Showing posts with label Health Care LGBTQ. Show all posts
Showing posts with label Health Care LGBTQ. Show all posts

July 24, 2018

Trump Wants Regulatory Changes to Make it More Difficult for LGBT to Obtain Medical Help

The Trump administration is considering regulatory changes that would worsen barriers many lesbian, gay, bisexual, and transgender (LGBT) people in the United States face in obtaining health care, Human Rights Watch said in a report released today. The US Department of Health and Human Services (HHS) should reconsider those changes, which would leave LGBT people more vulnerable to discrimination.

The 34-page report, “‘You Don’t Want Second Best’: Anti-LGBT Discrimination in US Health Care,” documents some of the obstacles that LGBT people face when seeking mental and physical health care services. Many LGBT people are unable to find services in their area, encounter discrimination or refusals of service in healthcare settings, or delay or forego care because of concerns of mistreatment.

“Discrimination puts LGBT people at heightened risk for a range of health issues, from depression and addiction to cancer and chronic conditions,” said Ryan Thoreson, an LGBT rights researcher at Human Rights Watch. “Instead of treating those disparities as a public health issue, HHS is developing politicized rules that will make them much worse.”

Two upcoming regulatory changes are likely to worsen these barriers, Human Rights Watch said. In January 2018, HHS issued a proposed rule that would broaden existing religious exemptions in health care law, giving sweeping discretion to insurers and providers to deny service to patients because of their moral or religious beliefs. In April 2018, the Trump administration announced plans to roll back a regulation that clarifies that federal law prohibits health care discrimination based on gender identity. If finalized, these changes would further undermine the limited antidiscrimination protections that currently exist for LGBT people.

Human Rights Watch interviewed 81 people for the report, including providers and individuals who said they had experienced discrimination in healthcare settings.

July 23, 2018 Report
“You Don’t Want Second Best”
Anti-LGBT Discrimination in US Health Care
Existing protections for LGBT people in health care are uneven. In 2016, the Obama administration issued a regulation clarifying that Section 1557 of the Affordable Care Act, which prohibits sex discrimination in health care, also prohibits discrimination against transgender people. Eight states and religious health care providers challenged the regulation in court, and the Trump administration has signaled it plans to roll it back.

Protections at the state level are lacking. As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. New Jersey prohibits discrimination based on gender identity but not sexual orientation. In 10 US states, transition-related health care is expressly excluded from Medicaid coverage, limiting options for low-income transgender people.

LGBT people interviewed for the report described difficulty finding hormone replacement therapy, HIV prevention and treatment options, fertility and reproductive services, and even just welcoming primary care services. Judith N., a transgender woman in East Tennessee, said, “I spent years looking for access to therapy and hormones and I just couldn’t find it.”

Others described discriminatory treatment by providers. Trevor L., a gay man in Memphis, recalled an incident when he took an HIV test at his annual checkup in 2016: “and they sat down and started preaching to me – not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, oh, thank you, I’ve been out for 20 years and I think I’m okay. It’s almost like they feel they have the right to tell you that it’s wrong.”

In addition to discrimination, many LGBT people are refused services outright because of their sexual orientation or gender identity. In a nationally representative survey conducted by the Center for American Progress in 2017, 8 percent of lesbian, gay, and bisexual respondents and 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity in the past year. Interviewees described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs precluded her from evaluating a same-sex couple’s 6-day-old child.

Both providers and LGBT people noted that concerns about discrimination and mistreatment led LGBT people to delay or forego care. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek care they needed because of concern about mistreatment based on gender identity.

Many interviewees expressed concern that laws permitting providers to refuse service on moral or religious grounds would make care even harder to obtain. Persephone Webb, a transgender activist in Knoxville, Tennessee, said that “[i]t tells people who are prone to being bigoted to be a little braver, and a little braver. And we see through this – we know this is an attack on LGBT people.”

