TELEMEDICINE - In May, in the middle of a typical workday, Florida Governor Ron DeSantis signed a ban on gender affirming care for teens, while also creating substantial obstacles for adults seeking care, kicking people off medication that some had relied on for decades.
At the Gender Affirming Care practice where I was working that day, it was suddenly illegal for the majority of our clinicians (nurse practitioners, physician assistants, and certified nurse midwives) to continue providing care for our adult patients in Florida, in person or via telehealth, abruptly ending care for our patients that day. Just a month earlier, DeSantis had signed a six-week abortion ban, effectively outlawing abortion care for the vast majority of Floridians and similarly throwing another essential medical service into crisis.
Dangerous restrictions like those in Florida have been signed into law in Alabama, Idaho, Missouri, North Dakota, Tennessee, Texas, and other states. As a licensed provider of both abortion and gender affirming care practicing across 20 states, these laws are catastrophic for my patients and for this country. The lasting public health impact is and will be irreparable for generations. In addition to the crises these laws create in the lives of real people, every new law and court order forces me to spend time deciphering politically-motivated, discriminatory legalese, rather than simply providing the evidence-based, life-saving care my patients urgently need.
Telemedicine has been a game-changer in expanding access to many kinds of care, and is becoming especially critical in the face of increasingly extremist bans on essential care.
Luckily my home state of California has a massive opportunity to change this if Governor Gavin Newsom signs SB 345, a “shield law” authored by Senator Nancy Skinner that would protect providers like me who wish to continue providing abortion and gender affirming care via telemedicine without having to navigate and decipher complicated legal restrictions that disregard medical best practices and seemingly change overnight on political whim.
When I practice at San Francisco General Hospital, care that is often stigmatized elsewhere—addiction treatment, abortion, and gender affirming care—is seen for the routine medical care that it is. But in other states, access to such care can be non-existent or extremely limited: Even before recent bans were in place, many people never truly had access to safe, compassionate abortion or gender affirming care. Telemedicine has been a game-changer in expanding access to many kinds of care, and is becoming especially critical in the face of increasingly extremist bans on essential care.
With telemedicine, my ability to provide care that can be otherwise inaccessible and stigmatized goes a lot farther. That is true even in states like California and Washington, where access to care in rural counties is very limited, despite the protective laws and progressive policies for which they are generally known. Using the same evidence-based protocols as I do with in-clinic care, I can offer high quality, direct care to my patients, like prescribing hormones and abortion pills without them ever needing to leave home, saving them time, money, and the mounting risks of stigmatization or criminalization. One of my first telehealth patients lived in a rural area of Texas and spent nearly 10 years trying to access gender affirming care through providers who, rather than providing the healthcare they sought, ridiculed and discriminated against them before turning them away. To access compassionate, non-discriminatory care from the comfort of their own home meant everything for this person.
The need for this care could not be more clear: Gender affirming care is life-saving. Gender dysphoria is a known cause for depression and suicidality, and we know access to care improves mental health and protects particularly young people from attempting suicide. That’s why I do this work, and why I navigate through these absurdly dizzying laws. When you are sitting with someone crying tears of joy that they are being seen for who they are and finally getting what they need to survive, that is everything.
Even as I and others work to expand access to care in states where abortion and gender affirming care are restricted or banned, the language written into these politically motivated bans puts me at significant risk. SB 345 would give me and my patients stability and peace of mind, so I can focus on providing the evidence-based, stigma-free care via telemedicine that my patients need. Governor Newsom signing SB 345 would make me feel exponentially more comfortable providing care to patients despite unjust laws like those in Florida, and thereby enable me to expand access for folks who have lost their bodily autonomy.
(Dr. Mai Fleming is a California family and community medicine doctor and a licensed provider of both abortion and gender affirming care practicing across 20 states. This article was first published in Common Dreams.)