Creating a National Standard for Equal Treatment of Lesbian, Gay, Bisexual and Transgender Patients and Their Families © 2009 by the Human Rights Campaign Foundation and the Gay and Lesbian Medical Association. The HRC Foundation and GLMA grant permission for the reproduction and redistribution of this publication only when reproduced in its entirety and distribution is free of charge. The Human Rights Campaign name and the Equality logo are trademarks of the Human Rights Campaign. The Gay and Lesbian Medical Association name and logo are trademarks of the Gay and Lesbian Medical Association.

ISBN 13: 978-1-934765-10-4 ISBN 10: 1-934765-10-4 Healthcare Acknowledgments C Foundation Family Foundation H RC the About the About Appendices Findings 5 and methodology index equality Healthcare and Solmonese Joe President Foundation HRC from Letter Contents Appendix D: Appendix C: Appendix B: Appendix A: Appendix Policies Collection Data Benefits and Policies Employment Services Client and Training Competency Cultural Policies Decision-Making Policies Visitation Policies Non-Discrimination Patient Criterion by Findings of Overview 2008 from Changes Index: Equality Healthcare Criteria Index Equality Healthcare Methodology Survey Index Equality Healthcare Schneider Jason President GLMA Data Collection Systems Collection Data Forms Intake Benefits Health Partner Policies Non-Discrimination Minor a of Treatment for Consent and Parents Same-Sex Directives Healthcare Advance ay and Lesbian and Gay Participating Facilities and Breakdown of Responses of Breakdown and Facilities Participating Participating Facilities by Network by Facilities Participating State by Facilities Participating Healthcare Equality Index 2009 Survey 2009 Index Equality Healthcare Equality Index dvisory Council Advisory Medical Project Association criteria 2 16 16 15 14 12 11 40 39 39 39 33 28 22 17 17 16 14 13 11 10 8 6 4 3 2 1

www.hrc.org/hei HEALTHCARE EQUALITY INDEX Header L expression.These insufficient facility policies as well or identity gender their on based discrimination 7percent of participants protect patients from than less — gap serious a identified also we But facilitiesextend these protections to their employees. basisof sexual orientation. Further, nearly all of the protecttheir patients from discrimination on the them of percent 75 nearly — practices best these facilities that found report The community. andpolicies related to equal treatment of the LGBT practices best emerging identify to try to — benefits competencytraining and employment policies and cultural decision-making, visitation, discrimination, non- patient — areas policy key five on focuses It Project. Family Foundation Campaign Rights Human the and Association Medical Lesbian and Gay the of project joint annual an report, the of hospitals both largehealthcare networks and, for the first time, numberfrom the year before — including several participatedin the HEI report — nearly double the Thisyear, 166 facilities across the country other. each and ourselves of care taking from us keep that biases and barriers of rid get to consumers healthcare LGBT and policymakers healthcare TheHealthcare Equality Index aims to educate theeyes of the law. recognition.But in many more, they are strangers in Ina few states, same-sex couples enjoy statewide patchworkof differing state laws and facility policies. wishesof their partners are at the mercy of a F F ETTER onesin the hospital or honor the healthcare transgenderpeople seeking to visit their loved lesbian,often, too ar gay, bisexual and and H ROM clinics.This is the third edition R implementing implementing are C F G AND SO JOE PRESIDENT OUNDATION L S JASON MA PRESIDENT President, Human Rights Campaign Foundation Campaign Rights Human President, Solmonese Joe Association Medical Lesbian and Gay President, M.D. Schneider, S. Jason Sincerely, tomorrow. healthier a for groundwork the laying haveparticipated in this project. Their involvement is Wethank the many healthcare professionals who useful. information this find you hope ahealthcare industry leader or a concerned ally, we Whetheryou’re a member of the LGBT community, leaders. industry healthcare with them share and Ourgoal is to identify emerging best practices Reform. Health on Forum House White organizations, took part in the Obama administration’sservices. And in March, HRC, along with other LGBT to impair LGBT patients’ access to basic healthcare “provider conscience” — eliminating the potential Department of Health and Human Services’ rules on administration has started the process of repealing Obama the Additionally, community. LGBT the the care, including the issues of greatest concern to panel to develop standards for culturally competent executive director of GLMA to serve on an advisory than 15,000 healthcare organizations, invited more accredits which theCommission, Joint the 2008, Fortunately, there are signs of hope. In November healthcareequality. LGBT to barriers rigid are laws state unequal as CH L MONESE NEIDER

www.hrc.org/hei 1 HEALTHCARE EQUALITY INDEX METHODOLOGY AND CRITERIA

The Healthcare Equality Index is an annual survey of healthcare industry policies and practices related to lesbian, gay, bisexual and transgender individuals and their families. The goals of the HEI are: 1) to benchmark healthcare facilities on identified best practices and policies with respect to equal treatment of LGBT individuals and families; and 2) to share, implement and recognize these best practices with healthcare industry leaders.

The HEI survey serves as a benchmarking tool through which these best practices and policies are identified. The HEI report is one of the many ways we engage with healthcare industry leaders and healthcare consumers to share and recognize these best practices.

Specifically, the index addresses basic components of the healthcare experiences of LGBT people, including patient non-discrimination and visitation policies; recognition of legal documents between same-sex partners that outline medical decision-making and guardianship rights; and the protection of LGBT employees through

HEALTHCARE EQUALITY INDEX fair employment policies.

2 HEALTHCARE EQUALITY INDEX SURVEY METHODOLOGY

Invitations to complete the Healthcare Equality Index 2009 survey (Appendix D) were sent to facility contacts nationwide in October 2008. If a facility had previously participated in the HEI, the survey was sent to the individuals responsible for the previous submission. If a facility had not previously participated in the HEI, the survey was sent to contacts found through research by HEI project staff; generally, these contacts were the facility’s chief administrative officer, a human resources professional or a marketing/communications www.hrc.org/hei representative.

Participating facilities submitted their responses through an online survey. Staff members from the HRC Foundation Family Project and the Gay and Lesbian Medical Association provided additional assistance and advice throughout the process.

The survey responses in this report represent the policies for 166 facilities in 17 states and the District of Columbia. Thirty of those participants submitted surveys for their individual facilities. The balance of the survey data comes from eight networks that submitted surveys covering a total of 136 facilities.

Healthcare networks participating in this year’s survey (Appendix C) include the Cleveland Clinic Foundation (8 facilities), the Kaiser Permanente Network (31), Legacy Health System (21), Multnomah County Health Department (7), Planned Parenthood of Greater Iowa (18), Scripps Health Network (23), University Hospitals (10) and University of Michigan Network (18).

A list of HEI 2009 survey participants by facility name appears in Appendix A. HEALTHCARE EQUALITY INDEX CRITERIA

The Healthcare Equality Index 2009 survey (Appendix D) included 31 questions, 11 of which pertain to LGBT-specific policy categories and are represented in this report. The remaining questions were included for informational purposes only. The Healthcare Equality Index focuses on the following five policy categories:

1. PATIENT NON-DISCRIMINATION POLICIES a. Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation” b. Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

2. VISITATION POLICIES a. Visitation policies allow same-sex partners/spouses the same visitation access as oppo- HEALTHCARE EQUALITY INDEX site-sex spouses and next of kin b. Visitation policies allow same-sex parents the same visitation access as opposite-sex par- 3 ents for their minor children

3. DECISION-MAKING POLICIES a. Recognize advance healthcare directives allowing same-sex partners/spouses decision- making authority for their partner/spouse under care b. Written policy allows same-sex parents the same rights as opposite-sex parents for medi- cal decision-making for their minor children* www.hrc.org/hei

4. CULTURAL COMPETENCY TRAINING AND CLIENT SERVICES a. Provide cultural competency training addressing sexual orientation and healthcare issues relevant to lesbian, gay and bisexual community b. Provide cultural competency training addressing gender identity and healthcare issues relevant to transgender community

5. EMPLOYMENT POLICIES AND BENEFITS a. Equal employment opportunity policy includes “sexual orientation” b. Equal employment opportunity policy includes “gender identity or expression” or “gender identity” c. Domestic partner health insurance benefits are offered

* See Note on Decision-Making Rights of Same-Sex Parents, page 4 METHODOLOGY AND CRITERIA

HEALTHCARE EQUALITY INDEX: CHANGES FROM 2008

Expanded Participation to Clinics For the Healthcare Equality Index 2009, participation was open to the full range of healthcare agencies and, as a result, expanded to include healthcare clinics as well as hospitals. Of the 166 facilities represented, 93 are hospitals and 73 are clinics. This resulted in certain questions being “not applicable” to a number of participants. For example, if a clinic does not provide inpatient services, it answered “not applicable” to our questions on visitation policies. If a clinic only treats adults, our question on visitation access for same-sex parents does not apply.

Documentation Required This year, documentation was required for all answers indicating an inclusive policy. This higher level of scrutiny has resulted in a clearer picture of how facilities are (or are not) ensuring equal treatment of the LGBT community within their policies. For more information on a specific policy, see the appropriate policy in Findings. HEALTHCARE EQUALITY INDEX Note on Decision-Making Rights of Same-Sex Parents Upon review of the surveys submitted, we have made the decision not to report the answers to question 13 4 (Criteria 3b): decision-making rights of same-sex parents. We have resolved to provide resources such as model policies and guidance before we will rate participants on this issue. Therefore, the findings section and appendices of this report only show responses to the other 10 criteria outlined on page 6. For more information, see Same-Sex Parents and Consent for Treatment of a Minor.

Cultural Competency Training In previous iterations of the HEI survey, we asked: “Does your hospital provide any diversity or cultural competency training to personnel addressing the unique issues related to LGBT patients and their families?”

www.hrc.org/hei To clarify our data on cultural competency training, this question was separated into two separate questions (one focusing on healthcare issues related to sexual orientation and the other focusing on healthcare issues related to gender identity). For more information, see Cultural Competency Training.

