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healthcare EQUALITY INDEX 2O1O Creating a National Standard for Equal Treatment of Lesbian, Gay, Bisexual and Transgender Patients and Their Families “There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital...”

President Barack Obama in an April 2010 presidential memorandum, directing the Secretary of the U.S. Department of Health and Human Services to protect the visitation and medical decision-making rights of LGBT people. healthcare EQUALITY INDEX 2O1O Creating a National Standard for Equal Treatment of Lesbian, Gay, Bisexual and Transgender Patients and Their Families

contents

5 Letter from HRC Foundation President Joe Solmonese

6 Overview of Findings 9 HEI 2010 Top Performers

10 Methodology & Rating Criteria 10 Methodology 10 Rating Criteria 12 Changes from 2009

14 Findings: HEI 2010 Rating Criteria 14 Patient Non-Discrimination Policies 16 Visitation Policies 18 Cultural Competency Training 22 Employment Non-Discrimination Policies

24 Findings: Additional Best Practices & Policies 24 Advance Healthcare Directive Compliance Training 28 Transgender Health Benefits 28 Partner Health Benefits 30 LGBT Employee Groups 30 Data Collection Policies

33 Appendices 33 Appendix A: HEI-Rated Facilities and Breakdown of Responses 39 Appendix B: HEI-Rated Facilities by State 45 Appendix C: HEI-Rated Facilities by Network 51 Appendix D: Testimonials from HEI 2010 Top Performers 61 Appendix E: LGBT Patient Protections within 200 of the Largest U.S. Hospitals

69 Acknowledgments 69 About the HRC Foundation Family Project

71 Healthcare Equality Index Advisory Council

72 a dedication

©2010 by the Human Rights Campaign Foundation. The Human Rights Campaign Foundation owns all right, title and interest in and to this publication and all derivative works thereof. Permission for reproduction and redistribution is granted if the publication is (1) reproduced in its entirety and (2) distributed free of charge. The Human Rights Campaign name and the Equality logo are trademarks of the Human Rights Campaign. The Human Rights Campaign Foundation and design incorporating the Equality logo are trademarks of the Human Rights Campaign Foundation.

ISBN 13: 978-1-934765-16-6 ISBN 10: 1-934765-16-3

healthcare equality index 2O1O www.hrc.org/hei 3 “The Joint Commission’s vision is that all people always experience the safest, highest-quality, best-value healthcare across all settings. Recently, The Joint Commission convened an expert panel to advance effective communication, cultural competence, and patient- and family-centered care in hospitals. The panel produced new and revised standards, which include language that expresses the commitment of hospitals to prohibit discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression. These standards are an important step toward meeting our mission to continuously improve healthcare for all. The Healthcare Equality Index fills an important role in this effort.W e congratulate the HEI project and the participating healthcare organizations for engaging in this work.”

The Joint Commission

4 letter from hrc foundation president joe solmonese

This has been a landmark year in the fight to make healthcare equality a reality in America. While considerable work remains to be done, it is clear that a sea change in the healthcare landscape for lesbian, gay, bisexual and transgender Americans is now under way.

Within just the past few months, the agency responsible for the accreditation and certification of healthcare facilities nationwide, The Joint Commission, announced new, fully inclusive patient non-discrimination standards as part of its accreditation process. This means that healthcare facilities nationwide — from Mississippi to Montana and Alabama to Alaska — will soon be accredited based on their respect for all patients. While there is no doubt that this is a critical step forward, there’s no reason why healthcare facilities shouldn’t do the right thing and voluntarily adopt these standards now.

This important development came shortly before another breakthrough: President Barack Obama’s directive that patients have the right to designate their visitors in hospital settings and have their choices respected about who will make key healthcare decisions for them. The president was moved to action by the tragic story of Janice Langbehn, who was denied access to her partner, Lisa Pond, in her final hours of life. It is entirely fitting that the Healthcare Equality Index 2010 is dedicated to Lisa’s memory and Janice’s advocacy.

Even with those important developments, we will still have much work to do.

As the Healthcare Equality Index 2010 illustrates, our nation’s hospital system is simply not meeting the needs of LGBT patients and their families. In this report, you will find two compelling snapshots of the healthcare industry:

zz The HEI 2010 rates 178 facilities on four measures of equality: patient non- discrimination, visitation, cultural competency training and employment non- discrimination. Only a handful of facilities achieved credit for each of these measures. However, there were some important bright spots. We are pleased to recognize Kaiser Permanente Network as the HEI’s first top-performing network of hospitals.

zz This report also includes the review of a representative sample of 200 of the largest healthcare facilities nationwide, which found that 93 percent fail to protect all LGBT patients from discrimination by not including “gender identity” in their patient non-discrimination policies. More than 40 percent do not include “sexual orientation” in these policies.

These barriers to equal access have serious consequences for LGBT patients and their families, who often delay treatment to avoid the challenging, embarrassing or openly hostile situations that may arise in a healthcare setting. The patchwork of regulations and policies that may cover, deny or ignore these issues creates a climate of uncertainty for LGBT people. Our unified message is clear: LGBT patients deserve access to high- quality healthcare — free from discrimination — in every healthcare facility in America.

Lastly, we are indebted to the hospital administrators and healthcare professionals who dedicate themselves every day to making healthcare equality a reality in America. We also thank LGBT patients and their families who continue to share their stories, reminding us all of the urgent need to end discrimination wherever and however it may occur.

Sincerely,

Joe Solmonese, President Human Rights Campaign Foundation

healthcare equality index 2O1O www.hrc.org/hei 5 overview of findings

The Healthcare Equality Index is an annual survey of healthcare policies and practices related to lesbian, gay, bisexual and transgender patients and their families. This report details the results of the 2010 survey, outlining the responses from 178 healthcare facilities from 21 states and the District of Columbia. Thirteen healthcare networks submitted surveys covering a total of 141 network facilities. The balance of the data comes from 37 surveys representing individual, non-network facilities.

While the HEI focuses primarily on U.S. hospitals, participation is open to the full range of healthcare facilities. The 2010 report includes data from 116 hospitals and 62 clinics. Thirty-four of the 178 facilities are rated for the first time this year. The complete list of HEI-rated facilities and their responses to the HEI 2010 survey is available as Appendix A on page 33.

Survey results show HEI-rated facilities are updating their policies and practices to ensure LGBT patients and their families are welcomed, respected and given culturally competent care. Several have updated their policies to protect LGBT patients from discrimination based on “sexual orientation” and/ or “gender identity.” They include HEI 2010 Top Performers: Baystate Medical Center, Dana-Farber Cancer Institute and The University of Texas MD Anderson Cancer Center. Notably, Kaiser Permanente Network (representing 31 hospitals) also amended its policy — making this network the first to achieve Top Performer status in the HEI. A complete list of HEI 2010 Top Performers is on page 9.

Legacy Health System (representing 21 facilities) amended its patient non- discrimination policy to include “sexual orientation.” However, the policy does not yet include “gender identity.” The same is true for Duke University Hospital.

Improvements have also been made in the area of employment protections. Both Beth Israel Deaconess Medical Center (Mass.) and Stanford University Hospital & Clinics updated their patient and employment non-discrimination policies to include “gender identity.” Advocate Illinois Masonic Medical Center, Oregon Health & Science University and University of California San Diego Medical Center also took the steps necessary to update their employment non- discrimination policies to include “gender identity” this year. These facilities now protect the entire LGBT community from employment discrimination.

In addition to these improvements, leading HEI-rated facilities updated their visitation policies to ensure equal access for same-sex couples and same-sex parents (more on page 16).

This is just a snapshot of the progress made since 2009. While this is encouraging, research conducted on 200 of the largest hospitals in the U.S. — independent of the HEI survey — found that only 58 percent of these hospitals protect patients from discrimination based on sexual orientation and a mere 7 percent protect patients from discrimination based on gender identity. (See Appendix E on page 61.)

6 healthcare equality index 2O1O www.hrc.org/hei overview of findings

Percent of participants that answered “yes” to each criterion, if applicable.

