Judge rules against use of telemed abortion system

DES MOINES — Iowa regulators were within their authority when they voted to ban a first-in-the-nation videoconferencing system that allows doctors here to dispense abortion drugs to women in rural clinics, a Polk County District Court judge ruled Tuesday.

Planned Parenthood of the Heartland had sued the Iowa Board of Medicine, contending that the board's decision to ban doctors from using its system was a blatant attempt to limit rural women's access to abortions.

"There is no question that the board has the power to establish standards of practice for the medical profession," Polk County District Judge Jeffrey Farrell wrote in allowing the prohibition. "Those standards include the authority to adopt and enforce standards regarding the minimal standards of acceptable and prevailing practice."

The system has remained in use while the two sides wrangled in court. The judge's ruling is set to take effect in 30 days. A Planned Parenthood spokeswoman said her agency will file a legal appeal.

Planned Parenthood contends that the board's decision, made last year, was political. It noted that Iowa Gov. Terry Branstad, a Republican and abortion opponent, appointed all 10 board members.

But the judge wrote that the board met legal requirements for making new rules, including holding public hearings and accepting written comments on the matter. He wrote that some of the board's moves invited scrutiny because "the board acted on the petition for rulemaking only three days after it was received and in contravention of advice from its in-house counsel and attorney general representative."

He also noted that the board declined requests from the state's main doctors' associations to take additional time to consider the matter.

Yet the board cited legitimate reasons to require physicians to perform an in-person physical examination before prescribing the abortion pills, Farrell wrote. If the service is no longer offered at satellite clinics, rural Iowa women would have to travel farther to obtain abortions, but he said this would not cause undue hardship.

Abortion opponents are confident that Planned Parenthood's telemedicine system will be shut down, said Jenifer Bowen, executive director of Iowa Right to Life.

Bowen predicted that fewer Iowa women would have abortions once the system is turned off, but she said it's unclear how many would be affected.

"It could be 12 lives saved in a year. It could be 1,200 lives saved in a year," she said.

Although the system tripled the number of Iowa towns where abortion services were available, it did not lead to an increase in the overall number of abortions in the state. In the most recent six years for which numbers are available, Iowa abortions decreased 30%, from 6,649 in 2007 to 4,648 in 2012, state records show.

Abortion opponents contend those numbers reflect their efforts to persuade Iowa women to avoid abortion. Planned Parenthood says the abortion decline is mainly because of increased use of contraceptives, including long-acting types.

Plannned Parenthood of the Heartland started using its first-in-the-nation video-conferencing system in 2008. More than 5,000 women have used it to obtain abortion pills at outlying clinics, mainly in rural areas.

Mark Bowden, the medical board's executive director, said the judge's ruling affirmed that board members took appropriate action.

"The board carefully studied the issue and provided ample opportunity for public comment before adopting the rule," Bowden wrote in e-mail. "The board considers a thorough medical history and physical examination to be the cornerstone of good medical care. The rule requires this valid physician-patient relationship prior to prescribing abortion-inducing drugs, and the rule requires an appropriate follow-up appointment to confirm the termination of the pregnancy and to evaluate the woman's medical condition."

Doctors in Des Moines or Iowa City use the system to communicate with patients and view sonogram results via closed-circuit video. If they decide a woman is eligible for an early term abortion, the doctors enter a computer command that opens a drawer in front of the patient.

The woman reaches into the drawer, removes the pills and takes the first one while the doctor watches via video. The woman then goes home, takes the remaining pills and has what amounts to an induced miscarriage.

Supporters say the system is a way to provide access to a safe and legal medical treatment. They contend it meets the terms of an Iowa law that allows only physicians to perform abortions. Detractors say the system exposes women to potentially dangerous drugs without proper medical oversight.

Planned Parenthood's video-conferencing system is not being used in as many places as it initially was because the agency has closed several small clinics and stopped providing telemedicine abortions at some others.

In 2011, Planned Parenthood officials said 16 Iowa clinics were hooked into the system. Earlier this year, the agency said seven clinics were using it.

Planned Parenthood said the shifts were made for efficiency reasons though abortion opponents say their prayer vigils and education efforts helped bring about the clinic closures.