[{"_1":2,"_87":-5,"_88":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6578002,"mediaKeyId","3082055-733c38e42498372c23b357d179b342bf","parentId",3082055,"title","Expert: Trained advanced practice clinicians can safely provide medication and aspiration abortions, witness says","audioSeconds",5318,"startMs",2762000,"endMs",8080000,"viewUrl","/Search/View?dp=1&key=3082055-733c38e42498372c23b357d179b342bf&start=2762&end=8080","thumbnailUrl","https://assets.pipeline.soar.com/3082055-733c38e42498372c23b357d179b342bf/thumbnail_2762000.jpg","articleUrl","/articles/6578002/Michigan/Expert-Trained-advanced-practice-clinicians-can-safely-provide-medication-and-aspiration-abortions-witness-says","mediaUrl","https://secure.pipeline.soar.com/6578002-02cb237f1d59ca638dbb63480fd9ac46/orig.mp4?Expires=1770826846&Signature=ogeIv2bkJY2oq8IMYohsf80xO4kXPrbP~WHoPgc7rzPp73Aw6lnRgnFLLhyNeiGCbqaPmmkI-9TS8iShuxEO4Wulj-xSS~2tJZIQEsUlXqU5ioSBXzCfU7pAI0QW5DyqifAE9sV6xShyW94j~kU-RwQfsXdoJC6ZHFH1k96h71tvsQbTmc4XDZ908kKk7OvFs6t4nVI5xnst13rfv3MC6C1bHzMRIpwd2MLbUfkQlYER5VL2LV33pUddyryDefBuSlpWOMdlMMLw1sMSY1NL7QdCAy9vZml2R78HXm2b5XNQ3xqIoePb~Npb1~uCjB2Z17gSNe44TVlbScYvVvPqsA__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-04-22T17:46:17.81Z","article","Amy Levi, a licensed nurse-midwife and consultant for the New Mexico Department of Health, told a Michigan court on Feb. 14 that trained advanced practice clinicians — nurse practitioners, certified nurse midwives and physician assistants — can provide medication and aspiration abortions with safety outcomes similar to physicians when they have competency-based training and appropriate credentialing.

Levi testified that “APCs provide miscarriage management, and the, ability to manage a miscarriage is very much like the ability to manage a first trimester abortion, whether with medication or aspiration.” Her direct testimony cited a multi-site California training program and peer-reviewed articles comparing outcomes for APCs and physicians.

The testimony was offered during a bench trial over Michigan’s physician-only law and related informed-consent and waiting-period requirements. Plaintiffs’ counsel called Levi as an expert on workforce, training and clinical competency for APCs. Intervening defendants and the attorney for Michigan’s licensing agency questioned how training, licensure and scope-of-practice rules would apply in Michigan.

Levi described the California Health Workforce Pilot Project (HWPP), which trained APCs to perform aspiration abortions. “It showed that there was no difference between the outcomes of certified nurse midwives, nurse practitioners, and PAs, and physicians,” she testified about the published evaluation.

She outlined standard professional and state licensure safeguards that, in her view, make APC provision of abortion care appropriate where permitted: graduation from accredited programs, successful national certification exams, and credentialing and scope-of-practice oversight at the employer level. On Michigan-specific licensing she said: “If Michigan’s statute did not exist, is it correct that APCs would still need to possess the necessary competency and skill in order to perform the type of abortion care that you have testified about today.” She answered, “Yes.”

On how APCs acquire procedural competence, Levi described a mix of didactic education, simulation-based skills practice and supervised clinical procedures. She testified that some APC postgraduate programs now run two- to three‑year curricula (master’s or DNP) and that, for certain procedural skills, on‑the‑job training and minimum procedural volumes are necessary. She told the court that the California pilot required trainees to perform a minimum procedural number (cited in testimony as about 40 procedures) to develop “muscle memory” before independent practice.

