A transgender woman has filed a discrimination complaint with the D.C. Office of Human Rights against MedStar Georgetown University Hospital on grounds that the hospital allegedly refused her request for breast implant surgery because of her gender identity.
Alexa Rodriguez, 38, vice president of D.C.’s Latino LGBT History Project, said the refusal came on May 8, five months after one of the hospital’s highly regarded breast surgeons, Dr. Troy Pittman, examined her and cleared her for the surgery contingent upon approval for coverage of the procedure by her health insurance provider.
Rodriguez said her insurer, United Healthcare, initially denied coverage but reversed its decision five months later in response to her appeal of the denial.
“They told me that when I got the pre-approval for the insurance we can schedule the surgery,” Rodriguez said. “So after I received that approval I called to make an appointment for the surgery.”
Much to her dismay, Rodriguez said a hospital employee who schedules Dr. Pittman’s appointments told her by phone on May 8 that the hospital was no longer taking transgender women for treatment or surgery.
“And I asked him why,” said Rodriguez. “He was like, ‘Oh, I don’t know. They’re not saying anything.’”
Ruby Corado, executive director of Casa Ruby, an LGBT community center that provides services to the transgender community, said at least two of her female transgender clients were also turned town for breast surgery at MedStar Georgetown around the same time that Rodriquez was turned down.
Rodriquez told the Blade one of her female transgender friends was turned down for breast-related surgery by Georgetown the same week she was informed the hospital isn’t doing the surgery for trans women.
Marianne Worley, director of media relations for MedStar Georgetown University Hospital, said in a statement to the Washington Blade that the hospital has a policy of not discriminating against patients based on sexual orientation and gender identity and expression among other categories.
While the hospital doesn’t offer some specific programs such as gender transition treatment, “We do see and diagnose anyone who presents to us,” she said, including transgender patients.
“MedStar Georgetown University Hospital does not have a policy on assisting with gender transition; it is just not a comprehensive service that we currently offer,” Worley said in her statement.
Saying the hospital decides which services to provide based on the “highest quality outcomes,” her statement adds, “A gender transition program is very complex, requiring an array of specialists with expertise in hormonal therapy, surgery and psychological services, to name just a few.”
“Our conclusion has been that a high quality gender transition service is best delivered in the context of an integrated program rather than in a one off manner, and such a program does not exist at MedStar Georgetown,” her statement says.
According to Worley, “Cases in which the treatment required is outside the scope of what we offer are referred to the appropriate health care facility both within and outside of MedStar Health.”
Both Rodriguez and Corado said they know of other transgender women who had transition-related breast surgery at MedStar Georgetown last year, with one trans woman having had breast surgery there as recently as January of this year.
“We know they did surgery on transgender women in January,” said Corado. “It was not an issue before. What has changed to not allow it now?”
Worley did not specifically answer that question in her written response to a Blade inquiry.
One source familiar with the hospital who spoke on condition of not being identified said some members of the medical staff at the hospital reported hearing that transgender-related surgery was discontinued earlier this year after complaints were lodged by conservative Catholic officials affiliated with Georgetown University.
“MedStar Georgetown is a Catholic hospital and, consistent with all Catholic hospitals, it operates under the Ethical and Religious Directives of the Catholic Church,” Worley said in a follow-up statement to the Blade.
Rodriguez said she had been referred to Dr. Pittman at Georgetown for the surgery by her primary care physician at Whitman-Walker Health, which is providing her with the full array of treatment and services that go along with gender transition, including hormone therapy and mental health counseling.
“I then went to their office about two weeks later to try to get an answer for why they were denying me my surgery,” Rodriguez told the Blade in discussing her interaction with Georgetown Hospital. She said the employee she spoke with by phone, who she only knows by his first name of David, repeated his earlier claim not to know the reason for the denial.
She said David did not arrange for her to speak with a higher up official at the hospital, as she requested, to find out why she was denied the surgery.
“We are surprised and disappointed to learn of Georgetown’s statement and its implications for access to much-needed surgery services for the metro D.C. transgender community,” said Shawn Jain, director of communications for Whitman-Walker Health.
“Whitman-Walker routinely refers transgender and other patients to qualified specialists, including Georgetown, for healthcare needs that we do not offer in-house,” Jain said. “We apply World Professional Association for Transgender Health (WPATH) standards of care when referring transgender patients for surgical care,” he said.
“Based on our reading of Georgetown’s statement, we believe this will present some very real and tangible access to care issues for our transgender patients,” said Jain.
Brian Markovitz, a civil rights attorney who has represented clients in cases before the D.C. Office of Human Rights, said Georgetown could have a difficult time defending its decision not to provide the surgery requested by Rodriguez.
He said the fact that Whitman-Walker handled the gender transition-related aspects of Rodriguez’s medical treatment, which Georgetown says it may not have the expertise to do, could undermine a claim by Georgetown that it was legally justified in refusing to perform the surgery.
“They could be running afoul of the Human Rights Act because they are providing implants for cancer patients and other people, and because they’re doing that and they’re not going to do it for this individual they’re running the risk of liability,” Markovitz said.
He said although Georgetown could argue that it’s a Catholic hospital and certain medical and surgical procedures are against church teachings, the Human Rights Office would likely rule that the hospital is open to the general public and therefore is operating as a public accommodation, which is bound by the D.C. Human Rights Act.
The Human Rights Act bans discrimination based on gender identity and expression and a wide range of other categories such as race, religion and ethnicity.
Elliot Imse, a spokesperson for the Office of Human Rights, said the office cannot comment on a pending case before the office completes an investigation and makes a determination of whether probable cause exists that discrimination occurred.
But he said that as a general principle, case law established from past court rulings and decisions by the OHR holds that if a public accommodation like a hospital offers services to non-transgender people, “under most circumstances they would have to offer that to transgender people unless there is something regarding safety or complications that are different than for a cisgender person.”
(Cisgender is a term used to describe non-transgender people.)
Markovitz said that if the OHR finds probable cause that Georgetown violated the Human Rights Act by denying implant surgery for a transgender person and the D.C. Commission on Human Rights upholds that decision, the case could become a hot button issue before D.C. and federal courts should Georgetown decide to appeal the ruling.
“I could see the hospital defending itself on First Amendment [religious liberty] grounds and this could turn into a very important case,” he said.
Should the case enter the federal court system Markovitz said Rodriguez could benefit from recent federal court rulings saying transgender people are covered under a federal civil rights law that bans discrimination based on gender.
Corado said one of the Casa Ruby clients turned down for surgery at Georgetown was suffering from complications related to breast augmentation surgery she had several years earlier in El Salvador. The client, Katherine Campos, told the Blade a Georgetown Hospital physician examined her after she experienced bleeding and pain in her breasts that may have been due to an infection.
She said the doctor determined surgery was needed to correct the problem, but a hospital official told her the hospital does not do transgender-related surgery and she would have to get the surgery someplace else.
Rodriguez said her friend who was refused breast augmentation surgery never had a chance to see a doctor at MedStar Georgetown because the person she spoke with by phone to make an appointment informed her she need not come in.
“With her it was worse because she called to schedule a consultation appointment and the guy said we are happy to have you, we are taking new clients, yada, yada, yada,” said Rodriguez. “And then he suddenly asked her are you a biological woman or are you a transgender woman?”
When her friend replied that she’s a transgender woman the hospital staffer on the phone told her, “Well at this time we are not taking transgender women,” Rodriguez said. “She was devastated. She said it was not right for him to do that.”