A first-of-its-kind criminal case against a New York abortion pill provider is likely to make its way through the legal system to the Supreme Court, presenting a threat to interstate relations akin to the one posed by the Fugitive Slave Act.
The legal battle could also dash President Donald Trump‘s hopes of leaving the federal government out of abortion policy.
The clash between New York Governor Kathy Hochul (D) and Louisiana Attorney General Liz Murrill (R) over an extradition request for Dr. Margaret Carpenter, who prescribed abortion pills that were given to a minor patient in Louisiana, has sparked an intense legal conflict that puts federalism in the spotlight of the abortion debate.
Hochul has vowed to spare Carpenter from extradition, citing New York’s shield law that was intended to protect healthcare providers from prosecution in states where abortion is illegal.
Murrill, meanwhile, has said that Hochul’s efforts are akin to protecting a “drug dealer” and has likened the sale of mifepristone in Louisiana to trafficking cocaine.
The unresolved conflict between Louisiana and New York is likely to make its way to the Supreme Court, which has been careful not to disturb the fragile status quo on abortion policy following the landmark Dobbs v. Jackson Women’s Health Organization decision in 2022 that overturned federal protections for abortion under Roe v. Wade.
The legal battle is a threat to Trump’s positioning on abortion. During the 2024 presidential election, Trump shifted the GOP platform towards a states’ rights position, arguing that the Dobbs decision in 2022 returned abortion policy to voters in individual states.
But the case against Carpenter highlights how letting states manage their own policies on abortion can prove challenging when abortion pills can be prescribed via telehealth and shipped in the mail directly to patients.
Because mifepristone is involved in nearly two-thirds of all abortions in the United States, this case could have far-reaching implications for abortion policy across the country.
“Poison in the mail”
At the heart of the case is a Baton Rouge area 17-year-old girl who prosecutors say was forced into a medication abortion by her mother in April 2024.
Prosecutors say the girl wanted to keep her pregnancy and was planning a gender reveal party when her mother coerced her into taking mifepristone by threatening to kick her out of the house.
The mother, whose name has been redacted from the public copy of the indictment to protect the minor’s identity, obtained the pills online from Carpenter without the physician screening the intended patient herself to verify gestational age or even her desire for an abortion.
District Attorney Tony Clayton, a Democrat, told the Times-Picayune that the case was “no kind of way, shape or form of safe telemedicine,” characterizing the exchange between the minor’s mother and Carpenter as “a couple of clicks.”
“Never met the doctor. Never talked to the doctor. For $150 bucks, she put that poison in the mail,” Clayton told the Times-Picayune.
Police reports indicate that the girl lost her pregnancy in the hospital after hemorrhaging following taking what Clayton described as “a cocktail of pills from Dr. Carpenter.”
Clayton did not charge either the mother or Carpenter with coerced abortion, a separate crime in Louisiana statute. Instead, each is facing charges of criminal abortion by means of abortion-inducing drugs, which carries a maximum of five years in prison.
Murrill told the Washington Examiner earlier this month that more charges could be filed in the case with respect to the coercion element, but Clayton’s office did not respond to the Washington Examiner with request for comment.
Carpenter is also facing a civil case in Texas following a lawsuit from Attorney General Ken Paxton in a similar case. Last week, a Texas judge issued a permanent injunction against Carpenter and ordered her to pay $113,000 in fines and legal fees. The office of New York Attorney General Letitia James, who has also promised to shield Carpenter from legal consequences in both Texas and Louisiana, did not respond to the Washington Examiner’s request for comment.
Extradition as a driving legal issue
Jessie Hill, a professor at Case Western Reserve law school specializing in reproductive rights, told the Washington Examiner that she expects the extradition issue to be the central feature in the complicated case.
“This is a level of conflict that we have not seen in a very long time as a country,” said Hill.
The Constitution requires that any state must extradite to the prosecuting state any person charged with “treason, felony, or other crime, who shall flee from justice and be found in another state.”
Hill said the case is especially challenging from a constitutional law perspective because Carpenter did not “flee” to New York. Rather, she followed the laws established in the Empire State.
“What does ‘fugitive from justice’ language mean?” Hill said. “It’s different from a situation where Dr. Carpenter was present in Louisiana, and she fled to New York to escape the criminal justice system. She never set foot in Louisiana.”
Hill said that extradition issues have not been as volatile since the pre-Civil War enforcement of fugitive slave laws, which required states without slavery to comply with extradition orders for runaway enslaved persons to be sent back to states that allowed slavery.
“I don’t think we’ve had such a direct, really passionate conflict between the states that has threatened our system of federalism in a way probably since the era of fugitive slave laws, the antebellum era,” said Hill.
Murrill told the Washington Examiner that she has been examining the precedent involved in interstate extradition and whether a governor can refuse to enforce an arrest warrant for political reasons.
“In terms of all the other laws that we have, all the criminal laws, whether it’s murder, rape, dealing meth or fentanyl: when an arrest warrant goes out and goes into the system, we expect other states to comply with our arrest warrants and deliver that person here so they can fight the indictment here in our state,” Murrill said.
A spokesperson for Murrill’s office confirmed for the Washington Examiner that Louisiana will likely continue to pursue this case at the federal level but could not share any more details regarding the legal strategy or the argument that might drive the case.
