Doran Stamps RN BSN CHC CPHRM Why do healthcare institutions need to address gender identity The right thing to do 70 of transgender individuals report experiencing discrimination in healthcare ID: 592838
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Slide1
The Intersection of Gender Identity and Healthcare
Doran Stamps, RN, BSN, CHC, CPHRMSlide2
Why do healthcare institutions need to address gender identity?
The right thing to do
70% of transgender individuals report experiencing discrimination in healthcare
19% of transgender or non-conforming individuals report being refused healthcare due to their status
41% of transgender individuals reported they had attempted suicide (compared with 1.6% of the general population)
Compliance with Non discrimination Section 1557 of the ACA Slide3
Key Parts of Section 1557 of the Affordable Care Act
Protecting individuals against sex discrimination
Ensuring Meaningful access for Individuals with Limited English Proficiency
Ensuring Effective Communication with and Accessibility for individuals with disabilities
Coverage of health insurance in marketplaces and other health plans Slide4
Protections Against Sex Discrimination
Includes discrimination based on:
An individual’s sex
Pregnancy, childbirth and related conditions
Gender identity
Sex stereotyping; including that an individual must identify as either male or female Slide5
Protections
Individuals cannot be denied health care or health coverage based on their sex, including their gender identity and sex stereotyping.
Women must be treated equally with men in the health care they receive and the insurance they obtain.
Categorical coverage exclusions or limitations for all health care services related to gender transition are discriminatory.
Individuals must be treated consistent with their gender identity, including in access to facilities. However, providers may not deny or limit treatment for any health services that are ordinarily or exclusively available to individuals of one gender based on the fact that a person seeking such services identifies as belonging to another gender.
Sex-specific health programs or activities are permissible only if the entity can demonstrate an exceedingly persuasive justification, that is, that the sex-specific health program or activity is substantially related to the achievement of an important health-related or scientific objective.
While the final rule does not resolve whether discrimination on the basis of an individual's sexual orientation status alone is a form of sex discrimination under Section 1557, the rule makes clear that OCR will evaluate complaints that allege sex discrimination related to an individual’s sexual orientation to determine if they involve the sorts of stereotyping that can be addressed under Section 1557. HHS supports prohibiting sexual orientation discrimination as a matter of policy and will continue to monitor legal developments on this issue.
Slide6
Examples of sex discrimination (from the OCR’s education slide deck)
Multiple staff at a hospital created a hostile environment for a transgender woman because she was transgender. She was also required to share a room with a male patient.
A pharmacist would not provide a flu vaccine to a woman and questioned her about her non-gender-conforming clothing and hairstyle.
Staff at a hospital’s emergency department ridiculed a male patient who arrived after sustaining injuries in a domestic incident. Staff did not evaluate the patient under a domestic violence protocol because he was male. Slide7
Gender Identity
An individual’s internal sense of gender, which may be female, male, neither, or a combination of female and male, and which may be different from an individual’s sex assigned at birth.Slide8
The way an individual expresses gender identity is frequently called “gender expression”, and may or may not conform to social stereotypes associated with a particular gender. A transgender individual is an individual whose gender identity is different from the sex assigned to that individual at birth. Slide9
What is gender identity?
Gender
identity
is one's personal experience of one's own gender. This is generally described as one's private sense of being a man or a woman, consisting primarily of the acceptance of membership into a category of people: male or female. All societies have a set of gender categories that can serve as the basis of the formation of a social identity in relation to other members of society.Slide10
Gender Categories
1. Male
2. Female
3. Female to Male (FTM)/Transgender Male/Trans Man
4. Male to Female (MTF)/Transgender Female/Trans Female)
5. Genderqueer, neither exclusively female nor male
6. Additional gender category or Other please specify
Decline to answer Slide11Slide12
Other terms
Cisgender:
A term used to describe someone whose gender identity aligns with the sex assigned to them at birth.
