BILL ANALYSIS Ó
AB 154
Page 1
ASSEMBLY THIRD READING
AB 154 (Atkins)
As Amended April 30, 2013
Majority vote
BUSINESS & PROFESSIONS 9-4HEALTH 13-6
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|Ayes:|Gordon, Bocanegra, |Ayes:|Pan, Ammiano, Atkins, |
| |Campos, Dickinson, | |Bonilla, Bonta, Chesbro, |
| |Eggman, Holden, Mullin, | |Gomez, |
| |Skinner, Ting | |Roger Hernández, |
| | | |Lowenthal, Mitchell, |
| | | |Nazarian, V. Manuel |
| | | |Pérez, Wieckowski |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Jones, Hagman, |Nays:|Logue, Maienschein, |
| |Maienschein, Wilk | |Mansoor, Nestande, |
| | | |Wagner, Wilk |
| | | | |
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APPROPRIATIONS 12-5
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|Ayes:|Gatto, Bocanegra, | | |
| |Bradford, | | |
| |Ian Calderon, Campos, | | |
| |Eggman, Gomez, Hall, | | |
| |Ammiano, Pan, Quirk, | | |
| |Weber | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Harkey, Bigelow, | | |
| |Donnelly, Linder, Wagner | | |
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SUMMARY : Authorizes a nurse practitioner (NP), certified nurse
midwife (CNM), and physician assistant (PA) to perform an
abortion by aspiration techniques, in addition to medication, in
the first trimester of pregnancy upon completion of specified
training and validation of clinical competency, as specified.
Specifically, this bill :
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1)Declares that it is unprofessional conduct for any NP, CNM, or
PA to perform an abortion by medication or aspiration
techniques in the first trimester of pregnancy without
completing training and validation of clinical competency.
2)Deletes obsolete references to "performing, assisting,
procuring or aiding, abetting, attempting, agreeing, or
offering to procure an illegal abortion" in regards to what
constitutes unprofessional conduct for failure to comply with
the Reproductive Privacy Act.
3)Deletes obsolete references to "surgical" and "nonsurgical"
abortions and replaces the terms as necessary with abortion by
"medication" or "aspiration techniques."
4)Deletes obsolete references to "assisting" in performing an
unauthorized abortion in regards to what constitutes a public
offense.
5)States that a person is not guilty of the public offense of
practicing medicine without the appropriate legal
authorization if he or she performs an abortion by aspiration
techniques in the first trimester of pregnancy while having a
valid, unrevoked, and unsuspended license or certificate
authorizing him or her to perform an abortion by aspiration
technique, as specified.
6)Requires a NP or CNM to complete training recognized by the
Board of Registered Nursing (BRN) in order to perform an
abortion by aspiration techniques; further requires the
competency-based training protocols established by Health
Workforce Pilot Project No. 171 (HWPP 171) through the Office
of Statewide Health Planning and Development (OSHPD) to be
used from January 1, 2014, until January 1, 2016.
7)Authorizes NPs or CNMs who have completed the HWPP 171
training, achieved clinical competency, and adhere to
specified standardized procedures, to perform abortions by
aspiration techniques.
8)Requires a NP and CNM to adhere to standardized procedures in
order to perform an abortion by aspiration techniques that
must specify all of the following:
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a) The extent of supervision by a physician and surgeon
with relevant training and expertise;
b) Procedures for transferring patients to the care of the
physician and surgeon or a hospital;
c) Procedures for obtaining assistance and consultation
from a physician and surgeon;
d) Procedures for providing emergency care until physician
assistance and consultation is available; and,
e) The method of periodic review of the provisions of the
standardized procedures.
9)Requires a PA to complete training either through training
programs approved by the Physician Assistant Board (PAB) or by
training to perform medical services which augment his or her
current areas of competency, as specified, in order to receive
authority from his or her supervising physician and surgeon to
perform an abortion by aspiration techniques; further requires
the training and clinical competency protocols established by
HWPP 171 through OSHPD to be used as training and clinical
competency guidelines to meet this requirement from January 1,
2014, through January 1, 2016.
10)Deems the training protocols established by HWPP 171 to meet
the PAB standards.
11)Authorizes a PA who has completed the HWPP 171 training,
achieved clinical competency, received authority from his or
her supervising physician and surgeon, and acts according to
specified protocols, to perform abortions by aspiration
techniques.
12)Requires a PA, in order to receive authority from his or her
supervising physician and surgeon to perform an abortion by
aspiration techniques, to comply with protocols that specify:
a) The extent of supervision by a physician and surgeon
with relevant training and expertise;
b) Procedures for transferring patients to the care of the
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physician and surgeon or a hospital;
c) Procedures for obtaining assistance and consultation
from a physician and surgeon;
d) Procedures for providing emergency care until physician
assistance and consultation is available; and,
e) The method of periodic review of the protocols.
