BILL ANALYSIS �
SB 623
Page 1
Date of Hearing: July 3, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 623 (Kehoe) - As Amended: June 21, 2012
SENATE VOTE : Not relevant.
SUBJECT : Public health: health workforce projects: abortions.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD) to extend until January 1, 2014, the Health
Workforce Pilot Project No. 171 (HWPP No. 171) to evaluate the
safety, effectiveness, and acceptability of nurse practitioners
(NP's), certified nurse-midwives (CNMs), and physician
assistants (PAs) in providing aspiration abortions.
Specifically, this bill :
1)Requires OSHPD to extend the HWPP No. 171 to evaluate the
safety, effectiveness, and acceptability of NPs, CNMs, and PAs
in providing aspiration abortions in order to provide the
sponsors an opportunity to achieve publication of the data in
a peer-reviewed journal, to maintain the competence of the
clinicians trained during the course of the project, and to
authorize training of additional clinicians in first-trimester
aspiration technique, as outlined in the project application.
2)Requires that the HWPP No. 171 continue to satisfy the
requirements of OSHPD.
3)Requires that the provisions in this bill remain in effect
only until January 1, 2014, and as of that date are repealed,
unless a later statute enacted before January 1, 2014 deletes
or extends that date.
4)Makes the following findings and declarations including, but
not limited to:
a) The Access through Primary Care Project, also known as
the HWPP No. 171, was approved in 2007 to teach new skills
to NPs, CNMs, and PAs, and to evaluate the safety and
efficacy of allowing NPs, CNMs, and PAs to use these new
skills to perform first trimester aspiration abortions.
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b) The study investigators from the University of
California (UC) find, from the data submitted to OSHPD that
trainees of the HWPP No. 171 have achieved competency and
safely perform first trimester aspiration abortions using
the new skills acquired through the project. The study
investigators intend to undergo additional peer review of
the data by submitting the results for publication in a
nationally recognized, peer-reviewed journal.
c) It is necessary to extend the HWPP No. 171 to maintain
the competencies of clinicians trained to date and to
authorize continued training of new clinicians while the
larger peer review process is conducted, and because the
HWPP No. 171 is likely to increase the availability of
safe, early abortion care that is limited in many areas of
California.
EXISTING LAW :
1)Authorizes OSHPD to, among other functions, collect data and
disseminate information about California's health care
infrastructure, promote equitable distribution of health care
outcomes, and publish information about health care outcomes.
Establishes within OSHPD the HWPP to designate experimental
health workforce projects as approved projects where the
projects are sponsored by community hospitals or clinics,
nonprofit educational institutions, or government agencies
engaged in health or education activities.
2)Establishes through regulations, the definitions and criteria
for administering the HWPP.
3)Specifies that a NP, CNM, and PA may legally perform a
"nonsurgical" abortion that includes termination of pregnancy
through the use of pharmacological agents.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, OSHPD
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initially approved the HWPP No. 171 based on arguments by
reproductive health care provider groups that access to early
abortion services is severely constrained throughout the
State. The author maintains that many counties have no
accessible abortion providers. As a result of these access
challenges in those parts of the State, the author asserts,
patients who are seeking an abortion after already having made
their decision, not only experience prohibitive wait times in
their own communities, but they also often confront grueling
travels to areas that have more accessible abortion providers.
The author argues that this bill will extend the HWPP No. 171
to allow the project to maintain its momentum and study
researchers from the UC to achieve publication in a
nationally-recognized peer-reviewed journal of their study
results, which find that trained clinicians may safely provide
first-trimester aspiration abortions.
2)BACKGROUND . In 1967, Governor Ronald Reagan signed the
Therapeutic Abortion Act, which expanded legal 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)
8 Cal.3d 320, 105 Cal.Rptr 1 ( People v. Barksdale) . The
United States Supreme Court issued its landmark Roe v. Wade
(1973) 410 U.S. 959, 35 L.Ed.2d 694 ( Roe v. Wade ), and Doe v.
Bolton , decisions in 1973, which invalidated two of the three
remaining provisions of the Therapeutic Abortion Act.
Although Roe v. Wade and People v. Barksdale rendered much of
the Therapeutic Abortion Act obsolete, the Therapeutic
Abortion Act itself was not repealed by the Legislature until
2003, pursuant to SB 1301 (Kuehl), Chapter 385, Statutes of
2002, the Reproductive Privacy Act. The Reproductive Privacy
Act codified the constitutional principles of Roe v. Wade .
One rationale for the passage of the Reproductive Privacy 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. In 2003, the California Assembly
also passed AJR 2 (Jackson), Chapter 63, Resolution Statutes
of 2003, urging Congress and the President to uphold the
intent and substance for Roe v. Wade and reiterated the
elements of reproductive rights.
3)HWPP No. 171 . In an effort to expand the pool of educated,
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trained, and skilled California abortion providers, the
Advancing New Standards in Reproductive Health (ANSIRH)
program at the UC San Francisco (UCSF) Bixby Center for Global
Reproductive Health sponsored the HWPP No. 171 beginning in
March 31, 2007, to evaluate the safety, effectiveness, and
acceptability of NPs, CNMs, and PAs in providing
first-trimester aspiration abortion. The HWPP No. 171
operates under the auspices of OSHPD to improve health care
access. For the duration of the project, OSHPD provides a
mechanism to temporarily suspend laws and regulations that
might otherwise restrict NPs, CNMs, and PAs from performing
aspiration abortion. The HWPP No. 171 is currently approved
through September 2012.
