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Healthcare Equality Index: Roll Out Press Conference Call

Speaker transcripts from the Healthcare Equality Index 2009 conference call on May 12, 2009. To read a transcript, click on the links below.


Joe Solmonese

President, Human Rights Campaign Foundation

Good morning everyone and thank you for joining us.

Today, the Human Rights Campaign Foundation and the Gay and Lesbian Medical Association are releasing the 2009 Healthcare Equality Index (HEI). The HEI project was started three years ago to educate healthcare policymakers and LGBT healthcare consumers to get rid of barriers and biases that keep us from taking care of ourselves and each other.

Unfortunately, the situation for LGBT families in the healthcare system remains an uneven patchwork of state laws and local policies. In a few states, same-sex couples enjoy statewide recognition. But in many more, they are strangers in the eyes of the law.

The existing healthcare system lags in addressing the concerns of the LGBT community on many levels. In particular, you will hear on today’s call about the striking disparity between the number of patient non-discrimination policies inclusive of sexual orientation and those inclusive of gender identity, which is symptomatic of the healthcare discrimination faced by transgender Americans every day, from the explicit denial of healthcare services to insensitive remarks by medical staff.

In this year’s report you will find survey responses from 166 facilities in from 17 states and the District of Columbia. That is nearly twice as many participants as in 2008 report, which for the first time will also include responses from clinics as well as hospitals.

Only ten of the participating facilities responded positively to all applicable, LGBT specific questions in this year’s survey. We are honored to be joined on the call today by representatives of several of these top-performing facilities.

From large university medical centers to community health clinics these are people on the front lines of healthcare today and we are grateful for their commitment to providing quality, bias free services.

I'd like to turn the call over to Tom Sullivan, Deputy Director of the HRC Family Project who will provide an overview of the 2009 HEI report and introduce you to our speakers.

Tom Sullivan

Deputy Director, Human Rights Campaign Family Project
Editor, Healthcare Equality Index

My name is Tom Sullivan and I will provide an overview of the methodology and findings in the 2009 Healthcare Equality Index report.

As Joe said, the HEI is all about eliminating barriers and bias. The HEI is designed to address these concerns by identifying best practices and policies with respect to equal treatment of LGBT individuals and families and then sharing this information with healthcare industry leaders.

To achieve this, an online survey was used to collect data for this report during the period from October 1 through December 31, 2008 and was open to the all healthcare facilities. As a result, this report includes on responses from 73 clinics and 93 hospitals.

It is important to point out that the statistics in the report come from a voluntary sample of hospitals and so it should not be assumed that they reflect the percentages for the entire American healthcare industry.

The survey answers are grouped in five areas in the report: patient non-discrimination, hospital visitation, decision making, cultural competency training for hospital staff, and employment policies.

Looking at the responses from all participants, the most striking statistics are found in the report are in the patient non-discrimination section. We found that only 7% of the facilities have patient non-discrimination policies that include “gender identity or expression” compared to the 73% that protect patients from discrimination on the basis of “sexual orientation”. Dr. Rebecca Alison, who serves on the HEI Advisory Board and holds a leadership position with the GLMA, will elaborate on this finding in just a few minutes.

Also, for the first time this year we required copies of policies to be submitted with survey responses. Thanks to the cooperation of this year’s participants, who provided their visitation and decision-making policies, we learned how facilities are and are not protecting LGBT families. What we found is that the vast majority of participants have visitation policies that include broad language for defining family such as “significant other” or “any person with whom the patient has an established relationship”. However, while this language is intended to be inclusive of all family members, including LGBT family members, it may be interpreted otherwise by individual staff members in a healthcare facility.

To respond to these concerns and to provide guidance in creating policies that are welcoming for LGBT families we are also releasing a new resource today from the HRC Foundation called “Breaking Down Barriers: An Administrator’s Guide to State Law & Best Policy Practice for LGBT Healthcare Access.” This resource is the result of our review of visitation and medical decision-making policies and will provide healthcare administrators and healthcare attorneys with best practices for ensuring the equal treatment of LGBT families in the healthcare setting. It also surveys the legal landscape governing medical decision-making rights and highlights the effect of LGBT relationship recognition law on this landscape. This resource will provide useful information to participants in future HEI surveys, the next of which will be launched October 2009.

