El Rio Community Health Center pediatricians Drew Cronyn and Tracey Kurtzman have been treating a growing number of patients who are transgender children and youth.
It's Monday afternoon and Kurtzman's already seen a 16-year-old in the slow process of transitioning to male. The other day she and one of El Rio's senior clinical pharmacists had a one-hour consultation with a trans teen interested in cross-gender hormones.
In recent months, El Rio's gotten feedback from trans patients, mostly adults relying on the clinic for primary care, who felt the center wasn't meeting the basic requirements in transgender healthcare.
Admitting there was much more El Rio could do for the community, the clinic created a committee with the sole task to transform the center into an organization that's sensitive to the demands of a population in need of safer medical spaces.
To Cronyn, who came out as gay at a time LGBT rights hadn't gained much momentum, establishing welcoming health spaces is key to support a new generation of people still vulnerable to discrimination.
"I had a kid come into my practice who had been asked to leave another practice. They didn't want to call him by the right name or right gender," he says. "I was so surprised to hear that. It's 2015, is that really still a thing? If you look at the transgender community, like any group that has felt a certain level of oppression and not being cared for, the cultural humility is really important there. For us, we are learning how to get the fact that we care across."
It's much needed.
An October 2010 survey by the National Transgender Discrimination Survey and the National Gay and Lesbian Task Force says that out of more than 7,000 LGBTQI people surveyed, close to 30 percent postponed visiting the doctor and that same number reported being harassed at a health center. Half of them said they ended up having to educate doctors and health providers about transgender care, and 19 percent said they were refused care over being trans or gender nonconforming.
El Rio wants to be a model for closing that gap.
Cronyn and Kurtzman recently brought transgender advocate and long-time friend Michael Woodward on board. Woodward is taking El Rio through the Healthcare Equality Index—four fundamental criteria created by the Human Rights Campaign that determines whether or not a health provider is LGBT friendly or not.
Through the years, Woodward's become the to-go person for health providers wanting to specialize in trans care.Michael
A good friend's suicide a few years ago pushed Woodward to develop an even stronger position in the transgender civil rights movement.
As he sits in his apartment's living room with one of his adopted cats on his lap, Woodward remembers his mentor, Alexander Goodrum—a transgender rights advocate, who was one of the first to make noise on behalf of trans people in Arizona. Goodrum was actually one of the reasons Woodward moved to the Old Pueblo. The duo balanced each other out perfectly: Goodrum took on politics and lobbying, and Woodward tackled health care and education.
"His mom said at his memorial service, 'Keep up his work,'" Woodward says. "I have taken that to heart. I was going to anyway, but the fact that she specifically said that ...I know that (Alexander) was making headway."
Born in a very conservative, pre-Internet Indiana, Woodward says he didn't even know what language to use to describe what went on inside of him.
He was assigned the gender female at birth. When puberty kicked in, he felt his body had betrayed him. At 16, he came out as lesbian merely because "that is what made sense at the time," he says. "I knew I liked women, and I guess I'm in this girl body, so that makes me lesbian."
From then on there was a lot of shame and a lot of confusion. He was an advocate in the lesbian community for two decades, but it never felt quite right. It wasn't until he hit his mid-30s that it all clicked for Woodward. He'd met a friend transitioning from female to male, and there it was. He, too, looked into transitioning, and around the same time decided to move to Tucson for a new job.
The timing was perfect.
At 36, he quit smoking, he lost weight, and discovered he could begin to love himself.
As soon as he reached the desert, Woodward got involved with Wingspan—an LGBT community space that shuttered last summer—and shortly after became one of the first employees of the Southern Arizona Gender Alliance. As he witnessed the faults between dignified health care and the trans community, Woodward found his calling. He enrolled at the UA and got a master's degree in public health policy and management.
In the final stages of his master's degree, Woodward connected with the Rev. Joseph Fitzgerald, former chaplain at the University of Arizona Medical Center (now, Banner-University Medical Center). Fitzgerald's boss at the time, Julie Kennedy, had assigned him to manage taking the hospital through the Healthcare Equality Index. "I said, 'Oh my God, I need an internship, I can help you with that," Woodward says.Banner-UMC
In 2013, Woodward began a very successful internship at what was known as the University of Arizona Health Network, which oversaw UAMC. To Woodward, the foundation of equal healthcare comes from establishing policies that are trans friendly, not just training providers.
Thanks to his work, Banner-UMC is one step from scoring 100 on the equality healthcare index. The only thing missing is training executive leaders on LGBT patient-centered care.
Thus far, Banner has added sexual orientation and gender identity to its nondiscrimination policy for patients. Before Tucson joined Banner, the company already had gender identity in its equal employment opportunity and affirmative action policy, according to Jennifer Sherwood, director of human resources at Banner-UMC. The policy covers all 29 Banner hospitals in seven states.
When Woodward came on board two years ago, there was a transgender employee in the process of transitioning.At the time, Woodward became a consultant with human resources, and helped them lift healthcare restrictions, such as not covering surgery costs, he says.
"We had to go through the whole conversation around, 'If you are going to have gender identity in your nondiscrimination policy, that includes not discriminating by not providing healthcare," Woodward says, noting the change went up the whole Banner network. "The fact that happened was a huge feather on my hat," he says. "I helped one guy, but I really helped a whole bunch of people who could now have access to (those benefits)."
Sherwood says Banner's benefits plans don't vary based on gender identity. "Employees who wish to change their gender identification on their employee profile would contact human resources who could assist them appropriately," she says in an email.
Many of these modifications are now required by the federal government. But other policy changes are up to the hospital or health provider itself.
The Affordable Care Act could protect transgender people from health care discrimination, according to the National Center for Transgender Equality. "The Affordable Care Act banned sex discrimination in most health care facilities and programs. While we still desperately need national laws that explicitly prohibit discrimination based on gender identity and sexual orientation, existing laws such as the Affordable Care Act can provide real protections in many circumstances," the center says on its website. Also, the Joint Commission—the entity that accredits certain hospitals and health providers—requires being trans inclusive. Still, in terms of insurance, there isn't explicit language in Arizona that bans transgender health care discrimination. Only 10 states prohibit it, including California, where private insurance and Medicaid have to offer equal coverage to transgender people.What's Next
Many of those close to Woodward are mourning his upcoming departure from Tucson. He's moving to Seattle to help lead a well-known trans education conference, but says his work in Tucson isn't over. As he puts it, he's just a phone call away.
"I was talking on the phone to a guy I met 10 years ago. He was a student at the time, and he had not started his transition until he found out about me," he remembers. "He would drive down from Flagstaff once a month to go to (SAGA) support group meetings. (He'd say) 'You are the first trans person I ever met, and you gave me hope.' I'm just doing what feels right to me. I clearly see a need here, and this is what I need to be doing."