BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 154
Author: Atkins (D), et al.
Amended: 6/24/13 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM. : 8-2, 6/17/13
AYES: Lieu, Block, Corbett, Galgiani, Hernandez, Hill, Padilla,
Yee
NOES: Emmerson, Wyland
SENATE HEALTH COMMITTEE : 7-2, 7/3/13
AYES: Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,
Wolk
NOES: Anderson, Nielsen
SENATE APPROPRIATIONS COMMITTEE : 4-1, 8/12/13
AYES: De León, Hill, Lara, Steinberg
NOES: Gaines
NO VOTE RECORDED: Walters, Padilla
ASSEMBLY FLOOR : 50-25, 5/28/13 - See last page for vote
SUBJECT : Abortion: authorizations
SOURCE : ACCESS Womens Health Justice
ACLU of California
Black Women for Wellness
California Latinas for Reproductive Justice
NARAL Pro-Choice California
Planned Parenthood Affiliates of California
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DIGEST : This bill permits a nurse practitioner (NP),
certified nurse-midwife (CNM) or physician assistant (PA), who
complete specified training and complies with specified
standardized procedures or protocols, to perform an abortion by
aspiration techniques during the first trimester of pregnancy.
ANALYSIS :
Existing law:
1.Establishes the Reproductive Privacy Act (Act) which:
A. Makes legislative findings that every individual
possesses a fundamental right of privacy with respect to
personal reproductive decisions.
B. Defines the terms "abortion" as any medical treatment
intended to induce the termination of a pregnancy except
for the purpose of producing a live birth; "pregnancy" as
the human reproductive process, beginning with the
implantation of an embryo; "state" as the State of
California, and every county, city, town and municipal
corporation, and quasi-municipal corporation in the state;
and "viability" as the point in a pregnancy when, in the
good faith medical judgment of a physician, on the
particular facts of the case before that physician, there
is a reasonable likelihood of the fetus' sustained survival
outside the uterus without the application of extraordinary
medical measures.
C. Provides that the state may not deny or interfere with a
woman's right to choose or obtain an abortion prior to
viability of the fetus, or when the abortion is necessary
to protect the life or health of the woman.
D. Specifies that the performance of an abortion is
unauthorized if either of the following is true: (1) the
person performing or assisting in performing the abortion
is not a health care provider authorized to perform or
assist in performing an abortion pursuant to Section 2253
of the Business and Professions Code; or (2) the abortion
is performed on a viable fetus, and it is established that
in the good faith medical judgment of the physician, the
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fetus was viable, and in the good faith medical judgment of
the physician, continuation of the pregnancy posed no risk
to the life or health of the pregnant woman.
1.Provides that failure to comply with the Reproductive Privacy
Act in performing, assisting, procuring or aiding, abetting,
attempting, agreeing or offering to procure an illegal
abortion constitutes unprofessional conduct.
2.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, and at the time of
so doing, does not have a valid, unrevoked, and unsuspended
license to practice as a physician and surgeon, or to assist
in performing a surgical abortion without a valid, unrevoked,
and unsuspended license or certificate obtained in accordance
with some other provision of law that authorizes him/her to
perform the functions necessary to assist in performing a
surgical abortion.
3.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, unrevoked, and unsuspended license to
practice as a physician and surgeon, or does not have a valid,
unrevoked, and unsuspended license or certificate obtained in
accordance with some other provision of law that authorizes
him/her to perform or assist in performing the functions
necessary for a nonsurgical abortion.
4.Provides that "nonsurgical abortion" includes the termination
of pregnancy through the use of pharmacological agents.
5.Provides that the practice of nursing may be performed under
"standardized procedures," as defined, for specified
functions, treatments and procedures.
This bill:
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.
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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/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/her to perform an abortion by aspiration
technique, as specified.
6. Notwithstanding any other provision of this bill, requires a
NP or CNM to complete training recognized by the Board of
Registered Nursing in order to perform an abortion by
aspiration techniques.
7. 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 utilized from January 1, 2014, until January 1,
2016.
8. 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.
9. Requires an NP and CNM to adhere to standardized procedures
in order to perform an abortion by aspiration techniques that
must specify all of the following: (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)
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procedures for obtaining assistance and consultation from a
physician and surgeon; (d) procedures for providing emergency
care until physician assistance and consultation are
available; and (e) the method of periodic review of the
provisions of the standardized procedures.
10.Requires a PA to complete training either through training
programs approved by the Physician Assistant Board or by
training to perform medical services which augment his/her
current areas of competency, as specified, in order to
receive authority from his/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.
11.Deems the training protocols established by HWPP #171 to
meet the Physician Assistant Board standards.