In summary, participation in the HEI project is natural fit for any healthcare facility’s mission. Basically, all healthcare facilities share the common goal of providing quality care to their clientele. Simply stated – a welcoming environment is a healthy environment.

By creating a welcoming environment for LGBT people, healthcare administrators make these patients feel secure and respected. When patients are secure in the belief that they will not be discriminated against, they can focus their energies on recuperating instead of worrying about what personal information they can safely share. This comfort level may make the difference between a patient deciding to seek medical treatment in a timely manner and a patient avoiding treatment from a healthcare setting that he or she perceives to be unfriendly.

We gratefully acknowledge the involvement and leadership shown by the 2009 HEI survey participants, some of whom you will be hearing from during this call. Their dedication to healthcare equality is setting the standard for a healthier tomorrow.

Thank you.

Rebecca A. Allison, MD

Cardiologist
President-Elect, GLMA
Chair, AMA Advisory Committee on GLBT Issues
Member, HEI Advisory Council

Thank you.  It’s an honor to represent GLMA on the Healthcare Equality Index Advisory Council.  The Gay and Lesbian Medical Association is the largest professional society serving the needs of healthcare providers and patients who are gay, lesbian, bisexual, or transgender.  At our annual meeting, original research is presented, and plenary speakers and workshops bring updated information on GLBT health concerns.  We also advocate for the health needs of the GLBT community, and it’s in that role that I have been involved with the HEI Advisory Council. 

The hospitals and clinics which participate in the HEI Survey do so voluntarily, and so we expect most of them will meet many of the criteria.  It’s therefore a matter of some concern that the survey finds less than seven percent of these facilities protect patients from discrimination based on gender identity.  This means that in the other ninety-three percent, a transgender patient may be addressed by an incorrect name or incorrect pronouns, perhaps even placed in a room with other patients of their birth gender.  By comparison, 73 percent of participating hospitals include sexual orientation in their non-discrimination policies for patients.

Regarding employee non-discrimination policies, 63 percent cover gender identity, while 98 percent include sexual orientation.

A clearly stated policy that forbids discrimination on the basis of sexual orientation and gender identity or expression is an important first step in encouraging openness, and in creating a climate for delivery of quality care. Transgender patients face healthcare discrimination everyday – a fact that makes the disparities identified in this report a call-to-action.

The fear of discrimination causes many LGBT people to avoid preventative care and, when they do seek treatment, studies have shown that LGBT people are often hesitant to come out to healthcare providers for fear of discrimination. This lack of openness can lead to missed opportunities in identifying individual health risks and the failure to provide appropriate screening. Discrimination, or the fear of discrimination, undermines the delivery of quality care.

I feel that most HEI participants want to avoid discrimination on the basis of gender identity.  I believe HRC and GLMA, through the Healthcare Equality Index, can provide feedback to these facilities so they will know what is still needed, and can give appropriate suggestions for sample policies.  When our survey identifies areas needing improvement, we confirm the worth of the HEI, and learn more about what we want from follow up surveys in the future.

Bradley G. Hinrichs

Assistant Professor,  Health Systems Management
VP Hospital Operations, Rush University Medical Center

I want to thank the HRC Foundation and the GMLA for inviting me to participate in this press conference. It turns out that I have a couple of hats to wear relative to the HEI initiative we are discussing, so I appreciate the opportunity to make a few comments today.

