When Brandon James walked into an ER trauma center suffering from elevated blood pressure and severe anxiety in 2011, he needed medical attention. Instead, he was humiliated by hospital staff who were unfamiliar with treating transgender patients.
James -- not his real name -- recounted his experience in an article published this month in the Journal of Emergency Nursing. He described hospital personnel who pointed at him and said things like: "No, that’s really a girl."
"It wasn’t business-like at all," he wrote. "I was a spectacle. I was a freak show at the circus. It was definitely to draw attention to the fact that my outward appearance didn't match [my identification].”
Sadly, James' story is part of larger trend of transgender patients being mistreated in health care settings. A 2011 survey found that 24 percent of transgender patients have been denied equal treatment in a doctor's office or hospital. Another survey published by LGBT civil rights advocates Lambda Legal found that 70 percent of non-gender conforming respondents had experienced some kind of discrimination, including refusal of needed care, verbal or physical abuse, and being blamed for the medical problem for which they sought care.
"I don’t think I know one trans person who doesn’t have a horror story of having some bad situation in a medical setting," Dru Levasseur, director of the transgender rights project at Lambda Legal, told The Huffington Post.
The Obama administration has made strides to strengthen the rights of transgender individuals, such as the inclusion of Section 1557 in the Affordable Care Act, prohibiting sexual discrimination in health care. And in September, the Department of Health and Human Services proposed even stronger nondiscrimination protections under Section 1557, entitling transgender people to equal health care treatment and the ability to make civil rights claims against providers and insurers who deny coverage or necessary care to trans people. In addition, the HHS proposal would forbid health insurance companies from categorically excluding gender transition treatments from coverage.
While there aren't standardized hospital procedures for addressing transgender patients' care, advocates like Levasseur are hopeful accounts like James' will go a long way toward bettering conditions for everyone.
The Journal of Emergency Nursing's report made specific recommendations to nurses for improving transgender patients' experiences in the emergency room, including asking people how they would like to be addressed, using pronouns that match gender identity, keeping the conversational clinical, keeping gender identity top of mind when assigning shared spaces with other patients to transgender individuals, and stepping in to diffuse any sensitive situations nurses encounter in a hospital setting.
Levasseur praised the Emergency Nursing article for putting transgender discrimination on the health care industry's radar. He also pointed to the case of Jakob Rumble, who in 2014 became one of the first individuals to file a suit under Section 1557 of the ACA. The suit alleged sexual discrimination at a Minnesota hospital, detailing a harrowing experience that included an "assaultive exam" that caused the patient to cry.
A preliminary ruling denied the hospital's request to throw out Rumble's case, paving the way for individuals who experience sexual discrimination in a health care setting to sue on those grounds.
"The facts of [Rumble's] case are very similar to this article, and the courts said that yes, absolutely, transgender people are protected on the basis of sex when they are accessing health care," Levasseur said.
“At a hospital, especially in an emergency room, you shouldn’t be concerned with somebody’s gender identity," James said he explained to an ER supervisor when he filed a complaint about his treatment. "You shouldn’t be concerned with how they present. You should be concerned with their health. And that should be the bottom line.”
Perhaps most importantly, calling attention to transgender health care discrimination cases, like James' and Rumble's, can help others realize that they're not alone.
"This population has extreme health disparities," Levasseur said. "I’m really pleased to see the health care industry trying to fill that gap."
CORRECTION: An earlier version of this article stated that Jakob Rumble was the first trans individual to file suit under Section 1557 of the ACA. In fact, Rumble was not the first trans person to file a suit, but his case resulted in the first decision regarding a trans person under the ACA.
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