On January 31, 2025, Louisiana prosecutors secured a grand jury indictment against Dr. Margaret Carpenter, a New York-based physician. The indictment charges Dr. Carpenter with criminal abortion by means of abortion-inducing drugs after allegedly mailing abortion pills she prescribed to a Louisiana minor, violating the state's stringent anti-abortion statutes (2)(7)(8). The indictment marks the first known criminal charges against a health care provider for distributing abortion medication across state lines following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization in 2022.

With the vastly differing laws regulating abortion that have emerged across states since 2022, the case is likely to emerge as a defining legal battle in America's post-Roe landscape. The case could prove a challenge to state "shield laws," laws enacted in eighteen states which protect telehealth providers from civil and criminal prosecutions stemming from reproductive care rendered to patients in abortion-restricted jurisdictions. With states like Louisiana enacting laws that expose clinicians to increased criminal penalties for providing reproductive care to residents (1)(9)—and states like Texas passing legislation that increases the risk of civil liability for providers (4)(5)(11)—these coordinated legal attacks signal escalating risks for providers who offer reproductive care in states with abortion bans. This article provides an overview of the two known cases against Dr. Carpenter, providing insight into what the legal landscape may look like post-Roe for many telehealth providers.

The Louisiana Criminal Case: Testing the Limits of State Jurisdiction

The indictment against Dr. Carpenter centers on an April 2024 telehealth consultation, where she allegedly prescribed mifepristone and misoprostol to a Louisiana resident who sought the medications for her daughter. Louisiana's §87.9 criminal code prohibits providing abortion-inducing drugs except through in-person administration by state-licensed physicians, effectively transforming cross-state prescribing as local criminal conduct regardless of the provider’s location. The statute classifies any violations of these rules as felonies, punishable by 1-5 years imprisonment and fines of up to $50,000  (1). The charges mark the first application of Louisiana's 2022 abortion ban to an out-of-state provider.

The state-level differences in telehealth prescribing laws—and the laws that many states have enacted to protect telehealth providers following Dobbs—only emphasize the complexity of the legal questions that are likely to arise at trial. New York, where Carpenter practices, is one of many states that have enacted “shield laws” designed to protect telehealth providers from prosecution for reproductive services rendered to out of state patients. Enacted in 2023, New York’s shield law (Civil Rights Law §79-H) bars extradition of providers who provider legal abortion services to out-of-state patients (7)(8). Governor Kathy Hochul invoked the state’s shield law following Louisiana’s extradition request (11), indicating that the trial may be a stress test of constitutional interstate enforcement limits.

Many expect that the case could revive the long-dormant Comstock Act, an 1873 law that banned the mailing of “obscene” materials. While the act has not been enforced in decades, anti-abortion advocacy groups have asked federal courts to interpret the law as a ban on mailing contraceptives and abortion-inducing drugs like mifepristone. Such an interpretation would have considerable consequences for providers who treat pregnant patients outside their state of practice, superseding state shield laws (3)(8) and leaving providers vulnerable to potential criminal penalties.

Notably, one state has already invoked civil penalties against Dr. Carpenter. Texas secured a $100,000 civil judgment under Senate Bill 8's private enforcement mechanism after a patient Carpenter treated virtually experienced complications from taking her prescribed medication, requiring emergency care (4)(5)(10). The Texas Medical Board has also begun the process of revoking the licenses of in-state clinicians who collaborate with shield providers (6)(9). While other states have not yet shown the same appetite for pursuing punitive measures for providers offering abortion care, the significant enforcement activity in Texas demonstrated a multi-faceted framework designed to deter cross-border care that other states may soon follow.