First, as a Vice President at Rush University Medical Center in Chicago, my colleagues and I appreciate the progressive and proactive approach taken by HRC and the GMLA in creating and disseminating the Healthcare Equality Index. Rush is a large academic medical center on the near west side of Chicago of about 700 beds, admitting about 32,000 patients annually to our hospital, and providing about 1,000,000 outpatient visits annually to our facilities and programs. We have more than 8,000 employees and there are more than 1,500 students in our 4 colleges. Included in these numbers are many thousands of LGBT people.  We have a long tradition at Rush of embracing a culture of inclusion, diversity, and equal treatment of all individuals, whether patients and their families, students in our University, our employees, or members of our wider community. We are proud that our policies and procedures allowed us to achieve a perfect score on the HEI, as it reflects our core values correctly, in this case, relative to members of the LGBT community and their families.

Second, I am a gay man myself, and an active member of HRC and its Federal Club. My partner and I of 22 years have a personal appreciation for the importance of this initiative and would not want to be affiliated with or seek care from a healthcare organization that didn't hold these values to be basic to its mission. Our LGBT community expects and deserves the same degree of dignity, respect, and equal treatment from the healthcare system as any other person seeking help in a time of need. It is important for all healthcare providers to assess their official policies as well as their less official practices with regard to members of the LGBT community, and to assure that the environments they provide are free of official and unofficial bias or unequal treatment of individuals based on their sexual orientation or gender identity or expression. Most healthcare needs of the LGBT community are no different than the rest of society, but sometimes they are unique and warrant extra consideration. The HEI is a good tool to help providers review their policies and practices relative to this and importantly, offers best-practice guidance for those who are ready to address and remove any barriers to equal treatment that they may find.

Finally, I would just like to add, perhaps provocatively, that as helpful as I think the HEI Initiative is in bringing focus to the issue of LGBT equity in the area of healthcare, I also feel that it is a shame that it is needed. The bar that it sets for achieving full compliance is not really so high. Hopefully, it will become unnecessary to survey healthcare providers relative to these issues in the near future. These same issues relative to race, religion, color, etc. have been part of our societal norms for quite some time. I would like to believe that my fellow hospital executives and administrators believe that the principles of fair and equal treatment of the LGBT community are just as fundamental. However, the most recent HEI demonstrated that very few providers have taken the initiative to update their nondiscrimination policies to explicitly include gender identity or expression, which is hopefully more symptomatic of organizational inertia than a conscious choice to accept discriminatory policies or practices in their organizations.

So, again, much thanks to HRC and the GMLA for taking the initiative to make these concerns transparent in the healthcare industry. I hope in future iterations of the HEI survey, we will see large scale improvement in the numbers and percentages of organizations who can join Rush and Brigham and Women's and UCSF and the other provider organizations who also achieved perfect scores on this very basic set of expectations around equal and respectful treatment of the LGBT community.

David Haltiwanger, Ph.D.

Director of Clinical Programs and Public Policy, Chase Brexton Health Services

Chase Brexton Health Services is honored to be one of only 10 healthcare facilities in the nation to receive a perfect score on the 2009 Healthcare Equality Index.  Those that know Chase Brexton might dismiss this as a “dog bites man” story, hardly a surprise for an organization founded over 30 years ago by volunteers from the LGBT community with a specific goal of addressing the barriers of access, acceptance, and awareness often faced when LGBT people seek healthcare.  With more knowledge of our history and what we are today, I do think there is a story here and there is a reason to be proud.  Over these 3 decades, we have grown from our primary location at the heart of Baltimore’s most gay-friendly neighborhood to become today a comprehensive community health center with 4 locations around the state of Maryland.  We are now the primary healthcare provider for 12,000 patients, and they come to us from urban, suburban and rural communities.  In 2009, we serve more LGBT patients than ever before, but with our increasingly diverse patient population, we have more patients who are not from the LGBT community than the number who are. 

