Trans worker sues state for delay in gender-affirming surgery

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A Dauphin County trans man has filed suit against the state of Pennsylvania, claiming a lengthy delay before the state’s health-insurance provider would cover his bilateral mastectomy caused him excessive pain and suffering.

“John Doe,” 39, is an employee of the State Department of Human Services. He receives his health coverage through the Pennsylvania Employees Benefits Trust Fund, which administers health benefits for eligible state workers. 

Doe has worked for the state since May 2008. He’s currently assigned to the Office of Mental Health and Substance Abuse Services, which is part of DHS. He tried to get coverage for a bilateral mastectomy from early 2016 until January 2018, when the coverage was granted.

Doe is seeking compensation for a roughly two-year period when he sought coverage for a bilateral mastectomy but was denied. It wasn’t until March 2018 when Doe finally had a bilateral mastectomy, according to his lawsuit.

Doe previously was denied coverage because the medical plan administered by the Pennsylvania Employees Benefits Trust Fund excluded coverage for trans-related surgeries, including mastectomies for trans men.  

On Dec. 23, Doe filed suit in federal court for the Middle District of Pennsylvania. “It is clear that these [anti-trans] exclusions are discriminatory, and the result of bare discriminatory animus against transgender people — on their face — as they expressly single out for exclusion — and bar — medically necessary treatments and services sought by transgender people because they are transgender,” Doe’s 58-page lawsuit states. 

Doe’s lawsuit emphasizes that his bilateral mastectomy was a medical necessity. “Doe had been receiving gender-affirming medical and behavioral health treatment since May 2014,” the lawsuit states.

Doe suffers from gender dysphoria, which increased during his two-year waiting period. “The distress and anxiety resulting from defendants’ conduct exacerbated Doe’s gender dysphoria and greatly negatively affected his social life. Doe spent most of his time indoors and alone. Doe experienced profound isolation and loneliness,” the lawsuit states.

Doe also developed body dysmorphia due to the two-year delay. “[The state’s] conduct exacerbated Doe’s gender dysphoria and caused Doe to experience severe emotional distress, in the form of body dysmorphia and immense psychological trauma attendant thereto, causing Doe to lose sleep, lose appetite, become physically ill, causing Doe to use sick leave from work due to illness, and causing intense physical pain, body dysmorphia, suicide ideation, embarrassment, humiliation, mental anguish, and severe emotional distress.”

For a lengthy period of time, Doe’s gender dysphoria greatly limited his ability to enjoy life, according to the lawsuit. Doe avoided recreational, sports and outdoor activities. He also engaged in “binding” to reduce the appearance of his breasts, which the lawsuit alleges was physically painful.  

Doe is seeking damages in excess of $150,000. The case has been assigned to U.S District Judge Sylvia H. Rambo of the Middle District of Pennsylvania. A jury trial has been requested.

Justin F. Robinette, an attorney for Doe, said his client was the victim of anti-trans discrimination. “My client suffered substantially without the surgery,” Robinette told PGN. “He continues to suffer to this day. We’re hoping a jury hearing all of the facts will conclude that what my client experienced is a form of discrimination, and that it is compensable.”

J.J. Abbott, a spokesperson for Gov. Tom Wolf, said in an email: “At this time, we are reviewing the lawsuit but decline further comment due to it being active litigation.”

Erin James, a spokesperson for DHS, also declined to comment.