Patient Non-Discrimination

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Why an LGBTQ-Inclusive Patient Non-Discrimination policy?

LGBTQ people experience many forms of discrimination in healthcare because of their sexual orientation (lesbian, gay, and bisexual people) and/or their gender identity (transgender people).

A large survey by Lambda Legal, “When Health Care Isn’t Caring” revealed that:

  • 56% of lesbian, gay, and bisexual respondents had experienced serious discrimination in healthcare
  • 70% of transgender respondents had experienced serious discrimination
  • 73 percent of transgender respondents and 29 percent of lesbian, gay and bisexual respondents reported that they believed they would be treated differently by medical personnel because of their LGBTQ status

Adding the words “sexual orientation” and “gender-identity or expression” to a facility website, patient bill of rights poster or brochure can help to alleviate these very real worries LGBTQ patients face when receiving care. Explicitly inclusive language not only allows LGBTQ patients and families to feel safe and welcomed at a facility – it can be the deciding factor for an LGBTQ patient when determining where to receive care.

Creating and broadly communicating a patient non-discrimination policy that includes both “sexual orientation” and “gender identity or expression” is a crucial step in ensuring equitable, high-quality care for LGBTQ patients. It sends an important message to patients and employees alike: LGBTQ people must receive equal treatment. In addition, Section 1557 of the Affordable Care Act prohibits sex discrimination in any hospital or health program that receives federal funds, and the U.S. Department of Health & Human Services, Office of Civil Rights, has issued regulations that this prohibition extends to claims of discrimination based on gender identity and sex stereotyping.

It has become common for organizations’ non-discrimination statements to include the terms “sexual orientation” and “gender identity.” For example, leading healthcare provider organizations have adopted policies that prohibit discrimination against LGBTQ people by including the terms “sexual orientation” and “gender identity.”

In some cases, inclusion of these terms reflect state law, affirming that the organization is aware of and committed to legal requirements of non-discrimination. In areas without a state law prohibiting LGBTQ discrimination, adding “sexual orientation” and “gender identity or expression” to a non-discrimination policy signals a clear and welcome commitment to equity and inclusion.

Joint Commission Standard

This HEI requirement reflects Joint Commission standard RI.01.01.01, EP 29, which calls on accredited facilities to prohibit discrimination based on both “sexual orientation” and “gender identity or expression.” The HEI criteria also reflects the recommendations of The Joint Commission LGBT Field Guide.

An explicitly LGBTQ-inclusive patient non-discrimination policy, together with comprehensive staff training, can do much to reduce the discrimination that LGBTQ patients experience in healthcare settings.

It is important to note that The Joint Commission Standard on patient non-discrimination does not currently require the adoption of a written non-discrimination policy. This is a requirement of the HEI. However, a written policy is one of the surest ways to confer adherence to The Joint Commission Standard and it conveys an organizational commitment to LGBTQ non-discrimination.

To receive credit in the HEI:

  • An organization must document that both terms, “sexual orientation” and “gender identity or expression” are included in their Patient Non-Discrimination policy.
  • The policy must be communicated to patients in at least two of the following ways:
    • Posted on facility website
    • Posted or displayed in waiting rooms and other public areas of the facility
    • In materials routinely given to patients at admitting/registration
    • In materials routinely given to patients at other time(s)
    • In materials routinely available for take-away in patient waiting areas
    • Posted in patient waiting area(s)
  • The policy must be communicated to employees in at least one of the following ways:
    • Posted on facility intranet site
    • Posted in employee work area(s)
    • In materials routinely given to employees at orientation
    • Reviewed in in-person employee training
    • Reviewed in online employee training

HEI Scored Questions

Sample Policies

The following excerpts from healthcare organizations' patient non-discrimination policies (or patients' bills of rights) meet the Patient Non-Discrimination criteria of including the terms “sexual orientation” and “gender identity or expression.”

Faulkner Hospital (Boston, MA)
This is a concise non-discrimination policy with clear, LGBTQ-inclusive language.
It is the policy of Faulkner Hospital to treat all patients and not to discriminate with regard to race, color, religion, national origin, age, sex, sexual orientation, gender identity or expression, or disability.

Group Health Central Hospital (Seattle, WA)
Group Health Cooperative shall operate in a manner that does not unlawfully discriminate against people on the basis of race, color, national origin, religion, sex (including pregnancy) age, sexual orientation (including gender identity and expression), marital status, disability, veteran status, or any other basis prohibited by federal, state, or local law. Group Health prohibits retaliation against any person because he or she opposed or complained about discrimination in good faith, assisted in good faith in the investigation of a discrimination complaint, or participated in a discrimination charge or other proceeding under federal, state, or local anti-discrimination law.

Rush University (Chicago, IL)
This university affiliated hospital’s LGBTQ non-discrimination policy delineates its application to all members of the university community.

Discrimination or harassment against any member of the Rush University Medical Center community (i.e., employee, faculty, house staff, student, or patient) because of age, ancestry, color, disability as defined by Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, gender, gender identity and/or expression, marital or parental status, national origin, pregnancy, race, religion, sexual orientation, veteran's status or any other categories protected by federal or state law is prohibited and will not be tolerated, nor will any person for those reasons be excluded from the participation in or denied the benefits of any program or activity within Rush University Medical Center or Rush University.

