New Jersey Department of Health and Senior Services
United States of America

In recent years, health care policy makers and providers have taken steps to develop initiatives that will advance cultural competence in the medical field.

Evidence that cultural competency improves quality of care and eliminates racial, ethnic, and religious disparities has given health care providers and policy makers the impetus to be more culturally attuned.

Research has shown that a successful provider-patient encounter bolsters patient satisfaction, increases the likelihood that medical instructions will be adhered to, and can be linked to a positive health outcome. As the United States becomes increasingly diverse, it is important that all workers who come into contact with patients are prepared to encounter myriad perspectives regarding medicine and health.

The provider-patient relationship is of such prognostic importance that several states have either proposed or passed legislation mandating that physicians and medical students take courses that increase their sensitivity towards and make them more responsive to the needs of minority patients. In 2005, New Jersey made this training compulsory for physicians who wish to obtain or renew a medical license.

While these measures have undoubtedly been instrumental in fostering positive attitudes towards patient differences, awareness of the unique issues pertinent to the lesbian, gay, bisexual, and transgender (LGBT) population is scant. In particular, the transgender population is the most likely to experience mistreatment, harassment, and bias in a health care setting. Even in the progressive state of California, the Transgender Law Center reports that its clients encounter discriminatory conduct. Across the country, transgender people are asked inappropriate and unnecessary questions about their genitals, endure slurs and name calling, and are denied the request to be addressed by their preferred name and gender. Some medical providers will even condemn their transgender patients and openly express disgust and hostility.

According to the National Transgender Discrimination Survey, the largest compilation of data concerning transgender people to date, 28% of respondents reported being verbally harassed in a medical setting, and 2% reported being physically attacked. Half of all respondents found that their doctors are ignorant of basic tenets of transgender health. Finally, 19% of respondents have been denied treatment altogether, even though fourteen states, including New Jersey, have laws in place that prohibit health care discrimination against transgender and gender non-conforming patients. High profile cases include that of Robert Eads, a female to male transgender with ovarian cancer who died after he was denied treatment by over twenty doctors, and that of Tyra Hunter, a pre-operative transgender woman who died at the scene of a car accident after emergency medical technicians uttered derogatory slurs in references to her genitalia and withdrew medical care.

The impact of marginalization is so powerful that it has ostracized transgender individuals from the medical community entirely. One fourth of survey respondents reported that they postpone care due to the disrespect that they anticipate from providers.

Additionally, it has come to the recent attention of this petition's author that certain NJ medical facilities are in dire need of culturally competent care that caters to the LGBT community, especially the transgender population. In particular, anecdotal evidence concerning the misconduct demonstrated by workers in the psychiatric department of a New Jersey hospital has elucidated the need for reform as soon as possible. Unacceptable behavior reported includes: refusal to comply with a patient's desire to be addressed by a preferred gender, consistently unsympathetic attitudes towards related requests, the denial of medically necessary and previously prescribed hormonal treatments during inpatient hospital stays, the heavy reliance of the staff on psychotropic drugs to treat gender dysphoria, the fabrication of sexual abuse incidents during a patient's childhood to rationalize gender dysphoria, hostility towards patients who revealed their homosexual or gender nonconforming status, and threats to hospitalize a patient indefinitely because it was believed that their gender non-conforming status was indicative of mental illness. The transgender population is disproportionately represented among suicide statistics.

The 41% suicide rate among transgender people is more than 25 times the rate of the general population, which is 1.6%. Thus, it is imperative that psychiatric facilities be equipped to assist the transgender people that come to them in a state of crisis. The treatment of transgender people in doctor's offices, hospitals, and psychiatric wards is reprehensible. Oftentimes, the treatment of lesbian, gay, and bisexual patients is not much better.

This petition calls on the New Jersey Department of Health and Senior Services to recognize the LGBT community as a unique cultural group whose needs must be addressed by cultural competency initiatives.

In particular, special attention should be given to the transgender population, as the needs of these individuals are often circumvented to accommodate the better understood lesbian, gay, and bisexual populations. Existing measures must be revised so that they are encompassing of all minority groups. A law aimed at reducing disparity between groups must ensure that those who use the same medical services have access to equal care and treatment.

There are numerous recommendations that the NJ Department of Health and Senior Services can take into consideration when developing a suggested training program for medical staff:

-Post a "Safe Zone" sticker or a similar sign in the waiting room that states, "We do not discriminate on the basis of age, race, sex, sexual orientation, gender identity, religion, language, or disability." It is important to include sexual orientation and gender identity in non-discrimination policies.

-Ensure that waiting room reading materials include at least one LGBT friendly item.

-Train staff members about issues that are specific to the LGBT community, including but not limited to homophobia, transphobia, hate crimes, HIV, and other health concerns.

-LGBT patients should have confidence that their partners and friends are afforded the same privileges that would be designated to the loved ones of a non-LGBT patient.

-Staff should be familiar with basic terminology that is relevant to the lesbian, gay, bisexual, and transgender communities. They should be trained to use inclusive language when interacting with patients.

-Patient intake forms should be free of heterosexual assumptions and list transgender as a third category for gender.

-Patient requests to be addressed by a preferred name and pronoun must be respected.

-Patient interviews should be completed in a non-judgmental manner. Questions about sexual history and reproductive systems should only be asked when relevant. For example, an eye doctor or a dentist should not be asking a transgender person about his or her genitals.

-Evaluation forms should be distributed so that LGBT patients can provide feedback.

With the help of the New Jersey Department of Health and Senior Services, the health care setting can be transformed into an LGBT friendly place!

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The Enhance LGBT Cultural Competence Among Health Care Workers petition to New Jersey Department of Health and Senior Services was written by Jordan and is in the category Health at GoPetition.