Bob's WebPage

I have been engaged in the fight for Gender Reaffirming Surgeries (SRS) in NS for more than 10 years. The first part of this journey was for me to understand what 'Transgender' is. That was a tough row to hoe. I would get to a point where I would say 'I Got It' - and a little while later I would ask more questions and I would discover that 'I Don't Got It'. Thank goodness for some very patient people who were always there to answer questions and help me along. In recent years I am finding that I have a lot fewer 'I Don't Got It' moments.

All that being said, I was involved with many very good people and groups who were able to keep their focus and continued to work toward total equality for one of the last politically, and medically, marginalized groups in our province.

Upon the election of the New Democratic Party, a party I understood was built on the principle of social justice for all, we were very optimistic that the goal to have SRS covered as an insured service in NS would be accomplished.

Unfortunately it took a long time for this basic value to be reflected in the transgender reality...shame on the NDP. Here is the text of a letter received by the Nova Scotia Rainbow Action Project in early June 2013 - almost 4 years after the first request to this government was made :

• Lucas Thorne-Humphrey
  Nova Scotia Rainbow Action Project
  
  Dear Mr. Thorne-Humphrey:
  Thank you for your letter e-mailed on October 1, 2012, requesting support from the Department of Health and Wellness to remove clause #4.8 from the MSI Physician’s Manual Preamble, which prohibits the approval of billing codes for surgical procedures relating to transgender health in Nova Scotia. I apologize for the delay in my response. I wanted to ensure that serious consideration was given to your request. Departmental staff was directed to do a careful policy review, including extensive research and consultation with other provinces regarding procedures that are currently insured and the short and long-term health outcomes.
  I regret to inform you that due to the lack of high quality scientific evidence to support the efficacy of the long-term outcomes of these procedures and lack of a strong economic argument for their benefit, the department is not in a position to grant your request at this time.
  I appreciate your patience and understanding while we have deliberated on this issue.
  
  Sincerely, Original signed by
  David. A Wilson Minister
  
  c. Kevin McNamara, Deputy Minister, Department of Health and Wellness

To everyone's surprise, a few days later the Minister of Health called NSRAP to a meeting where our team was informed that the government had reversed the above proclamation and would eliminate section 4.8 immediately. That resulted in a new reality where SRS could qualify as an insured service under the Medical Insurance Services (MSI) plan of the province.

That is to be celebrated!!!

My correspondence with government on this issue is included under the tabs above.

My new reality!

Unfortunately I am quite sad to report that, due to personalities and philosophical differences, I found it necessary to withdraw from my continued involvement in the quest. I have come to the conclusion that my continued involvement would be counter-productive and indeed may even slow down the process to achieve the ultimate objective - to have equality for the transgender community of Nova Scotia.

As St Francis said "...grant me the wisdom to know the difference."

All that being said, I am still interested and hopeful that the people leading the charge will ultimately be successful. In the mean time I am willing to lend whatever support I can but from the background.

Check the tab 'to NSRAP' above to see my response and my suggestions for future action.

Thanks for reading... I am looking forward to your feedback.

From the background,

Bob

UD-Oct 8, 2013

Now we have Transgender explicitly included in the Human Rights Act and SRS is eligible to become an insured service. These, particularly the latter, are major achievements.

Congratulations to all involved!

As a side note:

The NDP Government never did remove Section 4.8 from the Physicians' Manual and in the fall 2013 election the party was almost removed from the political map of the province. (I do not believe that this issue alone was the cause of their defeat but rather their move away from a basic philosophy, that had a strong 'Social Justice' bent, that resulted in their downfall; their refusal to remove Section 4.8 (despite their promise to do so) was a reflection of this change.)

In early 2014 the new Liberal government did in fact remove the infamous Section 4.8.

Action to implement changes resulting from this change have been postponed to April 2014 (the new fiscal year).

Our next challenge, on the trans front:

... have the moniker on the birth certificates changed to reflect the reality of the transgender person.

