US District Judge rules that ACA protects trans people from discrimination

 photo rumble_zpskjx6bl7m.jpgJacob Rumble of West St. Paul, MN is a student at Minneapolis Community and Technical College. He thought his troubles began when he felt severe abdominal pain in 2013. But they actually began when he and his mother arrived at the emergency room of Fairview Southdale Hospital in Edina.

He was treated so badly that he filed a federal lawsuit. Both the hospital and the organization which employs the emergency room physician, Emergency Physicians Professional Association (EPPA) filed motions to have the case dismissed.

In a 63-page ruling US District Judge Susan Richard Nelson ruled that Rumble had built a plausible case that he was a victim of discrimination on the basis of his gender identity by an emergency room doctor and denied the defendants' motions.

Nelson's ruling is believed to be the first extensive federal court analysis of Section 1557 of the Affordable Care Act, which prohibits discrimination in health care.

Section 1557(a):

Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including
credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments). <> The enforcement mechanisms provided for and available under such title VI, title IX, section 504, or such Age Discrimination Act shall apply for purposes of violations of this subsection.

Hospital attorney's disputed the applicability of that law and claimed Rumble was not denied care.

But Chad Strathman, EPPA’s attorney, stated, “For over 40 years, EPPA’s emergency providers have proudly cared for members of the Twin Cities community. Our group takes patient concerns seriously.”

According to the lawsuit, Rumble, a transgender man, experienced inflamation of his female reproductive organs to the point he could hardly walk, despite an antibiotic prescribed by his PCP. When his temperature hit 104, his mother took him to the ER.

[A] doctor later said he could have died without treatment.

At the Fairview Southdale ER, Jacob identified himself as a male, but added himself as transgender. A clerk told him he was on file as a female and put a wristband on him with an F.

I was very upset. My identity was disregarded. It wasn’t like I hadn’t explained it.


He was examined by an ER doctor 4.5 hours after arriving at the ER. He asked Rumble...

in a “hostile and aggressive manner … who are you having sex with?” the suit alleges. Rumble asked what he meant, and the doctor asked, “men, women or both?”

Rumble said the doctor seemed angry. He asked Rumble if he engaged in penetration and if “he had ever had sex with objects.”

He was in my face asking very personal questions and very repetitive questions about my sex life.


The doctor proceeded to examine Rumble's genitalia "in a rough manner." At one point Rumble felt he had been stabbed. He cried out in pain and asked the doctor to stop. The doctor continued his examination.

The suit says Rumble turned to his mother and said, “Mom, can you make him stop?” His mother yelled, “Stop!” and the doctor complied.

After another two hours, Rumble was admitted to the hospital. He asked his mother not to leave because he was afraid the ill-treatment would continue. His mother slept in a chair in his room for the next six days.

Weeks after he left the hospital, he got a bill stating, “Diagnosis inconsistent with the patient’s gender.”

To the court’s knowledge, this is the first case that requires an interpretation of Section 1557.


Nelson said Rumble’s alleged treatment constitutes “unprofessional behavior” and a fact-finder could infer discriminatory intent.

The doctor’s “comments and hostile questioning about plaintiff’s sexual activities,” Nelson wrote, “coupled with his disregard for Rumble’s repeated request for [the doctor] to stop the painful physical examination demonstrate that the alleged mistreatment plaintiff endured was because of Rumble’s gender identity.”

Addressing the suit’s claim that the doctor’s exam was “assaultive,” Nelson wrote, “When any individual permits a doctor to conduct a genital exam, the patient is in a physically vulnerable position, which the doctor controls.

“Here Rumble had a reasonable expectation that his treating doctor at the [ER] would not physically ‘assault’ him, or at the very least would stop an intrusive and painful genital exam when asked to stop.”

It’s a wonderful interpretation. For the first time a federal court has determined that the Affordable Care Act prohibits discrimination against transgender people by a health care provider.

--Sasha Buchert, staff attorney with the Transgender Law Center

We are very excited about the decision.

--Kyle Palazzo, Lambda Legal

LAMBDA has issued a report on a 2009 national survey of 4,916 LGBT people. Nearly 21 percent of transgender people said health care professionals used “hard, abusive language” and 7.8 percent of transgender people said health care professions were “physically rough or abusive.”

Rumble’s suit was filed by attorneys Christy Hall, Lisa Stratton and Jill Gaulding, who belong to Gender Justice, a St. Paul nonprofit group, and Katherine Barrett Wiik of the Robins Kaplan law firm.

Rumble said he was nervous abut filing the suit because he had to publicly disclosed the details of his hospital visit.

But I don’t want this to happen to other trans people. So whatever it takes.

I was traumatized by the whole experience.


Rumble says he now fears making medical visits with health care providers alone.

Rumble came out as transgender when he was 15. He is financial director of the Transgender Youth Support Network.





No votes yet


While health care maltreatment...

Robyn's picture a common among all transpeople, transgender men seem to experience worse treatment than transgender women.

No votes yet