Health Care

Skepticism understandable

Yesterday Secretary of Veterans Affairs David Shulkin was out and about and was asked about Trump's transgender tweet (can't call it a ban in its present state). He claimed that the VA has compassion for transgender veterans.

If anyone -- transgender people included -- serves in the military, they will get medical and other care for life.

--Shulkin

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VA opens gender clinic in Cleveland

A ceremony was held today in the Louis Stokes Cleveland VA Medical Center to announce the opening of the GIVE (Gender Identity Veteran Experience) clinic.

The clinic will have an initial enrollment of 20 transgender veterans, aged 21 to 75. GIVE will be open on a half day each month and will be supervised by Dr. Megan McNamara, who began working with trans veterans two years ago. Dr. McNamara is a primary care and women's health doctor. She will be the clinical lead physician. The treatment team will also include a nurse, a psychologist, and a social worker.

It felt like a good fit for me, professionally, and I felt that a lot of patients could use this service.

--Dr. McNamara

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Doctors needed

The Journal of the American Medical Association's online Medical column for October is Laura Buchholz' Transgender Care Moves Into the Mainstream

Despite the name of the article, Ms Buchholz highlights the difficulty transgender people have in obtaining competent medical care.

Trans people have been excluded from medical care, and their issues have been deemed not medical and not important.

--Joseph Freund, MD, a primary care physician at Franklin Family Practice in Des Moines, Iowa

Dr Freund recounted his struggles with insurance companies over reimbursement for transgender care, yet another barrier that transgender patients encounter.

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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.

 

 

 

 

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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.

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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.”

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Transgender medical crises

Video.

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.

 

 

 

 

 

 

TSSurgeryGuide.com 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

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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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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.

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Gender Prison: Aetna eliminates transgender exclusion for federal employees

Last month I reported on the State Department's decision to ask its insurers to remove the transgender exclusion from its insurance plans and its largest insurer, the American Foreign Service Protective Association's decision to honor that request. The exclusion ends in January.

Last week Aetna announced it will follow suit. Aetna will start covering gender reassignment related health care for federal workers in January.

Additionally, Aetna said it will begin rolling out the same coverage in many of its commercial plans over the next couple of years.

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