South Carolina Changes - Enacted

The South Carolina legislature, which rejected a near total abortion ban in April, passed a slightly less restrictive measure that was subsequently signed into law by the state's governor (May 25).

The law ban abortions after six weeks, which is generally when a fetal heartbeat is detected. Limited exceptions are provided for rape, incest, the health of the mother, and fetus viability. Prior state law permitted forms of abortion up to about 22 weeks. 

Violators of the new law face felony charges that include fines of $10,000 and potential prison time of up to two years. Physicians or medical providers found guilty of performing illegal abortions will have their medical licenses revoked.

The new law faces legal challenge, however. Similar restrictions enacted in 2021 were struck down by the state Supreme Court for violating the privacy protections of the state's constitution.

(updated: 5-25-23)

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North Carolina Law - Enacted

North Carolina enacted its latest abortion law that limits most abortions to 12 weeks with exceptions for rape or incest through 20 weeks, 24 weeks for fetal anomalies, and no limit in the case of protection of the life of the mother.

The law also limits use of abortions medication after 10 weeks of pregnancy, and with requirements such as an in-person consultation with a doctor ahead of the procedure.

The state was able to enact the restrictions following the party switch of a member of the North Carolina House providing Republicans with a veto-proof majority in both the House and the Senate. While the state's governor vetoed the legislation, the state legislature overrode the veto.

(posted: 5-17-23)

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Montana's Dueling Actions

The Montana Supreme Court upheld upheld abortion rights in the state (May 12) voting unanimously to support a lower state court decision permitting advanced practice registered nurses to legally provide abortions in the state, and also reaffirming 1999 state-court precedent in a separate case that abortion is a medical choice protected by the privacy language of the state's constitution.

In contrast with the Court's decision, Montana enacted two packages of measures related to abortion which emphasize abortion restrictions (May 3 and May 16). One of the core enacted provisions is one that attempts to clarify that the privacy clause of the state's constitution does not guarantee the right to an abortion, but that measure is likely now meaningless with the state Supreme Court decision.

Other key measures enacted by the state include:

• Limiting abortion to the point of fetal viability, at about 24 weeks, unless the mother's life is at risk.
  

• Limiting the use of dialation and evaculation abortions to 15 weeks, except for medical emergencies in which the child would not survive outside of the womb.
  

• Establishes a state right of medical conscience to protect nurses and physicians who have decided they cannot conscientiously perform an abortion procedure.

(posted: 5-17-23)

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Nebraska Restrictions Now Likely

After the state's legislature turned back a measure (April 27) to impose a "heartbeat" abortion restriction (i.e., a prohibition at the detection of cardiac activity, generally at six weeks), Republican leadership packaged a new, less restrictive abortion measure–generally limiting abortion to 12 weeks–along with a measure banning gender-affirming medical care for minors. 

The combined measure passed (May 16) in an initial vote in the state's legislative process, and is now expected to clear final votes and be enacted into law with the support of the state's governor.

(posted: 5-17-23)

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Louisiana Rejects Changes

Louisiana's state legislature turned back an attempt, supported by the state's governor, to ease the state's abortion law by permitting an exception in the case of rape and incest. The proposal was rejected in committee.

Abortion is generally banned in the state unless necessary to save the pregnant person's life, to prevent serious risk to the pregnant person's physical health, and if the fetus is not expected to survive the pregnancy.

(posted: 5-17-23)

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Emergency Care & Federal Law

The Department of Health and Human Services (HHS) reminded hospitals nationwide (May 1) of their legal obligation to provide necessary stabilizing medical care under Federal law: the Emergency Medical Treatment and Labor Act (EMTALA). 

An investigation of two hospitals by HHS found that they failed to offer abortion-related emergency care to a woman that her doctors determined was necessary given her medical condition, because the hospitals have policies against providing abortions. 

The woman had experienced a pre-term, premature rupture of membranes, and as a result was advised that her pregnancy was no longer viable. Her doctors advised her that her condition could rapidly deteriorate (the woman survived), which necessitated stabilizing medical intervention to prevent infection, hemorrhage, and potentially death. The doctors could not provide the treatment because their hospitals prohibited treatment that could be considered an abortion.

(posted: 5-17-23)

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South Carolina Effort Blocked

The South Carolina state legislature turned back (April 27) an effort to impose significant new abortion restrictions.

