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

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

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

I 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

A 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.

Three bills by Sen. Ed Hernandez, D-West Covina, who is also an optometrist, would expand the definition of the scope of practice and medical duties for optometrists, nurse practitioners and pharmacists, will be heard today at a hearing in the Assembly Business, Professions and Consumer Protection Committee.

Hernandez, who chairs the Senate Health Committee, introduced the three “scope and practice” bills earlier in the year to address the anticipated doctor shortage as Obamacare implementation takes place in California. But during committee hearings earlier in the spring, it became evident there will be a battle with physicians over this “scope of care,” and what the role of professionals versus para-professionals will be in the future.

And some are concerned with Hernandez authoring a bill from which he would personally benefit.

Ophthalmologists, optometrists and opticians all provide eye-care services, but optometrists and opticians are not physicians.

According to the Harvard Journal of Ophthalmology, an ophthalmologist is a physician (doctor of medicine, M.D., or doctor of osteopathy, D.O.) who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. An ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship and three or more years of specialized medical and surgical and refractive training and experience in eye care.

An optometrist is a health-service provider who is involved exclusively with vision problems. Optometrists are specifically educated and trained by an accredited optometry college in a four-year course but do not attend medical school.

Hernandez’s bills would allow optometrists to do many procedures currently only performed  by ophthalmologists.

Expanded coverage, but not enough care providers

“Here in the state of California, we have a capacity issue. We have a work-force shortage,” Hernandez said at a joint Senate Health Committee and Business and the Professions and Economic Development Committee hearing I attended in March. Hernandez warned the problem is already at a breaking point in California’s inner cities and rural areas. Up to 7 million uninsured Californians will be required to be insured as of next year.

“How is it that we’re going to be requiring somebody to purchase health insurance, but yet they won’t have access to a doctor?” Hernandez asked. “This is what we need to address.”

“We are working hard at the state level to ensure every Californian has access to affordable, quality health coverage, but what good is a health insurance card if you can’t get into see a health care provider when you need one?” said Hernandez. “We need to make better use of the trained health care workforce we already have if we are ever going to meet demand.”

But Senate Bill 492, which is opposed by the California Medical Association and other physician groups, would give minimally trained eye doctors the authority “to perform vaccinations and surgical and non-surgical primary care procedures,” according to Hernandez.

Donations raise conflict of interest question

“Such a major expansion in the scope of practice would financially benefit the state’s 9,000 optometrists, including Hernandez and his wife, Diane, who also is an optometrist at Hernandez Optometry,” my colleague John Hrabe wrote in June (“Sen. Hernandez authors bills to benefit his optometry practice”).

“In return, optometrists throughout the state, who under normal circumstances might be his competition, have supported Hernandez with gifts and more than $140,000 in campaign contributions.”

Hernandez’s bills are Senate Bills 491, 492 and 493. Sen. Fran Pavley, D-Agoura Hills, authored Senate Bill 352, which would expand the “scope of practice” for physician’s assistants.

Assemblyman Dr. Richard Pan, D-Sacramento, authored 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.

Taking up efforts defeated last year, Assemblywoman Toni Atkins, D-San Diego, is pushing AB 154 to allow nurses, midwives and physician assistants to perform abortions.

Last year, Sen. Christine Kehoe, D-San Diego, authored SB 1501, 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 that are 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.

By Dave Roberts

California women abort their unborn children at a significantly higher rate than the rest of the country, accounting for nearly one in five abortions in the United States. But for many Democratic politicians and abortion providers there aren’t enough abortions in the Golden State. Rather than keeping it safe, legal and rare, as the slogan goes, they are determined to expand abortion access, even if it might result in more injuries to women.

State Sen. Christine Kehoe, D-San Diego, has authored SB 1338, which expands the professions that are allowed to perform surgical abortions. Currently only licensed physicians and surgeons are allowed to do so. Anyone else would be subject to a $10,000 fine and imprisonment. SB 1338 would allow registered nurses, nurse practitioners and certified midwives who have received training by the end of the year also to perform aspiration abortions.

