Los Angeles Times, March 3, 2022
By Melody Gutierrez
SACRAMENTO — California would allow nurse practitioners to more easily work independently of a doctor and perform abortions under legislation that expands reproductive care as other states move to restrict access.
The bill is one of several introduced this year by California Democrats who have been preparing countermeasures to expand abortion access for those who live in and out of the state, a months-long effort that comes in response to the possibility that the U.S. Supreme Court could overturn Roe vs. Wade, the nearly 50-year-old landmark decision that barred states from criminalizing abortions.
Senate President Pro Tem Toni Atkins (D-San Diego) said Senate Bill 1375 addresses two issues by allowing experienced nurse practitioners in California to more quickly qualify to work independently of a doctor and adding abortion care to the services they can offer without physician oversight.
“SB 1375 is a proactive step further to increase access to affordable quality abortion care in California,” Atkins said. “Our state is facing a serious shortage of primary care clinicians, especially for our Latino, Black and Native American communities — a problem that is expected to get even more dire over the next decade.”
California is expected to face a massive shortage of healthcare workers in the next decade, with the need for care increasing as the population ages. A 2019 report by the California Future Health Workforce Commission recommended expanding the services that 30,0000 nurse practitioners in the state can independently provide as part of a plan to meet the state’s needs.
In addition, Atkins said more than 40% of counties in California do not have clinics that provide abortions, leaving people unable to access reproductive services.
In 2013, Atkins wrote a bill that was signed into law allowing certified nurse midwives, physician assistants and nurse practitioners who complete special training and operate under the supervision of a doctor to perform first-trimester abortions. A separate bill, Assembly Bill 890, was signed into law two years ago allowing nurse practitioners with advanced training certification to work independently of doctors, but it did not specifically mention abortion services as part of the expanded scope.
That bill, by Assemblymember Jim Wood (D-Santa Rosa), is slated to take effect next year, with specifics about the criteria a nurse practitioner must meet before working independently still being weighed by the Board of Registered Nursing.
Atkins said her new legislation bridges the gap between the two previous bills by including abortions as among the services nurse practitioners can perform without oversight of a doctor. It also goes a step further in removing the Board of Registered Nursing’s authority to define the minimum standard a nurse practitioner needs to meet to operate independently, setting it at three years of full-time work that can include prior practice experience.
Patti Gurney, president of the California Assn. for Nurse Practitioners, welcomed Atkins’ efforts, saying the Board of Registered Nursing has had “many meetings with input and very little movement” in setting the criteria for working independently.
“Those of us who’ve been working for many, many years as nurse practitioners then would automatically meet that transition to practice,” Gurney said.
That provision of the bill, however, is likely to elicit concern from the doctors’ lobbying group, the California Medical Assn., which has fought previous efforts to expand the scope of practice for nurse practitioners. A spokeswoman for the association said Wednesday that the group did not yet have a position on the bill.
“This new bill defines a transition period and recognizes work experience that nurse practitioners have had and that’s really important,” Wood said.
Antiabortion groups such as the California Catholic Conference oppose the bill, arguing that lawmakers should prioritize the high cost of housing, child care and healthcare that can lead a woman to choose abortion.
“It’s a dangerous bill,” said Kathleen Domingo, executive director of the California Catholic Conference. “I think what this is really doing is undermining the safety of women in all of their healthcare interactions. It’s putting access before safety.”
In September, Gov. Gavin Newsom and legislative leaders asked Planned Parenthood Affiliates of California and dozens of other supporters to develop a plan for the state to become a sanctuary for anyone denied abortion services in other parts of the country. The coalition, the California Future of Abortion Council, recommended 45 changes in December to improve access and create additional capacity should other states outlaw abortion.
The recommendations included easing the competency requirements for nurse practitioners, certified nurse-midwives and physicians in order for them to perform aspiration abortions.
Most abortions are performed in the first trimester by one of two methods. A medical abortion is a nonsurgical way to terminate a pregnancy that involves taking two prescription pills hours apart during a woman’s first 10 weeks of pregnancy to induce a miscarriage. An aspiration abortion, which is an option until the end of the first trimester, works by using suction to empty out a woman’s uterus.
Other bills include Senate Bill 245 by Sen. Lena Gonzalez (D-Long Beach), which would put an end to out-of-pocket costs paid by those seeking abortions that on average range from $300 for a medication abortion to nearly $900 for a procedural abortion, according to the California Health Benefits Review Program.
“I think if you had asked me 30 years ago when I was managing clinic services for a women’s reproductive health center if I’d still be talking about defending Roe vs. Wade and fighting for abortion access in 2022, I would have said I certainly hope not,” Atkins said. “But here we are. In statehouses and courthouses across the country all the way up to the Supreme Court, our reproductive rights are being stolen from us.”