12.Authorizes a PA who has completed the HWPP #171 training,
achieved clinical competency, received authority from his/her
supervising physician and surgeon, and acts according to
specified protocols, to perform abortions by aspiration
techniques.
A. Requires a PA, in order to receive authority from
his/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
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 are available; and
(e) the method of periodic review of the protocols.
Background
Reproductive Privacy Act . The Reproductive Privacy Act codified
the constitutional principles of Roe v. Wade and replaced in its
entirety the Therapeutic Abortion Act. In 1967, Governor Ronald
Reagan signed the Therapeutic Abortion Act, which expanded legal
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abortion in California under very restrictive criteria. Most of
those restrictions were subsequently ruled unconstitutional in
the 1972 California Supreme Court case, People v. Barksdale
(1972). The United States Supreme Court issued its landmark Roe
v. Wade (1973), and Doe v. Bolton, decisions in 1973, which
invalidated two of the three remaining provisions of the
Therapeutic Abortion Act.
Although Roe and Barksdale rendered much of the Therapeutic
Abortion Act obsolete, the Act itself was not repealed by the
Legislature until 2003, pursuant to SB 1301 (Kuehl, Chapter 385,
Statutes of 2002), the Reproductive Privacy Act. One rationale
for the passage of this Act was the concern that the United
States Supreme Court may overturn Roe v. Wade, and it would,
therefore, be important to have a state law which would protect
reproductive rights in the State of California.
Aspiration technique and procedure . Vacuum or suction
aspiration uses aspiration to remove uterine contents through
the cervix. It may be used as a method of induced abortion, a
therapeutic procedure used after miscarriage or a procedure to
obtain a sample for endometrial biopsy. The rate of infection
is lower than any other surgical abortion procedure at 0.5%.
Some sources may use the terms dilation and evacuation or
"suction" dilation and curettage to refer to vacuum aspiration,
although those terms are normally used to refer to distinct
procedures.
Vacuum aspiration may be used as a method of induced abortion,
as a therapeutic procedure after miscarriage, to aid in
menstrual regulation and to obtain a sample for endometrial
biopsy. It is also used to terminate molar (abnormal)
pregnancy. When used as a miscarriage treatment or an abortion
method, vacuum aspiration may be used alone or with cervical
dilation anytime in the first trimester (up to 12 weeks
gestational age). For more advanced pregnancies, vacuum
aspiration may be used as one step in a dilation and evacuation
procedure. Vacuum aspiration is the procedure used for almost
all first-trimester abortions in many countries.
Vacuum aspiration is an outpatient procedure that generally
involves a clinic visit of several hours. The procedure itself
typically takes less than 15 minutes. Suction is created with
either an electric pump (electric vacuum aspiration or EVA) or a
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manual pump (manual vacuum aspiration or MVA). Both methods use
the same level of suction, and so can be considered equivalent
in terms of effectiveness and safety. The clinician may first
use a local anesthetic to numb the cervix. Then, the clinician
may use instruments called "dilators" to open the cervix, or
sometimes medically induce dilation with drugs. Finally, a
sterile cannula is inserted into the uterus and attached via
tubing to the pump. The pump creates a vacuum which empties
uterine contents. After a procedure for abortion or miscarriage
treatment, the tissue removed from the uterus is examined for
completeness. Expected contents include the embryo or fetus as
well as the decidua, chorionic villi, amniotic fluid, amniotic
membrane and other tissue. Post-treatment care includes brief
observation in a recovery area and a follow-up appointment
approximately two weeks later.
HWPP Study #171 . In 2007, the Advancing New Standards in
Reproductive Health (ANSIRH) program at the University of
California, San Francisco, Bixby Center for Global Reproductive
Health sponsored HWPP #171. The purpose of the program was to
evaluate the safety, effectiveness and acceptability of NPs,
CNMs, and PAs in providing first-trimester aspiration abortion.
Until September 2012, HWPP #171 operated under the auspices of
California's Office of Statewide Health Planning and Development
(OSHPD) to improve health care access. For the duration of the
project, OSHPD provided a mechanism to temporarily suspend laws
and regulations that might otherwise restrict NPs, CNMs and PAs
from performing aspiration abortions. The results of the HWPP
#171 study were published in the American Journal of Public
Health (AJPH) on January 17, 2013. The study analyzed 11,487
aspiration procedures performed on patients in their first
trimester of pregnancy. Physicians performed 5,812 of the
procedures and the remaining 5,675 were performed by NPs, CNMs
or PAs. Results showed that complications were rare. The rate
of complications from CNM, NP, and PA performed aspirations was
1.8%, as compared to physicians' rate of 0.9%. The study
further 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 only 1 additional complication would
occur for every 120 procedures as a consequence of having a NP,
CNM or PA perform the procedure.