Aspiration is the most common type of abortion, primarily done in the first trimester, in which the baby is vacuumed out of the uterus. The technique is considered the safest abortion method — provided, of course, that you’re not the one being aborted. But it’s still an invasive procedure with sharp instruments, and complications can arise.

Those complications and whether they will increase when less skilled, less educated and less experienced people are allowed to vacuum uteruses were at the heart of the debate on SB 1338 in the Senate Business, Professions and Economic Development Committee meeting on Thursday.

“A rigorous, state-approved pilot project has demonstrated that clinicians can perform with high rates of patient safety and satisfaction,” Kehoe told the committee. “Advanced clinicians already perform surgical and non-surgical procedures: IUD insertion and removal, biopsies and some forms of insemination.”

Kehoe’s bill originally applied to all nurses, practitioners and midwives. But she watered it down to apply to those 41 people in the state who have received aspiration abortion training through a University of California, San Francisco study. It’s possible that more people could be trained, however, by the January deadline. Representatives of the California Nurses Association said there are 16,000 nurse practitioners in the state who might also want to perform abortions.

The more the better, as far as Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California, is concerned. “Over half the counties do not have  providers who will perform abortions for Medi-Cal patients,” said Kneer. “That requires women to drive long distances. We believe it’s very important that patients have access to early, safe abortion procedures. We believe that practitioners who they see for their regular routine care should also be able to offer this so they can provide continuity of care.”

Abortion study

Also leading the drumbeat for more abortions is Tracy Weitz, a UCSF associate professor in obstetrics, gynecology and reproductive science, who led the abortion study.

“We know that two things make abortion safer: making it legal, and doing it as early as possible in the pregnancy,” Weitz told the committee. “The widespread use of aspiration abortion technique as a preferred method for ending pregnancies in the first trimester is what has made abortion incredibly safe. The question of who can safely perform those procedures can now be answered by scientific evidence.”

During her four-year demonstration project, 41 clinicians performed nearly 8,000 abortions. It took about seven days and 45 abortions for each clinician to gain sufficient competency. Only 1.6 percent of the procedures resulted in complications, according to the study, with only six women requiring hospital care. All recovered “without any long-term physical harm,” Weitz said.

But the reliability of those numbers and the ethics of the study’s procedure came under assault by Assemblywoman Linda Halderman, R-Fresno, who is also a licensed surgeon. She has witnessed aspiration abortions, and said that the procedure can include the use of extremely sharp instruments in the blood-filled cervix to scrape its fetal contents.

“Incomplete abortion means that some of the fetal parts are left inside,” she said. “And that is in fact a known complication that is uncommon, but it’s reported in this procedure. However, there are additional complications that are reported. These are associated normally with surgical procedures done by board-certified obstetricians and gynecologists. The published rates (of complications) are between 3 and 5 percent. And they consist of incomplete abortions, failed abortions, hemorrhaging, excessive bleeding, anesthesia-related complications, bleeding within the uterus walls themselves, infections, cervical injury including cervical tear, and uterine injury which rarely requires hysterectomy.”

‘Disturbing’

Given all of those possibilities of something going wrong, Halderman said she found it “disturbing” that, in data published by pro-choice ob-gyn organizations, there is a 3-5 percent rate of complications when abortions are done by experienced doctors and surgeons, but Weitz’s study asserts that there was only a 1.6 percent rate of complications in abortions performed by nurses and midwives learning the procedure.

Halderman is concerned that there was not adequate follow-up about potential problems. Less than 10 percent of the women were interviewed in person after their abortion. Most interviews were done by phone or a mailed survey and some women were not contacted at all. She pointed out that the study has yet to be published in a medical journal, undergoing peer review.

“This is so outside the standard of research care that I am concerned that there may be violations here that may be of a legal magnitude,” said Halderman. “In particular, locations that were chosen for these pilot projects have substantial portions of minority women. And if the purpose is to increase access to early abortion, I don’t think the way we want to do that is to compromise women’s safety.”

Informed consent?

Halderman is also concerned that the women who participated in the study were not all provided with informed consent forms in their native languages (only English and Spanish forms were provided).