Residential and Inpatient Services A new section covering residential services was added to the HEI 2009 survey. These questions focus on access to jointly occupied rooms for same-sex partners/spouses and guidelines for room accommodations for transgender patients. Only one facility reported providing long-term residential facilities in which couples are permitted to jointly occupy rooms. This facility did report allowing same-sex partners/spouses the same access to jointly occupied rooms as opposite-sex partners/spouses. More information will be provided on residential policies as participation among facilities offering these services increases. The questions are included in the full HEI 2009 survey text (Appendix D).

Data Collection Policies In addition to questions related to the main criteria discussed in this report, the HEI survey asked facilities for information on their data collection policies related to the LGBT community. These questions focus on intake forms and data collection systems. The responses to these questions are listed in aggregate form this year. For more information, see Data Collection Policies. Appendix A. Appendix in appears survey 2009 HEI the to responses their and facilities participating of list complete The performance. their of measure routine a as survey HEI the in participate will nationwide facilities of number greater a year, subsequent each in that expect Association Medical Lesbian and Gay the and Foundation Campaign Rights Human The survey. the to response a submitting before policies their improve to prefer but HEI the of concept the welcome facilities Many policy. particular a having reported have that networks or facilities participating of number the indicating benchmarks as seen be can results survey these Rather, fraction.) small a are hospitals participating 93 our which of U.S., the in hospitals 6,000 over lists Association Hospital American (The industry. healthcare U.S. entire the reflect that percentages into translate report this in responses the that assumed be not should It below. listed are facilities 10 These them. to applied which questions 10 the of each to “yes” responded facilities these of Ten year. this time first the for participated facilities 113 remaining the survey; 2008 HEI the in participated also facilities Fifty-three clinics. are 73 hospitals; are facilities participating the of Ninety-three 2008. in 88 from up survey, 2009 HEI the in represented are facilities 166 of total A F INDINGS UCSF Medical Center Medical UCSF Center Medical University Rush Services Health Lyon-Martin Center Lesbian & Gay L.A. Associates Medical Vanguard Harvard Hospital Central Health Group Hospital Faulkner Services Health Brexton Chase Center Health Community Callen-Lorde Hospital Women’s and Brigham

San Francisco, CA Francisco, San IL Chicago, CA Francisco, San CA Angeles, Los MA Boston, WA Seattle, MA Boston, MD Baltimore, NY York, New MA Boston,

www.hrc.org/hei 5 HEALTHCARE EQUALITY INDEX www.hrc.org/hei 6 HEALTHCARE EQUALITY INDEX O F 5c 5b 5a 4b 4a 3a 2b 2a 1b 1a verview o verview INDINGS Domestic PartnerHealthBenefits “ “ Cultural CompetencyTraining onGenderIdentity Cultural CompetencyTraining onSexualOrientation Partners/Spouses Same-Sex Recognizes AdvanceHealthcareDirectivesBetween Parents Equal Visitation AccessforSame-Sex Partners/Spouses Equal Visitation AccessforSame-Sex Non-Discrimination Policy “Gender Identity”inPatients’BillofRightsand/orPatient Patient Non-DiscriminationPolicy inPatients’BillofRightsand/or “Sexual Orientation” Sexual Orientation” inEmployment Non-DiscriminationPolicy Sexual Orientation” Gender Identity”inEmploymentNon-DiscriminationPolicy Findings by Criterion f Findings to each criterion, ifapplicable. Percent ofFacilities thatResponded“Yes” 7 63 70 72 73 94 95 98 98 100 N by State umber o umber A completelistofH ties), Michigan (19),Iowa(18)andOhio(18). withhighernumbersofparticipantsincludeOregon(25facili- facilities.Otherstates participants with60 This year’sresultsincludefacilitiesfrom17 andtheDistrictofColumbia.Californiahadmost states 2 states 5 –10participants 10 states&D.C. 1 –4participant(s) l f Hea 2009 participantsbystateAppendix appearsinB. 2009 EI t hc are E are l qua ity I ity ndex 2009 P 2009 ndex 2 states +participants 21 3 states participants 11 –20 arti c ipants

www.hrc.org/hei 7 HEALTHCARE EQUALITY INDEX FINDINGS

PATIENT NON-DISCRIMINATION POLICIES

Implementing a patient non-discrimination policy that includes both “sexual orientation” and “gender iden- tity or expression” is a crucial step in ensuring fair and equitable treatment for LGBT patients.

SEXUAL ORIENTATION is the preferred term used when referring to an individual’s physi- cal and/or emotional attraction to the same and/or opposite gender. “Heterosexual,” “bisexu- al” and “homosexual” are all sexual orientations. A person’s sexual orientation is distinct from a person’s gender identity and expression.

GENDER IDENTITY, distinct from the term “sexual orientation,” refers to a person’s innate, deeply felt psychological identification as male or female, which may or may not correspond to the person’s body or assigned sex at birth (meaning what sex was originally listed on a person’s birth certificate). HEALTHCARE EQUALITY INDEX Gender expression refers to all of the external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, grooming, mannerisms, 8 speech patterns and social interactions. Social or cultural norms can vary widely and some characteristics that may be accepted as masculine, feminine or neutral in one culture may not be assessed similarly in another.

LGBT adults often cite a fear of discrimination as a reason why they do not discuss their sexual orientation or gender identity with their healthcare providers. This can result in patients failing to notify their healthcare providers of crucial information related to their healthcare needs. For example, in 2004, 20 percent of LGBT

www.hrc.org/hei Americans withheld information related to their sexual practices from their doctor or healthcare professional (compared to 6 percent of non-LGBT adults who reported withholding this information).1

When LGBT-inclusive non-discrimination policies are made visible within the healthcare facility, it fosters a welcoming environment for LGBT patients. It eliminates these barriers to open communication and helps healthcare professionals provide better-quality care.

Facilities that do not fulfill Criteria 1a and 1b either have general statements in their Patients’ Bill of Rights or non-discrimination policies that do not enumerate any class of persons, or they do enumerate protected classes (such as race, sex or religion), but fail to include sexual orientation and gender identity among these.

The results below indicate a drastic disparity between the number of policies inclusive of sexual orientation and those inclusive of gender identity. Less than 7 percent of participating facilities protect patients from discrimination based on gender identity, while nearly three-quarters of participants provide these protections

1 Witeck-Combs Communications/Harris Interactive Research shows that bias against the entire the against bias that shows Research VA. the within providers by veterans transgender to tion informa- and services healthcare of provision inconsistent the for allows policies formal of lack a that showed nation against the LGBT community by including the terms “sexual orientation” and “gender identity.” “gender and orientation” “sexual terms the including by community LGBT the against nation discrimi- prohibit that policies adopted have Physicians Family of Academy American and Association Medical California Association, Medical American the as such associations medical Leading practice. well-established a is policies) anti-bullying as such all, of safety and health the ensuring at aimed policies other in as well (as policies non-discrimination in classes protected Enumerating community. LGBT the to reference including explicitly by members staff of interpretation to possible as little as leave to best is it policies, through bias this addressing of their transgender identity, and one in five experienced discrimination from VA doctors. VA from discrimination experienced five in one and identity, transgender their of because Administration Veterans the from away turned was 10 in one that showed veterans transgender of expression” or “gender identity.” “gender or expression” or identity “gender included policies those of facilities) (11 percent 7 than less while policy, non-discrimination and/or Rights of Bill Patients’ their in orientation sexual of inclusion reported 166) of (121 facilities participating the of percent Seventy-three – 1b 1a, Criterion www.hrc.org/issues/8321.htm. language: policy model including policies, non-discrimination patient on information more For staff. medical by stigmatization to access healthcare of denial from — forms many in and day every discrimination healthcare face Americans Transgender orientation. sexual on based Available at:transgenderlawcenter.org/pdf/Health%20Law%20fact%20sheet.pdf. Health,2001.Available at:www.lgbthealth.net/downloads/hp2010doc.pdf. Available at:www.tavausa.org/Transgender%20People%20in%20the%20U.S.%20Military.pdf 4 3 2 Transgender LawCenter, Transgender HealthandtheLaw:IdentifyingFighting CareDiscrimination,July2004. Healthy People 2010 Companion Document forLesbian, Document Gay, Companion Gay andLesbianMedicalAssociationLGBT Bisexual,andTransgender healthexperts,HealthyPeople2010 (LGBT) Bryant, K.,&Schilt, K.,“Transgender Veterans Survey,” Transgender AmericanVeterans Association,August2008. or “gender identity” “gender or n n

Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or identity “gender includes policy non-discrimination and/or Rights of Bill Patients’ Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation” “sexual includes policy non-discrimination and/or Rights of Bill Patients’ 0 11 umber of Facilities that Facilities of Number 60 community spreads across the medical profession. medical the across spreads community LGBT 120 121 esponded “Y Responded es” 180 2 For example, a 2008 survey 2008 a example, For 3 This study also also study This Header

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www.hrc.org/hei 9 HEALTHCARE EQUALITY INDEX 10 www.hrc.org/hei HEALTHCARE EQUALITY INDEX parents for their minor children. minor their for parents opposite-sex as access visitation same the parents same-sex allow that policies visitation have facilities) 109 of (102 percent Ninety-four kin. of next and spouses opposite-sex as access visitation same the partners/spouses same-sex allow that policies visitation having reported applicable was question this which for 110) of (104 facilities participating the of percent Ninety-five – 2b 2a, Criterion

measured in subsequent survey years. survey subsequent in measured are facilities which on baseline the inform will policies These rights. families’ and patients’ all protecting practice, into translated is inclusion ensures it better the policy, the explicit more The subconscious-biases. or conscious- own their on based policies these interpreting members staff of possibility the decreases language policy Explicit parent. either of gender the of regardless visit to right the have parents that clear it making and partners” “same-sex terms the using by parents same-sex and partners same-sex of inclusive explicitly is that family of definition a include which policies visitation best-practice identified has review policy Our family. of understanding traditional the of outside fall may that structures family other as well as families LGBT of inclusive be to intended is which person,” “support or other” “significant as such language broad include often policies These marriage). or blood by related members family to visitation limiting (i.e. family visiting from parents or partners same-sex exclude not do policies these minimum, a At parents. and spouses opposite-sex as access visitation same the parents same-sex and partners/spouses same-sex allow that policies visitation reported participants of majority vast The inadequate visitation policies and staff training. by a facility’s definition of family. Same-sex partners and same-sexunit and often parents include are not parameters always recognized around who as is family permitted due to to visitvisitation and when. policies Visitation that outline access is protocol often determined around patientothers. and patient the of needs privacy visitation.and healthcare These policies can be facility-widethe and visitors from orsupport much-needed specificpatient’s the between balance a striking of challenge tothe with a faced are facilities Healthcare process. healing patient’s a to important is friends and family by Visitation VISITATION PO F For more information on visitation policies, including model policy language: policy model including policies, visitation on information more For n n of kin INDINGS