Instead of finalizing the proposed changes, HHS should preserve antidiscrimination protections and withdraw sweeping exemptions that put patients at risk, Human Rights Watch said. Lawmakers at the state and federal level should prohibit discrimination in health care on the basis of sexual orientation and gender identity and should repeal exemptions that allow providers to refuse to serve patients because of their sexual orientation or gender identity.

“When LGBT people seek medical care, the oath to do no harm too often gives way to judgment and discrimination,” Thoreson said. “Lawmakers need to make clear that patients come first, regardless of their sexual orientation or gender identity.”

March 20, 2018

LGBT Inclusive Hospice Care

Cover of
Cover of "LGBTQ-Inclusive Hospice and Palliative Care "
Discrimination against LGBT people is unacceptable in any instance. But it is particularly unforgiveable when encountered in a hospice or palliative care environment.
When an LGBT person has a serious or life-limiting illness and seeks palliative care or hospice care, they run the risk of isolation and marginalization at the precise time when they most need support. LGBT family members of straight patients seeking hospice care are also vulnerable.
A 2016 survey quoted in The Atlantic article “LGBT Seniors Are Being Pushed Back Into the Closet” by David R. Wheeler,” found that LGBT seniors were frequently mistreated by care-center staff. Abuse  included cases of verbal and physical harassment and refusal of basic services. Some respondents reported being prayed for and warned they might ‘go to hell’ for their sexual orientation or gender identity.” Stripped of any sense of comfort while facing a serious illness some find their situation all the more excruciating. LGBT adults who’ve already experienced a lifetime of discrimination may be particularly vulnerable as they seek out care.
When seeking LGBT-inclusive hospice and palliative care for ourselves or a loved one, it is critically important to know what to look for. In the handbook for hospice and palliative care professionals, LGBTQ-Inclusive Hospice and Palliative Care by Kimberly D. Acquaviva (Harrington Park Press) offers guidelines that translate easily into advice for those seeking palliative and end-of-life care. It is the Book of the Year for Palliative Care and Hospice category from the American Journal of Nursing.
Beyond sensitivity training in caring for LGBT patients, the handbook reiterates the broader tenet of never assuming anything about patients, family members, colleagues, or employees. Never assume the gender a person identifies as or the pronouns they want used to refer to themselves. Never make assumptions about how a person wants to be addressed, never assume that an LGBT person’s family either rejects or embraces theim and never assume anything regarding spirituality.
The handbook discusses how to conduct an inclusive “intake interview” and how to understand complex family dynamics. It offers guidance on topics that may not be as obvious, but are equally critical, such as whether or not an LGBT healthcare professional should disclose their gender identity and/or sexual orientation in an effort to bond with the patient. Professionals need to be mindful of not inadvertently “outing” patients whose sex anatomy and gender identity do not match by using their preferred gender pronouns, and making sure patients’ wishes are legally protected with a healthcare power of attorney.
For those searching for a hospice or palliative care organization, one of the most important things to look for is a prominently displayed, LGBT-inclusive, nondiscrimination statement.
The statement should, at minimum, include the phrases “gender identity” and “sexual orientation,” in addition to the other phrases that commonly appear in nondiscrimination statements. The statement should appear on the organization’s website homepage — not buried on some other page and be included in any printed marketing materials.
Type the terms “LGBT,” LGBTQ,” “gay,” “lesbian,” “bisexual,” “transgender,” “discrimination,” “gender identity,”  gender expression,” or “sexual orientation” into any search boxes embedded on the organization’s homepage. It should yield a link to the nondiscrimination statement.
In order for a hospice or palliative care employees also feel safe, comfortable, and valued. Look at the organization’s non-discrimination statement to make sure it protects LGBT employees. Also, look for staff diversity that don’t appear awkward, forced, or worse, stock photos of crayon-box lineups. Ads in LGBT newspapers and websites, an information booth at a local LGBT Pride festival, and availability of an LGBT bereavement group is ideal.
There’s an easy way to assess how inclusive a hospice or palliative care program really is: If you visit the program’s offices just look for gender-neutral bathrooms. A willingness to address the needs of ALL people by installing gender-neutral bathrooms is a pretty good indication of its commitment to LGBT inclusivity.
LGBTQ-Inclusive Hospice and Palliative Care is published by Harrington Park Press, and distributed by Columbia University Press.

