Critical Condition

CRITICAL CONDITION

Vanderbilt’s Prescription for Health Care Equality

by BEN ROCK, MANAGING EDITOR benrock@outandaboutnewspaper.com

After five years of participation, Vanderbilt University Medical Center has achieved the status of “Leader in Lesbian, Gay, Bisexual and Transgender Health Care” in the Human Rights Campaign's Health Care Equality Index.

By meeting the “Core Four” criteria of the HEI survey, Vanderbilt is one of 234 hospitals and clinics in the nation and the only one in Tennessee to receive this designation.

“Vanderbilt has a long history of inclusive policies and practices when it comes to caring for patients and supporting employees,” said assistant professor of anesthesiology Jesse Ehrenfeld of the hospital’s patient nondiscrimination policies, visitation policies, employment nondiscrimination policies and training in LGBT and intersex patient care.

“We didn’t achieve this milestone overnight,” Ehrenfeld said. “Rather, our designation as a leader in LGBTI health is a recognition of a concerted effort to make certain that all policies and practices are inclusive of LGBTI patients.”

Andre Churchwell, associate dean for diversity for the School of Medicine, said the status is a source of pride for the medical center campus.

“The leadership at Vanderbilt, including those at the highest levels at both the medical center and the university, have made this a priority,” Churchwell said. “There is an understanding that a broader definition of diversity is crucial for success, if you don’t have this broad view of patient and employee equality, success as a medical center is not possible.”

The announcement of Vanderbilt University Medical Center as one of HRC's Leaders in LGBTI Health Care coincides with the launch of the School of Medicine’s new Program in LGBTI Health.

“I think it is safe to say that while Vanderbilt has always had a forward-thinking policy of inclusion, that there is a new articulation and emphasis on programming and developing resources around supporting the health of LGBTI patients,” Ehrenfeld said. “Going through the HEI certification process, we realized that these resources needed a defined home. We're in the early formative phases of this program. We’re excited but there’s more work to be done.”

Having worked to address health disparities for LGBTI patients and been highly involved in achieving the HEI designation, Ehrenfeld will co-direct the Program in LGBTI Health with MD/PhD student Kristen Eckstrand.

"Our first priority inside the Medical Center is the patients,” Eckstrand said. “We want to make sure that not only do LGBTI patients feel comfortable coming here and being open, but when they do, we want to make sure they get the care they deserve and that it is appropriate to them.”

“The Program in LGBTI Health is a new articulation of a series of activities that, for the first time, have been brought to together in a coordinated way,” Ehrenfeld said. "Our specific interest in LGBTI health comes from our desire to ensure that we provide the best care possible for all patients.”

Kristen Eckstrand and Jesse Ehrenfeld.

Ehrenfeld and Eckstrand’s overall vision for the program is to promote national leadership in providing excellent patient care, education, research and advocacy for the LGBTI community. Specifically, they want to ensure LGBTI patients receive the care they need in an environment that supports their unique needs while making sure that VUMC employees and trainees possess the skills and knowledge needed to deliver the highest quality of care for LGBTI patients. The Program in LGBTI Health will also seek to ensure the hospital and university’s educational efforts and activities include LGBTI topics and its research programs reflect the need to advance its knowledge and understanding about LGBTI health.

“Just a few short years ago the health care industry wasn’t having conversations about LGBT health care equality," said HRC president Chad Griffin, responding to the new programs like Vanderbilt’s. “Now, thanks to advocacy by the LGBT community and some standout leaders, growing numbers of health care providers are making an explicit commitment to treat all patients with dignity and respect. The health care industry is beginning to heed the call for fairness and compassion.”

At a press conference held on June 19 with Griffin and HRC at Howard University Hospital in Washington, D.C., Secretary of Health and Human Services Kathleen Sebelius discussed how much work remained to be done to end discrimination in America’s health care system, but the once invisible issue of LGBT health care equity has continued to gain national prominence.

