Archived: Monday, October 2, 2023 3:33:54 PM  
From: Halley Crissman  
Mail received time: Mon, 2 Oct 2023 17:10:54  
Sent: Mon, 2 Oct 2023 13:09:59  
To: BPL-BoardSupport  
Cc: Ryan Burtka Vashali Bhargava  
Subject: MSACOG comments regarding Board of Medicine rules  
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Sensitivity: None  
Attachments:  
MSACOG Comment on Board of Medicine Rules 10022023.pdf;  
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To whom it may concern,  
Please accept the attached Public Comments from the Michigan Section of the American College of Obstetricians and  
Gynecologists regarding the Board of Medicine rules.  
Sincerely,  
Halley Crissman, MD, MPH, FACOG  
Michigan Section of ACOG  
October 2, 2023  
To whom it may concern,  
The American College of Obstetricians and Gynecologists (ACOG) is the governing body, and  
the source for clinical standards of care, for the specialty of obstetrics and gynecology across  
the United States. ACOG is a non-partisan organization representing more than 950 OBGYNs  
in Michigan and more than 60,000 OBGYNs nationwide.  
We are writing regarding the Michigan Board of Medicine rule 333.2411(7) that restricts the  
ability of an allopathic physician from delegating prescriptive authority for scheduled drugs to  
advanced practice clinicians for the purposes of abortion care. This rule restricting a physician’s  
ability to delegate their prescriptive authority for abortion care is not based in medical science  
nor patient safety.  
The American College of Obstetricians and Gynecologists is committed to ensuring access to  
the full spectrum of evidence-based quality reproductive health care, including abortion.  
Abortion is one of the safest medical procedures performed in the United States—safer than  
other routine medical procedures and substantially safer than childbirth. Yet, it is increasingly  
out of reach because of mounting government-imposed restrictions targeting women,  
physicians, and other clinicians. A report by the National Academies of Sciences, Engineering,  
and Medicine (NASEM) comprehensively reviewed the state of science all methods of abortion,  
and confirmed once again that abortion is one of the safest medical procedures. In fact, it found  
that the biggest threats to the quality of abortion care in the United States are unnecessary and  
burdensome government regulations that undermine evidence-based care.  
Mandates that only physicians can provide abortion care, are one example of government  
restrictions that are not based on scientific evidence, improperly regulate medical practice, and  
impede patients’ access to quality, evidence-based health care. Laws requiring that only  
physicians provide abortion care diminish the number of qualified medical professionals who  
can provide abortion care and block women from obtaining safe, legal, and accessible abortion.  
The pool of clinicians who provide first-trimester medication and aspiration abortion should be  
expanded to appropriately trained and credentialed advanced practice clinicians in accordance  
with individual state licensing requirements (ACOG Committee Opinion No. 815).  
In order to ensure access to safe abortion care, it is necessary to increase the availability of  
trained abortion providers. Advanced practice clinicians possess the clinical and counseling  
skills necessary to provide first-trimester abortion safely, and there is no medical rationale or  
benefit to restricting early abortion care to physicians (ACOG Committee Opinion No. 612).  
APCs who are properly trained have the clinical and counseling skills necessary to provide  
medication abortion. The safety and efficacy of medication abortion performed by APCs have  
been shown to be equivalent to physician provision through multiple randomized trials  
throughout the world (ACOG Practice Bulletin 225).  
Moreover, physician-only laws exacerbate health inequities for people who already face the  
most barriers to abortion care. Adolescents, people of color, those living in rural areas, those  
with low incomes, and people who are incarcerated can face disproportionate effects of  
restrictions on abortion access, including physician-only laws (ACOG Committee Opinion No.  
815).  
In conclusion, we ask that the Board of Medicine rule 338.2411(7) be struck given that it is not  
based in medical science nor patient safety.  
Sincerely,  
Halley Crissman, MD, MPH, FACOG  
Halley.crissman@gmail.com  
Michigan Section ACOG Fellow Advocacy Chair  
Vashali Bhargava, MD, FACOG  
vashalibhargava@gmail.com  
Michigan Section ACOG Chair  
References:  
National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of  
Abortion Care in the United States (March 2018) at https://www.nap.edu/read/24950/chapter/1  
Increasing access to abortion. ACOG Committee Opinion No. 815. American College of  
Obstetricians and Gynecologists. Obstet Gynecol 2020;136:e107–15 at  
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-  
access-to-abortion  
Abortion Training and Education. Committee Opinion No. 612. American College of  
Obstetricians and Gynecologists (Reaffirmed 2019). At https://www.acog.org/Clinical-Guidance-  
and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-  
Women/Abortion-Training-and-Education  
Medication abortion up to 70 days of gestation. ACOG Practice Bulletin No. 225. American  
College of Obstetricians and Gynecologists. Obstet Gynecol 2020;136:e31–47.  