Visitation policies allow same-sex parents the same visitation access as opposite-sex parents for their minor their for parents opposite-sex as access visitation same the parents same-sex allow policies Visitation Visitation policies allow same-sex partners/spouses the same visitation access as opposite-sex spouses and next and spouses opposite-sex as access visitation same the partners/spouses same-sex allow policies Visitation 0 umber of Facilities that Facilities of Number L 40 I C IES 80 esponded “Y Responded To achieve this balance, healthcare facilities implement 102 104 es” 120 www.hrc.org/issues/9814.htm. children children

– 3a Criterion family: your protect to documents legal on information For policies: directive healthcare advance on information more For patient. a by maker decision substitute a as appointed properly individuals defining (2) and directives; (foreign) out-of-state of validity the (1) are: community LGBT the to apply they as directives healthcare advance on training and education and policy both by addressed be to areas issue key Two bias. or ignorance staff to due directives healthcare advance around policies compliance of enforcement subjective of problem the remedy that practices or policies identify to work will HEI the forward, Moving language. policy insufficient or training staff inadequate to due policies compliance of enforcement and implementation the in breakdown a indicates This treatment. medical of-life end- and emergency of moments critical at couples same-sex between directives these recognize to failing tals hospi- of stories tragic with forward come individuals LGBT numerous Unfortunately, directives. healthcare advance valid honor facilities healthcare that requirement legal the with accordance in are results These ners. part- same-sex between directives healthcare advance of validity legal the recognize facilities Participating care. under partner/spouse their for authority decision-making partners/spouses same-sex allowing directives healthcare advance recognizes it that indicated facilities) 145 of (145 applicable was 3a Criterion which for facilities participating our of one Every partners. incapacitated for decisions medical make to ability their ensure to directives complete couples same-sex that important especially is it inclusive, non-LGBT remains incapacity mental by triggered law decision-making medical default most because and states, most in laws recognition relationship LGBT of lack the to Due behalf. their on decisions medical make may who surrogates designate and ments docu- these in wishes healthcare their express Individuals directives. of examples common are wills living and proxies healthcare attorney, medical of powers Durable incapacity. mental of event the in treatment medical their of course the control to individual an allow that documents legal are directives healthcare Advance DIRECTIVES HEALTHCARE ADVANCE DE authority for their partner/spouse under care under partner/spouse their for authority n

C Recognize advance healthcare directives allowing same-sex partners/spouses decision-making partners/spouses same-sex allowing directives healthcare advance Recognize 0 PO -MAKING ISION umber of Facilities that Facilities of Number L I C IES esponded “Y Responded 145 145 es” www.hrc.org/issues/7948.htm. www.hrc.org/issues/9819.htm.

11 www.hrc.org/hei HEALTHCARE EQUALITY INDEX 12 www.hrc.org/hei HEALTHCARE EQUALITY INDEX DE F 770,000 same-sex couples across the country, in communities large and small. and large communities in country, the across couples same-sex 770,000 The2005 American Community Survey conducted by the U.S. Census Bureau MINOR A OF reported TREATMENT FOR CONSENT AND PARENTS SAME-SEX that there are nearly to ensure they are respecting the rights of all parents while acting within the limits of state law. state of limits the within acting while parents all of rights the respecting are they ensure to facilities healthcare for practices best identify to continue will survey HEI the of iterations Future minor. a of ment treat- for consent to pertaining policies in addressed currently are parents same-sex for rights decision-making way thisissue. Thanks to the thoughtful responses and feedback from participants, andwe have we have a better resolved understanding to provide resources of the such as model policies and guidance before Dueweto willthis ratepatchwork participants of state parentingon laws, this is an especially complex area for healthcare facilities to navigate, theirchildren are at a serious disadvantage in terms of their rights. dren.However, in cases where legal parenting rights are chil- not minor their availablefor rights decision-making medical their protect to oruse may are parents same-sex cost-prohibitive, which parentage” of same-sex parents and “judgments or guardianships, court-appointed minor, a of treatment medical to consent for authorization an as such jurisdiction-by-jurisdiction)basis. When joint and cases, second-parent some in (or state-by-state a on circumstances, limited in available adoptionsonly are adoptions second-parent and Joint are not available, there are other options adoption. second-parent or joint through established often is relationship legal the parents, LGBT non-biological of thechild. A child’s legal parent or guardian has wide authority to make healthcare tiondecisions or surrogacy for the — the child. key factor In the casein terms of decision-making insemina- adoption, through it be — rights couple same-sex a of home is the the into come legal children how of Regardless relationship parents. each parent has with itcomes to protecting the basic rights of these families, including those related Despiteto decision-making this nationwide rights presence of same-sex of same-sex couples raising children, there remain significant gaps in the law when regions. other to compared children, raising couples lieslive in 96 percent of all counties in the United States, fami- These children. raising are with couples same-sex male the five of Southout one and couples having same-sex female three of out the one highest percentage of same-sex School ofLaw, Available UCLA at:www.law.ucla.edu/williamsinstitute/publications/SameSexCouplesandGLBpopACS.pdf. 2006. 5 Gates, Gary J., Ph.D., “Same-Sex Couples andtheGay,Gates, GaryJ.,Ph.D.,“Same-Sex Lesbian,BisexualPopulation: NewEstimatesfromtheAmericanCommunity Survey”. Williams Institute, INDINGS C PO -MAKING ISION separates or if the biological (or original adoptive parent) dies or becomes incapacitated. becomes or dies parent) adoptive original (or biological the if or separates orhewill continue tohave legally a recognized parental relationship tothechild ifthecouple Second-parentadoptions also protect therights ofthesecond parent, byensuring that she dreninsame-sex parented families bygiving thechild thesecurity ofhaving twolegal parents. chil- protect adoptions Second-parent parent. a as status legal parent’s first the terminating thatallow same-sexa parent toadopt herorhis partner’s biological oradoptive child without Second-parent child. the of custody legal parents both give adoptions These system. care foster the from or parent(s) biological child’s the from Joint are legal procedures which involve a couple adopting a child privately child a adopting couple a involve which procedures legal are adoptions (alsoadoptions called co-parent adoptions) arelegal procedures L I C IES 5 Census numbers further note that require only clinical employees to attend. to employees clinical only require voluntarybasis, requiring no employees a on to trainings attend. these offer facilities) (89 percent 76 identity, Twenty-two gender on training offering facilities 117 the Of attend. percent to employees (26 facilities) require all employees to attend and two facilities noemployees to attend. Twenty-three percent (27 facilities) require Ofthe all 119 employees facilities to offering attend and training two facilities on sexual require orientation, only clinical 76 percent (90 facilities) offer these trainings community. transgender to relevant on issues healthcare a and voluntary identity gender addressing training competency cultural provide basis, requiring andhealthcare issues relevant to lesbian, gay and bisexual community. Seventy-twoSeventy-one percent percent of participating of participating facilities facilities (119 of (117 166 facilities) facilities) provide cultural competency training addressing sexual orientation

Criterion 4a, 4b – 4b 4a, Criterion training: competency cultural on information more For employees. among confusion or anxiety relieve and welcome feel patients ensure will petencies on training through environment secure and nonjudgmental a Creating experiences. healthcare negative to due care routine avoiding community LGBT the in result to shown is ers provid- healthcare among competence cultural LGBT of Lack process. the in with interact they everyone by influenced is healthcare accessing while experience individual’s an because competence, cultural LGBT on ing train- receive should — clinicians only not — facilities healthcare in works who Everyone facilities. healthcare in respected and welcome safe, feel families and individuals LGBT ensure not do alone policies Inclusive C n community community n andbisexual community U

Providecultural competency training addressing gender identity and healthcare issues relevant to transgender Provide cultural competency training addressing sexual orientation and healthcare issues relevant to lesbian, gay gay lesbian, to relevant issues healthcare and orientation sexual addressing training competency cultural Provide L 0 L COMPETEN TURA umber of Facilities that Facilities of Number 60 C CL AND Y TRAINING 120 117 119 esponded “Y Responded www.hrc.org/issues/8250.htm. www.hrc.org/issues/8250.htm. es” 180 basic, SERVI IENT LGBT-specific skills and com- and skills LGBT-specific C ES 13 www.hrc.org/hei HEALTHCARE EQUALITY INDEX 14 www.hrc.org/hei HEALTHCARE EQUALITY INDEX orientation, while only 63 percent (105 facilities) of those policies include “gender identity or expression” or “gender identity.” “gender or expression” or identity “gender include policies those of facilities) (105 percent 63 only while orientation, sexual on based discrimination employment bar facilities) 166 of (163 facilities participating the of percent Ninety-eight – 5b 5a, Criterion EMP F toward full inclusion of their LGBT employees. LGBT their of inclusion full toward work to participants HEI future and current encourage strongly we evolve, to continue criteria HEI the As employees. LGBT their of inclusive be to implement must employers practices and policies many the of three only on focuses Index Equality Healthcare The competence. cultural LGBT of matters on colleagues their ing educat- by experience patient LGBT the to positively contribute to are they likely more the work, at identity LGBT their about open being with are providers LGBT comfortable more the example, For climate. overall its of assessment an inform can employees LGBT their to related benefits and policies employment facility’s a at look a However, families. their and patients LGBT of experiences the on is HEI the of focus primary The www.hrc.org/issues/workplace/equal_opportunity.asp. policies: non-discrimination employment on information more For www.hrc.org/about_us/state_laws.asp. laws: non-discrimination employment statewide on information more For workplace. the in inclusion LGBT for policy baseline essential an is identity” “gender and tion” orienta- “sexual includes that — compensation and termination promotions, hiring, including — employment of conditions to respect with policy opportunity) employment (equal non-discrimination defined and clear A identity. gender on based discrimination employment prohibiting laws passed have Columbia of District the and states 12 orientation; sexual on based discrimination employment prohibiting laws passed have Columbia of District the and states Twenty identity. gender or orientation sexual perceived or real on based nation discrimi- from employees protect yet not does law Federal disability. or age origin, national pregnancy), ing (includ- sex religion, color, race, of basis the on discrimination from employees protects law federal Currently, POLICIES NON-DISCRIMINATION workplace: the in inclusion LGBT on information more For n n