“It is for these reasons that I regretfully ask that you must vote no on this project until we have some data, until we have some proof and until we have some real answers on whether or not protocols of research were actually followed,” Halderman concluded.

Also speaking against SB 1338 was Carol Hogan, communications director for the California Catholic Conference. She said that a majority of Californians oppose allowing nurse practitioners and physician assistants to perform first trimester abortions, citing a poll of 778 people conducted in late March by Smith Johnson Research.

“The author’s rationale is to increase access to abortion, thereby increasing the actual number of abortions performed in California,” said Hogan. “For almost any medical procedure, people with either private or government health insurance have to schedule their appointments well in advance and may well have to travel some distance. Even toenail surgery or earwax removal is not available on the same day or the same week that the patient desires it. To have an abortion is a serious decision, one that ends the life of an unborn child and may change the life of the woman. Does it need to be as available as an aspirin at the corner drug store? They claim that abortions should be safe, legal and rare. This law would make abortion less safe and less rare.”

Wynette Sills, a Sacramento pro-life activist, said, “They are increasing the certification for pet groomers to ensure the health of our pets. So why would we turn around and lower the health standards of women? Women deserve better. In this pilot study with 8,000 women hurt and 8,000 human lives killed, it was found to be fairly safe for the women. Yet the intent is to expand abortion throughout the state. While it might have been found safe under rigorous research conditions, as you move away from UCSF and out into the Central and Imperial Valley, I don’t think we can ensure the same level of supervision and safety for women.”

Although the committee has a 6-3 Democrat majority, surprisingly it deadlocked 4-4 on SB 1338 with two Democrats voting against it. One of those Democrats, Juan Vargas, who represents Chula Vista, said he could not support a policy affecting women’s health based on a study that had yet to be published and peer reviewed.

Mark Wyland, R- San Juan Capistrano, agreed that the committee had insufficient information to make an informed decision on such a technical issue. “It seems to me, given what we know, that it’s a big leap to say people who have had a few days’ training and a few supervised procedures should be doing something like this,” he said. “I just think that’s an awfully big leap.”

Although the bill failed to make it out of the committee, it has not been, well, aborted. Kehoe’s representative said she plans to bring it back to the same committee on May 7 for a vote only, no testimony allowed.

By DAVE ROBERTS

Like a bad horror movie in which the monster dies only to come back from the grave, socialized medicine has once again reared its ugly head in California. Not content to wait for Obamacare to kick in, state Sen. Mark Leno, D-San Francisco, has introduced SB 810. It’s a reincarnation of SB 840, a government-run health-care bill authored by Sheila Kuehl that was vetoed in 2008 by then-Gov. Arnold Schwarzenegger.

“According to the Legislative Analyst’s Office, the bill is estimated to cost $210 billion in its first full year of implementation and cause annual shortfalls of $42 billion,” said Schwarzenegger in his veto message. “To place this in proper perspective, our state budget deficit this year started at $24.3 billion.”

The fiscal hemorrhaging from SB 810, which is likely to be looked on more favorably by Gov. Jerry Brown, could be worse, perhaps $250 billion annually, according to the bill’s analysis. Startup costs could be in the hundreds of thousands to millions of dollars. Additional costs would result from the transition to a health care system run by state bureaucrats, including the implementation of a claims payment system, electronic medical records, labor market disruptions, reduced tax revenue and job loss from insurance companies.

Where’s the money going to come from? “Since no revenue source is currently identified, it would be pressure on the state General Fund,” the analysis states. That’s the same General Fund that has been running multi-billion dollar deficits for much of the past decade and which is on track for another $9.2 billion shortfall in the next fiscal year.

“There would be ongoing General Fund pressure in the millions to billions of dollars, because this bill would provide that the General Fund would be responsible for providing loans to the Healthcare Fund in the event of a shortfall or the delayed passage of the state’s annual Budget Act,” the SB 810 analysis states. “This bill would also permit the [health] Commissioner to use reserves and to borrow funds in such a situation and to take cost control measures.”

