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.

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.