Senate Standing Committee on Business, Professions and Economic Development

We don't quite have a quorum, so I think we can start as a Subcommittee, but I would like to just do a call out really quick to my colleagues who are on Senate BPED. This is going to be quick, so please hustle down here if you can, and then I think we will just go to presenting this.

If my Vice Chair wouldn't mind helping me out.

Madam Chair, please proceed. We are looking at SB 233, the only item on the agenda.

Thank you so much. I'm going to make this as quick as we can, and I appreciate both of you for being here with me. SB 233 temporarily allows Arizona doctors to provide abortion care to Arizona patients in California. It sunsets in November of 2024 on the 30th. On June 6th, 2024, Arizona will face a total abortion ban.

It's a new law for them. Triggers two to five-year state prison sentence for doctors who provide care. Lack of access to safe, effective doctor-provided abortion means extremely dangerous conditions for pregnant individuals who seek to do this on their own.

Studies say an abortion ban within the U.S. would lead to a 21% increase in pregnancy-related deaths, a 33% increase in pregnancy-related deaths among Black women. And also, one in five abortion patients nationwide traveled out of state to obtain abortion care in the first six months of 2023.

To practice, Arizona doctor must, among other things, hold and verify that they have a medical license in good standing from Arizona and must have performed at least one abortion under their Arizona license within the last two years. California will not post information on its website regarding these physicians' insertions from identity protection purposes.

Arizona has repealed their 1864 law, but the repeal doesn't become effective until late October or early November at the earliest, which leaves a window of care that this Bill would then cover, providing Arizona doctors the ability to determine how best to meet the needs of their patients.

I will ask for an aye vote at the appropriate time from my colleagues.

Thank you, Madam Chair, is there any sponsors or lead witnesses in support of this Bill? Please come forward.

I think testifying in support of the Bill today is Planned Parenthood. Yeah, come on up. Hi, Symphoni.

And we'll allow each speaker two witnesses two minutes.

Thank you. Good afternoon. Good afternoon, Chair and Members of the Senate Business and Professions and Economic Development Committee, my name is Symphoni Barbee with Planned Parenthood Affiliates of California, representing the seven Planned Parenthood affiliates in the state who provide care through over 100 health centers, and we are proud supporters of Senate Bill 233.

The overturning of Roe v. Wade has caused a wave of confusion across the country, making it unclear whether there is access to abortion or not in certain states. A near-total ban happening in our neighboring State of Arizona will only add to that confusion.

On April 9th, the Arizona Supreme Court issued a decision that would allow a Civil War-era ban on abortion to go into effect as soon as next month. Last week, the Arizona Attorney General announced efforts to delay enforcement, and Arizona's Governor signed a bill into law to repeal the ban.

As a result, it is unclear when the 1864 Ban could go into effect and for how long. Since Dobbs, abortion bans have been enacted restricting abortion in 21 states, including Arizona. These bans are cruel and endanger the health of pregnant people and exacerbate existing barriers to care.

SB 233 reaffirms California's commitment as a reproductive freedom state and makes sure our neighbors know that abortion is still legal and accessible in California, regardless of where they may travel from. We appreciate the Legislature and the historic investments that have been made so that Planned Parenthood has the capacity to treat all patients who need care.

However, as the national landscape changes, we also appreciate any additional tools. We are grateful to be in a state that is committed to protecting access to abortion, and we stand ready to serve all patients.

I want to thank Senator Skinner, the majority leader and chair for the work on this Bill, and as members of the Future of Abortion Council, PPAC respectfully urges your aye vote today. Thank you.

Thank you. This time, if there's any witnesses who would like to support, please come forward. Please state your name, organization.

Good afternoon. Vrinda Vutkri on behalf of Governor, Lieutenant Governor Eleni Kounalakis, as a proud co-sponsor, in support. Thank you.

Thank you. Seeing there's no other. At this time, we'll ask for lead witness in opposition. Seeing none. We're then going to see if anybody would like to come up and just oppose the Bill. Seeing none. Bring it back to, oh, I'm sorry.

Mike Murray, on behalf of the American Council in opposition of the Bill. Thank you.

Thank you. This time we will bring it back to my colleagues. Please.

I need some clarification.

Sure.

So, you stated some of the dates the Supreme Court upheld the 1864 law, which, frankly, I don't think they really had a choice on that. The Legislature had to act otherwise, which they have, and it's not, I agree.

