2024 has become a more legally treacherous year for physicians and it's affecting the way they practice medicine.
Here are seven notes on the way that new legal actions are impacting physicians and their work with patients:
1. Texas Attorney General Ken Paxton recently filed a lawsuit against a New York physician who prescribed mifepristone and misoprostol, two medications commonly used to end pregnancies, via telemedicine to a patient in Texas. The lawsuit alleged that Margaret Carpenter, MD, violated Texas' law prohibiting a physician or medical supplier from providing any abortion-inducing drugs by courier, delivery or mail service. The lawsuit also alleges that Dr. Carpenter violated a law that prevents physicians not licensed in the Texas from delivering telemedicine services in the state.
Texas' near-total abortion ban went into effect in 2022, and the lawsuit marks the first challenge between state abortion laws, as New York has a shield law that protects providers from out-of-state investigations and prosecutions.
2. Mr. Paxton has also recently filed three separate lawsuits against physicians in Texas for allegedly providing gender-affirming care for transgender minors. The lawsuits allege that the physicians have all violated Texas law SB 14, which was passed in 2023 and was upheld in the state Supreme Court in June. The law prohibits "gender transition" medical interventions such as surgeries, puberty blockers and hormone replacement therapy for minors.
2. At the Association of American Medical Colleges' Annual Meeting on Nov. 11 in Atlanta, physicians gathered to discuss the impact of anti-abortion and anti-transgender legislation on physicians and their patients.
At the conference, Caitlin Bernard, MD, an Indianapolis-based OB-GYN, spoke about the legal consequences she faced after performing an abortion for a 10-year-old Ohio patient who had been raped. She summarized several cases where patients with life-threatening pregnancy complications were harmed or died because hospitals were unclear about permissible care under state laws.
3. Dr. Bernard noted that the "imprecise" wording of many laws, along with unclear guidance from medical organizations, has left physicians and lawyers confused about what procedures are legally allowed.
"People are not wanting to work in states where these laws exist. That's a big issue for OB-GYN now," Dr. Bernard said. "For example, we've had three maternity hospitals in northern Indiana close since our abortion ban went into effect, partly because of the difficulty in staffing them with physicians."
4. The number of U.S. medical school graduates applying to OB-GYN residencies in states with abortion bans dropped nearly 7% this year, according to AAMC, potentially worsening existing physician shortages.
5. According to The Atlantic, 96% of physicians caring for pregnant women in states with abortion restrictions reported feelings of moral distress.
6. According to the American College of Physicians, more than 500 anti-LGBTQ+ bills were introduced in state legislatures in 2024. At least 112 of those bills have proposed restrictions in at least 40 states on gender-affirming care or transgender healthcare. While many of those restrictions have been legislative, administrative methods are also being used to restrict access to gender-affirming care in some states. In Florida, for example, the state's Agency for Health Care Administration prohibited Medicaid from covering gender-affirming care for patients of any age.
7. In 2021, the American Medical Association sent a letter to the National Governors Association urging members to oppose legislation that would "inappropriately limit the range of options physicians and families may consider when making decisions for gender-diverse pediatric patients." The AMA also detailed the impacts of banning gender-affirming care for patients in its code of ethics in June 2023.