment from Louisiana will not change the MAP's plans, Foster said. The MAP currently has four staff doctors and is hiring one more. "I think there will be some providers who will step out of the space, and some new providers will step in. But it has not changed our practice," Foster said. "It has not changed our intention to continue to practice." The MAP's organizational structure was designed to spread potential liability, Foster said. "The person who orders the pills is different than the person who prescribes the pills, is different from the person who ships the pills, is different from the person who does the payments," she explained. In 22 states and Washington, D.C., Democratic leaders helped establish shield laws or similarly protective executive orders, according to the UCLA School of Law review of shield laws. The review found that in eight states, the shield law applies to in-person and telemedicine abortions. In the other 14 states plus Washington, D.C., the protections do not explicitly extend to abortion via telemedicine. Most of the shield laws also apply to civil lawsuits against doctors. Over a month before Louisiana indicted Carpenter, Texas Attorney General Ken Paxton filed a civil suit against her. A Texas judge ruled against Carpenter on Feb. 13, imposing penalties of more than $100,000. By definition, state shield laws cannot protect doctors when they leave the state. If they move or even travel elsewhere, they lose the first state's protection and risk arrest in the destination state, and maybe extradition to a third state. Physicians doing this type of work accept there are parts of the U.S. where they should no longer go, said Julie F. Kay, a human rights lawyer who helps doctors set up telemedicine practices. "There's really a commitment not to visit those banned and restricted states," said Kay, who worked with Carpenter to help start the Abortion Coalition for Telemedicine. "We didn't have anybody going to the Super Bowl or Mardi Gras or anything like that," Kay said of the doctors who practice abortion telemedicine across state lines. She said she has talked to other interested doctors who decided against doing it "because they have an elderly parent in Florida, or a college student somewhere, or family in the South." Any visits, even for a relative's illness or death, would be too risky. "I don't use the word 'hero' lightly or toss it around, but it's a pretty heroic level of providing care," Kay said. Governors Clash Over Doctor's Fate Carpenter's case remains unresolved. New York's rebuff of Louisiana's extradition request shows the state's shield law is working as designed, according to David Cohen and Rachel Rebouché, law professors with expertise in abortion laws. Louisiana officials, for their part, have pushed back in social media posts and media interviews. "It is not any different than if she had sent fentanyl here. It's really not," Louisiana Attorney General Liz Murrilltold Fox 8 News in New Orleans. "She sent drugs that are illegal to send into our state." Louisiana's next step would be challenging New York in federal courts, according to legal experts across the political spectrum. NPR and KFF Health News asked Clayton, the Louisiana prosecutor who charged Carpenter, whether Louisiana has plans to do that. Clayton declined to answer. Case Highlights Fraught New Legal Frontier A major problem with the new shield laws is that they challenge the basic fabric of U.S. law, which relies on reciprocity between states, including in criminal cases, said Thomas Jipping, a senior legal fellow with the Heritage Foundation, which supports a national abortion ban. "This actually tries to undermine another state's ability to enforce its own laws, and that's a very grave challenge to this tradition in our country," Jipping said. "It's unclear what legal issues, or potentially constitutional issues, it may raise." But other legal scholars disagree with Jipping's interpretation. The U.S. Constitution requires extradition only for those who commit crimes in one state and then flee to another state, said Cohen, a law professor at Drexel University's Thomas R. Kline School of Law. Telemedicine abortion providers aren't located in states with abortion bans and have not fled from those states - therefore they aren't required to be extradited back to those states, Cohen said. If Louisiana tries to take its case to federal court, he said, "they're going to lose because the Constitution is clear on this." "The shield laws certainly do undermine the notion of interstate cooperation, and comity, and respect for the policy choices of each state," Cohen said, "but that has long been a part of American law and history." When states make different policy choices, sometimes they're willing to give up those policy choices to cooperate with another state, and sometimes they're not, he said. The conflicting legal theories will be put to the test if this case goes to federal court, other legal scholars said. "It probably puts New York and Louisiana in real conflict, potentially a conflict that the Supreme Court is going to have to decide," said Rebouché, dean of the Temple University Beasley School of Law. Rebouché, Cohen, and law professor Greer Donley worked together to draft a proposal for how state shield laws might work. Connecticut