Texas AG sues telemedicine abortion provider in first-of-its kind lawsuit
There has never been a telehealth provider who has been sued by state authorities for prescribing across state lines. It brings the first challenge to shield laws protecting those doctors.
Texas Attorney General Ken Paxton filed a lawsuit against a New York abortion provider for violating the state’s law banning telehealth abortions.
The doctor in question is Margaret Daley Carpenter, a New York doctor and founder of the Abortion Coalition for Telemedicine. Paxton said she provided a Collin County resident with abortion-inducing drugs that resulted in serious complications for the mother, who then required medical intervention. Paxton is seeking a $250,000 civil penalty.
This is the first attempt by any attorney general or state authority to pursue civil charges against an out-of-state provider for violating laws that forbid prescribing abortion medication through telehealth.
According to the civil complaint, in mid-May 2024, a 20-year-old female resident of Collin County, Texas, became pregnant. She did not have any life-threatening physical condition aggravated by, caused by, or arising from the pregnancy that placed her at risk of death or any serious risk of substantial impairment. The mother used telemedicine or telehealth services and received, through Carpenter, two abortion-inducing drugs or prescriptions.
The case is interesting because it arises out of a concern for the man who impregnated her. The woman who had the abortion hadn’t told him that she was pregnant. Upon complications alleged to have come from the abortion medication, he discovered that she had sought reproductive care to end her pregnancy while taking her to a hospital to treat hemorrhaging. Later, he returned and found the medication containers for mifepristone and misoprostol.
I contacted Dr. Carpenter and did some research on her organization. In May, The Nation featured an interview with Dr. Linda Prine, a New York City doctor who helped form it. Julie F. Kay, an attorney who cofounded the Abortion Coalition for Telemedicine with Prine and Dr. Maggie Carpenter, told the publication that they launched the organization because they weren’t getting enough support on telemedicine shield laws from mainstream groups. She said few “of the traditional reproductive rights or pro-choice organizations were interested in making shield laws a priority.”
“If we don’t support those who are taking the risk to provide services, whether through telemedicine shield laws or other practices, we’re simply shifting the risk onto the patients, and onto the most marginalized women and pregnant people who don’t have the money to travel or who are more subjected to a racist criminal justice system.”
Some organizations and doctors have dragged their feet supporting telehealth because it removes operating revenue from their businesses. The San Francisco Chronicle reported in June that Planned Parenthood privately lobbied officials in California, New York, and Massachusetts against shield laws allowing doctors to provide abortion medication via telehealth, sources told the Chronicle. They aren’t alone. I’ve also spoken to some abortion providers who don’t support it at all.
There also remain many challenges at lower levels of government as there are jurisdictional disputes between different states over where the location of an abortion should be designated. That matters because pills can be prescribed from elsewhere and taken in an abortion-restrictive or banned state. If the abortion is deemed to have happened in a place like Alabama, then it would be considered a violation of state law.
That’s something that pioneering abortion rights scholars Greer Donley, David Cohen, and Rachel Rebouche wrote about in a Stanford Law Review article published in February. They pointed out that the location of an abortion could be at several places.
It could be where the patient interacts with the medical professional and receives the pills. It could be when the patient ingests the mifepristone, which could be in the medical office or later when the patient returns home. It could be where the patient ingests the misoprostol, which usually occurs twenty-four hours after the mifepristone is taken. Or it could be where the patient expels the products of conception, which could happen within hours of taking the misoprostol or a few days later. With each step, a patient could be in a different location. And the laws may differ.
In his news release, Paxton said that Texas laws prohibit a physician or medical supplier from providing any abortion-inducing drugs by courier, delivery, or mail service. He argues that no physician may treat patients or prescribe Texas residents medicine through telehealth services unless the doctor holds a valid Texas medical license.
“In this case, an out-of-state doctor violated the law and caused serious harm to this patient. This doctor prescribed abortion-inducing drugs—unauthorized, over telemedicine—causing her patient to end up in the hospital with serious complications. In Texas, we treasure the health and lives of mothers and babies, and this is why out-of-state doctors may not illegally and dangerously prescribe abortion-inducing drugs to Texas residents,” said Attorney General Paxton.