INDINGS

Equalemployment opportunity policy includes “gender identity orexpression” or“gender identity” Equal employment opportunity policy includes “sexual orientation” “sexual includes policy opportunity employment Equal 0 PO LOYMENT umber of Facilities that Facilities of Number 60 L I C BENE AND IES 105 51 120 esponded “Y Responded www.hrc.org/workplace. 163 F ITS es” 180 For more information on domestic partner benefits: partner domestic on information more For employees. LGBT their to committed employers among norm the now are and benefits employment high-value low-cost, are These profound. is compensation in disparity this benefits, those for eligible not children and/or partners with employees For families. their and/or themselves for benefits ance insur- health of form the in provided is compensation overall employees’ of percent 20 roughly average, On BENEFITS HEALTH PARTNER

Criterion 5c – 5c Criterion benefits only to same-sex partners (nine did not provide this information). this provide not did (nine partners same-sex to only benefits offer 22 and partners opposite-sex and same- to benefits partner offer 131 facilities, these Of partners. domestic employees’ their to coverage insurance health offering reported facilities) 166 of (162 facilities participating the of percent Ninety-eight n

Domestic partner health insurance benefits are offered are benefits insurance health partner Domestic 0 umber of Facilities that Facilities of Number 60 120 esponded “Y Responded www.hrc.org/issues/domestic_partner_benefits.htm. es” 162 180 15 www.hrc.org/hei HEALTHCARE EQUALITY INDEX 16 www.hrc.org/hei HEALTHCARE EQUALITY INDEX F DATA CO gender identification, including an option for transgender (both male-to-female and female-to-male). and male-to-female (both transgender for option an including identification, gender for options the in flexibility for allow should forms these Also, etc. “divorced,” “married,” “single,” to addition in theyare LGBT-inclusive. For example, choices for relationship status should include terms such as“partnered” firstA step inproviding culturally competent care isamending all patient-history and intake forms toensure that FORMS INTAKE systems. collection data and forms intake on focus questions These community. LGBT the to related policies collection data their on information for facilities asked survey HEI the report, this in discussed criteria 11 the to related questions to addition In orientation and gender identity. gender and orientation thisinformation intheir medical records and— facilitate the assessment ofhealth outcomes according tosexual becaptured byproviders while— not requiring this information from patients who prefer not todisclose orhave Datacollection systems that include fields for sexual orientation and gender identity allow for this information to SYSTEMS COLLECTION DATA forms: intake LGBT-inclusive on information more For INDINGS n n n n n n n n n

name and gender and name Twentypercent (34facilities) have intake forms that allow forflexibility inidentification of status transgender includes Sevenpercent (11facilities) have intake forms that allow fordesignation ofgender that maker decision medical as others or partner domestic Fifty-threepercent (88facilities) have intake forms that allow forthe designation of kin of next as other or partner Fifty-sixpercent (93facilities) have intake forms that allow forthe designation ofdomestic status parental or partnership unmarried otherwise or partnership Fifty-fourpercent (89facilities) have intake forms that allow forthe designation ofdomestic policies visitation their on information include that forms intake have facilities) participating (127 percent Seventy-seven healthcare facility healthcare ofpersons other than legal spouses whohave legal relationships topatients relevant tothe Seventy-fivepercent (125 facilities) have data collection systems that permit thetracking transgender Sixpercent (10facilities) have data collections systems that allow people toself identify as bisexual or gay lesbian, as self-identify to people allow that systems collection data have facilities) participating (30 percent Eighteen LL E C PO TION L I C IES www.hrc.org/issues/8253.htm. Healthcare Equality Index Policy Criteria Policy Index Equality Healthcare APPENDI 5c 5b 5a 4b 4 3a 2b 2a 1b 1a A:PARTI APPENDIX O BREAKDOWN AND Domestic partner health insurance benefits are offered are benefits insurance health partner Domestic identity” “gender or expression” or identity “gender includes policy opportunity employment Equal orientation” “sexual includes policy opportunity employment Equal community transgender to relevant issues care health- and identity gender addressing training competency cultural Provide community bisexual and gay lesbian, to relevant issues care health- and orientation sexual addressing training competency cultural Provide care under partner/spouse their for authority decision-making partners/spouses same-sex allowing directives healthcare advance Recognize children minor their for parents site-sex oppo- as access visitation same the parents same-sex allow policies Visitation kin of next and spouses opposite-sex as access visitation same the partners/spouses same-sex allow policies Visitation identity” “gender or expression” or tity iden- “gender includes policy non-discrimination and/or Rights of Bill Patients’ orientation” “sexual includes policy non-discrimination and/or Rights of Bill Patients’ C ES C F RESPONSES H IPATING OSPITAL S 17 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Hospital City State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c

A. Alfred Taubman Health Care Center Ann Arbor MI

Advocate IL Masonic Medical Center Chicago IL a Ames CenterHealthcare Equality IndexAmes Policy IA

Ankeny CenterCriteria Ankeny IA

Baystate Medical Center Springfield MA

Bedford Medical1a CenterPatients’ Bill of RightsBedford and/or OH non-discrimination policy includes

A ppendix Beth Israel Deaconess Medical Center Boston MA “sexual orientation” Brigham and Women's Hospital Boston MA Brighton Health1b CenterPatients’ Bill of RightsBrighton and/or MI Bronson Methodist Hospitalnon-discrimination policyKalamazoo includesMI Bronx Health Center “gender identity or expression”Bronx orNY California Hospital Medical“gender Center identity” Los Angeles CA California Pacific Medical Center San Francisco CA Callen-Lorde2a Community Visitation Health Center policies allowNew York same- NY Canton Health Centersex partners/spousesCanton the same MI Case Medical Centervisitation access as Clevelandopposite-sexOH

Cedar Falls Center spouses and next ofCedar kin Falls IA

Chase Brexton Health Services Baltimore MD

Chelsea Health2b CenterVisitation policies allowsChelsea same-sexMI parents the same visitation access Cleveland Clinic Cleveland OH

HEALTHCARE EQUALITY INDEX as opposite-sex parents for their Commonwealth Neuropsychologyminor children Clinic Ann Arbor MI Conneaut Medical Center Conneaut OH 18 Creston Center3a Recognize advance Crestonhealthcare IA Dana Farber Cancer Institutedirectives allowing same-sexBoston partMA- Dexter Family Medicineners/spouses decision-makingDexter MI Domino's Farms Healthauthority Center for their partner/spouseAnn Arbor MI Duke University Hospitalunder care Durham NC East Ann Arbor Ambulatory Surgery & Medical Proce- Ann Arbor MI dures Center4 Provide cultural competency train- East Ann Arbor Healthing & Geriatrics addressing Center sexualAnn ArbororientationMI East County Health Center Gresham OR www.hrc.org/hei and healthcare issues relevant to East Jefferson Generallesbian, Hospital gay and bisexualMetairie commuLA- Euclid Hospital nity Euclid OH Fairview Hospital Cleveland OH Family Practice4b Center, Provide The cultural competencyDes Moines trainIA- Faulkner Hospital ing addressing genderBoston identity andMA

Fort Dodge Center healthcare issues relevantFort Dodge to transIA -

Geauga Medical Centergender community Chardon OH

Geneva Medical Center Geneva OH

George Washington5a UniversityEqual Hospital employment opportunityWashington DC policy includes “sexual orientation” Group Health Central Hospital Seattle WA Harvard Vanguard5b MedicalEqual Associates employment opportunityBoston MA Healthy Connections policy includes “genderDes Moines identity orIA Hillcrest Hospital expression” or “genderMayfield identity” Heights OH Howell Pediatrics and Teen Center Howell MI Huron Hospital5c Domestic partner healthEast Cleveland insuranceOH Iowa City Center benefits are offered Iowa City IA