UCSF is collaborating on the HWPP No. 171 with five Partner
Organizations, including Kaiser Permanente of Northern
California and four Planned Parenthood Affiliates (Shasta
Pacific, Mar Monte, Los Angeles, and Pacific Southwest).
These Partner Organizations have trained approximately 45 NPs,
CNMs, and PAs who already offer a broad spectrum of
reproductive health care at their respective organizations.
The preliminary results, as indicated by the UCSF research
study, indicate that patients are highly satisfied with care
provided by NPs, CNMs, PAs, and physicians. Currently, almost
8,000 patients have received these services. The UCSF study
compares the outcomes of abortions performed by NPs, CNMs, and
PAs to an equal number of procedures performed by physicians,
for a total of approximately 16,000 procedures. The data show
similar rates of high patient satisfaction and low
complications in both groups. Abortion-related complications
for NPs, CNMs, and PAs and for physicians are similar
according to the UCSF study, and both are well below the
average published rates for this procedure (less than 2% for
HWPP No. 171 compared to 5% in published literature.)
4)VACUUM ASPIRATION PROCEDURE . 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
or a manual pump. Both methods use the same level of suction,
and so can be considered equivalent in terms of effectiveness
and safety. 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
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endometrial biopsy. Vacuum aspiration is most commonly used
for first-trimester abortions. The rate of infection is lower
than any other surgical abortion procedure at 0.5%. When used
for uterine evacuation, vacuum aspiration is 98% effective in
removing all uterine contents. Retained products of
conception require a second aspiration procedure. This is
more common when the procedure is performed very early in
pregnancy, before 6 weeks gestational age. Other
complications occur at a rate of less than one per 100
procedures and include excessive blood loss, injection injury
to the cervix or uterus, including perforation, and uterine
adhesions.
5)SUPPORT . The Planned Parenthood Affiliates of California
(PPAC) and the American Civil Liberties Union (ACLU) of
California, co-sponsors of this bill, write in support that
access to the full range of first trimester reproductive
health services is an important aspect of women's health.
According to PPAC and ACLU, 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. PPAC and ACLU maintain that by
increasing the number of aspiration providers, this bill helps
to ensure women receive comprehensive reproductive health care
from local providers they know and trust. Supporters also
write that by extending the HWPP No. 171, this bill will allow
the project to be properly analyzed, while preserving the
knowledge of the clinicians who have been trained through the
project.
6)OPPOSITION . The California Right to Life Committee, Inc.
write in opposition that the HWPP No. 171, lacking any
informed consent from the patient and employing non-physicians
as abortionists, places women's health and safety in danger
and removes their right of choice to control their own health
care decisions. The Life Priority Network (LPN) writes that
the HWPP No. 171 has been touted as increasing women's access
to abortion in rural areas, but medical safety must always
take priority. LPN poses the question if qualified physicians
are not available in rural areas now, how is a woman's safety
improved by affording her an aspiration abortion with its
potential for a punctured uterus? California Catholic
Conference, Inc. (CCC) writes in opposition that this bill is
a late introduction "gut and amend" bill, designed to address
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the failure of SB 1338 (Kehoe) earlier this year. According
to CCC, SB 1338 failed because the anecdotal statistics
presented by the project managers could not withstand
perfunctory scrutiny. CCC argues it is opposed to this
ill-considered, last minute and unfortunate extension of the
authorization and funding for the training of abortionists.
7)RELATED LEGISLATION . SB 1338 would have allowed a NP, CNM,
and PA who had completed training in the Project to continue
to perform abortions by aspiration technique. SB 1338 failed
passage in the Senate Business, Professions and Economic
Development Committee.
8)PREVIOUS LEGISLATION :
a) AJR 3 (Cohn), Chapter 83, Resolution Statutes of 2005,
relative to the 32nd anniversary of Roe v. Wade , urging
Congress and the President to uphold the intent and
substance for Roe v. Wade and reiterated the elements of
reproductive rights.
b) AJR 2 (Jackson), Chapter 63, Resolution Statutes of
2003, urging Congress and the President to uphold the
intent and substance for Roe v. Wade and reiterated the
elements of reproductive rights.
c) SB 1301 (Kuehl) enacts the Reproductive Privacy Act
which codifies the constitutional provisions of Roe v. Wade
and deletes provisions of the Therapeutic Abortion Act .
9)PROPOSED AMENDMENT . The author wishes to take the following
amendment to clarify that the intent of this bill is that the
HWPP No. 171continue without interruption:
On page three, at the end of line 23, please add the phrase:
It is the intent of the Legislature that HWPP No. 171 continue
without interruption.
REGISTERED SUPPORT / OPPOSITION :
Support
American Civil Liberties Union (cosponsor)
Planned Parenthood Affiliates of California (cosponsor)
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ACCESS Women's Health Justice
ACT for Women and Girls
American Nurses Association/California
California Association for Nurse Practitioners
California Medical Association
California Nurse-Midwives Association
NARAL Pro-Choice California
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Mar Monte
SEIU California
Six Rivers Planned Parenthood
Opposition
California Catholic Conference, Inc.
California Right to Life Committee, Inc.
Life Priority Network
Traditional Values Coalition
Two Individuals
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097