I

103D CONGRESS

1ST SESSION H. R. 2797

To improve programs of the Department of Veterans Affairs relating to

women’s health, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JULY 29, 1993

Mrs. SCHROEDER (for herself, Mrs. LLOYD, Mr. EVANS, Mr. FILNER, Mr. EDWARDS of California, Mr. KENNEDY, Mrs. MEEK, Mr. MCDERMOTT, Ms.

DELAURO, Ms. DANNER, Mr. DELLUMS, Mr. LIPINSKI, Ms. KAPTUR, Mr.

PETERSON of Minnesota, Mr. WAXMAN, Ms. NORTON, Ms. SLAUGHTER,

Mr. BILBRAY, Mr. KOPETSKI, Mr. TORRES, Mr. DEUTSCH, Ms.

MARGOLIES-MEZVINSKY, Ms. VELA ́ZQUEZ, Mrs. MORELLA, Mr. GENE

GREEN of Texas, Mr. HUGHES, Mr. SLATTERY, Mr. BOUCHER, Ms.

PELOSI, Ms. WOOLSEY, and Mr. INSLEE) introduced the following bill;

which was referred to the Committee on Veterans’ Affairs

A BILL

To improve programs of the Department of Veterans Affairs

relating to women’s health, and for other purposes.

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 ‘‘Veteran Women’s

5 Health Improvement Act of 1993’’.
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1 SEC. 2. WOMEN’S HEALTH SERVICES.

2 (a) WOMEN’S HEALTH SERVICES.—Section 1701 of

3 title 38, United States Code, is amended—

4 (1) in paragraph (6)(A)(i), by inserting ‘‘wom5 en’s health services,’’ after ‘‘preventive health serv6 ices,’’; and

7 (2) by adding at the end the following:

8 ‘‘(10) The term ‘women’s health services’ means

9 health care services provided to women, including counsel10 ing and services relating to the following:

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

12 ‘‘(B) Breast examinations and mammography.

13 ‘‘(C) Comprehensive reproductive health care,

14 including pregnancy-related care.

15 ‘‘(D) The management of infertility.

16 ‘‘(E) The management and prevention of sexu17 ally-transmitted diseases.

18 ‘‘(F) Menopause, osteoporosis, and other condi19 tions relating to aging.

20 ‘‘(G) Physical or psychological conditions aris21 ing out of acts of sexual violence.’’.

22 (b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—

23 Section 1703(a) of such title is amended by adding at the

24 end the following:

25 ‘‘(9) Women’s health services for veterans on

26 an ambulatory or outpatient basis.’’.
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1 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

2 106 of the Veterans Health Care Act of 1992 (Public Law

3 102–585; 38 U.S.C. 1710 note) is amended—

4 (1) by striking out subsection (a); and

5 (2) by striking out ‘‘(b) RESPONSIBILITIES OF

6 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec7 retary’’.

8 (d) REPORT ON HEALTH CARE AND RESEARCH.—

9 Section 107(b) of such Act (38 U.S.C. 1710 note) is

10 amended—

11 (1) in paragraph (1), by inserting ‘‘and wom12 en’s health services (as such term is defined in sec13 tion 1701(10) of title 38, United States Code)’’ after

14 ‘‘section 106 of this Act’’;

15 (2) in paragraph (2), by striking out ‘‘and (B)’’

16 and inserting in lieu thereof ‘‘(B) the type and

17 amount of services provided by such personnel, in18 cluding information on the numbers of inpatient

19 stays and the number of outpatient visits through

20 which such services were provided, and (C)’’;

21 (3) by redesignating paragraph (4) as para22 graph (7);

23 (4) by adding after paragraph (3) the following

24 new paragraphs:
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1 ‘‘(4) A description of the personnel of the De2 partment who provided such services to women vet3 erans, including the number of employees (including

4 both the number of individual employees and the

5 number of full-time employee equivalents) and the

6 professional qualifications or specialty training of

7 such employees and the Department facilities to

8 which such personnel were assigned.

9 ‘‘(5) A description of any actions taken by the

10 Secretary to ensure the retention of the personnel

11 described in paragraph (4) and any actions under12 taken to recruit additional such personnel or person13 nel to replace such personnel.

14 ‘‘(6) An assessment by the Secretary of any dif15 ficulties experienced by the Secretary in the furnish16 ing of such services and the actions taken by the

17 Secretary to resolve such difficulties.’’; and

18 (5) by adding after paragraph (7), as redesig19 nated by paragraph (3) of this subsection, the fol20 lowing:

21 ‘‘(8) A description of the actions taken by the

22 Secretary to foster and encourage the expansion of

23 such research.’’.
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1 SEC. 3. EXPANSION OF RESEARCH RELATING TO WOMEN

2 VETERANS.

3 (a) HEALTH RESEARCH.—Section 109(a) of the Vet4 erans Health Care Act of 1992 (Public Law 102–585; 38

5 U.S.C. 7303 note) is amended—

6 (1) by inserting ‘‘(1)’’ before ‘‘The Secretary’’;

7 (2) in paragraph (1), as so designated, by strik8 ing out ‘‘veterans who are women’’ and inserting in

9 lieu thereof ‘‘women veterans’’; and

10 (3) by adding at the end the following:

11 ‘‘(2) In carrying out this section, the Secretary shall

12 consult with the following:

13 ‘‘(A) The Director of the Nursing Service.

14 ‘‘(B) Officials of the Central Office assigned re15 sponsibility for women’s health programs and sexual

16 trauma services.

