The facility claims religious exemption to deny the surgery to trans man
BALTIMORE—A transgender man allegedly was denied gender affirmation surgery at the University of Maryland Medical System (UMMS) and St. Joseph Medical Center in Towson, according to The Baltimore Sun.
The media outlet reported that Jesse Hammons, 33, filed the lawsuit late last week in the “U.S. District Court for the District of Maryland.”
Hammons alleges, in Hammons v. University of Md Et Al the health care facilities “violated his First and Fourth Amendment rights and the Affordable Care Act (ACA)” when they negated to provide the hysterectomy needed for his treatment—gender dysphoria. The suit states that the procedure was canceled a week before it was scheduled in January.
Section 1557 of the ACA created specific protections barring insurance discrimination based on sexual orientation and gender identity. Prior to enactment, medically necessary gender-affirming hormones and surgeries were often excluded from insurance coverage. One of the barriers to transgender health care is “bias and discrimination,” according to the American Medical Association (AMA).
“Access to gender-affirming care can be lifesaving,” said Dr. Robert Goldstein, Medical Director of the Transgender Health Program at Massachusetts General Hospital, to The Rainbow Times in 2020. “Forty-percent of all trans and non-binary individuals have attempted suicide at some point in their lifetime and the best way we have to decrease these rates is through affirming individuals and validating their gender identity and expression.
Catholic guidelines v. ACA
The UMMS purchased the hospital in 2012 “but it is run by the organization Catholic Health Initiatives, and an agreement with the Archdiocese of Baltimore means that physicians and health care professionals at the hospital have to follow the Catholic guidelines.” Supporters of the lawsuit have opposed Catholic beliefs in Catholic-run hospitals for decades. The backers cite a 2020 Supreme Court decision that holds employment discrimination on the basis of gender identity to be a violation of U.S. civil rights law.
When the surgeon called Hammons, he reportedly said a hospital administrator told him he couldn’t perform the hysterectomy “on a healthy uterus” because it violated the health care center’s Catholic philosophies.
American Medical Association
The AMA wrote a letter to the Supreme Court in 2019 in which it tried to “educate” the Court on transgender issues.
“Many transgender individuals are diagnosed with gender dysphoria, a condition that is characterized by clinically-significant distress and anxiety resulting from the incongruence between an individual’s gender identity and birth-assigned sex,” read the letter. “Medical treatments are effective in alleviating gender dysphoria.”
One such medical treatment includes medically transitioning—through procedures often known as gender affirmation or gender confirmation surgery (GAS, GCS, respectively).
A 2019 healthcare brief by AMA and Health Professionals Advancing LGBTQ Equality (GLMA) estimated the number of trans people in the U.S. and shed light on the appropriate care that members of this community may opt to follow, based on their gender dysphoria.
Approximately “1.4 million adults and 150,000 youth ages 13 to 17 in the United States identified as transgender,” many of whom will seek some form of transition eventually.
“Standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include but are not limited to mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries,” read the AMA brief.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders states that “some people with gender dysphoria may experience significant distress or problems functioning when their gender identity differs from what is typically associated with the sex they were assigned at birth.”
The brief also found that “increased prevalence of these mental health conditions is widely thought to be a consequence of minority stress, the chronic stress from coping with societal stigma and discrimination because of one’s gender identity and expression.”
Twenty states (CA, CT, CO, DE, HI, IL, MA, MD, MI, MN, NJ, NM, NV, NY, OR, PA, RI, VT, and WA) and District of Columbia prohibit health insurers from excluding coverage for transgender health services. California, for example, prohibits health plans from denying coverage or limiting coverage on the basis of sex, which is defined to include gender, gender identity, and gender expression.