passed the first law - though it did not include protections specifically for telemedicine. It was signed by the state's governor in May 2022, over a month before the Supreme Court overturned Roe, in anticipation of potential future clashes between states over abortion rights. In some shield-law states, there's a call to add more protections in response to Carpenter's indictment. New York state officials have. On Feb. 3, Hochul signed a law that allows physicians to name their clinic as the prescriber - instead of using their own names - on abortion medications they mail out of state. The intent is to make it more difficult to indict individual doctors. Der Simonian is pushing for a similar law in Maine. Samantha Glass, a family medicine physician in New York, has written such prescriptions in a previous job, and plans to find a clinic where she could offer that again. Once a month, she travels to a clinic in Kansas to perform in-person abortions. Carpenter's indictment could cause some doctors to stop sending pills to states with bans, Glass said. But she believes abortion should be as accessible as any other health care. "Someone has to do it. So why wouldn't it be me?" Glass said. "I just think access to this care is such a lifesaving thing for so many people that I just couldn't turn my back on it." ____ This article is from a partnership that includes WWNO, NPR, and KFF Health News. Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
Yahoo
08-05-2025
- Health
- Yahoo
Despite historic indictment, doctors will keep mailing abortion pills across state lines
Packages of Mifepristone tablets are displayed at a family planning clinic on April 13, 2023 in Rockville, Maryland. (Photo illustration by) When the news broke on Jan. 31 that a New York physician had been indicted for shipping abortion medications to a woman in Louisiana, it stoked fear across the network of doctors and medical clinics who engage in similar work. 'It's scary. It's frustrating,' said Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, a clinic near Boston that mails mifepristone and misoprostol pills to patients in states with abortion bans. But, Foster added, 'it's not entirely surprising.' Ever since the Supreme Court overturned Roe v. Wade in 2022, abortion providers like her had been expecting prosecution or another kind of legal challenge from states with abortion bans, she said. 'It was unclear when those tests would come, and would it be against an individual provider or a practice or organization?' she said. 'Would it be a criminal indictment, or would it be a civil lawsuit,' or even an attack on licensure? she wondered. 'All of that was kind of unknown, and we're starting to see some of this play out.' The indictment also sparked worry among abortion providers like Kohar Der Simonian, medical director for Maine Family Planning. The clinic doesn't mail pills into states with bans, but it does treat patients who travel from those states to Maine for abortion care. 'It just hit home that this is real, like this could happen to anybody, at any time now, which is scary,' Der Simonian said. Der Simonian and Foster both know the indicted doctor, Margaret Carpenter. 'I feel for her. I very much support her,' Foster said. 'I feel very sad for her that she has to go through all of this.' On Jan. 31, Carpenter became the first U.S. doctor criminally charged for providing abortion pills across state lines — a medical practice that grew after the U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022, which overturned Roe. Since Dobbs, 12 states have enacted near-total abortion bans, and an additional 10 have outlawed the procedure after a certain point in pregnancy, but before a fetus is viable. Louisiana officials lament loss of USDA money to help schools, food banks buy from local farmers Carpenter was indicted alongside a Louisiana mother who allegedly received the mailed package and gave the pills prescribed by Carpenter to her minor daughter. The teen wanted to keep the pregnancy and called 911 after taking the pills, according to an NPR and KFF Health News interview with Tony Clayton, the Louisiana local district attorney prosecuting the case. When police responded, they learned about the medication, which carried the prescribing doctor's name, Clayton said. On Feb. 11, Louisiana's Republican governor, Jeff Landry, signed an extradition warrant for Carpenter. He later posted a video arguing she 'must face extradition to Louisiana, where she can stand trial and justice will be served.' New York's Democratic governor, Kathy Hochul, countered by releasing her own video, confirming she was refusing to extradite Carpenter. The charges carry a possible five-year prison sentence. 