It's not clear when that law will take effect because it is 90 days after they conclude their session, and you don't know when that'll be, but it's somewhere around the end of July.

So, that means that the law will take effect probably the end of October or so. Coincident with that, a court has stayed the decision enabling the original statute until September 26. That's about a four-week window, right?

Yeah, potentially eight if they end a little later than usual and go into November. So, yeah, you're really talking about providing a very short window. I mean, at the root of your question is Arizona has tried to solve this themselves, and they're really close to having a solution that covers all of their bases. But there's a four to eight-week window that is not covered.

But they've eliminated it because the Governor has taken away from any county attorney's any ability to prosecute under the law and has made it the exclusive jurisdiction of the Attorney General, who in turn has said that they will not enforce it.

That's true, but it's still a law on the books.

Window where it's not going to be enforced anyway. And then additionally, because of acts of this Legislature, if I understand the acts correctly, the services would be available in California to patients from Arizona just like any other state.

You want me to answer a couple of those questions? So, first of all, yes, California is a state that people travel to, not just Arizona when they need some help. The uniqueness of this particular Bill is actually how precise it is because it doesn't rely on California doctors to have an additional caseload.

It allows a person from Arizona to bring their own doctor with them. That would not be the case absent this Bill. So, if we didn't do this at all, could people from Arizona still come here in that eight-week window? Yes. Could their doctor? No. So that's the nuanced difference. The other piece about you saying they've solved it themselves. I know you know this, but yes, it is a law on the books that all the entities in place are saying they won't enforce, but it is still a law on the books.

And as you know, professionals, particularly doctors, are under a particular oath, and some of them may find it hard to go against that oath during that eight-week period. This just gives them another option in California where they wouldn't be violating any law even if they knew to do so in Arizona, meant they wouldn't likely see prosecution.

This would be a way for them to do it without just relying on the word of somebody saying that they wouldn't use the law currently in place. So, I think that that's the nuance difference.

So, in terms of violating the law, unless they're licensed in California, they'll be violating California law. So, the Medical Board, the Osteopathic Medical Board, those boards will have to make allowances for these practitioners to practice in California legally under California law. Two questions on that.

How long is that going to take to work out those, the details of those regulations? And there are lots of questions that go behind that relative to liability, insurability, etcetera. And the other broader question is, if we're willing to do it here, why don't we do it with a lot of other, many other practices also to allow, if out-of-state doctors, accountants, lawyers, etcetera, are competent to practice in California, why don't we open it up?

Well, we have, that's what this Committee routinely looks at. And there are many examples over the years of times that B and P has done something like this, a streamlined process to encourage people to come to the State of California because we had a shortage. Nurses is an example, teachers is an example.

And as you know, just even in the last year that we've been here reviewing bills in B and P, there have been other suggestions of groups that we might need to streamline their ability to come into California. And I can assure you that when the Assembly bills leave their house of origin and come over here, we will again be looking at some suggestions of groups that maybe we would streamline ways in.

What I think is unique about this Bill and the reason why it had the support of the California Medical Association as early as the kickoff that some of us were at with the Women's Caucus is because it is a defined period of time for a defined purpose, and it doesn't add to the caseload of doctors here, nor does it take away from the patients here.

Rather, what it does is allow doctors from Arizona to come with their patient and give them some privileges in a facility that would allow them the opportunity to do this one procedure during this very short window of time.

Have the Medical Board or the osteopathic medical board give, given any indication of how long it will take them to come up with the background allowances that they have to for appropriate licensure.

Well, actually doing this allows the Arizona license to then be valid here in California for that very short window period of time. And I think you heard probably in some of my comments that there are a couple of additional factors on this Bill. For example, they have to have performed that particular procedure in the last two years in Arizona. So, it doesn't open a floodgate to any kind of doctor coming into California for any particular reason. It had to be for that particular purpose.

So the legislation provides a blanket authorization.

It provides an opportunity that is surgical in nature for this one particular kind of healthcare for women for a very small period of time to assist our neighbors in Arizona with a continuum of care.

Without any review by the regulatory authority.

I suppose we're relying on Arizona's regulating authority for doctors for that window. Yes.

Thank you. Any other Members? Senator Archuleta.

I hope that it would provide the opportunity that, God forbid, something goes wrong, that the doctor right there, right there, can go ahead and go on to do something else to save the patient, take care of it right then and there, and you're not playing somebody tap you in the shoulder and this, that, and the other, that they can continue to serve and represent and take care of that patient and whatever's happening and whatever procedure is taking place at that moment in time.

