(CN) — Women won a battle over abortion rights in Montana on Friday, after the state Supreme Court upheld a lower court’s decision that a law banning advanced-practice registered nurses from performing early-stage abortions was unconstitutional.
Montana Supreme Court Judge Laurie McKinnon wrote in the court’s opinion that the “state has failed to meet its burden” showing that advanced-practice registered nurses (APRNs) providing abortion care “present a medically acknowledged, bona fide health risk. The state has failed to present any evidence that demonstrates abortions provided by APRNs include more risk than those provided by physicians and physicians assistants.”
McKinnon continued: “The district court correctly determined that no genuine dispute of material fact exists regarding the safety and efficacy of APRNs providing early abortion care.”
Plaintiffs Hellen Weems, owner of All Families Healthcare in Whitefish, and another woman identified as Jane Doe, are both APRNs. Weems did not respond to a request for comment by press time.
Medication and aspiration are the most common forms of early abortion care. The medications used are mifepristone and misoprostal. An aspiration abortion involves inserting a tube through the cervix into the uterus and using suction to remove uterine contents.
The state argued that while APRNs can perform an abortion, they are not trained to handle complications that may arise.
One of the state's experts, Dr. George Mulcaire-Jones, a family medicine and obstetrics physician in Butte, said the aspiration method involves the removal of tissue from the uterus with instruments, which can cause bleeding, cramping and possible infection. He said that there is an unacceptable risk to women when the abortions are performed without emergency backup policies, such as when APRNs perform the procedures in their offices.
Mulcaire-Jones also said that even medication abortions carry risks, including hemorrhage and bleeding, which could require surgical care beyond what a APRN could provide.
Bolstering Mulcaire-Jones’ views was Dr. Kathi Aultman, an ob-gyn licensed in Florida who serves as a fellow of the American College of Obstetrics and Gynecologists.
“Allowing less qualified practitioners to perform abortions, especially when they cannot handle the serious and life-threatening complications that can occur, creates an unacceptable risk for patients at any location, which expands exponentially in rural area without the necessary facilities and expertise to handle complications,” Aultman said.
One of the plaintiff’s experts, Dr. Suzan Goodman, disagreed.
“Legal abortion is one of the safest medical procedures in the United States. Complication rates of abortion are similar to or lower than other outpatient procedures,” Goodman, a California-licensed family medicine physician with a master's degree in public health, said.
The state Board of Medical Examiners has previously concluded that “medication and aspiration abortion procedures are not significantly different than the procedures, medications and surgeries the nurse practitioners currently perform without significant issues.”
McKinnon ultimately sided with the plaintiffs, citing the Montana Constitution's guarantee of the right of privacy to seek abortion care.
"The state argues that, while APRNs may be able to perform the abortion procedure, they are not capable or qualified to handle the 'unacceptable' risk of complications arising from an abortion. However, the same risk of complications exists in miscarriage care, which the state has not argued presents a threat to public health and safety when performed by APRNs," she wrote.
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