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Analysis

Transgender Discrimination Lawsuit Against Dignity Health Reinstated

By Steven Porter  
   September 19, 2019

An appeals court ruled the Catholic-affiliated health system can be sued for allegedly discriminating against a patient on the basis of his gender identity, after a lower court dismissed the case.

A transgender patient whose hysterectomy was delayed after he mentioned his gender identity to medical staff can sue Catholic-affiliated Dignity Health for discrimination under the state's Unruh Civil Rights Act, an appellate court ruled Wednesday.

Evan Minton was preparing to undergo the procedure at Dignity's Mercy San Juan Medical Center in Carmichael, California, when the alleged discrimination occurred in 2016. The procedure was rescheduled and completed at a non-Catholic hospital nearby within three days.

With backing from the American Civil Liberties Union, Minton sued Dignity Health in 2017, but a judge tossed out the lawsuit later that year, ruling that the prompt rescheduling and completion of the hysterectomy means Minton wasn't deprived of full and equal access to the care he sought.

The appellate ruling, however, overturned that lower court's decision, revived the allegations, and allowed the lawsuit to proceed.

"Without determining the right of Dignity Health to provide its services in such cases at alternative facilities, as it claims to have done here, we agree that plaintiff's complaint alleges that Dignity Health initially failed to do so and that its subsequent rectification of its denial, while likely mitigating plaintiff's damages, did not extinguish his cause of action for discrimination," Presiding Justice Stuart R. Pollak wrote for the appellate court in San Francisco.

In a statement, Dignity Health said that the company's medical teams recognize the specific healthcare needs of transgender patients, that many of its care sites offer specialty care for trans people, and that the organization has a legacy of providing care to all people regardless of their sexual orientation or gender identity, as Cathie Anderson reported for The Sacramento Bee.

"Catholic hospitals do not perform sterilizing procedures such as hysterectomies for any patient regardless of their gender identity, unless there is a serious threat to the life or health of the patient," Dignity told the Bee. "Courts have repeatedly recognized the right of faith-based hospitals not to provide services based on their religious principles."

Dignity Health merged with Catholic Health Initiatives earlier this year to form CommonSpirit Health, a $29 billion system with 142 hospitals across 21 states.

While this lawsuit pertains to the specific context of California law, it reflects a national conversation about the obligations healthcare providers have to lesbian, gay, bisexual, transgender, and queer patients.

On the federal level, Section 1557 of the Affordable Care Act prohibits sex-based discrimination in healthcare, which the Obama administration interpreted as banning discrimination on the basis of gender identity and expression. Some healthcare providers said that interpretation would force them to provide certain services that contradict their own medical judgment.

A federal judge in Texas—the same one who would later declare the entire ACA invalid—blocked the Health and Human Services (HHS) Office for Civil Rights (OCR) from enforcing the Obama administration's interpretation. Then the Trump administration moved this year to reinterpret that provision more narrowly, scrubbing gender identity altogether. The government received nearly 156,000 comments on the proposed rule.

HHS OCR Director Roger Severino has acknowledged that the dispute over whether sex-based discrimination includes gender identity discrimination is up for argument in a case pending before the U.S. Supreme Court. How the justices decide that case could affect the way HHS OCR must interpret Section 1557.

The debate over the ACA's nondiscrimination provisions comes as Trump's HHS OCR has pushed also for more vigorous enforcement of other federal laws that protect healthcare workers' right to refrain from assisting in the performance of services that contradict their religious views or conscience. That, too, has drawn praise from faith-based organizations and prompted concerns from LGBTQ rights advocates.

Related: HHS Policy Pendulum Swinging Back Toward Providers' Rights of Conscience

Related: What 7 Healthcare Execs Said About the HHS Freedom of Conscience Proposal

Related: HHS OCR Moves to Roll Back ACA's Nondiscrimination Provisions

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The alleged discrimination occurred when the patient's hysterectomy was delayed after he mentioned his gender identity to medical staff.

This decision pertains to California law, but it comes as the Trump administration is reinterpreting a similar provision of federal law.


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