I

103D CONGRESS

1ST SESSION H. R. 2715

To improve programs for women’s health in the Department of Defense.

IN THE HOUSE OF REPRESENTATIVES

JULY 22, 1993

Mrs. SCHROEDER (for herself, Mrs. LLOYD, Ms. FURSE, and Ms. HARMAN)

introduced the following bill; which was referred to the Committee on

Armed Services

A BILL

To improve programs for women’s health in the Department

of Defense.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Defense Women’s

5 Health Improvement Act of 1993’’.
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1 TITLE I—WOMEN’S HEALTH

2 CARE

3 SEC. 101. PRIMARY AND PREVENTIVE HEALTH-CARE SERV4 ICES FOR WOMEN.

5 (a) FEMALE MEMBERS AND RETIREES OF THE UNI6 FORMED SERVICES.—(1) Chapter 55 of title 10, United

7 States Code, is amended by inserting after section 1074c

8 the following new section:

9 ‘‘§ 1074d. Primary and preventive health-care serv10 ices for women

11 ‘‘Female members and former members of the uni12 formed services who are entitled to medical care under sec13 tion 1074 or 1074a of this title shall be furnished with

14 primary and preventive health-care services for women as

15 part of such medical care.’’.

16 (2) The table of sections at the beginning of such

17 chapter is amended by inserting after the item relating

18 to section 1074c the following new item:

‘‘1074d. Primary and preventive health-care services for women.’’.

19 (b) FEMALE DEPENDENTS.—Section 1077(a) of such

20 title is amended by adding at the end the following new

21 paragraph:

22 ‘‘(13) Primary and preventive health-care serv23 ices for women.’’.
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1 (c) DEFINITION.—Section 1072 of such title is

2 amended by adding at the end the following new para3 graph:

4 ‘‘(6) The term ‘primary and preventive health5 care services for women’ means health-care services

6 provided to women, including counseling, relating to

7 the following:

8 ‘‘(A) Papanicolaou tests (pap smear).

9 ‘‘(B) Breast examinations and mammog10 raphy.

11 ‘‘(C) Comprehensive reproductive health

12 care, including care related to pregnancy.

13 ‘‘(D) Infertility and sexually transmitted

14 diseases, including prevention.

15 ‘‘(E) Menopause.

16 ‘‘(F) Physical or psychological conditions

17 arising out of acts of sexual violence.’’.

18 SEC. 102. REPORT ON THE PROVISION OF HEALTH-CARE

19 SERVICES TO WOMEN.

20 (a) REPORT REQUIRED.—The Secretary of Defense

21 shall prepare a report evaluating the provision of health22 care services through military medical treatment facilities

23 and the Civilian Health and Medical Program of the Uni24 formed Services to female members of the uniformed serv-
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1 ices and female covered beneficiaries eligible for health

2 care under chapter 55 of title 10, United States Code.

3 (b) CONTENTS.—The report required by subsection

4 (a) shall contain the following:

5 (1) A description of the medical personnel of

6 the Department of Defense who provided health-care

7 services during fiscal year 1993 to female members

8 and covered beneficiaries, including—

9 (A) the number of such personnel (includ10 ing both the number of individual employees

11 and the number of full-time employee equiva12 lents);

13 (B) the professional qualifications or spe14 cialty training of such personnel; and

15 (C) the medical facilities to which such

16 personnel were assigned.

17 (2) A description of any actions, including the

18 use of special pays and incentives, taken by the Sec19 retary during fiscal year 1993—

20 (A) to ensure the retention of the medical

21 personnel described in paragraph (1);

22 (B) to recruit additional personnel to pro23 vide health-care services to female members and

24 female covered beneficiaries; and
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1 (C) to replace departing personnel who

2 provided such services.

3 (3) A description of any existing or proposed

4 programs to encourage specialization of health care

5 professionals in fields related to primary and preven6 tive health-care services for women.

7 (4) An assessment of any difficulties experi8 enced by military medical treatment facilities or the

9 Civilian Health and Medical Program of the Uni10 formed Services in furnishing primary and preven11 tive health-care services for women and a description

12 of those actions taken by the Secretary to resolve

13 such difficulties.

14 (5) An assessment of the extent to which gen15 der-related factors impede or complicate diagnoses

16 (such as inappropriate psychiatric referrals and ad17 missions) made by medical personnel described in

18 paragraph (1).

19 (6) A description of the actions taken by the

20 Secretary to foster and encourage the expansion of

21 research relating to health care issues of concern to

22 female members of the uniformed services and fe23 male covered beneficiaries.