Of course, anything that would happen as a result of that particular procedure would be under the care of that doctor and I'm sure would not be new to any of those physicians.

And again, the care of the patient is ultimate. And so I'm just hoping that it's not misinterpreted that somebody tapped you on the shoulder, as I said, and you have to walk away and someone else comes in because there's a kidney failure taking place or some other problem that that physician just, you know, needs to stay on the spot and take care of it.

I would potentially argue that there's actually. This is actually a better shot for them to not be interrupted because they would have left their home state of practice to come here for the sole purpose of one patient, for one procedure. And I assume when they're done with that procedure, they're going to head on home or else have a very lengthy eight-week career in California. Yeah.

And they don't have to be licensed in California, just Arizona.

Well, they become licensed for this very short period of time in California by virtue of their good standing in Arizona.

Okay. Thank you.

Thank you, Madam Chair, and thank you for bringing this Bill forward. And it's a shame that we're here today. You think about this law, and you think about 1864. I mean, we still have slaves in this country. We are going way, way back on so many rights that we are continuing to have to fight for in the 21st century. It is just shameful.

But one of the questions I had about the Bill, and it came up when we first started learning about this Bill is how will we ensure that women of color, particularly Black and brown, poor women in the State of Arizona, will know that this is even possible and available to them?

We know how access to care is difficult, even in parts of our own state, South Central being one of those. How do you actually get access to care? And how do physicians, you know, share this information with the communities that they serve? I'd like to understand a little bit more about that.

You want Planned Parenthood to answer that question?

That would be great.

Thank you, Senator, for that question. Planned Parenthood has been very firm in our commitment to treating patients from anywhere in the country, whether they come from Arizona or from Wisconsin, anywhere.

And in the efforts that we took, the Legislature took in 2022, just since the fall of Roe, we've made it very clear that we are here, and that California is a reproductive freedom state. That also happened with the Governor's declaration of California being a reproductive freedom state that was spread far and wide.

And so, at least from the purview of Planned Parenthood Affiliates of California, we've made it very clear that we are here and ready to serve and that this state is a reproductive freedom state, and that you will be protected legally here in this state if you need that care. So that's my answer for you. Thank you for that question.

No, I appreciate it. And I hope that in Arizona, we have to have, in some ways, we used to call them the underground networks, right? So that those women in that state know that their physician or some physician will be able to help them. When you're poor, you don't have the same access that's afforded to other folks.

So, just getting to California, making sure you're a physician, you have a physician who can inform you that they are going to be practicing in California and creating a way in which that information gets to our most vulnerable populations.

And we know Arizona has a lot of them, so that they have full access to the care that's potentially available to them even here in the State of California. What I would hate to see is that only wealthy White women from Arizona have a position that's practicing in California.

How do physicians who are serving underserved communities in Arizona, how do those potential patients have access to that information?

And Jodi Hicks did speak to this a little bit at the press conference. She talked about the network that Symphoni is also mentioning that Planned Parenthood has with the clinics, particularly the clinics in Arizona, many of which already have reciprocal relationships and partnerships with doctors in California.

And I believe this will be the word-of-mouth piece that you're looking for, I think will flow through those clinic providers and through Planned Parenthood.

Thank you. Thank you so much. I know about the Planned Parenthood network, and I'm so glad that you all are lifting this up and helping to protect those women wherever they are.

I don't see any other questions. I just want to follow up on a couple questions.

Sure.

One is with Senator Archuleta's comment, because you made a mention, Madam Chair, to Senator Niello, that this is a very specific procedure.

They're here not to do anything else but that what if, and he mentioned, I just want to get a clarification, what if during that procedure something happens, right?

Right.

Kidney failures, loss of blood, whatever. So first question is, can they perform life-saving because it's outside that procedure? Second, if the patient needs to be transported to the hospital, how does the hospital go about accepting that doctor to come in and continue that?

That's a great question. That's the import of the Bill, because the Bill giving licensure acceptability to the Arizona Doctor gives them the permissions they need to then take that patient to the hospital and stay with them and continue to provide that care. Anything that would happen to a patient in the process of a procedure would, of course, be handled by that doctor.