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Legislative Counsel's Opinion on aspiration abortion.
Legislative Counsel was recently asked whether existing law
authorizes an NP, CNM, or PA to perform an aspiration abortion.
On April 6, 2012, Counsel opined that existing law does not
authorize an NP, CNM or PA to perform an aspiration abortion.
Counsel reached the conclusion that an aspiration abortion is a
surgical abortion, as that term is used in BPC Section 2253
(b)(1), and, consequently may be performed only by a licensed
physician and surgeon.
Waiver for HWPP #171 . While the original HWPP #171 application
stated that aspiration abortions are within the legal authority
of NPs, CNMs and PAs, the application was amended prior to the
pilot project approval to reflect the uncertainty of that
assertion and the need for suspending BPC Section 2253. The
approved version of the application states in relevant part,
"There is a discrepancy of opinion among health care
professionals, boards and organizations as to whether advanced
practice clinicians are prohibited from performing aspiration
abortion under BPC Section 2253. Because of this discrepancy in
interpretation, ANSIRH seeks a waiver of BPC Section 2253 for
trainees participating in the pilot project for the duration of
the project." This amendment in the application was in response
to the disagreement within the health professional community as
to whether aspiration abortion should be classified as surgical
or nonsurgical abortion, and, therefore, whether the identified
health professionals could legally perform aspiration abortion
procedures. The suspension of BPC Section 2253, along with the
Title 22 California Code of Regulations (CCR) Section 75043 and
Title 16 CCR Section 1399.541, was deemed necessary for these
clinicians to legally provide aspiration abortions. A waiver of
these provisions was therefore granted by the OSHPD with the
approval of the HWPP #171 application on March 31, 2007.
Comments
According to the author, "Early abortion access is a critical
public health issue. An estimated one in three women will
decide to terminate a pregnancy by age 45, yet many women often
do not have sufficient access to early abortions because of the
limited number of physicians providing the services in their
communities?By authorizing trained and qualified health
professionals to provide care, this measure would allow women to
receive timely care locally from advanced trained practitioners
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they already know and trust through a more responsive health
care delivery system."
According to the author's office, many NP, CNM and PA programs
provide instruction on unintended pregnancy care including
medication abortion. Some programs teach uterine aspiration for
treating common women's health conditions such as uterine
bleeding problems, miscarriage management, or for gynecological
cancer diagnosis. These training programs are approved by
national accreditation bodies as well as state regulatory
agencies.
There are also opportunities for NPs, CNMs and PAs to obtain
post-graduate continuing education for early abortion care.
This training is currently offered by national professional
organizations that are required to meet national accreditation
standards established by the Department of Education and health
professional accreditation boards (American Nurses Credentialing
Center, American Association of Nurse Practitioners, American
College of Nurse-Midwives, American Academy of Physician
Assistants, and the Accreditation Council for Graduate Medical
Education). Further, these nationally accredited continuing
education providers are approved by the Board of Registered
Nursing and the Physician Assistant Board. For example,
numerous published abortion training curricula and guidelines
exist through the Association of Reproductive Health
Professionals and the National Abortion Federation which provide
competency-based training in comprehensive early abortion care
including medication/aspiration abortion procedures.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
One-time costs up to $150,000 for the adoption or revision of
regulations by the Board of Registered Nursing (Board of
Registered Nursing Fund).
One-time costs up to $150,000 for the adoption or revision of
regulations by the Medical Board of California (Contingent
Fund of the Medical Board of California).
Indeterminate impact on state health care programs, such as
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Medi-Cal and California Public Employees' Retirement System
(various funds). While the impact on state programs is not
known, the bill is not likely to increase overall state
spending on those programs.
By authorizing more health care providers to provide first
trimester aspiration abortions, it is possible that this bill
will increase the overall number of abortions performed in the
state. However, this impact is uncertain. It is not known
whether limitations in the number of providers for first
trimester abortions actually limits the number of abortions
that are performed in the state. Currently, women who desire a
first trimester abortion and face a shortage of providers may
travel to an area where services are available or delay their
abortion until later in the pregnancy. In such cases, this
bill will not increase the overall number of abortions. Given
that the cost to provide a first trimester aspiration abortion
is less than the cost to provide a second trimester surgical
abortion, greater access to first trimester aspiration
abortions may reduce state health care costs.