Clayton told local news outlets that a 1987 Supreme Court decision that affirmed the power of federal authorities to enforce arrest warrants for state charges could be a pivotal precedent for his case.
But because this is a first-of-its-kind case in the abortion domain, legal analysts hesitate to speculate on what could happen as this progresses through the federal court system.
“There’s just so many unanswered questions and so many gray areas and uncharted territories here,” Hill said. “All of this is somewhat tentative because we’re breaking new ground here.”
Mifepristone and shield laws
The criminal case against Carpenter comes amid ongoing litigation over mifepristone and shield laws in eight states, including New York, that protect doctors from prosecution for prescribing abortion pills to patients in states that have legislatively restricted the procedure.
In January, a federal judge in Texas, Matthew Kacsmaryk, allowed Idaho, Missouri, and Kansas to proceed with a lawsuit against states with such shield laws. The three states argue that shipping abortion pills in the mail harms their ability to effectuate anti-abortion statutes within their borders.
Much of the legal scholarship on shield laws earlier in the post-Dobbs era focused on whether doctors performing abortions on out-of-state residents could be prosecuted in the patient’s home state. So, for example, if a patient from Idaho traveled to Washington to obtain an abortion, the Washington doctor could not be extradited to Idaho for an action that was done in Washington.
But shield laws also apply to healthcare providers licensed by the Food and Drug Administration to prescribe mifepristone and sell the medication via telemedicine online.
Over 40,000 abortions occurred in 2023 in states with gestational age limits or prohibitions on abortion, according to a May 2024 report from the Society of Family Planning. This is because women were able to obtain the medication from telehealth prescriptions.
In 2024, the Supreme Court heard a case against the approval of mifepristone brought by the Alliance for Hippocratic Medicine, an anti-abortion physicians group. The court, though, declined to rule on the merits of the case, and instead determined that the group did not have the legal basis, or standing, to sue in the case.
Hill said the case against Carpenter, however, provides a “very concrete example” of how sending mifepristone through the mail harms a state’s interest, which is necessary to pursue a case in court.
“States are claiming they’re injured by the fact that people are just mailing this like willy-nilly across state lines into their own states,” Hill said. “It’s harming states’ sovereign interests in the enforcement of their own laws, their criminal abortion laws.”
Jim Stoner, a professor of political science at Louisiana State University and a resident of the Baton Rouge region, told the Washington Examiner that the facts of this case make it ideal for an impassioned political argument.
“This is a perfect case in some ways, from the political point of view, because here you have a mother who forces an abortion on her daughter,” said Stoner. “That’s what makes it such a particularly poignant case from the pro-life point of view.”
Pressure on states’ rights approach
The tension between states over the interstate sale of abortion pills could put significant pressure on Trump to act at the federal level to regulate mifepristone despite promises to the contrary on the campaign trail.
Trump and his allies suppressed the more conservative wing of the party during the Republican convention to ensure the removal of certain key provisions from the old party platform that called for federal gestational age limits on abortion, sparking outrage from ardent anti-abortionists.
Electorally, the tactic worked to assuage the trepidations of centrists, especially in the swing states of Pennsylvania and Michigan. But the interstate sale of mifepristone challenges this state-based framework.
Stoner compared the state-based perspective on abortion to extant federal policy on medical marijuana, where, although the federal government has the authority to regulate marijuana sale and distribution, it has been largely hands-off on intrastate policy affairs.
But what makes this case different, says Stoner, is that Louisiana is targeting a physician operating in a different state, where prescribing mifepristone from within and without state boundaries is legally protected.
“There’s no doubt that the procuring of an abortion within Louisiana would be a crime, and prescribing medicine within New York is not a crime, but entirely legal,” said Stoner. “How do you square those different laws? Which one applies?”
Safety of mifepristone
The impending legal drama could increase the pressure on the Trump administration to reinstate the safety protocols for mifepristone that were rolled back during the Biden administration.
The brand name drug Mifeprex, made by Danco Laboratories, was approved in September 2000 for use up to seven weeks gestation. In 2016, the FDA increased the gestational age limit to 10 weeks of pregnancy and removed requirements for physicians to report adverse complications other than maternal death.
In part due to the logistical challenges of seeing healthcare providers in person during the COVID-19 pandemic, the FDA in 2021 removed in-person screening requirements for obtaining mifepristone, making it possible to to prescribe the pills via telehealth and have them shipped to patients in the mail.
Both Trump and Vice President J.D. Vance came under sharp criticism from anti-abortion advocates during the campaign for their approach to mifepristone, each saying that their administration would not prohibit the drug.
During his Senate confirmation hearings, Health and Human Services Secretary Robert F. Kennedy Jr., one of Trump’s most controversial Cabinet picks, said that Trump specifically requested further study from public health agencies on mifepristone’s safety data and complication rates.
The FDA’s warning label on mifepristone estimates that as many as 4.6% of medication abortion patients will seek emergency medical treatment due to potentially life-threatening complications, such as hemorrhaging or sepsis.
Erin Hawley, senior counsel at the anti-abortion advocacy firm Alliance Defending Freedom, previously told the Washington Examiner that the “easiest thing to do” to settle the problems of transporting mifepristone across state lines is to reinstate in-person medical screening requirements before obtaining the prescription.
“The idea that they could shield their physicians or healthcare providers for giving something dangerous is really crazy and conditioned, I think, by this response to Dobbs,” said Hawley.