Criterion 1a 83.7%

Criterion 1b 29.2%

Criterion 2a 31.8%

Criterion 2b 32.3%

Criterion 3 53.4%

Criterion 4a 93.8%

Criterion 4b 52.2%

0 30 60 90

1a “Sexual Orientation” in Patients’ Bill of Rights and/or Non-Discrimination Policy 1b “Gender Identity” in Patients’ Bill of Rights and/or Non-Discrimination Policy 2a Equal Visitation Access for Same-Sex Couples 2b Equal Visitation Access for Same-Sex Parents 3 LGBT Cultural Competency Training for Staff 4a “Sexual Orientation” in Equal Employment Opportunity Policy 4b “Gender Identity” in Equal Employment Opportunity Policy

healthcare equality index 2O1O www.hrc.org/hei 7 overview of findings

Number of This year’s results include facilities from 21 states and the District of Columbia. Facilities For the first time, the HEI rated facilities from Maine, Missouri, Pennsylvania, Represented Texas and Virginia. California has the most rated facilities with 35, followed by by State Oregon (26 facilities), Michigan (22), Iowa (19) and Ohio (19). A complete list of HEI 2010-rated facilities by state is available as Appendix B on page 39.

l 1-4 Participant(s) l 5-10 Participants l 11-20 Participants l 21+ Participants 10 States & D.C. 6 States 2 States 3 States

D.C. Florida Iowa California Georgia Massachusetts Ohio Michigan Hawaii New York Oregon Illinois North Carolina Louisiana Virginia Maine Washington Maryland Missouri Pennsylvania Tennessee Texas

8 healthcare equality index 2O1O www.hrc.org/hei overview of findings

HEI 2010 Forty-two facilities (one network representing 31 hospitals, 8 individual hospitals and Top Performers 3 clinics) responded “yes” to each of the rated questions applying to them.

Advocate Illinois Masonic Medical Center Chicago, IL Baystate Medical Center Springfield, MA Beth Israel Medical Center New York, NY Callen-Lorde Community Health Center New York, NY Dana-Farber Cancer Institute Boston, MA Group Health Central Hospital Seattle, WA Kaiser Permanente Network (31 hospitals) Oakland, CA L.A. Gay & Lesbian Center Los Angeles, CA Penobscot Community Health Care Bangor, ME Rush University Medical Center Chicago, IL UCSF Medical Center San Francisco, CA The University of Texas MD Anderson Cancer Center Houston, TX

BEST HEALTHCARE FACILITY FOR LGBT FAMILIES Each Top Performer in this report is recognized as a “Best Healthcare Facility for LGBT Families” and is welcome to use this distinction in its advertising efforts. See www.hrc.org/best-health-facilities.

Testimonials To further illustrate LGBT inclusion within these institutions, this report includes testimonials from the eight top-performing individual hospitals. These testimonials describe in greater detail how these hospitals provide a welcoming environment and competent care for their LGBT patients and support their LGBT employees.

The testimonials are available in Appendix D on page 51 and online at www.hrc.org/best-health-facilities.

Advocate Illinois Masonic pg. 52 Making the Business Case for LGBT Inclusion Medical Center pg. 53 Baystate Medical Center Protecting all LGBT Patients from Discrimination Leveraging LGBT and Allied Employees: pg. 54 Beth Israel Medical Center The LGBT Employee Group Dana-Farber Demonstrating Commitment to LGBT pg. 55 Cancer Institute Staff & Families Group Health pg. 56 Translating Inclusive Practice into Policy Central Hospital Rush University Creating a Culture of Inclusion: pg. 57 Medical Center The Hospital Diversity Council Bringing Policies Alive: pg. 58 UCSF Medical Center LGBT Cultural Competency Staff Training Ensuring Successful Participation The University of Texas MD pg. 59 in the Healthcare Equality Index: Anderson Cancer Center An Incremental Approach

healthcare equality index 2O1O www.hrc.org/hei 9 methodology & rating criteria

Methodology The Healthcare Equality Index was created in partnership with the Gay and Lesbian Medical Association in 2007 as an annual survey focused on healthcare facilities’ LGBT-related policies and practices. The goals of the HEI are: 1) to benchmark healthcare facilities on identified best practices and policies with respect to equal treatment of LGBT patients and families; and 2) to share, implement and recognize these best practices with healthcare industry leaders. Now in its fourth year, the survey continues to address basic components of the healthcare experiences of LGBT people, including patient non-discrimination, visitation policies and cultural competency training, and the protection of LGBT employees through fair employment policies.

Invitations to complete the HEI 2010 survey were sent to facility contacts nationwide in October 2009. 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 HRC Family Project staff; generally, these contacts were the facility’s chief administrative officer, diversity or human resources professional or a marketing/ communications representative.

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

Healthcare The HEI 2010 survey included 31 questions, seven of which pertain to LGBT-specific Equality Index policy criteria and are rated in this report. The remaining questions were included for Rating Criteria informational purposes only. The HEI focuses on the following four policy criteria for rating purposes:

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 grant same-sex couples the same visitation access as different-sex couples and next of kin b. Visitation policies grant same-sex parents the same visitation access as different-sex parents for their minor children

3. Cultural Competency Training and Client Services Provide cultural competency training addressing healthcare issues relevant to the lesbian, gay, bisexual and transgender community

4. 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”

10 healthcare equality index 2O1O www.hrc.org/hei testimonial

“[Our] relationship with Chicago’s North Side LGBT community … has attracted hundreds (if not thousands) of new patients to the medical center annually ... Advocate Illinois Masonic Medical Center invests in the LGBT community, while the LGBT community recognizes that trust with clinical use. Doing the right thing truly does pay off.”

Marc A. Senesac, vice president of human resources, and Michael Swarzman, vice president of business development at Advocate Illinois Masonic Medical Center, discuss the business case for LGBT inclusion.

Read more in their testimonial on page 52.

11 methodology & rating criteria

Healthcare The Healthcare Equality Index survey is updated annually to capture Equality practices identified as emerging or positive trends in healthcare equality Index 2010: for LGBT patients and their families. Many new questions and the data that Changes are gathered from them are used for informational and reporting purposes from 2009 only. In some cases, new questions may become rated criteria for future HEI surveys. Below is an outline of updates made to the HEI 2010 survey.

Visitation Policies The HEI 2010 survey required documentation of explicitly inclusive visitation policy language that grants equal access to same-sex couples and/or same-sex parents.

Decision-Making Policies The decision-making policy section of the HEI 2010 survey has been updated to focus on compliance training for staff related to advance healthcare directives. These questions are not rated this year.

Cultural Competency Training The HEI 2010 survey asked participants to provide more details describing their LGBT cultural competency training, including information about topics covered, the mode in which training is delivered and the frequency of training.

In addition, the survey asked these training questions specifically for five staff groups: administrative staff, medical assistants and technicians, allied health professionals, nursing staff and physicians. For credit on this criterion, training must be offered for every group applicable but need not be mandatory.

Employment Policies & Benefits For the first time, the HEI 2010 survey asked participants whether or not they offer at least one health insurance plan that does not exclude coverage for medically necessary, transgender-related treatment and care. These questions are asked for informational purposes only and are not rated.

The survey continues to ask questions pertaining to partner benefits. These questions are also asked for informational purposes only and are not rated this year.

For more information about these changes and to view the complete HEI 2010 survey, visit www.hrc.org/issues/hei-2010-updates.htm.

12 healthcare equality index 2O1O www.hrc.org/hei testimonial

“At The University of Texas MD Anderson Cancer Center, everything we do is connected to our core values of caring, integrity and discovery. Participating in the HEI survey supports these values. … In 2008, we participated in our first HEI survey. … This helped us identify our needs and build upon our strengths.”

John Mendelsohn, M.D., president of The University of Texas MD Anderson Cancer Center, on the incremental approach the center took to participating in the HEI and achieving Top Performer status.

Read more in his testimonial on page 59.

13 findings hei 2O1O ratING criteria

Patient All patients deserve care free of discrimination, but the reality is that lesbian, gay, Non-Discrimination bisexual and transgender people face discrimination daily in healthcare settings. These Policies experiences of discrimination often prevent LGBT patients from accessing care in the future and, when they do, they may not discuss their sexual orientation or gender identity with their healthcare providers for fear of another negative encounter.