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January 19, 2018

Trump"s Conscience Law Will Allow Medical Personnel from Attending to Gays


 No abortions for you hnoey but you can have the cross of Christ and his love for people like me

Health care workers who want to refuse to treat patients because of religious or moral beliefs will have a new defender in the Trump administration.

The top civil rights official at the Department of Health and Human Services is creating the Division of Conscience and Religious Freedom to protect doctors, nurses and other health care workers who refuse to take part in procedures like abortion or treat certain people because of moral or religious objections.

"Never forget that religious freedom is a primary freedom, that it is a civil right that deserves enforcement and respect," said Roger Severino, the director of HHS's Office for Civil Rights, at a ceremony to announce the new division.

The establishment of the division reverses an Obama-era policy that barred health care workers from refusing to treat transgender individuals or people who have had or are seeking abortions.

That Obama rule was challenged in court by the Franciscan Alliance, a Christian health care organization in Texas, and a judge in 2016 blocked enforcement as the case played out in court.

The new division appears to be primarily aimed at preventing health care workers from participating in abortion services that go against their religious beliefs. The division cites a 2011 federal regulation guiding the enforcement of conscience protections that mentions abortion more than 30 times.
Louise Melling, deputy legal director at the American Civil Liberties Union, said those conscience objections could expand to allow health workers to refuse some services to gay, lesbian and transgender people.

"This administration has taken a very expansive view of religious liberty," she said in an interview. "It understands religious liberty to override antidiscrimination principles."

HHS makes clear that it won't allow gender discrimination that is banned by federal law. The question, according to Melling, is whether the administration includes gender identity and sexual orientation in the definition of gender.

She says there are many examples of health workers refusing care on religious grounds, including a nurse who didn't want to provide post-operative care to a woman who had an abortion, a pediatrician who declined to see a child because his parents were lesbians and a fertility doctor who didn't want to provide services to a lesbian couple.

Acting HHS Secretary Eric Hargan said Thursday that is the point.

"For too long too many of these health care practitioners have been bullied and discriminated against because of their religious beliefs and moral conviction," he said.

The government, he said, has "hounded religious hospitals and the men and women who staff them, forcing them to provide and refer for services that violate their consciences."

The new division won't have to wait to get to work. A pediatric nurse at the Winnebago County Health Department in Illinois filed a complaint with HHS on Tuesday because she objects to her employer requiring that she be trained to make referrals to providers of abortion services or to help woman get abortion drugs, according to the Rockford Register Star.

This isn't the first time in the Trump administration that HHS's Office of Civil Rights has moved to protect people with moral or religious objections to some kinds of health care. In October, the agency allowed employers to refuse to pay for birth control coverage.

"Health providers should have the ability to live their religious beliefs without fear of workplace discrimination," said Sen. James Lankford, R-Okla., in a statement.

Lankford has long advocated for such protections and has sponsored a bill called the Conscience Protection Act to codify the rules.

HHS head Roger Semerino (Former Director, DeVos Center for Religion and Civil Society, Institute for Family, Community, and Opportunity)

The media spends a lot of time tracking Donald Trump’s every move and chasing down members of Congress, but much of governing happens in these bland halls. Under Trump, HHS may see more changes than any other agency, in part because the president’s predecessor left his biggest mark here. As Congress stalls on passing a new health-care bill, the Trump administration can still fight Obamacare with revised regulations, rejiggered budgets, and lackluster enforcement. 

