For the second time in two months, the American Civil Liberties Union of Washington has filed a lawsuit claiming a transgender individual was denied medical care because of discrimination.
Ari Robbins, a 30-year-old law student at the University of Washington, claims Providence Health and Services, a nonprofit Catholic network of hospitals and the largest healthcare provider in Washington, as well as its affiliate — Swedish Health Services — abruptly canceled his chest reconstruction surgery.
The lawsuit, filed Dec. 20 in King County Superior Court, also named the plastic surgery office Swedish Plastics and Aesthetics and the doctor who was scheduled to perform the surgery, Dr. Mary Peters.
In a statement, Swedish Health Services said they care for "all patients regardless of race, color, religion, creed, sex, gender identity, sexual orientation or any other protected status."
"We take great pride providing compassionate care, and we do provide care and many treatment options for transgender patients," the statement read. "In light of that, we take this claim very seriously." Swedish said privacy laws and the pending litigation prevent them from saying anything further about the case.
Robbins grew up in Brier, and, according to the lawsuit, knew as early as kindergarten that he identified as male rather than the female gender of his birth. In an interview, Robbins said he came out as gay when he was in high school but after moving away from home, realized he wasn't gay but transgender.
In his twenties, Robbins began to tell others, including his family, about his identity as a transgender male. In 2014, he also began binding his chest as a way to hide his breasts. It was then that he realized he wanted to undergo a chest procedure. He started hormone replacement therapy in 2015.
Eventually, Robbins was diagnosed with gender dysphoria, a condition that sometimes afflicts those with a gender identity different from their gender at birth. According to the lawsuit, Robbins “received a recommendation for chest reconstruction surgery from his therapist and a referral from his general care provider.”
In the lawsuit, the ACLU claims "every major medical organization and the overwhelming consensus among medical experts" is that "treatments for gender dysphoria, including surgical procedures, are effective, safe, and medically necessary when clinically indicated to alleviate gender dysphoria." The American Medical Association, for example, recently passed a resolution that supported "broadening how gender identity is defined within medicine" and adopted a policy "opposing any efforts that would prevent a transgender person from accessing basic human services."
In December 2016, Robbins consulted with Peters at Swedish Plastics. The doctor told him, according to the lawsuit, that “the surgery was a ‘simple procedure.’” His surgery was scheduled for March 2017. But then, three weeks before his scheduled surgery, on Feb. 21, a patient care coordinator suddenly canceled the operation, telling him that the doctor “feels like she just does not have the expertise to take on the case.” The surgeries of several other transgender patients were also canceled, according to the lawsuit.
When he heard the news, Robbins said, “I was really scared.”
“I do not need to be experiencing that kind of chronic pain for no reason,” Robbins said, referring to the pain and discomfort from binding his breasts.
The lawsuit itself argues that "no one should suffer the indignity and humiliation of being turned away for medically necessary treatment because of who they are."
In October, the ACLU of Washington filed a similar lawsuit against PeaceHealth St. Joseph Medical Center. PeaceHealth St. Joseph Medical Center is part of a Catholic network of hospitals. It allegedly refused to cover transgender medical services for a Bellingham family and their 17-year-old son, Pax. Like Robbins, Pax had hoped to have his breasts removed.
PeaceHealth’s insurance employer plan does not cover transgender medical services, which the ACLU argues violates a provision in the Affordable Care Act that prohibits discrimination, including gender identity discrimination. The lawsuit also claims PeaceHealth violated the Washington state law against discrimination in places that offer goods and services to the general public.
Eleanor Hamburger, an attorney in Seattle who is not involved with the suit but has filed several lawsuits alleging disability discrimination by health insurers under the same provision of the Affordable Care Act, said Catholic hospitals may attempt to make a religious exemption argument.
“This area of the law is extremely new so I don’t know [that] you can say anything about how courts have traditionally ruled on this,” Hamburger said.
ACLU staff attorney Lisa Nowlin said, however: “We don’t think a religious exemption would be applicable here.” She cited a recent Washington state Supreme Court ruling that involved Arlene's Flowers in Richland. Owner Barronelle Stutzman, a Christian, had refused to sell a floral arrangement to a gay couple. The court sided with the ACLU, who argued Arlene’s Flowers refusal to sell an arrangement to the couple violated the Washington state law against discrimination.
Peter Renn, an attorney at Lambda Legal, said there are other cases like Robbins pending in other states, such as New Jersey, where St. Joseph’s Healthcare was recently sued because of its refusal to provide transgender care.
Renn argues that transgender patients who do not receive care suffer not only medical harm but also an affront to their dignity.
“When you go to the doctor the last thing you should have to face is discrimination,” Renn said.
In August, Robbins did receive the surgery but was forced “to drive to Idaho in the midst of law school final examinations” to complete it, according to the lawsuit. He says he can finally wear the clothes he wants and exercise comfortably.
"Nobody loves their body 100 percent of the time," Robbins said. "But it feels a lot better.”