Androgynous:
Identifying and/or presenting as neither distinguishably masculine nor
feminine
Bigender
:
Someone whose gender identity encompasses both man and woman. Some may feel that one side or the other is stronger, but both sides are presentSlide13
Gender fluid:
A person who does not identify with a single fixed gender, and expresses a fluid or unfixed gender identity. One’s expression of identity is likely to shift and change depending on
context
Gender non-conforming:
A broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category. Slide14
Genderqueer:
A term for people who reject notions of static categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as genderqueer may see themselves as being both male and female, neither male nor female or as falling completely outside these categories. Slide15
Two-spirit:
A term that refers to historical and current First Nations people whose individual spirits were a blend of male and female. This term has been reclaimed by some in Native American LGBT communities to honor their heritage and provide an alternative to the Western labels of gay, lesbian, bisexual, or transgender. Slide16
Gender Affirming Surgeries
For Affirmed Women
Breast
Augmentation
Facial Feminization (FFS)
Gluteal and hip augmentation
Orchiectomy
Vaginoplasty
Labiaplasty
Clitoroplasty
For Affirmed Men
Chest Construction, also known as “Top Surgery” (Mastectomy)
Hysterectomy
Bilateral Oophorectomy
Metoidioplasty
Phalloplasty
– Stage 1 includes:
Vaginectomy
,
Urethroplasty
& Forearm Pre-Lamination
Phalloplasty
– Stage 2 includes:
Scrotoplasty
&
GlansplastySlide17
Hormone Therapy
MTF: Estrogen and anti-androgens spironolactone
FTM
: TestosteroneSlide18
What do we do?
Strategies to improve health care for gender non-conforming patients and to comply with Section 1557 requirements:
Use the patient’s identified gender
In
the
demographics- EHR
When
addressing the patient
On
wristbands and labels
Follow
the Fenway guidelines (MTF,
FTM, etc.)Slide19
•Understand that gender nonconformity is not a disorder
•Gender identity is not
binary (male, female)
•Gain
knowledge of transgender medical care needs
•Room according to gender
identity- (no charge for
accomodation
of gender by using a private room)
•Identify and use the patient’s preferred pronounsSlide20
Include gender identity in Non Discrimination and Patient’s Rights policies
Provide
role specific transgender care staff trainingSlide21
The EHR
Not currently standardized nor mandated, but this is coming.
EHR requirements have been made a part of Meaningful Use requirements. All EHR systems certified under Stage 3 of Meaningful Use will allow users of record to record, change and access structured data on sexual orientation and gender identity. These requirements are slated to take effect in 2018.Slide22
Suggested questions
Female to Male (FTM/Transgender Male/Trans Man
Male to Female (MTF/Transgender Female/Trans Woman
Genderqueer, neither exclusively male nor female
Additional gender category/Other please specify__________________
Decline to answerSlide23
What sex were you assigned at birth on your birth certificate?
Male
Female
Decline to answerSlide24
Record name and preferred pronoun in EHR
Registration records, in additions to Legal Name fields, should include a field for Name in Use. Nickname, alias or similar fields can be used. Slide25
Pronouns
She/her/hers
He/him/his
They/them/theirs
Patient’s name
Decline to answer
UnknownSlide26
Sexual Orientation
Lesbian or Gay
Straight (not Lesbian or Gay)
Bisexual
Something else
Don’t know
Choose not to disclose Slide27
Federal Enforcement of Section 1557 (from OCR slide deck)
The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) enforces Section 1557 as to programs that receive funding from HHS.
OCR is a neutral, fact-finding agency that receives, investigates and resolves thousands of complaints from the public alleging discrimination in health services and health coverage.
When OCR finds violations, a covered entity will be required to take corrective actions, which may include revising policies and procedures, and implementing training and monitoring programs. Covered entities may also be required to pay compensatory damages.
When a covered entity refuses to take corrective actions, OCR may undertake proceedings to suspend or terminate Federal financial assistance from HHS. OCR may also refer the matter to the U.S. Department of Justice for possible enforcement proceedings.
Section 1557 also provides individuals the right to sue covered entities in court for discrimination if the program or activity receives Federal financial assistance from HHS or is a State-based Marketplace℠. Slide28
Enforcement
Violations and failure to address compliance issues can result in suspension or loss of federal funding and may include payment of compensatory damages.
Individuals can bring individual or class actions claims directly against covered entities in federal court.
Rumble v. Fairview Health ServicesSlide29
Resources
Fenway Institute National LGBT Health Education
Center: http://www.lgbthealtheducation.org/
Lambda Legal
OCR website (Section 1557 educational tools) www.hhs.gov/ocr Slide30
Questions?Slide31