December 22, 2017

Report Highlights Dangers of Religious Exemption Laws for LGBT Elders

 Everybody Ages and some days are longer for some than for others


[NEW YORK, NY] The Movement Advancement Project (MAP), the Public Rights/Private Conscience Project (PRPCP) at Columbia Law School, and SAGE, the nation’s largest and oldest organization dedicated to improving the lives of LGBT elders, released a new report, Dignity Denied: Religious Exemptions and LGBT Elder ServicesTo download the report, visit
The report highlights the unique ways in which lesbian, gay, bisexual, and transgender (LGBT) elders are harmed by a growing number of laws and policies aimed at exempting religious organizations and individuals from following nondiscrimination and civil rights laws and policies.
By 2050, the number of people older than 65 will double to 83.7 million, and there are currently more than 2.7 million LGBT adults who are 50 years or older living across the country. LGBT elders face unique challenges to successful aging stemming from current and past structural and legal discrimination because of their sexual orientation, their gender identity, their age, and other factors like race. These risk factors are exacerbated by recent efforts at the local, state, and federal levels to allow those with religious or moral objections to be exempt from nondiscrimination laws, leaving LGBT older adults vulnerable to increased risk for discrimination and mistreatment.
According to the report released by MAP, PRPCP at Columbia Law School, and SAGE, religiously affiliated organizations provide a majority of the services LGBT elders rely on for their most basic needs. LGBT older adults, like many older Americans in the United States, access a network of service providers for health care, community programming and congregate meals, food and income assistance, and housing, ranging from independent living to skilled in-home nursing. Approximately 85% of nonprofit continuing-care retirement communities are affiliated with a religion. Religiously affiliated facilities also provide the greatest number of affordable housing units that serve low-income seniors. Finally, 14% of hospitals in the United States are religiously affiliated, accounting for 17% of all the country’s hospital beds.
While many of these facilities provide quality care for millions of older adults, there exists a coordinated nationwide effort to pass religious exemption laws and policies, and file lawsuits that would allow individuals, businesses, and even government contractors and grantees to use religion as a basis for discriminating against a range of communities, including LGBT elders.
Dignity Denied: Religious Exemptions and LGBT Elder Services outlines myriad federal and state efforts to allow individuals, businesses, and organizations to opt out of following nondiscrimination laws as long as they cite a religious objection. While most providers will do the right thing when it comes to serving their clients, some will only do so when required by law. The report concludes that because so many service providers are religiously affiliated, these laws pose a considerable threat to the health and well-being of LGBT older adults.
In conjunction with the release of the report, a panel discussion was held on Friday, December 15, at Union Theological Seminary at Columbia University featuring speakers from Center for Faith and Community Partnerships, The LGBT & HIV Project, American Civil Liberties Union, The Movement Advancement Project, The New Jewish Home, New York City Commission on Human Rights, Public Rights/Private Conscience Project, Columbia Law School, the Union Theological Seminary, and SAGE.
“This report and the amicus brief SAGE filed in the Masterpiece Cake case clearly demonstrate that personal religious beliefs should never be a license to discriminate against LGBT people or anybody else,” said Michael Adams, CEO of SAGE. “That’s why we are bringing together aging experts, religious leaders, and our elders to expose the dangers that so-called religious exemptions pose for LGBT elders who need care and services. We must not allow the door of a nursing home or other critical care provider to slam in LGBT elders’ faces just because of who they are or who they love.”
“This important report reveals the many ways in which the privatization of elder services, largely to conservative religiously affiliated providers, leaves LGBT older adults no choice but to obtain care in facilities that do not welcome them,” said Katherine Franke, Sulzbacher Professor of Law, Gender and Sexuality Studies, and Faculty Director of PRPCP at Columbia University. “The many LGBT elders who are adherents of faith-based traditions themselves suffer a special indignity when they are forced to seek care in settings that deny the dignity of both their LGBT identity and their faith-based beliefs.”
“LGBT older adults already are more likely to be isolated and vulnerable. It is unconscionable that state and federal governments are working to allow providers to deny critical health care services and vital social supports to LGBT older adults simply because of who they are,” said Ineke Mushovic, executive director of the Movement Advancement Project. “Imagine how much harder it would be to reach out for help if you knew the organizations that were supposed to help you could legally reject you, and the government would back them up.”
The Movement Advancement Project (MAP) is an independent think tank that provides rigorous research, insight, and analysis that help speed equality for LGBT people. MAP works collaboratively with LGBT organizations, advocates and funders, providing information, analysis and resources that help coordinate and strengthen efforts for maximum impact. MAP’s policy research informs the public and policymakers about the legal and policy needs of LGBT people and their families.  Learn more at
PRPCP at Columbia Law School’s mission is to bring legal academic expertise to bear on the multiple contexts in which religious liberty rights conflict with or undermine other fundamental rights to equality and liberty. We undertake approaches to the developing law of religion that both respects the importance of religious liberty and recognizes the ways in which too broad an accommodation of these rights threatens Establishment Clause violations and can unsettle a proper balance with other competing fundamental rights. Our work takes the form of legal research and scholarship, public policy interventions, advocacy support, and academic and media publications.
SAGE is the country's largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults. Founded in 1978 and headquartered in New York City, SAGE is a national organization that offers supportive services and consumer resources to LGBT older adults and their caregivers, advocates for public policy changes that address the needs of LGBT older people, provides education and technical assistance for aging providers and LGBT organizations through its National Resource Center on LGBT Aging, and cultural competence training through SAGECare. Headquartered in New York City, with staff across the country, SAGE also coordinates a growing network of affiliates in the United States. Learn more at