“I commend the LGBT and health care communities for the progress made,” Sebelius said, “and I am proud to be part of an administration that has a historic record of accomplishment for the LGBT community. We will continue to take action to ensure that LGBT Americans get equal treatment in health care settings and that all patients are treated with the dignity they deserve.”

"Equal and inclusive health care saves lives," Griffin said. “Increasing numbers of hospitals across the country are working to ensure LGBT patients receive care free of prejudice and discrimination. We thank the HEI 2012 participants for their hard work and dedication to ensuring health care equality for all patients.”

The HEI 2012 report is based on the voluntary participation of hospital respondents. The annual survey has grown tremendously in participation since it began in 2007. This year, a record 122 surveys were completed, representing 407 individual health care facilities nationwide. The HEI survey questions apply to written policies and practices related to LGBTI health.

This year’s survey found a 40 percent increase in rated facilities, which totaled 407 nationwide. It also found an impressive 162 percent increase in the number of facilities achieving the status of "Leader in LGBT Health Care Equality,” special recognition given to facilities earning a perfect rating by meeting four core criteria for LGBT patient-centered care laid out in the HEI.

The HEI helps hospitals assess themselves against established best practices and ensure that they are complying with requirements for nondiscrimination. These include a requirement issued last year by the Joint Commission, the largest accrediting body for U.S. hospitals, calling on all accredited facilities to extend nondiscrimination protection to LGBT patients.

More than 90 percent of HEI 2012 participants explicitly prohibit discrimination against lesbian, gay and bisexual patients, and 76 percent ban discrimination against transgender patients. Additionally, about 75 percent of respondents have a written policy explicitly granting equal visitation rights to same-sex couples and same-sex parents. This represents a significant increase since the Department of Health and Human Services issued rules in 2011 requiring all hospitals that receive federal Medicare and Medicaid funding - nearly every hospital in America - to protect the visitation rights of LGBT people.

For the first time, the HEI additionally required participating facilities to document that high-level managers in key work areas had received expert training in LGBT health needs. As a result, more than 1,000 health care administrators across the country participated in training provided through the HEI. However, there is still progress to be made.

“LGBTI health disparities are very real and must be addressed,” Ehrenfeld said, addressing his hopes for Vanderbilt’s Program in LGBTI Health. “The national Lambda Legal survey in 2010 reported that 56 percent of LGB and 70 percent of transgender patients reported bias or discrimination when accessing health care. I hope that we are able to inspire others, in Tennessee and across the nation, to join us in supporting LGBTI patients.”

He and Eckstrand said Vanderbilt is working to produce important research and will be applying for further research grants in this area. Since national data has also shown 64 percent of medical students reported feeling inadequately trained to care for LGBTI patients. Vanderbilt University School of Medicine has already integrated training of key topics into the medical school curriculum.

“This model has been successful at Vanderbilt and can easily be replicated at other institutions across the country,” Eckstrand said.

The “Core Four” Criteria

The Healthcare Equality Index measures how equitably healthcare facilities in the United States treat their lesbian, gay, bisexual and transgender patients and employees. The index focuses on four core policy categories: patient non-discrimination; visitation; employment non-discrimination; and training in LGBT patient-centered care.

1

Patient Non- Discrimination Policies

a. Patient non-discrimination policy (or patients' bill of rights) is publicly available and includes the term "sexual orientation"

b. Patient non-discrimination policy (or patients' bill of rights) is publicly available and includes the term “gender identity”

2

Visitation Policies

a. Visitation policy explicitly grants same-sex couples (partners/ spouses/significant others) the same access as different-sex couples

b. Visitation policy explicitly grants same-sex parents the same access as different-sex parents for visitation of their minor children

3

Employment Non- Discrimination Policies

a. Employment non-discrimination policy (or equal employment opportunity policy) includes the term “sexual orientation”

b. Employment non-discrimination policy (or equal employment opportunity policy) includes the term “gender identity”

4

Training in LGBT Patient-Centered Care

Provides training for key staff members in LGBT patient-centered care

HEI 2012 Leaders in LGBT Healthcare Equality

Seventy-one survey respondents responded “yes” to all of the Core Four HEI criteria, earning Leader status for 2012. These 71 respondents represent 234 facilities that protect their LGBT patients and employees from discrimination, ensure equal visitation access for same-sex couples and same-sex parents through explicitly inclusive policies and provide staff training on LGBT patient-centered care.

