Court Rules That Transgender Patient Tortured By Doctors Is Protected Under Obamacare

[Dave (imported)]

An article from THINKPROGRESS. . .

I have, in my time, battled doctors over my health care and recently my Mom's health care. Do not take mistreatment by a doctor as "something you have to tolerate" or a treatment that is not benefitting you as something you cannot change. You can say "NO" and/or "STOP IT" and demand another doctor.

No one deserves to be treated like this.

http://thinkprogress.org/lgbt/2015/03/2 ... otections/

Court Rules That Transgender Patient Tortured By Doctors Is Protected Under Obamacare

This week, a federal court in Minnesota issued a preliminary ruling in a case concluding that discrimination against an individual because of his gender identity is prohibited under the Affordable Care Act (Obamacare).

In June of 2013, Jakob Tiarnan Rumble, a transgender man, sought treatment at Fairview Southdale Hospital, just outside of Minneapolis. He had a high fever and severe pain in his genitals. During his first day in the Emergency Room and subsequent six days in the hospital, Rumble alleges that he was subject to numerous forms of mistreatment because of his gender identity, including:

Despite indicating to nurses that he identified as a man, Rumble received a hospital bracelet identifying his sex as “female.”

Rumble then waited several hours — still in extreme pain — before receiving any attention or treatment.

When Dr. Randall Steinman eventually examined Rumble, he asked him disparaging questions about the gender of his sexual partners and the nature of those encounters, aggressively communicating that he didn’t know how to diagnose him because of his use of hormone therapy.

Steinman then conducted what Rumble described as an “assaultive exam,” during which he repeatedly jabbed at the patient’s inflamed genitals, refusing to stop even after a crying Rumble demand that he stop twice. Only Rumble’s mother’s intervention stopped the painful assault.

Steinman then left the room, indicating that he could not provide them with any information about Rumble’s condition because his mother had stopped the “exam,” and Rumble proceeded to wait several more hours before being admitted to the hospital.

Another doctor who treated Rumble, Dr. Stephen Obaid, examined his genital area while wearing gloves, then wiped the gloves on the examination bed’s blanket before proceeding to examine Rumble’s eyes and mouth using the same gloves. Rumble “later developed sores on his face in the places that Dr. Obaid had touched.”

At various times during his stay, nurses inexplicably examined Rumble’s genitals, whispered about him, and behaved unfriendly toward him.

When Rumble received his bill, it indicated that he owed the full amount because, “THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT’S GENDER,” despite the fact, as the Court noted, “his ultimate diagnoses were conditions that can, and do, affect people of any sex or gender.”

U.S. District Judge Susan Richard Nelson, an Obama appointee, concluded that Rumble had provided significant evidence to substantiate a case against the hospital under Section 1557 of the Affordable Care Act, which protects against sex discrimination in health care. She similarly allowed Rumble’s charges under the Minnesota Human Rights Act to proceed. This ruling, however, simply rejected the hospital’s request to dismiss the case, meaning that it will still proceed toward discovery and an eventual final outcome.

Nelson described Dr. Steinman’s treatment as “objectively offensive,” particularly his refusal to stop a painful genital exam. “A reasonable person, seeking treatment from an emergency room doctor at a hospital, would expect that the doctor would respect the patient’s wishes to stop a painful exam,” she wrote. It is plausible, she concluded, that this mistreatment was because of Rumble’s gender identity and did not constitute “random poor treatment that anyone might have received.” The bill’s reference to his gender “inconsistency” further bolsters Rumble’s claim that he experienced discrimination because he is transgender.

The same “objectively offensive” standard applies to the misgendering Rumble experienced from hospital staff, as well as the delays and refusals of treatment. It is plausible, Nelson concluded, that these were more than “perceived slights,” but a likely indication that he was treated poorly because of his protected class.

Harper Jean Tobin, Policy Director for the National Center for Transgender Equality, described the case as one that “illustrates the need for transgender people to stand up for their rights in health care settings.” Noting that she’d recently been hospitalized herself, Tobin offered that “the fear of mistreatment in medical settings is constant” for trans people, but they need to know that “there’s something you can do” thanks to the law’s new protections.

NCTE points out that according to the 2011 National Transgender Discrimination Survey, 19 percent of trans people have been refused medical care because of their gender identity, 28 percent have been subjected to harassment in medical settings, and 50 percent have had to teach their medical provides about transgender care.

[kristoff]

This is so bizarre. I read this the other day in our local paper. I get all of my health care from the Fairview system. I have never experienced anything even remotely like this, nor has anyone that I know. I don't doubt that it happened - how does one make a lie of such heart-felt emotions and experiences? I can only hope that Fairview looks within and does something good with this.

