CMA both for and against expanding non-physicians’ role

CMA both for and against expanding non-physicians’ role

The California Medical Association is both for and against allowing non-physicians to expand the kind of medical procedures they are allowed to perform.

Assemblywoman Toni Atkins, D-San Diego, is pushing AB 154 to allow nurses, midwives and physician assistants to perform abortions.

Assemblywoman Toni Atkins

Assemblywoman Toni Atkins

The CMA supports the bill.

But SB 491 by Sen. Ed Hernandez, to allow nurse practitioners to practice without the supervision of a physician, is opposed by the CMA.

Meanwhile, Assemblyman Dr. Richard Pan, D-Sacramento, has another bill, AB 980, which would remove the current requirements that abortions are to be done in a medically surgical and sterile setting, with a post-abortion recovery area adequate for recovering patients, and a counseling area that is maintained and provides privacy for patients requesting it.

Thus far, the CMA has been silent on Pan’s bill.

Old arguments about abortion now ignored

Based on the flimsy claim that there is a shortage of health care professionals able to provide early abortion care in California, AB 154 and AB 980 are billed as solving this dilemma. Atkins and Pan also claim the upcoming addition of three million to seven million California residents about to receive subsidized  Obamacare  necessitates allowing para-professional medical workers performing additional medical procedures.

But as with the CMA being both for and against expanding the scope of practice of non-physicians, there’s an inconsistency here. For years, Democrats have sought abortion rights on the grounds that women needed access to doctor-performed abortions instead of illegal back-alley abortions by non-physicians.

AB 154 and AB 980 would not only remove the state’s requirement that a physician perform a surgical abortion; they would drop from state law the requirement that it be done in a medically surgical and sterile setting.

As a child of the 1960s, I’ve heard Democrats harp for decades about how dangerous back-alley abortions are, and why conditions needed to be sterile and safe and procedures done by doctors. No more, apparently.

As of 2009, there were 107 Planned Parenthood clinics around the state.  And that is just Planned Parenthood clinics; there are many clinics affiliated with Planned Parenthood, and many private doctors perform abortions. So what is really behind this claim of a shortage of abortion providers?

Abortion bill redux: the San Diego connection

Atkins’ bill is a redux of bills authored in previous years by Sen. Christine Kehoe, D-San Diego. Kehoe authored SB 1501 last year, a bill originally written about boating and waterways. But Kehoe gutted it and replaced the language with the abortion bill.

Prior to SB 1501, there was SB 1338, also by Kehoe, which would have allowed nurse practitioners, nurse midwives and physician assistants to provide first-trimester abortions. Kehoe scaled her bill down to include only 41 providers involved in a UC San Francisco pilot program throughout the state. But a Senate committee deadlocked on the vote, and the bill failed to pass.

That bill was also sponsored by Planned Parenthoood, NARAL, the California Nurses Association and the SEIU. Most of the bill’s analysis was provided by these organizations.

However, Kehoe took the language from the failed bill, then placed it in budget bill SB 623. Kehoe received much criticism for trying to cram a failed bill into a budget trailer bill without the usual  committee hearings, public notification or debate.


ex-Sen. Christine Kehoe

wrote about Kehoe’s bills last year.

From gerontology to abortion

Atkins’ bill stems from a California “pilot project” which started as a program to increase access to gerontology care in 1973 and morphed into being used to train midwives and nurses to perform surgical abortion procedures.

The abortion program was quietly concealed in the pilot gerontology program behind a phrase in the code “expanding early pregnancy care.” But since 2006, this project has been used in some cities to train nurses and medical assistants to do abortions.

And state regulations were suspended in order to allow “Nurse Midwives, Nurse Practitioners and Physician Assistants” to do these procedures, according to former Assemblywoman Linda Halderman and former Sen. Sam Aanestad. Both lawmakers looked into the pilot program while still in office, and tried to get it stopped.

Planned Parenthood claims Atkins’ bill is necessary to “integrate abortion care into current practice settings.”

Voters don’t approve

recent poll of California voters sharply rejected the idea of allowing nurse practitioners and physician assistants to conduct abortions. By an even greater margin, 76 percent to 18 percent, voters reject the notion of also giving nurse midwives the ability to provide abortions.

The poll, which surveyed 600 registered voters in April 2013, was conducted by Smith-Johnson Research of Sacramento with a sampling error of plus or minus 4 percent.  (See survey ).

The bills are scheduled for hearing in the Senate Appropriations Committee on Monday, Aug. 12.

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