It would likely result in tax increases. The funding mechanism for Kuehl’s bill would have imposed a 12 percent tax on employers and employees along with another 11.5 percent in unspecified taxes.

Bureaucracy

If you thought the health care system was already bureaucratic, convoluted and confusing, wait until Sacramento takes over. A California Healthcare Agency would be formed along with the Healthcare Policy Board, the Office of Patient Advocacy, the Office of Health Planning, the Office of Health Care Quality, the Healthcare Fund, the Public Advisory Committee, the Payments Board, and the Partnerships for Health.

Few would argue that the current system is not in need of improvement.

Leno pointed out at the Jan. 17 Senate Appropriations Committee meeting that health care premiums have risen five times faster than the inflation rate since 2002. As a result, more employers are cutting back or dropping employee coverage. Employees are picking up more of the costs of premiums along with higher deductibles and co-pays. In the past year, 12 million Californians went without health insurance.

In 1960, the United States spent 5 percent of its gross domestic product on health care. That increased to 11 percent by 2000. Not it’s 17.6 percent of GDP, according to Leno. Without significant reform, the projections are that by 2015 we will be spending 20 percent of GDP on health care. Next: 25 percent by 2025 and 50 percent by 2060.

Leno said the World Health Organization ranks the United States 37th among nations in health care, despite Americans paying twice per capita than higher-rated countries with government-run health care. “So there is money in the system,” he said. “It’s just being wasted on both administrative and clinical waste. That’s what we’re purchasing: bureaucracy and waste instead of health care provision.”

He said costs can be cut through bulk purchasing of medicine and medical equipment. And he dismisses the concern about the impact on the General Fund budget, saying, “This is not a new $200 billion cost to the state of California. It’s the current $200 billion we are spending inefficiently on health care put into a new health plan that will be much more efficient, create greater results, keep Californians healthier and saving us billions of dollars.”

Leftist Support

California’s leftist organizations turned out in such large numbers that it took 17 minutes for all of them to come to the microphone and state their names and affiliations. In comparison, the opposition to the government takeover of a $200 billion industry was paltry.

Mark Burgat, representing the California Chamber of Commerce, said the Chamber disagrees that government systems are more efficient than private businesses, and that a single-payer system would be less costly than the current private system. But he provided no facts to back that up. He also warned about deficits in the tens of billions of dollars annually.

But he said the chamber supports Obamacare: “We believe the federal program is a program that is workable and we are working towards that end. We think that the state and the businesses in the state should focus on that. Trying to implement a California-only one-payer system is simply counter-productive.”

Also supporting Obamacare while opposing Lenocare is Nick Louizos, representing the California Association of Health Plans, who said, “Our industry is appropriately focused on implementing this [Obamacare] law and making it work. We believe the debate around SB 810 is counter-productive to those efforts. And, whether or not the funding is addressed in this bill or some future legislation, the cost of single-payer, as mentioned previously, is massive.”

Small Businesses Snuffed Out

The strongest argument against SB 810 was made by Ken DeVore, representing the National Federation of Independent Business.

“Right now small businesses in California are just struggling to survive,” he said. “Many of them can’t afford health care insurance for themselves, let alone for their employees. This could be the last thing that would drive them out of business, out of state. A study [on Kuehl’s bill] said that it would cost nearly a quarter million jobs in California if it was implemented with the imposition of all of these new costs on businesses. With 2.2 million unemployed in California right now, we just can’t afford something like this at this point in time with an economy that is still faltering.”

Several committee members spoke in favor of the bill; none spoke against it. But due to the need to further analyze the cost impacts on the General Fund, Chairwoman Christine Kehoe, D-San Diego, ushered it into the suspense file with an agreement to vote on the bill today (Thursday, Jan. 19).

Like its predecessor, SB 810 is likely to pass the Legislature and reach the governor’s desk. Leno is optimistic that Brown will sign it, noting that the governor pushed a government-run health plan when he ran for president in 1992. “In the brief conversations I had with him when he was a candidate [for governor in 2010], he does want to sit down, look at the numbers and understand it more clearly that it is, of course, affordable for California,” said Leno.