Hospitals under order to grant same-sex couples visitation rights

From the Massachusetts Nurse Newsletter
May 2010 Edition

Hospitals must now clearly allow gay and lesbian couples to have non-family visitors and cooperate on issues relating to partners having medical power of attorney. This has been the law in Massachusetts, but a presidential memorandum signed by President Barack Obama on April 15 orders the Department of Health and Human Services to prohibit discrimination on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or disability in hospital visitation policies and practice. The future rule will affect any hospital that receives Medicare or Medicaid funding.

The announcement establishes that in the future, hospitals can no longer insist that only family members by blood or marriage be allowed to visit patients. New rules will ensure that hospitals “respect the rights of patients to designate visitors.”

MNA receives periodic inquiries from nurses over gender issues arising in their nursing practice, such as dealing with visitation policies, rooming policies for transgendering patients, use of pharmaceuticals “off label” by transsexual (transgendering) patients, liability for abiding by discrimination laws when hospital policies or management directives do not, etc. There are a myriad of insurance, discrimination and access-to-care problems that affect the GBLT (gay, bisexual, lesbian, transgendered) community which are relevant for health professionals.

We are interested to know the extent to which these issues affect your practice and what resources, education or information might be helpful. Please contact Mary Crotty with your thoughts and suggestions by e-mail at mcrotty@mnarn.org or by phone at 781.830.5743.

Background

One explanation of terms and issues is found in a Journal of Emergency Nursing article “Transgender Patients: Implications for Emergency Department Policy and Practice.”

“Transgender” is an umbrella term for several distinct but related groups, which include cross-dressers, gender-variant individuals and transsexuals (TS). Transsexuals often express the feeling of being “trapped inside the wrong body,” and they may undergo medical and surgical treatments (sexual reassignment/ transition) to align their outer appearance with their gender identity. “Gender identity” refers to the internal sense of feeling male or female, regardless of biologic sex, and it may be firmly expressed by even very young children. Some TG persons do not completely identify with either gender. Gender expression and gender identity are unrelated to sexual orientation. Transgender people may define themselves as heterosexual, gay, lesbian or bisexual.

Public policy and legislation affecting TG status and rights vary. To date, six states, 62 cities, and 10 counties have passed laws prohibiting discrimination on the basis of gender identity or expression. Eight states have transgender-inclusive hate crime laws. However, most health insurance policies specifically exclude all procedures related to being TS. In fact, transsexual people are routinely denied health policy coverage solely because they are TS. Even those who have insurance coverage may be denied payment for essential health screenings, such as prostate examinations for male-to-female persons and pelvic examinations for female-to-male persons.

According to a recent study, TG persons frequently encountered humiliating treatment, widespread insensitivity and discrimination when seeking health care. There was a lack of provider knowledge necessary to adequately treat the routine health issues of TG individuals, who may remain silent about health issues they fear could lead to further stigmatization or loss of insurance. Another study found that male-to-female persons were more likely to seek care and adhere to human immunodeficiency virus (HIV) antiretroviral therapies when health care providers were perceived to be aware and accepting of sexual and social identity.

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