Wiener bill aims to improve transgender medical care in California
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Legislation to be taken up by California lawmakers this year aims to improve transgender medical care throughout the state. It would require medical professionals who interact with transgender, gender-nonconforming, and intersex patients to receive cultural competency training, and health providers would need to create searchable online directories of their gender-affirming services.
Gay state Senator Scott Wiener (D-San Francisco) is introducing Senate Bill 923, the TGI Inclusive Care Act, Friday (February 4). All health providers and staff who interact with transgender, gender-nonconforming, and intersex individuals would be required to undergo the cultural competency training under the bill. It also mandates that the trainings must be facilitated by TGI-led organizations and include the perspectives of TGI people.
"It's simple: transgender, gender-nonconforming, and intersex people deserve the same quality of health care that everyone else receives," stated Wiener. "No one should go to a doctor's appointment only to be misgendered, harassed, or even refused treatment."
According to a report about LGBTQ medical care in California called "Surveying the Road to Equity: The Annual State of LGBTQ Communities, 2019," which was released in November 2020, health care settings not affirming of LGBTQ patients are a considerable problem in the state. It called for mandatory training of doctors and other providers on LGBTQ issues, as the B.A.R. had reported.
The survey also revealed that LGBTQ people were unsure of how to find an LGBTQ-competent provider. They were also unaware if their health insurance covered such services, even though California requires insurers to do so.
"A number of providers just don't have the education they need, and they aren't going to get it if we continue to make it voluntary," noted Poshi Walker, who helped oversee the survey, during an online presentation to discuss the findings.
Of the 3,453 Californians who took part in the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, 33% reported having a negative interaction with a health care provider in the past year. Their experiences ranged from being refused treatment, verbally harassed, or physically or sexually assaulted to having to educate their provider about transgender people in order to get appropriate care.
Bill mirrors other laws
Fear of being mistreated as a transgender person led 22% of the respondents not to see a doctor when they needed to in the past year. Such issues remain a problem seven years later, said Pau Crego, a trans nonbinary person who's acting director of the San Francisco Office of Transgender Initiatives.
"It is very exciting to see this bill being introduced," said Crego. "It obviously can have a much broader impact at the state level."
It mirrors other laws passed in the Golden State that require LGBTQ cultural competency training for various professions, from teachers and educators to police and fiduciaries. Legislation that took effect in 2014, authored by gay former Assemblymember Rich Gordon, required continuing medical education curriculum to include a discussion of LGBT-specific issues.
UCLA's Office of Continuing Medical Education, for instance, next week is offering a two-day Transgender Health Symposium with sessions focused on mental health care, gender-affirming related medical procedures, and gender-affirming healthcare practices. Transgender advocates contend more such training is needed that focuses on their specific health issues.
"Medical providers and mental health providers alike do not get training around how to work with, both in a culturally competent way but also in a clinically competent way, and to treat transgender patients, or really how to work with them in any capacity," said JM Jaffe, who is a transgender person and the director of clinic operations at Lyon-Martin Health Services in San Francisco. "This bill would require that any provider contracted with a health plan gets that training. That is a huge deal; there is such a lack of providers out there that do this kind of care."
Crego and Jaffe did not work directly with Wiener's office on drafting the legislation. But issues around transgender health care came up in a fellowship they took part in last year.
"Transgender care is not taught in health professional schools," said Jaffe, co-chair at the National LGBT Primary Care Alliance. "It is not an integrated part of the curriculum."
In a joint phone interview with the B.A.R. to discuss Wiener's legislation, Jaffe noted that TGI people from all over the state, and even from other countries, seek out treatment at Lyon-Martin because they do not know how to access such services closer to their homes. The clinic, part of the nonprofit provider HealthRIGHT 360, will treat such patients.
But they would be better served knowing where to seek out such health care closer to home, said Jaffe, who applauded the legislation's requirement that health plans make it easy for their TGI members to locate doctors who provide gender-affirming care.
"This will expand access to many types of medical and mental health services for trans populations all over California," said Jaffe.
UCSF has created such a directory through its Transgender Care Navigation Program. Transgender patients can find a range of medical and surgical services via it, as well as schedule an e-consult service with a provider in the UCSF Health System.
It also offers a clinical training experience for UCSF residents in the medical fields of family and community medicine, internal medicine, and OB-GYN. Such training is not only needed of those entering into the medical profession, but also for current practitioners who did not learn about gender-affirming care when they were earning their medical degrees, argue LGBTQ advocates.
"Many medical students and medical providers who provide specialty care such as podiatry, cardiovascular, gastroenterology, etc. have a predetermined opinion that they will never serve the transgender, gender non-conforming and intersex community due to their specialization," stated Dannie Cesena, the transgender health equity manager for the California LGBTQ Health and Human Services Network. "The assumption that TGI community members will not seek specialty care is dangerous. As human beings, we deserve comprehensive and affirming medical care for all comorbidities that we may face, and this bill will ensure that all medical providers, regardless of their expertise, are properly trained to provide that access to care."
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