The Nova Scotia Rainbow Action Project (NSRAP) is the only directly politically active group that is trying to represent the LGBT Community in NS.

(read more)

I am very interested to know about NSRAP's position on this issue.

Let me explain from my point of view:

What is the problem?

One example - the trans guy is stopped by the police because, unknown to him, his left turning signal is broken. That is ok - now he is asked for his documentation. The officer looks at the paperwork and he sees a person with a beard and his paperwork indicates a female name and a gender marker "F".

This could be a disaster!

Maybe NSRAP could meet with the Minister of Justice with the objective to establish a protocol with Vital Statistics NS for a smooth way to have the moniker changed on birth certificates to reflect a person's 'TRUE" gender.

Maybe we should think outside the box and consider other options such as:

- instead of an F or an M they could give everyone the option of an X.

- maybe there is no need for an F or an M on that document.

Then having drivers' licenses, passports, MSI Card, medical records, etc corrected would be a relatively easy process.

I am hoping that NSRAP will put that issue at the top of their political action agenda.

Input:

If you have any comments on this I would very much like to hear from you.

UD- March 2014

Now we have it! What next?

My thoughts:

Our concern on SRS must be what the system will look like for effected individuals when the service is implemented.

The steps, as I understand them, are:

• If a doctor would like to have one of their patients have a surgery that does not have an MSI charge code, they must prepare a formal requested for same through Dr's NS. That request will be evaluated by Dr's NS to determine if the request is appropriate.
• That application will then be put to Physician Services, a section of the Department of Health and Wellness (DoH). (Again to be evaluated for appropriateness)
• Usually, if recommended by Dr's NS the new charge code would be approved and we are on the way.

That is the simple story - but hold on; as clarification - whatever individual doctor makes the initial application will be required to complete a great deal of paperwork. I suspect they are not paid for the time required to do that but I am not so sure about that.

I am quite sure, having chatted with the folks at Dr's NS, that the first approval step will not be a problem.

The next stage is fraught with potential problems:

• What protocol will the DoH want to implement?
• What model will they want to use for evaluation? (They would usually look to another province for a sample process - and very often the Ontario model is the one that is chosen. That particular model is one of the worst. Being trans in Ont. is not easy.)
• I now understand that the Manitoba model is getting serious attention. I do not have all of the information yet but what I do understand is:
1. They have their own experts who do the evaluation for individuals eligibility for surgery (they do not use CAMH - and that is a good thing).
2. Some surgeries (ie - chest masculinisation) is done in province. Other surgeries (ie - vaginoplasty) is done in Montreal.
3. Phalloplasty is not an insured service (do not yet know why not).
• Currently all of the provinces that have the service available have issues that are causing problems.

Therefore NS could develop a protocol that could be a model for other provinces. To accomplish that NSRAP, CPATH and pride Health together (working with members of the trans community of course) could/should develop a proposal to offer the Minister of Health and Wellness.

I think we (the community) should not wait to be invited to the table by the DoH, but rather let them know that we are working on a proposal for their consideration and ask that they use it as a starting point.

The Model:

My suggestion is that Capital Health build a program with a provincial scope, that would include all the services associated with trans health. This would be the ideal!

This would take time to develop and implement, so in the meantime lets start the ball rolling with an initial application for surgery (perhaps a vaginoplasty) and, with the guidance of CPATH, develop the evaluation protocol (for eligibility). Then, using that model, we could move on to chest masculinisation and even phalloplasty.

Things like a hysterectomy already have a charge code so it should be verified that having that surgery done now is not an issue. The bureaucrats could insist that all surgeries relating to trans health would have to be subject to the same kind of protocol described above. That I think would be unfortunate, but if that is the case then we should accept that reality and do the work necessary to make it happen.

Education:

I am wondering if you would be interested in attending an information session with some transgender people where you could learn more about what trans-gender is.

I would love to hear from you, just for my own information. If there is any interest I will pass your request on to the people who are doing that kind of work.

UD-Oct 8, 2013