[Danya (imported)]

Like Kristoff, I read this in the local (online) paper. I was not surprised. Not because I have heard any negative things about the Fairview system, but because I have heard stories of trans* people being mistreated in Twin Cities clinics/hospitals - especially in the suburbs. My gender therapist and trans* people I have met have conveyed similar messages. If you are trans, and especially if you have not had surgery so that your body's sex matches your gender expression, there is a good likelihood you will run into problems with the suburban health care system. I heard similar stories when I lived in the Chicago area.

[Dave (imported)]

When the Defense of Marriage Act (DOMA) was declared unconstitutional and California Prop 8 was declared unconstitutional (same-sex marriage) I Was of the opinion that at least one more battle had to be won -- that was transgendered rights. I do know that this upcoming Supreme Court case on the Affordable Care Act is crucial to that.

Also, I think exposing these hospitals and doctors who mistreat of poorly treat patients is necessary.

[kristoff]

When the Defense of Marriage Act (DOMA) was declared unconstitutional and California Prop 8 was declared unconstitutional (same-sex marriage) I Was of the opinion that at least one more battle had to be won -- that was transgendered rights. I do know that this upcoming Supreme Court case on the Affordable Care Act is crucial to that.

Also, I think exposing these hospitals and doctors who mistreat of poorly treat patients is necessary.

I would agree, and hope to make my voice heard as a member of this system.

[Losethem (imported)]

As a person who has actually provided care to patients and had to do things like setting up these bracelets, etc. I would like to address the bullet points. Some of them are troubling, but even as a member of this community (gender non-conforming individuals) I get why some of them happened and would likely continue to happen until gender confirmation surgery.

First, if the patient has not legally changed their gender on documents, they will be treated as the gender listed on any of their legal identification (IE drivers license). However it is required the nurses and doctors, etc. call the patient by their preferred name, pronouns, etc, and if they don't know, establish that when they first meet them. If the patient wants to be called "Sparkle Bunny Twinkletoes" than that is what the patient shall be called, and it should be noted. Same for gender pronouns, etc. This is where the disconnect between the sex on the bracelet and the patients gender identity could be addressed.

This is a rare case where it sounds like the care providers are having to treat a female genital disorder on someone who identifies as male. The bracelet wasn't the problem, it was the lack of care and compassion for addressing the patient as they wished to be addressed. Now, if the condition the patient was being treated for had nothing to do with the genital area, I can see the upset. But how the patient is dealt with by care providers providing treatment to what seems to be a scorching STD, they'll need to treat him as a female for the purposes of providing care to that part of the body, and as a male for EVERYTHING else. The bracelet is used to communicate basic information in cases where the patient cannot, and if this person became unconscious, it would be the first line of telling the care providers the equipment they need to treat as quickly as possible on a set of what are currently female genitals. The patients identity has nothing to do with that.

The gloves and eyes - there is NO EXCUSE whatsoever what happened there, but that is a problem of the care provider not following proper infection control procedures, not discrimination about the patients gender identity. This could have happened to any patient, but shouldn't.

Waiting several hours for treatment... not great, but hardly a transgender offense. It could happen to any of us. If they presented to the ER, a scorching STD, while inconvenient, isn't going to get immediate attention and placed higher on the triage list than a patient coming in the door with a knife in the head or a heart attack. We don't know the patient load or the case type of the facility where this person was seen at the time of the incident.

I wasn't in the room for the patient interview. I don't know what the patient would take as disparaging remarks about their sexual partners, and the article does not state what the remarks were. It's difficult to make any judgment here. Perhaps they were, perhaps they just seemed that way because the patient was already upset. Who knows? There is not enough information to go on.

Assaultive exam - Once the patient says stop the physical portion of the exam should discontinue and the doctor should question the patient as to why, and let them know the reason in spite of the pain that it should continue. The patient can then make their decision to continue or not. The doctor should not then restart until they have the consent of the patient or the patients responsible party in the absence of the patient being able to consent. Anything else physical at that point is assault.

If the patient or responsible party stops the exam (the patient in this case did, the mothers comments have nothing to do with it if the patient is an adult and otherwise capable to make their own decisions) then the doctor is not likely to say anything about the case. Hence the "I can't tell you" sort of comment. If the patient has refused treatment the doctor will stop providing treatment, and this includes any information as to diagnosis. So asking the doctor to make a diagnosis and opinion at that point will result in the doctor refusing to. I get that. How can you say "Stop" one minute, then get upset the doctor is not providing information about diagnosis? The doctor, protecting themselves (and as I nurse I'd do the same thing) will not say ANYTHING to you about a diagnosis once you've refused treatment because they will open themselves up to be sued, as has happened here in spite of their ceasing treatment, as the patient requested. Again, I wasn't in the room, I don't know the case. But being pissed you didn't get "information" after stopping the exam is a bit much. I'm not shocked that the information wasn't forthcoming. The patient refused treatment, the doctor couldn't diagnose.