June 21, 2017

The Dr. is Out and How They Are Failing the LGBTQ Community

You can’t deliver proper care to a patient you don’t truly see. Too often, medical providers aren’t even taught how to look at sexual and gender minority patients.

“A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world, ” said Harvey Cushing, a pioneer of American neurosurgery. Leaving aside the gendered language, the sentiment remains true. In medical school, you’re cautioned to see your patients as entire human beings and not to reduce them to a mere collection of symptoms or diagnoses. Viewing them through the narrow gauge of their illnesses alone limits a provider’s ability to care for them comprehensively.

But learning to view LGBTQ people within our own particular world has been largely absent from medical education. By failing to incorporate material about the specific needs of gender and sexual minority patients into their curricula, medical schools have produced graduates who are less aware of those patients’ needs. This lack of awareness can have measurable ill effects. 

Earlier this month, a study in JAMA Internal Medicine documented a wide discrepancy between how doctors perceived asking patients about being LGBTQ, and how patients themselves responded to such questions. Noting that both the Joint Commission and the National Academy of Medicine recommend asking patients about their gender and sexual identities, the authors conducted a survey of emergency department (ED) physicians and nurses, as well as potential ED patients, including gay, lesbian, bisexual, and straight respondents. (Technically, everyone is a potential ED patient, after all.)

About 80 percent of ED health care providers believed that patients would refuse to answer questions about their sexual identity. Just 10 percent of patients said they would actually do so. Only bisexual respondents were less likely than their straight counterparts to respond to such questions (which I interpret as a reflection of biphobia within both straight and gay communities).

In its report on the study, the New York Times quotes Dr. Adil H. Haider, the lead author, reflecting that the providers’ attitude “was mostly paternalistic: ‘We don’t want to make anyone feel different.’ But it turns out to be that, ‘Doctors, you may have the best of intentions, but your patients want to be asked.’ ”

“Patients are saying that you’ll make us feel more comfortable if you ask—and ask everyone, so that normalizes the questions,” Haider continued.

This new study isn’t the first report of physicians failing to ask their patients about sexual identity. A survey of gay and bisexual men conducted in 2014 by the Kaiser Family Foundation found that 47 percent of respondents had never discussed their sexuality with their physicians. As I wrote at the time, “By treating questions about being gay or bisexual as too embarrassing to ask, we merely reinforce the idea that they are shameful and allow the stigma to remain.”

If medical schools never teach students how and why to ask patients about sexual and gender identity, those questions will always seem foreign and foreboding. The consequences of failing to ask, and not knowing what to do with that information once gathered, have the potential to be catastrophic.

