This week, a federal court in Minnesota issued a preliminary ruling in a case concluding that discrimination against an individual because of his gender identity is prohibited under the Affordable Care Act (Obamacare).
In June of 2013, Jakob Tiarnan Rumble, a transgender man, sought treatment at Fairview Southdale Hospital, just outside of Minneapolis. He had a high fever and severe pain in his genitals. During his first day in the Emergency Room and subsequent six days in the hospital, Rumble alleges that he was subject to numerous forms of mistreatment because of his gender identity, including:
- Despite indicating to nurses that he identified as a man, Rumble received a hospital bracelet identifying his sex as “female.”
- Rumble then waited several hours — still in extreme pain — before receiving any attention or treatment.
- When Dr. Randall Steinman eventually examined Rumble, he asked him disparaging questions about the gender of his sexual partners and the nature of those encounters, aggressively communicating that he didn’t know how to diagnose him because of his use of hormone therapy.
- Steinman then conducted what Rumble described as an “assaultive exam,” during which he repeatedly jabbed at the patient’s inflamed genitals, refusing to stop even after a crying Rumble demand that he stop twice. Only Rumble’s mother’s intervention stopped the painful assault.
- Steinman then left the room, indicating that he could not provide them with any information about Rumble’s condition because his mother had stopped the “exam,” and Rumble proceeded to wait several more hours before being admitted to the hospital.
- Another doctor who treated Rumble, Dr. Stephen Obaid, examined his genital area while wearing gloves, then wiped the gloves on the examination bed’s blanket before proceeding to examine Rumble’s eyes and mouth using the same gloves. Rumble “later developed sores on his face in the places that Dr. Obaid had touched.”
- At various times during his stay, nurses inexplicably examined Rumble’s genitals, whispered about him, and behaved unfriendly toward him.
- When Rumble received his bill, it indicated that he owed the full amount because, “THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT’S GENDER,” despite the fact, as the Court noted, “his ultimate diagnoses were conditions that can, and do, affect people of any sex or gender.”
U.S. District Judge Susan Richard Nelson, an Obama appointee, concluded that Rumble had provided significant evidence to substantiate a case against the hospital under Section 1557 of the Affordable Care Act, which protects against sex discrimination in health care. She similarly allowed Rumble’s charges under the Minnesota Human Rights Act to proceed. This ruling, however, simply rejected the hospital’s request to dismiss the case, meaning that it will still proceed toward discovery and an eventual final outcome.
Nelson described Dr. Steinman’s treatment as “objectively offensive,” particularly his refusal to stop a painful genital exam. “A reasonable person, seeking treatment from an emergency room doctor at a hospital, would expect that the doctor would respect the patient’s wishes to stop a painful exam,” she wrote. It is plausible, she concluded, that this mistreatment was because of Rumble’s gender identity and did not constitute “random poor treatment that anyone might have received.” The bill’s reference to his gender “inconsistency” further bolsters Rumble’s claim that he experienced discrimination because he is transgender.
The same “objectively offensive” standard applies to the misgendering Rumble experienced from hospital staff, as well as the delays and refusals of treatment. It is plausible, Nelson concluded, that these were more than “perceived slights,” but a likely indication that he was treated poorly because of his protected class.
Harper Jean Tobin, Policy Director for the National Center for Transgender Equality, described the case as one that “illustrates the need for transgender people to stand up for their rights in health care settings.” Noting that she’d recently been hospitalized herself, Tobin offered that “the fear of mistreatment in medical settings is constant” for trans people, but they need to know that “there’s something you can do” thanks to the law’s new protections.
NCTE points out that according to the 2011 National Transgender Discrimination Survey, 19 percent of trans people have been refused medical care because of their gender identity, 28 percent have been subjected to harassment in medical settings, and 50 percent have had to teach their medical provides about transgender care.