Health Care

First do no harm

An article published Monday in the Journal of Emergency Nursing will hopefully change the treatment of transgender people in hospital emergency rooms. The article was submitted by Ethan Collin Cicero, BSN, RN and Beth Perry Black, PhD, RN, from Chapel Hill, NC and was entitled, I was a Spectacle...A Freak Show at the Circus: A transgender Person's ED Experience and Implications for Nursing Practice

The article offers a case study for Brandon James (not his real name), a transgender man who visited an Emergency Department in the southeastern US a few years ago, expecting to be treated like any other patient.

Instead, he was treated like a "freak show at the circus" by hospital staff when the female marker on his driver's license and medical record did not match up with his masculine appearance and preference to go by male pronouns.

The authors point to one recent study, which found that about 19 percent of transgender patients reported having been refused care because of their gender status, and 28 percent said they experienced harassment in a medical setting.

Unfortunately, this is fairly common. From a nursing perspective, those are very alarming numbers to learn about, so that's why we wanted to look a little more closely into this community's health care experiences.

--Cicero, a doctoral student at the Duke University School of Nursing



Pure Happy

 photo corey_zpsvh6vuw9q.jpgErica Maison is the mother of five children in Detroit. One of her daughters is a transgender girl named Corey.

Erica told BuzzFeed News that Corey was always feminine, even from the time she was very young. “She loved to dress in high heels and dresses. In public she wore boy clothes — I just assumed she might be gay.”

When Corey was in the fifth grade she was bullied so badly her mother made the decision to pull her out of public school and begin homeschooling. It wasn’t until Corey was 11 years old that the mother-daughter duo came across a video of transgender YouTuber Jazz Jennings and everything suddenly clicked. “She said, ‘Mom, I’m just like her, I AM a girl.’

Once she was at home and free to be herself, Corey started gaining confidence and began dressing like a girl in public — which wasn’t always easy.

Her hair was still very short, and she still looked like a boy. People would give her dirty looks, and take pictures of her with their cell phone cameras. They would laugh, and point, and stare. I told Corey, ‘Every time someone points their phone at you to take a picture, you turn and smile and strike a pose!’ That really boosted her self-esteem. I wanted to teach her to turn anything negative into something positive.

--Erica Maison




Duke University Hospital opens new gender clinic

Duke University Health System of Durham, NC has created a new clinic to treat children and teems with gender identity and development issues.

 photo Hunter_zpsztpcxong.jpgThe clinic will address young people who are transgender or intersex as well as those who may have genital development or puberty issues.

The link above provides some background through the story of Hunter Schafer, one of Duke's patients.







AIDS Conference Interruptus


 photo USCA_zpspevcdxyk.jpg

The 2015 US Conference on AIDS was held September 10-13 in Washington, DC. On the opening day dozens of transgender and gender-nonconforming people seized the stage at the lunchtime plenary session to draw attention to HIV+ gender-variant people.

The group was chanting, We are not gay men! to protest the inclusion of trans women in gay male research and statistics.



Trans woman denied healthcare

Minnesota resident Nova Bradford, 21, had a chemical dependency problem, which she wanted to get help with, so she tried to gain admission to the University of Minnesota Medical Center's Lodging Plus substance abuse treatment program.

You can recover from chemical addiction and live a fuller life. To do so, you most likely will need support or assistance. Our services include assessment, medically supervised detoxification, inpatient and outpatient evaluation and referral, inpatient-to-outpatient treatment, family counseling and aftercare. Working with us, you’ll recover physically, psychologically, interpersonally and spiritually.

As it turns out the use of the word "you" in the above was overly broad.

Nova was refused admission because she is a transgender woman. Fairview Health Services, which operates UMMC informed her that it would be inappropriate to accept her into the program because there were separate floors for male and female residents and "because they have open showers."



The social costs of denying health care for transfolk

For background you might read Joan McCarter's How bad is health insurance for trans people? Really, really bad.

A new nationwide survey measures the social cost of health care providers denying care to transgender people.

As a result of being denied insurance coverage for transition-related medical care, 35% of survey respondents reported needing psychotherapy, 23% became unemployed, 15% attempted suicide, 15% ended up on public assistance programs and 14% became homeless.

The report also discovered that 37% of respondents who were denied care turned to drugs and/or alcohol and 36% developed other physical symptoms.



HHS settles discrimination complaint with The Brooklyn Hospital Center

The HHS office of Civil Rights and The Brooklyn Hospital Center have announced a landmark voluntary settlement agreement that establishes a "new standard for appropriate policies and procedures to ensure privacy and appropriate care of transgender patients.

OCR’s agreement with The Brooklyn Hospital Center (TBHC) was prompted by allegations that it violated an antidiscrimination provision in the Affordable Care Act (ACA) when it assigned “a transgender female who presented as a female at the hospital…to a double occupancy patient room with a male occupant.”

Under the terms of a two-year settlement, TBHC agreed to adopt, and train employees, on new policies and procedures tailored to transgender patients that address everything from admitting and rooming to documenting patients’ “legal and a preferred name” and their “gender and/or transgender status, if the Patient has identified that status and agrees that it should be recorded.” Employees also are to become familiar with terms such as “gender non-conformity” and “sex assigned at birth.”



Transgender medical crises


Not every transgender person seeks a medical transition. Surgery is financially unreachable for many. It can be medically contraindicated for some. And some just do not desire it or find it to be necessary to living a fulfilling life.

But those who do seek a surgical transition encounter a major problem.



 lists fewer than 30 physicians who offer sexual reassignment surgery, mostly located on the coasts.

While a few more surgeons might not have been listed, that number is probably in the ballpark, according to medical professionals who told America Tonight that people who are transgender are dangerously underserved by the medical system, especially when it comes to surgical specialties.

I remember getting a phone call in my office on day from the chief of surgery, who was screaming at me on the other end of the line, saying – and I’ll never forget this – he said, ‘Don’t you even think about bringing those freaks into my hospital!’ So, that’s what I was dealing with when I started this.

--Dr. John Taylor, Red Bank, New Jersey



Transgender health research announcements

It has been reported that new research has found that transgender patients face no higher risk of breast cancer than the general population.

Medical researcher George Brown, MD, of Mountain Home VA Medical Center in Johnson City, TN has sifted through the medical records of veterans from 1998-2013 and identified 10 cases of breast cancer in transgender people.

Brown discovered that breast cancers of people who were declared male at birth tended to be more advanced tan those of people who were declared female at birth.




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