Friday, March 16, 2012

A Message from CM James: LGBT Legislative Updates

I would like to make you aware of my recent work on behalf of New York City’s LGBTQ community—

City Council Resolution Calling on the Medical Professionals to Treat and Provide Appropriate Healthcare to Transgender Persons

I have recently introduced a resolution into the New York City Council calling on medical and health professional to treat, and provide appropriate healthcare, to transgender individuals. This resolution follows a statement recently released by the American College of Obstetricians and Gynecologists (ACOG).

While the LGBTQ community as a whole experiences greater disparities in relation to access to health insurance and healthcare, there is a specific need for transgender individuals to have access to health plans and services for transgender-related care, as well as for healthcare professionals to receive appropriate training on how to treat transgender patients. ACOG noted a concern for the gynecological health of transgender men, who may still require female (breast and cervical) cancer screenings as well as other forms of care. According the the National LGBT Cancer Network, “Trans men are less likely to get regular medical/gynecological care than heterosexual women or lesbians.” Some trans men have noted feeling healthcare professionals are not aware of available treatment options for transgender persons, not sensitive to their individual preferred pronouns, and/or presumptive concerning their sexual activities. All of these real or perceived issues may prevent transgender individuals from seeking appropriate healthcare.

Furthermore, there is a need to ensure medical and health care providers do not engage in gender identity discrimination, and where necessary refer patients to healthcare professionals that are best able to treat them. The Gay and Lesbian Medical Association (GLMA) has issued clinical guidelines for medical professionals when providing care to LGBT persons. The resolution I introduced into the New York City Council recently, Resolution 1244-2012, urges that medical and health professionals adhere to similar guidelines to provide appropriate healthcare to transgender persons.

Resolution 1244 :

City Council Resolution Calling on the NYC Health Department to Repeal Requirement that Transgender Persons Undergo Surgery to alter gender marker of Birth Certificates

As you well know, in New York City many transgender individuals are unable to change the ‘gender marker’ listed on their birth certificate due to New York City Department of Health and Mental Hygiene (‘Health Department’, under the New York City Office of Vital Records) rules that are inappropriate, presumptive, intrusive, and unclear in their intentions. The Health Department’s requirements are also out-of-step with the requirements of the federal government (as outlined in the Department of State’s gender marker passport updates), which seek to make it simpler for transgender individuals to update their passport.

[On June 9, 2010, the United States Department of State updated their passport policy. A passport applicant must only provide certification from an attending medical physician stating that the applicant has undergone appropriate clinical treatment for gender transition, for the passport to reflect the desired gender. It is also possible to obtain a limited-validity passport if the physician’s statement shows the applicant is in the process of gender transition. No additional medical records will be required. Sexual reassignment surgery is no longer a prerequisite for passport issuance.]

The Health Department currently requires individuals to undergo genital surgery (also commonly referred to as “bottom surgery”) before changing the gender or sex-identifier on their birth certificates. The agency is unspecific about the nature of the genital reassignment surgery, as there are multiple types of bottom surgery available for both male-to-female (MTF) and female-to-male (FTM) transgender persons. This ambiguity creates confusion for those seeking to update their birth certificate to their identified gender, as these kinds of surgeries can be very costly. Furthermore, it is difficult to find information about the process on the department’s website.

Many transgender individuals can't afford bottom surgery for financial reasons; a high number of these individuals may be receiving hormone therapy through their medical care provider to address masculinization or feminization of physical features. Finally, not all transgender individuals— even those identifying in their current gender in all areas of life, as well as those on hormone therapy— are interested in genital reassignment surgery. It is highly inappropriate for the Health Department to make decisions that imply generalizations about transgender individuals and their personal, medical choices.

As one moves from locality or state, a person may be required to present their birth certificate to prove identity; this becomes an issue when the gender marker or sex-identifier on the birth certificate is different from that on the state identification. New York State has a specific process for amending the gender or sex-identifier on a state ID or driver’s license, but individuals moving from New York State to another state may encounter difficulty if their birth certificate is also required to receive a state ID there. Additionally, many employers require access to an individual’s birth certificate to apply for health insurance, and transgender individuals may not want their employer to know about their biological sex or medical/surgical history.

Numerous transgender-rights advocacy agencies, as well as the National Association of Social Workers, have encouraged City and State agencies to abandon surgical requirements for changing identity documents. For instance, in 2009 the state of Illinois agreed to develop new standards for how much surgery is required before a person is eligible to switch the gender or sex-identifier on a birth certificate. City and State agencies are recognizing that any regulations in regards to updating gender identification on documents must be based on the standards set by the physicians actually treating these individuals. The World Professional Association for Transgender Health (WPATH) is the major health association that sets the standards for medical treatment of transgender individuals. WPATH has stated “No person should have to undergo surgery or accept sterilization as a condition of identity recognition. Genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes.”

In 2006, the Health Department considered dropping their requirement for gender reassignment surgery before switching a birth certificate's gender or sex-identifier, but did not do so citing identity fraud concerns.

The resolution I introduced into the New York City Council last year, Res. 1099-2011, urges the Health Department to abandon these confusing and intrusive requirements.

Resolution 1099 :

It is imperative that we treat LGBTQ persons with dignity and respect in all areas of society. We need to ensure that our laws and public agencies do not isolate anyone from fair access to basic rights like housing, healthcare, and employment. I consider myself a strong advocate for the LGBTQ community, and I will continue to work on the issues that affect the gay community in New York City.

Letitia James
Member of the City Council

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