SUPPORT : (Verified 8/14/13)
ACCESS Women's Health Justice (co-source)
ACLU of California (co-source)
Black Women for Wellness (co-source)
California Latinas for Reproductive Justice (co-source)
NARAL Pro-Choice California (co-source)
Planned Parenthood Affiliates of California (co-source)
ACT for Women and Girls
American College of Nurse-Midwives
American Nurses Association\California
Asian Communities for Reproductive Justice
Bay Area Communities for Health Education
Board of Registered Nursing
Business and Professional Women of Nevada County
California Academy of Physician Assistants
California Association for Nurse Practitioners
California Church IMPACT
California Communities United Institute
California Family Health Council
California Medical Association
California National Organization for Women
California Nurse-Midwives Association
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California Women's Health Alliance
California Women's Law Center
Cardea Institute
Center on Reproductive Rights and Justice at UC Berkeley Law
Choice USA
Citizens for Choice
Forward Together
Fresno Barrios Unidos
Khmer Girls in Action
Law Students for Reproductive Justice
League of Women Voters of California
National Asian Pacific American Women's Forum
National Association of Social Workers, California Chapter
National Center for Lesbian Rights
National Council of Jewish Women - California
National Health Law Program
National Latina Institute for Reproductive Health
National Network of Abortion Funds
Nevada County Citizens for Choice
Nursing Students for Choice- UCSF
Physicians for Reproductive Health
Planned Parenthood Advocacy Project of Los Angeles County
Planned Parenthood Mar Monte
Planned Parenthood of Santa Barbara, Ventura and San Luis Obispo
Counties, Inc.
Planned Parenthood of the Pacific Southwest
Planned Parenthood Shasta Pacific Action Fund
Reproductive Justice Coalition of Los Angeles
SEIU
Students for Reproductive Justice at Stanford University
Women's Community Clinic
Women's Health Specialists of California
OPPOSITION : (Verified 8/14/13)
California Catholic Conference
Capitol Resource Family Impact
City of Shasta Lake, Greg Watkins, City Councilman
Coalition for Women and Children
Concerned Women for America
John Paul the Great Catholic University Students for Life
Life Legal Defense Fund
Pro-Life Mission: International
San Jose State Students for Life
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Traditional Values Coalition
University of Southern California Students for Life
ARGUMENTS IN SUPPORT : The California Women's Health Alliance,
representing 33 different organizations, including the sponsors
of this bill, writes, "AB 154 is necessary. Despite
California's history of supporting comprehensive reproductive
health care, over half of our counties do not have an accessible
abortion provider. This creates barriers to care in both rural
and urban areas; in rural areas, some women have to travel five
hours by train or bus and also arrange for child care and missed
work. In urban areas, many women face long delays in getting
medical appointments. These barriers can force women to delay
abortions into later stages of pregnancy, which can result in a
more complicated procedure."
Planned Parenthood Affiliates of California (sponsor), Planned
Parenthood of Santa Barbara, Ventura and San Luis Obispo
Counties, Inc., Planned Parenthood Mar Monte, Planned Parenthood
Advocacy Project of Los Angeles County, Planned Parenthood of
the Pacific Southwest and Planned Parenthood Shasta Pacific
Action Fund state, "AB 154 enacts the results and findings from
a multi-year study conducted by the University of California at
San Francisco's Bixby Center for Global Reproductive Health,
under the auspices of the Office of Statewide Health Planning
and Development?The study showed exceptionally low rates of
complications by both the NPs, CNMs and PAs and the physicians,
affirming that aspiration abortion is an extremely safe
procedure overall and safe whether performed by the trained NPs,
CNMs and Pas, or by the physicians. Access to the full range of
first trimester reproductive health services is an important
aspect of women's health. An estimated one in three women will
decide to terminate a pregnancy by age 45, yet many women often
do not have sufficient access to early, safe abortions because
of the limited number of physicians providing the services in
their communities."
The California Medical Association notes, "When any allied
health professional seeks to expand their authority or scope of
practice, CMA prioritizes patient safety. Physician supervision
and appropriate training and education are paramount factors in
this determination. AB 154 addresses both."
The American Nurses Association\California writes, "By expanding
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the types of trained and qualified health professionals who can
provide early abortions to include Nurse Practitioners,
Certified Nurse Midwives and Physician Assistants, AB 154
removes a barrier in the law that prevents an Advanced Practice
Registered Nurse from functioning as the Nurse Practice Act
defines."
The California Association for Nurse Practitioners (CANP)
writes, "CANP acknowledges the complex personal, political,
religious and professional sensitivities that surround the
advancement of AB 154. First and foremost, CANP is committed to
furthering the practice of nurse practitioners in California.
