The Myth of Location

Since the advent of telemedicine, and with its expansion during the pandemic, legal jurisdictions have maintained that the patient's location, not that of the provider, determines which jurisdiction's laws apply. A provider located in New York must have a Connecticut license if the patient is located in Connecticut.  Although this may sound logical, it can prove impractical, especially in metropolitan areas near state lines where people frequently travel among two or more states in the course of a typical day, sometimes living in one state but working in another. They might even choose a provider located in a third jurisdiction. Patients temporarily located in a new geographic location should not have to seek new providers, and those temporarily relocated for work or school should be free to keep their original providers.

Location relies upon the patient's self-report. We live in the real world. The patient could be on a boat in international waters, in an airplane with uncertain location, straddling a state line. Must the provider refuse to provide care unless the patient travels to an acceptable location? How will the patient prove where they are? How will the provider prove where the patient was? The patient could also change locations in the course of the encounter. For example, they  might drive across a state line after sending an email/text or during an audio-only encounter or video conference. Family psychotherapy adds another complication. If family members in multiple states can only participate via teleconference, whose location applies?

Please do not burden providers with a futile and unnecessary requirement to establish the patient's location. 

Berry Edwards, MD