24 (c) POPULATION STUDY OF THE NEED OF FEMALE

25 MEMBERS AND FEMALE COVERED BENEFICIARIES FOR
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1 HEALTH-CARE SERVICES.—(1) As part of the report re2 quired by subsection (a), the Secretary shall conduct a

3 study to determine the needs of female members of the

4 uniformed services and female covered beneficiaries for

5 health-care services, including primary and preventive

6 health-care services for women.

7 (2) The study shall examine the health needs of cur8 rent members and covered beneficiaries and future mem9 bers and covered beneficiaries based upon the anticipated

10 size and composition of the Armed Forces in the year

11 2000 and should be based on the demographics of society

12 as a whole.

13 (d) SUBMISSION AND REVISION.—The Secretary of

14 Defense shall submit the report required by subsection (a)

15 to Congress not later than April 1, 1994. The Secretary

16 shall revise and resubmit the report to Congress not later

17 than April 1, 1999.

18 (e) DEFINITIONS.—For purposes of this section:

19 (1) The term ‘‘primary and preventive health

20 care services for women’’ has the meaning given

21 such term in paragraph (6) of section 1072 of title

22 10, United States Code, as added by section 101(c)).

23 (2) The term ‘‘covered beneficiary’’ has the

24 meaning given such term in paragraph (5) of such

25 section.
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1 TITLE II—WOMEN’S HEALTH

2 RESEARCH

3 SEC. 201. DEFENSE WOMEN’S HEALTH RESEARCH CENTER.

4 (a) ESTABLISHMENT OF THE CENTER.—The Sec5 retary of Defense shall establish a Defense Women’s

6 Health Research Center (hereinafter in this section re7 ferred to as the ‘‘Center’’) in the Department of the Army.

8 The Center shall be under the authority of the Army

9 Health Services Command.

10 (b) PURPOSES.—(1) The Center shall be the coordi11 nating agent for multidisciplinary and multiinstitutional

12 research within the Department of Defense on women’s

13 health issues related to service in the Armed Forces. The

14 Center shall be dedicated to development and application

15 of new knowledge, procedures, techniques, training, and

16 equipment for the improvement of the health of women

17 in the Armed Forces.

18 (2) In carrying out or sponsoring research studies,

19 the Center shall provide that the cohort of women in the

20 Armed Forces shall be considered as a control groups.

21 (3) The Center shall support the goals and objectives

22 recognized by the Department of Defense under the plan

23 of the Department of Health and Human Services des24 ignated as ‘‘Healthy People 2000’’.
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1 (4) The Center shall support initiation and expansion

2 of research into matters relating to women’s health in the

3 military, including the following matters as they relate to

4 women in the military:

5 (A) Combat stress and trauma.

6 (B) Exposure to toxins and other environmental

7 hazards associated with military hardware.

8 (C) Psychology related stresses in warfare situ9 ations.

10 (D) Breast cancer.

11 (E) Reproductive health, including pregnancy.

12 (F) Gynecological cancers.

13 (G) Infertility and sexually transmitted dis14 eases.

15 (H) HIV and AIDS.

16 (I) Mental health, including post-traumatic

17 stress disorder and depression.

18 (J) Menopause, osteoporosis, Alzheimer’s dis19 ease, and other conditions and diseases related to

20 aging.

21 (K) Substance abuse.

22 (L) Sexual violence and related trauma.

23 (M) Human factor studies related to women in

24 combat.
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1 (c) PREPARATION OF A PLAN.—The Secretary of De2 fense, acting through the Secretary of the Army and in

3 coordination with the other military departments, shall

4 prepare a plan for the implementation of this section. The

5 plan shall be submitted to the Committees on Armed Serv6 ices of the Senate and House of Representatives before

7 May 1, 1994.

8 (d) REQUIREMENTS RELATING TO ESTABLISHMENT

9 OF CENTER.—(1) The Secretary shall provide for the es10 tablishment of the Center at an existing Army facility.

11 (2) The Center may be established only at a facility

12 having the following characteristics:

13 (A) A physical plant immediately available to

14 serve as headquarters for the medical activities to be

15 carried out by the Center.

16 (B) Ongoing fellowship and residency programs

17 colocated with ongoing collaborative health-related

18 and interdisciplinary research of (i) a facility of the

19 Department of Veterans Affairs, (ii) an accredited

20 university with specialties in medical research and

21 clinical diagnostics, and (iii) a hospital owned and

22 operated by a municipality.