Telehealth Providers Face Mounting Civil and Criminal Exposure

The cases against Dr. Carpenter are striking reminders of the legal risks for telehealth providers offering out-of-state services following Dobbs, particularly for those working in reproductive health. These cases highlight three key risk areas for reproductive health providers:

1. Expanded Criminal Jurisdiction: States are claiming authority over out-of-state clinicians based on patient residency and medication receipt locations (1)(8). Louisiana's application of criminal abortion statutes to telehealth prescriptions sets a precedent for extradition battles and federalism conflicts under the Dormant Commerce Clause (3)(8). Providers must now assess risks in all states where patients reside, not just their licensing jurisdiction.

2. Civil Enforcement Mechanisms: Texas secured civil penalties of more than $100,000 against Dr. Carpenter, demonstrating that civil enforcement mechanisms can financially devastate providers (4)(5)(10). The use of private citizen bounty hunter provisions, as seen in Texas Senate Bill 8, allows for ideologically motivated plaintiffs to bring lawsuits against out-of-state clinicians (6)(9), creating even greater legal and professional risk.

3. Professional Licensing Vulnerabilities: The Texas Medical Board's investigation of providers who collaborated with Dr. Carpenter highlights licensing boards as emerging enforcement bodies in abortion-restricting states (6)(9). Even in shield law states, clinicians cannot be protected from disciplinary actions in states where they hold licenses, creating potentially career-threatening risks.

Mitigating Legal Risks in Post-Roe Practice

As a telehealth provider, providing appropriate patient care during an increasingly uncertain legal landscape can be stressful. With the uncertainty the Carpenter cases create, providers contemplating cross-border telehealth abortions should consider protective measures. First, providers should be sure to understand state abortion regulations in effect in patients’ home states. A general understanding of these laws—including whether the state has shield laws or, conversely, laws imposing significant civil or criminal penalties for out of state providers offering abortion medication—is a crucial first step in assessing the legal and professional risk a provider may incur. Providers should also consider updating their informed consent procedures, being sure to verify the patient’s age, identity, stage of pregnancy, and residency status in consultations. Louisiana's case turns in part on the allegation that the minor who ultimately took the medication Carpenter prescribed did not consent, underscoring the need for robust documentation (2)(5). While the full scope of the implications of these cases for providers has yet to unfold, these first steps are crucial in protecting your practice in the interim.

Conclusion: Navigating the New Forensic Landscape

The Carpenter cases illustrate a marked shift the legal landscape when it comes to providing reproductive healthcare across state lines, with some states beginning to seek harsher civil and even criminal penalties for providers offering abortion services. While state-level shield laws may provide some comfort, federal courts have yet to decide which states’ laws control in cases like Carpenter’s. With this uncertainty looming, healthcare professionals wanting to provide reproductive care in states with abortion restrictions face significant risks—including felony charges, substantial civil penalties and fines, and potential restrictions to or loss of professional licensure.

Citations:

1. https://www.legis.la.gov/legis/Law.aspx?d=1294864
2. https://www.beckershospitalreview.com/legal-regulatory-issues/landmark-criminal-case-challenges-telemedicine-abortion-shield-laws.html
3. https://19thnews.org/2024/03/telehealth-abortion-pill-access-supreme-court/
4. https://www.texasattorneygeneral.gov/news/releases/attorney-general-ken-paxton-sues-activist-new-york-doctor-illegally-providing-abortion-drugs-across
5. https://www.jurist.org/news/2025/02/texas-judge-finds-new-york-doctor-liable-for-unlawfully-providing-abortion-inducing-drugs-to-texas-woman/
6. https://19thnews.org/2024/05/texas-abortion-lawsuit-ruling-rejects-medical-exemptions/
7. https://www.nbcnews.com/news/us-news/new-york-doctor-indicted-prescribing-abortion-pill-louisiana-rcna190214
8. https://www.politico.com/news/2025/01/31/abortion-shield-laws-louisiana-challenge-010223
9. https://versustexas.com/texas-abortion-law/
10. https://19thnews.org/2024/12/texas-files-first-lawsuit-against-out-of-state-abortion-provider/
11. https://www.cbsnews.com/news/texas-judge-fines-new-york-doctor-prescribing-abortion-pills-woman-near-dallas/

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