Attorneys General of Three States File Two Sweeping Lawsuits Targeting Telehealth Abortion Providers and State Shield Laws

On September 30, 2026, the attorneys general of Louisiana, Arkansas, and Alabama filed two coordinated federal lawsuits targeting the interstate telehealth medication abortion infrastructure that has grown since Dobbs v. Jackson Women’s Health Organization.

Health care organizations, telehealth providers, and health systems operating in or adjacent to the reproductive health space should understand what these suits seek, who is named, and what the implications may be.

The Two Lawsuits

Louisiana v. New York

The first lawsuit was filed directly in the U.S. Supreme Court, which has original jurisdiction to hear controversies arising between states, and names New York, Massachusetts, and California as defendants. The suit seeks a declaration that the telehealth shield laws enacted by those three states violate (1) the Full Faith and Credit Clause; (2) the equal sovereignty doctrine; (3) the dormant Commerce Clause; and (4)the federal common law of public nuisance . The suit further seeks an injunction preventing those states’ officials from enforcing those shield laws.

The complaint argues that telehealth shield laws—which “attempt to immunize health care providers, pharmacies, and other actors that illegally dispense abortion drugs into pro-life states from both liability in those states and professional repercussions in shield-law states”—have no legitimate purpose within the enacting states’ own borders. The sole function of these laws, the plaintiff states argue, is to facilitate conduct that violates the laws of Louisiana, Arkansas, Alabama, and other states with abortion restrictions, while insulating the actors who engage in that conduct. According to the complaint, the outcome of the case will determine whether states that have restricted abortion can enforce their own laws against providers who operate from states with shield laws.

Louisiana v. Nouhavandi

The second lawsuit, filed in the U.S. District Court for the Western District of Louisiana, names approximately 30 individual providers, organizations, and pharmacies as defendants. The complaint asserts claims under (1) the federal common law of public nuisance; (2) the Louisiana Unfair Trade Practices Act; and (3) parallel state consumer protection statutes of Arkansas and Alabama. It seeks injunctive relief, damages, and civil penalties.

The Core Legal Theories

Louisiana v. New York

Louisiana v. New York advances four independent theories.

The Full Faith and Credit Clause argument invokes the principle that states may not adopt a “policy of hostility to the public Acts of a sister State,” quoting Franchise Tax Bd. of Cal. v. Hyatt, 578 U.S. 171, 176 (2016). The plaintiff states argue that shield laws constitute precisely that prohibited hostility. The defendant states are expected to respond that shield laws are properly characterized as regulations of in-state conduct governing what providers physically located within the enacting state may do, rather than as extraterritorial interference with another state’s laws. Telehealth policy and the standard of care have long treated the location of care as where the patient is—not where the provider is—but medication abortion complicates that approach because one or both drugs used in the procedure can be taken in different locations and the pregnancy can end somewhere else entirely. That unresolved question regarding the location of care for purposes of medication abortion will be central to both the constitutional litigation in Louisiana v. New York and to the personal jurisdiction analysis in Louisiana v. Nouhavandi.

The equal sovereignty argument invokes the principle, drawn from the 2013 Supreme Court case of Shelby County v. Holder, that states are “equal in power, dignity, and authority.” The plaintiff states argue that shield laws allow the defendant states to make abortion policy for the entire nation, usurping the plaintiff states’ sovereign prerogative to regulate abortion within their own borders.

The dormant Commerce Clause argument characterizes the shield laws as state-sponsored economic protectionism driving illegal commercial transactions across state lines. The defendant states will likely invoke recent Supreme Court precedent that substantially narrowed the dormant Commerce Clause extraterritoriality doctrine.

Finally, the federal common law of public nuisance argument characterizes the combined effect of the shield laws as facilitating ongoing, knowing harm to residents of the plaintiff states—analogous to cross-border environmental nuisances the Supreme Court has recognized in prior cases.

Taken together, the four theories in Louisiana v. New York ask the Court to decide a single underlying question: whether a state may build its legal system to facilitate conduct that another state has made illegal. The answer will turn largely on whether courts will treat shield laws as regulation of in-state providers or as interference with the laws of other states.

Louisiana v. Nouhavandi In contrast to the constitutional focus of the claims in Louisiana v. New York, Louisiana v. Nouhavandi rests primarily on the federal common law of public nuisance, arguing that the defendants’ cross-border scheme of advertising, prescribing, and mailing abortion medication into states where such conduct is prohibited constitutes an ongoing and unreasonable interference with the plaintiff states’ public health and sovereign authority.

The state unfair trade practices claims allege that the defendants made material misrepresentations to patients about: the legality of their services; the safety profile of medication abortion relative to Food and Drug Administration (FDA) labeling; FDA’s approval of the regimen as used beyond 10 weeks; efficacy rates; the necessity of in-person evaluation; and appropriate responses to complications, including instructions to characterize medication abortion complications as miscarriages when presenting to emergency providers.

