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Funding shortfall strands trans people without assessment in BC

UPDATE: Advocates welcome province's bid to make changes to services

Pivot Legal Society lawyer Adrienne Smith says the province’s trans health program has not been a government priority for several years. “The particular funding shortfall we’re concerned about today has to do with a key gatekeeping role; it’s the last step in a two-year process,” Smith says. Credit: pivotlegal.org

UPDATE: Oct 31, 2014

Physician Andrea Szewchuk says they’re pleased to hear that the province intends to make changes to services for the transgender community, following news that funding had dried up for a BC office that assesses people’s eligibility for gender-affirming surgeries.

In an Oct 30 release, the ministry indicated that Vancouver Coastal Health had committed to continue program funding until the end of the current fiscal year, March 31, 2015. The ministry also promised that an advisory committee would be formed, which would include transgender community members and clinical experts, to do a review of services and supports with the aim of establishing a new provincial program that will offer expanded and sustainable services for the community. Acccording to the release, the Provincial Health Services Authority (PHSA) will coordinate transgender services in the province, starting April 2015.

"I really look forward in particular to a shift towards a more streamlined provincial system for trans care related to surgeries, Szewchuk tells Xtra. “I think it’s really exciting that the PHSA is wanting to involve input from the community and from care provider working in the trans community, and I look forward to that happening."

Aside from the issue of wait times, what they and other community providers want to see is more surgery services offered in British Columbia. “I think the province has the capacity to take leadership in this regard,” Szewchuk adds. Access to surgery and follow-up care closer to home would reduce some of the stress and extra cost for people who travel out of province for procedures, they note. 

Vancouver West End MLA Spencer Chandra Herbert says he’s happy that the province seems to have received the message that these are essential medical services and should be supported. “It looks good, the devil will be in the details,” he adds, but says he is confident the community’s advocacy will keep the pressure up.

UPDATE: Oct, 30, 2014 

In the wake of news that provincial funding had run out for a BC office that assesses people for their eligibility for gender-affirming surgeries, the Ministry of Health issued a press release indicating they are restoring funding to the program.

The release says the ministry is working with other stakeholders to provide a new program that will offer expanded and sustainable services for the transgender community.

The funding shortfall for the office of chief assessor, Dr Gail Knudson of Vancouver Coastal Health, meant hundreds of people, already saddled with a protracted and delay-ridden assessment process, had to wait until April 2015 when new assessments would resume.

In the Oct 30 release, the ministry says Vancouver Coastal Health (VCH) has committed to continue funding for the program with immediate effect until the end of the current fiscal year, March 31, 2015. “This funding will sustain timely physician coverage for the assessment of gender reassignment surgery candidates throughout BC,” VCH president and CEO Mary Ackenhusen says in the release.

Beginning in April 2015, the Provincial Health Services Authority (PHSA) will coordinate transgender services in the province and aim to expand capacity for such services over the next year, the release adds. PHSA’s chief operating officer Arden Krystal is quoted as saying that the focus will be on improving the network of services, including access to care for people who require gender-affirming surgery.

The PHSA is forming an advisory committee, which will involve the transgender community and clinical experts, to do a review of services and supports, the release concludes.

Oct 29, 2014

Provincial funding for a BC office that assesses whether people are eligible for gender-affirming surgeries has dried up, leaving hundreds stranded as they wait for medically necessary care, advocates and health practitioners say.

The funding ran out as of Oct 1, and patients are now forced to wait until April 2015, when assessments are expected to resume.

The outgoing message from the office of chief assessor Dr Gail Knudson, who is with Vancouver Coastal Health, confirms that funding has been exhausted and no new assessments will be done.

The message also says that patients who have already been assessed and have had their applications approved prior to or on Oct 1 will have their cases sent to the Medical Services Plan for processing. “You can expect to receive a letter from MSP within three to four months informing you of your approval for surgery,” it says. Those in crisis or who need immediate assistance are advised to contact the BC Crisis Line or go to a local emergency room.

“Dr Knudson and her team look forward to accepting new referrals in the spring. Please be assured that we are doing everything we can to support this program,” the message concludes.

The news is a blow that compounds an already stressful process for transgender and gender-nonconforming British Columbians who go through several steps before being able to access funding for surgeries, says Pivot Legal Society lawyer Adrienne Smith, who uses the gender-neutral pronoun they. Those steps include 18-month wait times for assessment and hormone replacement therapy for one year or more before surgery, after which they could wait up to two years before seeing a surgeon.

Smith says the province’s trans health program has not been a government priority for several years. “The particular funding shortfall we’re concerned about today has to do with a key gatekeeping role; it’s the last step in a two-year process,” they say. “There’s no envelope of funding for this program to the point that there’s not even an allocation of operating-room time in British Columbia,” they add, noting that people end up travelling to Montreal for surgery after being approved.

At the very least, there needs to be a sustainably funded program to apply for and receive funding for surgeries, adds Dr Andrea Szewchuk, a physician at the volunteer-run Catherine White Holman Wellness Centre, which provides services to transgender and gender-nonconforming people.

“Furthermore, we need to have a program that offers more surgeries in BC, including the follow-up care that’s needed for people,” adds Szewchuk, who also uses the pronoun they.

In an Oct 28 statement, the health ministry says it’s aware of the situation, adding that Knudson can continue assessments and bill MSP as some other assessors do.

But Szewchuk says as far as they know, there is no current billing code for MSP that covers assessments for gender-affirming surgeries.

In its statement, the ministry also says that patients waiting for assessments can be referred to another assessor in another health authority or wait until the clinic reopens.

But Szewchuk says that while there have been more designated surgical assessors in recent times, all referrals must be approved by the sole office that is now underfunded and on hold. “Regardless of where someone goes to request surgery, their application will still be on hold in a queue until April 2015,” they add, reiterating that the situation “reflects a larger systemic need to have a sustainable, streamlined surgical system for the province.”

The ministry says it is working with Vancouver Coastal Health and the Provincial Health Services Authority (PHSA) to come up with strategies to meet the increasing demand for services for transgender people.

“We are working to adapt our practices within our ability to pay,” the statement says. “In fact, BC has recently removed the requirement that individuals must live as their chosen gender for a year before being eligible for referral to surgery. This allows the transgender population to access procedures to transition more easily and quickly than before.”

Szewchuk says the key message is that the current system functions completely differently from other avenues for accessing medically necessary care. “For a non-trans person accessing a different type of surgery, they don’t have to go through an assessment process, they don’t have to request special funding, so although these procedures are medically necessary, they’re being treated essentially differently and being treated in a two-tier system,” they say.

“All of this is leading to unnecessary health effects in this community, which is already quite marginalized.”