HOUSE OF REPRESENTATIVES
THIRTY-FIRST LEGISLATURE, 2021
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 has many qualified licensed health care providers, including physician assistants and advanced practice registered nurses, who can safely and effectively provide abortion care. However, the legislature also finds that Hawaii's current laws restrict any health care provider other than physicians from providing aspiration abortion care. Consequently, numerous Hawaii residents live on an island without, or with limited access to, an abortion care provider.
The legislature further finds that the health and economic security of Hawaii's residents is suffering due to various issues caused by the State's abortion provider shortage, including unnecessary travel, long wait times, high costs, and delays to time-sensitive care. In addition, residents on Kauai, Molokai, Lanai, and the west side of the island of Hawaii do not have access to local physicians who can provide abortion care. These residents are therefore forced to travel long distances to access care, increasing costs for travel, lodging, and childcare. Travel to reach care is an insurmountable barrier for people who already face systemic barriers to health care, including people with low incomes, young people, survivors of intimate partner violence, and people in rural communities. The coronavirus disease 2019 (COVID-19) pandemic has highlighted the existing challenges of the abortion provider shortage and exacerbated current barriers to care, including making travel to access abortion care exceedingly difficult and potentially risking viral spread of COVID-19.
The legislature also finds that physician assistants and advanced practice registered nurses can safely and effectively provide aspiration abortion care. Studies have found no difference in abortion safety when performed by qualified licensed health care providers other than physicians. Further, numerous health care and professional organizations, including the National Academies of Sciences, Engineering, and Medicine, agree that restricting qualified licensed health care providers from providing aspiration abortion care confers no medical benefit and instead harms patients by limiting access to care.
To improve equitable access to health care, the legislature concludes that allowing qualified licensed health care providers to provide aspiration abortion care would allow residents to stay in the residents' respective communities and safely receive high-quality care with fewer financial and logistical barriers.
Accordingly, the purpose of this Act is to lift the burdensome and medically unnecessary physician-only restriction on performing certain abortion care procedures to ensure that all people in Hawaii can equally access abortion care, no matter their income or where they live, by authorizing licensed physician assistants and advanced practice registered nurses to perform aspiration abortions.
SECTION 2. Chapter 453, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows:
"§453- Qualified health care providers; intentional termination of pregnancy. Notwithstanding any other law to the contrary, a qualified health care provider may provide aspiration abortion care; provided that the qualified health care provider:
(1) Has prescriptive authority;
(2) Practices within the qualified health care provider's respective scope of practice; and
(3) Has an unencumbered license obtained in accordance with this chapter or chapter 457, as applicable.
As used in this section, "qualified health care provider" means a physician assistant licensed under this chapter or an advanced practice registered nurse licensed under chapter 457."
SECTION 3. Section 453-16, Hawaii Revised Statutes, is amended by amending subsection (a) to read:
"(a) No abortion shall be
performed in this State unless[
:] 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 physician's or osteopathic
physician's office and the abortion is:
abortion is performed] Performed by a licensed physician or surgeon,
or by a licensed osteopathic physician and surgeon; [ and] or
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
physician's or osteopathic physician's office.] An aspiration abortion performed
by a licensed physician assistant, or a licensed advanced practice registered nurse
in compliance with section 453- ."
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 shall be authorized to provide abortion care pursuant to sections 453-16 and 453- .
(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
(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
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect on July 1, 2060.
Aspiration Abortions; Physician Assistants; Advanced Practice Registered Nurses; Scope of Practice
Authorizes licensed physician assistants and advanced practice registered nurses to perform aspiration abortions. Effective 7/1/2060. (HD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.