Healthcare facilities alleviate this problem by implementing patient non- discrimination policies that include both “sexual orientation” and “gender identity.” These policies make it clear that LGBT inclusion is a priority for facility staff and communicate a welcoming and affirming message to the LGBT community.

For more information on patient non-discrimination policies, including model policy language: www.hrc.org/issues/patient_rights.htm.

Criteria 1a Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation” 1b Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

Number of Hospitals that Responded “Yes”

1a 83.7%

1b 29.2%

0 30 60 90

83.7 percent of HEI-rated facilities (149 of 178) include sexual orientation in their Patients’ Bill of Rights and/or non-discrimination policy, while less than 30 percent (52 of 178 facilities) of those policies include “gender identity or expression” or “gender identity.”

Similar to the 2009 report, these survey results show a large disparity between the number of policies inclusive of sexual orientation and those inclusive of gender identity.

And since participation in the HEI is voluntary, it is expected that responses from HEI- rated hospitals actually tend to be more LGBT-inclusive than the U.S. hospital industry as a whole. This year, to get a clearer sense of where the industry stands, research independent from the HEI survey was conducted on the patient non-discrimination policies of 200 of the largest hospitals in the country.

The results confirm that LGBT patient protections are even weaker within U.S. hospitals than a review of the HEI survey data alone would lead one to conclude. Only 58 percent of the hospitals researched include “sexual orientation” in their patient non-discrimination policies. And only 7 percent include “gender identity.” Twelve of the 14 hospitals researched that included “gender identity” in their policies have participated in the HEI either individually or as part of a network.

More information on this research, including a list of the 200 hospitals and their policy information, is available in Appendix E on page 61.

14 healthcare equality index 2O1O www.hrc.org/hei testimonial

“When the HEI 2009 report was published, our Patients’ Bill of Rights did not include ‘gender identity or expression’ … We recognized this as an opportunity to improve. This gap helped us realize that our Patients’ Bill of Rights did not fully align with our mission and our operating principles. Having this commitment in print, now as part of our system-wide policy, gives us something to point to that says, ‘Yes, we support you and accept you wholly.’ It also gives us support when providing internal education: It shows that education about transgender issues and care is supported by the leadership of the organization.”

Visael “Bobby” Rodriguez, chief diversity officer of Baystate Health, on updating its Patients’ Bill of Rights to include “gender identity or expression.”

Read more in his testimonial on page 53.

15 findings HEI 2O1O rating criteria

Visitation The LGBT community has a long and rich history of challenging our society’s Policies traditional understanding of family. Some of these earliest challenges involved hospital visitation access. And still today, LGBT families, including same-sex couples (partners/spouses/significant others) and same-sex parents, are not always recognized as family due to inadequate visitation policies and staff training, leading to tragic circumstances of loved ones being denied visitation access.

President Obama acted to eliminate this inequality in April 2010 with a memorandum directing the Secretary of Health and Human Services to issue regulations requiring hospitals receiving Medicare and Medicaid funding to respect the right of all patients to designate visitors and to prohibit the denial of visitation access based on several factors, including sexual orientation and gender identity.

Best-practice visitation policies include a definition of family that is explicitly inclusive of same-sex couples and same-sex parents. This explicit policy language decreases the possibility of staff members interpreting these policies based on their own biases. The more explicit the policy, the better it ensures inclusion is translated into practice, protecting all patients’ and families’ rights.

For more information on visitation policies, including model policy language: www.hrc.org/issues/visitation-policies.htm.

Criteria 2a Visitation policies allow same-sex couples the same visitation access as different-sex couples and next of kin 2b Visitation policies allow same-sex parents the same visitation access as different-sex parents for their minor children

Number of Hospitals that Responded “Yes”

2a 31.8%

2b 32.3%

0 30 60 90

Policies meeting these criteria are explicitly inclusive of the LGBT community by: zz Including an explicitly inclusive definition of family within their existing, standalone visitation policy zz Referencing an explicitly inclusive definition of family, as part of a companion “definitions” policy section, within their existing, standalone visitation policy zz Prohibiting discrimination in visitation access based on “sexual orientation” and “gender identity”

31.8 percent of HEI-rated facilities for which this question was applicable (42 of 132 facilities) report having visitation policies that grant same-sex couples the same visitation access as different-sex couples and next of kin. 32.3 percent (42 of 130 facilities) have visitation policies that grant same-sex parents the same visitation access as different-sex parents for their minor children.

16 healthcare equality index 2O1O www.hrc.org/hei testimonial

“While we have long had a culture of inclusiveness and non-discrimination protections, participation in the HEI survey helped us see that our policies did not necessarily fully reflect our culture or set expectations of inclusive behavior and non-discriminatory practices for our staff … This realization moved Group Health forward in assuring … that hospital visitation policies included a definition of family that included spouses, domestic partners and both different-sex and same-sex significant others, and that the concept of parenthood was to be liberally construed without limitation for the purpose of visitation rights.”

Desiray Bailey, M.D., chief of medical staff, and Erin Leff, M.B.A., hospital administrator at Group Health Central Hospital, on updating its visitation policy to ensure equal access for same-sex couples and same-sex parents.

Read more in their testimonial on page 56.

17 findings HEI 2O1O rating criteria

Cultural Inclusive policies alone do not ensure LGBT individuals and families feel Competency safe, welcome and respected in healthcare facilities. Everyone who works in Training healthcare facilities — not only clinicians — should receive training on LGBT cultural competency, because an individual’s experience while accessing healthcare is influenced by everyone they interact with in the process.

For more information on cultural competency training: www.hrc.org/issues/cultural-competence.htm.

Criterion 3 Provide cultural competency training addressing healthcare issues relevant to the lesbian, gay, bisexual and transgender community

Number of Hospitals that Responded “Yes”

3 53.4%

0 30 60 90

This criterion requires participants to train each of the following staff groups, as they apply to their facility: administrative staff, medical assistants and technicians, allied health professionals, nurses and physicians.

53.4 percent of HEI-rated facilities (95 of 178 facilities) provide cultural competency training addressing healthcare issues relevant to the LGBT community to each applicable staff group. More specifically: zz 53.4 percent of HEI-rated facilities train administrative staff on LGBT cultural competency vv 44.2 percent of these facilities make these trainings mandatory for all administrative staff vv 8.4 percent require employees to update this training on an annual basis zz 65.7 percent train medical assistants and technicians vv 54.7 percent of these facilities make these trainings mandatory for all medical assistants and technicians vv 6 percent require an annual update zz 65.3 percent train allied health professionals vv 26.9 percent of these facilities make these trainings mandatory for all allied health professionals vv 5.2 percent require an annual update zz 65.7 percent train nursing staff vv 54.7 percent of these facilities make these trainings mandatory for all nursing staff vv 6.8 percent require an annual update zz 64 percent train physicians vv 9.6 percent of these facilities make these trainings mandatory for all physicians vv 7 percent require annual update

Administrative staff are most likely to receive this training online, while for each other staff group, these trainings are most likely to be offered in person as stand-alone, LGBT-specific trainings, rather than as online trainings or as part of general orientation/diversity trainings.

18 healthcare equality index 2O1O www.hrc.org/hei testimonial

“It’s one thing for people to read words on a page, and another for them to hear how those words actually help people have good healthcare and employment experiences … We would encourage all medical centers to consider LGBT training for their personnel. At UCSF, training has brought our LGBT policies and benefits alive, and played a vital part in creating a truly equitable and inclusive atmosphere.”

Shane Snowdon, director of the LGBT Resource Center at the University of California San Francisco, on the importance of LGBT cultural competency training.

Read more in her testimonial on page 58.

19 testimonial

“We have been a multi-year sponsor of many LGBT events … to ensure that all members of the LGBT community know they can come to Dana-Farber for cancer care, education and prevention ...