Levi also testified about the existing regulatory landscape. She said certified nurse midwives and nurse practitioners are licensed by the state and that physician assistants practice under physician supervision in Michigan. She noted national and state-level boards (for example, the Accreditation Commission for Midwifery Education and the American Midwifery Certification Board) define education and certification requirements.

Attorneys for the intervening defendants and for the Michigan Department of Licensing and Regulatory Affairs pressed Levi on the limits of state licensure and professional discipline. Levi agreed that practicing outside one’s competency or beyond a license could subject a clinician to discipline: “If any clinician of any kind practices outside of their competency or outside of what they're licensed to do, then they can be subject to, professional discipline,” she testified.

Levi also gave contemporaneous counts of state practice rules she had reviewed: she testified that 22 states allow APCs to provide medication abortion and that 20 states allow aspiration abortions by APCs. She added that training requirements and supervisory arrangements vary by state and that where states grant independent practice authority APCs providing later procedures generally train to competency before practice.

Courtroom questioning also addressed how statutory physician-only rules interact with licensing and credentialing. Christopher Braverman, counsel for Marlon Brown of the Michigan Department of Licensing and Regulatory Affairs, emphasized that all licensed health professionals must follow Michigan’s licensing rules and that licensing discipline is available where clinicians exceed permitted practice.

The trial record includes Levi’s descriptions of the HWPP and peer-reviewed publications she helped author or consulted for, and her testimony that both professional credentialing and employer-based credentialing are the mechanisms through which competency is determined and enforced.

Levi was cross-examined on details of the pilot project’s design and on whether all training pathways are equally available across states; she acknowledged variation across education programs and that clinical training availability is not universal. Her testimony concluded with an acknowledgment that whether APCs provide abortion care in Michigan depends on state law and on clinicians’ demonstrated competency and credentialing.

The bench trial continues; Levi was excused after cross-examination and other witnesses were scheduled by agreement of counsel.

","mediaType","Video","parentTitle","Court of Claims 24-00001MM Northland Family Planning Center v Nessel","oneSentenceSummary","Amy Levi, a licensed nurse-midwife and consultant for the New Mexico Department of Health, told a Michigan court on Feb. 14 that trained advanced practice clinicians can provide medication and aspiration abortions with safety outcomes similar to physicians when they have competency-based training and appropriate credentialing.","taxTitle","Supreme Court Judicial Rulings ( Opinions ), Judicial, Michigan","taxId",74552,"location","Michigan","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6577998,"Research witness: mandatory waiting, disclosure requirements offer no mental-health benefit and can harm patients, expert testifies",6368,3604000,9972000,"/Search/View?dp=1&key=3082055-733c38e42498372c23b357d179b342bf&start=3604&end=9972","https://assets.pipeline.soar.com/3082055-733c38e42498372c23b357d179b342bf/thumbnail_3604000.jpg","/articles/6577998/Michigan/Research-witness-mandatory-waiting-disclosure-requirements-offer-no-mental-health-benefit-and-can-harm-patients-expert-testifies","https://secure.pipeline.soar.com/6577998-e40e253f74156cb80d64f53ed85cb62e/orig.mp4?Expires=1770826846&Signature=RDvcrE4UZUtK600TwkkgA8ETkQXehyRw~OOknTvvqBKS-01jn~592pg~cBAY6N30sewxPvmUtpT3yJ2lAobMMBp2tuEIYDHX-fW~aZK1l6Edy0iqHMwuW6DQlck~KRsQHflklrIyqFTrqA23thQoP-Mcb14AMsX4yG1Bnv7PB5kIfQw5rlSETVp4uBNun8dIQumfKiaSEbmD4PM3qlbk~A4WstdHwy3mrmyMUvBVz2iacBk3wVZ4ZmvRw0nroruUwqR7x9WIALoF4qKyeX8e2xD5gDyloZcT4klKsg3K-OE1NDWEjcBng07wA9SaXqgUsNqCrB3VU-eOzAGB4zFFVA__&Key-Pair-Id=KUT5TJCACFTXG","Antonia (Maria) Biggs, a professor at the University of California, San Francisco and acting director of ANSIRH (Advancing New Standards in Reproductive Health), testified at a Michigan bench trial that the best available research does not show that abortion causes long-term mental-health problems and that state-mandated waiting-period and disclosure requirements do not improve decision-making.