Ireland Cancer Center Cleveland OH

Key to Responses nn YES no nn not applicable K Legacy ClinicTigard-King City Legacy ClinicSt.Helens Creek Legacy ClinicSalmon Legacy ClinicNorthwest Legacy ClinicNortheast Legacy ClinicMountHood Legacy ClinicGoodSamaritan Legacy ClinicFisher'sLanding Legacy ClinicFirwood Legacy ClinicEmanuel Legacy ClinicCanby Ground Legacy ClinicBattle Lakewood Hospital HealthCenter La ClinicadelaBuenaSalud L.A. Gay&LesbianCenter Knoxville Center Kaiser Permanente Woodland HillsMedicalCenter Kaiser Permanente West LosAngelesMedicalCenter Kaiser Permanente Walnut CreekMedicalCenter Kaiser Permanente Vallejo MedicalCenter Kaiser Permanente SunnysideMedicalCenter FranciscoMedicalCenter Kaiser Permanente SouthSan MedicalCenter Kaiser Permanente SouthSacramento MedicalCenter Kaiser Permanente SouthBay TeresaKaiser Permanente Santa MedicalCenter MedicalCenter Rosa Kaiser Permanente Santa Campus) ClaraMedicalCenter(Kiely Kaiser Permanente Santa RafaelMedicalCenter Kaiser Permanente San FranciscoMedicalCenter Kaiser Permanente San DiegoMedicalCenter Kaiser Permanente San MedicalCenter Kaiser Permanente Sacramento Kaiser Permanente RosevilleMedicalCenter Kaiser Permanente RiversideMedicalCenter Kaiser Permanente Richmond MedicalCenter Kaiser Permanente RedwoodCityMedicalCenter Kaiser Permanente PanoramaCityMedicalCenter Kaiser Permanente OaklandMedicalCenter Kaiser Permanente MoanaluaMedicalCenter Kaiser Permanente MantecaMedicalCenter Kaiser Permanente LosAngelesMedicalCenter Kaiser Permanente HaywardMedicalCenter Kaiser Permanente FresnoMedicalCenter Kaiser Permanente FremontMedicalCenter Kaiser Permanente MedicalCenter Fontana Kaiser Permanente BellflowerMedicalCenter ParkMedicalCenter Kaiser Permanente Baldwin Kaiser Permanente AnaheimMedicalCenter ey to R YES nnYES esponses Hospital Portland St. Helens Vancouver Portland Portland Gresham Portland Vancouver Sandy Portland Canby Ground Battle Lakewood Portland Los Angeles Knoxville Woodland Hills Los Angeles Walnut Creek Vallejo Clackamas Francisco San Sacramento Harbor City Jose San Rosa Santa Clara Santa Rafael San Francisco San Diego San Sacramento Roseville Riverside Richmond Redwood City Panorama City Oakland Honolulu Manteca Los Angeles Hayward Fresno Fremont Fontana Bellflower Park Baldwin Anaheim applicable nnnot no City OR OR WA OR OR OR OR WA OR OR OR WA OH OR CA IA CA CA CA CA OR CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA HI CA CA CA CA CA CA CA CA CA State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 19 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Appendix a 20 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Appendix a K Scripps Coastal MedicalCenterHillcrest Scripps Coastal MedicalCenterEscondido Scripps Coastal MedicalCenterEncinitas Scripps Coastal MedicalCenterEastlake Scripps Coastal MedicalCenterCarlsbad Scripps Coastal Scripps ClinicTorrey Pines Scripps ClinicSantee Diego Scripps ClinicRancho San Scripps ClinicRancho Bernardo Scripps ClinicMissionValley Scripps ClinicLaJolla Scripps ClinicEncinitas Scripps ClinicDelMar Scripps ClinicCoronado Scripps ClinicCarmelValley MedicalCenter FranciscoGeneralHospital San HealthCenter Saline Rush UniversityMedicalCenter Rosenfield Center Richmond MedicalCenter Red OakCenter &Children'sHospital Rainbow Babies Quad CitiesCenter Psychiatry AmbulatoryServices Piedmont Hospital Park NicolletMethodistHospital Northeast Portland HealthCenter North Portland HealthCenter Newton Center New HopeOutreach Clinic Mid CountyHealthCenter Medical CenterofLouisiana GeneralHospital Massachusetts Maimonides MedicalCenter MacDonald Women's Hospital Lyon-Martin HealthServices Lutheran Hospital Livonia CenterforSpecialtyCare CreekHospital Legacy Salmon Legacy MountHoodMedicalCenter Legacy MeridianParkHospital &MedicalCenter Hospital Legacy GoodSamaritan &HealthCenter Legacy EmanuelHospital Legacy EmanuelChildren'sHospital Legacy ClinicWoodburn Legacy ClinicWest Linn Legacy ClinicTualatin ey to R YES nnYES esponses Hospital San Diego San Escondido Encinitas Chula Vista Carlsbad La Jolla Santee La Mesa Rancho Bernardo Diego San La Jolla Encinitas Diego San Coronado Diego San Francisco San Saline Chicago Des Moines Richmond Heights Red Oak Cleveland Bettendorf Ann Arbor Atlanta LouisPark Saint Portland Portland Newton Ann Arbor Portland New Orleans Boston Brooklyn Cleveland Francisco San Cleveland Livonia Vancouver Gresham Tualatin Portland Portland Portland Woodburn West Linn Tualatin applicable nnnot no City CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA MI IL IA OH IA OH IA MI GA MN OR OR IA MI OR LA MA NY OH CA OH MI WA OR OR OR OR OR OR OR OR State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c K Ypsilanti HealthCenter Westside HealthCenter West Center West AnnArborHealthCenter Vanderbilt UniversityMedicalCenter DiegoMedicalCenter University ofCaliforniaSan ExtendedCareCampus University Hospitals University Hospital BriarwoodMedicalGroup UM MedicalCenter UCSF Knapp HealthCenter Susan Storm LakeCenter andClinics Hospital Stanford Spencer Center Southeast Portland HealthCenter South Pointe Hospital Sioux CityCenter ChulaVista Scripps MercyHospital Scripps MercyHospital LaJolla Scripps MemorialHospital Encinitas Scripps MemorialHospital Scripps GreenHospital MedicalCenterWaringScripps Coastal MedicalCenterVista Scripps Coastal MedicalCenterMission Scripps Coastal ey to R YES nnYES esponses Hospital Ypsilanti Portland Urbandale Ann Arbor Nashville Diego San Chardon Ann Arbor Ann Arbor Francisco San Des Moines Storm Lake Palo Alto Spencer Portland Warrensville Heights Sioux City Chula Vista Diego San La Jolla Encinitas La Jolla Oceanside Vista Oceanside applicable nnnot no City MI OR IA MI TN CA OH MI MI CA IA IA CA IA OR OH IA CA CA CA CA CA CA CA CA State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 21 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Appendix a 22 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Appendix a Healthcare Equality Index Policy Criteria Policy Index Equality Healthcare B:PARTI APPENDIX APPENDI 5c 5b 5a 4b 4a 3a 2b 2a 1b 1a Domestic partner health insurance benefits are offered are benefits insurance health partner Domestic identity” “gender or expression” or identity “gender includes policy opportunity employment Equal orientation” “sexual includes policy opportunity employment Equal community transgender to relevant issues healthcare and identity gender addressing training competency cultural Provide community bisexual and gay lesbian, to relevant issues healthcare and orientation sexual addressing training competency cultural Provide care under partner/spouse their for authority decision-making partners/spouses same-sex allowing directives healthcare advance Recognize children minor their for parents opposite-sex as access visitation same the parents same-sex allow policies Visitation kin of next and spouses opposite-sex as access visitation same the partners/spouses same-sex allow policies Visitation identity” “gender or expression” or identity “gender includes policy non-discrimination and/or Rights of Bill Patients’ orientation” “sexual includes policy non-discrimination and/or Rights of Bill Patients’ C ES C F IPATING A C I L BY STATEITIES K Scripps Coastal MedicalCenterHillcrest Scripps Coastal Scripps ClinicMissionValley Scripps ClinicDelMar Scripps ClinicCarmelValley DiegoMedicalCenter Kaiser Permanente San MedicalCenter Kaiser Permanente SouthSacramento MedicalCenter Kaiser Permanente Sacramento Kaiser Permanente RosevilleMedicalCenter Kaiser Permanente RiversideMedicalCenter Kaiser Permanente Richmond MedicalCenter Kaiser Permanente RedwoodCityMedicalCenter Scripps ClinicRancho Bernardo Kaiser Permanente PanoramaCityMedicalCenter andClinics Hospital Stanford MedicalCenterWaringScripps Coastal MedicalCenterMission Scripps Coastal Kaiser Permanente OaklandMedicalCenter Kaiser Permanente MantecaMedicalCenter L.A. Gay&LesbianCenter Kaiser Permanente West LosAngelesMedicalCenter Kaiser Permanente LosAngelesMedicalCenter MedicalCenter California Hospital Diego Scripps ClinicRancho San LaJolla Scripps MemorialHospital Scripps GreenHospital Scripps ClinicTorrey Pines Scripps ClinicLaJolla Kaiser Permanente HaywardMedicalCenter MedicalCenter Kaiser Permanente SouthBay Kaiser Permanente FresnoMedicalCenter Kaiser Permanente FremontMedicalCenter Kaiser Permanente MedicalCenter Fontana MedicalCenterEscondido Scripps Coastal Encinitas Scripps MemorialHospital MedicalCenterEncinitas Scripps Coastal Scripps ClinicEncinitas Scripps ClinicCoronado ChulaVista Scripps MercyHospital MedicalCenterEastlake Scripps Coastal MedicalCenterCarlsbad Scripps Coastal Kaiser Permanente BellflowerMedicalCenter ParkMedicalCenter Kaiser Permanente Baldwin Kaiser Permanente AnaheimMedicalCenter CALIFORNIA ey to R YES nn YES esponses Hospital San Diego San Diego San Diego San Diego San Diego San Sacramento Sacramento Roseville Riverside Richmond Redwood City Rancho Bernardo Panorama City Palo Alto Oceanside Oceanside Oakland Manteca Los Angeles Los Angeles Los Angeles Los Angeles La Mesa La Jolla La Jolla La Jolla La Jolla Hayward Harbor City Fresno Fremont Fontana Escondido Encinitas Encinitas Encinitas Coronado Chula Vista Chula Vista Carlsbad Bellflower Park Baldwin Anaheim applicable nnnot no City 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 23 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix b 24 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix b K West Center Storm LakeCenter Spencer Center Sioux CityCenter Red OakCenter Newton Center Knoxville Center Iowa CityCenter Fort DodgeCenter Knapp HealthCenter Susan Rosenfield Center Healthy Connections Family PracticeCenter, The Creston Center Cedar FallsCenter Quad CitiesCenter Ankeny Center Ames Center IOWA Kaiser Permanente MoanaluaMedicalCenter HAWAII Piedmont Hospital GEORGIA George Washington UniversityHospital OFCOLUMBIA DISTRICT Kaiser Permanente Woodland HillsMedicalCenter Kaiser Permanente Walnut CreekMedicalCenter MedicalCenterVista Scripps Coastal Kaiser Permanente Vallejo MedicalCenter Scripps ClinicSantee MedicalCenter Rosa Kaiser Permanente Santa ClaraMedicalCenter(KielyCampus) Kaiser Permanente Santa RafaelMedicalCenter Kaiser Permanente San TeresaKaiser Permanente Santa MedicalCenter FranciscoMedicalCenter Kaiser Permanente SouthSan MedicalCenter UCSF MedicalCenter FranciscoGeneralHospital San Lyon-Martin HealthServices FranciscoMedicalCenter Kaiser Permanente San California PacificMedicalCenter DiegoMedicalCenter University ofCaliforniaSan Scripps MercyHospital CALIFORNIA ey to R YES nnYES esponses Hospital Urbandale Storm Lake Spencer Sioux City Red Oak Newton Knoxville Iowa City Fort Dodge Des Moines Des Moines Des Moines Des Moines Creston Cedar Falls Bettendorf Ankeny Ames Honolulu Atlanta Washington Woodland Hills Walnut Creek Vista Vallejo Santee Rosa Santa Clara Santa Rafael San Jose San Francisco San Francisco San Francisco San Francisco San Francisco San Francisco San Diego San Diego San applicable nnnot no City 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c K Callen-Lorde CommunityHealthCenter Maimonides MedicalCenter Bronx HealthCenter YORK NEW Duke UniversityHospital CAROLINA NORTH Park NicolletMethodistHospital MINNESOTA Ypsilanti HealthCenter HealthCenter Saline Livonia CenterforSpecialtyCare Bronson MethodistHospital Howell Pediatrics andTeen Center Dexter FamilyMedicine Chelsea HealthCenter Canton HealthCenter Brighton HealthCenter West AnnArborHealthCenter University Hospital BriarwoodMedicalGroup UM Psychiatry AmbulatoryServices New HopeOutreach Clinic East AnnArborHealth&GeriatricsCenter Center East AnnArborAmbulatorySurgery&MedicalProcedures Domino's FarmsHealthCenter Commonwealth Neuropsychology Clinic A. AlfredTaubman HealthCareCenter MICHIGAN Chase BrextonHealthServices MARYLAND MedicalCenter Baystate GeneralHospital Massachusetts Harvard Vanguard MedicalAssociates Faulkner Hospital Dana FarberCancerInstitute Brigham andWomen's Hospital Beth IsraelDeaconessMedicalCenter MASSACHUSETTS Medical CenterofLouisiana East JeffersonGeneralHospital LOUISIANA Rush UniversityMedicalCenter MasonicMedicalCenter Advocate IL ILLINOIS ey to R YES nnYES esponses Hospital New York Brooklyn Bronx Durham LouisPark Saint Ypsilanti Saline Livonia Kalamazoo Howell Dexter