Family physician tells committee mifepristone and misoprostol can be provided safely via telemedicine during S.28 hearing

Claire Keegan, a family physician who practices in Chittenden County, testified to the Senate Health & Welfare Committee in support of evidence that medication abortion with mifepristone and misoprostol is safe and can be provided through telemedicine and asynchronous care pathways.

Keegan told the committee that the combination of mifepristone and misoprostol has been in routine clinical use and that evidence supports its safety and efficacy for medication abortion. She said physical examination generally is not required for assessing eligibility: "I don't have to do any physical exam at all," Keegan said, describing typical primary-care evaluation by verbal history. She explained that most contraindications — for example, adrenal, liver or kidney failure — are identified through history rather than physical exam.

Keegan highlighted key clinical screening points. She told the committee that the medicines will not treat an ectopic pregnancy and estimated ectopic incidence at about 2% of pregnancies, so clinicians screen for risk factors (prior ectopic pregnancy, an IUD in place, prior tubal surgery or pelvic inflammatory disease). For patients at higher risk of ectopic, Keegan said she recommends ultrasound before providing medication; when ultrasound is available but an early pregnancy is too early to visualize conclusively, clinicians may still provide mifepristone but emphasize follow-up because ultrasound limitations can leave ectopic unresolved.

On complications, Keegan said heavy bleeding is the most common serious complication and that patients with bleeding-risk medications or conditions are typically steered to a procedural option. She described follow-up as essential regardless of whether care was delivered in person, by video or via an asynchronous portal — noting that asynchronous messaging and chart review used during the COVID-19 pandemic produced safety data supporting remote care models.

Committee members asked for written materials and clinical flowcharts to document the screening and follow-up process. Keegan said she would provide a flow sheet and links to supporting evidence and offered to share testing and protocol templates electronically with committee staff.

The committee thanked Keegan for the testimony and said staff would accept her written materials and circulate them to members for S.28 deliberations.