Amended in Assembly April 30, 2013

Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 154

Introduced by Assembly Member Atkins

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(Principal coauthor: Senator Jackson)

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(Coauthors: Assembly Members Mitchell and Skinner)

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January 22, 2013

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

LEGISLATIVE COUNSEL’S DIGEST

AB 154, as amended, Atkins. Abortion.

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 begin delete Committee end delete begin insert Board within the jurisdiction end insert of the Medical Board of California.

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, begin insert and to comply with standardized procedures or protocols, as specified, end insert 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.

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

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.

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

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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

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SECTION 1.  

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

734.  

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.

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begin delete SEC. 2. end delete
begin insert SECTION 1. end insert   

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

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) constitutes
unprofessional conduct.

(b) (1) Except as provided in paragraph (2), a person is subject
to Section 2052 if he or she performs an abortion, and at the time
of so doing, does not have a valid, unrevoked, and unsuspended
license to practice as a physician and surgeon.

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

(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.

begin delete SEC. 3. end delete
begin insert SEC. 2. end insert   

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

2725.4.  

(a) In order to perform an abortion by aspiration
techniques begin insert end insert begin insert pursuant to Section 2253 end insert , 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.

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(b) In order to perform an abortion by aspiration techniques
pursuant to Section 2253, a person with a license or certificate to
practice as a nurse practitioner or a certified nurse-midwife shall
adhere to standardized procedures developed in compliance with
subdivision (c) of Section 2725 that specify all of the following:

end insert begin insert

(1) The extent of supervision by a physician and surgeon with
relevant training and expertise.

end insert begin insert

(2) Procedures for transferring patients to the care of the
physician and surgeon or a hospital.

end insert begin insert

(3) Procedures for obtaining assistance and consultation from
a physician and surgeon.

end insert begin insert

(4) Procedures for providing emergency care until physician
assistance and consultation is available.

end insert begin insert

(5) The method of periodic review of the provisions of the
standardized procedures.

end insert begin delete

(b)

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begin insert (c) end insert  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 begin insert pursuant to Section 2253, in adherence to
standardized procedures described in subdivision (b) end insert .

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(d) It is unprofessional conduct for any nurse practitioner or
certified nurse-midwife to perform an abortion by aspiration
techniques pursuant to Section 2253 without prior completion of
training and validation of clinical competency.

end insert

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

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

3502.4.  

(a) In order to receive authority from his or her
supervising physician and surgeon to perform an abortion by
aspiration techniques begin insert end insert begin insert pursuant to Section 2253 end insert , a physician
assistant shall complete training either through training programs
approved by the begin delete Physician Assistant Board end delete begin insert board end insert 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.

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(b) In order to receive authority from his or her supervising
physician and surgeon to perform an abortion by aspiration
techniques pursuant to Section 2253, a physician assistant shall
comply with protocols developed in compliance with Section 3502
that specify:

end insert begin insert

(1) The extent of supervision by a physician and surgeon with
relevant training and expertise.

end insert begin insert

(2) Procedures for transferring patients to the care of the
physician and surgeon or a hospital.

end insert begin insert

(3) Procedures for obtaining assistance and consultation from
a physician and surgeon.

end insert begin insert

(4) Procedures for providing emergency care until physician
assistance and consultation is available.

end insert begin insert

(5) The method of periodic review of the provisions of the
protocols.

end insert begin delete

(b)

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begin insert (c) end insert  The training protocols established by HWPP No. 171 shall
be deemed to meet the standards of the begin delete Physician Assistant Board end delete
begin insert board end insert . A physician assistant who has completed training and
achieved clinical competency through HWPP No. 171 shall be
authorized to perform abortions by aspiration techniques begin insert pursuant
to Section 2253, in adherence to protocols described in subdivision
(b) end insert .

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(d) It is unprofessional conduct for any physician assistant to
perform an abortion by aspiration techniques pursuant to Section
2253 without prior completion of training and validation of clinical
competency.

end insert

begin delete SEC. 5. end delete
begin insert SEC. 4. end insert   

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

123468.  

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

(a) The person performing the abortion is not a health care
provider authorized to perform 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.

begin delete SEC. 6. end delete
begin insert SEC. 5. end 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.