Health & Medicine

Court says Sacramento-area transgender man can sue Mercy San Juan over denying hysterectomy

The 1st District Court of Appeal in San Francisco ruled that a Sacramento-area transgender man can sue Mercy San Juan Medical Center over the last-minute cancellation of his hysterectomy, overturning a lower-court ruling that dismissed the case.

Dignity Health, which operates Mercy San Juan, arranged for Evan Minton to have the procedure at Methodist Hospital in south Sacramento within 72 hours of the denial, court records state. The procedure was canceled, the lawsuit stated, after Minton mentioned to a nurse that he is transgender.

In his appeal court decision, Presiding Justice Stuart R. Pollak stated: “Without determining the right of Dignity Health to provide its services in such cases at alternative facilities, as it claims to have done here, we agree that plaintiff’s complaint alleges that Dignity Health initially failed to do so and that its subsequent rectification of its denial, while likely mitigating plaintiff’s damages, did not extinguish his cause of action for discrimination.”

In a statement released Tuesday night, Dignity Health leaders wrote that the company has a legacy of providing care to all people regardless of their background, sexual orientation or gender identity.

Catholic hospitals do not perform sterilizing procedures such as hysterectomies for any patient regardless of their gender identity, unless there is a serious threat to the life or health of the patient,” the Dignity statement continued. “Courts have repeatedly recognized the right of faith-based hospitals not to provide services based on their religious principles....In this case, Mr. Minton was able to quickly receive the sought-after procedure at another nearby Dignity Health hospital that is not Catholic-affiliated.”

Attorneys for the American Civil Liberties Union represented Minton and argued that Mercy San Juan’s actions violated California’s Unruh Civil Rights Act, which says businesses must offer full and equal access to state residents.

But a San Francisco Superior Court judge dismissed the lawsuit, saying the Carmichael-based hospital followed the direction of California Supreme Court justices in quickly rescheduling the procedure at a different facility. The superior court found this action fell in line with the high court’s decision in North Coast Women’s Care Medical Group Inc. v. San Diego County Superior Court.

Minton was diagnosed with gender dysphoria, a serious medical condition that results from a feeling of incongruence between one’s gender identity and one’s sex assigned at birth, according to a court filing dated April 19, 2017. Minton was assigned the sex of female, the lawsuit stated, but identified as a male as he developed.

His physicians recommended a series of treatments to help him transition and affirm his gender identity, records showed, and Minton underwent hormone replacement therapy in 2012 and a mastectomy in 2014. He planned to undergo the hysterectomy before undergoing the surgical creation of a penis.

Minton’s surgeon, Dr. Lindsey Dawson, scheduled the procedure on a day when she planned another hysterectomy at Mercy San Juan, court records stated, but two days before the surgery, Minton mentioned to a pre-operation nurse that he is transgender. In an interview with The Bee in April 2017, Dawson said Dignity Health officials assisted her in getting emergency privileges at Methodist so she could perform the procedure there.

Dignity Health leaders said in the statement that its medical teams are sensitive to the specific health needs of transgender patients and that specialty care for trans individuals is offered at many of the company’s care sites.

Elizabeth Gill, senior staff attorney for the ACLU Northern California, told The Bee the procedure was not any more elective for Minton than it is for cisgender women who have hysterectomies at Mercy San Juan for conditions that are not life-threatening.

Pollak, in his ruling, wrote that the denial of a procedure that treats a condition particular to transgender persons supports an inference that Dignity Health discriminated against Minton based on his gender identity. This is true, he noted, even if the denial was based upon a policy that does not appear discriminatory on its face. Justices Alison Tucher and Tracie L. Brown concurred on the opinion.

In the lawsuit, Gill noted there are widely accepted standards of care for treating gender dysphoria published by the World Professional Association for Transgender Health, saying the standards are recognized by leading medical organizations, the U.S. Department of Health and Human Services, and federal courts.

Correction: This article was updated Wednesday to correct the name of the justice who issued the opinion for the 1st District Court of Appeal in San Francisco. The ruling was made by Presiding Justice Stuart R. Pollak.

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Cathie Anderson covers health care for The Bee. Growing up, her blue-collar parents paid out of pocket for care. She joined The Bee in 2002, with roles including business columnist and features editor. She previously worked at papers including the Dallas Morning News, Detroit News and Austin American-Statesman.