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In early April, the Kaiser Family Foundation released a study outlining the challenges that LGBT adults face in the United States related to healthcare.[1] According to the study, LGBT patients are “twice as likely as non-LGBT adults to report negative experiences while receiving health care in the last three years, including being treated unfairly or with disrespect (33% v. 15%) or having at least one of several other negative experiences with a provider (61% v. 31%), including a provider assuming something about them without asking, suggesting they were personally to blame for a health problem, ignoring a direct request or question, or refusing to prescribe needed pain medication.”[2]

Additionally, the study showed that LGBT patients were more likely to have negative health care experiences in the past three years that caused their health to get worse and were less likely to seek care.[3] Lower income patients, as well as those who are younger, or are women, reportedly experience higher rates of discrimination and unfair treatment than older, male LGBT patients.

Avoiding Discrimination
Providers can take steps to make healthcare more inclusive for the LGBTQIA+ community, which includes lesbian, gay, bisexual, transgender, queer, intersex, and asexual individuals.

First, implementing an intake protocol to quickly identify LGBTQIA+ individuals can promote patient-centered care and foster an inclusive environment for all patients. For example, providers can include prompts such as gender history, sexual orientation, gender identity, and sex assigned at birth. Further, the method for collecting the information should be considered. Typically, utilizing a registration desk is least preferred by patients, however, other ideas include capturing information on paper or laminated forms with dry erase markers, electronic check-ins from the patient’s home, self-check-ins at the healthcare facility, or going over information in a private setting with a medical assistant, nurse, or other provider.

Additionally, gender and LGBTQIA+ status is considered protected health information (PHI) under HIPAA. Therefore, intake forms should include confidentiality and privacy language, and medical staff should be equipped to discuss HIPAA protections with patients to help them understand the security of their sensitive information.

Providers should also consider implementing training to identify and treat the unique health needs of LGBTQIA+ patients. Trainings can focus on improving patient-provider communication, enhancing patient-centered, compassionate care, and creating a safer and more inclusive environment.

The Joint Commission’s Field Guide recommends the following practices:

1. Integrate unique LGBTQ+ patient needs into new policies or modify existing policies
2. Review nondiscrimination and visitation policies, revise the definition of family
3. Demonstrate ongoing commitment to inclusivity for LGBQT+ patients and families
4. Develop a mechanism for reporting discrimination or disrespectful treatment[4]

Lastly, providers should ensure they are complying with local, state, and federal laws related to discrimination. Relevant federal laws to be aware of include the Public Health Services Act, which among other prohibitions, prohibits discrimination on the basis of age, race, color, national origin, disability, religion, or sex in programs, services, and activities funded by Preventative Health and Health Services Block Grants;[5] Section 1557 of the Affordable Care Act, which prohibits discrimination against individuals on the basis of race, color, national origin, sex, age and disability in covered health programs or activities; and the Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals with emergency departments to provide medical screening examinations to any individual who comes to the emergency department and requests examination, regardless of ability to pay or insured status.[6]

If you have any questions regarding caring for LGBTQIA+ patients and avoiding discrimination, please don’t hesitate to contact BMD Health Law Group Member Jeana M. Singleton at jmsingleton@bmdllc.com or 330-253-2001, or BMD Attorney Rachel Stermer at rcstermer@bmdllc.com or 330-253-2019.  

[1] Kaiser Family Foundation, “LGBT Adults’ Experiences with Discrimination and Health Care Disparities: Findings from the KFF Survey of Racism, Discrimination, and Health” (Apr. 2, 2024) https://www.kff.org/racial-equity-and-health-policy/poll-finding/lgbt-adults-experiences-with-discrimination-and-health-care-disparities-findings-from-the-kff-survey-of-racism-discrimination-and-health/. 

[2] Id.

[3] Id.

[4] The Joint Commission, “Meeting the Needs of the LGBTQ+ Community – Then and Now” (June 25, 2023) https://www.jointcommission.org/resources/news-and-multimedia/blogs/advancing-health-care-equity/2022/06/meeting-the-needs-of-the-lgbtq-community/#:~:text=The%20Joint%20Commission's%20Field%20Guide,policies%20or%20modify%20existing%20policies. 

[5] 42 USC § 300w-7.

[6] 42 USC § 1395dd.