The proposal would have banned abortion at all stages with exceptions up to 12 weeks for rape and incest. The proposal passed the South Carolina House, but failed in the Senate. Current law, which remains in place permit forms of abortion up to about 22 weeks. 

(posted: 5-17-23)

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Birth Control Medication Over-the-Counter

An advisory panel of the Food and Drug Administration (FDA) voted to approve (May 10) over-the-counter (OTC) access to contraception medication Opill produced by HRA Pharma. This would be the first oral contraception available OTC.

If approved by the FDA, a decision which will likely come sometime this summer, Opill would become available to persons without the requirement of a visit to a doctor and a prescription. A version of Opill was approved in 1973, and was updated and re-approved in 2017 as prescription contraception under its current name.

While the FDA panel confirmed that there are some medical side effects of concern, the potential benefits of improved access to this contraception outweighs the known risks. Younger persons, in particular, are less likely to visit a doctor for contraception and instead use less reliable birth control methods (e.g., condoms). That being the case, the reliability of Opill relies heavily on the user taking the dosage every day.

(posted: 5-11-23)

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North Dakota - Unmatched?

North Dakota enacted (April 24) perhaps the toughest anti-abortion law in the US. 

The law bans abortion after six weeks of pregnancy (down from 22 weeks), with no exceptions for rape or incest. An exception would be permitted in the case of preventing "death or serious health risk" of the mother.

The state constitutionality of abortion restrictions under prior state law are currently being challenged before the North Dakota State Supreme Court. For now, the newest law can go into effect, but it is likely to face legal challenge, and also could be overruled with any State Supreme Court ruling on the prior law.

(posted: 4-15-23)

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Abortion Medication

The US Supreme Court ruled (April 21) that the abortion medication mifepristone can remain on the market and be dispensed consistent with current Food and Drug Administration (FDA) standards, but only while an appeal is being considered on a pending Federal district court case. 

A Texas Federal Appeals Court is considering a case against the FDA on appeal from a Texas District Court. The District Court ruling (April 7) supported a plain-reading view of the Comstock Act (the original version passed in 1873) which effectively forbids the mailing of abortion-inducing drugs, as well as several arguments supporting that the FDA did not properly approve mifepristone decades ago, or consider through proper administrative public review procedures the safety side effects that became known over time. The judge did not consider the other common abortion-inducing drug - misoprostol - which is often used in combination with mifepristone. The Justice Department outlined its counterarguments against the lawsuit in January.

While the appeal is being heard, the Appeals Court ruled that mifepristone could be used only up to an upper limit of seven weeks of pregnancy (instead of the 10 weeks approved by the FDA), and also decided that the medication could not be sent through the mail while the appeal is being considered.  The Supreme Court denied those restrictions during the appeals process. 

After any Appeals Court decision, the matter could be elevated to the Supreme Court, which may have to rule again on any lower-court-imposed restrictions.

In a separate Washington state Federal District Court case, 17 states and the District of Columbia filed a lawsuit against the FDA concerning dispensing restrictions the agency put in place in January. The plaintiff states were seeking a requirement that the FDA keep the prior availability of mifepristone in place for those states filing the lawsuit. The parties included Arizona, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont and Washington.

In his decision, the Federal judge determined that the FDA must maintain the “status quo” with respect to its prior availability standards of mifepristone before the January dispensing changes, as he generally agreed with plaintiffs that the FDA had not gone through proper administrative review procedures before putting more restrictive dispensing measures in place. The Justice Department says it is considering the results of the ruling but has not yet committed to an appeal.

With the two District Court decisions, the FDA basically has one lawsuit requiring mifepristone be taken off the market for now, and the other requiring no change in the medication's availability (at least for some states). Research collected by the Guttmacher Institute found that abortion medication was used for more than 50% of US abortions in 2020.

More on the latest abortion policy developments HERE.

(posted: 4-20-23)

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Florida Enacts an Enhanced Ban

Florida enacted significant enhancements (April 13) to its already restrictive abortion law enacted 2022. The 2022 version of the law is currently being challenged in state courts.

