[Congressional Record Volume 141, Number 130 (Saturday, August 5, 1995)]
[Extensions of Remarks]
[Pages E1690-E1691]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 1996

                                 ______


                               speech of

                          HON. PETER HOEKSTRA

                                of ohio

                    in the house of representatives

                        Wednesday, August 2, 1995

       The House in Committee of the Whole House on the State of 
     the Union had under consideration the bill (H.R. 2127) making 
     appropriations for the Departments of Labor, Health and Human 
     Services, and Education, and related agencies, for the fiscal 
     year ending September 30, 1996, and for other purposes:

  Mr. HOEKSTRA, Mr. Chairman, I want to submit the following 
information in the Record which will clarify that I did, in fact, 
invite the Accreditation Council for Graduate Medical Education [ACGME] 
to testify at the hearing of the Economic and Educational Opportunities 
Subcommittee on Oversight and Investigations.
  The statement made by the gentleman from Iowa is incorrect. The 
executive director of the ACGME was invited by the majority, not the 
minority.
  Thank you.
                               Memorandum

       To: Republican Members, Subcommittee on Oversight and 
     Investigations.
       From: George Conant, Professional Staff Member.
       Re: June 14 Hearing on Accreditation Council for Graduate 
     Medical Education Policy on Abortion Training.
       Date: June 13, 1995.
       The Subcommittee on Oversight and Investigation will hold a 
     hearing on Wednesday, June 14 at 1:00 p.m. in room 2261 
     Rayburn to examine the recent ruling by the Accreditation 
     Council for Graduate Medical Education (ACGME) requiring all 
     medical schools it accredits to provide students with 
     training in abortion procedures during their residencies.
       The hearing is intended to provide detailed information on 
     the revised policies of the ACGME concerning the 
     accreditation of residency programs in Obstetrics and 
     Gynecology. The hearing will examine the impact of the 
     ACGME's policies on: (a) the relationship between the federal 
     government and medical training in the United States; and (b) 
     the moral and social aspects of medical training related to 
     individual and organizational conscience.


                               witnesses

       The hearing will consist of one panel with five majority 
     witnesses and one minority witness:
       Thomas Elkins, M.D., Chairman of the Department of 
     Obstetrics and Gynecology at Louisiana State University 
     Medical School, Former Chairman of Obstetrics and Gynecology 
     at the University of Michigan, and an active member of the 
     Christian Medical and Dental Society.
       Edward V. Hannigan, M.D., Director of the Division of 
     Gynecological Oncology, Vice Chairman for Clinical Affairs, 
     and Professor of Obstetrics and Gynecology at the University 
     of Texas at Galveston.

[[Page E1691]]

       Anthony Levatino, M.D., J.D., Assistant Clinical Professor 
     at the Albany Medical Center Department of Obstetrics and 
     Gynecology, a Diplomate with the American Board of Obstetrics 
     and Gynecology, and a former abortion practitioner.
       Pamela Smith, M.D., Director of Medical Education at Mt. 
     Sinai Medical Center, Member of the Association of Professors 
     of Obstetrics and Gynecology, and President-Elect of the 
     American Association of Pro-Life Obstetricians and 
     Gynecologists.
       John Gienapp, Ph.D., Executive Director of the 
     Accreditation Council for Graduate Medical Education.
       At this time we do not have any information on the minority 
     witness.