17 ‘‘(C) The members of the Advisory Committee

18 on Women Veterans established under section 542 of

19 title 38, United States Code.

20 ‘‘(D) Members of appropriate task forces and

21 working groups within the Department of Veterans

22 Affairs (including the Women Veterans Working

23 Group and the Task Force on Treatment of Women

24 Who Suffer Sexual Abuse).
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1 ‘‘(3) The Secretary shall foster and encourage re2 search under this section on the following matters as they

3 relate to women:

4 ‘‘(A) Breast cancer.

5 ‘‘(B) Gynecological and reproductive health, in6 cluding gynecological cancer, infertility, sexually7 transmitted diseases, and pregnancy.

8 ‘‘(C) Human Immunodeficiency Virus and Ac9 quired Immune Deficiency Syndrome.

10 ‘‘(D) Mental health, including post-traumatic

11 stress disorder, depression, combat related stress,

12 and trauma.

13 ‘‘(E) Diseases related to aging, including meno14 pause, osteoporosis, and Alzheimer’s Disease.

15 ‘‘(F) Substance abuse.

16 ‘‘(G) Sexual violence and related trauma.

17 ‘‘(H) Exposure to toxic chemicals and other en18 vironmental hazards.

19 ‘‘(4) The Secretary shall, to the maximum extent

20 practicable, ensure that personnel of the Department of

21 Veterans Affairs engaged in the research referred to in

22 paragraph (1) include the following:

23 ‘‘(A) Personnel of the geriatric research, edu24 cation, and clinical centers designated pursuant to

25 section 7314 of title 38, United States Code.
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1 ‘‘(B) Personnel of the National Center for Post2 Traumatic Stress Disorder established pursuant to

3 section 110(c) of the Veterans Health Care Act of

4 1984 (Public Law 98–528; 98 Stat. 2692).

5 ‘‘(5) The Secretary shall ensure that personnel of the

6 Department engaged in research relating to the health of

7 women veterans are advised and informed of such research

8 engaged in by other personnel of the Department.’’.

9 (b) INCLUSION OF WOMEN AND MINORITIES IN

10 CLINICAL RESEARCH PROJECTS.—(1) In conducting or

11 supporting clinical research, the Secretary of Veterans Af12 fairs shall ensure that—

13 (A) women who are veterans are included as

14 subjects in each project of such research; and

15 (B) members of minority groups who are veter16 ans are included as subjects of such research.

17 (2) The requirement in paragraph (1) regarding

18 women and members of minority groups who are veterans

19 may be waived by the Secretary of Veterans Affairs with

20 respect to a project of clinical research if the Secretary

21 determines that the inclusion, as subjects in the project,

22 of women and members of minority groups, respectively—

23 (A) is inappropriate with respect to the health

24 of the subjects;
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1 (B) is inappropriate with respect to the purpose

2 of the research; or

3 (C) is inappropriate under such other cir4 cumstances as the Secretary of Veterans Affairs may

5 designate.

6 (3) In the case of a project of clinical research in

7 which women or members of minority groups will under

8 paragraph (1) be included as subjects of the research, the

9 Secretary of Veterans Affairs shall ensure that the project

10 is designed and carried out so as to provide for a valid

11 analysis of whether the variables being tested in the re12 search affect women or members of minority groups, as

13 the case may be, differently than other persons who are

14 subjects of the research.

15 (c) POPULATION STUDY.—Section 110(a) of such Act

16 (38 U.S.C. 1710 note) is amended—

17 (1) in paragraph (1), by striking out the second

18 sentence; and

19 (2) by amending paragraph (3) to read as fol20 lows:

21 ‘‘(3)(A) Subject to subparagraph (B), the study shall

22 be based on—

23 ‘‘(i) an appropriate sample of veterans who are

24 women; and
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1 ‘‘(ii) an examination of the medical and demo2 graphic histories of the women comprising such sam3 ple.

4 ‘‘(B) The sample referred to in subparagraph (A)

5 shall constitute a representative sampling (as determined

6 by the Secretary) of the ages, the ethnic, social and eco7 nomic backgrounds, the enlisted and officer grades, and

8 the branches of service of all veterans who are women.

9 ‘‘(C) In carrying out the examination referred to in

10 subparagraph (A)(ii), the Secretary shall determine the

11 number of women of the sample who have used medical

12 facilities of the Department, nursing home facilities of or

13 under the jurisdiction of the Department, and outpatient

14 care facilities of or under the jurisdiction of the Depart15 ment.’’.

16 SEC. 4. MAMMOGRAPHY QUALITY STANDARDS.

17 (a) APPLICABILITY TO DEPARTMENT OF VETERANS

18 AFFAIRS OF MAMMOGRAPHY QUALITY STANDARDS ACT

19 OF 1992.—Subsections (a) through (k) of section 354 of

20 the Public Health Service Act (42 U.S.C. 263b) shall

21 apply with respect to facilities of the Department of Veter22 ans Affairs without regard to the last sentence of subpara23 graph (A) of subsection (a)(3) of such section.

24 (b) EXTENSION OF DEADLINES.—Any deadline for

25 the completion of any action prescribed under any provi-
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1 sion referred to in subsection (a) shall be applied with re2 spect to facilities of the Department of Veterans Affairs

3 by extending such deadline so as to be two years after

4 the date of the enactment of this Act or two years after

5 the date which would otherwise be applicable under such

6 provision, whichever is later.

7 (c) INTERAGENCY COOPERATION.—The Secretary of

8 Veterans Affairs shall take appropriate steps to cooperate

9 with the Secretary of Health and Human Services in the

10 implementation of this section.

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