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BC still sending trans people away for surgery

Despite having trained a local specialist

ACCESS DENIED. Dr Cameron Bowman, who underwent a year of training to perform sex reassignment surgeries for trans British Columbians, can't get access to any operating room time. Credit: Janet Rerecich photo

More than 150 transgendered British Columbians who expected to have their sex reassignment surgeries done in Vancouver now find themselves looking for qualified doctors elsewhere.

Despite having paid to train a specialist, the BC Ministry of Health has confirmed that it will continue to send candidates for SRS out of province – largely at the patients’ own expense.

BC’s medical services plan covers some of the medical fees related to SRS but does not extend to travel or postoperative clinic stays.

“How am I supposed to come up with a thousand dollars for postoperative care and a thousand dollars for the airfare?” wonders trans activist Danna Waldman. She plans to have surgery in Montreal and will be required to pay for a weeklong stay.

According to Dr Cameron Bowman, who underwent a year of training to become an SRS authority, a trans surgery program in Vancouver would save the BC government thousands of dollars – and would be safer for patients.

The period leading up to surgery is “one of the most stressful times in a trans person’s life,” says Bowman. “To have to do that thousands of miles away from home and your support systems, knowing that there’s a cost to you every day that you have to stay there” is dangerous, he adds.

Bowman says travelling soon after surgery can be unsafe and that patients should be able to follow up with the same doctor who operated on them. Both he and Waldman question the province’s motives for denying hospital time for SRS.

“What, are we back to the 1950s?” charges Waldman. “We don’t want our operating rooms contaminated with queer blood?”

For those who need it, she adds, SRS is “a survival issue.”

BC health ministry representative Sarah Plank confirms that the province referred patients approved for SRS to Bowman – whose waiting list grew for two years while he was repeatedly denied access to hospital facilities for trans surgeries.

Finally in 2007 Bowman and his colleagues in the UBC Plastic Surgery division filed a business case with the ministry detailing a cost-benefit analysis of an in-province SRS program.

The case was turned down in March of this year.

Plank says the ministry’s decision was based partially on research that “indicates that outcomes for complex surgical procedures are better in facilities that perform high volumes.”

She says the ministry remains unconvinced that a local program would see a sufficient number of patients “to maintain quality of care.”

“This surgery is requested more here than anywhere else” in Canada, counters Bowman. “What is [Health Minister George Abbott] suggesting? That patients aren’t going to get good quality health care in the province in which he’s the health minister?”

Plank confirms that the province paid to have Bowman trained in SRS because “there was no local expertise in the area of sex reassignment surgery” at the time.

Now she says “the fact it was based on the practice of one single surgeon” was another reason to reject Bowman’s case for an in-province SRS program.

Bowman says that it’s obvious from the length of his waiting list that the demand for SRS overwhelms its availability.

Sex reassignment surgeries aren’t the only treatments unavailable to trans people transitioning in BC.

Lauren Sundstrom, a member of the recently formed Vancouver Trans Advocacy Group (VanTAG), would like secondary procedures like facial feminization surgeries and facial hair removal to be added to provincial health plans “because so many trans women aren’t able to pass.”

“And to not pass,” she says, “equals a lot of danger.”

Right now, surgeries such as the reshaping of nose and jawbones – which may diminish the look of having experienced puberty in a male body – are not covered at all by BC’s medical services plan.

Waldman says that for her “there was no question from the start that [SRS] was definitely part of the program.” But while her transition will include surgery, Waldman acknowledges a “continuum” of being trans.

“Some of us will never have surgery [and] some of us will never take hormones. Some of us will never dress as our own gender,” she says. Waldman agrees that a wider range of options should be covered by provincial health care.

Currently, no province in Canada covers facial feminization surgeries or depilatory methods for trans women. VanTAG calls the situation in BC a “silent crisis.”

For trans women, BC covers vaginoplasty and, in some cases, breast augmentation. Trans men are funded only for mastectomy and the removal of their reproductive organs – not for the creation of male genitals.

“A mastectomy simply means removing the breast and closing the skin in a straight line – no nipple, no contouring, no nothing,” Bowman points out. Reconstruction is only covered for people who have had mastectomies due to breast cancer.

Bowman says he is fully qualified to perform the procedure in which a penis is created for a trans man. He claims that he has already performed the surgery for an intersex individual in BC and billed it to the province as “penile reconstruction.”

Medically termed a phalloplasty, the procedure is only covered under Alberta’s medical services plan.

The Prairie provinces all extend some benefits to their trans populations, but to varying degrees. While Saskatchewan and Alberta include coverage similar to BC’s for trans women, Manitoba refunds only 60 percent of the costs – and leaves the patients to pay upfront.

Ontario’s government recently announced that it will reinstate SRS as an insured service in its medical plan.

Quebec will only fund surgeries that take place in public hospitals, effectively excluding those performed by Montreal’s world-famous private SRS clinic.

Further east, although some procedures may be done on a case-by-case basis, only Newfoundland specifically names sex reassignment in its health care plan.

Bowman plans to keep fighting for the creation of an SRS program in BC.

“I’m not going to let this decision of the current government put an end to what I know in my heart is the right thing to do,” he says.