For Evan Minton, the hysterectomy was a step toward becoming his “most authentic self.” The surgery, scheduled to take place on Tuesday of this week, would pave the way for a phalloplasty that Minton had set for November. He needed three months to recover between the two surgeries.
“For transgender people there’s all sorts of ways that they take to be their most authentic self, and for me, my journey dictates that I have medical intervention,” Minton, 35, told Rewire. “At this point in the path my body is calling out for bottom surgery.”
According to Minton, a hospital representative called him on Sunday to review pre- and post-operative instructions. Minton asked that a note be made in his records about his use of male pronouns.
Then on Monday, a day before the surgery, Minton’s doctor called to deliver the news: the surgery was cancelled. The Catholic hospital where it was set to take place—Dignity Health Mercy San Juan Medical Center in Carmichael, California—said Minton’s hysterectomy would conflict with its religious rules.
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Minton said he was “heartbroken.”
“I was in my parents’ bedroom, and I threw myself on the floor, just crying uncontrollably … because it hurt so bad, and then also because the timeline of this procedure is so important,” Minton said. “The waiting list to get the phalloplasty, if I were to reschedule, is anywhere from nine months to two years out.”
Minton’s doctor, Lindsey Dawson, said it was difficult breaking the news to Minton.
“I went into the other room and cried for a minute,” Dawson told Rewire.
Dawson says she has performed many hysterectomies at the same hospital. In fact, Dawson says the hospital declined to cancel another hysterectomy she had scheduled for that same day.
“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities in accordance with the Ethical and Religious Directives for Catholic Health Care Services (ERDs) and the medical staff bylaws,” a Dignity Health spokesperson said in an emailed statement. “Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”
Catholic hospitals make up a growing percentage of the health-care landscape, with one in six acute-care hospital beds nationwide now in Catholic-owned or -affiliated facilities. Generally, these institutions follow religious directives issued by the U.S. Conference of Catholic Bishops, which restrict access to reproductive health care and describe abortion and “direct sterilization” as “intrinsically evil.”
“I know the Catholic directives very well,” Dawson told Rewire. “I read them again before I scheduled Evan’s case, and there was nothing that I could see in there that precluded this case from happening, because, of course, I think dysphoria is a serious and present pathology.”
That’s also how Minton describes it.
“The longer that I wait to take the next step, the dysphoria heightens, and so what this dysphoria feels like is, I want to crawl out of my skin,” Minton said. “And sometimes I can feel the regions on my body that are female, and it feels so extremely uncomfortable. It’s a horrendous nightmare that I don’t wish anyone else to have to go through.”
San Francisco-based Dignity Health describes itself as the fifth-largest health system in the country and the largest hospital provider in California. Dignity was called Catholic Healthcare West until 2012, when it announced a new name and governance structure.
“Under the new governance structure, Dignity Health is a not-for-profit organization, rooted in the Catholic tradition, but is not an official ministry of the Catholic Church,” according to a press release at the time.
Dignity spokesperson Melissa Jue said the company has 39 hospitals across three states (Arizona, California, and Nevada), 24 of which are “Catholic-based.” Asked by Rewire why some of Dignity’s hospitals follow Catholic rules and others don’t, Jue said, “Over the years as a health system, we have acquired other hospitals and there were no requirements for them to be Catholic in order to become a Dignity Health hospital.”
Of the nearly $40 billion Dignity Health charges patients annually, more than half comes from taxpayer funds through Medicare and Medicaid, according to MergerWatch.
“Dignity Health is this enormous health-care corporation that takes millions of dollars in state and federal funding and yet discriminates both against women and against LGBT people, or really in particular, transgender people,” Elizabeth Gill, senior staff attorney at the ACLU of Northern California, told Rewire.
Gill is involved in two lawsuits against Dignity over access to health care—one challenging the denial of post-partum tubal ligations and another challenging the denial of transition-related insurance coverage for a transgender Dignity Health employee. In that case, the ACLU has invoked Section 1557 of the Affordable Care Act, which, as Rewire’s Jessica Mason Pieklo writes, expressly prohibits anti-transgender discrimination by health-care entities that receive federal funds. (Dignity Health has also been accused of repeatedly underfunding its employee pension plan; it has argued, so far unsuccessfully, that it has a church plan not subject to federal regulations.)
In objecting to the Section 1557 protections last year, a coalition of religious groups, including the U.S. Conference of Catholic Bishops, wrote, “We believe, as do many health care providers, that medical and surgical interventions that attempt to alter one’s sex are, in fact, detrimental to patients. Such interventions are not properly viewed as health care because they do not cure or prevent disease or illness.”
Minton said he is considering legal action to address the systemic issue of anti-transgender discrimination. Minton, who is co-chair of the California Democratic Party LGBT Caucus, wants to advocate for other LGBTQ people too. His situation comes amid a wider legal battle over transgender rights: On Monday, as Minton received the news his surgery had been cancelled, a school board across the country in Virginia went all the way to the U.S. Supreme Court in a bid to defend its policy barring a transgender teenager from using the bathroom that corresponds to his gender identity.
“In cases involving trans individuals, from health-care cases to schools cases to public accommodations cases, we are increasingly seeing objections to the very existence of trans individuals based on an articulated religious belief that gender is exclusively what a person is assigned at birth,” Chase Strangio, ACLU staff attorney, wrote to Rewire.
In Minton’s case, however, relief could come sooner rather than later. He and his doctor have been working to re-schedule his surgery at another Dignity hospital that does not follow Catholic directives. He may be able to get the surgery as soon as Friday.
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