Equity in the doctor’s office

A news story has been circulating about a Michigan pediatrician who, “after much prayer,” refused to care for a newborn because the baby had two moms. It’s a story of personal discrimination and ignorance — but also indicates systemic problems.

Jami and Krista Contreras said they’d chosen Dr. Vesna Roi of Eastlake Pediatrics because of her holistic and natural approach, reported the Detroit Free Press. After a prenatal visit, they went to her office last October for the first appointment with their 6-day-old daughter. Roi was not there, however. Another pediatrician in the practice, Dr. Karam, told them Roi had decided that, because they are lesbians, she couldn’t care for their baby.

On Feb. 9, once the story began to spread, Roi explained in a letter to the Contrerases that she “never meant to hurt either one of you” and that, “after much prayer following your prenatal, I felt that I would not be able to develop the personal patient-doctor relationship that I normally do with my patients. I felt that you deserved that type of relationship and I knew you could get that with Dr. Karam.” She apologized for not notifying them in advance, saying she had no way of contacting them. She also thought that if she shared her decision during the first appointment with their child, it would “take away much of the excitement.”

Ultimately, I think the Contrerases will be better off with a doctor who is more comfortable with their family — and to the extent that Roi herself realized that, I cannot blame her. Perhaps her refusal to serve them came less from animosity and more from insecurity over how to interact with a type of family she had never encountered before.

If that were true, however, she still could have explained in person that she was questioning whether her lack of experience with same-sex parents would make her the best doctor for them. She could have left it up to them to decide. Simply avoiding them, though, speaks of deeper discomfort and bias.

To go about it the way she did is discrimination. Even worse, it’s legal discrimination in Michigan, which has no law banning discrimination on the basis of sexual orientation. There are also no federal regulations prohibiting such discrimination. That must change.

It is unlikely to change soon in Michigan, where a “religious-freedom” bill has passed the state House and now sits before the Senate. It would allow a person to claim religious freedom even in the face of any antidiscrimination laws that might pass.

Nevertheless, the fact that Roi ultimately felt the need to apologize at all is a sign of progress. She was also not adverse to another doctor at her practice helping the family. That does not excuse her actions — but indicates a growing awareness that anti-LGBTQ bias is no longer generally acceptable.

But Roi’s actions, whether from overt bias or mere insecurity, are not just a failure of her personally, but of a system that still has a long way to go in teaching medical professionals about LGBTQ cultural competence.

Some organizations have taken initial steps. The American Academy of Pediatrics, of which Roi is a member (according to the Eastlake Pediatrics website), has a nondiscrimination policy that says, “The AAP is opposed to discrimination in the care of any patient on the basis of … gender, marital status, sexual orientation, gender identity or expression … of the patient or patient’s parent(s) or guardian(s).” AAP policies don’t have the force of law, but should cause pediatricians to hesitate when they flout them.

The larger American Medical Association has an even more-strongly worded policy: “Physicians cannot refuse to care for patients based on race, gender, sexual orientation, gender identity or any other criteria that would constitute invidious discrimination.” (Roi was a member of the AMA only between 1996-2001, however.)

I wonder, though, what more could be done to reach out to medical professionals like Roi. They need to be aware of relevant laws and policies and of recent medical and social-science research on LGBTQ people and families, but also of how to make us feel welcome (e.g., with forms that say “Parent” and “Parent” instead of “Mother” and “Father”). They need to hear our stories and learn how we are like — and unlike — other families.

Some organizations have already made inroads here. The National LGBT Cancer Network offers a cultural-competency program and a best-practices guide for health and social-service agencies on delivering such trainings. The Gay and Lesbian Medical Association offers a set of Guidelines for Care of LGBT Patients, a webinar series on LGBT cultural competence and an annual conference for medical practitioners and students. I fear practitioners like Roi, however, would never attend such a conference.

Most of these materials, too, focus on the health needs of LGBT adults — important, certainly, but not complete. I would love to see more programs incorporate resources from youth and family programs like HRC’s Welcoming Schools initiative and the Family Acceptance Project. Simple things, like putting LGBTQ-inclusive children’s books in a waiting room, could go a long way towards making all families feel welcome in health-care environments.

I feel for the Contrerases, and commend them for wanting to make their story known. As a community, we need to make sure that the situation they faced doesn’t happen to any more families.