Lift restriction on who can perform medication abortions, NC providers ask judges

Since the Supreme Court’s decision to overturn Roe v. Wade in June, abortion clinics in North Carolina have seen an influx of patients from neighboring states that have more restrictive laws.

To alleviate some of increased demand on the state’s 14 clinics, abortion rights groups are asking a panel of judges to lift a restriction under state law that prevents physician assistants, certified nurse-midwives, and nurse practitioners from providing medication abortions.

Such abortions use the medications mifepristone and misoprostol to end pregnancies in the first trimester, typically up until 10 weeks.

A motion filed Monday by Planned Parenthood South Atlantic and other abortion rights groups in Wake County Superior Court asks the three-judge panel to grant a preliminary partial injunction against provisions of state law that specifically block these medical personnel, referred to as advanced practice clinicians (APCs), from providing medication abortions in North Carolina.

The groups note that state law allows APCs to prescribe mifepristone and misoprostol to patients who have had a miscarriage, but not to patients who meet certain criteria, such as not using an intrauterine device or having certain medical conditions, and want to terminate their pregnancy in the first trimester.

They also argue that the fact that APCs are trained and qualified to prescribe medications for the treatment of more complicated conditions, as well as controlled substances like opioids and amphetamines, shows that there is no medical justification for the prohibition on providing medication abortions.

North Carolina currently allows abortions up until 20 weeks of pregnancy, and in some cases, after 20 weeks, if a patient experiences a medical emergency as defined by state law.

Nurse practitioner can treat patients in Virginia, not NC

One of the plaintiffs in the lawsuit, Anne Logan Bass, is a family nurse practitioner at Planned Parenthood South Atlantic. She’s trained and qualified to perform both surgical abortions and medication abortions, and provides patients with both forms of the procedure at Planned Parenthood health centers in Virginia, where APCs are allowed to provide medication abortions.

“The prohibition of qualified advanced practice clinicians providing medication abortion is completely arbitrary, medically unnecessary, and profoundly limits access to abortion in North Carolina,” Bass said in a release. “Certified nurse midwives and nurse practitioners like myself are highly trained medical professionals who are qualified to provide this care and already do in other states — just not in North Carolina.”

In total, Planned Parenthood employs or contracts with 18 APCs at its clinics in North Carolina, all of whom the organization says “specialize in reproductive health care and would be qualified to prescribe medication abortion if legally permitted.”

Rise in out-of-state patients and wait times

In the months following the Supreme Court’s decision, the share of patients coming to North Carolina clinics from other states has skyrocketed. Between July 1 and Sept. 30, more than a third of Planned Parenthood’s abortion patients — 1,317 in total — were from other states. During the same period in 2021, that figure was just 322 patients.

The share of out-of-state patients has increased even more dramatically at clinics in Asheville and Charlotte in particular, according to data shared in the court filing. In Asheville, for example, the proportion of out-of-state patients jumped from 30% to 66% between July 2021 and July 2022. In Charlotte, that figure increased from 20% in July 2021 to 58% in July 2022.

Lawyers for Planned Parenthood say in the motion that the organization has increased the number of appointments it offers and the number of days when abortion services are offered, but despite that, wait times continue to increase due to the large number of out-of-state patients.

At a clinic in Asheville, average wait times for patients seeking an appointment for a medication abortion have gone up from 12 days during July, August and September 2021, to between 14 and 21 days since July 1 of this year, the motion states. This is despite staff increasing the availability of abortion services from once a week in 2020, to two days a week in July 2022 and three days a week in September 2022.

Between making travel arrangements, finding time off from work and other logistical challenges, the increased wait times can delay when a patient receives an abortion by up to three weeks, lawyers for Planned Parenthood state, pushing people closer to the 10- or 11-week limit, after which medication abortions are no longer safe to perform.

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