New and novel uses of telemedicine have become increasingly common. During Covid most physicians’ offices and clinics were closed. Many began treating patients over the phone (including my dog’s vet). After the threat of Covid subsided, many entrepreneurial providers began looking for newer and more innovative telemedicine practice models. There are more than a dozen websites that specialize in weight-loss drugs, and / or erectile dysfunction, birth control, etc. Many have branched out into broader practice areas like men’s and women’s health, including testosterone and hormone replacement therapy. A patient fills out a questionnaire, and a doctor approves treatment. A week or so later a prescription for generic Viagra or a compounded GLP-1 drug arrives in the mail. Some even allow one-on-one consultations with a physician for more complex conditions.
A major obstacle to telemedicine is that each of the 50 states has the right to regulate the practice of medicine within their borders. Not every medical board welcomes virtual startups prescribing drugs without an in-person exam. Most of these operations are perfectly legal because telemedicine websites generally have a doctor in each state who can sign off on the prescription. It can get a little risky when a provider sends prescriptions by mail to a state in which he or she are not licensed to practice medicine.
The attorney general of Texas is suing a nurse practitioner located in Delaware for mailing abortion pills to Texas women. Debra Lynch, NP operates Her Safe Harbor, a telemedicine clinic where she practices medicine by phone. Lynch also prescribes through a web-based questionnaire consultation form. Her website claims she treats women living in all 50 states.
Ms. Lynch likely violates laws in states that have laws against her type of practice. Yet, the state where she’s licensed protects her to some extent against those state laws that would prosecute her. That got me thinking: What is to prevent doctors, nurse practitioners, entrepreneurs with AI startups from doing the same from an Indian reservation?
Indian nations are mostly exempt from federal and state laws. They have their own laws, police force, gambling casinos and sometimes hospitals. For years a few Indian nations had a lucrative business selling tax free cigarettes by mail. Why not prescription drugs and telehealth visits? Indian nations also tend to have a shortage of doctors, nurses and medical facilities. Allowing a telemedicine firm to operate nationwide from a reservation may be a way to entice more providers to practice there. An entrepreneur could potentially even team up with Google on my YouTube group therapy practice idea. That is where most medical consultations are recorded for a larger audience and patients can watch them at their convenience. Live events (i.e. group consults) could even be scheduled for a given time with the video archived for later use as well. There would need to be some mechanism to facilitate drug therapy, otherwise it’s just a YouTube video for entertainment purposes. As one YouTube doctor often repeats in her videos, “Don’t contact me for dosing or other questions. I’m a doctor but I’m not your doctor.” Maybe in the future she could answer questions, bill nominal amounts and become my doctor without ever meeting me because she’s in Arizona and I live in Texas. Anything that can cut through the bureaucracy and turf wars to nudge medical care into the Information Age would benefit consumers and boost access to care.
Read more at: Texas Sues Delaware Nurse Practitioner for Mailing Abortion Pills to the State
Goodman Institute Health Blog: Social Medicine: Would You Attend Interactive Group Therapy on YouTube?