Health-care professionals have long understood the effects of holistic wellness on the physical health of their patients. In response to this wisdom, a new kind of organization is beginning to emerge: one that seeks to meet the full complement of needs expressed by its clients. It’s known as a medical/legal partnership, and it’s essentially a way of integrating legal assistance into the medical setting, providing people with an additional tool to advocate for their health and well-being.
Nationwide, health organizations are paying more attention to the way legal problems create real obstacles to their patients’ well-being. Challenges with housing, utilities, employment, family disputes, discrimination and other legal matters can drain resources that patients would otherwise use to get well. Issues with insurance coverage can prevent patients from seeking the care they need altogether. With so many possible impediments, patients, particularly those who are low-income, frequently go without the medical care they need. Medical/legal partnerships can help to remove these impediments and provide the necessary medical care to patients who are otherwise unable to seek this complement of services.
Nationally, the medical/legal partnership is getting more notice and, in Philadelphia, we are paving the way for a new health-care model. In September 2011, U.S. Sens. Tom Harkin (D-Iowa), Patrick Leahy (D-Vt.) and Dan Inouye (D-Hawaii) introduced a bill to create, strengthen and evaluate medical/legal partnerships around the country, if passed. Right here in Philadelphia, Mazzoni Center offers a continuum of medical, counseling, case management and legal services to the LGBT community. As a pioneer in the field of medical/legal partnerships, Mazzoni Center is helping shape the very notion of how they might operate, with its eye to holistic wellness.
At Mazzoni Center Legal Services, LGBT individuals can receive legal assistance on a wide variety of matters including discrimination, advanced planning, marriage dissolution, insurance and legal name changes. With the help of the legal clinic, many people resolve ongoing legal disputes, plan for the future of their families, appeal insurance decisions or adjust identity documents. All of these services lead to greater access to benefits, including health care. The ease of locating resources to resolve all possible obstacles to wellness in a single organization makes health and well-being a reality for individuals who might have otherwise found such goals unattainable.
At first glance, it might not be obvious why legal services might be necessary or helpful within a medical setting. At Mazzoni Center, our legal-services staff frequently works with transgender clients who are seeking legal name changes, to update their documentation to reflect their transition and altered gender expression. These clients often report refusal of services, difficulty accessing benefits and even significant challenges obtaining identity documentation in their original legal name as a result of identification that appears not to match its holder. A legal name change often removes significant impediments to public assistance, as well as obstacles with other forms of health insurance, in addition to providing people with greater peace of mind and safety in public forums where they are required to produce identification. Legal name changes alone go a long way toward improving clients’ quality of life.
Perhaps even more salient are the struggles that many clients have with health insurance policies that do not acknowledge that gender markers on official documentation are not determinative of medically necessary treatment. Mazzoni Center has assisted a number of transgender clients in months-long appeals processes to convince insurance policy administrators that a male gender marker does not preclude the necessity of gynecological treatment or a female gender marker the necessity of urology treatment. What the insurance companies call a “gender mismatch,” the practice of refusing treatment associated with certain genders to people of the opposite gender, without investigation, places many people in danger. The onerous appeals process to reverse such decisions can delay medical care for long enough to see their illnesses worsen beyond repair or even claim lives. Without access to legal services, far fewer people would have access to appropriate medical coverage and would undoubtedly go without the treatment they need.
2012 Philadelphia Trans-Health Conference
All of these services and a wide variety of educational workshops for both providers and community members alike come together once a year at the Philadelphia Trans-Health Conference, which takes place May 31-June 2 at the Pennsylvania Convention Center. This free event offers three days of workshops covering all aspects of health and wellness, aimed at transgender-identified individuals, as well as their family, friends and allies. Last year it drew more than 2,000 people from around the U.S. and the world to Philadelphia. Workshops range from physical and mental health to spirituality and legal rights, and this year’s conference includes a major focus on international issues, including panels on immigration and the challenges faced by refugees and asylees, transgender activism in Europe and spotlight discussions on the state of trans communities in Latin America and South Asia.
From its inception, the Trans-Health Conference has taken a holistic approach to the definition of health and well-being, recognizing that accessible and quality health care is an integral part of self-determination when it comes to presenting one’s body and identity in the larger world. As much as possible, PTHC strives to ensure it addresses the diverse needs of all transgender communities: transgender men, transgender women, gender-queer and gender-variant people, as well as their partners, families and allies. In addition, in an effort to increase the availability of quality, culturally competent care for transgender communities, PTHC also provides workshops for medical, mental health and social-service providers.
On a historical note, this year marks the 10th anniversary of the addition of gender identity to Philadelphia’s Fair Practices Ordinance. The protections apply to public accommodations, housing and employment and are enforced by the Philadelphia Commission on Human Relations. (City Council passed the bill on May 16, 2002, and it was signed into law by then-Mayor John Street on May 29, 2002.) A celebration of this milestone will take place at the opening reception of the PTHC from 7:30-9 p.m. May 31 at the William Way LGBT Community Center, 1315 Spruce St. The reception will also provide an opportunity to browse the exhibit presented by the center’s John J. Wilcox Jr. Archives celebrating this milestone anniversary and the dedication of the community activists who made it happen.
For more information or to register for this year’s Trans-Health Conference, go to www.trans-health.org.
R. Barrett Marshall is a staff attorney at Mazzoni Center Legal Services, the only LGBT health center in the Philadelphia region. Visit www.mazzonicenter.org for more information.