General Information / History / Stats / Types

TeleMed Abortion – History & Update

JULY 21, 2011

Here is the Abstract of the first 'glowing article to convince practitioners and the public that Telemed abortions are the answer we're all been looking for'.

As you read the abstract, reflect on the fact that the urgent D&C rate is 8% at 7 wks, 16% at 8 wks, and 23% at 9 wks (according to the FDA safety studies of 10 years ago).

Physicians will be seeing these people in the Emergency Department.

Unless, of course, to take care of tele-complications, they develop tele-transfusions and tele-surgery…

The Abstract:
Abortions via 'telemedicine' are safe, effective, Iowa study finds
Women don't need face-to-face contact to take RU-486; doctors supervise remotely

Grossman, Daniel; Grindlay, Kate; Buchacker, Todd; Lane, Kathleen; Blanchard, Kelly
Obstetrics & Gynecology. 118(2, Part 1):296-303, August 2011.
Purchase Access
doi: 10.1097/AOG.0b013e318224d110

Abstract:
OBJECTIVE: To estimate the effectiveness and acceptability of telemedicine provision of early medical abortion compared with provision with a face-to-face physician visit at a Planned Parenthood affiliate in Iowa.

METHODS: Between November 2008 and October 2009, we conducted a prospective cohort study of women obtaining medical abortion by telemedicine or face-to-face physician visits. We collected clinical data, and women completed a self-administered questionnaire at follow-up. We also compared the prevalence of reportable adverse events between the two service delivery models among all patients seen between July 2008 and October 2009.

RESULTS: Of 578 enrolled participants, follow-up data were obtained for 223 telemedicine patients and 226 face-to-face patients. The proportion with a successful abortion was 99% for telemedicine patients (95% confidence interval [CI] 96–100%) and 97% for face-to-face patients (95% CI 94–99%). Ninety-one percent of all participants were very satisfied with their abortion, although in multivariable analysis, telemedicine patients had a higher odds of saying they would recommend the service to a friend compared with face-to-face patients (odds ratio, 1.72; 95% CI 1.26–2.34).

Twenty-five percent of telemedicine patients said they would have preferred being in the same room with the doctor. Younger age, less education, and nulliparity were significantly associated with preferring face-to-face communication. There was no significant difference in the prevalence of adverse events reported during the study period among telemedicine patients (n=1,172) (1.3%; 95% CI 0.8–2.1%) compared with face-to-face patients (n=2,384) (1.3%; 95% CI 0.9–1.8%) (82% power to detect difference of 1.3%).

CONCLUSION: Provision of medical abortion through telemedicine is effective and acceptability is high among women who choose this model.

AAPLOG NOTE: As long as it has to do with abortion, almost anything goes.

Women are not well served by a tele-doctor. He is not there when you need him.

And the baby's death is not a tele-death, it is a real death. This is not a television serial.

ARCHIVED Special March 2010 Report: ‘Telemed Abortions’ Endanger Women and Drive Up Insurance Costs
There is a disturbing new trend in the abortion industry that could be endangering the lives and health of thousands of women – and costing insurance companies and taxpayers millions.

As the number of abortionists continues to decline, some clinics have found a unique way of staying open using what is known as the “telemed abortion.”

“Telemed” is short for the term telemedicine, whereby medical consults occur with the aid of electronic communications. It is used legitimately in the medical field to lower the cost of consultations with specialist and exchange medical information between physicians electronically.

Telemedicine has also been successfully used in legitimate medical practices for such things as history review, psychiatric evaluations, and ophthalmology assessments.

However, telemedicine, or care in absentia, was never meant as a replacement for the personal, hands-on examination by a physician.

Now, a Midwestern Planned Parenthood abortion business has taken telemedicine to an all new and dangerous level.

The Telemed Abortion

Operation Rescue investigated telemed abortions in Iowa, which are keeping open a dozen clinics. According to an undercover phone conversation with a receptionist with Planned Parenthood of the Heartland, medical abortions are offered in 16 clinics throughout Iowa, but only four of the clinics actually have doctors. At the other twelve, smaller clinics, telemed abortions have become routine.