23 (C) A technologically modern laboratory capa24 bility at the site and at the affiliated sites referred

25 to in subparagraph (B), with the capability to in-
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1 clude state-of-the-art clinical diagnostic instrumenta2 tion, data processing, telecommunication, and data

3 storage systems.

4 (D) Compatibility with and capability to effec5 tively expand its existing mission in accordance with

6 the mission of the Center under this section.

7 (E) Maximum multi-State geographic jurisdic8 tion to permit regional health-related issues to be re9 searched and integrated into national military

10 databases.

11 (F) An existing relationship for the provision of

12 services to Native Americans through the Indian

13 Health Service.

14 (e) ACTIVITIES FOR FISCAL YEAR 1994.—During fis15 cal year 1994, the Center shall address the following:

16 (1) Program planning, infrastructure develop17 ment, baseline information gathering, technology in18 fusion, and connectivity.

19 (2) Management and technical staffing.

20 (3) Data base development of health issues re21 lated to service on active duty as compared to serv22 ice in the National Guard or Reserves.

23 (4) Research protocols, cohort development,

24 health surveillance and epidemiologic studies.
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1 SEC. 202. CONTINUATION OF ARMY BREAST CANCER RE2 SEARCH PROGRAM.

3 During fiscal year 1994, the Secretary of the Army

4 shall continue the breast cancer research program estab5 lished in the second and third provisos in the paragraph

6 in title IV of the Department of Defense Appropriations

7 Act, 1993 (Public Law 102–396; 106 Stat. 1890) under

8 the heading ‘‘RESEARCH, DEVELOPMENT, TEST, AND

9 EVALUATION, ARMY’’ .

10 SEC. 203. INCLUSION OF WOMEN AND MINORITIES IN CLIN11 ICAL RESEARCH PROJECTS.

12 (a) GENERAL RULE.—In conducting or supporting

13 clinical research, the Secretary of Defense shall ensure

14 that—

15 (1) women who are members of the Armed

16 Forces are included as subjects in each project of

17 such research; and

18 (2) members of minority groups who are mem19 bers of the Armed Forces are included as subjects

20 of such research.

21 (b) WAIVER AUTHORITY.—The requirement in sub22 section (a) regarding women and members of minority

23 groups who are members of the Armed Forces may be

24 waived by the Secretary of Defense with respect to a

25 project of clinical research if the Secretary determines that
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1 the inclusion, as subjects in the project, of women and

2 members of minority groups, respectively—

3 (1) is inappropriate with respect to the health

4 of the subjects;

5 (2) is inappropriate with respect to the purpose

6 of the research; or

7 (3) is inappropriate under such other cir8 cumstances as the Secretary of Defense may des9 ignate.

10 (c) REQUIREMENT FOR ANALYSIS OF RESEARCH.—

11 In the case of a project of clinical research in which women

12 or members of minority groups will under subsection (a)

13 be included as subjects of the research, the Secretary of

14 Defense shall ensure that the project is designed and car15 ried out so as to provide for a valid analysis of whether

16 the variables being tested in the research affect women

17 or members of minority groups, as the case may be, dif18 ferently than other persons who are subjects of the re19 search.

20 SEC. 204. REPORT ON RESEARCH RELATING TO FEMALE

21 MEMBERS OF THE UNIFORMED SERVICES

22 AND FEMALE COVERED BENEFICIARIES.

23 Not later than July 1 of each of 1995, 1996, and

24 1997, the Secretary of Defense shall submit to Congress

25 a report containing—
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1 (1) a description (as of May 31 of the year in

2 which the report is submitted) of the status of any

3 health research that is being carried out by or under

4 the jurisdiction of the Secretary relating to female

5 members of the uniformed services and female cov6 ered beneficiaries under chapter 55 of title 10, Unit7 ed States Code; and

8 (2) recommendations of the Secretary as to fu9 ture health research (including a proposal for any

10 legislation relating to such research) relating to such

11 female members and covered beneficiaries.

12 TITLE III—WOMEN’S HEALTH

13 EDUCATION

14 SEC. 301. WOMEN’S HEALTH CURRICULUM ADVISORY COM15 MITTEE.

16 The Secretary of Defense shall establish at the F.

17 Edward Hebert School of Medicine of the Uniformed Serv18 ices University of the Health Sciences a women’s health

19 curriculum advisory committee to promote the comprehen20 sive integration of women’s health issues into the curricu21 lum at the University. The committee shall include the

22 surgeon general of each of the military departments and

23 the dean of the School of Medicine. The committee shall

24 be established by April 1, 1994.

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