Archived: Monday, October 2, 2023 4:32:00 PM  
From: Monika Miner  
Sent: Mon, 2 Oct 2023 20:22:49  
To: BPL-BoardSupport  
Cc: Lee Roosevelt CNM  
Subject: Comments for Administrative Rules for Medicine - General Rules in Rule Set 2023-30  
Importance: Normal  
Sensitivity: None  
Attachments:  
ACNM affliate comments.pdf;  
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Dear BPL:  
Attached you will find comments for the administrative rules for the medicine, on behalf of the Michigan Affiliate of the American  
College of Nurse-Midwives (ACNM).  
Thank you,  
Monika Miner  
Michigan Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing  
Board and Committees Section  
P.O. Box 30670  
Lansing, Michigan 48909-8170  
To Whom It May Concern:  
The Michigan Affiliate of the American College of Nurse-Midwives (ACNM) offers the  
following comments to the Michigan Department of Licensing and Regulatory Affairs on the  
currently proposed Administrative Rules for Medicine - General Rules in Rule Set 2023-30. On  
behalf of our members and in support of our mission to advocate for public policy that will improve  
sexual and reproductive health services in the State of Michigan, we support equitable access for  
every Michigander to a comprehensive range of reproductive health care provided by a qualified  
healthcare provider of their choosing.  
The American College of Nurse Midwives has long affirmed the support of Advanced  
Practice Clinicians, including nurse-midwives, as qualified reproductive health service providers.  
There is a wealth of research documenting that advanced practice registered nurses (APRN),  
including Certified Nurse-Midwives, are capable of performing medication abortion (abortion with  
pills) at least as safely and effectively as physicians. In many other states APRNs are already  
providing abortion services safely and effectively. That is why the American College of Obstetrics  
and Gynecology, the American Public Health Association, the American Association of Physician  
Assistants, the American College of Nurse-Midwives, and the World Health Organization all take  
the position that APRNs should be permitted to provide full-scope first trimester abortion care.  
We believe the proposed language in rule 338.2411(7) to prohibit a physician from  
delegating their prescribing authority to an APRN, with a specialty certification under MCL  
333.17210 for any drug or device for any woman known to be pregnant with the intention of  
causing either “miscarriage or fetal death” lacks any medical or scientific basis and is not rooted in  
concerns about patient safety or the ability of an APRN to competently perform a medication  
abortion.  
We request subsection (7) be removed in its entirety from R 338.2411. We believe such  
action is in keeping with Michigan voters’ passage of Proposal 3 in 2022 to enshrine the full  
continuum of reproductive rights in the Michigan Constitution. Lastly, we would draw attention to  
the fact that subsection (7) is the only portion of R 338.2411 targeted at a specific population  
(women) and a specific medical condition (pregnancy). It also discriminates against APRNs,  
effectively limiting their scope of practice, by removing their ability to receive delegation that is not  
similarly limited to other licensed health professionals.  
8403 Colesville Road, Suite 1550, Silver Spring, MD 20910-6374 240.485.1800 fax: 240.485.1818 www.midwife.org  
Abortion care is an essential element of reproductive health care in accordance with the  
American College of Nurse-Midwives’ view that “everyone has the right to make reproductive  
health choices that meet their individual needs.” Nurse-midwives who choose to do so are ideal  
reproductive health service providers. Their services help to improve access to reproductive health  
services in Michigan. If further information about our request is needed, please let us know.  
Sincerely,  
Lee Roosevelt, PhD, MPH, CNM, FACNM  
President  
American College of Nurse-Midwives, Michigan Affiliate  
Archived: Monday, September 25, 2023 1:34:53 PM  
From: Colleen Ryan  
Mail received time: Mon, 25 Sep 2023 15:12:46  
Sent: Mon, 25 Sep 2023 10:12:18  
To: BPL-BoardSupport  
Subject: Board of Medicine Rules Comments  
Importance: Normal  
Sensitivity: None  
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Dear BPL:  
I have reviewed the proposed changes to the Board of Medicine Rules and have the following comments.  
The rules provide that a physician is allowed to delegate prescribing authority to an advanced practice  
registered nurse (APRN) for a range of controlled substances listed in Schedules 2 through 5. But the  
rules specifically prohibit a physician from delegating “the prescription of a drug or device . . . for a woman  
known to be pregnant with the intention of causing either a miscarriage or fetal death.” See R 338.2411(7).  
This rule is contradictory to the constitutional right to individual reproductive freedom (enacted through  
Proposal 3 of 2022) and the Governor’s Executive Directive 2022-13.  