The whispering by nurses at this point is heresay. I can't make comments about it. If it happened, that is wrong. The examinations may have been justified at once per shift per nurse or as frequently as a doctor has ordered. This is the check for change of condition of the patient which needs to be noted so proper treatment can happen. Now, if they were examining beyond what was ordered, the patient may be justified here. The patient could also refuse that examination, in this case it sounds like he didn't.

The bill being the responsibility of the patient? Well, I'd have to see what their insurance covers. However, "being inconsistent with patients gender" when treating what seems to be a case of a sexually transmitted disease, seems a bit over the top as men and women are both able to acquire all the STD's I know of. I believe the patient is completely justified on that one.

--LT

An article from THINKPROGRESS. . .

I have, in my time, battled doctors over my health care and recently my Mom's health care. Do not take mistreatment by a doctor as "something you have to tolerate" or a treatment that is not benefitting you as something you cannot change. You can say "NO" and/or "STOP IT" and demand another doctor.

No one deserves to be treated like this.

http://thinkprogress.org/lgbt/2015/03/2 ... otections/

Court Rules That Transgender Patient Tortured By Doctors Is Protected Under Obamacare

This week, a federal court in Minnesota issued a preliminary ruling in a case concluding that discrimination against an individual because of his gender identity is prohibited under the Affordable Care Act (Obamacare).

In June of 2013, Jakob Tiarnan Rumble, a transgender man, sought treatment at Fairview Southdale Hospital, just outside of Minneapolis. He had a high fever and severe pain in his genitals. During his first day in the Emergency Room and subsequent six days in the hospital, Rumble alleges that he was subject to numerous forms of mistreatment because of his gender identity, including:

Despite indicating to nurses that he identified as a man, Rumble received a hospital bracelet identifying his sex as

“female.”

Rumble then waited several hours — still in extreme pain —

before receiving any attention or treatment.

When Dr. Randall Steinman eventually examined Rumble, he asked him disparaging questions about the gender of his sexual partners and the nature of those encounters, aggressively communicating that he didn’t know how to diagnose him because of his use of hormone therapy.

Steinman then conducted what Rumble described as an

“assaultive exam,”

during which he repeatedly jabbed at the patient’s inflamed genitals, refusing to stop even after a crying Rumble demand that he stop twice. Only Rumble’s mother’s intervention stopped the painful assault.

Steinman then left the room, indicating that he could not provide them with any information about Rumble’s condition because his mother had stopped the “exam,” and Rumble proceeded to wait several more hours before being admitted to the hospital.

Another doctor who treated Rumble, Dr. Stephen Obaid, examined his genital area while wearing gloves, then wiped the gloves on the examination bed’s blanket before proceeding to examine Rumble’s eyes and mouth using the same gloves. Rumble “later developed sores on his face in the places that Dr. Obaid had touched.”

At various times during his stay, nurses inexplicably examined Rumble’s genitals, whispered about him, and behaved unfriendly toward him.

When Rumble received his bill, it indicated that he owed the full amount because, “THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT’S GENDER,” despite the fact, as the Court noted, “his ultimate diagnoses were conditions that can, and do, affect people of any sex or gender.”

U.S. District Judge Susan Richard Nelson, an Obama appointee, concluded that Rumble had provided significant evidence to substantiate a case against the hospital under Section 1557 of the Affordable Care Act, which protects against sex discrimination in health care. She similarly allowed Rumble’s charges under the Minnesota Human Rights Act to proceed. This ruling, however, simply rejected the hospital’s request to dismiss the case, meaning that it will still proceed toward discovery and an eventual final outcome.

Nelson described Dr. Steinman

’s treatment as “objectively offensive,”

particularly his refusal to stop a painful genital exam. “A reasonable person, seeking treatment from an emergency room doctor at a hospital, would expect that the doctor would respect the patient

’s wishes to stop a painful exam,”

she wrote. It is plausible, she concluded, that this mistreatment was because of Rumble’s gender identity and did not constitute “random poor treatment that anyone might have received.

” The bill’s reference to his gender “inconsistency” further bolsters Rumble’

s claim that he experienced discrimination because he is transgender.

The same

“objectively offensive”

standard applies to the misgendering Rumble experienced from hospital staff, as well as the delays and refusals of treatment. It is plausible, Nelson concluded, that these were more than

“perceived slights,”

but a likely indication that he was treated poorly because of his protected class.

Harper Jean Tobin, Policy Director for the National Center for Transgender Equality, described the case as one that “illustrates the need for transgender people to stand up for their rights in health care settings.

” Noting that she’

d recently been hospitalized herself, Tobin offered that “the fear of mistreatment in medical settings is constant” for trans people, but they need to know that

“there’s something you can do” thanks to the law’

s new protections.

NCTE points out that according to the 2011 National Transgender Discrimination Survey, 19 percent of trans people have been refused medical care because of their gender identity, 28 percent have been subjected to harassment in medical settings, and 50 percent have had to teach their medical provides about transgender care.