'Louisiana has changed their laws, but that has no bearing on the laws here in the state of New York,' Hochul said. Eight states — New York, Maine, California, Colorado, Massachusetts, Rhode Island, Vermont, and Washington — have passed laws since 2022 to protect doctors who mail abortion pills out of state, and thereby block or 'shield' them from extradition in such cases. But this is the first criminal test of these relatively new 'shield laws.' In the Deep South, health care fights echo civil rights battles The telemedicine practice of consulting with remote patients and prescribing them medication abortion via the mail has grown in recent years — and is now playing a critical role in keeping abortion somewhat accessible in states with strict abortion laws, according to research from the Society of Family Planning, a group that supports abortion access. Doctors who prescribe abortion pills across state lines describe facing a new reality in which the criminal risk is no longer hypothetical. The doctors say that if they stop, tens of thousands of patients would no longer be able to end early pregnancies safely at home, under the care of a U.S. physician. But the doctors could end up in the crosshairs of a legal clash over the interstate practice of medicine when two states disagree on whether people have a right to end a pregnancy. Maine Family Planning, a network of clinics across 19 locations, offers abortions, birth control, gender-affirming care, and other services. One patient recently drove over 17 hours from South Carolina, a state with a six-week abortion ban, Der Simonian said. For Der Simonian, that case illustrates how desperate some of the practice's patients are for abortion access. It's why she supported Maine's 2024 shield law, she said. Maine Family Planning has discussed whether to start mailing abortion medication to patients in states with bans, but it has decided against it for now, according to Kat Mavengere, a clinic spokesperson. Reflecting on Carpenter's indictment, Der Simonian said it underscored the stakes for herself — and her clinic — of providing any abortion care to out-of-state patients. Shield laws were written to protect against the possibility that a state with an abortion ban charges and tries to extradite a doctor who performed a legal, in-person procedure on someone who had traveled there from another state, according to a review of shield laws by the Center on Reproductive Health, Law, and Policy at the UCLA School of Law. 'It is a fearful time to do this line of work in the United States right now,' Der Simonian said. 'There will be a next case.' And even though Maine's shield law protects abortion providers, she said, 'you just don't know what's going to happen.' Data shows that in states with total or six-week abortion bans, an average of 7,700 people a month were prescribed and took mifepristone and misoprostol to end their pregnancies by out-of-state doctors practicing in states with shield laws. The data, covering the second quarter of 2024, is part of a #WeCount report estimating the volume and types of abortions in the U.S., conducted by the Society of Family Planning. Among Louisiana residents, nearly 60% of abortions took place via telemedicine in the second half of 2023 (the most recent period for which estimates are available), giving Louisiana the highest rate of telemedicine abortions among states that passed strict bans after Dobbs, according to the #WeCount survey. Louisiana considers 'homelessness courts' as housing advocates stress lack of resources Organizations like the Massachusetts Medication Abortion Access Project, known as the MAP, are responding to the demand for remote care. The MAP was launched after the Dobbs ruling, with the mission of writing prescriptions for patients in other states. During 2024, the MAP says, it was mailing abortion medications to about 500 patients a month. In the new year, the monthly average has grown to 3,000 prescriptions a month, said Foster, the group's co-founder. The majority of the MAP's patients — 80% — live in Texas or states in the Southeast, a region blanketed with near-total abortion restrictions, Foster said. But the recent indictment from Louisiana will not change the MAP's plans, Foster said. The MAP currently has four staff doctors and is hiring one more. 'I think there will be some providers who will step out of the space, and some new providers will step in. But it has not changed our practice,' Foster said. 'It has not changed our intention to continue to practice.' The MAP's organizational structure was designed to spread potential liability, Foster said. 'The person who orders the pills is different than the person who prescribes the pills, is different from the person who ships the pills, is different from the person who does the payments,' she explained. In 22 states and Washington, D.C., Democratic leaders helped establish shield laws or similarly protective executive orders, according to the UCLA School of Law review of shield laws. The review found that in eight states, the shield law applies to in-person and telemedicine abortions. In the other 14 states plus Washington, D.C., the protections do not explicitly extend to abortion via telemedicine. Most of the shield laws also apply to civil lawsuits against doctors. Over a month before Louisiana indicted Carpenter, Texas Attorney General Ken Paxton filed a civil suit against her. A Texas judge ruled against Carpenter on Feb. 13, imposing penalties of more than $100,000. By definition, state shield laws cannot protect doctors when they leave the state. If they move or even travel elsewhere, they lose the first state's protection and risk arrest in the destination state, and maybe extradition to a third state. Louisiana looks to RFK Jr. for school lunch guidelines, limits on SNAP purchases Physicians doing this type of work accept there are parts of the U.S. where they should no longer go, said Julie F. Kay, a human rights lawyer who helps doctors set up telemedicine practices. 