The complaint details undercover investigations in which plaintiff state officials posing as women ordered medication abortion from each named defendant, receiving drugs in several instances based on entirely fabricated patient information, without any telehealth consultation. The complaint also alleges that several defendants openly acknowledged the illegality of their conduct in plaintiff states while relying on shield law protections to proceed.

The Racketeer Influenced and Corrupt Organizations Act (RICO) reservation in footnote 169 of the complaint signals that the plaintiff states view the defendants as a coordinated network, not as independent actors. The complaint’s detailed allegations about shared infrastructure—shared shipping platforms, shared prescribers, shared payment processors, and a stated common mission—are designed to lay the factual predicate for RICO claims if discovery supports them.

What These Lawsuits May Mean for Health Care Organizations

For Telehealth Providers and Reproductive Health Organizations

Louisiana v. Nouhavandi names organizations that operate under state shield laws and have structured their operations specifically to take advantage of those protections. Several named defendants have publicly described their models as designed to distribute operational risk and limit the identifiability of individual prescribers. Whether those structural choices provide meaningful legal protection against the claims asserted in this case will be a central question to watch in the litigation.

Organizations that provide, facilitate, or fund medication abortion through cross-state telehealth should also consult with counsel about their potential exposure under the RICO framework the complaint’s footnote reserves.

For Health Systems and Emergency Providers

The complaint in Louisiana v. Nouhavandi contains a specific and operationally significant strategy: the plaintiff states intend to use patient records to be obtained through discovery—specifically, defendants’ “complete identification of the individuals in Plaintiff States to whom they prescribed and dispensed abortion drugs”—and to cross-reference those records against Medicaid databases to calculate Medicaid costs attributable to complications from medication abortion. Health systems and emergency departments in the plaintiff states that have treated patients for complications arising from medication abortion should be attentive to whether their records may be sought through this litigation. They should also consult with counsel about potentially applicable doctor-patient privilege concerns and patient confidentiality protections, including under the Health Insurance Portability and Accountability Act (HIPAA) and state health privacy law.

The complaint also directly addresses clinical instructions that some defendant organizations have provided to patients, including instructions to characterize complications as miscarriages when presenting to emergency providers. Health systems whose emergency departments may encounter this situation should ensure their clinical staff understand both the clinical dimensions (such as accurate recording of medical history and treatment of complications) and legal dimensions (such as emergency care obligations, reporting requirements, and responding to subpoenas of medical records related to such care) of treating patients who present with medication abortion complications.

What Happens Next

Given that Louisiana v. New York is an original action, the Supreme Court must first grant leave to file and may decline to hear the case. Whether a majority of the Court will agree to hear the case remains to be seen. 

Louisiana v. Nouhavandi, by contrast, will proceed on a conventional track, likely starting with motions to dismiss on personal jurisdiction, venue, and the merits. Discovery will then likely be the pressure point, as the Massachusetts and California shield law provisions limiting cooperation with out-of-state subpoenas will collide with anticipated requests for records, and the district court must decide whether those restrictions can limit compliance with federal court subpoenas, a question not yet squarely answered.

Regardless of ultimate merits, both cases create immediate operational uncertainty. Counsel for defendant states will likely advise them to document their compliance posture, preserve records, and assess whether their current practices—particularly the absence of telehealth consultations confirmed by the sting operations—create independent regulatory exposure beyond the legal theories asserted in these suits. Providers that have relied on shield law protections as a complete answer to enforcement risk should reassess: the shield laws may protect against state-court judgments and extradition, but they do not protect against federal court litigation.

Key Takeaways

1. The Louisiana v. Nouhavandi complaint names approximately 30 defendants, with detailed allegations about their operations, corporate structures, financial transactions, and patient communications. Organizations that operate in the same space as named defendants—whether as providers, funders, or referral partners—should assess whether their activities could be characterized similarly.
2. The RICO reservation in that case signals that the plaintiff states view the named defendants as a coordinated network, not as independent actors. Discovery will likely focus on establishing the connections between entities. Organizations that share operational infrastructure with named defendants face increased risk of being drawn into the litigation.
3. The plaintiffs’ intended cross-referencing of provider patient records against Medicaid databases is a novel enforcement mechanism that, if implemented, could expose significant Medicaid cost claims. Health systems and state Medicaid programs should monitor this aspect of the litigation carefully.
4. Louisiana v. New York, if accepted, will require the Supreme Court to rule on the constitutional validity of shield laws for the first time. That ruling will define the legal framework within which every telehealth reproductive health provider operates. A decision invalidating shield laws would fundamentally alter the risk calculus for providers currently operating under their protection.
5. Regardless of the litigation’s outcome, these suits demonstrate that state attorney general enforcement activity against out-of-state telehealth abortion providers has materially escalated in scope, coordination, and legal sophistication since 2022. Organizations operating in this space should treat this as a sustained enforcement environment, not an isolated challenge.

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The Health Law Advisor blog is currently edited by Emily Chi Fogler.