... In 2009, Dana-Farber received the Outstanding Employer of the Year award from the Greater Boston Business Council, the LGBT ‘chamber of commerce’ in Boston, for its work in the community and in creating a safe and welcoming place for its staff, patients and their families.”

Edward Benz, M.D., president and chief executive officer of the Dana-Farber Cancer Institute, on the facility’s commitment to LGBT staff and families.

Read more in his testimonial on page 55.

20 findings HEI 2O1O rating criteria

Cultural The HEI 2010 survey also asked for information on topics covered in these Competency trainings, focusing on the following core training topics: Training zz LGBT terminology zz LGBT demographics zz LGBT community: history and background zz Stories of LGBT bias and substandard care zz Barriers to care for the LGBT community zz Applicable state and local laws for LGBT people with respect to healthcare zz LGBT health risks zz LGBT health disparities zz LGBT sub-populations zz Primary care issues zz Patient-provider interactions zz Patient-staff interactions

The most-covered topics for each staff group include: LGBT terminology, barriers to care for the LGBT community and patient-staff interactions. Information on LGBT sub-populations is the least likely topic to be addressed in these trainings, even though these populations face multiple barriers to care and can have specific, nuanced healthcare needs. An example of this would be addressing any specific healthcare needs of African-American LGBT patients or LGBT immigrants.

healthcare equality index 2O1O www.hrc.org/hei 21 findings HEI 2O1O rating criteria

Employment Currently, federal law protects employees from discrimination on the basis of Non-Discrimination race, color, religion, sex (including pregnancy), national origin, age, disability and Policies genetic information. Federal law does not yet protect employees from discrimi- nation based on real or perceived sexual orientation or gender identity.

Twenty-one states and the District of Columbia have passed laws prohibiting employment discrimination based on sexual orientation; 12 states and the District of Columbia have passed laws prohibiting employment discrimination based on gender identity. At least 130 cities and counties throughout the U.S. prohibit employment discrimination based on both sexual orientation and gender identity.

A clear and defined non-discrimination (equal employment opportunity) policy with respect to conditions of employment — including hiring, promotions, termination and compensation — that includes “sexual orientation” and “gender identity” is an essential baseline policy for LGBT inclusion in the workplace.

For more information on statewide employment non-discrimination laws: www.hrc.org/about_us/state_laws.asp.

For more information on employment non-discrimination policies: www.hrc.org/about_equal_opportunity.asp.

Criteria 4a Equal employment opportunity policy includes “sexual orientation” 4b Equal employment opportunity policy includes “gender identity or expression” or “gender identity”

Number of Hospitals that Responded “Yes”

4a 93.8%

4b 52.2%

0 30 60 90

93.8 percent of HEI-rated facilities (167 of 178 facilities) bar employment discrimination based on sexual orientation, while only 52.2 percent (93 of 178 facilities) prohibit employment discrimination based on “gender identity or expression” or “gender identity.”

The Healthcare Equality Index primarily focuses on the experiences of LGBT patients and their families. However, a look at a facility’s employment policies and benefits pertaining to their LGBT employees can inform an assessment of its overall climate. The HEI rates facilities on two of the many policies and practices employers should implement to be inclusive of their LGBT employees.

For more information on LGBT inclusion in the workplace: www.hrc.org/workplace.

22 healthcare equality index 2O1O www.hrc.org/hei testimonial

“We strive to make Rush a place where personal differences are not just accepted, but understood, respected and valued … To advance this commitment, Rush established the Rush Diversity Leadership Group, which provides guidance about ways of promoting diversity, inclusion and equity. The DLG’s work reflects an understanding that the more we pay attention to and understand the diversity of our patients, staff, faculty and students, the more successful we will be as an institution of healing.”

Larry J. Goodman, M.D., president and chief executive officer of Rush University Medical Center, on the center’s commitment to fostering an LGBT-inclusive work environment.

Read more in his testimonial on page 57.

23 findings additional best practices & policies

In addition to questions related to the seven rated criteria discussed in this report, the HEI survey asked facilities for information on several other policies and practices related to the LGBT community. These questions focused on decision making, employee benefits, employee groups and data collection.

Advance Advance healthcare directives (i.e., durable powers of attorney, healthcare proxies and Healthcare living wills) allow individuals to express their healthcare wishes and designate surrogates Directive who may make medical decisions on their behalf in the event of mental incapacity. Compliance Training Due to the lack of LGBT relationship recognition laws in most states, and because most default medical decision-making law is not inclusive of LGBT families, it is especially important that same-sex couples complete directives to ensure their ability to make medical decisions for incapacitated partners. Unfortunately, LGBT individuals come forward with tragic stories of hospitals failing to recognize these directives at critical moments of emergency and end-of-life medical treatment.

The April 2010 memorandum sent by President Obama to the Secretary of Health and Human Services also clarifies that existing federal regulations require hospitals participating in Medicare or Medicaid to respect all patients’ advance healthcare directives. The failure to do so indicates a breakdown in compliance due to inadequate staff training or insufficient policy language.

To better understand the implementation and enforcement of these policies and to identify best practices in this area, the HEI 2010 survey asked questions focused on advance healthcare directive compliance training.

45 percent of HEI-rated facilities provide advance healthcare directive compliance training to all applicable staff groups. More specifically: zz 47.5 percent train administrative staff on compliance to advance healthcare directive policies vv 39.3 percent of these make this training mandatory for all administrative staff vv 17.9 percent require that this training be updated on an annual basis zz 49.2 percent train medical assistants and technicians vv 39.1 percent of these make this training mandatory for all medical assistants and technicians vv 17.2 percent require an annual update zz 51.4 percent train allied health professionals vv 36.3 percent make this training mandatory for all allied health professionals vv 17.6 percent require an annual update zz 56.5 percent train nursing staff vv 45 percent of these facilities make this training mandatory for all nursing staff vv 16 percent require an annual update zz 40 percent train physicians vv 36.3 percent make this training mandatory for all physicians vv 10 percent require an annual update

24 healthcare equality index 2O1O www.hrc.org/hei 25 “Historically, LGBT people have received healthcare from providers who have been disrespectful, judgmental and insensitive. As the premier LGBT health and social services organization in Southern California for 36 years, we have sought to heal the damage caused by discrimination based on sexual orientation and gender identity, in large part by providing high-quality health and mental health services in a compassionate, accepting and culturally sensitive manner.”

Darrel Cumming Chief of Staff, L.A. Gay & Lesbian Center HEI 2010 Top-Performing Clinic

26 findings additional best practices & policies

Advance The survey also asked what topics are covered in this training. The most Healthcare frequently covered topics included: Directive zz State law and policies on the recognition of valid advance healthcare directives Compliance zz State law and policies on default surrogate selection Training when no advance healthcare directive exists zz Procedure for documenting advance healthcare directives in medical records zz Reciprocal recognition of advance healthcare executed in another state

These trainings are far less likely to discuss advance healthcare directive policies in relationship to the LGBT community. For example, in the case of nursing staff: zz Only 56 percent of HEI-rated facilities that train nurses on advance healthcare directive compliance include information on state relationship recognition law and surrogate decision-making rights for same-sex couples in this training. zz 21 percent include example scenarios related to advance healthcare directive policy and practice and only 7 percent include scenarios explicitly involving LGBT individuals/same-sex couples.

Only one percent of the HEI-rated facilities train any nurses on the medical decision-making rights of same-sex parents for their minor children within these trainings. There remain significant gaps in the law when it comes to protecting the decision-making rights of same-sex parents. Due to the current patchwork of state parenting laws, this is an especially complex area for healthcare personnel to navigate — especially without adequate training.

For more information on advance healthcare directive policies: www.hrc.org/issues/decision-making-policies.htm.

healthcare equality index 2O1O www.hrc.org/hei 27 findings additional best practices & policies

Transgender Transgender-inclusive health insurance benefits — insurance that covers Health sex reassignment surgery and related treatment as defined by the World Benefits Professional Association for Transgender Health — are critically important for many transgender people and are historically of insignificant cost to an employer. But, because of pervasive “transgender exclusions,” many health insurance plans in the United States regularly deny transgender people coverage for even basic medical treatments unrelated to being transgender, or would only cover harmful, so-called “reparative therapy” and related treatments.

