Legal framework needed to support telemedicine
The New York Times has been keeping score of the vaccine rollout in all the states and territories. It calculates jabs as a percentage of population and then presents the information in a ranked table, like league standings.
It’s been gratifying to see New Mexico vying for first place with American Samoa, Alaska and South Dakota. It will be even more gratifying to see the contest end in a massive tie.
There’s a feeling that the COVID-19 pandemic is dying down in the United States, even as we read about new heights being reached elsewhere in the world. The daily death toll in America remains at a level that would have horrified us a year ago. New information about the long-term physical and cognitive effects of the disease continues to trickle out.
But people are traveling again. On several days in March, the daily tally of people passing through TSA airport checkpoints topped 1.5 million.
Not every adjustment we’ve made to pandemic life has been bad. I’m a big fan of curbside pickup for groceries and hope it remains an option forever. Allergy sufferers have an extra reason to be grateful that face masks no longer draw stares.
We’ve even seen a shy, modest trickle of articles from people admitting that they rather like communicating digitally and skipping the big meetings at work. For such people, the cessation of forced socializing has been like finally turning off an annoying background noise. The newsletter writer Dave Pell says he intends to use “abundance of caution” as his excuse to skip social events for the next 10 years.
Writing in Atlantic Magazine, sociologist Zeynep Tufekci detailed three ways in which “this awful year” has nonetheless changed the world for the better. First, the rapid development of messenger RNA technology has been “an epochal scientific and technical breakthrough.”
Second, we’ve seen an explosion in open scientific activity, including the rapid informal peer review of preprints. The Chinese scientist Zhang Yongzhen shared the genetic structure of the SARS-COV-2 virus with other researchers just 40 hours after the first sample reached his lab. We can hope such open collaboration remains a norm.
Third, we’ve discovered, belatedly, that it’s not necessary for people to cluster in big cities, facing grueling daily commutes, to do work that can as easily be done from home while living in a mid-sized city with reasonable housing costs, a pleasant climate and ready access to outdoor recreation. (Know any place like that?)
Tufekci also cites CDC statistics that show telemedicine visits increased by 50% during the first half of 2020. Remote access to health care is a godsend to those living in rural areas and traditional communities.
Fully 81 million Americans live in medically underserved areas, according to the Health Resources and Services Administration. A disproportionate number of them call New Mexico home.
But does a world-renowned specialist from the Cleveland Clinic or Cedars-Sinai need a New Mexico medical license to consult with a patient in rural New Mexico? Does the practice of medicine occur where the physician exercises professional judgment or where the patient receives care?
The Interstate Medical Licensure Compact, enacted by 29 states and D.C., provides an elegant way around that conundrum, creating a streamlined procedure for physicians to obtain licensure in multiple states with a single application. New Mexico isn’t a signatory, instead offering its own telemedicine license. Its requirements appear no more stringent than those imposed by the compact, but it imposes additional fees and paperwork.
If a physician commits malpractice remotely, in which state is a lawsuit properly filed? It’s not so easy for an injured person, already facing mounting medical bills, to find a trustworthy, competent lawyer in a city far away. But requiring doctors to defend themselves in rural courthouses around the country would only discourage them from treating patients in far-flung places.
There’s also the question of the standard of care used as the measure of professional competence. In medical malpractice cases, New Mexico jurors are instructed to compare the defendant’s skill with that of other doctors “practicing under similar circumstances, giving due consideration to the locality involved.” Which locality is that?
In the future, remote medical examinations might become more like virtual reality, no longer dependent on the spyhole cameras built into our computer monitors. But until that day, should doctors examining a patient through imperfect technology be held to the same standard as doctors examining a patient in person? If not, how do we balance the deficit of care against the ease of access?
The possibilities of telemedicine are inspiring. Now we need a legal framework to turn them into sustainable reality.