Trans Teen Sues Catholic Health Organization After Being Denied Medical Care

"This is discrimination, and it is plainly illegal," a ACLU attorney said.
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Pax Enstad discusses his lawsuit with reporters at ACLU Washington Thursday.

Pax Enstad discusses his lawsuit with reporters at ACLU Washington Thursday.

Sarah Toce

A 17-year-old transgender boy named Pax Enstad was denied medical care by his mother’s employer, a Catholic health organization called PeaceHealth St. Joseph Medical Center in Bellingham.

The civil rights lawsuit was filed Thursday on behalf of the family by ACLU of Washington. Pax, his mother Cheryl and father Mark, spoke at the ACLU press conference in Seattle about the lawsuit.

Pax was assigned female at birth, but never felt quite right about himself. He suffered severe anxiety starting when he hit puberty at age 11 and was eventually diagnosed with gender dysphoria, a serious medical condition marked by persistent and clinically significant distress caused by incongruence between an individual’s gender identity and that individual’s sex designated at birth. Gender dysphoria is a condition codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and International Classification of Diseases (ICD-10).

In order to properly treat Pax’s gender dysphoria, Pax’s doctor prescribed chest reconstruction surgery. Not only did PeaceHealth deny the request after his insurance approved it, they refused treatments on the basis of his admission of being transgender.

The lawsuit asserts PeaceHealth’s blanket policy of refusing to pay for medically necessary healthcare for otherwise covered transgender individuals simply because of who they are discriminates on the basis of sex and gender identity, violates the Patient Protection and Affordable Care Act (ACA) and the Washington Law Against Discrimination (WLAD), and is harmful to the health of transgender individuals.

Cheryl Enstad addresses reporters at ACLU Washington Thursday.

Cheryl Enstad addresses reporters at ACLU Washington Thursday.

Sarah Toce

“PeaceHealth’s blanket of exclusion of ‘transgender services’ is not based on standards of medical care,” said ACLU-WA Staff Attorney Lisa Nowlin. “This is discrimination, and it is plainly illegal. Under state and federal law, no company is allowed to single out and exclude one group of individuals from medical care that is prescribed for them by their doctors and that the company routinely provides for others.”

In the past, some public and private insurance companies excluded coverage for gender dysphoria (or “transition-related care”) based on the erroneous assumption that such treatments were cosmetic or experimental. Today, however, every major medical organization recognizes that such exclusions have no basis in medical science and that transition-related care is effective for the treatment of gender dysphoria.

Discrimination by health care providers routinely causes transgender people to delay or forgo preventative and necessary medical care, putting them at greater risk for debilitating anxiety, depression, self-harm, and even suicide.

As a result of PeaceHealth’s exclusion for “transgender services,” the Enstads were forced to remove $10,000 from their son’s college savings account and take out a second mortgage on their house in order to get the help Pax needed to live a full and healthy life.

“We were willing to do whatever it took to get Pax the medical care he needed - as any parent would,” Cheryl said. “When your child is singled out and rejected simply for being themselves, it’s heartbreaking, and it isn’t fair. We’re bringing this lawsuit to ensure no family has to go through what we did.”

Cheryl worked at PeaceHealth over 20 years in social work and continues to be employed at the facility on an on-call basis. She admitted that it has become a strained environment since her son was denied life-saving coverage. Her husband works as a marine engineer.

The lawsuit asks the court to declare PeaceHealth’s blanket exclusion of “transgender services” discriminatory and illegal. It also seeks unspecified damages for the Plaintiffs.

The lawsuit, Enstad v. PeaceHealth, was filed in U.S. District Court in the Western District of Washington. PeaceHealth operates 70 sites in Washington, Oregon, and Alaska and has approximately 16,000 employees.

In addition to Nowlin, attorneys for the Enstads include Josh Block and Leslie Cooper with the ACLU LGBT & HIV Project and Denise Diskin and Beth Touschner of Teller & Associates.

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