'There's really a commitment not to visit those banned and restricted states,' said Kay, who worked with Carpenter to help start the Abortion Coalition for Telemedicine. 'We didn't have anybody going to the Super Bowl or Mardi Gras or anything like that,' Kay said of the doctors who practice abortion telemedicine across state lines. She said she has talked to other interested doctors who decided against doing it 'because they have an elderly parent in Florida, or a college student somewhere, or family in the South.' Any visits, even for a relative's illness or death, would be too risky. 'I don't use the word 'hero' lightly or toss it around, but it's a pretty heroic level of providing care,' Kay said. Carpenter's case remains unresolved. New York's rebuff of Louisiana's extradition request shows the state's shield law is working as designed, according to David Cohen and Rachel Rebouché, law professors with expertise in abortion laws. Louisiana officials, for their part, have pushed back in social media posts and media interviews. 'It is not any different than if she had sent fentanyl here. It's really not,' Louisiana Attorney General Liz Murrill told Fox 8 News in New Orleans. 'She sent drugs that are illegal to send into our state.' Louisiana's next step would be challenging New York in federal courts, according to legal experts across the political spectrum. NPR and KFF Health News asked Clayton, the Louisiana prosecutor who charged Carpenter, whether Louisiana has plans to do that. Clayton declined to answer. A major problem with the new shield laws is that they challenge the basic fabric of U.S. law, which relies on reciprocity between states, including in criminal cases, said Thomas Jipping, a senior legal fellow with the Heritage Foundation, which supports a national abortion ban. 'This actually tries to undermine another state's ability to enforce its own laws, and that's a very grave challenge to this tradition in our country,' Jipping said. 'It's unclear what legal issues, or potentially constitutional issues, it may raise.' But other legal scholars disagree with Jipping's interpretation. The U.S. Constitution requires extradition only for those who commit crimes in one state and then flee to another state, said Cohen, a law professor at Drexel University's Thomas R. Kline School of Law. Telemedicine abortion providers aren't located in states with abortion bans and have not fled from those states — therefore they aren't required to be extradited back to those states, Cohen said. If Louisiana tries to take its case to federal court, he said, 'they're going to lose because the Constitution is clear on this.' 'The shield laws certainly do undermine the notion of interstate cooperation, and comity, and respect for the policy choices of each state,' Cohen said, 'but that has long been a part of American law and history.' Louisiana senators face wrongful death lawsuit against nursing home they co-own When states make different policy choices, sometimes they're willing to give up those policy choices to cooperate with another state, and sometimes they're not, he said. The conflicting legal theories will be put to the test if this case goes to federal court, other legal scholars said. 'It probably puts New York and Louisiana in real conflict, potentially a conflict that the Supreme Court is going to have to decide,' said Rebouché, dean of the Temple University Beasley School of Law. Rebouché, Cohen, and law professor Greer Donley worked together to draft a proposal for how state shield laws might work. Connecticut passed the first law — though it did not include protections specifically for telemedicine. It was signed by the state's governor in May 2022, over a month before the Supreme Court overturned Roe, in anticipation of potential future clashes between states over abortion rights. In some shield-law states, there's a call to add more protections in response to Carpenter's indictment. New York state officials have. On Feb. 3, Hochul signed a law that allows physicians to name their clinic as the prescriber — instead of using their own names — on abortion medications they mail out of state. The intent is to make it more difficult to indict individual doctors. Der Simonian is pushing for a similar law in Maine. Samantha Glass, a family medicine physician in New York, has written such prescriptions in a previous job, and plans to find a clinic where she could offer that again. Once a month, she travels to a clinic in Kansas to perform in-person abortions. Carpenter's indictment could cause some doctors to stop sending pills to states with bans, Glass said. But she believes abortion should be as accessible as any other health care. 'Someone has to do it. So why wouldn't it be me?' Glass said. 'I just think access to this care is such a lifesaving thing for so many people that I just couldn't turn my back on it.' SUPPORT: YOU MAKE OUR WORK POSSIBLE This article is from a partnership that includes WWNO, NPR, and KFF Health News. It first appeared on KFF Health News and is republished here under a Creative Commons license. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF and subscribe to KFF Health News' free Morning Briefing.
