The Assembly gave final approval last week to a bill designed to allow certain mid-level providers to perform aspiration abortions in the first trimester when supervised by a physician.
Approval of the bill was linked by one Republican legislator to rejection of a different measure to expand mid-level practitioners' role in a more general clinical setting.
An Assembly floor vote concurred amendments and approved AB 154 by Assembly member Toni Atkins (D-San Diego) on Friday. The bill already passed Assembly and Senate votes, and now heads to the governor's desk.
"This bill reaffirms California's status as a leader in women's reproductive health -- for all women, regardless of where they reside," Atkins said.
The bill expanding the role of nurse practitioners, nurse midwives and physician assistants is intended to ease some of the demand on physicians that is expected to increase under health care reform.
"Almost half of our counties now don't have an accessible abortion provider," said Assembly member Bonnie Lowenthal (D-Long Beach). "By expanding the number of health care professionals who provide these services, we can expand access to care."
Last week, another bill designed to expand access to care was held in committee. SB 491 by Sen. Ed Hernandez would have expanded independence of practice for nurse practitioners, nurse midwives and physician assistants.
Assembly member Tim Donnelly (R-Twin Peaks) said lawmakers had to make a choice between the two bills and that voting for AB 154 could have a detrimental impact on the fate of the more-general expansion under SB 491.
"One of the unintended consequences of this bill, which expands the right to perform an abortion to nurse practitioners, is that it may be the death knell for another bill that actually is something I could have supported, SB 491," Donnelly said.
"Now [passage of AB 154] is going to impact our ability for us to expand the number of health care providers," Donnelly said. "Because I refuse to vote for any bill that will expand the number of nurse practitioners if those nurse practitioners are now going to be performing abortions."
Assembly member Kristin Olsen (R-Modesto) took a different tack, saying that the real issue was the health of women.
"I believe this is an ill-advised proposal that will actually lower the standard of care for women," Olsen said. "For women like all of us women who serve here in the Legislature. There's no question performing an abortion can produce a host of complications for women, hemorrhaging, uterine perforation and damage to pelvic organs. No matter where you stand on the issue of abortion, all of us should be concerned about the practical effects of allowing non-doctors to perform the procedure."
"Why are we allowing this to be performed by anyone other than a surgeon?" asked Assembly member Shannon Grove (R-Bakersfield). "This bill would portray to take it right back to the back alleys."
That drew a sharp response from Assembly member Holly Mitchell (D-Los Angeles.
"It's not my understanding or experience that [mid-level practitioners] are conducting their work in back alleys," Mitchell said. "They are trained health professionals. To suggest that nurse practitioners are inadequate, that they aren't trained to perform a very routine medical procedure, a serious but routine procedure, is irresponsible."
Assembly member Richard Pan (D-Sacramento) said the bill is important, given the looming expected shortage of physicians in California when health coverage expansion begins.
"These procedures need to be performed under the supervision of a physician, it's something they work together on," Pan said. "To me, this assures me this procedure's going to be safely done, and that we can address the access issues we know we're going to be confronting."
Bill author Atkins added that the bill was supported by the California Medical Association. "This is not a bill that lowers standard of care for women," she said. "We are expanding access."
The bill passed on a 49-25 floor vote and now goes to Gov. Jerry Brown (D).