Document ID: ./input/supremecourt_opinions/opinions/19pdf/18-1323_c07d.pdf
Page Number: 86.0

Cite as:  591 U. S. ____ (2020) 

5 

ALITO, J., dissenting 

who  perform  abortions  meet  a  higher  standard  of  compe-
tence than is shown by the mere possession of a license to 
practice.  In deciding whether to grant admitting privileges, 
hospitals typically undertake a rigorous investigative pro-
cess  to  ensure  that  a  doctor  is  responsible  and  competent
and has the training and experience needed to perform the 
procedures for which the privileges are sought.  As the Fifth 
Circuit explained, “hospitals verify an applicant’s surgical 
ability, training, education, experience, practice record, and 
criminal history.  These factors are reviewed by a board of 
multiple physicians.”  June Medical Services, L. L. C. v. Gee, 
905 F. 3d 787, 805, n. 53 (2018). 

The standards used by the great majority of hospitals in
deciding whether to grant privileges clearly show that hos-
pitals demand proof of a higher level of competence.  The 
Joint Commission, a nonprofit organization that accredits 
healthcare institutions, has issued standards for granting 
admitting  privileges,  and  all  of  the  hospitals  whose  rules 
are relevant here (and the vast majority of Louisiana hos-
pitals) comply with those standards.1  These standards call 
for an examination of each applicant’s licensure, education,
training, and current competence.  See Joint Commission, 
2020 Hospital Accreditation Standards, pp. MS–23, 25, 26, 
29.  They require an examination of a doctor’s health rec-
ords, clinical data on performance, and peer recommenda-
tions, and they demand that a hospital make a careful as-
sessment of the procedures a physician may perform.  Ibid. 
Dr. Robert Marier, the former director of the Louisiana 
Board of Medical Examiners (and the former dean of Loui-
siana  State  University  Medical  School),  testified  that  the 
process conducted by hospitals in deciding whether to grant 
admitting  privileges  is  “the  primary  way  of  determining 
—————— 

1 Quality  Check,  Find  a  Gold  Seal  Health  Care  Organization  (2020),
https : // www .qualitycheck . org / search / ? keyword=louisiana # keyword = 
louisiana&accreditationprogram=Hospital  (listing  “[o]rganizations  that
have achieved The Gold Seal of Approval from the Joint Commission”).