Bill Renews Debate Over Rural Access to Abortion

Before Texas' abortion sonogram law passed last legislative session, some women in rural communities seeking to end their pregnancies relied on telemedicine, with physicians — working in partnership with medical technicians or nurses — administering prescription drugs via videoconference to induce early-stage abortions. 

If new legislation filed by Sen. Dan Patrick, R-Houston, passes in 2013, women in remote corners of the state may have even fewer options to get the procedure. 

2011's abortion sonogram law — another measure Patrick championed — requires that a physician, as opposed to a technician or nurse, perform a sonogram on a woman seeking an abortion at least 24 hours ahead of the procedure. That in effect prohibits the use of telemedicine for drug-induced abortions, which opponents of the procedure call a welcome consequence for a little-discussed practice.   

SB 97, Patrick's latest measure, would further increase the in-person requirements for physicians. In addition to the in-person sonogram 24 hours ahead of the abortion, doctors would have to personally administer both of the two medications used for drug-induced abortions, and see the patient again for a follow-up appointment within 14 days, a particular challenge for the roving doctors who treat women in the state's rural counties.

Amy Hagstrom Miller, CEO of the abortion provider Whole Woman’s Health, said that before last session's sonogram law took effect in February, her clinics in Beaumont, McAllen and Fort Worth relied on telemedicine. A technician would perform the sonogram and a physician based in Austin would review the patient’s medical records, then videoconference with the patient to answer any questions. 

"Through telemedicine we were able to serve women in communities, mainly more rural communities, where access to abortion was much more difficult,” she said.

In an email, Patrick said the intent of SB 97, his new legislation, is to improve the doctor-patient relationship. And Joe Pojman, the executive director of Texas Alliance for Life, said, "For safety reasons and good care for women concerning abortion, a physician clearly should be present when an abortion pill is administered.” 

Only one of the two drugs used in abortions — Mifeprex, or RU-486 — is required by the Food and Drug Administration to be taken under the supervision of a physician. Patrick's bill appears to require that a second drug, misoprostol, or Cytotec, be administered by the physician. Most abortion clinics allow women to take misoprostol — which is administered two days after the first abortion pill — at home.  

“That’s unprecedented in this country,” said Hagstrom Miller, adding that there is “tons of medical literature that proves that second dose is able to be administered by the woman at home.”

Hagstrom Miller called another provision in Patrick's proposed bill — one that requires the physician performing the abortion to have a written contract with a back-up physician, and provide the state with that doctor’s name and phone number — a “witch hunt” intended to discourage doctors with hospital privileges from partnering with physicians who provide abortions. “It is a huge thing to add,” she said.

Hagstrom Miller said the number of abortions at Whole Woman’s Health clinics has decreased since the sonogram law took effect — but she emphasized that viewing the sonogram has not changed many women's minds. Rather, she said the logistical hurdles created by the law have limited access to abortions and the abortions still being performed are often occurring later than women want. She said the effects of the law have been starkest at the clinics that previously used telemedicine, because those clinics often only have a physician on site two weekends a month.

Dr. Dan Grossman, who co-authored a study on telemedicine abortions in Iowa published in the American Journal of Public Health on Thursday, found that early abortion "is safer than later abortion, and from a public health perspective, providing early medical abortion using telemedicine makes sense.” 

But Pojman said the 24-hour waiting period and face-to-face consultation with a doctor required by Texas' abortion sonogram law raised the standard of care for women seeking abortions statewide. 

“Women should receive the same standard of care for abortion that patients for virtually every other medical or surgical procedure in Texas receive,” he said.