A telemed abortion is abortion via a teleconferencing service similar to “Skype.” Patients are put in a room where an off-site abortionist appears on a computer monitor and explains the medical abortion procedure to them over an Internet hook-up.

After the brief teleconference, the dangerous abortion drug RU486, also known as Mifepristone and Mifeprex, and its counterpart, Misoprostol, are prescribed. The drugs are then administered to the patient by a nurse or “clinician” who may or may not be licensed.

The patient presses a button an on computer screen that opens a box containing the abortion drugs.

The patient is never physically examined by the medical doctor prescribing the drugs – or any other, for that matter – and never sees the abortionist again.

Listen to a Planned Parenthood receptionist describe this.

Increased Risks To Women

This development should trouble those who are concerned about the health and safety of women and their pre-born babies.

Mifepristone (Mifeprex or RU 486), the main component of medical abortions, has been responsible for at least eight abortion deaths and over 1,100 serious complications in the United States alone. It is recommended only for early abortions under nine weeks gestation.

In addition, medical abortions carry a 7 percent -20 percent failure rate, depending on how the pills are administered. Women who suffer failed or incomplete abortions would require them to be completed surgically or face life-threatening complications. With no doctor in sight, that presents a new danger to women.

Described by one Planned Parenthood receptionist as a “self-induced miscarriage,” the medical abortion process takes days, can be very painful, and involves heavy bleeding and cramping until the pre-born baby is expelled. Yet, the only follow-up offered by Planned Parenthood is a recommended appointment in “two or three weeks” after the abortion where a second ultrasound is offered to make sure the “pregnancy no longer exists.”

This follow-up care is completely inadequate. If tissue from the pregnancy is retained, that presents a risk of infection to the woman that could kill her, especially if care is delayed 2-3 weeks.

In a recently published study conducted on 120 women who under

went medical [medication] abortions [mifepristone] at 9 weeks, 34 of the women (28%) retained tissue.

Fetal heartbeats were detected in fourteen of those pregnancies (11.6%), but abdominal ultrasound only detected the heartbeats in ten of those cases for a 29% failure rate.

The study concluded that abdominal ultrasound examination alone is not entirely reliable after medical abortion and also concluded that the higher the woman’s body mass index, the higher the risk of not detecting retained tissue or even a complete pregnancy[sic].

[http://www.novoseek.com/DocumentDetailAction.action?numdocs=0&filters=&corpus=MEDLINE&criterion=1&showType=2&docId=20159181&query=%22MIFEPRISTONE%22 ; A comparison of transabdominal and transvaginal ultrasonography for determination of gestational age and clinical outcomes in women undergoing early medical abortion; Contraception 2010,Mar,01;81(3):240-4; (PMID: 20159181) ; see Abstract below this article]

“I cannot imagine a woman going through the process of miscarriage, either natural or forced, and not having access to a physician, especially for follow-up care,” said Newman. “Any number of things could go wrong, and to never actually be seen by a licensed doctor during the entire process seems risky at best, grossly negligent, and perhaps criminal.”

Illegal Abortions?

An abortion is legally defined in Iowa Code 146.1 as, “the termination of a human pregnancy with the intent other than to produce a live birth or to remove a dead fetus.” It is a legal requirement that abortions in Iowa only be done by “licensed physicians.”

In an undercover call made by an Operation Rescue investigator, the Planned Parenthood receptionist was clear that the so-called “nurse” would actually be doing the abortion procedure.

Caller: Okay, so when she goes in for the procedure, um, do you guys like have a doctor there or something, that she can talk to?

Planned Parenthood: Some of our sites are called telemed, which there is not a doctor on site. All instructions would be given through teleconferencing and there’s a nurse there to answer any questions. Some of our bigger clinics, yes, we have a doctor on site.