                               background

       On February 14, 1995, the 23-member Accreditation Council 
     for Graduate Medical Education decided unanimously that 
     obstetrics and gynecology residency programs must provide 
     training in surgical abortion.
       Institutions with moral or ethical opposition to abortion 
     would be exempt from teaching these procedure within their 
     own facility, but would be required to contract with another 
     program in order to maintain accreditation. Likewise, the 
     ruling exempts students with moral or religious objections to 
     the practice of abortion from having to participate in 
     training on the grounds that those students would not perform 
     abortions regardless.
       The ruling applies only to residency programs focussed 
     especially on obstetrics and gynecology. Family practice 
     programs, which cover some obstetrics and gynecology as part 
     of their curriculum, are not required to train their 
     residents in surgical abortion unless they think it 
     necessary.
       The new rule takes effect on January 1, 1996, and all Ob/
     Gyn residency programs accredited or re-accredited after that 
     date must train doctors in abortion or contract with another 
     program to do so. Programs that fail to provide the training 
     could lose their accreditation and, therefore, federal 
     reimbursement under some programs.
       The Accreditation Council for Graduate Medical Education, 
     formed in 1974, is the national panel which supervises 
     medical education and decides what training programs medical 
     schools must provide. Additionally, it is the only 
     organization with the authority to accredit medical schools 
     for participation in some federal programs. Teaching 
     hospitals need Council accreditation to qualify for federal 
     reimbursement for services medical residents provide to 
     patients.
       The Council has argued that their decision is not so much a 
     new rule as it is a clarification of the existing rule. Ob/
     Gyn residency requirements have always included ``clinical 
     skills in family planning,'' but the council had never 
     specified what that meant. The revised rule reads: 
     ``Experience with induced abortion must be a part of 
     residency training, except for residents with moral or 
     religious objections.''
       The Council decided to clarify the Ob/Gyn residency 
     requirements after a four-year legal battle with a hospital 
     in Baltimore. In 1986, the Council withdrew the accreditation 
     of St. Agnes Hospital, a Catholic institution, because it did 
     not provide training in abortion. The hospital then sued the 
     Council claiming that their First Amendment right to 
     religious freedom had been violated. The judge decided in the 
     Council's favor, ruling that the public has a right to expect 
     a doctor to be trained in all facets of a specialty.
       The Council spent two years formulating the language of the 
     new ruling and sought comment on the proposal from interested 
     parties for a year before agreeing on the final wording.


                       implications of the ruling

       There is concern among members of the graduate medical 
     education community that failure to comply with the ruling 
     based on conscience will result in the loss of accreditation 
     for institutions with a moral or ethical opposition to 
     abortion. Additionally, many argue the ACGME is not merely a 
     ``private organization,'' and this policy has definite state 
     and federal implications.
       Under federal law, some Medicare costs (Part A, costs of 
     intern and resident services) cannot be reimbursed if a 
     teaching program is not accredited.
       Ob/Gyn students enrolled in a program not accredited by 
     ACGME are ineligible for repayment deferrals on federal 
     Health Education Assistance Loans (HEAL).
       States tie their licensure requirements to graduation from 
     ACGME accredited programs.
       If you have any questions regarding the hearing or need 
     additional information, please contact George Conant at 225-
     6558.
         Committee on Economic and Educational Opportunities, 
           House of Representatives,
                                     Washington, DC, June 8, 1995.
     Dr. John C. Gienapp, Ph.D.,
     Executive Director, Accreditation Council for Graduate 
         Medical Education, Chicago, IL
       Dear Dr. Gienapp: On Wednesday, June 14, 1995, at 1:00 p.m. 
     in Room 2261 of the Rayburn House Office Building, the 
     Subcommittee on Oversight and Investigations will hold a 
     hearing on the topic of training in abortion procedures as a 
     requirement for the accreditation of Obstetrics-Gynecology 
     programs for residency students. Specifically, the hearing 
     will look at the recently revised educational requirements on 
     family planning of the Accreditation Council for Graduate 
     Medical Education (ACGME). I would like to take this 
     opportunity to invite you to testify before our subcommittee 
     and to provide us with your insight on this issue.
       We would be interested in your evaluation of the ACGME's 
     requirement for abortion training and whether it places an 
     undue burden on individuals and institutions that oppose 
     abortion for ethical or religious reasons. Given your 
     experience with the ACGME, we are also interested in your 
     perspective on whether the ACGME's requirement for abortion 
     training is necessary to the profession or whether it 
     unfairly coerces individuals and institutions to provide 
     training that may be ethically or morally objectionable.
       If you have any questions, please feel free to contact 
     George Conant at 202-225-6558. Thank you for your 
     consideration of this request. I look forward to your 
     appearance.
           Sincerely,

                                                Pete Hoekstra,

                               Chairman, Subcommittee on Oversight
                                               and Investigations.
     

                          ____________________