Catholic hospitals dealt blow in transgender discrimination case

In a setback for Catholic hospitals, a California appellate court ruled that Dignity Health discriminated against a transgender man seeking a hysterectomy when one of its hospitals turned him away for the procedure.

The 1st District Court of Appeal ruled unanimously Tuesday that the state nondiscrimination law, the Unruh Act, barred discrimination against the patient, Evan Minton. The court sent the case back to the San Francisco Superior Court, which had dismissed the lawsuit on the basis that Minton had quickly received the procedure at another facility.

Minton now will be able to gather and present evidence of discrimination and damages. He is seeking an injunction prohibiting Dignity from refusing hysterectomies for transgender patients or any engaging in other discrimination based on gender identity.

Dignity, backed by the Catholic Health Association, had argued that the courts have recognized the right of religious-based hospitals not to provide services based on their religious principles.

But the court disagreed. 

“Any burden [state law] places on the exercise of religion is justified by California’s compelling interest in ensuring full and equal access to medical treatment for all its residents,” the appellate panel said.

Catholic hospitals have faced lawsuits and controversy over application of their Ethical and Religious Directives which prohibit services such as abortion, contraception, tubal ligation, gender transition surgery and physician aid in dying.

Minton was scheduled to receive a hysterectomy at Dignity’s Mercy San Juan Medical Center in August 2016. It was canceled two days after he told a nurse he is transgender. The procedure was rescheduled and performed soon after at one of Dignity’s hospitals that operates under a less-restrictive religious policy.

The court wrote that “when his surgery was canceled, he was subjected to discrimination. Full and equal access requires avoiding discrimination, not merely remedying it after it has occurred.”

“The Unruh Act promises full and equal access to public accommodations, yet Dignity Health refuses to provide necessary care to transgender patients,” said Elizabeth Gill, a senior staff attorney with the ACLU of Northern California, in a written statement. “We will continue to fight for the right to care for everyone, even if their local hospital has a religious affiliation.”

Dignity said it does not discriminate, but that it has the right not to provide services based on Catholic religious principles. It said Catholic hospitals do not perform sterilization procedures such as hysterectomies for any patient regardless of gender identity, unless there is a serious threat to the life or health of the patient.

“We are sensitive to the specific health needs of transgender patients and specialty care for trans individuals is offered at many of our care sites,” Dignity said in a written statement. “In this case, Mr. Minton was able to quickly receive the sought-after procedure at another nearby Dignity Health hospital that is not Catholic-affiliated.

St. Joseph Health System in California is facing a similar lawsuit filed by a transgender man, Oliver Knight. He claims he was prepped to undergo a hysterectomy in August 2017 at St. Joseph Hospital in Eureka, Calif., as part of his treatment for gender dysphoria. But his OB-GYN surgeon came in minutes before the scheduled start of the procedure and told him the hospital wouldn’t allow it because Knight is transgender.

In its response to Knight’s lawsuit, St. Joseph said it has a constitutional right to refuse to perform procedures barred by Catholic religious doctrine.

Emergency Physicians Urge Policymakers to Remove Obstacles to Treatment for Opioid Use Disorder

WASHINGTON, DC (Sept. 4, 2019) —As the U.S. Department of Health and Human Services (HHS) compiles a report to Congress on treating opioid use disorder, the American College of Emergency Physicians (ACEP) urges policymakers to consider steps to remove obstacles to appropriate care in the emergency department.

Remove the “X-waiver.” Emergency physicians continue to see strong results when they can utilize buprenorphine as part of medication-assisted treatment (MAT) to start patients on the path toward recovery from opioid use disorder. Initiating MAT in the emergency department closes gaps in treatment and helps individuals stay in treatment longer, reduces illicit opioid use and infectious disease transmission, and decreases overdose deaths.

The waiver requires completion of an eight-hour course and license application, and it can take 60 to 90 days for physicians to receive the waiver from the U.S. Drug Enforcement Administration (DEA). The waiver requirement has also resulted in a misperception that buprenorphine is fundamentally different from other medications—including narcotics—that physicians are trained to prescribe. As a result, some physicians have been less willing to pursue the waiver or engage in treatment of patients with opioid use disorder at all. In some cases, there is not an adequate supply of buprenorphine in the emergency department or hospital pharmacy because of the confusion surrounding the X-waiver. ACEP believes Congress should take action to remove the X-waiver.

Modify the “three-day rule.”  This federal regulation requires administration of buprenorphine one day at a time and requires patients to return to the emergency department or other care setting to receive treatment. Emergency departments should be able to dispense a three-day supply of buprenorphine or administer a dose that will last three days.  

Remove pre-authorization requirements. In most states there is a pre-authorization approval requirement by insurers to prescribe buprenorphine. It is estimated that only 25 percent of emergency patients visit during typical office hours. Some states have removed prior authorization for buprenorphine for patients on Medicaid, but the requirement persists in most states for most insurers.

ACEP also supports steps to improve prescription drug monitoring program reporting so that fragmented state-level prescribing data can be meaningfully reported at the federal level.

ACEP and its members would welcome a chance to work with HHS and others to improve and expand education about pain management and addiction treatment, including the benefits of MAT and an effort to correct misperceptions about treating opioid use disorder.

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit www.acep.org.