Regardless of howthe rules would be analyzed under a constitutional challenge, the executive directive  
contains clear (and mandatory) instructions to LARA. LARA “must” do the following: (1) ensure that all of  
LARA’s operations and practices related to reproductive rights provide “the maximum protection possible  
for the fundamental right to reproductive freedom”; (2) “identify any laws, regulations, policies, or  
practices within [LARA’s] jurisdiction, if any, that conflict with the constitutional right to reproductive  
freedom and work with the [DAG] to address those conflicts”; and (3) “identify potential opportunities to  
proactively increase protections for reproductive freedom.”  
The rule, on its face, limits access to abortion medication by providing that only a physician can prescribe  
abortion medication, which cannot be delegated to an APRN. Further, this limitation has been  
implemented solely by administrative rule, and is not expressly required by the Michigan Public Health  
Code. Accordingly, this rule should be rescinded to be consistent with all three directives in the executive  
directive outlined above.  
Sincerely,  
Colleen Ryan  
Archived: Monday, October 2, 2023 3:31:11 PM  
From: Elisabeth Smith  
Sent: Mon, 2 Oct 2023 16:58:38  
To: BPL-BoardSupport  
Subject: Administrative Rules for Medicine - General Rules in Rule Set 2023-30  
Importance: Normal  
Sensitivity: None  
Attachments:  
R 338.2411_Center for Reproductive Rights_10.2.23.pdf;  
CAUTION: This is an External email. Please send suspicious emails to abuse@michigan.gov  
To Whom It May Concern:  
The Center for Reproductive Rights is a legal advocacy organization that uses the power of law to advance reproductive rights as  
fundamental human rights around the world. As a part of our mission, we aim to ensure that all people have meaningful access to  
abortion care services.  
We write to offer the following comments to the Michigan Department of Licensing and Regulatory Affairs on the currently  
proposed Administrative Rules for Medicine - General Rules in Rule Set 2023-30.  
Specifically, we request subsection (7) be removed in its entirety from R 338.2411 “Delegation of prescribing controlled  
substances to an advanced practice registered nurse; limitation.” Our full comments are attached.  
Please do not hesitate to contact me with any questions.  
All my best,  
Elisabeth Smith  
ELISABETHS. SMITH, J.D.* (she/her/hers)  
Director, State Policy and Advocacy  
esmith@reprorights.org  
199 Water Street, 22nd Floor  
New York NY 10038  
Tel 917 637 3694  
Website | Facebook | Twitter  
*admitted only to the bar of Washington State  
This message may contain confidential or privileged information. If you are not the intended recipient, please advise the sender immediately by reply e-mail and  
delete this message and any attachments without retaining a copy.  
October 2, 2023  
ꢀ
Michigan Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing  
Board and Committees Section  
P.O. Box 30670  
Lansing, Michigan 48909-8170  
VIA ELECTRONIC MAILꢀ  
ꢀ
Re:ꢀ Administrative Rules for Medicine - General Rules in Rule Set  
2023-30; R 338.2411  
ꢀ
To Whom It May Concern:  
The Center for Reproductive Rights (“Center”) is a legal advocacy  
organization that uses the power of law to advance reproductive rights as  
fundamental human rights around the world. As a part of our mission, we  
aim to ensure that all people have meaningful access to abortion care  
services.  
We write to offer the following comments to the Michigan Department of  
Licensing and Regulatory Affairs on the currently proposed  
Administrative Rules for Medicine - General Rules in Rule Set 2023-30.  
Specifically, we request subsection (7) be removed in its entirety from R  
338.2411 “Delegation of prescribing controlled substances to an  
advanced practice registered nurse; limitation.”  
Medication abortion is an important component of abortion care—it  
accounts for more than half of the abortion care provided in the U.S.1 and  
is the only method of abortion care that patients can access remotely.  
These important factors have made medication abortion the target of anti-  
abortion factions that seek to deny abortion access to all pregnant people  
in the United States. Michigan law should promote access to medication  
abortion to the greatest extent possible to ensure Michiganders’ bodily  
1 Rachel K. Jones, Elizabeth Nash, Lauren Cross , Jesse Philbin, and Marielle Kirstein,  
Medication abortion now accounts for more than half of all US abortions,  
GUTTMACHER INSTITUTE (last updated Dec. 1, 2022)  
https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-  
half-all-us-abortions.  
Field Code Changed  
autonomy and to implement the constitutional requirements contained in  
Article 1, Section 28 of the Michigan Constitution.2  
Rule 338.2411(7) lacks any medical or scientific basis, does not further  
patient safety, and incorrectly limits advanced practice registered nurses  
(APRNs) from prescribing medication abortion although numerous  
studies have demonstrated their competence.3 Such limitations on  
prescribing authority harm Michiganders’ ability to make their own  
decisions about their health and their bodies, including decisions about  
abortion.  
Please do not hesitate to contact me if you have questions or would like  
further information.  