Caller: Okay, so if she has questions she has a nurse she can talk to. Would it be the nurse who actually administers – who actually gives her, like, the procedure or whatever?

Planned Parenthood: Right.

Caller: Okay.

According to this information, it is doubtful that these abortions are even legal since the abortions are not done by a licensed physician, but an abortion worker at a clinic that the physician never visits.

“The term ‘nurse’ is used loosely by abortion clinics. More often than not, what they refer to as a ‘nurse’ is really an unlicensed worker with little education or training,” said Newman. “It is actually very rare to find an abortion clinic that employs registered nurses or even licensed practical nurses, because they drive up the costs and drive down the profit margin.”

This means that dangerous medical abortions are being done on unsuspecting women without the direct supervision of a physician – and perhaps without the oversight of any licensed medical personnel whatsoever. The patient is never physically examined by the abortionist, whose only contact with her is a brief teleconference. After the teleconference is terminated, she never sees the abortionist again.

Susan Haskell, a Planned Parenthood abortionist in Des Moines, is involved in the teleconferencing prior to abortions around the state.

According to a receptionist at a Planned Parenthood in Council Bluffs, Haskell never comes to their clinic, and neither does any other licensed physician.

And so it is at the other eleven telemed abortion clinics run by Planned Parenthood: no physician — ever.

“Taking an abortion pill is not like taking an aspirin. Women have died from it,” said Newman. “Yet Planned Parenthood has reduced the dispensing of this dangerous abortion drug to little more than supplying advice of the kind you might get from a pharmacist when buying an over-the-counter medication. That is placing the lives of women at serious risk.”

Operation Rescue attempted to contact the Iowa Board of Medicine for a comment on the legality and safety of telemed abortions, but numerous phone calls were not returned.

Women Unaware Of Dangers

Are women even aware of the new risks involved? Probably not. The receptionist from Planned Parenthood that spoke with our undercover investigator seemed surprised that questions about emergency protocols were even asked. Below is a partial transcript of that conversation.

Listen to the audio clip.

Caller: Is the ultrasound person, like, a doctor? Are there any doctors there at all in case anything goes wrong?

Planned Parenthood: There’s nurses there. Nurses, mp’s and doctor – er, sorry, clinicians. There wouldn’t be anything to go wrong in the medical procedure because you don’t do anything with that right away. You get one pill there in the clinic and that pill stops the pregnancy from growing. Then they give you four more pills, and those pills they send you home with, and they’ll give you the instructions on how and when you would take those.

Nothing to go wrong? Certainly not until the patient is long gone from their facility and on her own to deal with the painful and risky abortion. What a woman would do in the event of an emergency remains unclear.

Bilking Insurance Companies and Taxpayers

But beyond the obvious health concerns to women and their pre-born babies, telemed abortions in Iowa are costing insurance companies millions of dollars in inflated charges. Soon, it could be taxpayers footing the bill.

According to Operation Rescue’s research, which surveyed medical abortions from coast to coast, the average cost of a medical abortion nationally is about $390, ranging from a low of $300 to a high of $600. But in Iowa, insurance companies are being billed at a rate of $1,000, two and a half times greater than the national average – with a fraction of the cost.

However, if the patient does not have insurance, the cost of the medical abortion is “discounted” by Planned Parenthood to $500, still well above the national average. Limited financial assistance from various abortion funds can further discount the abortion, but the money from the grant money still goes into Planned Parenthood coffers insuring that the abortion clinic never receives less than $500 for each telemed abortion.

“Planned Parenthood of the Heartland is making a killing on medical abortions,” said Newman. “Think about it. They are charging by far the highest price in the nation, but at perhaps the lowest overhead costs. They don’t have the expense of having to pay for a doctor on site or pay for traveling expenses. The abortionist never leaves Des Moines. That’s how they can afford to keep abortion clinics running in small towns such as Spencer, Storm Lake, and Ankeny.