Under the new 2023 law, abortions will be prohibited after six weeks, down from 15 weeks, even though women often do not realize they may be pregnant after six weeks. There are exceptions for rape, incest and human trafficking, or in cases where a baby has a fatal fetal abnormality up to 15 weeks, provided the pregnant person has documentation such as a police report or restraining order in the case of rape and incest. Last year's law did not provide exemptions for rape, incest, and human trafficking.

This year's enhanced restrictions will not go into effect until the Florida State Supreme Court rules on the constitutionality of restrictions on abortion rights connected the 2022 law and under the privacy clause of the state's constitution. While the Court had previously upheld such rights, Court membership is now more conservative and prior precedent has an increased potential to be overturned.

(posted: 4-14-23)

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Idaho & "Abortion Trafficking"

The Idaho legislature passed (March 30) a bill intended to limit the ability of minors to travel out-of-state for abortions. The measure is expected to be approved by the state's Governor.

The bill seeks to accomplish this goal by making it a felony crime–dubbed "abortion trafficking"– for an adult to help a minor, without parental consent and with the intent to conceal the action from parents, to obtain an abortion or obtain an abortion-inducing drug. As abortions are generally illegal in Idaho, such an individual would need to travel out of state to receive an abortion or, in the case of abortion-inducing drugs a minor might need an adult's help to obtain such drugs within a state.

A felony conviction could result in a 2-5 year prison sentence.

(posted: 3-31-23)

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DOD & Abortion Care Access

Senator Tommy Tuberville (R-AL) has placed a hold on all Defense Department promotions requiring Senate approval over the agency's abortion policy. The Senator has called the policy "illegal," connecting the policy to Federal law banning Federal funding support for abortions.

The Department of Defense issued (February 16) several policies related to reproductive health care which can impact service member decisions on, and access to, abortion.The policies cover command notification of pregnancy, administrative absence for non-covered reproductive health care, and travel allowances for non-covered reproductive health care.

The policies do not provide Federal funding for abortion. Through the new/updated policies, service members will have more time to notify commanders about a pregnancy (i..e, up to 20 weeks) giving them more time to decide and act on reproductive healthcare decisions; will have the ability to request administrative leave from their duty station to receive reproductive care without being charged leave, which could be important if a local area does not offer or permit relevant care; and will potentially have the ability to receive travel and transportation allowances when local access to non-covered reproductive health care services is not available.

It is primarily the last matter–travel and transportation allowances–where the Senator is asserting that the policy is illegal.

(updated: 4-13-23)

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Oklahoma is Forced to Loosen Its Law, Slightly

The Oklahoma Supreme Court issued a ruling (March 21) that says the state's constitution ensures women have a right to abortion when pregnancy risks their health, not just in a medical emergency under the state's restrictive abortion law.

The Court ruled that a woman has the right under the state Constitution to receive an abortion to preserve her life if her doctor determines that continuing the pregnancy would endanger her life due to a condition she has or is likely to develop during the pregnancy.

The Court declined, however, to issue a ruling on any broader abortion rights protections that may be implicit under the state's constitution.

(posted: 3-21-23)

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Wyoming Bans Abortion Medication

Wyoming became the first state to enact a specifically-targeted ban on abortion medication (March 17), though some states have universal abortion bans that include medication-induced abortions.

Research collected by the Guttmacher Institute found that abortion medication (i.e., mifepristone and misoprostol) was used for more than 50% of US abortions in 2020.

Wyoming’s abortion pill law will take effect on July 1, making it illegal to "prescribe, dispense, distribute, sell or use" abortion-inducing medication. Doctors face misdemeanor penalties for violating the law, including up to six months in prison and a $9K fine. Pregnant patients, however, would be exempt from charges and penalties.

Exceptions in the new law include contraception provided before pregnancy, treatment tied to a natural miscarriage; treatment to prevent "imminent peril" (physical, not psychological or emotional) that substantially endangers the mother's life or health; or pregnancy as the result of incest.

(posted: 3-21-23)

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State Attorney’s General & Abortion Pills

Attorney Generals from 20 states signed on to a letter (February 1) that effectively threatens legal action against CVS and Walgreens if they move forward plans to dispense abortion pills through the mail system, which could lead to such pills crossing state lines.

Ensuring that the companies “are fully informed of the law, ” the letter implies that they will violate both Federal law and laws within those states with restrictions on abortion.

