9:19 am Aug. 8, 2011
Back in 2008, the public advocate's office produced a pretty scathing report that included the story of a man who went to an emergency room at Lincoln Hospital in the Bronx and asked for Post-Exposure Prophylaxis (or P.E.P.) treatment.
The procedure, often carried out immediately after a patient suspects exposure to H.I.V. and routinely in cases of sexual assault, is thought to be effective in reducing the risk of H.I.V. infection when administered within one hour of the potential exposure.
According to the report, the man waited 45 minutes to be seen by a triage nurse who then announced in front of the waiting patients and hospital staff, "You don't need P.E.P.; you're a boy." He left the hospital without undergoing the treatment.
The report singled out Lincoln as among the worst offenders in the treatment of lesbian, gay, bisexual and transgender patients, but painted a picture of widespread insensitivity and sometimes discrimination across much of the city's Health and Hospitals Corporation, the largest municipal public hospital system in the country with 1.3 million patients, of whom more than a third are uninsured. In some cases the discrimination demonstrably led to problems with diagnosis and care.
Nor was the public advocate's the only report giving the H.H.C. low marks: The Human Rights Campaign Foundation just produced a national index of hospitals that fit its definition of "LGBT Healthcare Equality" in which only one hospital in the city's hospital network—Metropolitan Hospital Center on the Upper East Side—qualified for inclusion. (Download the PDF here.)
The problem is in fact a national one and well known: Studies and reports demonstrating the inadequacy of treatment in hospitals of gay, lesbian and transgender patients have been consistent over the last several years, but seemed to culminate in a 2010 report published by Lambda Legal, a gay-rights advocacy group, that found that nationally nearly 56 percent of lesbian and gay people, and 70 percent of transgender people, say they have experienced some form of discrimination at the hands of health-care providers.
These kinds of studies have hospitals trying to keep pace, as businesses, with a series of events they can’t ignore, like the state’s legalization of same-sex marriage, and new rules about fair visitation rights ordered by the White House and implemented by the Joint Commission, which accredits U.S. hospitals. Ignoring the problem is no longer good business.
And so the pressure has increased on multiple fronts on New York hospitals to fix the problem. Increasingly, New York hospitals are teaching doctors and nurses how to provide care without discriminating on the basis sexual orientation, how to anticipate the specific health needs of gay patients, and how to ensure equal visitation rights for their partners and, now, spouses—even at Lincoln.
“The good thing is that now we’re actually talking about this,” said Lydia Thomas, director of training for H.H.C. at Lincoln and Harlem Hospitals, in an interview.
LIZ MARGOLIES HAS NOTICED THE SHIFT. A PSYCHOTHERAPIST BY TRADE, she runs the National LGBT Cancer Network from a long wooden table in her kitchen on West 16th Street in Chelsea.
Though she founded the organization four years ago, its services have in the last few months been in sudden heavy demand, as hospitals seek her help to improve the quality of health care they provide to gay, lesbian and transgender patients.
“Emails and phone calls have measurably increased,” she said.
It’s not technical medical expertise the hospitals are in search of, exactly. What they seek from Margolies is, more than anything else, help in normalizing the experience gay, lesbian and transgender patients and their partners have in hospitals.
Margolies, 58, grew up in New Rochelle. She has short wavy hair, a narrow face and blue eyes. She started the National LGBT Cancer Network after helping to coordinate a program for lesbian cancer patients at the LGBT Community Center on West 13th Street.
The National LGBT Cancer Network is funded mostly by project grants from the city, the state, and private foundations. This year, it will be the only LGBT charity represented in the New York City Marathon.
“We pride ourselves on making a great deal of noise with very little money,” Margolies said.
In April of last year, the H.H.C. hired Margolies to organize two training sessions—one 15-minute mandatory session for all of its 38,000 employees, and one 60-minute optional session. Both include a screening of a video, shot in different rooms in Margolies’ apartment, of people describing discrimination and poor care they say they encountered in local hospitals because of their sexual orientation or gender identity.
LGBT HEALTH-CARE TRAINING IS A RAPIDLY expanding field in New York, with a growing number of hospitals not under the auspices of H.H.C. either moving to institute a training program, or at least to put it on the record that they are aware of the need to do so.
In response to an inquiry for this article, a spokesperson for New York University Langone Medical Center outlined a long-term plan that included panel discussions, work groups featuring N.Y.U. Medical Center professors, and educational forums for various departments.
“It’s not one-stop shopping,” said Jody Gill, the director of language, cultural and disability services at the hospital.
A spokesman for Continuum Health Partners, an umbrella organization that includes uptown institutions St. Luke's and Roosevelt and downtown's Beth Israel, noted that both hospitals were the only ones in New York State to receive perfect scores on Human Rights Campaign’s 2011 Health Care Equality Index.
Beth Israel’s OB/GYN department recently hosted a grand rounds—a lunchtime meeting that includes the entire department—on care of these patients, and the hospital’s Methadone Maintenance Program has made LGBT-sensitivity training mandatory for its entire staff.
Further uptown, Columbia’s School of Nursing will host a conference this October on LGBT health care. The school’s dean, Bobbie Berkowitz, has brought patients into classrooms to describe their experiences as patients with discrimination and insensitivity to their sexual orientation or gender identity.
“Personal stories are very powerful for students,” she said, noting that transgender people specifically “have had some pretty terrible experiences in health care.”
Even the city’s behemoth Department of Health was eager to chat about its LGBT-friendliness. The department works with the Community Healthcare Network, Gay Men’s Health Crisis, Callen-Lorde Community Health Center and Bellevue Hospital to provide housing, outreach, nutrition programs, and H.I.V. testing. The department’s division of mental health hosted a training session two weeks ago entitled “Effective Service Provision for LGBT and Questioning Youth.”
Such programs are somewhat ahead of the curve, since a fair number of New York hospitals have yet to implement any sort of LGBT-specific training for employees.
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