Trial News

A California appeals court has revived a transgender man’s lawsuit alleging a hospital discriminated against him when it prohibited his hysterectomy after learning the procedure was to treat gender dysphoria. The court ruled that the amended complaint sufficiently alleges that the hospital violated the plaintiff’s civil rights under state law when it prevented him from receiving a procedure it permits for patients with other medical diagnoses. (Minton v. Dignity Health, 2019 WL 4440132 (Cal. Dist. Ct. App. Sept. 17, 2019).)

Evan Minton is a transgender man with gender dysphoria, a condition the complaint describes as the “medical diagnosis for the feeling of incongruence between one’s gender identity and one’s sex assigned at birth, and the resulting distress caused by that incongruence.” Minton’s surgeon, Lindsey Dawson, and two mental health professionals who had treated Minton agreed that a hysterectomy was “medically necessary care” to treat his gender dysphoria. The procedure was scheduled for Aug. 30, 2016, at Mercy San Juan Medical Center (Mercy), a Catholic hospital owned by Dignity Health.

Two days before the scheduled hysterectomy, Minton shared with a Mercy nurse that he is transgender. The next day, a Mercy representative told Dawson that Minton’s hysterectomy was cancelled. When Dawson contacted Mercy’s president, Brian Ivie, for more information, he informed her that she would “‘never’ be allowed to perform a hysterectomy on Minton at Mercy because ‘it was scheduled as part of a course of treatment for gender dysphoria, as opposed to any other medical diagnosis.’”

The amended complaint describes how this decision caused Minton “great anxiety and grief,” particularly because his hysterectomy had to be completed three months before his phalloplasty, already scheduled for Nov. 23, 2016. After Dawson’s conversation with Ivie, she and Minton reached out to local contacts and media agencies, which shared his story with the public.

After this publicity, Dawson and Ivie discussed the possibility of performing Minton’s surgery at another location. This option, however, posed several obstacles. Dawson, for example, did not have surgical privileges at other hospitals, and it was unclear whether Minton’s insurance would permit this change. Ultimately, Dawson secured emergency surgical privileges at another, non-Catholic Dignity Health hospital and performed Minton’s hysterectomy on Sept. 2, 2016.

Minton sued Dignity Health, alleging it violated California’s Unruh Civil Rights Act by intentionally discriminating against him as a transgender man and by denying him “full and equal access” to medical care. The defendant filed a demurrer, arguing that it had followed the facially neutral directives issued by the United States Conference of Catholic Bishops—which prohibit direct sterilization—and that even if Minton had alleged a civil rights violation, its federal and state constitutional rights of free exercise of religion and freedom of expression barred that claim.

The court sustained the demurrer with leave to amend. After the amended complaint was filed, the defendant filed another demurrer on the grounds previously asserted. After briefing and argument, the court sustained this demurrer without leave to amend, ruling that Minton was not unlawfully deprived of full and equal access to medical care because he had the hysterectomy, even if days later than originally planned.

The appellate court reversed, emphasizing that Mercy denied Minton’s procedure because it was to treat gender dysphoria, a condition unique to transgender people. “Denying a procedure as treatment for a condition that affects only transgender persons supports an inference that Dignity Health discriminated against Minton based on his gender identity. This is true even if the denial was pursuant to a facially neutral policy,” the court wrote. Although the defendant disputed that it had denied Minton’s procedure because of his transgender status, the court found that the “matter is not suitable for resolution by demurrer” because Minton’s allegations supported a viable cause of action.

The court also rejected the trial court’s conclusion that Minton’s claim was precluded by North Coast Women’s Care Medical Group, Inc. v. Superior Court (44 Cal. 4th 1145 (Cal. 2008)). In North Coast, a patient sued a medical group alleging Unruh Act violations after doctors, citing their religious beliefs, refused to artificially inseminate her because she is a lesbian. The California Supreme Court held that the state constitution’s “guarantee of free exercise of religion does not exempt physicians from conforming their conduct to the Unruh Act’s antidiscrimination requirements even if compliance substantially burdens their religious beliefs.” But it also said doctors with religious objections could avoid violating patients’ right to “full and equal” medical care by ensuring they received the necessary procedure from another physician without religious objections.

Citing North Coast, the trial court found that Minton did not have a discrimination claim because the hysterectomy was done at another facility shortly after Mercy’s refusal. The appellate court, however, reversed, finding that the trial court had “misconstrue[d] Minton’s pleading.” As the appellate court described, Minton did not allege that forcing him to have the hysterectomy at another hospital violated the Unruh Act; rather, Minton alleged that Mercy violated the law when it cancelled the procedure and told Dawson that she would “never be allowed to perform Minton’s hysterectomy at Mercy.” By later making alternate facilities available—after media pressure—the defendant may have mitigated the impact, but it did not undo the harm its denial had caused. “‘Full and equal’ access,” the court wrote, “requires avoiding discrimination, not merely remedying it after it has occurred.”

“The appellate court’s crisp response reflects the strong protections the Unruh Act provides,” said ACLU of Northern California attorney Elizabeth Gill, who represents the plaintiff. “The lower court erred when it relied on what happened after Minton was turned away from the hospital. If you walk into a restaurant and they refuse to seat you because you’re transgender, that’s discrimination, even if the owner directs you to another restaurant across the street that can serve you. Being a transgender person is to experience discrimination and identity erasure at a lot of levels, and our client feels validated for the time being that the court recognized him and his need for surgery.”