California’s telemedicine law forces rare disease patients to leave the state to receive care

To receive treatment and consultations for hemophilia A, a rare clotting disorder, Shellye Horowitz will periodically travel from her home in rural Northern California to the hemophilia clinic affiliated with Oregon Health & Science University (OHSU) Hospital in Portland, Oregon.

California telemedicine laws require that physicians who treat or consult with patients in California must also be licensed in California. Because the specialists Horowitz sees are not licensed in California, she often has to make a 14-hour round trip to Portland for visits she could easily do remotely.

“So far, I have made three visits to my hemophilia treatment center, where when I was able to go to Portland, appointments were only made by phone,” Horowitz says. “I had to physically travel to Portland to sit in a hotel with worse internet than my home to use telehealth.”

Telemedicine has boomed during Covid-19, as states lifted restrictions on remote medical visits through emergency orders as part of their social distancing systems. Since then, many have undergone permanent policy changes allowing out-of-state physicians to offer their services to patients.

But California lags far behind, as a January report from the Reason Foundation (which publishes this website) makes clear.

California is one of 27 states where out-of-state physicians and other health care providers cannot treat or consult with patients. It also has not joined the 40-state Interstate Medical Licensing Compact, which allows doctors to apply for licensure in multiple states at once.

Gov. Gavin Newsom’s telemedicine order during the pandemic provided only minor regulatory relief on patient privacy and data security laws. With the end of the state of emergency, temporary deregulation also disappeared.

In 2023, the state passed a new law allowing doctors licensed in other states to provide telehealth services, but only in “emergencies” when the patient was expected to survive only a few months and had not been cleared for clinical trials closer to their home.

California’s licensing requirements pose particular problems for patients like Horowitz, who have rare conditions that require specialized and frequent care.

They also pose a major obstacle to specialist clinics that want to treat small numbers of patients spread across the country. The time and expense of obtaining and maintaining a license in California or other equally restrictive states may not be worth it if only a handful of patients seek care there.

Last week, Horowitz and Sean McBride, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York, filed a lawsuit against the head of the California Medical Licensing Board, Randy Hawkins.

Their lawsuit was filed in the United States District Court for the Eastern District of California.

The lawsuit alleges that California’s restrictions on the interstate practice of medicine without a purported local benefit violate the U.S. Constitution’s “dormant commerce clause,” which prohibits states from “enacting laws that discriminate against interstate commerce or unduly burden interstate commerce for any purported local advantage.” ”

“Licensing requirements are essentially identical from state to state. “Cancer treatment in California is the same as cancer treatment in Vermont,” said Caleb Trotter, an attorney with the Pacific Legal Foundation, which represents Horowitz and McBride.

California’s discrimination against out-of-state licensed doctors does not improve the quality of medical care, Trotter says. The withdrawal of such licensing requirements in other states during the pandemic has also not resulted in any harm to patients.

Their lawsuit only challenges California’s restrictions on doctors licensed out of state to consult and care for patients. Leaves unchallenged licensing requirements for out-of-state physicians who treat patients (e.g., through remote therapy sessions) or prescribe medications.

That California’s licensing restrictions apply to ordinary communications between doctors and patients also violates the First Amendment’s free speech protections, the lawsuit argues.

For Horowitz, the opportunity to have further consultations with doctors and medical specialists is especially important. California’s restrictions leave her unsure whether she could even consult a nurse at the Oregon clinic if she was bleeding.

“It’s my body and my health care,” she says. “I should be able to choose a service provider I trust. I don’t like the fact that my condition limits my ability to connect and communicate with the provider of my choice.”