In the wake of the Dobbs v. Jackson Women’s Health Organization decision, a number of conservative states enacted protections for unborn children. At the same time, pro-abortion advocates began working to circumvent these changes and provide abortion access to women even in violation of state law. And liberal states started to circle the wagons around the practitioners who provided abortions to out-of-state clients, hoping to insulate them from the potential adverse consequences of this strategy.
This is the contemporary landscape of abortion in America — which is why, on Dec. 12, Texas Attorney General Ken Paxton filed a lawsuit against a New York abortionist who provided chemical abortion drugs to a Texas woman in violation of state law.
As of 2022, Texas regulates abortion closely, permitting abortion only if the life or health of the mother is at risk. Even then, only a licensed physician can perform the abortion, and the patient must have a “life-threatening condition and be at risk of death” or substantial harm. In the procedure, the doctor must try to “save the life of the fetus” unless doing so would increase the risk of maternal death.
Unable to procure an abortion on demand for anything less than extreme danger, Texas women who want an abortion can either travel out-of-state for the procedure or obtain chemical abortion pills to end their pregnancy at home.
A number of online abortion pill providers advertise the ease and privacy of these chemical abortion pills. Founded in 2022, the Abortion Coalition for Telemedicine (ACT) “supports clinicians who make safe, timely, and affordable telemedicine abortion care available to patients in all 50 states.”
But there’s an obvious catch for doctors prescribing chemical abortion pills for out-of-state patients: laws vary from state to state, not only regarding abortion but also the legitimacy of inter-state telemedicine. Depending on licensing regulations, a doctor licensed in one state may not be able to legally provide virtual care for a patient living in another.
In June 2023, New York Governor Kathy Hochul signed a “shield law” that protects New York physicians providing telemedicine abortion services to out-of-state patients, insulating them against “litigation in states where abortion services are outlawed or restricted.” Other states, like Washington, Colorado, Vermont, Massachusetts, and California have similar shield laws.
The New York shield law “prohibit[s] state law enforcement from cooperating with cases prosecuting doctors in New York who use telehealth services to prescribe medication abortion or deliver any reproductive health care to people in states with restrictive abortion laws.” And, what’s more, the law ensures that providers “are not subject to professional discipline from medical malpractice insurance companies” for prescribed chemical abortions.
Given carte blanche by the state government, physicians can prescribe chemical abortions without accountability, despite the dangers associated with mifepristone, the drug that “cuts off the child’s supply of oxygen and nutrients,” and misoprostol, which induces contractions to expel the child’s body.
Though the FDA no longer requires reports of non-fatal adverse events caused by these chemical abortion pills, 28 women have died after taking them, with over 4,000 non-fatal adverse events reported between 2000 and 2016. A 2015 peer-reviewed study found that more than one-third of women who took the pills were admitted to an emergency room within 30 days of their chemical abortions.
After a woman in Collin County, Texas, was admitted to a hospital due to severe bleeding after taking chemical abortion pills, Attorney General Ken Paxton is seeking to hold the doctor who prescribed the pills accountable.
In May 2024, the 20-year-old Collins County woman became pregnant but did not disclose her pregnancy to the child’s father. Without life-threatening conditions, the woman could not procure an abortion in Texas, so she turned to telemedicine options. Dr. Margaret Daley Carpenter, who is licensed in New York, is a long-time abortionist and provides telemedicine abortion services to out-of-state patients — including patients in Texas. Through Carpenter, the Collins County woman obtained the chemical abortion pills, mifepristone and misoprostol.
On July 16, the Collins County woman was taken to the hospital by her child’s biological father for severe bleeding. Medical professionals at the hospital informed the father that her hemorrhage was caused by the termination of the pregnancy and the child’s death. Texas regulations on chemical abortions require that the prescribing doctor have admitting privileges to a nearby hospital, that the woman’s health is thoroughly examined, and that a scheduled follow-up visit assesses continued blood loss. By prescribing abortion pills via telehealth, Carpenter side-stepped all protections due by law and justice to the woman in question.
“Carpenter is not a licensed Texas physician, nor is she authorized to practice telemedicine in the State of Texas,” explains Paxton. “An abortion in the State of Texas may only be performed by a physician licensed to practice medicine in the State of Texas.” Moreover, he explains, “A physician or supplier may not provide a patient any abortion-inducing drug by courier, delivery, or mail service.”
Carpenter is liable under Texas state law, but she’s also deeply embedded in the community protected by New York’s shield laws. With Hochul prohibiting her state’s law enforcement officers from cooperating in cases like this, Paxton’s case could do more than bring Carpenter to justice — it could also provide a model for pro-lifers seeking to navigate the complex legal landscape after Dobbs.
Mary Frances (Myler) Devlin is a contributing editor at The American Spectator. She graduated from the University of Notre Dame in 2022.
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