Chelsea Canton Brighton Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Ann Arbor Baltimore Springfield Boston Boston Boston Boston Boston Boston New Orleans Metairie Chicago Chicago applicable nnnot no City 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 25 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix b 26 www.hrc.org/hei HEALTHCARE EQUALITY INDEX APPENDIX B K Legacy ClinicWoodburn Legacy ClinicWest Linn Legacy MeridianParkHospital Legacy ClinicTualatin Legacy ClinicSt.Helens Legacy ClinicFirwood Westside HealthCenter Southeast Portland HealthCenter Northeast Portland HealthCenter North Portland HealthCenter Mid CountyHealthCenter &MedicalCenter Hospital Legacy GoodSamaritan &HealthCenter Legacy EmanuelHospital Legacy EmanuelChildren'sHospital Legacy ClinicTigard-King City Legacy ClinicNorthwest Legacy ClinicNortheast Legacy ClinicGoodSamaritan Legacy ClinicEmanuel HealthCenter La ClinicadelaBuenaSalud Legacy MountHoodMedicalCenter Legacy ClinicMountHood East CountyHealthCenter Kaiser Permanente SunnysideMedicalCenter Legacy ClinicCanby OREGON South Pointe Hospital Richmond MedicalCenter Hillcrest Hospital Lakewood Hospital Geneva MedicalCenter Euclid Hospital Huron Hospital Conneaut MedicalCenter &Children'sHospital Rainbow Babies MacDonald Women's Hospital Lutheran Hospital Ireland CancerCenter Fairview Hospital Cleveland Clinic Case MedicalCenter ExtendedCareCampus University Hospitals Geauga MedicalCenter Bedford MedicalCenter OHIO ey to R YES nn YES esponses Hospital Woodburn West Linn Tualatin Tualatin St. Helens Sandy Portland Portland Portland Portland Portland Portland Portland Portland Portland Portland Portland Portland Portland Portland Gresham Gresham Gresham Clackamas Canby Warrensville Heights Richmond Heights Mayfield Heights Lakewood Geneva Euclid East Cleveland Conneaut Cleveland Cleveland Cleveland Cleveland Cleveland Cleveland Cleveland Chardon Chardon Bedford applicable nn not no City 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c K Legacy Salmon CreekHospital Legacy Salmon Creek Legacy ClinicSalmon Legacy ClinicFisher'sLanding Group HealthCentralHospital Ground Legacy ClinicBattle WASHINGTON Vanderbilt UniversityMedicalCenter TENNESSEE ey to R YES nnYES esponses Hospital Vancouver Vancouver Vancouver Seattle Ground Battle Nashville applicable nnnot no City 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 27 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix b 28 28 www.hrc.org/hei HEALTHCARE EQUALITY INDEX Healthcare Equality Index Policy Criteria Policy Index Equality Healthcare C:PARTI APPENDIX APPENDI 5c 5b 5a 4b 4a 3a 2b 2a 1b 1a Domestic partner health insurance benefits are offered are benefits insurance health partner Domestic identity” “gender or expression” or identity “gender includes policy opportunity employment Equal orientation” “sexual includes policy opportunity employment Equal community transgender to relevant issues healthcare and identity gender addressing training competency cultural Provide community bisexual and gay lesbian, to relevant issues healthcare and orientation sexual addressing training competency cultural Provide care under partner/spouse their for authority decision-making partners/spouses same-sex allowing directives healthcare advance Recognize children minor their for parents opposite-sex as access visitation same the parents same-sex allow policies Visitation kin of next and spouses opposite-sex as access visitation same the partners/spouses same-sex allow policies Visitation identity” “gender or expression” or identity “gender includes policy non-discrimination and/or Rights of Bill Patients’ orientation” “sexual includes policy non-discrimination and/or Rights of Bill Patients’ C ES C F IPATING A C I L BY NETWORK ITIES K Kaiser Permanente HaywardMedicalCenter Kaiser Permanente FresnoMedicalCenter Kaiser Permanente FremontMedicalCenter Kaiser Permanente MedicalCenter Fontana Kaiser Permanente BellflowerMedicalCenter ParkMedicalCenter Kaiser Permanente Baldwin Kaiser Permanente AnaheimMedicalCenter NETWORK PERMANENTE KAISER South Pointe Hospital Lutheran Hospital Lakewood Hospital Huron Hospital Hillcrest Hospital Fairview Hospital Euclid Hospital Cleveland Clinic FOUNDATION CLINIC CLEVELAND Vanderbilt UniversityMedicalCenter DiegoMedicalCenter University ofCaliforniaSan MedicalCenter UCSF andClinics Hospital Stanford MedicalCenter FranciscoGeneralHospital San Rush UniversityMedicalCenter Piedmont Hospital Park NicolletMethodistHospital Medical CenterofLouisiana GeneralHospital Massachusetts Maimonides MedicalCenter Lyon-Martin HealthServices L.A. Gay&LesbianCenter Harvard Vanguard MedicalAssociates Group HealthCentralHospital George Washington UniversityHospital Faulkner Hospital East JeffersonGeneralHospital Duke UniversityHospital Dana FarberCancerInstitute Chase BrextonHealthServices Callen-Lorde CommunityHealthCenter California PacificMedicalCenter MedicalCenter California Hospital Bronx HealthCenter Bronson MethodistHospital Brigham andWomen's Hospital Beth IsraelDeaconessMedicalCenter MedicalCenter Baystate MasonicMedicalCenter Advocate IL NETWORK NO ey to R YES nnYES esponses Hospital Hayward Fresno Fremont Fontana Bellflower Park Baldwin Anaheim Warrensville Heights Cleveland Lakewood East Cleveland Mayfield Heights Cleveland Euclid Cleveland Nashville Diego San Francisco San Palo Alto Francisco San Chicago Atlanta LouisPark Saint New Orleans Boston Brooklyn Francisco San Los Angeles Boston Seattle Washington Boston Metairie Durham Boston Baltimore New York Francisco San Los Angeles Bronx Kalamazoo Boston Boston Springfield Chicago applicable nnnot no City CA CA CA CA CA CA CA OH OH OH OH OH OH OH OH TN CA CA CA CA IL GA MN LA MA NY CA CA MA WA DC MA LA NC MA MD NY CA CA NY MI MA MA MA IL State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 29 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix c 30 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix c K Legacy Salmon CreekHospital Legacy Salmon Legacy MountHoodMedicalCenter Legacy MeridianParkHospital &MedicalCenter Hospital Legacy GoodSamaritan &HealthCenter Legacy EmanuelHospital Legacy EmanuelChildren'sHospital Legacy ClinicWoodburn Legacy ClinicWest Linn Legacy ClinicTualatin Legacy ClinicTigard-King City Legacy ClinicSt.Helens Creek Legacy ClinicSalmon Legacy ClinicNorthwest Legacy ClinicNortheast Legacy ClinicMountHood Legacy ClinicGoodSamaritan Legacy ClinicFisher'sLanding Legacy ClinicFirwood Legacy ClinicEmanuel Legacy ClinicCanby Ground Legacy ClinicBattle SYSTEM HEALTH LEGACY Kaiser Permanente Woodland HillsMedicalCenter Kaiser Permanente West LosAngelesMedicalCenter Kaiser Permanente Walnut CreekMedicalCenter Kaiser Permanente Vallejo MedicalCenter Kaiser Permanente SunnysideMedicalCenter FranciscoMedicalCenter Kaiser Permanente SouthSan MedicalCenter Kaiser Permanente SouthSacramento MedicalCenter Kaiser Permanente SouthBay TeresaKaiser Permanente Santa MedicalCenter MedicalCenter Rosa Kaiser Permanente Santa ClaraMedicalCenter(KielyCampus) Kaiser Permanente Santa RafaelMedicalCenter Kaiser Permanente San FranciscoMedicalCenter Kaiser Permanente San DiegoMedicalCenter Kaiser Permanente San MedicalCenter Kaiser Permanente Sacramento Kaiser Permanente RosevilleMedicalCenter Kaiser Permanente RiversideMedicalCenter Kaiser Permanente Richmond MedicalCenter Kaiser Permanente RedwoodCityMedicalCenter Kaiser Permanente PanoramaCityMedicalCenter Kaiser Permanente OaklandMedicalCenter Kaiser Permanente MoanaluaMedicalCenter Kaiser Permanente MantecaMedicalCenter Kaiser Permanente LosAngelesMedicalCenter NETWORK PERMANENTE KAISER ey to R YES nn YES esponses Hospital Vancouver Gresham Tualatin Portland Portland Portland Woodburn West Linn Tualatin Portland St. Helens Vancouver Portland Portland Gresham Portland Vancouver Sandy Portland Canby Ground Battle Woodland Hills Los Angeles Walnut Creek Vallejo Clackamas Francisco San Sacramento Harbor City Jose San Rosa Santa Clara Santa Rafael San Francisco San Diego San Sacramento Roseville Riverside Richmond Redwood City Panorama City Oakland Honolulu Manteca Los Angeles applicable nnnot no City WA OR OR OR OR OR OR OR OR OR OR WA OR OR OR OR WA OR OR OR WA CA CA CA CA OR CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA HI CA CA State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c K Scripps Memorial Hospital Encinitas Scripps MemorialHospital Scripps GreenHospital MedicalCenterWaringScripps Coastal MedicalCenterVista Scripps Coastal MedicalCenterMission Scripps Coastal MedicalCenterHillcrest Scripps Coastal MedicalCenterEscondido Scripps Coastal MedicalCenterEncinitas Scripps Coastal MedicalCenterEastlake Scripps Coastal MedicalCenterCarlsbad Scripps Coastal Scripps ClinicTorrey Pines Scripps ClinicSantee Diego Scripps ClinicRancho San Scripps ClinicRancho Bernardo Scripps ClinicMissionValley Scripps ClinicLaJolla Scripps ClinicEncinitas Scripps ClinicDelMar Scripps ClinicCoronado Scripps ClinicCarmelValley NETWORK HEALTH SCRIPPS West Center Knapp HealthCenter Susan Storm LakeCenter Spencer Center Sioux CityCenter Rosenfield Center Red OakCenter Quad CitiesCenter Newton Center Knoxville Center Iowa CityCenter Healthy Connections Fort DodgeCenter Family PracticeCenter, The Creston Center Cedar FallsCenter Ankeny Center Ames Center IOWA GREATER OF PARENTHOOD PLANNED Westside HealthCenter Southeast Portland HealthCenter Northeast Portland HealthCenter North Portland HealthCenter Mid CountyHealthCenter HealthCenter La ClinicadelaBuenaSalud East CountyHealthCenter DEPARTMENT HEALTH COUNTY MULTNOMAH ey to R YES nnYES esponses Hospital Encinitas La Jolla Oceanside Vista Oceanside Diego San Escondido Encinitas Chula Vista Carlsbad La Jolla Santee La Mesa Rancho Bernardo Diego San La Jolla Encinitas Diego San Coronado Diego San Urbandale Des Moines Storm Lake Spencer Sioux City Des Moines Red Oak Bettendorf Newton Knoxville Iowa City Des Moines Fort Dodge Des Moines Creston Cedar Falls Ankeny Ames Portland Portland Portland Portland Portland Portland Gresham applicable nnnot no City CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA OR OR OR OR OR OR OR State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c 31 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix c 32 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix c K Ypsilanti HealthCenter West AnnArborHealthCenter University Hospital BriarwoodMedicalGroup UM HealthCenter Saline Psychiatry AmbulatoryServices New HopeOutreach Clinic Livonia CenterforSpecialtyCare Howell Pediatrics andTeen Center East AnnArborHealth&GeriatricsCenter Center East AnnArborAmbulatorySurgery&MedicalProcedures Domino's FarmsHealthCenter Dexter FamilyMedicine Commonwealth Neuropsychology Clinic Chelsea HealthCenter Canton HealthCenter Brighton HealthCenter A. AlfredTaubman HealthCareCenter NETWORK MICHIGAN OF UNIVERSITY ExtendedCareCampus University Hospitals Richmond MedicalCenter &Children'sHospital Rainbow Babies MacDonald Women's Hospital Ireland CancerCenter Geneva MedicalCenter Geauga MedicalCenter Conneaut MedicalCenter Case MedicalCenter Bedford MedicalCenter CLEVELAND OF HOSPITALS UNIVERSITY ChulaVista Scripps MercyHospital Scripps MercyHospital LaJolla Scripps MemorialHospital NETWORK HEALTH SCRIPPS ey to R YES nnYES esponses Hospital Ypsilanti Ann Arbor Ann Arbor Ann Arbor Saline Ann Arbor Ann Arbor Livonia Howell Ann Arbor Ann Arbor Ann Arbor Dexter Ann Arbor Chelsea Canton Brighton Ann Arbor Chardon Richmond Heights Cleveland Cleveland Cleveland Geneva Chardon Conneaut Cleveland Bedford Chula Vista Diego San La Jolla applicable nnnot no City MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI OH OH OH OH OH OH OH OH OH OH CA CA CA State 1a 1b 2a 2b 3a 4a 4b 5a 5b 5c n 4. n n n Patient Non-DiscriminationPolicies General Facility Information PATIENT 3. n 2. n D:H APPENDIX APPENDI 1. for informational purposes only. purposes informational for with marked Questions answers. your preparing in use your for printed be can and Foundation The online survey is pre-populated with previous survey answers and/or information gathered by theUp-to-date Human Rights help andCampaign additional information specificUse this to each document survey for question your information is available only online. — surveys must be submitted online. Visitation Policies