Since 2006, the HRC Foundation has made it a primary goal to work with employers to end health insurance discrimination against transgender people by requiring Corporate Equality Index survey participants to examine their insurance policies for these transgender exclusions. The HRC Foundation began sharing this work with HEI participants this year and will continue to share related resources with HEI-rated facilities.

Among HEI-rated facilities this year, 10.6 percent offer transgender- inclusive benefits, 19 facilities total (one individual hospital and one network which represents 18 facilities).

For more information on transgender-inclusive health benefits: www.hrc.org/issues/transgender_inclusive_benefits.htm.

Partner On average, roughly 20 percent of employees’ overall compensation is Health provided in the form of health insurance benefits for themselves and/or Benefits their families. For employees with partners and/or children not eligible for those benefits, the resulting disparity in compensation is profound. These are low-cost, high-value employment benefits and are now the norm among employers committed to recruiting and retaining LGBT employees.

88.2 percent of HEI-rated facilities (157 of 178 facilities) offer health insurance coverage to their employees’ domestic partners.

For more information on domestic partner benefits: www.hrc.org/issues/domestic_partner_benefits.htm.

28 healthcare equality index 2O1O www.hrc.org/hei “The Healthcare Equality Index is a critical tool in reforming healthcare delivery. As an LGBT- focused primary care center, we hear daily reports from patients about the lack of knowledge and sensitivity in the healthcare system at large. Cultural competency will be a critical component of successful expansion of healthcare access.”

Wendy Stark Executive Director, Callen-Lorde Community Health Center HEI 2010 Top-Performing Clinic

29 findings additional best practices & policies

LGBT LGBT employee groups can provide guidance and input on a facility’s policies and Employee practices and help provide a sense of safety, acceptance and respect for LGBT Groups employees within the facility by maintaining a visible presence and establishing a meaningful voice within the facility.

50 percent of HEI-rated facilities (89 of 178 facilities) have an officially recognized LGBT employee group.

For more information on employee groups: www.hrc.org/issues/employee-groups.htm.

Data Intake Forms Collection All patient-history and intake forms should use language that is inclusive of LGBT Policies patients and their families. For example, choices for relationship status should include terms such as “partnered” in addition to “single,” “married,” “divorced,” etc. Also, these forms should allow for flexibility in the options for gender identification, including an option for transgender (both male-to-female and female-to-male). zz 55.6 percent have intake forms that include information on their visitation policies zz 38.2 percent allow for the designation of domestic partnership or otherwise unmarried partnership or parental status within these forms zz 53.4 percent allow for the designation of domestic parner or other as next of kin on these forms zz 30.9 percent have intake forms that allow for the designation of domestic partner or others as medical decision maker zz 24.2 percent allow for designation of transgender status on intake forms zz 23 percent have intake forms that allow for flexibility in identification of name and gender

Data Collection Systems The value of inclusive intake forms is diminished when data collection systems do not allow providers to capture this information. Tracking LGBT status — while not requiring this information from patients who prefer not to disclose or have it in their medical records — facilitates the assessment of health outcomes according to sexual orientation and gender identity. zz 17.4 percent have data collection systems that allow people to self-identify as lesbian, gay or bisexual zz 5.6 percent have data collections systems that allow people to self-identify as transgender zz 72.5 percent have data collection systems that permit the tracking of persons other than legal spouses who have legal relationships to patients relevant to the healthcare facility

For more information on data collection: www.hrc.org/issues/data-collection-policies.htm.

30 healthcare equality index 2O1O www.hrc.org/hei testimonial

“The goal of [our LGBT] committee is to establish and maintain a culture of inclusion within which all LGBT patients and staff feel that they are in a safe, supportive and non-judgmental setting ...

... The [LGBT] committee developed a list of ‘Top Ten Provider Tips for Serving the LGBT Patient Population’ … this was distributed to providers through a blast e-mail to all medical center staff, and was also posted in patient care areas. The tips list (as well as other resources) remains accessible to providers and staff via the medical center’s intranet website.”

Members of the LGBT Committee describe their contributions to ensuring LGBT healthcare equality at Beth Israel Medical Center.

Read more in their testimonial on page 54.

31 32 appendix A hei-rated facilities and breakdown of responses

Healthcare Equality Index Rating Criteria

1a Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation”

1b Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

2a Visitation policies grant same-sex couples the same visitation access as different-sex couples and next of kin

2b Visitation policies grant same-sex parents the same visitation access as different-sex parents for their minor children

3 Provide cultural competency training addressing healthcare issues relevant to the lesbian, gay, bisexual and transgender community

4a Equal employment opportunity policy includes “sexual orientation”

4b Equal employment opportunity policy includes “gender identity or expression” or “gender identity”

healthcare equality index 2O1O www.hrc.org/hei 33 appendix A HEI-rated facilities and breakdown of responses

l yes l no l not applicable

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

A. Alfred Taubman Health Care Center Ann Arbor MI l l l l l l l Advocate Illinois Masonic Medical Center Chicago IL l l l l l l l l Ames Center Ames IA l l l l l l l Ankeny Center Ankeny IA l l l l l l l Annie Penn Hospital Reidsville NC l l l l l l l Barnes-Jewish Hospital St. Louis MO l l l l l l l Baystate Medical Center Springfield MA l l l l l l l l Bedford Medical Center Bedford OH l l l l l l l Behavioral Health Center Greensboro NC l l l l l l l Beth Israel Deaconess Medical Center Boston MA l l l l l l l Beth Israel Medical Center New York NY l l l l l l l l Brigham and Women’s Hospital Boston MA l l l l l l l Brighton Health Center Brighton MI l l l l l l l Bronx Health Center Bronx NY l l l l l l l Brooks Rehabilitation Hospital Jacksonville FL l l l l l l l Callen-Lorde Community Health Center New York NY l l l l l l l l Canton Health Center Canton MI l l l l l l l Case Medical Center Cleveland OH l l l l l l l Cedar Falls Center Cedar Falls IA l l l l l l l Chelsea Health Center Chelsea MI l l l l l l l Children’s Hospital of Philadelphia Philadelphia PA l l l l l l l Cleveland Clinic Cleveland OH l l l l l l l Clinton Memorial Hospital Saint Johns MI l l l l l l l Commonwealth Neuropsychology Clinic Ann Arbor MI l l l l l l l Conneaut Medical Center Conneaut OH l l l l l l l Creston Center Creston IA l l l l l l l Dana-Farber Cancer Institute Boston MA l l l l l l l l Dexter Family Medicine Dexter MI l l l l l l l Domino’s Farms Health Center Ann Arbor MI l l l l l l l Duke University Hospital Durham NC l l l l l l l East Ann Arbor Ambulatory Surgery & Medical Ann Arbor MI l l l l l l l Procedures Center East Ann Arbor Health & Geriatrics Center Ann Arbor MI l l l l l l l East County Health Center Gresham OR l l l l l l l Emory University Hospital Atlanta GA l l l l l l l Euclid Hospital Euclid OH l l l l l l l Fairview Hospital Cleveland OH l l l l l l l Faulkner Hospital Boston MA l l l l l l l Fort Dodge Center Fort Dodge IA l l l l l l l Geauga Medical Center Chardon OH l l l l l l l Geneva Medical Center Geneva OH l l l l l l l George Washington University Hospital Washington DC l l l l l l l Group Health Central Hospital Seattle WA l l l l l l l l Harborview Medical Center Seattle WA l l l l l l l

