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Maternity telemedicine in Iowa raises malpractice questions

As of New Year's Day, Iowa joined many other U.S. states in enacting a parity law for telemedicine. Your private health insurer must now cover telehealth (services delivered via the internet) to the same extent as in-person care.

The change has been widely welcomed as good news for rural Iowans. And the law might be even more important if your family is planning to have children.

A growing shortage in maternity care

In a guest column for the Gazette, Dr. Marygrace Elson notes Iowa's shrinking supply of rural maternity units. Of its 99 counties, the number with maternity services has dropped since 2001 from 75 to 51.

Elson offers recommendations to address this shortage of maternity services, including increased use of telehealth as part of "standardized, evidence-based care using all the modern tools ... with all team members practicing at the top of their license."

If you reside in a rural setting, it seems reasonable to suspect that you may have more of your maternity services delivered through telemedicine in the future.

Unknowns for doctors, attorneys and patients

A recent article in the National Law Review may raise some sticky questions about what Iowa's new parity law actually requires and what will happen as it rolls out.

For example, the article warns doctors the prescribing of medication after only a video conference may be malpractice if a physical examination has not been performed by a licensed medical care provider. If negligent prescribing does occur, any malpractice lawsuits are likely to be filed in the patient's state, where the physician may not be licensed.

When telemedicine takes place, patient's need to know where the physician is residing and where he or she is licensed to practice medicine. If the physician is not licensed in the state of Iowa, how much does the telemedicine physician know about Iowa's standards and regulations, and does the physician's malpractice insurance cover them and their Iowa patients?

Does the state in where the telemedicine physician is licensed share Iowa's laws for malpractice insurance liability, statutes of limitations and damage caps? If there are damage caps that are more restrictive that Iowa, then will a patient be limited by the damage caps in the state where the physician resides and is licensed.

If a type of care is allowed in Iowa but not in your doctor's state, will your doctor's malpractice insurance follow Iowa's laws or those of your doctor's state?

As the article points out, the rapid rise of telemedicine raises interesting questions for legal scholars and uncertainties for doctors and patients in situations where malpractice occurs and a lawsuit follows. 

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