If YES, please provide the language of the definition below. definition the of language the provide please YES, If family”? “immediate or “family” of definition a have you Do

n n n Please credit. receive to copy a submit If Note: policy. non-discrimination patient or Rights of Bill Patients’ your of copy a attach Please identity”? “gender or expression” or identity “gender term the include policy non-discrimination patient or Rights of Bill Patients’ primary your Does “sexual orientation”? “sexual term the include policy non-discrimination patient or Rights of Bill Patients’ primary your Does Yes Yes Yes

Primary Service Primary Type Ownership Personnel Full-Time of # Range Size Bed Address Web Address Facility provide

non-discrimination you are reporting your policy for the first time, or are reporting changes, you need to need you changes, reporting are or time, first the for policy your reporting are you n n n n n No, but we plan to in the next one year one next the in to plan we but No, No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, will be used in part or in their entirety for scoring purposes this year. All other questions are questions other All year. this purposes scoring for entirety their in or part in used be will 2009 the public L EA C T ES web HC policy address L EQUA ARE is posted. where n n n ’ B ill Patients’ your No No No SURVEY 2009 INDEX ITY n n n Do not know not Do Do not know not Do know not Do Rights of or

33 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix D 34 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix d 2009 2009 2009 Decision-Making Policies

n 8. n 7. n 6. n 5.

9.

n 10. n

partners/spouses and next of kin? of next and partners/spouses reporting your policy for the first time, or are reporting changes, you need to submit a copy to receive credit. receive to copy a submit to need you changes, reporting are or time, first the for policy your reporting question). previous to attached already (unless policy the of copy a attach please YES, If opposite-sex as access visitation same the parents same-sex allow policies visitation your Do credit. receive to copy a submit to need you changes, reporting are or time, first the for policy your reporting question). previous to attached already (unless policy the of copy a attach please YES, If opposite-sex as access same the partners/spouses same-sex allow policies visitation your Do question). previous to attached already (unless policy the of copy a attach please YES, If visitors? their designate to patients allow policies visitation your Do policy. the of copy a attach please YES, If family? immediate and/or family friends, between differentiate policies visitation your Do parents for their minor children? minor their for parents care, healthcare proxies, or living wills in allowing same-sex partners/spouses decision-making partners/spouses same-sex allowing in wills living or proxies, healthcare care, health for attorney of powers durable as such directives healthcare advance recognize you Do authority for their partner/spouse under your care? care? your under partner/spouse their for authority someone else as medical decision maker when advising them of advance directive rights? directive advance of them advising when maker decision medical as else someone Do you counsel individuals under your care on their right to designate their domestic partner or partner domestic their designate to right their on care your under individuals counsel you Do Yes Yes Yes Yes Yes Yes prerogative Physician n exemption Religious n apply)? that all indicate (please recognized they aren’t why NO, If explain.) please OTHER, (If Other n physician admitting from Verification n authorization oral Patients’ n apply)? that all indicate (please directives advance such recognize to require you do documentation or proof what YES, If n n n n n n n n No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, year one next the in to plan we but No, year one next the in to plan we but No, No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, If OTHER, please explain.) please OTHER, (If Other n law State n intake upon documentation Hospital n documentation Written n n n n n n n No No No No No No n n n n n n Do not know not Do know not Do know not Do know not Do Do not know not Do know not Do Note: If you are are you If Note: are you If Note: n n n

Not Applicable Not Applicable Not Applicable Not

2009 Residential Facility andInpatientServices Decision-Making Policies n 16. n n 15. n 14. n 13. n 12. n 11.

If YES, please attach a copy of the policy. the of copy a attach please YES, If individuals? transgender for accommodations room appropriate address that guidelines or policy a have you Do rooms? occupy jointly to permitted couples are facility, your Within residents). by use in currently are they not or whether use for staffed and up set beds all Indicate (Note: residents? for available currently are beds many how YES, If facilities? residential long-term, provide you Do credit. receive to copy a submit to need you changes, reporting are or time, first the for policy your reporting question). previous to attached already (unless policy the of copy a attach please YES, If children? minor their for decision-making medical for parents opposite-sex as rights same the parents same-sex allows that policy a have you Do wills? living or proxies healthcare healthcare, for attorney of powers durable as such directives healthcare advance regarding policies and laws state with compliance on staff train you Do intake? at forms directive healthcare advance provide you Do Yes Yes Yes Yes Yes Yes If YES, please attach a copy of the policy. the of copy a attach please YES, If occupied jointly to access same the partners/spouses same-sex allows that policy a have you do YES, If Yes n n n n n n n

