Health
Texas Judge Fines New York Doctor and Orders Her to Stop Sending Abortion Pills to Texas
In a case that could have major implications for abortion access in the United States, a Texas judge on Thursday ordered a New York doctor to stop prescribing and sending abortion pills to patients in Texas and to pay a penalty of more than $100,000 for providing the medication to one woman.
The case is widely expected to reach the Supreme Court and become a pivotal test in the escalating battle between states that ban abortion and states that support abortion rights. It essentially pits Texas, which has a near-total abortion ban, against New York, which has a “telemedicine abortion shield law” intended to protect abortion providers who send medications to patients in other states.
These shield laws have become a key abortion rights strategy since the Supreme Court overturned the national right to abortion in 2022. The laws, enacted in eight states so far, stipulate that officials and agencies will not cooperate with civil suits, prosecutions or other legal actions filed against health care providers who prescribe and send abortion medication to patients in other states.
Such laws represent a stark departure from typical interstate practices of extraditing, honoring subpoenas and sharing information. Under telemedicine abortion shield laws, which have been in use since summer 2023, health care providers in states where abortion is legal have been sending more than 10,000 abortion pills per month to patients in states with abortion bans or restrictions.
The Texas lawsuit was filed in December by the Texas attorney general, Ken Paxton, against Dr. Margaret Daley Carpenter of New Paltz, N.Y., who works with telemedicine abortion organizations to provide pills to patients across the country. The suit alleges that Dr. Carpenter, who is not licensed in Texas, supplied abortion pills to a woman in Texas.
The order signed on Thursday by Judge Bryan Gantt of Collin County District Court said that Dr. Carpenter “is permanently enjoined from prescribing abortion-inducing drugs to Texas residents.” Violating an injunction can result in a contempt order from a judge, which could carry additional financial penalties or a jail sentence. The judge also ordered a $100,000 fine and about $13,000 in attorneys’ fees and court costs plus interest.
With New York’s shield law prohibiting cooperation with out-of-state legal actions, Dr. Carpenter and her lawyers did not respond to the Texas suit or appear in court on Wednesday for a hearing before the judge.
The 40-minute session in the court north of Dallas was notably quiet and sedate for an issue of such controversy and national significance.
Two lawyers for the attorney general’s office asked the judge to issue a default judgment in their favor, essentially a ruling against a defendant who has not shown up or provided any response.
The attorney general’s lawyers argued in court filings that because Dr. Carpenter did not respond within a certain period of time, Texas law deems that “defendant by her non-answer has admitted all of the plaintiffs’ allegations of fact establishing liability.”
The defense table was empty. About 30 minutes into the hearing, Judge Gantt said, “I noticed she is not here.” He asked the attorney general’s lawyers if they had heard from Dr. Carpenter that morning.
When they said no, the judge asked the bailiff to “call the hall” and announce Dr. Carpenter’s name in the corridor outside the courtroom. Less than a minute later, the bailiff returned and said, “Your honor, I called Margaret Daley Carpenter three times with no response.”
Texas was the first state with an abortion ban to initiate legal action against abortion providers in states with shield laws. But other states with abortion bans are expected to follow suit.
In January, the first criminal charges against a shield-law abortion provider were filed. In that case, a state grand jury in Louisiana issued a criminal indictment, also against Dr. Carpenter, accusing her of violating Louisiana’s near-total abortion ban by sending pills to that state.
On Thursday, Louisiana’s governor, Jeff Landry, said he had signed a warrant seeking to extradite Dr. Carpenter to his state to stand trial. New York’s governor, Kathy Hochul, responded by citing the state’s shield law and saying, “I will not be signing an extradition order that came from the governor of Louisiana, not now, not ever.”
The Texas and Louisiana cases are each expected to lead to court battles with the state of New York.
New York’s refusal could lead Louisiana to ask the federal courts to order extradition, experts said. The potential outcome is unclear, but Mary Ziegler, a law professor and abortion expert at the University of California, Davis, said there was legal precedent for extradition not being required for defendants who were not in the state where the alleged crime was committed and did not flee from that state.
In the civil case, Texas is considered likely to file a petition in a state court in New York to try to collect the financial penalty. If New York were to cite its shield law to argue against the Texas penalty, as expected, the case could transform into a battle in federal court or the Supreme Court over whether the shield law is constitutional in allowing one state to refuse to cooperate with another state’s legal actions.
