Transgender Patients

Purpose

Presbyterian/St. Luke’s Medical Center and the Rocky Mountain Hospital for Children will not discriminate against any person on the basis of Gender Identity or Gender Expression.

Policy

All patients have the right to competent, considerate, and respectful care in a safe setting that fosters their comfort and dignity and that is free from all forms of abuse and harassment, including abuse or harassment based on gender identity or gender expression.

The hospital will ensure that hospital staff members interact with transgender patients with professionalism, courtesy, and respect.

The hospital will establish guidelines for the safe, ethical, and appropriate assignment of rooms for transgender patients.

A patient’s transgender status may, or history of transition-related procedures may, constitute protected health information, and action will be taken to limit disclosure to any person not directly involved in the treatment of that patient to the minimum necessary to accomplish the authorized purpose of the use, disclosure, or request, in accordance with applicable federal law and regulations, including minimizing incidental disclosures.

The hospital will provide training to ensure compliance.

Definitions

Gender Identity is a person’s internal, deeply felt sense of being either male or female, man or woman, or something other or in-between.

Gender expression refers to all of the external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, mannerisms, speech patterns, social roles and social interactions.

Transgender includes any person whose gender identity or inner sense of being male, female, both, or neither differs from their assigned or presumed sex at birth.

Procedure

Admitting/Registration Records

In the Gender Field in admitting/registration records, staff will record the patient’s gender (Male or Female) as reported by the patient.

If the patient states that he or she is transgender, staff will:

  1. Inform the patient that the hospital prohibits discrimination based on gender identity and gender expression
  2. Provide a copy of this policy to the patient if they would like one
  3. Ask the patient if he or she would like their transgender status to be indicated in their medical record. If the staff person is unsure of which gender option to select, he or she should politely and discreetly ask the patient to verify whether the patient is a transgender male or transgender female.
  4. Ask if the patient would like to have his or her preferred name, nickname or pronouns recorded in the medical record. If the patient indicates that this information should be recorded, the staff should ask if the patient prefers male, female or gender-neutral pronouns.

Unless a patient volunteers that they identify as transgender, the staff person should not attempt to guess whether a patient is transgender or ask the patient whether he or she is transgender. The patient’s transgender status should only be recorded if the patient volunteers the information and agrees that it should be recorded.

Protocols for Interaction with Transgender Patients

When a transgender patient presents for care, they will be addressed and referred to on the basis of their selfidentified gender, using their preferred pronoun and name, regardless of the patient’s appearance, surgical history, legal name, or sex assigned at birth. If the patient’s family members suggest that the patient is of a gender different from that which the patient self-identifies, the patient’s view should be honored.

Hospital staff will not use language or tone that a reasonable person would consider to demean, question, or invalidate a patient’s actual or perceived gender identity or expression.

Hospital staff will not ask questions or make statements about a transgender person’s genitalia, breasts, other physical characteristics, or surgical status except for professional reasons related to the patient’s plan of care/treatment. Information about a patient’s transgender status or any transition-related services that the patient is seeking and/or has obtained is sensitive medical information, and hospital staff members will treat it as such.

A transgender patient’s preferred pronoun should be determined as follows:

  • If the patient’s gender presentation clearly indicates to a hospital staff member the gender with which the patient wishes to be identified, the hospital staff member should refer to the patient using pronouns appropriate to that gender
  • If the hospital staff member determines the patient’s preferred pronoun on the basis of the patient’s gender presentation, but then is corrected by the patient, the staff member should then use pronouns associated with the gender identity verbally expressed by the patient.
  • If the patient’s gender presentation does not clearly indicate the patient’s gender identity, the hospital staff member should discreetly and politely ask the patient for the patient’s preferred pronoun and name.

A patient should not be asked about transgender status, sex assigned at birth, or transition-related procedures unless such information is directly relevant to the patient’s care. If it is necessary to the patient’s care for staff to inquire about such information, the staff should explain to the patient: 1) why the requested information is relevant to the patient’s care, 2) that the information will be kept confidential but some disclosures of the information may be permitted or required, and 3) that the patient may consult the hospital’s release of information policies for details concerning permitting disclosures of patient information.

Restroom Access

Unimpeded access to restrooms is essential to all patients and visitors. Gender-neutral restrooms will be clearly indicated in the common areas of the hospital (first and second floors of the facility).

Access to Items That Assist Gender Presentation

Transgender patients will have access to items of their own that facilitate gender expression (e.g. clothing, make-up) to the same extent that other patients have access to these items, regardless of gender, unless the items are considered to be a safety risk (in the case of an M1 Hold, for example). Transgender patients may also have access to items of their own that only transgender persons would ordinarily use to effect their gender presentation, including items used in binding, padding and tucking, unless use of those items hinders treatment or recovery, as determined by the patient’s attending physician, or is considered to be a safety risk.

Education

Presbyterian St. Luke’s Medical Center and Rocky Mountain Hospital for Children will provide education to transgender patients and to families of transgender patients about this policy. This education will be documented within the medical record.

References

Transgender Legal Defense & Education Fund/Transgender Health Initiative of New York, Policy & Protocol for Serving Transgender Patients, Retrieved from http://www.transgenderlegal.org/media/uploads/doc_22.pdf in September 2017.