No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, No year one next the in to plan we but No, year one next the in to plan we but No, year one next the in to plan we but No, rooms as opposite-sex partners/spouses? opposite-sex as rooms n n No, but we plan to in the next one year one next the in to plan we but No, n n n n n n No No No No No No n n n n n Do not know not Do know not Do know not Do know not Do know not Do n Do not know not Do Note: If you are are you If Note:

35 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix D 36 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix D 2009 2009 Cultural CompetencyTraining andClientServices

17. n 20. n 19. 18. n n n n n n n healthcare issues relevant to the lesbian, gay and bisexual community? bisexual and gay lesbian, the to relevant issues healthcare Do you provide cultural competency training to personnel addressing sexual orientation and the and orientation sexual addressing personnel to training competency cultural provide you Do governing or advisory board? advisory or governing a on serving person LGBT openly or organization LGBT an of representative a have you Do apply) that all indicate (please services? or programs other following the of any provide you Do community? transgender the to relevant issues healthcare the and identity gender addressing personnel to training competency cultural provide you Do attend to required employees no Yes, n attend to required employees all Yes, n Other (If OTHER, please explain) please OTHER, (If Other n attend to required employees no Yes, n attend to required employees all Yes, n n Yes

specify) please OTHER, (If Other n patients LGBT to related concerns or status Immigration n people/families gay/lesbian/bisexual of needs health Psychosocial/physical/mental n apply)? that all indicate (please include training the does what provided, is training If Please describe all services or programs that are provided. are that programs or services all describe Please specify) please OTHER, (If Other n bathroom private to access as such patients transgender of needs Accommodating n patients transgender for exams necessary non-medically Preventing n people transgender and transitioning of needs health Psychosocial/physical/mental n apply)? that all indicate (please include training the does what provided, is training If Programs that support unique psychosocial/physical/mental health needs of LGBT community LGBT of needs health psychosocial/physical/mental unique support that Programs Programs that support unique psychosocial/physical/mental health needs of LGBT youth LGBT of needs health psychosocial/physical/mental unique support that Programs Treatment/services for transgender patients that support “transitioning” support that patients transgender for Treatment/services Treatment/services for transgender patients that acknowledge transgender history transgender acknowledge that patients transgender for Treatment/services HIV/AIDS services targeting LGBT people of color of people LGBT targeting services HIV/AIDS services testing/treatment/counseling/other HIV/AIDS STD/STI community education/services or treatment specific to the LGBT community LGBT the to specific treatment or education/services community STD/STI Community outreach plan that reflects specific commitment to LGBT community LGBT to commitment specific reflects that plan outreach Community Other services or programs or services Other n n No, but we plan to in the next one year one next the in to plan we but No, No, training not offered not training No, n attend to required employees clinical only Yes, n No, training not offered not training No, n attend to required employees clinical only Yes, n n No n Do not know not Do

2009 2009 Data CollectionPolicies Employment Policies andBenefits 25. n 24. 23. n 22. n 21. n n n n n n 26. Do you have an officially recognized LGBT employee resource group? group? resource employee LGBT recognized officially an have you Do employees? benefits-eligible your to coverage insurance health partner opposite-sex) and same- (or same-sex offer you Do credit. receive to copy a submit to need you changes, reporting are or time, first the for policy your reporting are you If Note: policy. opportunity employment equal or non-discrimination your of copy a attach Please board? advisory or governing a on serving person LGBT openly or organization LGBT an of representative a have you Do orientation”? “sexual term the include policy opportunity employment equal or non-discrimination primary your Does E-mail n Group of Name n information. contact following the provide please YES, If equal or non-discrimination your where address web public the provide please applicable, If n Which of the following are included on your patient intake/information forms? (please indicate all that apply): Yes Yes Yes

Do not know/info not available not know/info not Do n partners opposite-sex and same- both Includes n partners? define you do how YES, If employment opportunity policy is posted. is policy opportunity employment Flexibility in indication of preferred name and gender and name preferred of indication in Flexibility status transgender includes that gender of Designation maker decision medical as others or partner domestic of Designation kin of next as others or partner domestic of Designation status parental or partnership unmarried otherwise or partnership domestic of Designation policies Visitation n n n n No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, year one next the in to plan we but No, Address Web n Name Contact n n n n No No No Includes same-sex partners only partners same-sex Includes n n n n Do not know not Do know not Do know not Do Phone n n Not Applicable Not

37 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix D 38 www.hrc.org/hei HEALTHCARE EQUALITY INDEX appendix D

n 28. n 27. 31. 30. n 29.

optional basis? optional attach here. attach an on transgender as self-identify to people allow that systems collections data have you Do basis? optional an on bisexual or gay lesbian, as self-identify to people allow that systems collections data have you Do If you have any additional information or supporting documents you would like to submit, please submit, to like would you documents supporting or information additional any have you If etc. community, LGBT the affect that services or practices innovative on information include could This employees. or patients LGBT views hospital your how illustrate would that information other any include Please proxy)? healthcare designated a or partner domestic registered a has patient a that record to able being (e.g., facility healthcare legal than other persons of track keeping permit that systems collection data have you Do spouses who have legal relationships to patients that give them rights that are relevant to your to relevant are that rights them give that patients to relationships legal have who spouses Yes Yes Yes n n n n n No, but we plan to in the next one year one next the in to plan we but No, year one next the in to plan we but No, year one next the in to plan we but No, n n n No No No n n n Do not know not Do know not Do know not Do

HEALTHCARE EQUALITY INDEX 2009: Creating a National Standard for Equal Treatment of Lesbian, Gay, Bisexual and Transgender Patients and Their Families

EDITORS James Beaudreau, GLMA Education & Policy Associate Ellen Kahn, HRC Family Project Director Tom Sullivan, HRC Family Project Deputy Director

AUTHOR Alison Delpercio, HRC Family & Workplace Project Coordinator

ABOUT THE GAY AND LESBIAN MEDICAL ASSOCIATION

The Gay and Lesbian Medical Association works to ensure equality in healthcare for lesbian, gay, bisexual and transgender individuals and healthcare professionals. GLMA achieves its goals by using HEALTHCARE EQUALITY INDEX healthcare expertise in professional education, public policy work, patient education and referrals, and the promotion of research. 39

ABOUT THE HRC FOUNDATION FAMILY PROJECT

The Human Rights Campaign Foundation Family Project aims to serve as a comprehensive resource for lesbian, gay, bisexual and transgender families. The project provides information on a wide range of issues, including adoption, civil unions, custody and visitation, donor insemination, family law, mar- www.hrc.org/hei riage, parenting, schools, senior health and housing, state laws and legislation, straight spouses and transgender issues. In addition to maintaining the most inclusive and up-to-date resources for LGBT families in the U.S., the project provides guidance to those who work closely with these families in various fields, such as adoption agencies, social workers and healthcare institutions.

ACKNOWLEDGMENTS

Thank you to HRC Law Fellow Matt Stiff for his assistance in the thorough review of policies received from participating facilities and preparation of the HEI report. We also acknowledge the contributions to this report by HRC staff Rob Falk and Lindsey Taylor and HRC Family Project interns Rachael McGarry and Hannah Cohen-Blair. Thanks to HRC staff Samir Luther for assistance in data analysis, Sarah Streyle for design and Janice Hughes and Carolyn Simon for editorial guid- ance.

We also extend special thanks to the HRC Workplace Project for its groundbreaking work on the Corporate Equality Index on which the Healthcare Equality Index is based. HEALTHCARE EQUALITY INDEX ADVISORY COUNCIL

The Healthcare Equality Index Advisory Council supports the Human Rights Campaign Foundation Family Project and Gay and Lesbian Medical Association’s Healthcare Equality Index initiative. While not serving as official representatives of their employers, members provide expert advice and counsel on LGBT healthcare issues based on their professional experience and knowledge.

Rebecca Allison, M.D. Romana Hasnain-Wynia, Ph.D. Section Head, Cardiology Director, Center for Healthcare Equality CIGNA Medical Group of Arizona Feinberg School of Medicine Phoenix, Ariz. Chicago, Ill.

Desiray Bailey, M.D. Hutson W. Inniss Hospital Chief of Staff Vice President of Community Group Health Central Hospital and Organizational Development Seattle, Wash. Tapestry Health Systems Inc. Springfield, Mass. Julian Myers Benton Independent Consultant Kevin Jordan, M.D. HEALTHCARE EQUALITY INDEX Great Falls, Va. Chief Medical Officer Touro Infirmary 40 Diane Bruessow, RPA-C New Orleans, La. President LGBT Physician Assistant Caucus Ritchie Miller Middle Village, N.Y. Senior Associate Analytic & Forensic Technology Sonya Bruton Deloitte Financial Advisory Services LLP Altarum Institute Washington, D.C. Washington, D.C. Randall Sell www.hrc.org/hei Leslie Calman Associate Professor Executive Director Department of Community Health The Mautner Project and Prevention Washington, D.C. Drexel School of Public Health Philadelphia, Pa. Mary Foley Associate Director David Staats, M.D. Center for Research and Innovation Director in Patient Care Geriatric Medicine Fellowship UCSF School of Nursing Training Program San Francisco, Calif. University of Oklahoma Oklahoma City, Okla. Robert Garofalo, M.D. Deputy Director Paul Wertsch, M.D. The Howard Brown Health Center Wildwood Family Clinic Chicago, Ill. Madison, Wis. NOTES 41 www.hrc.org/hei HEALTHCARE EQUALITY INDEX 42 www.hrc.org/hei HEALTHCARE EQUALITY INDEX NOTES

Human Rights Campaign Foundation Gay and Lesbian Medical Association 1640 Rhode Island Ave., N.W. 459 Fulton St., Suite 107 Washington, D.C. 200036 San Francisco, CA 94102 phone 202-628-4160 phone 415-255-4547 TTY 202-216-1572 fax 866-304-3257 fax 415-255-4784 hrc.org/hei [email protected] glma.org [email protected]

ISBN 13: 978-1-934765-10-4 ISBN 10: 1-934765-10-4