Dr. Carpenter has not been reachable for comment about either the Texas or Louisiana case. The Abortion Coalition for Telemedicine, an organization she co-founded, has issued statements in response to the cases. “Shield laws are essential in safeguarding and enabling abortion care regardless of a patient’s ZIP code or ability to pay,” the coalition has said. “They are fundamental to ensuring everyone can access reproductive health care as a human right.”
The Texas lawsuit accuses Dr. Carpenter of providing a 20-year-old woman with the two medications used in a standard abortion regimen, mifepristone and misoprostol. Typically used up through 12 weeks into pregnancy, mifepristone blocks a hormone needed for pregnancies to develop, and misoprostol, taken 24 to 48 hours later, causes contractions similar to a miscarriage.
According to a complaint filed by the Texas attorney general’s office, the woman, who had been nine weeks pregnant, asked the “biological father of her unborn child” to take her to the emergency room in July “because of hemorrhage or severe bleeding.” In court on Wednesday, Ernest C. Garcia, chief of the administrative law division in the attorney general’s office, said that at the hospital, the woman’s partner “ended up finding out that she had been pregnant” and that “he then started to suspect that maybe she had not been truthful about it.”
When the man returned to the house, he found the medications and realized that they had been taken to induce an abortion, Mr. Garcia said, adding “that individual then filed a complaint with the Texas Attorney General’s Office.”
The Texas case is an example of an increasing pattern in states with abortion bans: men reporting to the authorities that their female partners had abortions. There have been other such cases in Texas, and John Seago, the president of Texas Right to Life, said in an interview that, in the coming weeks, several men plan to file suits for wrongful death against doctors, organizations or people who assisted in arranging abortions for the men’s female partners.
Emily Cochrane contributed reporting.
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If you’re trying to quit smoking, try a brisk walk or bike ride to curb your craving for a cigarette.
Researchers found that just one workout can reduce the urge to light up. But the type of exercise you do and how you do it makes a big difference.
High-intensity, aerobic exercise is most effective at reducing people’s cigarette cravings, a review of 59 randomized controlled trials involving more than 9,000 adults found.
FITNESS EXPERT REVEALS SIMPLE RULE TO GET IN SHAPE WITHOUT DREADING THE GYM: ‘JUST MOVE’
“Single-bout exercise reduced acute cravings immediately and up to 30 minutes post-exercise, but not longer-term cravings,” the authors of the study, published in the Journal of Sport and Health Science, reported.
Aerobic exercise is the most effective form of exercise for reducing cravings for cigarettes, researchers found. (iStock)
The research team highlighted other key findings from their study of “exercise-based interventions for smoking cessation.”
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Exercise training made people between 15% and 21% more likely to abstain from smoking than those who didn’t exercise, the authors found.
Researchers found that exercise curbs people’s cigarette cravings for up to 30 minutes after they stop exercising. (iStock)
Regular exercise also caused smokers to cut back by an average of two cigarettes per day.
In addition to being a free and accessible method for reducing smoking, exercise is also effective at reducing anxiety and stress, which drive many people to smoke.
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The authors suggest that because exercise boosts feel-good hormones, such as dopamine, and reduces the stress hormone cortisol, smokers who work out feel less inclined to use nicotine as a brain reward.
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Exercise should be integrated into other smoking cessation programs to enhance quit success, the authors concluded.
Exercise releases similar feel-good brain chemicals that people get from cigarettes, researchers suggested. (iStock)
They also noted that none of the trials addressed vaping and recommended that future research target the use of electronic cigarettes.
The deadly hantavirus outbreak aboard the cruise ship MV Hondius has put the spotlight on a rare pathogen that typically attracts relatively little attention, even from scientists.
There are no targeted treatments for hantaviruses, which are typically carried by rodents, and no widely available vaccines. So when passengers began falling ill in the middle of the Atlantic Ocean, doctors and public health experts were limited in what they could offer.
“It’s kind of a wake-up call,” said Dr. Vaithi Arumugaswami, an infectious disease researcher at the University of California, Los Angeles. “Our tool kit is almost empty.”
That’s not for lack of trying. A handful of scientific teams around the world have been working — for decades, in some cases — to develop hantavirus treatments and vaccines. But it has not been easy to find funding or nurture commercial interest in medical interventions for a type of pathogen that does not infect humans often and does not spread easily between people.
“It’s not an airborne, highly contagious viral threat, so it hasn’t been as high a priority for groups trying to prevent pandemics,” said Jay Hooper, a virologist at the United States Army Medical Research Institute of Infectious Diseases.
