Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 154

Introduced by Assembly Member Atkins

January 22, 2013

begin delete An act relating to reproductive health care. end delete begin insert An act to amend Section 2253 of, and to add Sections 734, 2725.4, and 3502.4 to, the Business and Professions Code, and to amend Section 123468 of the Health and Safety Code, relating to healing arts. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 154, as amended, Atkins. begin delete Healing arts: reproductive health care. end delete begin insert Abortion. end insert

Existing law makes it a public offense, punishable by a fine not exceeding $10,000 or imprisonment, or both, for a person to perform or assist in performing a surgical abortion if the person does not have a valid license to practice as a physician and surgeon, or to assist in performing a surgical abortion without a valid license or certificate obtained in accordance with some other law that authorizes him or her to perform the functions necessary to assist in performing a surgical abortion. Existing law also makes it a public offense, punishable by a fine not exceeding $10,000 or imprisonment, or both, for a person to perform or assist in performing a nonsurgical abortion if the person does not have a valid license to practice as a physician and surgeon or does not have a valid license or certificate obtained in accordance with some other law authorizing him or her to perform or assist in performing the functions necessary for a nonsurgical abortion. Under existing law, nonsurgical abortion includes termination of pregnancy through the use of pharmacological agents.

Existing law, the Nursing Practice Act, provides for the licensure and regulation of registered nurses, including nurse practitioners and certified nurse-midwives, by the Board of Registered Nursing. Existing law, the Physician Assistant Practice Act, provides for the licensure and regulation of physician assistants by the Physician Assistant Committee of the Medical Board of California.

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Existing law authorizes the Office of Statewide Health Planning and Development to designate experimental health workforce projects as approved projects that, among other things, teach new skills to existing categories of health care personnel. The office has designated a pilot project, known as the Access through Primary Care Project, relating to the provision of health care services involving pregnancy.

end delete begin delete

This bill would state that it is the intent of the Legislature to enact legislation that would expand access to reproductive health care in California by allowing qualified health care professionals to perform early abortions.

end delete begin insert

This bill would instead make it a public offense, punishable by a fine not exceeding $10,000 or imprisonment, or both, for a person to perform an abortion if the person does not have a valid license to practice as a physician and surgeon, except that it would not be a public offense for a person to perform an abortion by medication or aspiration techniques in the first trimester of pregnancy if he or she holds a license or certificate authorizing him or her to perform the functions necessary for an abortion by medication or aspiration techniques. The bill would also require a nurse practitioner, certified nurse-midwife, or physician assistant to complete training, as specified, in order to perform an abortion by aspiration techniques, and would indefinitely authorize a nurse practitioner, certified nurse-midwife, or physician assistant who completed a specified training program and achieved clinical competency to continue to perform abortions by aspiration techniques. The bill would delete the references to a nonsurgical abortion and would delete the restrictions on assisting with abortion procedures. The bill would also make technical, nonsubstantive changes.

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Because the bill would change the definition of crimes, the bill would impose a state-mandated local program.

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The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert

begin insert Section 734 is added to the end insert begin insert Business and
Professions Code end insert begin insert , to read: end insert

begin insert

begin insert 734. end insert   

It is unprofessional conduct for any nurse practitioner,
certified nurse midwife, or physician assistant to perform an
abortion pursuant to Section 2253, without prior completion of
training and validation of clinical competency.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 2253 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2253.  

(a) Failure to comply with the Reproductive Privacy
Act (Article 2.5 (commencing with Section 123460) of Chapter 2
of Part 2 of Division 106 of the Health and Safety Code) begin delete in
performing, assisting, procuring or aiding, abetting, attempting,
agreeing, or offering to procure an illegal abortion end delete constitutes
unprofessional conduct.

(b) (1)  begin delete A end delete begin insert Except as provided in paragraph (2), a end insert person is
subject to begin delete Sections end delete begin insert Section end insert 2052 begin delete and 2053 end delete if he or she performs
begin delete or assists in performing a surgical end delete begin insert an end insert abortion, and at the time of
so doing, does not have a valid, unrevoked, and unsuspended
license to practice as a physician and surgeon begin delete as provided in this
chapter, or if he or she assists in performing a surgical abortion
and does not have a valid, unrevoked, and unsuspended license or
certificate obtained in accordance with some other provision of
law that authorizes him or her to perform the functions necessary
to assist in performing a surgical abortion end delete .

