Since 2017, the Healthcare Equality Index (HEI) has scored participants based on criteria in four core sections that reflect the number of policies and best practices from each section each participant has implemented. In addition to these four criteria, there is a fifth criteria section called “Responsible Citizenship” that focuses on known activity that would undermine LGBTQ+ equality or patient care. Healthcare facilities will have 25 points deducted from their score for a significant anti-LGBTQ+ blemish on their recent records, due to either an official policy decision or a public action.

A similar criteria category is also part of the scoring system for the Corporate Equality Index (CEI) and on rare occasions has been utilized during the CEI’s 20-year history. Hopefully, like the CEI, this point deduction will rarely be needed. Prior to 2022, the deduction has only been applied once in the HEI. The penalty will only be applied for this criteria to an HEI score after ample notice has been given to the healthcare facility and the facility has an opportunity to address the HRC Foundation’s concerns.

In the HEI 2022, Mercy San Juan Medical Center received this major penalty applied to their HEI score because they withheld medically necessary care for a transgender man while providing the same type of care to cisgender women and arguing in a court of law that the hospital is entitled to refuse transgender people gender-affirming care.

Evan Minton was scheduled to undergo a hysterectomy at Mercy San Juan Medical Center near Sacramento, CA. As part of a pre-surgery call, Mr. Minton mentioned that he is transgender and the next day he was notified that the procedure was canceled. Because this procedure is provided at the hospital for cisgender women, this amounts to discrimination against Mr. Minton because he is transgender, a clear violation of their own internal Patient Non-Discrimination Policy. The ACLU is suing Dignity Health on behalf of Evan Minton because this denial of care based on Mr. Minton’s gender identity is a violation of California’s Unruh Civil Rights Act.

Mercy San Juan Medical Center is a Catholic Hospital and as such follows the Catholic Ethical and Religious Directives (ERDs), one of which does not allow the “direct sterilization” of either men or women to occur in a Catholic healthcare institution. However, the ERDs do allow for sterilizing procedures “when their direct effect is the cure or alleviation of a present and serious pathology.” How the ERDs are applied in each Catholic hospital may be different depending on how the hospital interprets the medical necessity for a procedure like a hysterectomy for the diagnosis of gender dysphoria.

Every credible medical organization recognizes the medical necessity of affirming care for transgender and non-binary people. Sexual orientation and gender identity are real concepts recognized by major medical and mental health associations — including the American Medical Association, the American Academy of Pediatrics, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry — as part of the normal spectrum of human experience.

Mercy San Juan Medical Center is part of the Dignity Health system, which includes both Catholic and non-Catholic hospitals in California. Since the lawsuit, Dignity Health has examined its policies and procedures to better serve LGBTQ+ patients throughout its system to help ensure that they do not have further incidents of discrimination like the one that happened with Mr. Minton. As part of that effort, Dignity Health had 27 of their California hospitals, including Mercy San Juan Medical Center, participate in the HEI 2022. As part of this process, Dignity Health has also created a webpage to be more transparent about which of their hospitals do not provide certain transition-related care like hysterectomies and has created processes to ensure transgender patients receive this care at one of their nearby non-Catholic hospitals.

The HEI team is committed to continuing to engage with Dignity Health on this critical work. Transgender people deserve comprehensive health care without discrimination.