But there are promising vaccines and treatments in development. And some of them, experts said, could be moved through the pipeline rapidly if hantavirus interventions became a priority.
“I do think there are things that are sitting there on the bench that could be quickly developed,” said Dr. Ronald Nahass, the president of the Infectious Diseases Society of America. “But nothing is ready.”
Vaccine development
There are two main types of hantaviruses: Old World viruses, which circulate primarily in Asia and Europe, and New World viruses, which are found in the Americas. The cruise ship outbreak has been linked to a New World virus known as the Andes virus, which is endemic to South America and is the only hantavirus known to spread between people.
There are vaccines that target some of the Old World viruses in Asia, but their efficacy is modest, experts said. And there are no licensed vaccines for the New World viruses, which include the Sin Nombre virus endemic to rodents in the western United States.
But there are some in development. Dr. Hooper and his colleagues have developed a DNA vaccine for the Andes virus, which proved promising in a small phase 1 trial. Under certain dosing regimens, the researchers found, more than 80 percent of participants produced neutralizing antibodies. “It’s pretty amazing,” said Dr. Hooper, who is an inventor on multiple hantavirus vaccine patents owned by the U.S. government. “Getting these kinds of neutralizing antibodies in humans is impressive.”
There were drawbacks, including that the vaccine seemed to require at least three doses. But the vaccine is ready for further development “if there’s a need,” Dr. Hooper said. “We’ve done the science. It’s just other forces that are required to move vaccines forward — markets, government demand.”
Other teams have potential vaccines in earlier stages of development. For instance, Bryce Warner, a hantavirus researcher at the University of Saskatchewan, and his colleagues are exploring a variety of approaches, including a nasal vaccine that they hope might spark a more robust immune response in the airway.
But the research, which is being conducted in hamsters, is still in early stages, and hantavirus vaccine candidates can be challenging to move forward. Scientists lack good large-animal models for hantaviruses, Dr. Warner said, and human cases are rare enough to make trials tricky. “It’s very difficult to conduct a clinical trial when you only have a limited number of cases annually,” he said. “You don’t have the numbers of people to really show a robust effect.”
Drug hunting
Currently, the primary treatment for hantavirus infection is supportive care, which may include supplemental oxygen or heart-lung bypass machines. Doctors also sometimes prescribe an existing antiviral drug, called ribavirin, but there is not strong evidence that it is effective for New World viruses, scientists said.
The hunt for new drugs is underway, though. At U.C.L.A., Dr. Arumugaswami and his colleagues found that favipiravir, an antiviral approved to treat influenza in Japan, inhibited the Andes virus in human cells. They also identified several compounds that had broad antiviral activity, blocking hantaviruses as well as other types of viruses, in human organoids, miniature clusters of tissue that mimic the function of organs.
Other teams have been working to develop therapeutic antibody treatments, often working from blood samples collected from hantavirus survivors. “We were able to isolate the natural antibodies that people are making and basically winnow them down and find one that was really good,” said Kartik Chandran, a virologist at the Albert Einstein College of Medicine in New York. “We actually found several.”
When Dr. Chandran and his colleagues tested these antibodies in hamsters, one produced especially encouraging results: It seemed to work against both Old and New World hantaviruses and was effective even when given relatively late in the course of infection, Dr. Chandran said.
(Dr. Chandran is listed as an inventor on patents for hantavirus antibodies.)
Several other teams have also produced antibodies that were broadly effective in small animals, but that is where a number of potential products have stalled, experts said.
“We have a lead drug, and now what we need is someone to pay the money, which would be something like $40 million, to go the next step,” said Dr. James Crowe, director of the Vanderbilt Center for Antibody Therapeutics. “We have neither government nor foundation nor company support to do that. So we’re just waiting to find a partner.”
(Vanderbilt University has applied for patents related to these antibodies; Dr. Crowe is listed as the inventor.)
Experts said that they hoped the current outbreak might help bring attention to a family of often-overlooked viruses.
“Certainly judging by just my inbox and text messages, there’s a renewed interest in these agents, and renewed interest in maybe at least revisiting where they are in the priority list,” Dr. Chandran said.
Whether that interest can be sustained after the virus fades from the headlines remains to be seen, experts acknowledged.
“Raising awareness never hurts,” Dr. Warner said. “We’ll see whether or not it leads to anything tangible, at least in terms of funding and resources for advancing some of these things that are lacking for hantavirus.”
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