For me, our perfect score on the Healthcare Equality Index is welcomed confirmation that we have not drifted from our original mission.  But another part of the story is that you do not have to be any less gay-affirming in order to be sought out by others who seek quality healthcare.  Based on our experience, I would propose to any facility that doing right by your LGBT patients will lead to benefits for other patients too.  Let me explain the several ways that has worked for us.  Knowing that we are sensitive to the impact of discrimination based on sexual orientation and gender identity attracts other patients who have experienced their own forms of discrimination.  Recognizing the importance of same-sex partners even when law does not has helped us understand that, for all of our patients, the most important person in their life may not be who you first think it is.  Providing LGBT-affirming healthcare is based in an appreciation for the importance of cultural context in all healthcare, and that has served as an excellent starting point as we have added other underserved groups into our Chase Brexton family.  Valuing our LGBT employees for the insights they bring to our work with LGBT patients helped us to understand that as our patient population became more diverse, our workforce needed the same diversity.  All of this suggests that doing well on the various measures of the Health Equity Index may be relevant first to LGBT patients and employees, but ultimately can create a higher quality of healthcare for everyone.

Rafael Posey

A transgender man’s personal story

Hi.  My name is Rafael Posey and I am a trans man.  In my case, this means that I was born into a female body, and as an adult, transitioned from female to male with the help of surgery and hormone replacement therapy. I began the physical part of my transition from female to male in the summer of 2005, in New York City.  Now I am a grad student in a Baltimore MFA program.

During the spring of 2006, I experienced a life threatening medical emergency that ended with me at the emergency room at a Brooklyn hospital.  I made a point of choosing that particular ER because it was in a neighborhood with a reputation of being the FTM population center of New York City, and so I felt that this ER would be more likely to be more experienced with (and compassionate toward) an FTM patient.

Because I was still very early in the transition process, having only been on testosterone for about six months, my presentation and outward appearance were still somewhat ambiguous.  My voice had only recently begun to change, and I had not yet begun to grow facial hair. However, I had made a point of getting my name change done in court, and acquiring a driver's license and work ID with the correct name and a male signifier.  At work, at home, and out in the world I lived exclusively as a man.

The hospital's personnel ranged from uncomfortable to hostile, and none of the staff, nurses, or doctors that I encountered were at all prepared to work with a trans male patient.

The triage nurse left the gender marker in the system blank, even after I showed her my driver's license.  She also seemed unsure how to record the information that I received shots of testosterone every two weeks, or how to ask about other health issues (including menstruation history, etc) that might have been more appropriate for a patient who had been born as, and still lived as, female-bodied.  I had to explain the effects of testosterone on my reproductive system, which embarrassed us both.

In the treatment area, I was separated from my female partner for several hours, because they couldn't understand the relationship. The EKG nurse was reluctant to touch me after she saw the scar from my top surgery.  Although she did not refuse, she did add an extra layer of gloves.  In addition, on my chart and other paperwork, some staff wrote F and some left gender blank. Staff and medical personnel also consistently referred to me as "she" or "her," and at no point during the experience did anyone use either my name or a male pronoun.

When a doctor finally came to examine me, he refused to show me even the simple kindness of using male pronouns.  This made me feel anxious and embarrassed, so I explained that I had transitioned from female to male, and that I used male pronouns exclusively.  I hoped that my explanation would be helpful, and that it would be a more coherent and less difficult medical experience for both of us as a result.  Instead, however, he said, "I can't treat someone like that," and walked out of the cubicle.  It was another hour before a second doctor came to examine me.  The second doctor gave me a cursory exam, but also refused to use male pronouns.

The final results were inconclusive, although one nurse suggested that my issues might be a result of stress and testosterone therapy.  The doctor filled out a form to excuse me from work for two days, but wrote "she" on it.  He did write a new form using only my name, and no pronouns, when I explained that I used male pronouns in my everyday life, and at work, and that female pronouns would not match my employee records.  I also had to ask them to redo the insurance paperwork so that the pronouns would match.

I would like to share this story because I think it's so important to bring attention to medical issues facing the trans community.  Also, I am fortunate in having a supportive partner and friends, so that I have been able to choose to be very out and visible as a trans person, even though I pass completely if I do not actually out myself.  Many trans folk are not as lucky as I am in the people who are part of my life, and I am hopeful that my story will help others in the trans community.