13)Makes other clarifying and technical changes.
14)States that no reimbursement is required by this act pursuant
to Section 6 of Article XIIIB 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 Government Code Section 17556, or changes the
definition of a crime within the meaning of Section 6 of
Article XIIB of the California Constitution.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, unknown costs or savings, potentially in excess of
$150,000. For example, if the number of Medi-Cal first
trimester procedures increases by 350 per year, Medi-Cal costs
would increase by approximately $152,000. On the other hand, a
similar reduction in second trimester procedures would result in
savings of approximately $212,000, based on data from 2009.
COMMENTS :
1)Purpose of this bill . This bill authorizes NPs, CNMs and PAs
to perform an abortion by aspiration techniques in the first
trimester of pregnancy upon completion of specified training
and validation of clinical competency, based on protocols
developed under a multi-year University of California, San
Francisco pilot program. This bill is sponsored by the
California Women's Health Alliance, which is comprised of the
following groups: ACCESS Women's Health Justice, American
Civil Liberties Union of California, Black Women for Wellness
California, Latinas for Reproductive Justice, NARAL Pro-Choice
California, and Planned Parenthood Affiliates of California.
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2)Current law regarding surgical and nonsurgical abortion .
Current California law states that only a physician and
surgeon may perform a surgical abortion. The law does not
define a "surgical abortion," but Legislative Counsel has
opined that it includes abortion by aspiration techniques.
Aspiration techniques are also not defined in current law, but
according to Planned Parenthood, an aspiration abortion is a
procedure that ends pregnancy by emptying the uterus with the
gentle suction of a manual syringe or with machine-operated
suction. The most common first-trimester abortion method is
vacuum aspiration.
"Nonsurgical abortion" is defined in current law to include
the termination of a pregnancy through the use of
pharmacological agents (for example, RU-486). PAs, CNMs, and
NPs are permitted under current law to perform nonsurgical
abortions.
The sponsors of the bill indicate that the terms "surgical"
and "nonsurgical" are no longer current and that abortion
procedures are more appropriately described as "medicinal" and
"aspiration techniques." This bill would permit PAs, CNMs,
and NPs to provide abortions by aspiration techniques after
completing specified training modeled after a recent
peer-reviewed study described below.
3)OSHPD pilot projects . OSHPD was created in 1978 to provide
California with an enhanced understanding of the structure and
function of its healthcare delivery systems. OSHPD considers
itself the leader in collecting data and disseminating
information about California's healthcare infrastructure,
promoting an equitably distributed healthcare workforce, and
publishing valuable information about healthcare outcomes.
The Health Workforce Pilot Program (HWPP) within OSHPD allows
organizations to test, demonstrate, and evaluate new or
expanded roles for healthcare professionals, or new healthcare
delivery alternatives before changes in licensing laws are
made by the Legislature. An OSHPD pilot project is authorized
to waive laws that would otherwise bar clinicians from
learning and performing procedures outside their current scope
of practice.
OSHPD establishes minimum standards, guidelines, and
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instructions for approved pilot projects after one or more
public hearings. Pilot projects must be sponsored by
community hospitals or clinics, nonprofit educational
institutions, or government agencies engaged in health or
education activities.
4)HWPP 171 pilot project outcomes . The Advancing New Standards
in Reproductive Health program at the University of
California, San Francisco Bixby Center for Global Reproductive
Health applied for a pilot project in 2005 to evaluate the
safety, effectiveness and acceptability of NPs, CNMs, and PAs
in providing aspiration abortions. This pilot project, known
as HWPP 171, was approved in 2007. The project is ongoing
through 2014, but results were published in the peer-reviewed
American Journal of Public Health (AJPH) on January 17, 2013.
The study collected data from 8,000 patients whose first
trimester aspiration abortion was provided by a NP, CNM or PA.
The study concluded that, overall, complications were rare.
Although the rate of complications from CNM, NP, and
PA-performed aspirations was 1.8%, as compared to physicians'
rate of 0.9%, the study noted that the majority of
complications were minor and "complication rates from
aspiration abortions performed by recently trained NPs, CNMs,
and PAs were statistically no worse than those performed by
the more experienced physician group." The study also noted
that the rates of complication amongst CNMs, NPs, and PAs
would likely further decline with greater experience.
The AJPH article further states that "Nationally, 92% of
abortions take place in the first trimester, but black,
uninsured, and low-income women have less access to this care.
In California, only 87% of women using state Medicaid
insurance obtain abortions in the first trimester. Because
the average cost of a second-trimester abortion is
substantially higher than that of a first-trimester procedure,
shifting the population distribution of abortions to earlier
gestations would result in safer, less costly care.
Increasing the types of health care professionals involved in
abortion care is one way to reduce this health care
disparity."
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
AB 154
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319-3301
FN: 0000808