UCSF Medical Center (San Francisco, CA)
It is the policy of UCSF Medical Center not to engage in discrimination against, or harassment of, any person employed or seeking employment or patient care with UCSF Medical Center on the basis of race, color, national origin, religion, sex, gender identity, pregnancy, physical, mental or other disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or status as a covered veteran (special disabled veteran, Vietnam-era veteran, or any other veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized). Non-discrimination information is available in an alternate form of communication to meet the needs of people with sensory impairments.

Mount Sinai Beth Israel Medical Center (New York, NY)
This LGBTQ-inclusive non-discrimination policy makes it clear that it applies to all facets of patient care. Additionally, this policy goes the extra step of declaring respect of their patient’s gender identity and preferred pronouns, extending a clear welcome to transgender patients.

It is the policy of MSBI to provide equitable health care without discrimination against, or harassment of, any person on the basis of race, color, national origin, language, religion, sex, age, disability, citizenship, marital status, creed, sexual orientation, gender expression or gender identity (the patient’s preferred gender will be respected, and the patient will be referred to by their name and pronoun of choice, whenever feasible) or other non-medically relevant factor or any other characteristic protected by federal or state law. Any such discrimination or harassment is prohibited and will not be tolerated. This applies to admission, treatment, discharge or other participation in any of MSBI’s programs, services or activities, including, but not limited to: all patient admissions; all care, whether inpatient, outpatient or emergency in nature; all patients’ room, floor or section assignments or transfers, except in those cases where patient safety or health condition is a necessary consideration; and employee assignments to patient services.

Cincinnati Children’s Hospital Medical Center (Cincinnati, OH)
This patient non-discrimination policy for a pediatric facility specifically incorporates the patient’s family in the non-discrimination statement, addressing the worries faced by same-sex parents.

Patients and parents/guardians have the right: to be treated considerately and respectfully regardless of the patient and/or family’s race, religion, sex, sexual orientation, gender identity/expression, cultural background, economic status, education or illness.

Vanderbilt Hospital and Clinics (Nashville, TN)
We will treat you without regard to your race, nationality, religion, beliefs, age, disability, sex, sexual orientation, gender identity or expression, or source of payment.

Saint Luke’s Health System (Kansas City, MO)
The patient has the right to treatment without discrimination as to race, age, religion, sex, national origin, socioeconomic status, sexual orientation, gender identity or expression, disability, veteran status, or source of payment.

Veterans Health Administration
You will be treated with dignity, compassion, and respect as an individual. Consistent with Federal law, VA policy, and accreditation standards of The Joint Commission, you will not be subject to discrimination for any reason, including for reasons of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression.

Policy Statements from Healthcare Provider Organizations

The following national healthcare provider organizations have passed supportive policy statements on patient non-discrimination inclusive of both "sexual orientation" and "gender identity."

American Academy of Physician Assistants
Physician assistants should not discriminate against classes or categories of patients in the delivery of needed health care. Such classes and categories include gender, color, creed, race, religion, age, ethnic or national origin, political beliefs, nature of illness, disability, socioeconomic status, physical stature, body size, gender identity, marital status, or sexual orientation.
Guidelines for Ethical Conduct for the Physician Assistant Profession []

American Medical Association
Our AMA will encourage and work with state medical societies to provide a sample printed nondiscrimination policy suitable for framing, and encourage individual physicians to display for patient and staff awareness-as one example: "This office appreciates the diversity of human beings and does not discriminate based on race, age, religion, ability, marital status, sexual orientation, sex, or gender identity." (Res. 414, A-04; Modified: BOT Rep. 11, A-07)
AMA Policy Regarding Sexual Orientation []

American Medical Student Association
OPPOSES all public and private discrimination based on sexual orientation or gender identity, including in: medical school admissions, promotion and graduation; postgraduate placement; hospital staff appointments; licensure; availability of health services; and access to social welfare; (2008).
Principles Regarding Sexuality []

American College of Obstetricians and Gynecologists
The patient-physician relationship: The welfare of the patient (beneficence) is central to all considerations in the patient-physician relationship. Included in this relationship is the obligation of physicians to respect the rights of patients, colleagues, and other health professionals. The respect for the right of individual patients to make their own choices about their health care (autonomy) is fundamental. The principle of justice requires strict avoidance of discrimination on the basis of race, color, religion, national origin, sexual orientation, perceived gender, and any basis that would constitute illegal discrimination (justice).
Code of Professional Ethics []

American Association of Family Physicians
The AAFP opposes all discrimination in any form, including but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin. (1996) (2010 COD)
Discrimination, Patient []

American College of Healthcare Executives
ACHE works to foster an inclusive environment that recognizes the contributions and supports the advancement of all, regardless of race, ethnicity, national origin, gender, religion, age, marital status, sexual orientation, gender identity or disability because an inclusive environment can enhance the quality of healthcare, improve hospital/community relations, and positively affect the health status of society. This priority is reflected in ACHE's various activities and initiatives.
Statement on Diversity []

American Academy of Pediatrics
The mission of the American Academy of Pediatrics (AAP) is “to attain optimal physical, mental, and social health and wellbeing for all infants, children, adolescents and young adults.” In support of this mission, therefore, the AAP is opposed to discrimination in the care of any patient on the basis of race, ethnicity, ancestry, national origin, religion, gender, marital status, sexual orientation, gender identity or expression, age, veteran status, immigration status, or disability of the patient or patient's parent(s) or guardian(s).
Nondiscrimination in Pediatric Health Care []