The letter provides that while the Biden Administration issued a legal opinion supporting the dispensing of such drugs in the mail, it is only an opinion and not what the law permits in its strict reading. The letter says that the Biden Administration’s opinion “fails to stand up even to the slightest amount of scrutiny” representing a “ bizarre interpretation” that will not stand up to judicial review.

Further, these letter signatory states believe that abortion pills are “far riskier than surgical abortions,” and “invite” an increase in abortion coercion because there is no oversight.

(posted: 2-2-23)

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FDA, Abortion Pills, and a Legal Challenge

The FDA finalized a rule (January 3) that alters the labeling of abortion drugs so that more retail pharmacies can dispense the medication if certification requirements are met. Prior labeling effectively limited dispensing to a subset of speciality offices and clinics given safety concerns.

This rule, however, may soon become irrelevant. The FDA's underlying approval of abortion medication is being challenged in court. The most significant pending case was filed via the leadership of the Alliance for Defending Freedom in November 2022. The lawsuit claims that the FDA exceeded its authority when it used an accelerated process to approve abortion medication in 2000. The FDA estimates that more than 3.7 women have used the medication.

The lawsuit was filed in a conservative-leaning Federal District Court that is itself under a conservative-leaning Federal Appeals Court jurisdiction. Any ruling against the FDA could result in an injunction against the dispensing of approved medications even if the matter moves to higher courts including, eventually, the US Supreme Court.

(posted: 2-2-23)

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Mailing/Shipping Abortion Drugs

The Justice Department issued a legal opinion (December 23) for the U.S. Postal Service (USPS) that provides the legal support for the service permitting the mailing of abortion drugs to states that have restrictive abortion laws.

The overarching summary legal basis is that because there are “manifold ways” in which recipients can use such drugs legally, including to produce an abortion, “the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully.” Long-standing law (the Comstock Act) , which has been updated numerous times and addressed through cases in the courts, still has left some questions about the legality under Federal law of the mailing of abortion-related drugs; mostly mifepristone or misoprostol.

While this opinion provides some assurance for the USPS (and other shippers) regarding such drugs flowing through the mail system, the opinion does not address state-level legal actions against persons or organizations sending or receiving the drugs.

(posted: 1-5-23)

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2022 State Ballot Abortion Measures

Five states included ballot measures for the 2022 elections to either restrict abortion rights (Kentucky and Montana), or enshrine rights within state constitutions (Vermont, Michigan, and California).

Here is a summary of the specifics and results:

Kentucky - a ballot measure that would have added language to the state’s constitution that citizens do not have a right to abortion and that the state is not required to provide government funding for abortion. The measure failed by more than 52% of the vote.

Montana - a ballot measure that would have established that infants born alive at any stage of development are legal persons; and, that medical care would be required for any infant born alive after an attempted abortion, induced labor, or other method. Criminal penalties would have been imposed on non-compliant health care providers. The proposal was viewed as less direct way to restrict abortion care. The measure failed by nearly 53% of the vote.

Vermont - adds language to the state’s constitution providing that all individuals have a right to personal reproductive autonomy. The measure was approved by nearly 77% of the vote.

Michigan - adds language to the state’s constitution to establish an individual right to reproductive freedom, in this case defined as the right for individuals to make all decisions about pregnancy, including prenatal care, childbirth, postpartum care, contraception, sterilization, abortion, miscarriage management, and infertility. The measure was approved by nearly 57% of the vote.

California - a ballot measure to prohibit the state from interfering with an individual's reproductive freedom, including the rights to choose to have an abortion and use contraceptives. The meausure was approved with nearly a 67% "yes" vote.

(posted: 11-15-22)

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Portion of Iowa Law Blocked

A Federal Judge issued a preliminary injunction against Iowa's new abortion law which can punish a doctor for performing an abortion to protect the health of a patient. The Department of Justice (DOJ) had filed a lawsuit (August 2) against the State stating that the law  "presumptively criminalizes all abortions, making it a felony for doctors to provide emergency treatment required by federal law, even where a denial of care will likely result in the death of the pregnant patient."

