Iowa state board votes to halt “tele-med” abortions

DES MOINES – A state panel that oversees and regulates physicians and medical practices in Iowa voted Friday to adopt rules curtailing doctors’ ability to dispense abortion-inducing pills via a video-conferencing system, citing concerns over the medical care being provided to rural women.

The Iowa Board of Medicine voted 8-2 to approve proposed administrative rule that would establish standards of practice for physicians who prescribe and administer abortion-inducing drugs. The revised rules – which could take effect in November – would require in-person meetings between doctors and patients along with direct after-care services.

“How can any of us possibly find that a medical abortion performed over the Internet is as safe as one provided by a physician in person at the bedside? I will vote for adopting this rule,” said board chairman Greg Hoversten, an Iowa City physician who formerly served in the Iowa House as a Sioux City representative.

“It is not about abortion, this is about standard of care,” said Dr. Hamed Tewfix, an Iowa City physician who moved that the board adopt a rule change to effectively halt the telemedicine services currently provided at clinics operated by Planned Parenthood of the Heartland.

At issue is a practice whereby licensed physicians use a remote-controlled system to conduct medical assessments with patients in rural Iowa clinics. They then are able to dispense Mifepristone, also known as RU-486, in the early stages of a pregnancy. Proponents say Planned Parenthood’s practice – implemented in 2008 — is safe and patients get the same level of care as those who see a doctor in person. They contend telemedicine procedure was thoroughly researched to ensure it was in full compliance with Iowa law and service helps women in remote parts of the state.

However, board member Msgr. Frank Bognanno of Des Moines expressed concern that abortion-related services were being provided without adequate guidelines and administered by medical assistants with minimal training.

“This is Iowa. This isn’t Tanzania. What’s going on here?” Bognanno said in expressing concern that young women are being given a pill and told to call an 800 number if they experience complications.

“I think we could do a little better than this. This is a big deal. This isn’t like taking an aspirin,” he said. “This is substandard.”

Board member Anne Gales, a Bode attorney, said she preferred the state panel made up of 10 members all appointed by Gov. Terry Branstad delay a decision until a subcommittee made up of physicians on the board and other stakeholders could thoroughly examine the issue, especially the impact on rural women.

Abortion opponents asked the state board to block the program, saying it violates state medical standards and poses a health risk to women because it doesn’t entail a face-to-face meeting with the doctor.

Following the meeting, Jill June, president and chief executive officer of Planned Parenthood of the Heartland, issued a statement charging that the board has “rushed to judgment” in voting to ban telemedicine delivery for medication abortion for Iowa women.

“This decision is a political attack aimed at restricting access to abortion in Iowa. Proponents of this rule aren’t against telemedicine technology; they are against safe, legal abortion and are unjustly targeting our system with no scientific information or evidence to back their claims,” June said.

“This undermines the concept and integrity of the Board of Medicine and health care in Iowa as we know it,” added June, who pledged that her agency would continue to provide medication abortion through telemedicine delivery at 15 health centers across Iowa until the rule goes into effect.

Prior to Friday’s vote, Planned Parenthood legal counsel Mike Falkstron requested that, if board members took action to approve the rule change, they stay the implementation after the Nov. 6 effective date pending any litigation over the issue. The board did not follow his recommendation, however.

“We’re just going to keep all of our options on the table. We will update you when any action has been taken,” Falkstron said after the meeting.

The Iowa Medical Society had asked the board to put the rule on hold rather than adopt it Friday, expressing concerns that other tele-medicine practices will be thrown into doubt if the board adopts the rule. - See more at:

http://theiowarepublican.com/2013/planned-parenthood-chairman-refuses-to-answer-questions-at-webcam-abortion-hearing/
“Planned Parenthood Chairman Refuses to Answer Questions at Webcam Abortion Hearing”
“A three and a half hour long hearing on webcam abortions provided plenty of drama on Wednesday, as pro-life and pro-abortion activists stated their case during a public hearing. Much of that drama did not reflect well on Planned Parenthood and its representatives.

The Iowa Board of Medicine called for the hearing to discuss banning the practice of tele-med, or webcam, abortions. Planned Parenthood of the Heartland, which includes clinics throughout Iowa, began the practice in 2008. A petition sent to the Board of Medicine by 14 Iowa doctors asked them to look into the long distance abortions and decide whether or not to ban them.

Tele-med abortions are performed via a webcam conversation between a Planned Parenthood doctor and a pregnant woman. They are often hundreds of miles apart. The doctor pushes a button and a drawer opens, providing an abortifacient to the patient. She takes one pill at the clinic and another later at home. This method induces a miscarriage. Critics of the method say it is dangerous for the woman, since she is not cared for by an in-person physician.

Around 30 speakers, split fairly evenly on both sides, stated their case during the hearing. The most heated discussion of the day ensued between Iowa Board of Medicine member Dr. Robert Bender and Planned Parenthood of the Heartland Chairman Robert Shaw.

Bender noted that a previous speaker, former Planned Parenthood nurse Todd Buchacker, mentioned that physical examinations of patients at the clinics were sometimes done by CMAs (certified medical assistants).

Dr. Bender noted that CMAs are not qualified to perform these examinations. Bender grilled Chairman Shaw about this practice and asked if Shaw, also a physician, ever relied on CMAs to perform physicals in his private practice. Shaw repeatedly refused to answer. In doing so, he appeared evasive and clearly came out of the exchange looking worse.

It would appear that Planned Parenthood’s speakers at the hearing accidentally opened up a whole can of worms they did not intend to. Bender says their reliance on CMAs, instead of licensed doctors, is a dangerous practice that violates the basic tenets of standard care.

“The basis of medicine is the history and physical,” Dr. Bender told TheIowaRepublican.com after the meeting. “If you came to my office and I had a CMA come in and examine you, come out, tell me his opinion, and I said, ‘Oh, give him this’, and you left, that’s not good medicine. I don’t know who can argue with that. I think one of our colleagues here asked me when I said that if I’m going to argue with the American College of OB-GYN, well, if they say a history and physical isn’t necessary, then yes, I will argue with them.”

Sue Thayer, who worked at the Planned Parenthood clinic in Storm Lake, testified that she would be required to perform ultrasounds, although she was not qualified to do so. Thayer also stated that when the organization began providing webcam abortions, they wanted to “establish a new standard of care without anyone knowing about it.”

Iowa Right to Life Executive Director Jenifer Bowen attended the entire hearing and was pleased with a lot of what she heard, but realizes the battle to ban webcam abortions is not over.

“I was cautiously optimistic going into this. I still am cautiously optimistic,” Bowen said. “The more that the Iowa Board of Medicine asks questions, the more concerned

they became. It wasn’t just the webcam abortions that started to unravel. Issues were raised about how performs ultrasounds, and are they qualified. One person testifies that it’s RNs doing exams and another testifies that sometime’s it’s a CMA. So, I think in a lot of ways, the more Planned Parenthood revealed, the worse it got for them.”

Iowa Board of Medicine Chairman, Dr. Greg Hoverstein, said the board will take its time and consider all of the input from today’s hearing, as well as written statements and other evidence before making a decision on whether or not to ban webcam abortions. Iowa Right to Life has tried to ban webcams via the legislative process, but has been unable to do so.’’

video at:
http://www.youtube.com/watch?v=fUH8YpYIiJs

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