Sincerely,  
Elisabeth S. Smith  
Director, U.S. State Policy and Advocacy  
Center for Reproductive Rights  
esmith@reprorights.org  
2 MICH. CONST. art. 1, § 28  
3 Tracy A. Weitz, Diana Taylor, Sheila Desai, Ushma D. Upadhyay, Jeff Waldman,  
Molly F. Battistelli, and Eleanor A. Drey,  
Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse  
Midwives, and Physician Assistants Under a California Legal Waiver  
103 AM. J. OF PUB. HEALTH, 454, 461 (Mar. 2013)  
https://doi.org/10.2105/AJPH.2012.301159.  
Archived: Sunday, October 1, 2023 8:43:53 AM  
From: Amy Zaagman  
Sent: Thu, 28 Sep 2023 22:42:34  
To: BoardSupport@michigan.gov BPL-BoardSupport  
Subject: Written comments for Medicine 2023-30 LR  
Importance: Normal  
Sensitivity: None  
Attachments:  
MCMCH comments 2023-30 LR 10.27.pdf;  
CAUTION: This is an External email. Please send suspicious emails to abuse@michigan.gov  
Please find written comments attached for the public hearing on Monday, October 2 re: Administrative Rules for Medicine –  
General Rule in Rule Set 2023-30 LR.  
Thank you -  
Amy U. Zaagman  
Executive Director  
517-482-5807 - office  
517-230-1816 - mobile  
www.mcmch.org  
September 27, 2023  
Michigan Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing  
Board and Committees Section  
P.O. Box 30670  
Lansing, Michigan 48909-8170  
SUSTAINING MEMBERS  
Beaumont Children’s Hospital  
To Whom It May Concern:  
Children’s Hospital of  
Michigan/Detroit Medical Center  
The Michigan Council for Maternal and Child Health offers the following comments to  
the Michigan Department of Licensing and Regulatory Affairs on the currently  
proposed Administrative Rules for Medicine - General Rules in Rule Set 2023-30.  
On behalf of our members and in support of our mission to advocate for public policy  
that will improve maternal and child health, we support equitable access for every  
Michigander to any type of reproductive health service, including exams and health  
screenings, every form of contraception, any type of procedure and any medically  
necessary care delivered by competent and qualified providers.  
Henry Ford Health System  
University of Michigan C.S. Mott  
Children’s Hospital and Von  
Voigtlander Women’s Hospital  
CONTRIBUTING MEMBERS  
Michigan Section, American  
College of Obstetricians and  
Gynecologists  
Mott Children’s Health Center  
We believe the proposed language in rule 338.2411(7) to prohibit a physician from  
delegating their prescribing authority to an advanced practice registered nurse  
(APRN) with a specialty certification under MCL 333.17210 for any drug or device for  
any woman known to be pregnant with the intention of causing either “miscarriage  
or fetal death” lacks any medical or scientific basis and is not rooted in concerns  
about patient safety or the ability of an APRN to competently perform a medication  
abortion. We request subsection (7) be removed in its entirety from R 338.2411.  
School-Community Health  
Alliance of Michigan  
PARTNERING MEMBERS  
Honor Community Health  
Michigan Association for Infant  
Mental Health  
Michigan Association of  
School Nurses  
We believe such action is in keeping with Michigan voters’ passage of Proposal 3 in  
2022 to enshrine the full continuum of reproductive rights in the Michigan  
Constitution, as well as the subsequent Executive Directive issued by Governor  
Whitmer stating, among other provisions, “departments and agencies must identify  
any laws, regulations, policies, or practices within their jurisdiction, if any, that conflict  
with the constitutional right to reproductive freedom … departments and agencies  
must respect the Michigan Constitution’s provision that only a compelling state  
interest may justify infringement on the protected right and that any such  
infringement must be achieved by the least restrictive means necessary.”  
Michigan Breastfeeding  
Network  
Michigan School Health  
Coordinators’ Association  
Michigan State Medical Society  
Northern Michigan Health  
Consortium  
Washtenaw County  
Public Health  
GENERAL MEMBERS  
Lastly, we would draw attention to the fact that subsection (7) is the only portion of R  
338.2411 targeted at a specific population (women) and a specific medical condition  
(pregnancy). It also discriminates against APRNs, effectively limiting their scope of  
practice, by removing their ability to receive delegation that is not similarly limited to  
other licensed health professionals. If further information about our request is needed,  
please let us know.  
Maternal-Newborn Nurse  
Professionals of Southeastern  
Michigan  
Michigan Chapter, National  
Association of Pediatric  
Nurse Practitioners  
EXECUTIVE DIRECTOR  
Amy Zaagman  
azaagman@mcmch.org  
Sincerely,  
Amy U Zaagman  
Executive Director  
106 W. Allegan Street / Suite 610 / Lansing / MI 48933 517.482.5807 mcmch.org  
;