Active: Federal lawsuit challenges California’s unconstitutional telehealth restrictions

Shellye Horowitz has hemophilia A, an extremely rare bleeding disorder. Making matters worse, she has complicating factors such that minor medical procedures, regular exercise, and day-to-day activities can be dangerous because any trauma may set off bleeding that is difficult to stop. As a result, she often consults with her hemophilia specialists. Shellye lives in Trinidad, California—a remote coastal location in the northern reaches of the state. No local doctors have the necessary expertise to treat her condition. 

Shellye’s hemophilia has also had significant effects on her professional life. After spending 25 years working in K-12 education, she worked as the associate director of Education for the Hemophilia Federation of America. She took that role after spending several years learning and writing about hemophilia and the struggles encountered by people with the condition. Shellye also serves on the Board of Directors of the Hemophilia Council of California. As a result of her professional and personal experience, she deeply understands the importance of having knowledgeable medical specialists available.  

Shellye previously traveled to the Bay Area for care, but a negative surgical experience prompted her to look elsewhere. She ultimately switched her medical care to a hemophilia treatment center in Portland, Oregon, due to its renowned multi-disciplinary clinic for treating women and girls with bleeding disorders—the first such center on the West Coast. Despite the long distance, telehealth made the transition a godsend for Shellye, resulting in the best medical care she has ever received. 

Unfortunately, as the more lax days of the COVID-19 pandemic waned, her Oregon specialists were increasingly unable or unwilling to speak with Shellye over the phone due to California’s medical license requirements. The restrictions mandate physicians who engage in telehealth with California patients to be licensed in California. As a result, Shellye must choose between 14-hour drives to Oregon or simply going without life-saving care. 

The restrictions are equally devastating for out-of-state medical specialists whose care is critical to their patients in California. This includes Dr. Sean McBride, a respected radiation oncologist at Memorial Sloan Kettering Cancer Center in New York, who specializes in treating complex cancers. He uses telehealth to consult with his out-of-state patients virtually, discuss whether they should travel to New York for in-person treatment, and follow up with them upon their return home after treatment. He currently treats several patients from California and anticipates future patients from the state. 

Dr. McBride, licensed in New York but not California, is barred from providing crucial telehealth consultations with patients before or after cross-country travel to New York. Furthermore, violating California’s telehealth restriction is punishable by criminal charges and hefty fines and can put the doctor’s medical license at risk. 

California’s telehealth restrictions are not just wrong, they’re also unconstitutional. Placing undue burdens on both out-of-state physicians and California patients—that far outweigh any benefits—violates the Constitution’s Dormant Commerce Clause and Privileges and Immunities Clause.  

Also, just as physicians have a First Amendment right to speak with potential and existing patients via telehealth, physicians and their patients have the right to receive information from each other. The government cannot use licensing requirements to impede the exchange of information between patients and their doctors. 

Represented by Pacific Legal Foundation free of charge, Shellye and Dr. McBride are challenging California’s licensing law that threatens patients’ access to necessary, specialized medical care and rights of qualified specialists to treat them. 

What’s At Stake?

  • The government cannot use licensing requirements to prevent patients from accessing specialty medical care that their local doctors have no expertise in, or resources to provide. Nor can the government impede the exchange of information between patients and their doctors.
  • Limiting access to medical specialists benefits no one. It is wrong for the government to place undue burdens on both out-of-state physicians and in-state patients that far outweigh any benefits. There is no excuse for Californians—or anyone—to suffer simply because a member of their care team is in another state.

Case Timeline

May 16, 2024