Administrators face tough decisions as hospitals confront abortion issue.

PIP: Only 17% of US hospitals (265 public and 926 private hospitals) perform abortions, and hospital-based abortions represent only a small fraction of the number of abortions performed each year. Despite this low level of involvement, US hospitals have become involved in difficult situations concerning law, ethics, and standards of practice. A case in point is Baltimore's Saint Agnes Hospital, where the accreditation of the hospital's residency training program in obstetrics and gynecology was withdrawn in 1986 by the Accreditation Council for Graduate Medical Education. This decision was based on the hospital's refusal, for religious reasons, to perform abortions, sterilizations, and artificial insemination. The hospital further was cited for not providing family planning education to medical students. Saint Agnes Hospital maintained that the Council's decision represented discrimination against Catholic hospitals; as evidence, it cited the fact that, while Catholic- affiliated residency programs comprised only 10% of such programs, they accounted for 83% of programs in which deficiencies or concerns were identified by the Accreditation Council. Some Catholic hospitals deal with this situation by allowing residents to rotate to other facilities if they want to be trained in abortion services--an option Saint Agnes rejected. The number of hospitals that offer residents training in abortion has declined by 22% since 1977; at present, 13% of all gynecology-obstetrics residents have no access to such training.^ieng