Health Care

AuthorAlly Windsor Howell
ProfessionFormer practicing lawyer from Alabama
Transgender persons face several obstacles to getting proper health
care, even when they can pay for it or are otherwise entitled to it. Health
care professionals are like the general population; some of them are biased,
uninformed, and so on too. This leads to a refusal to treat or a denial of
care and, at its worst, leads to mistreatment and abuse.
It has been suggested by those who study such issues that better collec-
tion of data by including gender identity and sexual orientation information
in electronic medical records would help reduce or maybe even eliminate
bias and discrimination in the provision of health care to the Lesbian, Gay,
Bisexual and Transgender (LGBT). “The Institute of Medicine’s (IOM’s)
2011 report on the health of LGBT people pointed out that there are lim-
ited health data on these populations and that we need more research. It
also described what we do know about LGBT health disparities, including
lower rates of cervical cancer screening among lesbians, and mental health
issues related to minority stress. Patient disclosure of LGBT identity enables
provider–patient conversations about risk factors and can help us reduce
and better understand disparities. It is essential to the success of Healthy
People 2020’s goal of eliminating LGBT health disparities. This is why the
IOM’s report recommended data collection in clinical settings and on Elec-
tronic Health Records (EHRs). The Centers for Medicare and Medicaid
Health Care
how50368_08_ch08_p099_p122.indd 99how50368_08_ch08_p099_p122.indd 99 19/03/15 11:53 AM19/03/15 11:53 AM
Services and the Of ce of the National Coordinator of Health Informa-
tion Technology rejected including Sexual Orientation and Gender Identity
(SOGI) questions in meaningful use guidelines for EHRs in 2012” but are
reconsidering this issue again in 2014. “There is overwhelming commu-
nity support for the routine collection of SOGI data in clinical settings, as
evidenced by comments jointly submitted by 145 leading LGBT and HIV/
AIDS organizations in January 2013. Gathering SOGI data in EHRs is sup-
ported by the 2011 IOM’s report on LGBT health, Healthy People 2020,
the Affordable Care Act, and the Joint Commission. Data collection has
long been central to the quality assurance process. Preventive health care
from providers knowledgeable of their patients’ SOGI can lead to improved
access, quality of care, and outcomes. Medical and nursing schools should
expand their attention to LGBT health issues so that all clinicians can
appropriately care for LGBT patients.”1 Unfortunately, these studies take
time and current year data are only available as anecdotes.
§8.1 Bias and Prejudice in the Delivery
of Health Care and Denial of Care
In responding to an inquiry from an LGBT advocacy organization, the Direc-
tor of the Of ce for Civil Rights of the U.S. Department of Health & Human
Services about Section 15572 of the Patient Protection and Affordable Care
Act’s nondiscrimination provisions stated, “We agree that Section 1557’s sex
discrimination prohibition extends to claims of discrimination based on gen-
der identity or failure to conform to stereotypical notions of masculinity or
femininity and will accept such complaints for investigation. Section 1557
also prohibits sexual harassment and discrimination regardless of the actual
or perceived sexual orientation or gender identity of the individuals involved.”3
1. Sean Cahill and Harvey Makadon (September, 2013) Sexual Orientation and Gender
Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending
LGBT Health Disparities, LGBT H 1:1,
lgbt.2013.0001 (last visited July 27, 2014).
2. 42 U.S.C.A. § 18116 (which incorporates the bans on discrimination in Title VI of the
Civil Rights Act of 1964, 42 U.S.C.A. §§ 2000d, et seq., Title IX of the Education Amend-
ments of q972, 20 U.S.C.A. §§ 1681, et seq., the Age Discrimination Act of 1975, 42 U.S.C.A.
§§ 6101, et seq., and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C.A. §§ 794).
3. Letter from Leon Rodriguez, Dir. of Of ce for Civil Rights, Dept. of Health & Human
Servs. to Maya Rupert, Fed. Pol’y Dir., Nat’l Ctr. for Lesbian Rights (July 12, 2012) (OCR
Transaction No. 12-000800).
how50368_08_ch08_p099_p122.indd 100how50368_08_ch08_p099_p122.indd 100 19/03/15 11:53 AM19/03/15 11:53 AM

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT