Will physician assistants join nurse practitioners on front lines of CA abortion access efforts?

As last year’s wave of laws protecting abortion in California go into effect, nurse practitioners and other advanced practice clinicians are at the frontline of the access issue.

Jessica Dieseldorff, a nurse practitioner at Planned Parenthood Mar Monte with more than 20 years of experience, pointed out that the expansions of scope offered by Senate Bill 1375 (Atkins, 2022) are a matter of practicality.

“We are already the core workforce,” she said, “so if we’re able to offer more services, then we are able to support our patients in what they need.”

Debbie Bamberger, a nurse practitioner who worked at Planned Parenthood for over 20 years before heading to Fiji this past month to work on a UCSF research project on sexually transmitted infections, agrees.

Bamberger noted that SB 1375’s major impact was to get rid of “abortion exceptionalism,” which maintained the need for physician oversight in the practice of providing abortions, despite the fact that nurse practitioners regularly do similar procedures, such as IUD insertion, without the need for such supervision.

In addition to the expected ripple effect of SB 1375, its author Senate pro Tem Toni Atkins introduced another bill (Senate Bill 385) on February 13th to extend abortion procedure training to physician assistants.

“We are already the core workforce, so if we’re able to offer more services, then we are able to support our patients in what they need.”

Dieseldorff described SB 1375 as a “refinement” of Atkins’ 2013 measure Assembly Bill 154, and SB 385 would represent yet another refinement in the direction of more readily available care.

“Abortion is not different from other kinds of healthcare,” Dieseldorff says. “We’ve already been doing this.”

Explaining the thought process behind SB 1375, which clarifies the scope of who can do abortions, both procedural and medicinal, she says, “Medication abortion is a medication; advanced practice clinicians can give medications. This is a procedure; advanced practice clinicians can be taught to do procedures.”

Bamberger and Dieseldorff both note they were participants in the 2013 UC San Francisco study that made the case for the safety and satisfaction of patients receiving procedural abortions from nurse practitioners, certified nurse midwives, and physician assistants.

Despite AB 154 allowing them to perform procedural abortions, it took almost 10 more years to allow them to do it without oversight through SB 1375.

“First the law and the money,” said Dieseldorff, “and then the training.”

As for the money, Bamberger is hopeful that the new California Reproductive Health Service Corps (AB 1918 Petrie-Norris, 2022) will give the necessary support.

The measure aims to provide scholarships and stipends for new reproductive health students, while also offering loan repayments for reproductive health professionals who may be in debt from their education in the field. Paired with more than $20 million dollars from the state’s Clinical Infrastructure Fund that became available this year for reproductive health clinicians to apply for in the form of grants, the front-line providers of California may be closer than ever to doing their work with no obstacles.

Both women were quick to emphasize the importance of medication abortions in the issue of abortion accessibility. In the scope of practice conversation, there has never been a debate (in California) about who can prescribe such drugs.

Since 2000 when the FDA approved the use of mifepristone in medication abortions, they have been a part of Californian nurse practitioners’ scope of practice.

As of 2020, medication abortions counted for more than half of all abortions performed in the United States, per the Guttmacher Institute.

That could change dramatically pending the results of a lawsuit currently before a Texas district court. The suit, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration,  endangers the availability of one of the drugs used most commonly in medication abortions. If Judge Matthew Kacsmaryk, a 2019 Trump appointee, decrees that the FDA overstepped its authority in approving the drug mifepristone for use via a telemedicine consultation, rather than an in-person visit, it could be off shelves within weeks.

The decision is expected no later than February 24th. The Biden administration has indicated it will appeal the ruling should Kacsmaryk rule in favor of the plaintiffs.

Of the potential elimination of mifepristone through this lawsuit, Bamberger said, “Folks all over the country are getting protocols in place, though we’re not happy about it.”

Typically, mifepristone is administered along with the drug misoprostol in a medication abortion. If the case is successful, and mifepristone becomes inaccessible in the US, Bamberger says that providers will turn to misoprostol-only abortions, although they are less effective.

The historic overturn of Roe v. Wade in summer 2022 prompted concerns among many that states with freer abortion access would see a significant influx of patients traveling from out of state to receive the procedure. The reality in California has so far been slightly different.

While health centers close to major airports have been seeing some patients from out of state, Dieseldorff notes that having the time and money to travel for the procedure is a privilege, and not all people who want an abortion are able to pick up and head to California to obtain one.

If the case is successful, and mifepristone becomes inaccessible in the US, Bamberger says that providers will turn to misoprostol-only abortions, although they are less effective.

Just as much of a concern for her are the state’s “abortion deserts,” communities within California where people “further away from the coastal and urban areas have to travel farther for abortion.”

For Dieseldorff, who is currently working to train others in the procedure, the fact that many are needing to travel for a “ten-minute procedure,” whether in-state or out, while frustrating, only fuels her desire to train more people.

She said she’s driven to train other clinicians who, as she noted, are able to learn to give this care much earlier in their career than she had the opportunity for. Those she trains, she hopes, will go on to serve rural areas where there may not have been abortion providers before.

“The training is the bridge,” she said, “that makes the law become reality.”

Claire McCarville is an intern with Capitol Weekly. She is a junior at Arizona State University.