The Guardian
26-04-2025
- Health
- The Guardian
Volunteers rush to send abortion pills to US women in need as ‘war between the states' looms
Seated around a circular table in a nondescript office building just outside Boston, the volunteers pack the abortion pills into envelopes with practiced efficiency. Each of the volunteers – five women and one man – have a unique role in the assembly line. One volunteer drops slim, orange boxes of mifepristone, the first drug typically used in a medication abortion, into the envelopes, while another volunteer adds green-capped bottles of the second drug, misoprostol. A few volunteers add brochures on topics such as how to use abortion pills or what to do if a woman suspects she has an ectopic pregnancy. Finally, one volunteer drops small purple cards into each envelope. They all bear the same handwritten message: 'We wish you the best.' The cards are signed with a swooping heart and a nondescript name: 'the Map', or the Massachusetts Medication Abortion Access Project. By the end of the day, dozens of these envelopes will have been dropped off at a US Postal Service office – many on their way to people who live in states that have banned abortion. The Map is one of a handful of organizations operating under a controversial legal innovation known as a 'shield law'. Enacted by eight states in the years since the US supreme court overturned Roe v Wade, shield laws are designed to protect abortion providers from red-state prosecutions and legal actions, even if the providers' patients are located in states that ban abortion. Providers in shield law states routinely ship abortion pills across state lines: in spring 2024, they facilitated more than 7,700 monthly abortions in states with total or six-week abortion bans, according to #WeCount, a research project by the Society of Family Planning. But shield laws are now being put to the test. In December, Texas sued Dr Margaret Carpenter, a New York doctor, over allegations that she violated Texas's abortion bans by mailing abortion pills to a Texas woman. Then, in January, a Louisiana grand jury criminally indicted Carpenter. The New York governor, Kathy Hochul, has refused to sign an extradition order for Carpenter. Citing the state's shield law, a New York county clerk has also refused to enforce a $113,000 fine, levied by a Texas court, against her. Now, Texas is expected to sue New York over the shield law – a move that could ultimately land the case in front of the supreme court, dominated 6-3 by conservatives, and tip the balance of power between states that protect abortion rights and those that do not. 'No one wanted this, but it's not unexpected,' said Dr Angel Foster, the Map's co-founder, of the state-on-state fight. 'I think we were prepared for this to happen, and we're waiting for the next shoe to drop.' The legal battle has not slowed down demand at the Map. Before dropping their prices last year, the Map was mailing pills to about 500 patients a month. Now, it provides pills to roughly 2,500 per month. 'Since the election, it's felt even more urgent to have a tangible and literally hands-on impact. A package is going to somebody who needs it, in a place where they are being denied their rights,' one Map volunteer said as she sealed envelopes. She spread her palm out on a package as if she were placing a hand on a Bible. 'It's going to a real person.' To order pills from the Map, a patient must be within their first trimester of pregnancy and at least 16, the age of consent for an abortion under Massachusetts law. After they fill out an online intake form, a licensed clinician reviews their chart; if a patient has questions, someone from Map will take their call. Because the organization operates on a sliding scale, patients can receive pills for as little as $5. On one recent Tuesday morning, Cheryl, a retired OB-GYN, sat in the Map's tiny, dimly lit office and quietly clicked through patients' charts, evaluating the answers to questions about the date of their last period and their past pregnancies. Patients shared why they wanted abortions, but Cheryl rarely lingered over their answers. One, however, struck her: a 25-year-old single mom who felt like another pregnancy would endanger her ability to take care of her child. It reminded Cheryl of the five years she spent providing abortions at Mississippi's last abortion clinic, which shuttered shortly after the supreme court's 2022 decision in Dobbs v Jackson Women's Health Organization paved the way for state abortion bans to unfurl across the US. 