34 healthcare equality index 2O1O www.hrc.org/hei appendix A HEI-rated facilities and breakdown of responses

l yes l no l not applicable

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

Harvard Vanguard Medical Associates Newton MA l l l l l l l Healthy Connections Des Moines IA l l l l l l l Hillcrest Hospital Mayfield Heights OH l l l l l l l Howell Pediatrics and Teen Center Howell MI l l l l l l l Huron Hospital East Cleveland OH l l l l l l l Iowa City Center Iowa City IA l l l l l l l Iowa Methodist Medical Center Des Moines IA l l l l l l l Ireland Cancer Center Cleveland OH l l l l l l l Jackson Memorial Hospital Miami FL l l l l l l l Jackson North Medical Center North Miami Beach FL l l l l l l l Jackson South Community Hospital Miami FL l l l l l l l Joe DiMaggio Children’s Hospital Hollywood FL l l l l l l l Johns Hopkins Hospital Baltimore MD l l l l l l l Kaiser Permanente Anaheim Medical Center Anaheim CA l l l l l l l l Kaiser Permanente Baldwin Park Medical Center Baldwin Park CA l l l l l l l l Kaiser Permanente Bellflower Medical Center Bellflower CA l l l l l l l l Kaiser Permanente Fontana Medical Center Fontana CA l l l l l l l l Kaiser Permanente Fremont Medical Center Fremont CA l l l l l l l l Kaiser Permanente Fresno Medical Center Fresno CA l l l l l l l l Kaiser Permanente Hayward Medical Center Hayward CA l l l l l l l l Kaiser Permanente Los Angeles Medical Center Los Angeles CA l l l l l l l l Kaiser Permanente Manteca Medical Center Manteca CA l l l l l l l l Kaiser Permanente Moanalua Medical Center Honolulu HI l l l l l l l l Kaiser Permanente Oakland Medical Center Oakland CA l l l l l l l l Kaiser Permanente Panorama City Medical Center Panorama City CA l l l l l l l l Kaiser Permanente Redwood City Medical Center Redwood City CA l l l l l l l l Kaiser Permanente Richmond Medical Center Richmond CA l l l l l l l l Kaiser Permanente Riverside Medical Center Riverside CA l l l l l l l l Kaiser Permanente Roseville Medical Center Roseville CA l l l l l l l l Kaiser Permanente Sacramento Medical Center Sacramento CA l l l l l l l l Kaiser Permanente San Diego Medical Center San Diego CA l l l l l l l l Kaiser Permanente San Francisco Medical Center San Francisco CA l l l l l l l l Kaiser Permanente San Rafael Medical Center San Rafael CA l l l l l l l l Kaiser Permanente Santa Clara Medical Center Santa Clara CA l l l l l l l l (Kiely Campus) Kaiser Permanente Santa Rosa Medical Center Santa Rosa CA l l l l l l l l Kaiser Permanente Santa Teresa Medical Center San Jose CA l l l l l l l l Kaiser Permanente South Bay Medical Center Harbor City CA l l l l l l l l Kaiser Permanente South Sacramento Medical Sacramento CA l l l l l l l l Center Kaiser Permanente South San Francisco Medical South San Francisco CA l l l l l l l l Center Kaiser Permanente Sunnyside Medical Center Clackamas OR l l l l l l l l Kaiser Permanente Vallejo Medical Center Vallejo CA l l l l l l l l Kaiser Permanente Walnut Creek Medical Center Walnut Creek CA l l l l l l l l

healthcare equality index 2O1O www.hrc.org/hei 35 appendix A HEI-rated facilities and breakdown of responses

l yes l no l not applicable

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

Kaiser Permanente West Los Angeles Medical Los Angeles CA l l l l l l l l Center Kaiser Permanente Woodland Hills Medical Center Woodland Hills CA l l l l l l l l Knoxville Center Knoxville IA l l l l l l l L.A. Gay & Lesbian Center Los Angeles CA l l l l l l l l La Clinica de la Buena Salud Health Center Portland OR l l l l l l l LAC/USC Medical Center Los Angeles CA l l l l l l l Lakewood Hospital Lakewood OH l l l l l l l Legacy Clinic Battle Ground Battle Ground WA l l l l l l l Legacy Clinic Canby Canby OR l l l l l l l Legacy Clinic Emanuel Portland OR l l l l l l l Legacy Clinic Firwood Sandy OR l l l l l l l Legacy Clinic Fisher’s Landing Vancouver WA l l l l l l l Legacy Clinic Good Samaritan Portland OR l l l l l l l Legacy Clinic Mount Hood Gresham OR l l l l l l l Legacy Clinic Northeast Portland OR l l l l l l l Legacy Clinic Northwest Portland OR l l l l l l l Legacy Clinic Salmon Creek Vancouver WA l l l l l l l Legacy Clinic St. Helens St. Helens OR l l l l l l l Legacy Clinic Tigard-King City Portland OR l l l l l l l Legacy Clinic Tualatin Tualatin OR l l l l l l l Legacy Clinic West Linn West Linn OR l l l l l l l Legacy Clinic Woodburn Woodburn OR l l l l l l l Legacy Emanuel Children’s Hospital Portland OR l l l l l l l Legacy Emanuel Hospital & Health Center Portland OR l l l l l l l Legacy Good Samaritan Hospital Portland OR l l l l l l l Legacy Meridian Park Hospital Tualatin OR l l l l l l l Legacy Mount Hood Medical Center Gresham OR l l l l l l l Legacy Salmon Creek Hospital Vancouver WA l l l l l l l Livonia Center for Specialty Care Livonia MI l l l l l l l Lutheran Hospital Cleveland OH l l l l l l l Lutheran Medical Center Brooklyn NY l l l l l l l MacDonald Women’s Hospital Cleveland OH l l l l l l l Massachusetts General Hospital Boston MA l l l l l l l Medical Center of Louisiana New Orleans LA l l l l l l l Memorial Hospital Miramar Miramar FL l l l l l l l Memorial Hospital Pembroke Pembroke Pines FL l l l l l l l Memorial Hospital West Pembroke Pines FL l l l l l l l Memorial Regional Hospital Hollywood FL l l l l l l l Memorial Regional Hospital South Hollywood FL l l l l l l l Mid County Health Center Portland OR l l l l l l l Moses H. Cone Memorial Hospital Greensboro NC l l l l l l l New Hope Outreach Clinic Ann Arbor MI l l l l l l l

36 healthcare equality index 2O1O www.hrc.org/hei appendix A HEI-rated facilities and breakdown of responses

l yes l no l not applicable

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

New York Presbyterian Hospital New York NY l l l l l l l Newton Center Newton IA l l l l l l l North Portland Health Center Portland OR l l l l l l l Northeast Portland Health Center Portland OR l l l l l l l Oregon Health & Science University Hospital Portland OR l l l l l l l Pennsylvania Hospital Philadelphia PA l l l l l l l Penobscot Community Health Care Bangor ME l l l l l l l l Piedmont Hospital Atlanta GA l l l l l l l Psychiatry Ambulatory Services Ann Arbor MI l l l l l l l Quad Cities Center Bettendorf IA l l l l l l l Rainbow Babies and Children’s Hospital Cleveland OH l l l l l l l Red Oak Center Red Oak IA l l l l l l l Richmond Medical Center Richmond Heights OH l l l l l l l Rosenfield Center Des Moines IA l l l l l l l Rush University Medical Center Chicago IL l l l l l l l l Saline Health Center Saline MI l l l l l l l Sentara Bayside Hospital Virginia Beach VA l l l l l l l Sentara CarePlex Hospital Hampton VA l l l l l l l Sentara Leigh Hospital Norfolk VA l l l l l l l Sentara Norfolk General Hospital Norfolk VA l l l l l l l Sentara Obici Hospital Suffolk VA l l l l l l l Sentara Potomac Hospital Woodbridge VA l l l l l l l Sentara Virginia Beach General Hospital Virginia Beach VA l l l l l l l Sentara Williamsburg Regional Medical Center Williamsburg VA l l l l l l l Sioux City Center Sioux City IA l l l l l l l South Pointe Hospital Warrensville Heights OH l l l l l l l Southeast Portland Health Center Portland OR l l l l l l l Sparrow Hospital Lansing MI l l l l l l l Sparrow Specialty Hospital Lansing MI l l l l l l l Spencer Center Spencer IA l l l l l l l St. Lawrence Hospital Lansing MI l l l l l l l St. Mary Medical Center Long Beach CA l l l l l l l Stanford Hospital and Clinics Stanford CA l l l l l l l Storm Lake Center Storm Lake IA l l l l l l l Susan Knapp Health Center Des Moines IA l l l l l l l The Family Practice Center Des Moines IA l l l l l l l UCSF Medical Center San Francisco CA l l l l l l l l UM Briarwood Medical Group Ann Arbor MI l l l l l l l University Hospital Ann Arbor MI l l l l l l l University Hospitals Extended Care Campus Chardon OH l l l l l l l University of California San Diego Medical Center San Diego CA l l l l l l l The University of Texas MD Anderson Cancer Center Houston TX l l l l l l l l University of Toledo Medical Center Toledo OH l l l l l l l University of Washington Medical Center Seattle WA l l l l l l l Vanderbilt University Medical Center Nashville TN l l l l l l l

healthcare equality index 2O1O www.hrc.org/hei 37 38 appendix B hei-rated facilities by state

