U.S. District Judge Susan Richard Nelson, an Obama appointee on the U.S. District Court for the District of Minnesota, ruled on Monday that Section 1557 of the Affordable Care Act allows individuals to sue a health care facility if they experience discrimination based on their gender identity.
The order denies a request from Fairview Southdale Hospital, a Minnesota facility, to throw out a lawsuit filed on behalf of a young trans man, Jakob Tiarnan Rumble, who alleges he was badly mistreated while hospitalized because of his gender identity.
No regulations exist on the interpretation of Section 1557, and the hospital alleges a 2012 opinion letter from HHS affirming trans people are protected under the law isn’t binding. The court nonetheless determines the letter carries weight as it looks for guidance on the statute.
“Here, the court finds the OCR’s interpretation of Section 1557 persuasively concludes that Section 1557 protects plaintiffs, like Rumble, who allege discrimination based on ‘gender identity,'” Nelson writes in the 63-page decision.
The order could have widespread implications across the country for trans people who feel they’ve experienced discrimination in the health care system and wish to seek restitution.
Harper Jean Tobin, policy director for the National Center for Transgender Equality, said in a blog post the court order makes clear trans people have options if they face discrimination.
“This case illustrates the need for transgender people to stand up for their rights in health care settings,” Tobin said. “Having recently experienced a stay in a hospital myself, I know that no matter who you are, if you are trans the fear of mistreatment in medical settings is constant. When it happens, trans people need to know that, no matter where you live, there’s something you can do.”
The lawsuit, known as Rumble v. Fairview Health Services, was filed in June 2014 by the Minnesota-based advocacy group Gender Justice. In addition to making claims on the basis of the Affordable Care Act, the lawsuit also alleges the hospital violated the Minnesota Human Rights Act. The court also allows the litigation to move forward on the basis of alleged discrimination under this statute.
According to the order, Rumble went to the hospital in June 2013 because he had a fever of more than 100 degrees. Even though indicated to the clerk he was male, the hospital labeled him as female, and he was given an “F” wristband because his driver’s license incorrectly identified him as such and he’s listed in the hospital computers as female.
When the physician, Dr. Randall Steinman, came to see him after an unusually long four to five-and-a-half hour waiting period, the physician allegedly asked Rumble in hostile manner “[w]ho are you having sex with,” “[m]en, women, or both?” and whether “he’d ever had sex with objects.” The questioning, Rumble alleges, seemed more an attempt to embarrass him, rather than treat him.
During an examination, Steinman allegedly handled Rumble’s genitals in a rough manner, causing the patient to cry out in pain. The doctor allegedly stated he “couldn’t tell what was going on because of the male hormones.”
As Steinman continued to jab at Rumble’s genitals, the patient asked him to stop, but the doctor continued until his mother said something. When Steinman finally stopped, he allegedly said he couldn’t determine the problem because “because your mom made me stop the exam,” then left the room without further explanation.
Rumble was eventually admitted to the hospital, where he alleges he continued to face mistreatment for six days that followed. When he received the bill for his stay, it indicated no insurance payments were made and he owed the full amount, stating, “THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT’S GENDER.” According to the order, Rumble alleges his ultimate diagnoses were conditions that affect people of any gender.
The hospital had urged the court to throw out on the case on the basis that Rumble failed to allege that he sought medical care from a health service receiving federal funds and didn’t present facts demonstrating he faced differential treatment on the basis of sex, sexual orientation or gender identity. The order allowing the case to proceed denies these requests.
The court will make a decision after it obtains additional briefing. Rumble is seeking a permanent injunction requiring the hospital to adopt practices conforming with the Affordable Care Act and Minnesota, compensatory damages for physical and emotional pain, and punitive damages.
According to the order, Rumble has filed a complaint with the Office of Civil Rights at the Department of Health & Human Service, where an investigation is still ongoing.