Transgender man denied hysterectomy at Mercy San Juan

Mercy San Juan hospital won’t perform hysterectomy on transgender man

Transgender man Evan Michael Minton was denied a hysterectomy at Mercy San Juan just hours before he was scheduled to have surgery.
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Transgender man Evan Michael Minton was denied a hysterectomy at Mercy San Juan just hours before he was scheduled to have surgery.

Tuesday was supposed to be a big day for Evan Michael Minton. The Fair Oaks resident packed his bags for the hospital, said a prayer and counted down the hours until he would undergo the hysterectomy that would take him one step further in his transition from female to male.

Instead he spent the day on the phone with doctors and lawyers after Mercy San Juan hospital in Carmichael abruptly canceled the procedure on religious grounds.

The surgery, part of Minton’s transition to a fully male body, had been scheduled for three weeks but was called off Monday as hospital officials were preparing his admissions paperwork.

Both Minton and his surgeon, Dr. Lindsey Dawson, said they were caught unawares by the hospital’s decision.

“I was a little bit blindsided by it,” said Dawson, a Sacramento obstetrician gynecologist in private practice who said the majority of her hysterectomies are done at Mercy San Juan.

“When I got that news, I fell on the ground and cried uncontrollably,” said Minton, a 35-year-old state legislative aide who has been preparing for the procedure for the past year. “It hurt because of the fact that I’m being discriminated against based on my innate and immutable characteristics, and it also hurt because it put everything in flux.”

The hospital, part of the Dignity Health chain, said the procedure goes against its anti-sterilization policies, which are based on ethical and religious directives issued in 2009 by the U.S. Conference of Catholic Bishops.

In a statement, Dignity Health, which until 2012 was affiliated with the Roman Catholic Church, declined to discuss Minton’s case, citing patient privacy laws.

“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities,” said spokeswoman Melissa Jue, in an emailed statement. Sterilization procedures, such as hysterectomies or tubal ligations, she said, are permitted by Catholic hospitals only to cure or alleviate a “serious pathology and (if) a simpler treatment is not available.”

In Minton’s case, there is a clear, medical need for a hysterectomy, according to his surgeon.

“Gender dysphoria is very clearly a pathology,” said Dawson. “It’s a recognized state of health,” noting that national obstetrics groups recommend that transitioning transgender patients be put on hormones and provided with appropriate surgeries.

She said Minton is her first patient seeking a hysterectomy as a part of gender transition care.

Minton, who came out as transgender six years ago and has been living as a man since, takes male hormones and has already undergone a double mastectomy. He is scheduled to have a phalloplasty, or male organ construction surgery, on Nov. 23, but the hysterectomy needs to happen first.

Every setback in the transition process means more time that Minton spends feeling uncomfortable in his body, he said.

“It makes me feel like I want to crawl out of my skin,” he said. “It brings me to my knees, it gives me anxiety, it makes me so emotional and that’s when I know that I need to take the next step in my transition. ... I want to live as the complete man that I know myself to be. That’s all.”

Ben Hudson, executive director of Sacramento’s Gender Health Center, said he helped Minton connect with legal services months ago while he was struggling to get insurance coverage for other medical steps in his transition.

A 2013 law requires all insurance entities regulated by the California Department of Managed Health Care to remove blanket exclusions on transgender care, but most companies are still catching up with the regulations, Hudson said.

Having a hospital refuse to perform a procedure is an entirely different issue, he said.

“We know that these are life-saving procedures for transgender individuals,” he said. “It’s not up to (hospitals) to decide.”

Mental health experts say transgender people are at high risk for suicide with 41 percent of transgender individuals having attempted suicide, compared to 4.6 percent of the overall U.S. population and 10 to 20 percent of lesbian, gay and bisexual respondents, according to a 2014 report by UCLA and the American Foundation for Suicide Prevention.

Ruth Dawson, staff attorney for the American Civil Liberties Union of Southern California, said officials were “dismayed” by Dignity Health’s decision in the Minton case. In the last year, patients across California have called the ACLU about being denied access to reproductive health care, including hysterectomies and gender surgeries. “It’s a widespread problem,” she said.

Last year, the ACLU sued Dignity Health officials in Redding after several women were denied tubal ligations immediately after childbirth, as a form of permanent birth control.

“Trans patients must have and deserve meaningful comprehensive access to health care, without burdensome and unnecessary preconditions. Unfortunately, that’s what Mr. Minton is experiencing here,” said Dawson, who is not related to Minton’s doctor.

Despite Tuesday’s surgery cancellation, Dr. Dawson said Dignity Health officials were helpful in getting her set up with emergency privileges at Methodist Hospital of Sacramento, a Dignity Health facility that is not bound by Catholic doctrines.

“I don’t blame the staff,” Dawson said. “I don’t blame the administrators. I blame the (Catholic) doctrines.”

Minton was tentatively scheduled for his hysterectomy on Friday at Methodist .

Sammy Caiola: 916-321-1636, @SammyCaiola