DOJ argued that the law "places medical professionals in an impossible situation: they must either withhold stabilizing treatment required by ...  [the Emergency Medical Treatment and Labor Act - EMTLA] ... or risk felony prosecution and license revocation." DOJ is seeking a declaratory judgement that Idaho’s law violates the Supremacy Clause of the Constitution; a declaratory judgment that Idaho may not punish medical providers based on their performing an abortion authorized by federal law; and, an injunction prohibiting Idaho’s enforcement of the law "to the extent that it conflicts and prevents physicians from providing the emergency treatment that federal law requires."

(updated: 8-24-22)

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Kansas Ballot Measure Defeated

A measure on the Kansas 2022 primary election ballot was defeated. The measure would have modified the state's constitution to say that nothing in it creates a right to abortion or requires government funding for abortion, and that the state legislature has the authority to pass laws regarding abortion.

The ballot measure was in response to a 2019 state supreme court case which resulted in abortion remaining legal even if the Roe v. Wade were overturned. The state court decided in favor of abortion rights based on the Kansas Bill of Rights providing that "all men are possessed of equal and inalienable natural rights, among which are life, liberty, and the pursuit of happiness." The state's court decided that these words provide "substantive rights" that include "a woman's right to make decisions about her body"  including abortion decisions.

(updated: 8-24-22)

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Contraception Rights Protection

The House approved legislation (H.R. 8373) to explicitly protect within law to obtain and use contraception by a vote of 228-195-2, with all Democrats and 8 Republicans voting for the proposal. Two Republicans did not vote.

The legislation provides that a person has a statutory right “to obtain contraceptives and to engage in contraception, and a health care provider has a corresponding right to provide contraceptives, contraception, and information related to contraception.” Ultimately, no state or Federal laws or operating practices would be able to “expressly, effectively, implicitly, or as implemented” that impedes access to contraceptives, contraception, or contraception-related information.

Opponents in the House argued that the legislation, as written, would permit abortions via drugs without any restriction. And, it would violate the rights of religious health providers by forcing them to prescribe forms of contraception that they might not agree with on religious grounds. Opponents also argued that the legislation was unnecessary because no state is moving to obstruct contraception access.

Senate consideration of the legislation at some point is likely, though the timing is not known and also the Senate may want to develop a version that would ensure passage.

(updated: 7-22-22)

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Abortion Rights Protection

In the wake of the Supreme Court’s landmark new ruling on abortion rights that overturned Roe v. Wade, the House voted (July 15th) on two abortion rights bills.

The House voted to approve the Ensuring Access to Abortion Act of 2022 (H.R.8297) by a vote of 223-205-3, with all Democrats and three Republicans voting for the bill. Three Republicans did not vote. The bill would prohibit anyone acting under state law from interfering with a person's ability to access out-of-state abortion services by preventing, restricting, impeding, or retaliating against such persons. This includes both persons seeking an abortion and doctors who perform services out-of-state.

The House also voted to approve the Women’s Health Protection Act of 2022 (H.R. 8296) by a vote of 219-210-2, with all but one Democrat voting for the bill and all but two Republicans voting to oppose the bill. Two Republicans did not vote. This legislation is generally the same bill that passed the House last September that would secure within law a women’s right to an abortion through a statutory right for health care providers to provide, and their patients to receive, abortion care without medically unnecessary restrictions, limitations, and also bans state law actions that delay (and have the potential to completely obstruct) access to abortion.

Neither bill is likely to be considered in the Senate this year. Earlier this year, the Senate failed to overcome primarily Republican opposition (by a vote of 49 to 51) to consider the Women's Health Protection Act.

Senator Joe Manchin (D-WV) voted against consideration of the bill, arguing that legislation was “too broad.” Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK), who also voted against the bill but who have stated support for codifying Roe v. Wade in law, claimed that this particular legislation did not protect basic “conscience protections” for health care providers who have religious objections to performing abortions.

(updated: 7-15-22)

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Constitution-based Right of Abortion Overturned

The Supreme Court overturned Roe v. Wade (June 24th) in an opinion. Justices in the majority included Alito, Thomas, Gorsuch, Kavanaugh, and Barrett. Justices Breyer, Sotomayor, and Kagan issued an opposing opinion. Chief Justice Roberts did not join the majority opinion, but filed his own that argued he would not have overturned Roe but instead would have merely upheld Mississippi’s law that was the focus of the case before the Court.

More detail on this decision can be found here.