Healthcare Equality Index Rating Criteria

1a Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation”

1b Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

2a Visitation policies grant same-sex couples the same visitation access as different-sex couples and next of kin

2b Visitation policies grant same-sex parents the same visitation access as different-sex parents for their minor children

3 Provide cultural competency training addressing healthcare issues relevant to the lesbian, gay, bisexual and transgender community

4a Equal employment opportunity policy includes “sexual orientation”

4b Equal employment opportunity policy includes “gender identity or expression” or “gender identity”

healthcare equality index 2010 www.hrc.org/hei 39 APPENDIX B HEI-RATED FACILITIES BY STATE

● YES ● NO ● NOT APPLICABLE

Facility Name City Top Performer 1a 1b 2a 2b 3 4a 4b

CALIFORNIA Kaiser Permanente Anaheim Medical Center Anaheim ● ● ● ● ● ● ● ● Kaiser Permanente Baldwin Park Medical Center Baldwin Park ● ● ● ● ● ● ● ● Kaiser Permanente Bellflower Medical Center Bellflower ● ● ● ● ● ● ● ● Kaiser Permanente Fontana Medical Center Fontana ● ● ● ● ● ● ● ● Kaiser Permanente Fremont Medical Center Fremont ● ● ● ● ● ● ● ● Kaiser Permanente Fresno Medical Center Fresno ● ● ● ● ● ● ● ● Kaiser Permanente South Bay Medical Center Harbor City ● ● ● ● ● ● ● ● Kaiser Permanente Hayward Medical Center Hayward ● ● ● ● ● ● ● ● St. Mary Medical Center Long Beach ● ● ● ● ● ● ● Kaiser Permanente Los Angeles Medical Center Los Angeles ● ● ● ● ● ● ● ● Kaiser Permanente West Los Angeles Medical Center Los Angeles ● ● ● ● ● ● ● ● L.A. Gay & Lesbian Center Los Angeles ● ● ● ● ● ● ● ● LAC/USC Medical Center Los Angeles ● ● ● ● ● ● ● Kaiser Permanente Manteca Medical Center Manteca ● ● ● ● ● ● ● ● Kaiser Permanente Oakland Medical Center Oakland ● ● ● ● ● ● ● ● Kaiser Permanente Panorama City Medical Center Panorama City ● ● ● ● ● ● ● ● Kaiser Permanente Redwood City Medical Center Redwood City ● ● ● ● ● ● ● ● Kaiser Permanente Richmond Medical Center Richmond ● ● ● ● ● ● ● ● Kaiser Permanente Riverside Medical Center Riverside ● ● ● ● ● ● ● ● Kaiser Permanente Roseville Medical Center Roseville ● ● ● ● ● ● ● ● Kaiser Permanente Sacramento Medical Center Sacramento ● ● ● ● ● ● ● ● Kaiser Permanente South Sacramento Medical Center Sacramento ● ● ● ● ● ● ● ● Kaiser Permanente San Diego Medical Center San Diego ● ● ● ● ● ● ● ● University of California San Diego Medical Center San Diego ● ● ● ● ● ● ● Kaiser Permanente San Francisco Medical Center San Francisco ● ● ● ● ● ● ● ● UCSF Medical Center San Francisco ● ● ● ● ● ● ● ● Kaiser Permanente Santa Teresa Medical Center San Jose ● ● ● ● ● ● ● ● Kaiser Permanente San Rafael Medical Center San Rafael ● ● ● ● ● ● ● ● Kaiser Permanente Santa Clara Medical Center Santa Clara ● ● ● ● ● ● ● ● (Kiely Campus) Kaiser Permanente Santa Rosa Medical Center Santa Rosa ● ● ● ● ● ● ● ● Kaiser Permanente South San Francisco Medical Center South San Francisco ● ● ● ● ● ● ● ● Stanford Hospital and Clinics Stanford ● ● ● ● ● ● ● Kaiser Permanente Vallejo Medical Center Vallejo ● ● ● ● ● ● ● ● Kaiser Permanente Walnut Creek Medical Center Walnut Creek ● ● ● ● ● ● ● ● Kaiser Permanente Woodland Hills Medical Center Woodland Hills ● ● ● ● ● ● ● ●

DISTRICT OF COLUMBIA George Washington University Hospital Washington ● ● ● ● ● ● ●

FLORIDA Joe DiMaggio Children’s Hospital Hollywood ● ● ● ● ● ● ● Memorial Regional Hospital Hollywood ● ● ● ● ● ● ● Memorial Regional Hospital South Hollywood ● ● ● ● ● ● ● Brooks Rehabilitation Hospital Jacksonville ● ● ● ● ● ● ● Jackson Memorial Hospital Miami ● ● ● ● ● ● ● Jackson South Community Hospital Miami ● ● ● ● ● ● ● Memorial Hospital Miramar Miramar ● ● ● ● ● ● ● Jackson North Medical Center North Miami Beach ● ● ● ● ● ● ● Memorial Hospital Pembroke Pembroke Pines ● ● ● ● ● ● ● Memorial Hospital West Pembroke Pines ● ● ● ● ● ● ●

GEORGIA Emory University Hospital Atlanta ● ● ● ● ● ● ●

40 HEALTHCARE EQUALIT Y INDE X 2O 1 O w w w . h r c.o r g / hei APPENDIX B HEI-RATED FACILITIES BY STATE

● YES ● NO ● NOT APPLICABLE

Facility Name City Top Performer 1a 1b 2a 2b 3 4a 4b

Piedmont Hospital Atlanta ● ● ● ● ● ● ●

HAWAII

Kaiser Permanente Moanalua Medical Center Honolulu ● ● ● ● ● ● ● ●

ILLINOIS

Advocate Illinois Masonic Medical Center Chicago ● ● ● ● ● ● ● ●

Rush University Medical Center Chicago ● ● ● ● ● ● ● ●

IOWA

Ames Center Ames ● ● ● ● ● ● ●

Ankeny Center Ankeny ● ● ● ● ● ● ●

Quad Cities Center Bettendorf ● ● ● ● ● ● ●

Cedar Falls Center Cedar Falls ● ● ● ● ● ● ●

Creston Center Creston ● ● ● ● ● ● ●

Healthy Connections Des Moines ● ● ● ● ● ● ●

Iowa Methodist Medical Center Des Moines ● ● ● ● ● ● ●

Rosenfield Center Des Moines ● ● ● ● ● ● ●

Susan Knapp Health Center Des Moines ● ● ● ● ● ● ●

The Family Practice Center Des Moines ● ● ● ● ● ● ●

Fort Dodge Center Fort Dodge ● ● ● ● ● ● ●

Iowa City Center Iowa City ● ● ● ● ● ● ●

Knoxville Center Knoxville ● ● ● ● ● ● ●

Newton Center Newton ● ● ● ● ● ● ●

Red Oak Center Red Oak ● ● ● ● ● ● ●

Sioux City Center Sioux City ● ● ● ● ● ● ●

Spencer Center Spencer ● ● ● ● ● ● ●

Storm Lake Center Storm Lake ● ● ● ● ● ● ●

West Center Urbandale ● ● ● ● ● ● ●

LOUISIANA

Medical Center of Louisiana New Orleans ● ● ● ● ● ● ●

MAINE

Penobscot Community Health Care Bangor ● ● ● ● ● ● ● ●

MARYLAND

Johns Hopkins Hospital Baltimore ● ● ● ● ● ● ●

MASSACHUSETTS

Beth Israel Deaconess Medical Center Boston ● ● ● ● ● ● ●

Brigham and Women’s Hospital Boston ● ● ● ● ● ● ●

Dana-Farber Cancer Institute Boston ● ● ● ● ● ● ● ●

Faulkner Hospital Boston ● ● ● ● ● ● ●

Massachusetts General Hospital Boston ● ● ● ● ● ● ●

Harvard Vanguard Medical Associates Newton ● ● ● ● ● ● ●

Baystate Medical Center Springfield ● ● ● ● ● ● ● ●

MICHIGAN

A. Alfred Taubman Health Care Center Ann Arbor ● ● ● ● ● ● ●

Commonwealth Neuropsychology Clinic Ann Arbor ● ● ● ● ● ● ●

Domino’s Farms Health Center Ann Arbor ● ● ● ● ● ● ● East Ann Arbor Ambulatory Surgery Ann Arbor & Medical Procedures Center ● ● ● ● ● ● ● East Ann Arbor Health & Geriatrics Center Ann Arbor ● ● ● ● ● ● ●

