BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 623
AUTHOR: Kehoe
AMENDED: August 7, 2012
HEARING DATE: August 29, 2012
CONSULTANT: Moreno
PURSUANT TO SENATE RULE 29.10
SUBJECT : Public health: health workforce projects: abortions.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD) to extend the duration of the health
workforce project known as Health Workforce Pilot Project (HWPP)
No. 171 regarding clinicians until January 1, 2014.
Existing law:
1.Authorizes OSHPD, among other functions, to 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 the HWPP within OSHPD to designate experimental
health workforce projects as approved projects 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.Permits a trainee in an approved project, notwithstanding any
other provision of law, to perform health care services under
the supervision of a supervisor where the general scope of the
services has been approved by OSHPD.
4.Prohibits OSHPD from approving a project for a period lasting
more than two training cycles plus a preceptorship of more
than 24 months, unless it determines that the project is
likely to contribute substantially to the availability of
high-quality health services in the state or a region of the
state.
5.Permits nurse practitioners (NPs), certified nurse-midwives
(CNMs), and physician assistants (PAs) to legally perform a
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"nonsurgical" abortion that includes termination of pregnancy
through the use of pharmacological agents.
This bill:
1.Requires OSHPD to extend the duration of the HWPP No. 171
until January 1, 2014, 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,
as amended.
2.Requires the project to continue to satisfy the OSHPD
requirements.
3.Sunsets its provisions on January 1, 2014.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, negligible state fiscal impact.
PRIOR VOTES :
Assembly Health: 13- 6
Assembly Appropriations:12- 5
Assembly Floor: 52- 26
COMMENTS :
1.Author's statement. Since March 31, 2007, researchers at the
University of California at San Francisco (UCSF) Bixby Center
for Global Reproductive Health have been conducting a
comprehensive study under the auspices of HWPP No. 171 to
train and evaluate NPs, CNMs and PAs in the provision of
first-trimester aspiration abortion. 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 safe and early abortions. OSHPD has
suspended practice limits in a similar manner for numerous
past pilot projects. This bill would extend HWPP No. 171
through January 1, 2014, to maintain the competencies of
currently trained clinicians and to authorize training of new
health professionals to ensure that women continue to have
access to early abortions. Currently, HWPP No. 171 is expected
to conclude in 2012. As a result of extending the pilot
project, the Legislature can collect data to further assess
the study findings and explore options for expanding the
access benefits of HWPP No. 171. UCSF also intends to submit
the results of the study for publication in a nationally
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recognized, peer-reviewed journal.
2.Background. According to OSHPD, the HWPP program allows
organizations to test, demonstrate, and evaluate new or
expanded roles for health care professionals, or new health
care delivery alternatives before changes in licensing laws
are made by the Legislature. Nonprofit education
institutions, community hospitals, clinics, and governmental
agencies engaged in health or education activities may apply
to HWPP program. The program does not provide funding for
approved projects, rather applicants must seek their own
funding and, as part of the application, demonstrate and
indicate the funding required for piloting the project and the
funding source. Between 1972 and 2012, there have been 172
applicants for projects involving registered and vocational
nurses, physicians, medical auxiliaries, pharmacies, dental
hygienists, dentists, mental health, podiatry, and maternal
and children's health professionals.
3.HWPP No. 171: Access through Primary Care Project. According
to the project application submitted to OSHPD for HWPP No.
171, the Advancing New Standards in Reproductive Health
(ANSIRH) program at UCSF is sponsoring the Access through
Primary Care (APC) Project. The project seeks to demonstrate
and evaluate the role of advanced practice clinicians in
providing first-trimester aspiration abortion and miscarriage
management as part of coordinated early pregnancy care.
Training advanced practice clinicians in aspiration abortion
as part of early pregnancy care will address the critical
shortage of abortion providers in California. It will create
providers in underserved areas that need them the most, assist
with better follow-up and complication management, and
integrate abortion services into previously existing health
care networks. The project seeks to: a) increase access to
early abortion services, particularly in rural and underserved
areas; b) improve patient safety by allowing early diagnosis
and management of unintended pregnancy; c) improve patient and
clinical satisfaction by integrating abortion services in
existing women's primary care; and d) improve overall women's
health care delivery by coordinating early pregnancy care and
thereby reducing costs associated with such care and
referrals.
4.APC project data. According to a December 2011 ANSIRH fact
sheet on the project, 41 NPs/CNMs/PAs have been trained to
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competency in aspiration abortion care. Clinicians participate
in a comprehensive didactic and supervised clinical training
program, which includes a written exam and competency-based
evaluation process. Trainee competency is evaluated daily and
at the end of the training phase on confidence, procedural
performance, patient care, communication, interpersonal
skills, professionalism, practice-based learning, and clinical
knowledge. As of September 2011, 7,585 first-trimester
aspiration abortion procedures were completed by NPs/CNMs/PAs
and 6,195 procedures were completed by physicians as part of
the project. Of the 13,876 patients who agreed to participate
in HWPP No. 171, less than 20 percent (2,469) declined having
a NP/CNM/PA perform their abortion procedure.
5.Related legislation. SB 1338 (Kehoe) of 2012 would have
allowed a NP, CNM, and PA who had completed training in the
HWPP No. 171 to continue to perform abortions by aspiration
technique. SB 1338 failed passage in the Senate Business,
Professions and Economic Development Committee.
6.Prior legislation. SB 761 (Aanestad) of 2009 would have
required OSHPD to submit an annual report to the Legislature
on all approved or renewed health workforce pilot projects,
including, but not limited to, assessment of outcomes, budget
impact, and sources of funding. SB 761 failed passage in the
Assembly Health Committee.
AB 1409 (Brown), Chapter 324, Statutes of 1995, authorized
OSHPD to extend a geriatric care pilot project, called "Health
Manpower Pilot Project No. 152," for up to four years.
SB 167 (McCorqudale), Chapter 857, Statutes of 1987, expands
the types of facilities that qualify for sponsorship and
allows for an increase in the number of projects.
7.Support. 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
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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.
8.Opposition. The California Right to Life Committee, Inc.
writes 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
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.
SUPPORT AND OPPOSITION :
Support: American Civil Liberties Union (co-sponsor)
Planned Parenthood Affiliates of California
(co-sponsor)
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
Oppose: California Catholic Conference
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California Right to Life Committee
Coalition for Women and Children
Life Priority Network
Traditional Values Coalition
Two individuals
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