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Montana Supreme Court says advanced practice registered nurses can provide abortions

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Montana Supreme Court says advanced practice registered nurses can provide abortions


Advanced practice registered nurses can provide abortion care in Montana following a unanimous order by the state Supreme Court issued Friday.

Abortion providers said the decision is a victory for abortion rights in Montana and will expand access to health care in the state, making patients safer.

The state Department of Justice, which defended the 2005 law that aimed to limit who can provide abortion care to only physicians and physician assistants (PAs), called the court “out of touch” and said the case was not about the right to access an abortion but standards of care.

The lawsuit decided Friday was first filed in 2018 by Helen Weems, who operates All Families Healthcare in Whitefish, and a provider identified as Jane Doe, a licensed registered nurse with a certification in the advanced practice of nurse midwife. Since that year, the state has been under a preliminary injunction blocking the law.

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More than a year ago, Lewis and Clark County District Court Judge Mike Menahan ruled abortion care provided by advanced practice registered nurses, or APRNs, is safe and the 2005 law was unconstitutional because it interfered with a woman’s right to seek an abortion from the health care provider of her choice. The Supreme Court held a hearing in the case last year.

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Friday’s ruling cited the landmark state Supreme Court’s Armstrong decision, which found the Montana Constitution’s right to privacy guarantees a person’s right to a pre-viability abortion from the qualified health care provider of their choice.

Even after the U.S. Supreme Court struck down the Roe decision last year and overturned the federal right to access an abortion, the procedure remained legal in Montana under the state document’s long-recognized stronger right to privacy.

The state, through the Montana Department of Justice, appealed the district court’s ruling to the Montana Supreme Court. The high court, in its 30-page opinion Friday, said early abortion care was safe, advanced practice registered nurses (APRNs) were more than qualified to provide the procedure, and the state’s ability to regulate for the health and safety of its citizens did not supersede the constitutional right to access an abortion.

“This is a resounding victory and an unequivocal win for the people of Montana. … The Montana Supreme Court clearly and unequivocally ratified the principle that our state constitutional right to privacy protects the right to an abortion in Montana. That cannot be disputed,” said Alex Rate, a lawyer for ACLU of Montana that represented Weems. “ … That constitutional right guarantees an individual’s ability to seek medical care from a health care provider of their choice, and that part’s important here in Montana where we live in a geographically large state and it’s not always easy to travel to get the health care that you need.”

Emilee Cantrell, a spokesperson for the state Department of Justice, panned the ruling, as well as the court, in a statement issued Friday.

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“The state Supreme Court has become disgracefully radicalized and out of touch with Montanans. This case was not about the right to abortion — it was about whether women have a right to an elevated standard of care during an abortion,” Cantrell wrote. “The Montana Supreme Court said ‘no’ and lowered the standard of care set by the Legislature, effectively constitutionalizing the right of unqualified individuals to perform unregulated abortions. This decision is a loss for Montana women who will be less safe because of the state Supreme Court.”

In the order written by Justice Laurie McKinnon and signed by the other six justices, the court said the state “failed” to prove its arguments on several points.

That included not proving that abortions done by APRNs were riskier than those performed by physicians or physician assistants. The state also didn’t show why APRNs should be restricted from providing abortions or any associated health risks.

While the court in this decision recognized the state has general and inherent “police power” to regulate the health and safety of its citizens, the record showed no evidence APRNs providing abortion care presented any medical risk to women.

“The state’s argument is detached from the overwhelming evidence presented to the district court that abortion care is one of the safest forms of medical care in this country and the world, and that APRNs are qualified providers,” the order reads. “ … There is no medically recognized bona fide health risk for APRNs to perform abortion care, much less one that is clearly and convincingly demonstrated.”

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The court also pointed out that all parties in the case agreed managing a miscarriage is identical or nearly so to early abortion care, but the state did not argue it was unsafe for APRNs to provide that care.

“The court pointed to a logical fallacy in the state’s argument. … How can the state say it has a compelling interest to regulate abortion when identical procedures are not subject to the same onerous requirement?” Rate said.

APRNs also regularly provide care far more advanced than early abortions, the court noted, such as neuraxial anesthesia, central line insertions and intubations. They can also prescribe dangerous and addictive drugs that pose far more risk than abortion medications.

The court also pointed to studies showing the risk of early abortion complications ranging from minor at 1.32% to major at 0.05% is far less than other common procedures such as wisdom teeth removal at 7% and tonsillectomies at 8-9%.

The ruling also cited safety repercussions associated with a lack of abortion care, highlighting evidence that delays in accessing care can force women to seek later-term abortions, which can come with higher risks, more costs and possibly the inability to get a medication abortion.

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“Access to abortion care in Montana is the difference between obtaining quality care or no care at all, especially for patients who might otherwise ‘time out’ of early abortion care because their pregnancy extended past a certain gestational age, which can result in safety repercussions for the patient,” the court wrote.

One doctor who testified on behalf of Weems and Doe said research has established the median distance a patient must travel for early abortion care in Montana increased by nearly 50 miles between 2011 and 2014, the court wrote. That year the average distance traveled was 180 miles. In 2017, more than 90% of the state’s counties, home to half of the Montana population, had no abortion provider.

Other litigation

Republicans in the state have aimed to limit access to the procedure through several laws passed this legislative session and in 2021. Several of those bills are under litigation now, as is an administrative rule from the state health department that in addition to requiring preauthorization for abortions would limit the procedure to only be provided by a physician for those covered by Medicaid. Lawmakers passed a law earlier this year to codify the same policy.

“(Friday’s order) bodes well for the myriad lawsuits that are challenging the abortion restrictions that were adopted by the 2023 Montana Legislature,” Rate said. “All of that sends a clear message the state can’t legitimately defend these patently unconstitutional laws.”

Holly Michels is the head of the Montana State News Bureau.  You can reach her at holly.michels@lee.net

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Montana group welcomes South Dakotans seeking abortion, reproductive care

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Montana group welcomes South Dakotans seeking abortion, reproductive care


A Montana-based abortion rights group is reaching out to neighboring states announcing abortion and contraception are legal and available there.

South Dakota has a near total abortion ban, which extends to pregnancies caused by rape or incest. Health care professionals say the state’s current abortion exception is unclear.

“Minnesota and Colorado are being so inundated with volume from other states that they might have wait times,” said Nicole Smith, executive director of Montanans for Choice.

Smith said the number of South Dakota women travelling to Montana is quite small. That’s why the group is raising awareness that the state is an option to procure the procedure, which includes a billboard campaign that welcomes those seeking the procedure.

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 “In Montana, we can see people same day that they get here, pretty much,” Smith said. “We just want folks to know that we do have a lot of availability and if they don’t want to wait and they can get into Montana—we can probably see them pretty quickly.”

Since September last year, 280 South Dakotans travelled to Minnesota for an abortion and 170 travelled to Colorado for the procedure. That’s according to the Guttmacher Institute, a sexual and reproductive health group.

The closest abortion facilities to South Dakota in Montana are located in Billings. Smith says clinics also offer abortion medication through telemedicine.

Smith said Montana’s constitution has strong health care privacy rights.

“We have almost unfettered access to abortion in Montana,” Smith added. “There’s no mandatory waiting periods. There’s no mandatory counselling. We have telehealth for medication abortion. We’re very grateful that our constitution has protected those rights—that doctors and providers are able to give best practice medicine to us without politicians interfering in that way.”

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South Dakota voters are set to vote on whether to enshrine abortion access in the state constitution this November. Constitutional Amendment G grants South Dakota women access to abortion in the first two trimesters of pregnancy. It allows the state to restrict the procedure in the third trimester, with exceptions for health and life of the mother.

Planned Parenthood North Central States believe the measure will not “adequately reinstate” abortion access in the state. Abortion opponents call the measure extreme.





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Sheehy, PERC and the future of public lands conservation in Montana

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Sheehy, PERC and the future of public lands conservation in Montana



A great recent article by Chris D’Angelo reports on the connection between Tim Sheehy, the Republican challenging Jon Tester for his senate seat, and PERC, the Bozeman-based Property and Environment Research Center that promotes what it calls “free market environmentalism.”  

While Montanans might wonder about Sheehy’s background and policy positions given the shifting sands in his explanations, the fact that he was on the board of PERC is not in question — despite his failure to disclose that fact as required by Senate rules which his campaign says is an “omission” that’s being “amended.”   

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For those who have long been in the conservation, environmental, and public lands policy arena, PERC is a very well-known entity. As noted on its IRS 990 non-profit reporting form, the center is “dedicated to advancing conservation through markets, incentives, property rights and partnerships” which “applies economic thinking to environmental problems.” 

But to put it somewhat more simply, PERC believes that private land ownership results in better conservation of those lands under the theory — and it is a disputable theory — that if you own the land and resources, you take better care of it due to its investment value.  This has long been their across the board approach to land, water, endangered species and resource extraction.

If one wanted to dispute that theory, it certainly wouldn’t be difficult to do, particularly in Montana where checking the list of Superfund sites left behind by private industries and owners bears indisputable evidence of the myth that private ownership means better conservation of those resources.

In fact, the theory falls on its face since, when “using economic thinking” the all-too-often result is to exploit the resources to maximize profit as quickly as possible.  And again, this example is applicable across a wide spectrum of resources.  In Montana, that can mean anything from degrading rangeland by putting more livestock on it than it can sustain to, as in Plum Creek’s sad history, leaving behind stumpfields filled with noxious weeds on their vast private — once public — land holdings. 

None of this is particularly a mystery, yet PERC has sucked down enormous amounts of funding from anti-conservation sources for more than four decades as it tries mightily to put lipstick on the pig of the all-too-obvious results of runaway private lands resource extraction.

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Running one of the most high-stakes senate campaigns in the nation, however, produces a lot of tap-dancing around the truth in an effort to convince voters that you’re for whatever position will garner the most votes come Election Day. 

In that regard, both Sheehy and PERC are scuttling sideways in their positions.  Given the overwhelming support for “keeping public lands in public hands” in Montana, PERC now claims it “firmly believes that public lands should stay in public hands. We do not advocate for nor support privatization or divestiture.”  

Funny that, given its previous and very long-held position that private ownership of lands and waters is the key to conservation.  Likewise, Sheehy’s position, “that “public lands must stay in public hands” is completely the opposite from the one he held only a year ago, and parrots PERC not only in its verbiage, but in its realization of which way public sentiment and the electoral winds are blowing.

Since what’s at stake is nothing less than the future of public lands in the Big Sky State, it behooves us to demand specific policy positions in writing from all candidates for public office — including the race for Montana’s Senate seat.  



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Couple walking across the U.S. reach Montana

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Couple walking across the U.S. reach Montana


WHITE SULPHUR SPRINGS — A couple from Missouri have a goal to walk through every state in the lower 48.

Paige and Torin – known by their social media handle “Walking America Couple” – are in leg three of a five-leg, cross-country journey.

They’ve already traversed through 21 states, and on Thursday, their journey brought them to just outside White Sulphur Springs.

“Even out here in the more rural open space, we still make a lot of friends on the side of the road. People often stop and ask what we’re doing, or stop to see if we need water or food,” says Paige.

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Each leg takes the couple roughly six months to one year, though they take short breaks in-between. They’re also completing the entire journey with their dog Jak.

“I think he loves the adventure more than we do,” Paige adds.



Through rain, shine, snow, and severe weather warnings, the couple have not been deterred, their purpose and mission propelling them.

“We would like to set the example that you can find contentment under almost any circumstance,” says Torin. “I started out the journey an incredibly cynical person, and it was through these repeated interactions of kindness with people that I had otherwise written off in the past, that my perspective began to change dramatically,” he adds.

Now, their journey is helping to spread the same happiness they’ve discovered to those they encounter on their journeys.

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“We hope to be the example that we’re, as humans, all more malleable than we think,” says Paige.

For more information, click here to visit their website.





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