Inside the legal fight over the telehealth clinics that help women defy
abortion bans
[June 13, 2025]
By MICHAEL HILL and SUSAN HAIGH
Every month, thousands of women thwart abortion bans in their home
states by turning to telehealth clinics willing to prescribe
pregnancy-ending drugs online and ship them anywhere in the country.
Whether this is legal, though, is a matter of debate. Two legal cases
involving a New York doctor could wind up testing the shield laws some
states have passed to protect telehealth providers who ship abortion
pills nationwide.
Dr. Margaret Carpenter faces a felony charge in Louisiana for supplying
abortion medication through the mail to a pregnant teen in that state.
The patient's mother also faces criminal charges. A Texas judge fined
the same physician $100,000 after the state accused her of prescribing
abortion medication for a woman near Dallas.
So far, the prosecution hasn't progressed thanks to New York's shield
law, which has protected Carpenter from extradition to Louisiana. But
other telehealth centers operating in states with similar legal
protections for abortion providers are watching closely.
"We have great legal counsel who have advised us that what we are doing
is legal,” said Dr. Angel Foster, co-founder of The Massachusetts
Medication Abortion Access Project, which is among a handful of
telehealth providers that facilitate abortions from afar in states with
bans.
As more states consider enacting shield laws or expanding existing ones,
whether one state can shield providers from liability for breaking
another state's laws around abortion is still an unsettled area of law.
Erik Baptist, senior counsel for the Alliance Defending Freedom, which
opposes abortion, said shield laws violate a constitutional requirement
that states respect the laws and legal judgments of other states.
"What these shield law states are doing are undermining the prerogative
of these pro-life states to implement and enforce pro-life laws,” said
Baptist, director of the group’s Center for Life. ”And so I think the
Supreme Court ultimately will want to take this.”
“That is inherently a challenge with shield laws and telehealth,” said
Carmel Shachar, faculty director of the Health Law and Policy Clinic at
Harvard Law School. “At a certain point, for the purposes of abortion
bans, the courts will need to decide: Do we treat a telehealth abortion
as happening within the state of the provider or within the state of the
patient?”
Abortion pills sent to your home
Decades ago, the FDA approved the use of two prescription medicines —
mifepristone and misoprostol — to terminate pregnancies.
But it wasn't until 2023 that telehealth abortions across states became
more popular, after the U.S. Supreme Court overturned Roe v. Wade in
2022.
The Society of Family Planning, which supports abortion rights, said
that between April and June 2024 there were an average of 7,700
telehealth abortions performed each month in states that either ban
abortion totally or after six weeks of pregnancy.
The prescribing process at telehealth clinics varies by provider, but
usually takes place entirely online, with the patient answering a series
of health-related questions and consent forms.
At some telehealth clinics, medical providers don't come face-to-face
with patients, even via videoconferencing, and patients don't
necessarily know the prescriber's name unless requested.
For instance, when Foster's clinic, also known as The MAP, puts pills in
the mail, only the name of the practice appears on the label, as allowed
under the Massachusetts shield law. If patients have follow-up
questions, they can talk or text the doctor working that day, but may
not know that doctor's name either.
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Dr. Angel Foster, co-founder of Massachusetts Medication Abortion
Access Project, points out on a map of the United States where her
organization provides care, May 13, 2025, in Somerville, Mass. (AP
Photo/Charles Krupa)
 Pills can arrive in a less than a
week.
“This has been the safety net, post-Dobbs, of allowing people who
don’t have the ability to travel out of state to get abortion care,”
said Greer Donley, a University of Pittsburgh law professor and
abortion law expert.
When dealing with medications not related to
abortion, doctors are often able to write prescriptions for patients
in other states. However, in most states, if the patient is located
within its borders, the doctor must have a license issued by that
state, according to Mei Wa Kwong, executive director of the The
Center for Connected Health Policy.
States with shield laws
Twenty three states and Washington, D.C., currently have shield laws
protecting abortion providers.
Of those, eight have specific provisions protecting them from
criminal prosecution or civil lawsuits even if the patient is in
another state, according to the nonprofit research organization KFF.
They include California, Colorado, Maine, Massachusetts, New York,
Rhode Island, Vermont and Washington.
Louisiana’s request to extradite Carpenter hit a roadblock when New
York Gov. Kathy Hochul rejected it, citing the state’s shield law.
(A county clerk also cited the shield law as he refused to file the
civil judgment from Texas.)
“These are not doctors providing health care. They are drug
dealers,” Republican Louisiana Attorney General Liz Murrill told
state lawmakers as she promoted a bill that would expand who can sue
and be sued in abortion medication cases. “They are violating our
laws. They are sending illegal medications for purposes of procuring
abortions that are illegal in our state.”
Clinics say they will keep prescribing
Julie Kay, the executive director of the Abortion Coalition for
Telemedicine, the nationwide organization co-founded by Carpenter,
said providers won’t be “bullied and intimidated” into ceasing
operations.
Other telehealth abortion providers said they also won't be deterred
by legal threats.
“I have been working in this field for 25 years and this is part of
the work," said Dr. Rebecca Gomperts, founder and director of Aid
Access, an abortion pill supplier. ”It’s something that we all
anticipated would happen," she said of the legal challenges.
A doctor who is part of A Safe Choice, a network of California-based
physicians that prescribes abortion pills to women in all 50 states,
told The Associated Press he believes he is protected by the state's
shield law, but is also taking precautions.
“I’m not going to be traveling outside of California for a very long
time,” said the doctor, who spoke with The Associated Press on
condition of anonymity because he wanted to protect his identity for
safety reasons.
___
Associated Press writer Sara Cline in Baton Rouge, Louisiana,
contributed to this report.
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