March 12, 2015 — The Iowa Supreme Court on Wednesday heard oral arguments over whether a state rule banning the use of telemedicine in abortion services was a legitimate exercise of state authority or an unconstitutional restriction on women's access to abortion, the Cedar Rapids Gazette reports (Boshart, Cedar Rapids Gazette, 3/11).
The case was heard by six justices, with one justice recusing himself from the case (Leys, Des Moines Register, 3/11). According to the AP/Bellingham Herald, the state Supreme Court is not expected to release a ruling in the case for several months (AP/Bellingham Herald, 3/11).
In the case, Planned Parenthood of the Heartland is challenging an Iowa Board of Medicine rule that bans the use of telemedicine in abortion services. PPH's telemedicine system has enabled more than 7,000 women in the state to access medication abortions since 2008.
Although the Iowa Board of Medicine in 2010 ruled that doctors at PPH could continue to dispense medication abortion drugs via the telemedicine system, Gov. Terry Branstad (R) later replaced all of the board members, who then approved rules barring PPH from administering medication abortions through the system.
PPH challenged the ban in court. The Iowa Supreme Court stayed the ban in September as the case proceeds through the legal system.
The case is the first involving abortion rights to reach the state Supreme Court in more than 40 years and is being nationally watched by stakeholders on both sides of the abortion-rights debate (Women's Health Policy Report, 3/11).
PPH's Oral Arguments
Attorney Alice Clapman, arguing on behalf of PPH, said during oral arguments that the board's decision was not constitutional because it had no basis in medical evidence.
She said that "[i]t was a highly irregular process" that "was opposed by medical organizations" (AP/Bellingham Herald, 3/11). Specifically, Clapman noted that the largest physician association in the state and the largest obstetrician group in the U.S. objected to the rule (Des Moines Register, 3/11).
Further, Clapman urged the court to "honor its own tradition of zealously protecting individual rights and accordingly to hold that the board rule violates the Iowa Constitution because it deprives women of their reproductive freedom." According to Clapman, the rule would put abortion rights at risk and would restrict the reproductive freedom of women in the state by potentially increasing costs, delays and travel time.
She said, "Telemedicine advances are medical advances for patients and there is no reason why ... pregnant women should be singled out and denied medical advances regardless of how risk adverse the board is. And these are advances that have been demonstrated to improve patient safety" (Cedar Rapids Gazette, 3/11).
State's Oral Arguments
Meanwhile, Iowa Solicitor General Jeffrey Thompson argued that the telemedicine ban "is within the Board of Medicine's authority" and "is absolutely constitutional."
Thompson said he would not object to the court finding that the state constitution protects abortion rights. However, he said that if the state Supreme Court does so, it should apply the U.S. Supreme Court's "undue burden" standard to the medical board's ruling. He argued that the board's ruling did not impose such a burden on women in the state.
In addition, he said the medication used for the procedure "is a unique drug" and "not a typical pharmaceutical" (Des Moines Register, 3/11). Further, he said federal courts have found that states have an interest in making sure medical and health standards are met, which he said was the intention of the medical board's rule (Cedar Rapids Gazette, 3/11).
Thompson added that the rule was designed to help remove "uncertainty for doctors" and "uncertainties for Planned Parenthood" (AP/Bellingham Herald, 3/11).
Justices Question Both Sides
Some justices posed questions that suggested they are wary of overruling the medical board, while others asked questions indicating they had concerns that the board might have singled out abortion care for special regulation, the Des Moines Register reports (Des Moines Register, 3/11).
For example, Justice Thomas Waterman asked Clapman, "[S]houldn't our court defer to the medical judgment of the Iowa Board of Medicine? We went to law school, not medical school." Clapman said the role of the state Supreme Court is to serve as an "effective check" in evaluating the actions of the executive branch (Cedar Rapids Gazette, 3/11).
Meanwhile, Justice David Wiggins asked Thompson if the state medical board had similarly specific rules for other medical practice areas, such as family medicine or neurology. He asked, "Is there any other standard of care such as this contained in any rule or regulation of the (Board of Medicine) that you're aware of?"
Thompson responded, "Not that I'm aware of" (Des Moines Register, 3/11).
In response to questioning by Chief Justice Mark Cady, Thompson also acknowledged that nothing had changed between when the board initially approved telemedicine abortions and its later decision banning the practice (Cedar Rapids Gazette, 3/11).
PPH 'Cautiously Optimistic'
PPH Chief Operating Officer Suzanna de Baca said she is "cautiously optimistic" about the case (Cedar Rapids Gazette, 3/11). She added that access to legal, safe abortion care is "a woman's constitutional right, and we certainly hope that in Iowa that will be preserved and women will continue to have the access they need to this kind of safe care" (AP/Bellingham Herald, 3/11).