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

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.