HHS Secretary Mike Leavitt has issued a third blog post on physician conscience, announcing the release of the official proposed regulation following the draft which has generated so much controversy. I continue to be amazed and appalled by Leavitt's reliance on the certification argument as justification for the measure.
Leavitt continues to either misunderstand or deliberately misrepresent the certification issue as a primary argument for the introduction of the proposed regulations. He writes:
This became a topical matter when the American College of Obstetricians and Gynecologists (ACOG) issued guidelines that could shape board certification requirements and necessitate a doctor to perform abortions to be considered competent.
Physician certification is a powerful instrument. Without it, a doctor cannot practice the specialty. Putting doctors (or any one who assists them) in a position where they are forced to violate their consciences in order to meet a standard of competence violates more than federal law. It violates decency and the core value of personal liberty. Freedom of expression and action are unfit barter for admission to medical employment or training.
As Secretary of Health and Human Services, I called on the organization that oversees Ob-Gyn board certification to alter its guidelines to assert that refusal to violate conscience will not be used to block board certification. Their answer was dodgy and unsatisfying.
The American Board of Obstetrics and Gynecology (ABOG) is the certifying organization for ob/gyns, and has clearly stated since at least March of this year that refusal to perform or refer for abortion would have no bearing on issuance or renewal of provider certification. As this NPR piece documents,
Norman Gant, executive director of the certifying board, says HHS got it all wrong.
"They took two and two and came up with five," he said.
Gant, who didn't respond sooner because he was out of the office, backed up what ACOG spokesman Gregory Phillips said Tuesday, which is that the ethics committee opinion regarding referrals is not a binding portion of the college's ethics code, and therefore not a factor in the decision about board certification.
"We do not restrict access to our exams for anyone applying for initial certification, or maintenance of certification, based on whether they do or do not perform an abortion," Gant said. "We do not base this upon whether they do or do not refer patients to an abortion provider if they do not choose to do abortions."
Gant has publicly released his organization's response [PDF] to the issuance of the official regulation, in which Leavitt again refers to "the potential to force physicians to either violate their conscience by referring patients for abortions (or taking other objectionable actions) or risk losing their board certification." In his response, Gant states that he is:
"both shocked and very dismayed at the grossly untrue and unfair allegation that:
"...action by the American Board of Obstetrics and Gynecology...had the potential to force physicians to either violate their conscience by referring patients for abortions (or taking other objectionalbe actions) or risk losing their board certification."
The "subsequent action" to which you refer is totally unspecified in the Release. Moreover, your allegation is directly contrary to the advice I provided you in my letter to you of March 19, 2008, which expressly stated:
"The American Board of Obstetrics and Gynecology has taken no stand, pro or con, against individual physicians who choose to or choose not to perform abortions or to refer patients to abortion providers.
Moreover, such an issue is not a consideration in the application or in the examinations administered by the American Board of Obstetrics and Gynecology in any of its certification or in its Maintenance of Certification requirements or examinations."
Gant goes on to challenge Leavitt, essentially, to prove it:
In none of our various communications with you and your Department have you provided the American Board of Obstetrics and Gynecology with "even one" instance of the discrimination of which you have publically accused it in your Press Release, let alone any supporting documentation. My careful and comprehensive review of the ABOG files does not disclose "even one" instance of a physician who was denied certification or recertification, or whose certification was revoked, because the ABOG allegedly required that physician, as you have charged, to violate his or her conscience by referring patients for abortions.
The ABOG has previously and privately requested you to provide it with any cases or documentation you have to support your accusations so that it could know by whom it has been accused and for what offense. By this letter, which we are releasing to the public and the press, we again ask that you provide evidence supporting the serious and damaging charges you have made.
In other words, ABOG has clearly restated that certification is not at issue if a provider refuses to perform or refer for abortion, and is challenging Leavitt to provide any evidence that this is a real justification for the regulation, which he has thus far failed to provide. Gant goes on to request that formal hearings be held for receipt of public comment so the the "intent and full implications of any proposed Regulations governing ‘conscience rights' may be fully understood."
Gant also notes that it would provide "a public forum in which the allegations against the ABOG may be refuted, and will offer an opportunity for a complete consideration of the implications of the conduct the Regulation would impact, including, but not limited to, considerations of malpractice liability and the implications on women's health care."
This piece was originally posted at Our Bodies Our Blog.
