This section focuses on known activities that undermine LGBTQ+ equality or patient care.
Healthcare organizations can have points deducted from their score if they have policies in place that may lead to discriminatory treatment or a large-scale official or public anti-LGBTQ+ blemish on their recent records.
Scores on this criterion are based on information that has come to HRC Foundation’s attention related to topics including but not limited to:
HRC realizes that no institution is perfect and that situations may arise where an individual or small group act in a way that is not in alignment with the organization’s policies and commitment to LGBTQ+ equality and patient care. This criterion is not intended to penalize an organization in those situations where an isolated negative action takes place, provided that the organization addresses the situation and takes action to ensure that their commitment to LGBTQ+ patient care remains uncompromised.
In the cases where HRC would consider applying the responsible citizenship deduction based on the actions of one individual employed by the hospital, health system or affiliated university, we would only do so after looking at the totality of the situation and considering the following factors:
Prior to applying the point deduction, the HRC Foundation will make every attempt to work with the organization to resolve the concerns. If it is necessary to apply the point deduction, it may be reflected in a current or future score, depending on the situation. If applied to a current score, HEI Leader in LGBTQ+ Healthcare Equality status will be suspended or revoked as necessary. If at any time after losing points on this criterion, a healthcare facility changes course and satisfies the HRC Foundation’s noted concerns, HRC Foundation will re-evaluate the criterion for that facility.
The HRC Foundation does not take the application of this penalty lightly and prior to the HEI 2022, it has only been used in one instance. Unfortunately, in the HEI 2022, three hospitals received the 25 point deduction: University of Texas Southwestern Medical Center and Children’s Health in Dallas received the deduction for discriminating against transgender children by not providing them with the same care that they provide to other children; and Mercy San Juan Medical Center for discriminating against a transgender man, Evan Minton by denying him a hysterectomy. Learn more about each of these cases by following the links above.
If a healthcare organization follows a religious directive or has a policy in place that prevents them from providing specific medically necessary treatments, such as hysterectomy or mastectomy, to some patients based on a diagnosis of gender dysphoria, but allows them to provide the same treatment to other patients based on other diagnoses, this may result in discriminatory treatment that is in conflict with their non-discrimination policy. However, there are ways to mitigate the risk of discriminatory treatment to LGBTQ+ patients. This option outlines the steps a hospital must take in order to only receive a 5-point deduction and be listed in the HEI.
Organizations with this type of directive or policy in place may only be subject to a five-point deduction (to offset the points received for the Patient Non-Discrimination Policy) if they take the following actions to mitigate the potential for discriminatory situations to occur. In order to only receive this 5 point deduction and to be listed in the HEI, the organization must take affirmative action to clearly communicate the existence of the directive or the policy and what services they do not provide to help prevent potential discriminatory situations.
They must:
After taking these communication steps an organization would only be assessed a 5 point deduction. If after this deduction, the organization has a final score of between 80-95 and meets the other criteria for earning the Top Performer designation (full credit in criteria 1 and at least partial credit in criteria sections 2, 3, & 4), the organization may earn the Top Performer designation.
Organizations that choose not to take these mitigating steps would be subject to the full 25 point deduction. Organizations that take these steps and later have a discriminatory incident may be subject to the full 25 point deduction.
In the HEI 2022, 137 HEI 2022 participants received this deduction. The majority (115) of these participants are facilities operated by the Veteran’s Health Administration, which due to an exclusion in the VA medical benefits package are unable to provide gender-affirming surgeries. The other group of 22 hospitals that received this penalty are Catholic healthcare facilities that interpret one or more of the Catholic Ethical and Religious Directives in a way that means they will not perform certain gender-affirming surgeries while they would provide the same surgeries for other patients based on other diagnoses.