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Nurse sues employer that won't cover gender reassignment treatments

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A transgender nurse has sued San Francisco-based Dignity Health for denying its transgender employees insurance for transition-related health care.

The lawsuit, Josef Robinson v. Dignity Health dba Chandler Regional Medical Center, filed Monday in the U.S. District Court for the Northern District of California in San Francisco, accuses Dignity Health, the nation's fifth largest hospital system, of sex discrimination in violation of Title VII of the Civil Rights Act and the Patient Protection and Affordable Care Act by treating transgender employees unequally by “depriving them of all medical care for gender dysphoria,” the lawsuit states.

Gender dysphoria is a condition in which a person experiences significant distress because of differences in his or her assigned sex and gender identify.

Attorneys for the American Civil Liberties Union are representing Mr. Robinson, a transgender male working as a nurse at Dignity Health Chandler Regional Medical Center in Chandler, Arizona.

The U.S. Health and Human Services Department in May issued a final rule banning discrimination against transgender people in the health care system.

But according to the lawsuit, Dignity Health's self-funded employee health plan explicitly excludes “treatment, drugs, medicines, services and supplies for, or leading to, sex transformation surgery.”

There's a consensus among “every major medical organization” and “medical experts” that “treatments for gender dysphoria, including surgical procedures, are effective, safe, and medically necessary when clinically indicated to alleviate gender dysphoria,” the lawsuit states.

Because of Dignity Health's exclusion of coverage for sex transformation surgery, Mr. Robinson has paid thousands of dollars out of pocket for hormone therapy and a double mastectomy to treat his gender dysphoria, according to the lawsuit.

After his attempts for pre-authorization of a double mastectomy were denied twice, Mr. Robinson paid $7,450 out of pocket for the surgery.

He has also forgone “medically necessary phalloplasty surgery” because he does not have the funds to pay without insurance.

Mr. Robinson filed a discrimination charge with the Equal Employment Opportunity Commission in December, and the EEOC issued a “right-to-sue” letter to Mr. Robinson in May.

Dignity Health responded to Mr. Robinson's discrimination charge that the exclusion of transition-related health care coverage was not discriminatory because the plan doesn't provide health benefits for “personality disorders, including sexual/gender identity disorders and behavior and impulse control disorders,” the lawsuit states.

The plaintiff argues that gender dysphoria is not a personality disorder.

Mr. Robinson seeks declaratory relief, injunctive relief, compensatory and punitive damages, and attorney's fees.

“Every major medical association has affirmed that transition-related health care for transgender people is medically necessary,” Josh Block, an attorney with the ACLU LGBT & HIV Project, said in an ACLU statement published Monday. “Under Title VII and the Affordable Care Act, these sorts of discriminatory insurance provisions are illegal in all 50 states.”

“I was shocked when Dignity, which is supposed to be in the business of healing and holds itself out to the public as a bastion of 'humankindness,' told me they would not authorize insurance coverage for my doctor-prescribed treatment,” Mr. Robinson said in the statement. “All I want is the same health benefits other, non-transgender Dignity employees receive, which is coverage for medically necessary treatments.”