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 1. Healthcare Equality Index Resource Guide
 2. Patient Non-Discrimination


PATIENT NON-DISCRIMINATION

Patient Non-Discrimination

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Select One Overview HEI Scored Questions
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OVERVIEW


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


DOES YOUR PATIENT NON-DISCRIMINATION POLICY INCLUDE THE TERM "SEXUAL
ORIENTATION" AND THE TERM "GENDER IDENTITY OR EXPRESSION" OR ("GENDER
IDENTITY")?

To receive credit in the HEI, a facility must:

Upload a copy of the facility's patient nondiscrimination policy or patient bill
of rights.

Examples:

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
[www.aapa.org]

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 [www.ama-assn.org]

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 [www.amsa.org]

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 [www.acog.org]

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 [www.aafp.org]

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 [www.ache.org]

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 [www.aap.org]




IS YOUR PATIENT NON-DISCRIMINATION POLICY COMMUNICATED TO PATIENTS IN AT LEAST
TWO DIFFERENT WAYS?

To receive credit in the HEI, a facility must:

Provide at least two examples of how policy is communicated to patients –
typically one is a website example and the other will be a document like a
brochure. It could also be a poster or photo of sign/poster in waiting area.

More information:

Communicating your LGBTQ-inclusive patient non-discrimination policy to patients
is just as, if not more important than having the policy itself in place. The
HEI requires survey participants to make these policies readily accessible to
patients in at least two of the following ways:

 * Posted on facility website
 * In materials given to patients at admitting/registration
 * In materials given to patients at other time(s)
 * In materials available for take-away in patient waiting areas
 * Posted in patient waiting area(s)

Examples:

Posted on facility website:

 * HCA took the initiative to integrate their system-wide patient
   non-discrimination and equal visitation policies into each of their hospital
   facility websites for the following reasons: the Patient Rights and
   Responsibilities page can easily be found through each hospital’s homepage
   menu structure; their non-discrimination statement is clearly spelled out at
   the top of the pages; and the page also includes their equal visitation
   policy. See an example of an HCA hospital website Patient Rights page at
   Dominion Hospital, part of HCA Virginia Health System. Through this easily
   accessible and prominent webpage, HCA facilities clearly convey their LGBTQ
   inclusion to patients and families.
 * University of Mississippi Medical Center has this statement lead their
   patients rights which is easy to find on their website under the
   Patient/Visitor page: Patients have the right to receive considerate,
   respectful delivery of care regardless of age, race, color, national origin,
   culture, ethnicity, language, socioeconomic status, religion, physical or
   mental disability, sex, sexual orientation, or gender identity or expression,
   or manner of payment.
 * Seattle Children’s Hospital's Rights and Responsibilities webpage has a
   LGBT-inclusive non-discrimination policy for LGBT patients and families.
   Seattle Children’s clear LGBT-inclusive policies are similar to other
   hospitals, as pediatric facilities do not need to craft special or different
   language to ensure LGBT inclusion for patients and visitors.

In materials given to patients at admitting/registration:

 * Henry Ford Macomb Hospital offers a comprehensive patient handbook that
   delineates “sexual orientation” and “gender identity” in the first bullet in
   their Patient Rights & Responsibilities (pg. 15).
 * Einstein Healthcare Network's Patient Rights and Responsibilities brochure
   has an LGBT inclusive patient non-discrimination statement under the heading
   “the right to care no matter what your background or circumstances.”
 * Cleveland Clinic's Patient Rights and Responsibilities brochure clearly
   ensures that patients have access to care regardless of “sexual orientation”
   and “gender identity or expression” in its “Access to Care” section (pg. 4).
   In the “Personal Privacy/Visitation” section (pg. 4), it guarantees patients
   the right to designate a visitor of their choosing, including a same-sex
   domestic partner in the list of visitors a patient might designate.

In materials given to patients at other time(s):

 * California Pacific Medical Center's Patient Rights and Responsibilities flyer
   lists an LGBTQ inclusive patient non-discrimination statement as Number 1.
 * Chester County Hospital's Statement of Patient’s Rights guarantees patients
   care without discrimination based on gender identity or expression or sexual
   orientation (highlighted on the first page). These LGBTQ-inclusive policies
   apply to all of the hospitals in the University of Pennsylvania Health
   System, including Chester County Hospital, Penn Presbyterian Medical Center,
   Pennsylvania Hospital and the Hospital of the University of Pennsylvania.

In materials available for take-away in patient waiting areas:

 * Christiana Care Health System has a Patient Rights and Responsibilities
   brochure (also available in Spanish) that lists “sexual orientation” and
   “gender identity or expression” as protected classes under the first bullet
   in “Participating in your care.”

Posted in patient waiting area(s):

 * Children’s Mercy Hospital has a poster with a simple non-discrimination
   statement that is posted in patient areas.
 * Bon Secours Health System has a poster with a sign underneath adding
   LGBTQ-inclusive language to their existing publication materials, without
   having to reprint posters. The extra sign goes a long way for LGBTQ patients,
   who deeply appreciate the additional welcoming language.
 * Kaiser Permanente lists their LGBT-inclusive patient non-discrimination
   policy first on their Patients’ Rights poster.


IS YOUR PATIENT NON-DISCRIMINATION POLICY COMMUNICATED TO YOUR EMPLOYEES IN AT
LEAST ONE WAY?

To receive credit in the HEI, a facility must:

Upload at least one example of how this policy is communicated to staff. This
example must be an internal example and not a public document. It cannot be the
same as the example of how the policy is communicated to patients.

More information:

The HEI requires facilities to share their LGBTQ-inclusive Patient
Non-Discrimination Policy with its 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

Posted on facility intranet site:

 * Sharp Memorial Hospital's intranet system called SharpNET creates an easy way
   for employees to access policies and procedures.
 * Bridgeport Hospital of Yale-New Haven Health System uses Policy Manager so
   employees can readily access their Patients’ Rights and Responsibilities
   document.

Posted in employee work area(s):

 * Steps to Recovery displays its Patient Non-Discrimination and Equal
   Visitation in employee only areas such as the lunchroom.

In materials routinely given to employees at orientation:

 * VA Coatesville Medical Center and other VHA facilities provide a handout in
   each employee’s orientation packet that includes links to the patient
   non-discrimination policies as well as other LGBTQ patient initiatives and
   policies.

Reviewed in in-person employee training:

 * NYC Health + Hospital's facilities review the patient and resident rights in
   their new employee orientation.
 * Boston Children’s Hospital includes a review of the patient
   non-discrimination policy in their new employee training.

Reviewed in online employee training:

 * F.F. Thompson Hospital requires employees to review their key
   non-discrimination policies using an online training module.
 * A Southern California hospital uses this online training module to review
   patient’s rights policies with employees.

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