“Overbilling has the result of driving up the cost of health insurance for everybody. And if taxpayers are forced to f

und abortions, there’s no telling how much they will charge, because government funding is a blank check. This will mean that we all will be paying more for health coverage in order to cover the exaggerated rates for these abortions. Meanwhile, Planned Parenthood laughs all the way to the bank.”

In fact, less than a week after the House passed the health care bill, an amendment was rejected that would have prevented tax funding of medical abortions. That means that whenever a person subscribes to an insurance plan in the government exchange, tax dollars will pay for their medical abortions, and in Iowa, it will be at over twice the price of other states.

So profitable is the telemed abortion that there is concern that Planned Parenthood of the Heartland, which operates the clinics in Iowa, may try to sell their system to abortion franchises in other states. That will mean an increase in abortion profits for Planned Parenthood at a burdensome cost to insurance companies and taxpayers, all at the consequence of an increased risk of life-threatening complications to women.

Telemed Abortions Symptomatic Of Widespread Problem of Abortion Industry Abuses

The dangerous and costly telemed abortion is just another example of abortion industry abuse and exploitation that has become so widespread in the United States that anyone is hard pressed to find an abortion business that is in full compliance with the law.

The entire industry is rife with problems, as evidence by recent headlines, including sex abuse and non-reporting, filthy and unsafe clinic conditions, unlicensed workers, substandard care, illegal abortions, fraud, and illegal disposal of human remains and medical records, to name a few.

The solution that will protect women, babies, and society from further harm by the greatest moral problem of our time is complete abolition of abortion and the restoration of legal personhood to the pre-born.

Until that can be accomplished, there are steps that can be taken to protect women and their babies from the immediate threat of risky telemed abortions. As the new health care system is about to be implemented, which will flush millions of dollars into the abortion industry, now is the time for states to step up and protect women by outlawing abortions in absentia.

Efforts should also be made to prohibit the bilking of insurance companies and taxpayers with over-inflated fees that Planned Parenthood is now charging for the low-cost telemed abortions in Iowa, lest their dangerous scheme to give medical abortions via the Internet spread to other states.
_____

Related: Planned Parenthood in Iowa is not the only organization involved in dangerous and possibly illegal abortions. In Kansas, Planned Parenthood has been charged with 107 criminal counts – 23 of which are felonies – related to illegal late-term abortions. The case is hung-up in the Kansas Supreme Court.
[March 29, 2010, Cheryl Sullenger, Senior Policy Advisor, Operation Rescue, http://www.operationrescue.org/archives/special-report-telemed-abortions-endanger-women-and-drive-up-insurance-costs/ ]

Abstract [see above]
BACKGROUND: We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion.

METHODS: We included all 120 women enrolled in a study of simultaneous oral mifepristone and buccal misoprostol for abortion through 63 days' gestation. Vaginal and abdominal ultrasound examinations were performed before and 24 h after medication administration. Visualization of a gestational sac and embryonic pole and presence or absence of cardiac activity were recorded. Sensitivity and specificity were calculated with the results from vaginal ultrasonography as the gold standard. The effect of body mass index (BMI) on ultrasound findings was also assessed.

RESULTS: Before treatment, the sensitivities of abdominal ultrasonography were 100% (95% CI 97-100) and 68% (95% CI 58-77) for presence of a gestational sac and an embryonic pole, respectively. Overall, abdominal imaging underestimated mean gestational age by 1.6 days (95% CI 1.0-2.2). After treatment, abdominal ultrasonography missed three of 34 retained gestational sacs (sensitivity 91%, 95% CI 76-98%). Fourteen women had gestational cardiac activity by vaginal ultrasound at follow-up. Abdominal imaging identified the gestational sac in all cases, but cardiac motion was only visible in 10 (71%, 95% CI 42-92%). For every 10-point increase in BMI, the odds ratio for missing an embryonic pole at baseline was 2.8 (95% CI 1.5-5.0).

CONCLUSIONS: Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists.