How one Providence Swedish nurse helped change state law
A Providence Swedish nurse helped change burdensome state legal requirements for families going through pregnancy loss.
When Rachel Johnson, CNM, ARNP, stepped into her role as a perinatal clinical nurse specialist at Providence Swedish, one of the first assignments was to update fetal demise policies. It was complex, deeply sensitive work, and it led her somewhere she never expected: the state Capitol.
As she reviewed the policy, Johnson uncovered a gap between Washington law and modern clinical practice. State law relied on a patient’s last menstrual period to determine whether a pregnancy loss occurred before or after 20 weeks, a threshold that carries important legal implications.
That distinction matters. Once a pregnancy loss is legally classified at 20 weeks or later, families are required to complete additional steps, including filing a death certificate and coordinating with a funeral home, tribal organization or medical examiner. In an already devastating moment, those requirements can add emotional, logistical and financial strain.
In clinical practice, however, providers determine gestational age using the most accurate methods available, often confirmed by ultrasound. That difference meant families could face requirements based on a timeline that did not reflect how pregnancy dating is actually determined in modern medicine.
Recognizing the disconnect, Johnson began reaching out to other hospitals across the state.
“I started calling around and asking, ‘What are other hospitals doing in these situations?’” she said. “The response was basically, ‘Wait, the law says what?’”
She connected with retired Providence Swedish OB-GYN Judy Kimmelman, M.D., a longtime physician and advocate with the American College of Obstetrics and Gynecologists (ACOG). Together, they worked with ACOG to support a bill that would update the law to define gestational age based on clinically accurate criteria determined by a medical provider.
Johnson testified before both the Washington Senate and House, sharing why the change mattered for patients and caregivers.
“It’s a big deal for patients to be required to take on extra steps when the reason those things are being required is not accurate,” she said. “That’s not doing right by patients.”
Senate Bill 6025 passed through the Legislature and was signed by the governor on March 14. Once it takes effect in 90 days, the updated law will better align state policy with clinical practice and bring clearer guidance for healthcare teams across Washington.
For Johnson, the experience is a reminder that meaningful change can start with a single question.
“If you find something that isn’t right, speak up,” she said. “Find the resources, find the right people, and advocate.”
Photo caption: From left, Nancy Shapiro, ACOG lobbyist; Kevin Gordon, aide to bill sponsor, Sen. Annette Cleveland; Washington State Gov. Bono Ferguson; Judy Kimmelmen, retired OB/GYN and ACOG supporter; Rache Johnson Providence Swedish Perinatal Clinical Nurse Specialist.
About Providence Swedish
Providence Swedish has served the Puget Sound region since the first Providence hospital opened in Seattle in 1877 and the first Swedish hospital opened in 1910. The two organizations affiliated in 2012 and today comprise the largest health care delivery system in Western Washington, with 24,000 caregivers, eight hospitals and 244 clinics throughout Western Washington – from Everett to Centralia. A not-for-profit family of organizations, Providence Swedish provides more than $545 million in community benefit in the Puget Sound region each year. The health system offers a comprehensive range of services and specialty and subspecialty care in a number of clinical areas, including cancer, cardiovascular health, neurosciences, orthopedics, digestive health and women’s and children’s care. For more information, visit providence.org/swedish.
For Johnson, the experience is a reminder that meaningful change can start with a single question.
“If you find something that isn’t right, speak up,” she said. “Find the resources, find the right people, and advocate.”
