California set to expand the number of practitioners who can provide abortions

With many states poised to ban abortions after the Supreme Court issues its decision on Roe v. Wade this summer, California lawmakers are working to expand the number of practitioners who can provide abortion care. Senate Bill 1375, sponsored by Senate President pro Tempore Toni Atkins (D – San Diego), would allow experienced nurse practitioners (NPs) to provide first trimester abortions without physician supervision.

The bill is part of the 13-bill package being promoted by the Legislative Women’s Caucus in the wake of the national threat to reproductive health care.

 

 

Atkins says California is preparing for a surge of patients fleeing conservative states for states like California, which are working to strengthen abortion care. 

In an Assembly Business and Professions Committee meeting on Tuesday—during which the bill passed 14-3, placing it closer to a final vote on the Assembly floor—Atkins said this bill is critical for expanding access to abortion care as the Supreme Court’s decision looms.

“This is a decision that we need to prepare for in every way that we can, and SB 1375 is part of that preparation,” Atkins said. “By giving more trained and qualified nurse practitioners the ability to provide first trimester abortions without the supervision of a doctor, SB 1375 is a proactive step to further increase access to affordable, quality reproductive care in California.”

In 2013, then-Assemblymember Atkins passed Assembly Bill 154, which allowed NPs to perform first trimester abortions. In 2020, Asm. Jim Wood (D – Santa Rosa) passed AB 890, which allowed qualified NPs care for patients without physician supervision.

SB 1375, according to Atkins, connects these 2 previous bills by codifying that NPs can provide first trimester abortions via aspiration without physician supervision. It also removes barriers to abortion care training for NPs, allowing experienced NPs to be certified to provide abortion care more expeditiously.

“First trimester abortion is not a complicated procedure,” testified Jennifer Kerns, an OBGYN and Associate Professor in the University of San Fancisco Department of Obstetrics and Gynecology. “It is a very simple, basic procedure, and nurse practitioners are immensely qualified to do these procedures.”

AB 890 implemented a “transition to practice” requirement for nurses to be able to practice independently, consisting of 3 years of practice where NPs meet certain education, experience, and certification requirements. The state Board of Registered Nursing (BRN) currently has authority to define the minimum standards for meeting the transition to practice requirement.

SB 1375 removes this authority from the BRN and allows NPs to meet the “transition to practice” requirement through prior experience. Under the bill, NPs who have practiced for at least 3 years as of Jan. 1st, 2023, can skip the transition to practice requirement.

“Advanced practice clinicians play a critical role in providing reproductive care,” she said. “By removing barriers to abortion training and allowing experienced nurse practitioners to utilize their full training and education, SB 1375 will expand the number of qualified reproductive care practitioners, particularly in areas lacking access to care.”

The California Hospital Association, which supports the bill, says it will help address disparities in reproductive health care, as NPs are more likely to take patients on Medi-Cal or who are uninsured. 

“By allowing experienced nurse practitioners, who have been practicing in good standing under physician supervision for decades, to utilize prior experience to fulfill the TTP requirement, California can increase its ability to quickly expand access to high-quality care, especially for those who need it most,” said Vanessa Gonzales, Legislative Advocate for CHA.

“SB 1375 is a key step to ensuring that thousands of qualified and experienced nurse practitioners (NPs) are available to provide services for communities who need them.”

The California Association of Nurse Practitioners is sponsoring the bill, and Access Reproductive Justice, ACLU California Action, and the American Nurses Association of California also support the bill.

The California Medical Association (CMA) and the California Academy of Family Physicians are in an “opposed unless amended” position. 

CMA affirmed their support for increasing abortion access, but are opposed to the bill’s elimination of the transition to practice requirement, arguing that these are important measures for ensuring NPs are qualified to safely care for patients individually.

“The transition to practice provision was one of the few consumer protections in AB 890,” CMA wrote. “And now, [this bill] is proposing to effectively eliminate the transition to practice requirement by exempting any nurse practitioner who has practiced for only three years or 4600 hours, while also removing the BRN’s ability to determine the transition to practice minimum standards. 

These minimum standards, which will ensure the new categories of nurse practitioners have the necessary clinical training and education to practice without supervision, are crucial to the high quality care that all patients deserve. Removing the minimum standards for the transition to practice, as this bill currently does, will not solve abortion access issues, but is a threat to patient safety.”