In a devastating article about the ongoing HIV epidemic among black gay and bisexual men, the Times notes that only about 10 percent of prescriptions for PrEP (a medical regimen that can prevent infection with the virus) are written for black men. In addition to lacking basic access to care, many of these men do not feel safe discussing their sexuality with providers, and many providers are unfamiliar with PrEP. Without doctors who know how to create a safe environment for disclosure of vitally important information about their patients and are up-to-date on the medical care of LGBTQ people, an underserved population of gay and bisexual men will continue to go without potentially life-saving medication.

Thankfully, medical schools are increasingly recognizing how important it is to include LGBTQ health in the education they provide.

“Over the past decade, schools have absolutely become more receptive to the need for improved LGBTQ health education,” Dr. Kristen L. Eckstrand, a psychiatry resident at the University of Pittsburgh, told me. As a medical student at Vanderbilt University, Eckstrand was co-director of the medical school’s Program for LGBTI Health, and chair of the Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development for the Association of American Medical Colleges (AAMC).

“This [increased interest] is due do many factors,” Eckstrand continued, “including students’ desire to take on scholarly projects towards understanding [other] students’ knowledge and attitudes regarding LGBTQ health, recognition of the importance of this topic by curriculum faculty and administrators, and release of recommendations by national regulatory bodies supporting improvement in medical training on LGBTQ health.”

In 2014, the AAMC released a comprehensive resource for medical educators to help improve the care of patients who are gender or sexual minorities. It offers a detailed description of how medical schools can recognize institutional barriers to creating an LGBTQ-friendly environment for learning, and how to implement curricular changes to better serve not only LGBT people but also those born with different sexual development (DSD), something about which my own education is seriously out of date. (DSDs have often been described as “disorders of sexual development,” which is the language the AAMC avoids.) Clinical topics range from HIV risk factors in gay men, to a DSD man suffering from “corrective” surgical trauma from after birth, to a child with same-sex parents, among several others.

“Our goal is to ensure that this topic is not siloed, but instead is embedded throughout the curriculum, similar to any other important topic,” said Laura Castillo-Page, AAMC senior director for diversity policy and programs. “We want to ensure that there is not solely an optional course which everything gets dumped into. We believe a more holistic approach works best for all diversity-related topics.”

In addition to the 2014 publication, the AAMC has an extensive range of online resources for medical education. These resources include videos and webinars devoted to all aspects of LGBTQ health care, from faculty development to clinical vignettes to enhanced focus on LGBTQ and DSD issues in research, and range from introductory t an advanced degree of familiarity with the various topics.

“We have developed various types of webinars on this topic, for a range of audiences and experience levels. Some are more introductory and include topics such as what does it mean to be transgender” said Castillo-Page, “what’s the appropriate terminology, how to take a medical history of a patient, and how to best collect data.”

As more new physicians learn these skills as a basic part of their education, the health needs of LGBTQ people will be better recognized and met. Simply learning how to ask patients about their sexual and gender identity as a matter of routine would be a good first step.

Top Comment:

"In a devastating article about the ongoing HIV epidemic among black gay and bisexual men, the Times notes that only about 10 percent of prescriptions for PrEP (a medical regimen that can prevent infection with the virus) are written for black men. 
Despite the encouraging trend over the past several years, Eckstrand identifies several ongoing barriers to widespread change. Due to lack of national standards for teaching the topic, experiences vary widely from school to school. In regions where the LGBTQ population is less present or the climate is more hostile, opportunities for supervised patient care can be limited. Similarly, few schools directly assess students’ skills in delivering care to sexual and gender minority patients, relying more on methods like multiple-choice testing. Finally, she notes the “hidden curriculum” of lessons students learn if they are in an institutional culture that is discriminatory against LGBTQ people, which reinforces bias against sexual and gender minority patients.

The work that remains notwithstanding, it’s encouraging to see how much more attentive medical schools are to these aspects of patient care than when I was in school myself. The needs of gender and sexual minority patients can’t be met so long as those needs are invisible. Learning how to see us in the first place is a necessary step toward equitable health care for LGBTQ people.

Daniel Summers is a pediatrician in New England. He writes about medicine and LGBTQ issues.
This article was first published on

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