State’s View of Telemedicine: Dangerous for Women, Fine for Kids with Developmental Problems!

Governor Kristi Noem happily ignored medical research when she declared telemedicine consultations for women seeking medication abortions too dangerous to be legal.

But now when she wants to cheat health care providers of payment, she declares telemedicine perfectly safe and effective for children in therapy, contrary to the informed opinion of practitioners:

Rule changes recently made by the state Board of Education Standards will result in less travel reimbursement paid to direct-service providers and possibly more use of teletherapy in South Dakota’s Birth to 3 program that assists youngsters who have developmental delays or disabilities.

South Dakota Office of Early Childhood Services administrator Sarah Carter told the state board that general funds are used to cover travel to and from families by direct-service providers who deliver Medicaid-supported assistance for physical therapy, occupational therapy and speech-language pathology.

…Carter’s suggestion was to pay traveling providers $1 per mile, similar to the rate that lawyers are paid by the state Unified Judicial System. For fiscal 2023 that would save Birth to 3 an estimated $319,862, she said, and Birth to 3 could absorb the net increase of $129,000 in other ways, such as using teletherapy more often.

…Testifying against the travel changes were Holly Nordstrom, a speech-language pathologist from Rapid City, and Kris Detert, a speech-language provider and contractor from Sioux Falls. They said it would make providers less interested in working for Birth to 3. Detert also said the tele-therapy sessions weren’t in the best interest of the child [Bob Mercer, “SD Birth to 3 Providers Will Get Less Travel Pay,” KELO-TV, 2022.08.02].

Hey, I’d jump at a buck a mile for my travel, but I’m also not a trained and licensed therapist.

Telemedicine for medication abortions for women is different from telemedicine for physical, occupational, and speech therapy for infants and toddlers. The consultation for a medication abortion is mostly sharing information—which pills to take and when, what side effects to watch for, what conditions warrant calling the doctor or going to the hospital—that an adult is capable of understanding and acting on. Birth to 3 is providing therapy to very young children who may have trouble understanding what’s going on in a videoconference even without the developmental delays and disabilities the program seeks to remedy. Some of the patients may not even be using language yet. These therapists use touch to diagnose, guide, and evaluate their patients. Telemedicine always requires finding ways to compensate for the absence of physical presence, but the physical presence missing from a telemedicine therapy session is much greater and much more vital to therapy for very young, developmentally delayed or disabled students than it is for women seeking medication abortions.

We just ran a $115.5-million surplus, but to save another 0.3% of that queenly sum, the Noem Administration will skimp on in-person therapy for kids and subject those tiny tots to the same care-by-wire that the state says is too risky for grown women.