'That was a really common refrain: 'I just want to do right by the kids I have,'' Cheryl recalled. About half of the Map's patients, she said, already have children. They are also predominantly under 35 and people of color – similar to abortion patients writ large, at least before Roe fell. After Roe's collapse forced the Mississippi clinic to close, Cheryl started providing abortions in North Carolina – until that state banned the procedure after 12 weeks and the clinic where she worked no longer needed her services. 'I was sitting at home, being sad and useless and doing local advocacy stuff,' Cheryl said. She also grew increasingly angry and frustrated with what she saw as mass complacency with the post-Roe reality. That's when someone told her: 'I have just the group for you.' Working with the Map means assuming a certain level of risk. There is no way to guarantee that a staffer or volunteer won't get drawn into a lawsuit – or worse. To diffuse risk, the Map never mails anything that includes clinicians' names. Foster no longer travels to or through states with abortion bans, and does not drive outside of Massachusetts; she doesn't want to run the risk of getting pulled over for speeding and learning that another state has put out a warrant out for her arrest. This is also, in part, why the Map relies on an assembly line to put its packages together: there is no single person to point a finger at. 'I'm feeling like the people that have the power to protect us really aren't, so we just have to keep moving along and doing what we think is right,' Cheryl said. 'It's terrifying, but the whole world is terrifying. I feel like just walking down the street these days is terrifying. Someone's going to whisk you off and accuse you of writing an op-ed or something.' She asked to be identified only by her first name to protect her ability to travel in the US, although Cheryl has no plans to enter a state with an abortion ban. As Cheryl worked, a US map dotted with silver stars glimmered on the wall above her head. Each star represented the location of a patient served in October 2023, the Map's first month of operation. Although sky-blue areas like the coast of Oregon glinted with stars, most were clustered in the south-eastern US, which is now blanketed in abortion bans. Today, a third of the Map's patients come from Texas, which outlaws virtually all abortions, while another third hail from Florida and Georgia, which both prohibit abortion past six weeks of pregnancy. The map's constellations illuminate a paradox of the post-Roe US: even though 26 million women of reproductive age live under a total or six-week abortion ban, many are still receiving abortion pills in the mail or crossing state lines to visit a brick-and-mortar clinic. In 2023 and 2024, the US saw more than 1m abortions – some of the highest numbers in a decade, according to the Guttmacher Institute. The question is whether this paradox is sustainable. Anti-abortion activists consider this kind of interstate networking an existential threat. While Texas and Louisiana have gone after Carpenter, a number of states have attempted to criminalize people who help others cross state lines for abortions. Courts have frozen many of those efforts, but these legal battles are far from over. With different US states now home to fundamentally contradictory reproductive regimes, both sides – whether they seek to punish out-of-state travel or offer banned healthcare – are scrambling traditional codes of conduct between states, creating new questions about what the constitution allows. These questions are sure to end up before the supreme court. 'There isn't really much of a precedent for anything like shield laws, and the courts are very conservative,' warned Mary Ziegler, a University of California, Davis School of Law professor who studies the legal history of reproduction. The US constitution protects people's right to travel, but also mandates that states honor court rulings from other states – such as the fine that Texas won against Carpenter (because she and her lawyer did not show up to a court date in the state). In addition, the constitution specifies that, if an individual commits a crime in one state and 'shall flee from justice' to another state, that individual must be 'delivered up' – or extradited – back to the scene of the crime. Yet there's no evidence that Carpenter and other shield law providers did 'flee from justice'; rather, they're practicing within and obeying the law of their own home states. 