(updated: 6-24-22)

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Recent State Abortion Restriction Laws

The following are select recent actions by States to restrict or protect abortion rights. All actions are not listed here. The NY Times keeps a good tracker of abortion law status by State.

Indiana:  Indiana's law (August 2022) bans abortion from conception (i.e., zero weeks) except in some cases of rape, incest, a fatal fetal abnormality, or when a woman faces risk of death or certain severe health risks. Victims of rape and incest have up until 10 weeks to seek an abortion. Abortion tied to eligible fetal abnormalities can occur up to 20 weeks. Abortion clinics will no longer be able to operate in the state. Any legal abortions will have to be performed in hospitals and ambulatory outpatient surgical centers owned by hospitals. Doctors can be convicted for a felony for performing an illegal abortion, with the potential of 1-6 years in prison and a fine of up to $10,000. Women receiving illegal abortions would not be subject to criminal penalties.

New York. New York enacted a series of new abortion rights laws (June 2022) before the new Supreme Court ruling overturning Roe v. Wade. Key new laws included measures that block New York courts from issuing subpoenas in connection with out-of-state abortion proceedings; with limited exception, prohibiting the extradition of abortion providers; prohibiting disciplinary measures against health practitioners for providing legal reproductive health services to patients who reside in states where abortion is illegal; and, barring medical malpractice insurance companies from taking adverse actions against a reproductive health care provider performing legal reproductive health care.

California. California recently enacted a law that protects those in California from civil liability for providing, aiding, or receiving abortion care in the State. California is also considering a State constitutional amendment to enshrine the right to an abortion.

Mississippi. Mississippi law bans all abortions over 15 weeks gestational age except in medical emergencies and in the case of severe fetal abnormality. While the law was not enacted recently (it was enacted in 2018), it is considered a landmark law because the center of a case brought before the Supreme Court (Dobbs v. Jackson) that the Court used to overturn Roe v. Wade.

Kentucky & Arizona. Arizona and Kentucky have enacted similar 15-week abortion ban laws. Arizona’s law was enacted on April 7, 2022. Kentucky’s legislature overrode a veto by the State’s governor (April 13, 2022) to implement its law. There are no exceptions for rape or incest in either state, and doctors performing certain abortions could face felony charges including fines and state prison terms.

Florida. Florida enacted a 15-week abortion ban law (April 14, 2022) with no exceptions for rape or incest. Abortions would be permitted to save the life of a mother or to prevent serious injury. Exceptions will also be permitted for fetal abnormalities, though two doctors will have to confirm a baby will die shortly after birth before an abortion is permitted.

Texas. The Texas Heartbeat Act bans abortions once fetal cardiac activity is detected, typically at six weeks of gestation. An exception is for medical emergencies where a woman's life is at risk, but there are no exemptions for cases of rape and incest. In general, the law allows anyone to sue a Texas doctor who has performed, or intends to perform an abortion, or sue anyone who aides a woman in receiving an abortion. Monetary awards for someone successfully suing under this law will total at least $10K. In December (2021), the U.S. Supreme Court refused to put the law on hold while the law is being challenged in the courts.

Idaho. Idaho adopted a similar version of the Heartbeat Act (March 14, 2022), the first state to do so since the Texas law. The most significant difference of the bill relates to an exception for rape or incest. While the Texas law allows no exceptions for women who are victims of rape or incest, the Idaho bill permits an exception but requires women to file a police report and show it to the provider before they can obtain an abortion. 

Oklahoma. Oklahoma enacted a law (April 12, 2022) making it a felony to perform an abortion, or attempt to perform one, punishable by a maximum fine of $100,000 or a maximum of 10 years in state prison, or both. No exceptions are provided in the case of rape or incest; only if there is a “medical emergency.” Oklahoma is also said to be considering a Texas-style Heartbeat Act bill.

Wyoming. Wyoming bans abortion except when a woman is at "serious risk of death or of substantial irreversible physical impairment of a major bodily function" not including psychological/emotional conditions, and also in the case of incest.

South Dakota. South Dakota enacted a law (March 23, 2022) that restricts access to legal abortions via medication. The law, if it clears court challenges, will require women to make at least three separate trips to a clinic to obtain medication – an initial screening, as early as three days later for a first dose of medication, and a third trip for a second dose.