The Ontario government will use standards from 1998 when it resumes funding for sex reassignment surgery, a decision that has some in the trans community worried.
“The community response has been sharp,” says Susan Gapka, chair of the Trans Health Lobby Group. “I think you’ll find the community has a bite.”
Ontario health minister George Smitherman says the process will pick up where it left off when Mike Harris’s Progressive Conservative government delisted it from the Ontario Health Insurance Plan (OHIP) in 1998. That process will involve candidates for surgery being approved by the Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto.
“We’re going to restart the process as it existed when it was brought to an end in 1998,” says Smitherman. “The program will restart on conditions that are really very, very well-known to people, that is with substantial involvement of a process including CAMH and our anticipated numbers are eight to 10 people a year.”
Smitherman says OHIP will use a private clinic in Montreal to perform the surgery. But he didn’t specify a starting date or whether OHIP coverage will include payment for any or all of counselling, electrolysis, chest surgery, voice surgery and therapy, facial surgery or hormone therapy. OHIP will cover phalloplasty — creating a penis in female-to-male transitions. In 1998 CAMH did not recommend candidates for phalloplasty.
Gapka says CAMH uses a very strict and outdated process — which, according to its website, includes “a two-year period of cross-living in the felt-gender role prior to consideration of a recommendation for sex reassignment surgery.”
“I think we really have to push for more people to be approved, less rigorous standards and more community standards,” says Gapka. “The Gender Identity Clinic is a place where there’s still tension between how they deliver services and how the community would like to see it deliver services. There’s a growing body of literature that says a new method of evaluation is not only recommended but needed.”
CAMH itself seems to have been taken by surprise by the relisting and its proposed role in it. Michael Torres, a spokesperson for CAMH, hadn’t heard about Smitherman’s decision to return to 1998 standards.
“He didn’t give any more details?” Torres asked. “1998. That could mean anything really. We’ll be happy to speak more after we’ve met with the ministry.”
Gapka sees that uncertainty as a chance to alter CAMH’s approach.
“That’s to be seen as an opportunity,” she says. “They were caught off-guard. We were caught off-guard. I think it’s important to work on moving the CAMH standards to the world’s international standards.”
Gapka says she would like to see Toronto’s Sherbourne Health Centre — which works extensively with the city’s trans community — play a larger role in the process.
“I feel some hope that the Sherbourne Health Centre is a model that the minister has been supporting politically and financially,” she says. “Hopefully the work they’ve been doing can be expanded.”
A spokesperson for the Sherbourne Health Centre says they haven’t heard from Smitherman.
“It’s really too early to ask what they might want us to do,” says Denny Young, the director of community relations. “We’re having a meeting with the minister and his staff in June. We already do provide quite a bit of support for people in the trans community and we expect to continue to do that. We’ve been operating programs that weren’t in place 10 years ago. We weren’t here 10 years ago.”
Smitherman admits that the 1998 standards aren’t necessarily set in stone. He refers to the work of Rainbow Health Ontario, a recently formed network seeking to improve healthcare for queers in the province.
“I certainly would acknowledge that trans issues are evolving issues,” he says. “We have high expectations that Rainbow Health Ontario, the funding we provided, will help us to create more knowledge and greater capacity to address the health needs of the broad LGBTT community. While I understand there might be some disappointment or other points of view around the way these services could be provided we’re really working hard to create a better capacity and to learn more about the needs of the trans community.”
Gapka also worries about Smitherman’s expectation that relisting will only cost the province about $200,000 a year and be utilized by eight to 10 people annually.
“There’s a 10-year backlog,” she says. “There’s been a concern from our membership about people who have gone ahead and paid for the surgery themselves. I’m less confident the government will be persuaded to pay for some of those.”
Smitherman is adopting a wait-and-see approach to the question of numbers.
“We have to make sure the process gets up and running, that will give everybody a much better chance to gauge the numbers of people who are interested in following the process,” he says. “There are many people who have identified as trans but from my understanding not all those individuals are necessarily interested in surgical intervention.”
Gapka says that for all the potential problems with the relisting she does it see as a very positive step.
“I do need to get in my praise on this,” she says. “So thank you health minister Smitherman.”