Doctors across Ohio fear that two new administrative rules will restrict gender-affirming care for people of all ages. The rules were signed by Ohio Gov. Mike DeWine on Jan. 5.
Among other things, the rules require trans adults to obtain a detailed care plan and medical consent from a psychiatrist, an endocrinologist and a bioethicist before the “prescription, initiation or provision of treatment for a gender-related condition” can take place. The treatments referred to include hormone replacement therapy (HRT).
The public is invited to comment on the administrative rules, which the ACLU has called a “de facto ban on transgender care,” via the Ohio Department of Mental Health and Addiction Services through Jan. 19 and the Ohio Department of Health through Feb. 5.
Tying doctors’ hands
Logan Sherman, a nurse practitioner and gender-affirming care provider at Central Outreach Wellness Center, told The Buckeye Flame that the administrative rules will likely block their ability to provide care due to the fact that having a bioethicist, endocrinologist and psychiatrist involved in each patient’s care is “not really feasible for most of [Central Outreach’s] offices”
“This not only makes more barriers for the patient to be able to access care, but it also ties the hands of healthcare providers to be able to continue providing the care that we are already doing,” Sherman said.
Sherman said that since the administrative rules were released, patients have been asking how they can be prescribed one year’s worth of medications, due to the fear that they could lose access to treatment.
“It’s heartbreaking because all we can really do is offer support to our patients and reassure them that we’re fighting for them,” Sherman said. “It feels like our hands have been tied.”
According to Rhea Debussy, director of external affairs for LGBTQ+ healthcare provider Equitas Health, DeWine’s “draconian” administrative rules will cause medical providers to leave the state.
“This will absolutely impact the broader population’s access to quality health care services,” Debussy told The Buckeye Flame.
Clogging the system
According to Debra Beight, a bioethicist and Ph.D. student at Case Western Reserve University, the fact that there are only a small number of bioethicists in the state will create a major barrier to trans people being able to access gender-affirming care.
“There’s not a lot of bioethicists in the state to begin with, and when it comes to ones that specifically look at trans care, there’s even fewer,” she told The Buckeye Flame.
Beight said that the rules are impractical, unnecessary and will “bog the system down and delay care for trans youth and trans adults.”
She explained that bioethicists are only useful in very specific instances involving gender-affirming care, such as when there is a dispute between custodial parents over whether their child should be allowed to receive the care.
She said that requiring a bioethicist to be involved any time a patient is receiving gender-affirming care is “creating a problem that doesn’t exist” and “[gives] the optics to the public that physicians don’t already make ethical decisions.”
In addition to there being few bioethicists in the state, Mimi Rivard, Central Outreach Wellness Center nurse practitioner and former director of gender-affirming care at Equitas Health, noted that there are only a few endocrinologists in Franklin County, where her clinic is located.
“That presents a problem,” she said.
A trans registry
The administrative rules mandate that healthcare providers report within 30 business days to the Department of Health each time they diagnose an individual with a “gender-related condition”—including gender dysphoria—provide any medical or surgical service to someone with a “gender-related condition,” and end or change a treatment plan for a “gender-related condition.”
The reports are required to include the “age and biological sex” of the patients, as well as information on the nature of the individual’s diagnosis and types of treatments provided. The Department of Health will then aggregate and anonymize this information and release it annually to the general assembly and the public.
Jonah Yokoyama, a registered nurse and the Director of Heartland Trans Wellness in Cincinnati, said that the fact that Ohio’s trans population is so small will make it “fairly easy” for some people included in the published reports to be identified.
“It can be easy to start having things like insurance denials and loss of life insurance,” he told The Buckeye Flame.
Yokoyama explained that trans people are at particular risk of losing health coverage simply due to being trans. He explained the phenomenon of “trans broken arm syndrome,” which he said is named after a hypothetical scenario where a trans woman is denied insurance coverage for her broken arm because the insurance company stated that she had made her bones weak by taking estrogen.
“It’s completely outrageous,” Yokoyama said. “But that kind of denial happens all the time.”
A war on identity
“[Dewine’s administrative rules] are going to kill trans adults,” Yokoyama said.
He explained that the inability for many providers to obtain a bioethicist, psychiatrist and endocrinologist for each patient will lead to many trans adults losing access to life-saving care.
“None of those are needed to provide trans health care,” Yokoyama said. “Informed consent, along with the clinicians’ assessment of the individual, is really all that’s needed.”
Yokoyama noted that the hardest hit will be the most vulnerable members of the trans community. He said that he has been receiving calls from people who are “terrified” and want to move out of the state but can’t afford to do so.
Yokoyama, who himself has been receiving hormone replacement therapy for over a decade, said that he personally could lose access to trans healthcare because of the rules.
“It feels like a war that’s being waged on my identity,” he said.
Governor Dewine’s office responds
When asked by The Buckeye Flame for comment, a spokesman for Governor Dewine said that most of the treatment provided in Ohio for “these medical conditions,” presumably referring to gender dysphoria, is provided “in a manner described in the rules.” The spokesman claimed to base this statement on information “provided to us by doctors in this field,” though he did not specify in his comment what doctors he was referring to.
The spokesman said that hospitals and outpatient clinics “generally use the multidisciplinary approach to develop general care plans that are used in the treatment of conditions each facility may treat.” His comment did not specify whether the multidisciplinary approach he was referring to had anything to do with gender-affirming care or involved medical ethicists, endocrinologists and psychiatrists.
In regards to the medical ethicist requirement, the spokesman said, “If a citizen is concerned that each patient must have an individual consultation with a medical ethicist, that is not correct and is a misreading of the rule.” His comment did not clarify what part of the rule is being misread or what the correct reading of the rule is.
In response to concerns about data collection, the spokesman said that reporting of aggregate data is done frequently in Ohio for a variety of conditions and medical practices, such as flu cases and abortions. He said that aggregate data does not identify individual patients and that public data sets “allow the public and policymakers to make informed decisions.” 🔥
IGNITE ACTION
- Comments on the proposed rules for the Mental Health and Addiction Services Department, please send them in an email to MH-SOT-rules@mha.ohio.gov no later than 5 pm on Friday, Jan. 19, 2024. In the subject matter line of the email, indicate “Comments on Gender Transition Care Rules.”
- Comments on the Health Department rules draft should be submitted to ODHrules@odh.ohio.gov no later than Monday, Feb. 5.
- If you are a young person struggling, contact the Trevor Project: 866-4-U-Trevor.
- If you are an adult in need of immediate help, contact the National Trans Lifeline: 877-565-8860
- To register to vote or to check your voter eligibility status in the state of Ohio, click here.
- To find contact information for your Ohio state representative, click here.
- To find contact information for your Ohio senator, click here.
- To access the full LGBTQ+ Legislation Tracker, click here.
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