Among CANP's core missions is the promotion of expanding the
scope of practice for licensed NPs?In reaching a 'support'
position, the association has concluded that AB 154 is amenable
to this mission. We believe that the performance of these
procedures is consistent with the education and training held by
nurse practitioners. Additionally, as fewer physicians are
willing or available to provide these services, it becomes
important for women to have access to all types of health care
services provided by non-physicians."
ARGUMENTS IN OPPOSITION : Concerned Women for America states,
"The bill's proponents hold that increasing access to abortion
in this manner is a 'critical public health issue.' We contend
that allowing non-physicians to supervise medical abortions and
perform aspiration abortions presents a critical public health
issue as well. Abortion carries the potential for serious
complications, including hemorrhage, uterine perforation,
cervical injury and incomplete abortion. There is no need to
increase the risk to patients for an elective
procedure?especially in a state where, according to the
Guttmacher Institute, a mere one percent of women live in a
county where there is no abortion provider. The need for a very
small number of women to potentially have to travel across a
county line in order to obtain an elective procedure hardly
seems worth the general risk to women's safety."
The Coalition for Women and Children writes, "We must put the
health and safety of women first, rather than the profits of the
abortion industry. The UCSF pilot project's study was done
under the most highly supervised, specially selected, hygienic
conditions and even then, women whose abortions were done by
non-physicians experienced complication rates twice that of
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those women whose abortions were performed by physicians.
Proponents of this bill argue that these unsafe non-physician
providers will increase abortion access to women in rural
counties, yet the abortion industry's own Guttmacher Institute
lists California already as the #1 state in abortion provider
access and publicly funded support for abortion."
Shasta Lake City Councilman Greg Watkins writes, "I strongly
oppose AB 154. Women deserve the highest level of medical care,
but this bill would lower the standard of care for women in
California."
The University of Southern California Students for Life write,
"It is surprising that the Legislature would consider approving
a lowered standard of care for women. According to the UCSF
pilot project's own study, abortions performed by these
non-physicians have complication rates twice that of abortions
performed by physicians."
San Jose Students for Life and John Paul the Great Catholic
University Students for Life both write, "We urge you to put the
safety of women first and vote no on AB 154."
The California Catholic Conference, Inc. argues, "The reality of
a 'right' to health care, which we support, does not and should
not require the government to facilitate access by weakening
health standards or reclassifying medical practices?Decisions of
this import, made quickly and with no consideration of
unintended consequences for women's health, for future health
policy, insurance rate, or government subsidized payments, etc.
will set a very poor precedent, particularly at a time when the
government is playing a more influential role in health care
delivery through the implementation of the Federal ACA."
The Traditional Values Coalition state, "Current California
Business 4826 requires that an animal abortion be performed only
by a veterinary surgeon. Yet AB 154 removes the current
requirement that a human abortion be performed only by a trained
surgeon. Non-doctors could perform surgical abortions in AB 154
is passed?Why compromise the health of women? Why give animals
a higher standard of care than human beings?"
Pro-Life Mission: International argues, "Women deserve the
highest level of medical care, but this bill would lower the
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standard of care for women in California. Abortion is a
dangerous surgical medical procedure, often leading to
hemorrhage, perforation of the uterus and bowels, and sometimes
death. It is one of the least regulated industries in
California and a further diminution in the requirements as set
out in AB 154 of those who perform the procedure will only put
more women at risk."
The Capitol Resource Family Impact contends, "Women, and
certainly young girls who are given access in this state to
abortion at 12 years of age, are unaware of the complications
that even a first term pregnancy can bring. Pregnant women
seeking abortions should not be deceived into believing that the
experience of a clinician is equal to the training of a
physician. This bill simply creates an industry for
non-physician abortionists, generating more revenue for the
Abortion Industry."
ASSEMBLY FLOOR : 50-25, 05/28/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chesbro, Daly, Dickinson, Eggman, Fong, Frazier,
Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall, Roger
Hernández, Jones-Sawyer, Levine, Lowenthal, Medina, Mitchell,
Mullin, Muratsuchi, Nazarian, Pan, Perea, V. Manuel Pérez,
Quirk, Quirk-Silva, Rendon, Skinner, Stone, Ting, Weber,
Wieckowski, Williams, Yamada, John A. Pérez
NOES: Achadjian, Bigelow, Chávez, Conway, Dahle, Donnelly, Beth
Gaines, Gorell, Grove, Hagman, Harkey, Jones, Linder, Logue,
Maienschein, Mansoor, Melendez, Morrell, Nestande, Olsen,
Patterson, Salas, Wagner, Waldron, Wilk
NO VOTE RECORDED: Allen, Cooley, Fox, Holden, Vacancy
MW:nl 8/14/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
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