California's restrictive telemedicine regulations are compelling rare disease patients to embark on arduous out-of-state journeys to receive essential care and consultations. Shellye Horowitz, a resident of rural northern California who suffers from hemophilia A, a rare bleeding disorder, finds herself periodically traveling to a hemophilia clinic associated with the Oregon Health & Science University Hospital in Portland, Oregon, for treatment and consultations.
The state's telemedicine regulations mandate that doctors treating or consulting with patients in California must also be licensed in the state. Since the specialists Horowitz sees are not licensed in California, she is frequently forced to make the grueling 14-hour round trip to Portland for appointments that could have been easily conducted remotely. Horowitz laments, "I have had so far three appointments at my hemophilia treatment center where when the time I was available to travel to Portland, they only had phone appointments available. I've had to physically travel to Portland to sit in a hotel with worse internet than my home to have telehealth appointments."
While telemedicine experienced a surge during the COVID-19 pandemic, with many states waiving restrictions on remote medical appointments through emergency orders, California has lagged behind in implementing permanent policy changes. The state is one of 27 that does not allow medical professionals outside the state to treat or consult with patients, and it has not joined the 40-state Interstate Medical Licensure Compact, which streamlines the process for doctors to obtain licensure in multiple states simultaneously.
California's licensure requirements pose significant obstacles for patients with rare conditions who require specialized and frequent care. They also create barriers for specialized clinics that aim to treat a small number of patients scattered across the country. The time and expense of acquiring and maintaining licensure in California, or other equally restrictive states, may not be justifiable if there are only a handful of patients seeking their care.
In response to these challenges, Horowitz and Sean McBride, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York, have filed a lawsuit against Randy Hawkins, the head of California's medical licensing board. The lawsuit, filed in the U.S. District Court for the Eastern District of California, argues that California's restrictions on interstate medical practice without any purported local benefit violate the U.S. Constitution's Dormant Commerce Clause, which prohibits states from enacting laws that discriminate against or excessively burden interstate commerce in relation to any putative local benefits.
Caleb Trotter, an attorney with the Pacific Legal Foundation representing Horowitz and McBride, asserts that California's discrimination against out-of-state licensed doctors does not enhance the quality of medical care. He points out that the COVID-era rollback of such licensure requirements in other states did not result in any harm to patients.
The lawsuit specifically challenges California's restrictions on out-of-state licensed doctors consulting and following up with patients, leaving unchallenged the licensure requirements for out-of-state doctors treating patients or prescribing medicine. The plaintiffs argue that applying licensure restrictions to mere communication between doctors and patients violates the First Amendment's free speech protections.
For Horowitz, the ability to have follow-up consultations with doctors and medical professionals is crucial. California's restrictions leave her uncertain about whether she could even consult with a nurse at her Oregon clinic in the event of a bleeding incident. She asserts, "It's my body and my healthcare. I should be able to choose to go to a provider I trust. I don't like the fact that my state is limiting my ability to connect with and follow up with a provider of my choice."