WEST COAST

California Pacific Medical Center, San Francisco, CA

Kaiser Permanente (36 facilities), Oakland, CA

L.A. Gay & Lesbian Center, Los Angeles, CA

Lyon-Martin Health Services, San Francisco, CA

San Francisco General Hospital and Trauma Center, San Francisco, CA

Scripps Health (28 facilities), San Diego, CA

Sutter Maternity & Surgery Center, Santa Cruz, CA

UC San Diego Health System, San Diego, CA

UCSF Medical Center, San Francisco, CA

University of California Davis Medical Center, Sacramento, CA

Multnomah County Health Department (9 facilities), Portland, OR

Oregon Health & Science University, Portland, OR

Group Health (30 facilities), Seattle, WA

UW Medicine (2 facilities), Seattle, WA

Valley Medical Center, Renton, WA

1 World Medicine, Las Vegas, NV

SOUTHWEST

Legacy Community Health Services, Houston, TX

The University of Texas MD Anderson Cancer Center, Houston, TX

Southwest Center for HIV/AIDS, Phoenix, AZ

MIDWEST

University of Iowa Hospitals & Clinics, Iowa City, IA

Advocate Illinois Masonic Medical Center, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Rush University Medical Center, Chicago, IL

Indiana University Health Ball Memorial Hospital, Muncie, IN

Park Nicollet Methodist Hospital, St. Louis Park, MN

Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

University Hospitals of Cleveland (8 facilities), Cleveland, OH

University of Toledo Medical Center, Toledo, OH

SOUTHEAST

H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL

Jackson Health System (9 facilities), Miami, FL

Tallahassee Memorial HealthCare, Tallahassee, FL

Feminist Women’s Health Center, Atlanta, GA

Grady Health System (12 facilities), Atlanta, GA

Piedmont Hospital, Atlanta, GA

Duke University Hospital, Durham, NC Durham Regional Hospital, Durham, NC

Greenville Hospital System University Medical Center (5 facilities), Greenville, SC

Vanderbilt University Medical Center, Nashville, TN

NORTHEAST

Penobscot Community Health Care (11 facilities), Bangor, ME

Baystate Health (9 facilities), Springfield, MA

Beth Israel Deaconess Medical Center, Boston, MA

Boston Medical Center, Boston, MA

Brigham and Women’s Hospital, Boston, MA

Cooley Dickinson Hospital, Northampton, MA

Faulkner Hospital, Boston, MA

Fenway Health, Boston, MA

Harvard Vanguard Medical Associates, Newton, MA

Mount Auburn Hospital, Cambridge, MA

Newton-Wellesley Hospital, Newton Lower Falls, MA

AIDS Care, Rochester, NY

Beth Israel Medical Center, New York, NY

Callen-Lorde Community Health Center, New York, NY

Catskill Regional Medical Center, Harris, NY

NYU Langone Medical Center, New York, NY

St. Luke’s-Roosevelt Hospital Center, New York, NY

VillageCare Health Center, New York, NY

AtlantiCare Regional Medical Center, Atlantic City, NJMazzoni Center, Philadelphia, PA

George Washington University Hospital, Washington, DC

Howard University Hospital, Washington, DC

MedStar-Georgetown Medical Center, Washington, DC

National Rehabilitation Hospital, Washington, DC

Sibley Memorial Hospital, Washington, DC

Specialty Hospital of Washington - Hadley, Washington, DC

Whitman-Walker Health, Washington, DC

Christiana Care Health System (2 facilities), Wilmington, DE

Adventist HealthCare Inc. (2 facilities), Rockville, MD

Bon Secours Health System (14 facilities), Marriottsville, MD

Chase Brexton Health Services, Baltimore, MD

Johns Hopkins Hospital, Baltimore, MD

Northwest Hospital Center, Randallstown, MD