'New York is going to say: 'She's not a fugitive. This is not the kind of scenario where a court should get involved,'' Ziegler said. 'Precedent would say they don't have to extradite her, and the question would become whether Louisiana can find a way around that.' Ziegler also questioned whether Texas could convince a court to force New York to collect its $113,00 fine. The constitution, she said, forces states to recognize fines levied in lawsuits between individuals – not necessarily fines that result from a lawsuit by a state against an individual. But Steven Aden, the chief legal officer and general counsel at the powerful anti-abortion group Americans United for Life, is bullish about Texas's chances. 'You can't go to Reno and incur a gambling debt in a casino and then go back home and raise a defense in court, when the casino comes after you for that gambling debt, by saying: 'We don't have gambling in our state,'' Aden said. Ziegler and Aden did agree on one thing, though: not only is the supreme court all but certain to take up Carpenter's case in one form or another, but the high court will likely see a deluge of similar cases over the next several years. 'These are the first shots fired in what we like to call – what we reluctantly, I guess, call – a coming war between the states,' Aden said. Experts have noted that the closest parallels are the pre-civil war battles over how to treat enslaved people who had escaped southern states (which permitted slavery) and fled to northern states (which did not). When these disputes reached the US supreme court, as in the case of Dred Scott v Sandford, the court repeatedly sided with enslavers and lent power to the federal government to enforce pro-slavery laws. The modern-day dispute between states over abortion is dramatically different from the 19th-century interstate battle over slavery – but Abraham Lincoln's famous warning still seems to resonate: 'A house divided cannot stand.' Other threats to abortion pills could soon imperil shield-law providers, too. The attorneys general of Idaho, Kansas and Missouri are now pursuing a lawsuit that could roll back providers' ability to prescribe the pills through the mail. Anti-abortion activists are also trying to cajole the Trump administration to enforce the Comstock Act, a 19th-century anti-vice law that bans the mailing of abortion-related materials but went dormant under Roe. The Map would close if the law no longer protected its work, Foster said. But that doesn't necessarily mean she would give up. 'We might, as a group of people, decide to pivot and do something that's around civil disobedience, and create a different kind of entity doing different work,' she said. Even if anti-abortion forces prevail in court, there is likely no way to keep abortion pills out of US hands. The US Postal Service already fails, frequently, to detect the illicit drugs that swim through it. In addition to shield law abortion providers, there is a thriving online market for abortion pills that are sent straight from overseas pharmacies, allowing women to end their pregnancies without involving the formal US healthcare system. (Medical experts widely agree that it is safe to end your own pregnancy using pills in the first trimester of pregnancy.) For now, the Map has no shortage of volunteers. As the volunteers stuffed abortion pills into envelopes, a woman working in another part of the office building, who had no connection to the group, walked by the conference room and asked Foster: 'Can I volunteer?' Another bystander told them: 'Thank you guys for what you're doing.' It took less than two hours for the volunteers to package some 200 envelopes. Soon after they departed, another pair of volunteers arrived to add shipping labels and drop off the packages, discretely packed into a bin, at a nearby post office. In January, the Map was mailing roughly 150 packages a day – in part, Map project manager Andrea suspects, due to fears surrounding Donald Trump's inauguration – but that volume has slowed, to about 65 to 85 packages a day. (Andrea asked to be identified by her first name only.) A woman working at the post office once asked Andrea if she was running a jewelry business, given the number of shipments and the rattling sounds each package made. She had mistaken the pills for beads. Andrea smiled. She did not confirm or deny.
