HOUSE OF REPRESENTATIVES

H.B. NO.

2684

THIRTIETH LEGISLATURE, 2020

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to health care.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. The legislature finds that Hawaii is facing a health care workforce crisis that has stretched providers to their limits and jeopardized access to care for many people in Hawaii. These shortages impose particularly substantial burdens on people living in rural areas, on islands other than Oahu, and in under-served communities in Hawaii who already experience significant health disparities. This shortage extends to reproductive health care, which is critical for the health and economic security of all of Hawaii's people.

The legislature further finds that a 2018 review by the National Academies of Sciences, Engineering, and Medicine concluded that advanced practice registered nurses are just as capable of providing safe and effective abortion care as physicians and surgeons, provided that the advanced practice registered nurses have received proper training. Many people routinely receive well-women care from advanced practice registered nurses who are considered primary care providers in Hawaii and are qualified to safely perform the procedure contemplated by this measure.

The legislature further finds that Hawaii has already seen the benefit of allowing qualified licensed providers, like advanced practice registered nurses, to perform a wide range of health care services. Advanced practice registered nurses in Hawaii already provide a wide range services, from administering anesthesia during surgeries to managing chronic conditions like hypertension and diabetes to providing gynecologic care and family planning services. Hawaii has consistently expanded what services advanced practice registered nurses can provide, improving access to comprehensive health care for both urban and rural people of Hawaii. Since 2009, Hawaii's legislature has passed twenty-two laws improving the scope of practice for advanced practice registered nurses. Now, advanced practice registered nurses are recognized in state policy as primary care providers. They are permitted to evaluate patients, order and interpret diagnostic tests, and prescribe treatments and medications. Qualified licensed providers in Hawaii already provide a wide range of reproductive health procedures and they provide many procedures that are similar to, or more complicated than, abortion, such as intrauterine device insertion and endometrial biopsy.

The legislature further finds that restricting qualified providers from providing abortion care confers no medical benefit and instead harms patients by limiting access to care.

This purpose of this Act is to alleviate the physician shortage and ensure equitable, timely, and safe access to abortion care by removing the physician-only requirement and allowing advanced practice registered nurses and other qualified health care providers to provide early abortion care.

SECTION 2. Chapter 457, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"457- Advanced practice registered nurses; abortion care by medication or aspiration. Notwithstanding any other law to the contrary, an advanced practice registered nurse may perform an abortion by medication or aspiration; provided that the advanced practice registered nurse:

(1) Has prescriptive authority;

(2) Practices within the nurse's practice specialty; and

(3) Has a valid, unrevoked, and unsuspended license obtained in accordance with this chapter."

SECTION 3. Section 453-16, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (a) to read:

"(a) No abortion shall be performed in this State unless:

(1) The abortion is performed by a licensed physician or surgeon, [or by] a licensed osteopathic physician and surgeon[;], an advanced practice registered nurse, or a health care provider acting within the licensed qualified health care provider's lawful scope of activity; and

(2) The abortion is performed in a hospital licensed by the department of health or operated by the federal government or an agency thereof, [or] in a clinic, or in a physician's [or], osteopathic physician's, advanced practice registered nurse's, or licensed qualified health care provider's office."

2. By amending subsections (d) and (e) to read:

"(d) Any person who knowingly violates subsection (a) shall be fined not more than $1,000 [or imprisoned not more than five years, or both].

(e) Nothing in this section shall require [any hospital or] any person to participate in an abortion nor shall [any hospital or any] that person be liable for a refusal[.]; provided that the person has given prior written notice to the appropriate and responsible hospital, firm, corporation, or association, if applicable, and the refusal does not cause a serious risk to another person's health or life."

SECTION 4. Section 457-2.7, Hawaii Revised Statutes, is amended to read as follows:

"457-2.7 Advanced practice registered nurse. (a) Practice as an advanced practice registered nurse means the scope of nursing in a category approved by the board, regardless of compensation or personal profit, and includes the registered nurse scope of practice. The scope of an advanced practice registered nurse includes but is not limited to advanced assessment; telehealth; and the diagnosis, prescription, selection, and administration of therapeutic measures including over the counter drugs, legend drugs, and controlled substances within the advanced practice registered nurse's role and specialty-appropriate education and certification.

(b) An advanced practice registered nurse may perform abortions pursuant to section 453-16; provided that nothing in this section shall be construed to expand the authorized scope of practice of any advanced practice registered nurse.

[(b)] (c) The advanced practice registered nurse's scope of practice supersedes the registered nurse's scope of practice. Advanced practice registered nurses shall practice within standards established or recognized by the board and be guided by the scope of practice authorized by this chapter, the rules of the board, and nursing standards established or recognized by the board including but not limited to:

(1) The National Council of State Boards of Nursing Model Nursing Practice Act, Article II, Scope of Nursing Practice, section 4; and

(2) The National Council of State Boards of Nursing Model Nursing Administrative Rules, Chapter Two, Standards of Nursing Practice, section 2.4.1;

provided that NCSBN shall have no legal authority over the board and shall have no legal authority or powers of oversight of the board in the exercise of its powers and duties authorized by law.

[(c)] (d) An advanced practice registered nurse shall comply with the requirements of this chapter; recognize limits of the advanced practice registered nurse's knowledge and experience and planning for the management of situations that exceed the scope of authorized practice; and consult with or refer clients to other health care providers, as appropriate."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

 

INTRODUCED BY:

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Report Title:

Nurses; Health Care Practitioner; Scope of Practice

 

Description:

Authorizes advanced practice registered nurses and other licensed qualified health care providers to perform abortions.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.