Dr. James Holsinger, the nominee to be the next surgeon general, is facing tough questions from gay rights groups that say his religious beliefs will prevent him from being a fair public health advocate.

Chief among their concerns are unfavorable decisions for homosexuals that Holsinger made as an official for the United Methodist Church, a position paper he wrote in 1991 that said homosexuality is not "complementary" physically, and therefore leads to greater chance of disease and injury, and his role in the establishment of a Kentucky church in 2000.

Holsinger, a cardiologist, was Kentucky's top public health official, and also was chancellor of the University of Kentucky's medical center. In his nomination, President Bush said one of Holsinger's focuses would be on preventing obesity, something he was praised for in his state role back home.

Bryan Hopping, 30, is a third-year medical student who is gay and has been watching the issue since Holsinger's May 24 nomination. He said based on what he knows about the man, Holsinger should not be the surgeon general.

"He has a lot of explaining to do," said Hopping, who also is the spokesman of the Touro University Gay Straight Alliance in Vallejo, Calif. "Anything short of condemnation [of his previous positions on homosexuality] really, I don't think will satisfy me. Really, the [1991] paper is totally offensive. ... He's willing to twist scientific knowledge ... towards a certain agenda, that he's not neutral."

But whether or not the criticism of Holsinger spells trouble for his nomination has yet to be seen.

The Senate Health, Education, Labor and Pensions Committee has not scheduled a hearing date yet for Holsinger's nomination, and "it's too premature" to say what kind of effect the criticism would have on the nomination, said committee spokeswoman Laura Capps. She said only that news of the criticism is being followed by the committee.

Holsinger could not be reached for comment Thursday. His wife, Barbara Holsinger, said by telephone from their Lexington home that they have been instructed not to talk to the press and

"As a physician, Dr. Holsinger’s focus has been to provide compassionate effective care to any and all who need it. If confirmed as Surgeon General, he has expressed his commitment to addressing the evidence-based health care needs of all populations," Health and Human Services spokeswoman Christina Pearson said in a prepared statement.

Adding that Holsinger's "professional record built over a 40-year career in public service speaks for itself," Pearson noted that he fought to include a panel on lesbian health at a 2002 conference "because he believes we must educate health care providers to be prepared to meet the needs of anyone who seeks care. He is committed to continuing to advance that position."

Pearson said the 1991 study was commissioned by the United Methodist Church, which asked for a compilation of peer-reviewed scientific data on homosexual health issues.

"Since then, the science has deepened with continued research on these issues. Dr. Holsinger remains focused on addressing the health of all in need, including gay and lesbian populations, consistent with sound science and the best medical practices," Pearson said.

Other questions over Holsinger's role in the founding of a church are overblown, said Rev. David Calhoun, lead pastor of Hope Springs Community Church, a Methodist church in Lexington.

A number of gay rights groups have pointed to a program in the church as one of the negative factors against Holsinger. They say that a program in the church is designed to re-educate, or "cure" gay men from their homosexuality.

Calhoun disagrees.

"The perception that Dr. Holsinger founded a church who targets the gay population is not correct, is inaccurate," Calhoun said in a telephone interview.

Calhoun said news reports have confused facts around one program under the church's recovery ministry, a catch-all group for solving personal problems based on the Alcoholics Anonymous 12-step program. In that ministry is housed the men's sexual integrity support group, Calhoun said, which is focused on "unhealthy and destructive, and spiritually unhealthy" activity, like pornography or promiscuity.

"[Sexual] orientation is not the issue," he said.

Calhoun added that Holsinger had nothing to do with the establishment of that program. Although Holsinger and his wife helped start the church in 2000 -- the were among the first group of about 15 volunteers who signed up -- Holsinger should not be confused as the founder of the church.

Rather, Holsinger and his wife's role were as volunteers who established outreach events to get the church started in its early days, possibly hosting a bible study once in a while, and pitching in on other activities as needed.

"It wasn't glamorous work in those early days," Calhoun said.

Calhoun also said he never has had a conversation with Holsinger about whether homosexuality is a sickness.

"He's a great guy. He cares about people. He'll be a wonderful surgeon general," Calhoun said, adding that he had never been under Holsinger's medical care.

Holsinger's role on the national Judicial Council of the Methodist Church also is proving to be a source of concern for gay rights groups. He cast a dissenting vote in 2004 in a decision on whether to retain a pastor who was lesbian. The majority agreed to maintain her position. Last year, he also favored a pastor who wanted to block a gay man from joining his congregation.

"He has a pretty clear bias against gays and lesbians," said Christina Gilgor, director of the Kentucky Fairness Alliance, a gay rights group. "This ideology flies in the face of current scientific medical studies. That makes me uneasy that he rejects science and promotes ideology."

Gay rights groups also note that several medical professional associations, such as the American Medical Association, have adopted policy positions that homosexuality is not a disease. The AMA did not offer comment regarding the nomination on Thursday.

Blair Jones, a White House spokesman, said Holsinger had spent his career in public service and taking care of others.

"On numerous occasions, Dr. Holsinger has taken up the banner for underrepresented populations, and he will continue to be a strong advocate for these groups and all Americans," Jones said.

"Jim is able, as most of us are in medicine, to separate feelings that we have from our responsibility in taking care of patients," said Douglas Scutchfield, a professor of public health at the University of Kentucky.

But Hopping, the California medical student, said he's not convinced that Holsinger should be surgeon general.

"It's a leadership issue. It's showing that he's not even aware of the problems that we have in the United States with healthcare," he said.

The Associated Press contributed to this report.