Biggs described the Turnaway Study, a prospective, longitudinal study that recruited people seeking abortion at 30 U.S. facilities and followed them for five years. “We recruited APCs… 956 women were recruited, so nearly a thousand,” she said in direct examination, summarizing the study design and sample size. Using repeated interviews every six months, the Turnaway Study compared people who obtained abortions to those denied abortions because they were past a facility’s gestational limit.

Biggs told the court she and other reviewers found the principal mental‑health result to be that people who were denied wanted abortions fared worse in several domains than people who obtained care. “It was not the abortion. It wasn't the people who had an abortion who were worse off from a mental health perspective. It was people who were denied an abortion,” she said. She testified that higher anxiety, stress and lower self‑esteem were observed in the short term among people denied care, but that abortion itself was not associated with adverse long‑term mental‑health outcomes.

She summarized the Turnaway Study’s strengths — the prospective design, a closely matched comparison group, validated measures and multi‑state recruitment — and acknowledged limitations commonly raised in peer review: a baseline participation rate below 50 percent and cumulative attrition over five years; the team used sensitivity analyses and analytic methods (mixed-effects models) to assess whether those factors biased conclusions. Biggs told the court the study’s principal short-term findings are robust even when sensitivity analyses and higher‑participation sites are analyzed separately.

Biggs further reviewed major evidence syntheses. She told the court the National Academies of Sciences, Engineering, and Medicine and American Psychological Association reviews both concluded that abortion is not shown to increase the risk of adverse mental-health outcomes. She described the Turnaway Study and subsequent literature as reinforcing that consensus.

Biggs criticized the language that Michigan requires in its informed-consent materials — language that says some individuals “may have feelings of sadness, guilt, anger, or trouble sleeping or doing daily activities after an abortion.” She described that mandated disclosure as misleading and stigmatizing, saying it “is not an evidence‑based statement” and that including it risks spreading misinformation and reinforcing stigma. “It is misleading and, and, can reinforce stigma related to abortion and and add to spreading misinformation,” she testified.

On mandatory waiting periods, Biggs said the evidence does not support the proposition that a 24-hour delay improves decision certainty. She testified that most people presenting for abortion care are already “very certain about the decision,” and that mandatory delays commonly add logistical, financial and privacy burdens and may push some patients later in pregnancy, complicating available options.

Biggs also detailed harms documented when people are denied abortions: greater economic hardship, higher rates of poverty for the birthing parent and children, worse physical health outcomes and increased likelihood of remaining in abusive relationships. She told the court that, in the Turnaway cohort, some women who were denied care experienced more negative economic and health outcomes; she noted two maternal deaths in the cohort among women who were denied abortions and later gave birth.

On cross‑examination, defense counsel probed methodological limits — participation and attrition rates and the representativeness of samples — and Biggs reiterated the study team’s sensitivity checks and the rationale for the cohort design. She acknowledged the Turnaway Study oversampled later‑gestation seekers to obtain a matched comparison group, and that those design choices affect generalizability in quantified ways; she also said subsequent publications and reviews further support her opinions.

Biggs was excused after redirect; trial testimony continued with additional witnesses scheduled for follow-up.

","UCSF researcher Antonia Biggs testified that the Turnaway Study and major literature reviews find no long-term mental-health harms from abortion, that most patients are certain at the time of their appointment, and that mandated waiting or misleading informed-consent disclosures can increase barriers, stigma and risk — particularly for people in","actionData","errors"]

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Expert: Trained advanced practice clinicians can safely provide medication and aspiration abortions, witness says

Research witness: mandatory waiting, disclosure requirements offer no mental-health benefit and can harm patients, expert testifies