Despite Historic Indictment, Doctors Will Keep Mailing Abortion Pills Across State Lines

When the news broke on Jan. 31 that a New York physician had been indicted for shipping abortion medications to a woman in Louisiana, it stoked fear across the network of doctors and medical clinics who engage in similar work. Dr. Margaret Carpenter became the first U.S. doctor criminally charged for providing abortion pills across state lines — a medical practice that grew after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision on June 24, 2022, which overturned Roe.

The Indictment and Extradition Battle

Carpenter was indicted alongside a Louisiana mother who allegedly received the mailed package and gave the pills prescribed by Carpenter to her minor daughter. According to an NPR and KFF Health News interview with Tony Clayton, the Louisiana local district attorney prosecuting the case, the teen wanted to keep the pregnancy and called 911 after taking the pills. When police responded, they learned about the medication, which carried the prescribing doctor’s name, Clayton said. The charges against the physician carry a possible five-year prison sentence.

On Feb. 11, Louisiana’s Republican governor, Jeff Landry, signed an extradition warrant for Carpenter, arguing she “must face extradition to Louisiana, where she can stand trial and justice will be served.” New York’s Democratic governor, Kathy Hochul, countered by releasing her own video, confirming she was refusing to extradite Carpenter. “Louisiana has changed their laws, but that has no bearing on the laws here in the state of New York,” Hochul said.

Impact on Abortion Providers and Telehealth

At the Massachusetts Medication Abortion Access Project, physicians use telehealth to prescribe and mail pills to people who live in states that ban or restrict abortion. “It’s scary. It’s frustrating,” said Angel Foster, co-founder of the clinic near Boston that mails mifepristone and misoprostol pills to patients in states with abortion bans. Foster added that abortion providers like her had been expecting prosecution or another kind of legal challenge from states with abortion bans since the 2022 Supreme Court decision.

The indictment also sparked worry among abortion providers like Kohar Der Simonian, medical director for Maine Family Planning. “It just hit home that this is real, like this could happen to anybody, at any time now, which is scary,” Der Simonian said. Ever since the Supreme Court overturned Roe v. Wade in 2022, it was unclear when those tests would come, and would it be against an individual provider or a practice or organization.

The Legal Landscape of Abortion Access

Eight states have passed laws since 2022 to protect doctors who mail abortion pills out of state, and thereby block or “shield” them from extradition in such cases. The current legal status of abortion and provider protections includes the following data points:

• States with Shield Laws: New York, Maine, California, Colorado, Massachusetts, Rhode Island, Vermont, and Washington.
• Near-Total Abortion Bans: 12 states have enacted near-total bans since the Dobbs decision.
• Partial Abortion Bans: An additional 10 states have outlawed the procedure after a certain point in pregnancy, but before a fetus is viable.
• Potential Penalties: Criminal indictments in states with bans can carry up to a five-year prison sentence.

Despite these challenges, clinics like the Massachusetts Medication Abortion Access Project continue to treat patients. As Angel Foster noted, providers had been wondering, “Would it be a criminal indictment, or would it be a civil lawsuit,” and we are now starting to see some of this play out.