Ontario considers expanded sex-reassignment surgery coverage

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Ontario's Health Minister is considering expanding the number of locations where transgendered people in the province can obtain approvals for publicly funded sex reassignment surgeries, a change that could reduce the lengthy waits that health experts say are putting trans people at risk.

Eric Hoskins said Friday that he asked the Ministry of Health and Long-Term Care to look into the issue a "number of months ago," and that he is hoping it can be addressed in the "near future."

Right now, the Ontario Health Insurance Plan (OHIP) covers sex reassignment surgeries only if doctors at the Centre for Addiction and Mental Health's Adult Gender Identity Clinic in Toronto first deem patients fit for the procedure.

But the increase in demand for sex-change operations means it now takes nearly two years to secure an appointment at the clinic, which is the sole approval site for trans people, not just from Ontario but from Newfoundland and Labrador and, until last year, from Saskatchewan as well.

"I asked [ministry staff] specifically to look at [whether] it's time that we should have more than the one site at CAMH available for these individuals around Ontario," Dr. Hoskins said. "I want to make sure that this is done correctly. … I suspect in the near future we should have some further suggestions and actions by the ministry which will address the issue of wait times and the single site."

The Globe and Mail reported Friday on the case of Chrystofer Maillet, an Ottawa trans man who paid nearly $7,500 out of his own pocket for a double mastectomy after he was told it would take one to two years to obtain an initial appointment at CAMH.

When Mr. Maillet, now 35, eventually got into the clinic – nine months after his surgery – doctors there gave him retroactive approval, but the quasi-judicial panel that reviews OHIP rejections decided against him, saying the rules clearly dictate that approvals must be granted before surgery, not after.

Right now, there are 680 clients on the waiting list for the clinic, the vast majority seeking sex reassignment surgery. Despite adding a full-time social worker in 2013, the small outfit cannot keep up.

"The waiting list is far too long," said Christopher McIntosh, the psychiatrist who leads the clinic. "People can't access either the assessment process or the surgery in their communities."

The Ontario NDP's critic for lesbian, gay, bisexual, trans and queer (LGBTQ) issues said limiting approvals to a single facility is a "patently absurd" rule that should have been scrapped years ago.

"It's not only absurd, it's cruel," Cheri DiNovo said. "The trans population is the most marginalized of marginalized groups, based on their suicide rates, depression rates, income rates, you name it."

Ms. DiNovo does not put much stock in Dr. Hoskins's promises to address the trans community's access to health services, saying the Liberal government has been aware of the problems for years. "How long does it take?" she asked.

Indeed, Anna Travers, the director of Rainbow Health Ontario, a provincewide program aimed at improving access to health services for the LGBTQ community, said her organization and others began meeting with ministry officials as far back as February, 2010, about designating more places to approve sex reassignment surgeries.

The government did provide some funding for a program called Trans Health Connections that has trained social workers and family doctors to care for trans patients, including prescribing hormone treatments for those who want to change genders, Ms. Travers said.

But when it comes to adding approval sites, "it just doesn't seem to go anywhere," she said in an interview earlier this week.

"They say there's no cap on how many people can go [for surgery]," she added, "but when you have this much of a bottleneck it acts like a cap."