Santa Clarita Valley resident Robin Clough, who has been managing anaplastic thyroid cancer for four years, faces ongoing challenges beyond her health as she seeks to continue telemedicine follow-ups with her out-of-state oncologist. Despite successful treatment at MD Anderson Cancer Center in Houston, Texas, state-level restrictions in California prevent her from maintaining remote contact with the specialist who helped control her aggressive cancer, forcing repeated long-distance travel for in-person care.

Clough’s experience highlights a broader issue affecting patients across multiple states grappling with limitations on interstate telemedicine. California is one of approximately 30 states that restrict doctors from providing virtual care to patients who reside beyond their licensed jurisdiction. While telemedicine saw significant expansion during the COVID-19 pandemic—facilitating cross-state consultations out of necessity—many states have since tightened regulations, limiting such access to patients with active, life-threatening conditions and excluding those in remission.

Medical experts and patient advocates warn that these rules increasingly clash with the evolving landscape of healthcare delivery. Dr. Helen Hughes, a pediatrician at Johns Hopkins and an advocate for reform, notes that many patients with chronic, complex, or rare diseases rely on specialists unavailable locally, creating barriers to continuous care. Dr. Shannon MacDonald, a radiation oncologist specializing in rare pediatric cancers, also emphasizes that attempting to advise out-of-state patients without appropriate licenses can jeopardize physicians’ professional standing and even expose them to criminal liability in some states.

Clough and her husband, Dr. Gene Dorio—a geriatrician and California advisory senior legislator—proposed legislation (Senate Bill 1002) aimed at extending interstate telemedicine access to patients in remission. The bill, introduced by Sen. Roger Niello (R-Sacramento) earlier this year, passed the California Senate but failed in the Assembly amid concerns from state medical authorities. Opponents, including representatives from the Medical Board of California and the California Medical Association, argued that out-of-state doctors unlicensed in California might be unfamiliar with local standards and laws, complicating patient safety oversight and disciplinary enforcement.

Assemblyman Marc Berman (D-Menlo Park), whose committee rejected the bill, stated that licensed physicians can continue to provide care through in-state doctors or by having patients physically visit the doctor’s location. He pointed to existing pathways including consultation models wherein an out-of-state doctor advises an in-state physician while both care for the patient. Berman also cited liability concerns, noting a lack of clear recourse if malpractice occurs with an unlicensed provider.

Proponents contend that these alternatives frequently impose significant logistical and financial burdens. MacDonald described the impracticality of coordinating multi-party video consultations amid busy clinical workloads. Dorio highlighted that obtaining medical licenses in multiple states is costly and time-consuming, with fees and paperwork multiplying exponentially for broad interstate practice.

Niello, who remains committed to introducing similar legislation should he be reelected, criticized the barriers as “cruel” and disconnected from modern medical realities. Meanwhile, some patient advocacy groups pursue legal challenges, and academic institutions such as Johns Hopkins are conducting research projects exploring exceptions for established doctor-patient relationships.

Clough and Dorio have had to make multiple trips to Houston for follow-ups that could be managed virtually if current laws were more flexible. Dorio expressed frustration at the regulatory inconsistencies, questioning why physicians must be licensed separately in every state despite standardized national training and certification. “We’re going to look back one day and see how ridiculous this is,” he said, underscoring the tension between patient needs, medical innovation, and existing legal frameworks governing telehealth across state lines.