I think your question is if something else happened in the middle of the procedure and suddenly we're in an emergency situation and we need something far more intensive, could that doctor stay to the extent that that doctor is comfortable performing those additional duties? The answer is yes, because they would, they would be a doctor fully fledged in California.

It's just that you're not going to see somebody who is here for heart surgery using this because that heart surgeon would have had to have performed an abortion in the last two years in Arizona to qualify for this reciprocal agreement to practice in California.

So, yes, if the person, if the doctor came with the patient and was performing this form of health care to the woman, and the woman for some reason started to have a problem, that doctor would be able to see it all the way through and would have is a fully-fledged doctor by our California standards for that period of time, but would also have the supports of these facilities when we're not talking about back rooms somewhere.

That's the whole point. That's what we don't want to have happen. We think if we don't do this, there will be people. Eight weeks seems like a really short window, but I've had three kids and eight weeks in a pregnancy is a pretty substantial period of time. And the first eight weeks of a pregnancy, it's ironic that that's the amount because that's a really critical period of time in a pregnancy.

So, we don't want to close that window for those eight weeks because doing so, as I think Senator Smallwood-Cuevas is pointing out eloquently for a lot of women, would prevent them from ever being able to have the opportunity for the care that they need. Eight weeks is substantial.

So that's why the author of this Bill, Senator Skinner, wants to see it through all the way through, because we want to provide for the women in Arizona healthcare standards that are closer to 2024 than 1864.

I'm going to ask one more question. Malpractice. I mean, do they carry their insurance over? How does that work? And second part to that is, or to the first part, another question is the hospital, how does the hospital know that this doctor is qualified, etcetera?

I mean, I'm assuming when doctors come in they're, they have a list and we know who they are and the hospital is comfortable with it. I just want to make sure that the process is.

Yeah. In order to be a medical professional doing this type of procedure in Arizona, you'd already have to have that insurance. It would follow you. Since you're talking about their own patient from Arizona, it's not a California patient, that's going to follow them, too. The only thing that might change would be jurisdiction, which is the whole point.

Thank you.

Yeah.

Sure. Senator Archuleta.

In reference to my colleague's question about finances, the patient is not going to be burdened with any financial headaches after this is over because I'm assuming there was some arrangement from Arizona that it would be paid. And this way it's open to everybody. I mean, that's the whole idea. Who's finally paying for the procedure? Arizona?

This Bill does not include a fiduciary component. This is just a licensure component. As I think Senator Niello and Senator Nguyen have pointed out, California has already taken several positions in previous bills that do provide some assistance to folks that need to come here and need help. Planned Parenthood is also the champion for those resources.

But Senator Smallwood-Cuevas' point is that there are some people who would be able to afford an airline ticket and to pay for their doctor to come out here, and there are some people who wouldn't. This Bill does not address that. But what does address that is exactly what she's saying.

The clinical friends and reciprocity that exists between the clinics and Planned Parenthoods. So, they would be working that piece out. So to her point, her point is we want to make sure they know that this is possible and available for people who are receiving their services and care in those clinics and that they have the resources they need to come here as well.

This Bill doesn't address that, but it creates the necessary component for licensure to then enable folks to use some of the other resources that can.

My concern was that the patient wouldn't be burdened with expenses that they weren't prepared for.

They might be, but this Bill wouldn't create those expenses any different than would be necessary for them somewhere else. This Bill doesn't address the financial components.

That's where the equality is, is what I'm looking for.

Right.

Thank you.

Yep.

Colleagues, any other questions? At this time, Madam Chair, I'm going to pause so we can establish a quorum. Madam Secretary, please.

[Roll call]

Thank you. At this time, would you like to close? Actually, is there a motion? There is a motion. Would you like to close?

Sure. Just very briefly, say that I'm extremely proud today to stand in front of you as a member of the Women's Caucus and honored to even try to fill the shoes of Senator Skinner and ask for your aye vote.

Thank you. There's a. The Bill has been moved by Senator Smallwood-Cuevas. This motion is that the Assembly amendments be concurred in. Please call for the vote.

[Roll call]

We'll keep the roll call open for other Members. Thank you.

Thank you.

All right, let's call the roll one more time.

SB 233 motion is that the assembly amendments be concurred in. Current vote is, eight to three. [Roll call]

All right, that's it. So the Bill is nine to three. That's out and headed to. Where are we going? Senate Floor? All right, we will see this Bill next on the Senate Floor. Thank you, everyone. This meeting is adjourned.