(2) A person begin delete is end delete begin insert shall not be end insert subject to begin delete Sections end delete begin insert Section end insert 2052
begin delete and 2053 end delete if he or she performs begin delete or assists in performing a
nonsurgical abortion, end delete begin insert an abortion by medication or aspiration
techniques in the first trimester of pregnancy, end insert and at the time of
so doing, begin delete does not have a valid, unrevoked, and unsuspended
license to practice as a physician and surgeon as provided in this
chapter, or does not have end delete begin insert has end insert a valid, unrevoked, and unsuspended
license or certificate obtained in accordance with some other
provision of law begin insert , including, but not limited to, the Nursing Practice
Act (Chapter 6 (commencing with Section 2700)) or the Physician
Assistant Practice Act (Chapter 7.7 (commencing with Section
3500)), end insert that authorizes him or her to perform begin delete or assist in performing end delete
the functions necessary for begin delete a nonsurgical abortion. end delete begin insert an abortion by
medication or aspiration techniques end insert begin insert . end insert

begin delete

(c) For purposes of this section, “nonsurgical abortion” includes
termination of the use of pharmacological agents.

end delete begin insert

(c) In order to perform an abortion by aspiration techniques
pursuant to paragraph (2) of subdivision (b), a person shall comply
with Section 2725.4 or 3502.4.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 2725.4 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2725.4. end insert   

(a) In order to perform an abortion by aspiration
techniques, a person with a license or certificate to practice as a
nurse practitioner or a certified nurse-midwife shall complete
training recognized by the Board of Registered Nursing. Beginning
January 1, 2014, and until January 1, 2016, the competency-based
training protocols established by Health Workforce Pilot Project
(HWPP) No. 171 through the Office of Statewide Health Planning
and Development shall be used.

(b) A nurse practitioner or certified nurse-midwife who has
completed training and achieved clinical competency through
HWPP No. 171 shall be authorized to perform abortions by
aspiration techniques.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 3502.4 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 3502.4. end insert   

(a) In order to receive authority from his or her
supervising physician and surgeon to perform an abortion by
aspiration techniques, a physician assistant shall complete training
either through training programs approved by the Physician
Assistant Board pursuant to Section 3513 or by training to perform
medical services which augment his or her current areas of
competency pursuant to Section 1399.543 of Title 16 of the
California Code of Regulations. Beginning January 1, 2014, and
until January 1, 2016, the training and clinical competency
protocols established by Health Workforce Pilot Project (HWPP)
No. 171 through the Office of Statewide Health Planning and
Development shall be used as training and clinical competency
guidelines to meet this requirement.

(b) The training protocols established by HWPP No. 171 shall
be deemed to meet the standards of the Physician Assistant Board.
A physician assistant who has completed training and achieved
clinical competency through HWPP No. 171 shall be authorized
to perform abortions by aspiration techniques.

end insert

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 123468 of the end insert begin insert Health and Safety Code end insert begin insert is
amended to read: end insert

123468.  

The performance of an abortion is unauthorized if
either of the following is true:

(a)  The person performing begin delete or assisting in performing end delete the
abortion is not a health care provider authorized to perform begin delete or
assist in performing end delete an abortion pursuant to Section 2253 of the
Business and Professions Code.

(b)  The abortion is performed on a viable fetus, and both of the
following are established:

(1)  In the good faith medical judgment of the physician, the
fetus was viable.

(2)  In the good faith medical judgment of the physician,
continuation of the pregnancy posed no risk to life or health of the
pregnant woman.

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begin insert SEC. 6. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

end insert

begin delete

SECTION 1.  

It is the intent of the Legislature to enact
legislation that would expand access to reproductive health care
in California by allowing qualified health care professionals to
perform early abortions, provided that the functions are within the
scope of their licenses.

end delete