New Hope Outreach Clinic Ann Arbor ● ● ● ● ● ● ●

HEALTHCARE EQUALIT Y IND E X 2 O 1 O www.hrc.org/ hei 41 APPENDIX B HEI-RATED FACILITIES BY STATE

● YES ● NO ● NOT APPLICABLE

Facility Name City Top Performer 1a 1b 2a 2b 3 4a 4b

Psychiatry Ambulatory Services Ann Arbor ● ● ● ● ● ● ●

UM Briarwood Medical Group Ann Arbor ● ● ● ● ● ● ●

University Hospital Ann Arbor ● ● ● ● ● ● ●

West Ann Arbor Health Center Ann Arbor ● ● ● ● ● ● ● Brighton Health Center Brighton ● ● ● ● ● ● ● Canton Health Center Canton ● ● ● ● ● ● ● Chelsea Health Center Chelsea ● ● ● ● ● ● ● Dexter Family Medicine Dexter ● ● ● ● ● ● ● Howell Pediatrics and Teen Center Howell ● ● ● ● ● ● ● Sparrow Hospital Lansing ● ● ● ● ● ● ● Sparrow Specialty Hospital Lansing ● ● ● ● ● ● ● St. Lawrence Hospital Lansing ● ● ● ● ● ● ● Livonia Center for Specialty Care Livonia ● ● ● ● ● ● ● Clinton Memorial Hospital Saint Johns ● ● ● ● ● ● ● Saline Health Center Saline ● ● ● ● ● ● ● Ypsilanti Health Center Ypsilanti ● ● ● ● ● ● ●

MISSOURI Barnes-Jewish Hospital St. Louis ● ● ● ● ● ● ●

NEW YORK Bronx Health Center Bronx ● ● ● ● ● ● ● Lutheran Medical Center Brooklyn ● ● ● ● ● ● ● Beth Israel Medical Center New York ● ● ● ● ● ● ● ● Callen-Lorde Community Health Center New York ● ● ● ● ● ● ● ● New York Presbyterian Hospital New York ● ● ● ● ● ● ●

NORTH CAROLINA Duke University Hospital Durham ● ● ● ● ● ● ● Behavioral Health Center Greensboro ● ● ● ● ● ● ● Moses H. Cone Memorial Hospital Greensboro ● ● ● ● ● ● ● Wesley Long Community Hospital Greensboro ● ● ● ● ● ● ● Women’s Hospital of Greensboro Greensboro ● ● ● ● ● ● ● Annie Penn Hospital Reidsville ● ● ● ● ● ● ●

OHIO Bedford Medical Center Bedford ● ● ● ● ● ● ● Geauga Medical Center Chardon ● ● ● ● ● ● ● University Hospitals Extended Care Campus Chardon ● ● ● ● ● ● ● Case Medical Center Cleveland ● ● ● ● ● ● ● Cleveland Clinic Cleveland ● ● ● ● ● ● ● Fairview Hospital Cleveland ● ● ● ● ● ● ● Ireland Cancer Center Cleveland ● ● ● ● ● ● ● Lutheran Hospital Cleveland ● ● ● ● ● ● ● MacDonald Women’s Hospital Cleveland ● ● ● ● ● ● ● Rainbow Babies and Children’s Hospital Cleveland ● ● ● ● ● ● ● Conneaut Medical Center Conneaut ● ● ● ● ● ● ● Huron Hospital East Cleveland ● ● ● ● ● ● ● Euclid Hospital Euclid ● ● ● ● ● ● ● Geneva Medical Center Geneva ● ● ● ● ● ● ● Lakewood Hospital Lakewood ● ● ● ● ● ● ● Hillcrest Hospital Mayfield Heights ● ● ● ● ● ● ● Richmond Medical Center Richmond Heights ● ● ● ● ● ● ● University of Toledo Medical Center Toledo ● ● ● ● ● ● ● South Pointe Hospital Warrensville Heights ● ● ● ● ● ● ●

42 HEALTHCARE EQUALIT Y INDE X 2O 1 O w w w . h r c . o r g/hei APPENDIX B HEI-RATED FACILITIES BY STATE

● YES ● NO ● NOT APPLICABLE

Facility Name City Top Performer 1a 1b 2a 2b 3 4a 4b

OREGON Legacy Clinic Canby Canby ● ● ● ● ● ● ● Kaiser Permanente Sunnyside Medical Center Clackamas ● ● ● ● ● ● ● ● East County Health Center Gresham ● ● ● ● ● ● ● Legacy Clinic Mount Hood Gresham ● ● ● ● ● ● ● Legacy Mount Hood Medical Center Gresham ● ● ● ● ● ● ● La Clinica de la Buena Salud Health Center Portland ● ● ● ● ● ● ● Legacy Clinic Emanuel Portland ● ● ● ● ● ● ● Legacy Clinic Good Samaritan Portland ● ● ● ● ● ● ● Legacy Clinic Northeast Portland ● ● ● ● ● ● ● Legacy Clinic Northwest Portland ● ● ● ● ● ● ● Legacy Clinic Tigard-King City Portland ● ● ● ● ● ● ● Legacy Emanuel Children’s Hospital Portland ● ● ● ● ● ● ● Legacy Emanuel Hospital & Health Center Portland ● ● ● ● ● ● ● Legacy Good Samaritan Hospital Portland ● ● ● ● ● ● ● Mid County Health Center Portland ● ● ● ● ● ● ● North Portland Health Center Portland ● ● ● ● ● ● ● Northeast Portland Health Center Portland ● ● ● ● ● ● ● Oregon Health & Science University Hospital Portland ● ● ● ● ● ● ● Southeast Portland Health Center Portland ● ● ● ● ● ● ● Westside Health Center Portland ● ● ● ● ● ● ● Legacy Clinic Firwood Sandy ● ● ● ● ● ● ● Legacy Clinic St. Helens St. Helens ● ● ● ● ● ● ● Legacy Clinic Tualatin Tualatin ● ● ● ● ● ● ● Legacy Meridian Park Hospital Tualatin ● ● ● ● ● ● ● Legacy Clinic West Linn West Linn ● ● ● ● ● ● ● Legacy Clinic Woodburn Woodburn ● ● ● ● ● ● ●

PENNSYLVANIA Children’s Hospital of Philadelphia Philadelphia ● ● ● ● ● ● ● Pennsylvania Hospital Philadelphia ● ● ● ● ● ● ●

TENNESSEE Vanderbilt University Medical Center Nashville ● ● ● ● ● ● ●

TEXAS The University of Texas MD Anderson Cancer Center Houston ● ● ● ● ● ● ● ●

VIRGINIA Sentara CarePlex Hospital Hampton ● ● ● ● ● ● ● Sentara Leigh Hospital Norfolk ● ● ● ● ● ● ● Sentara Norfolk General Hospital Norfolk ● ● ● ● ● ● ● Sentara Obici Hospital Suffolk ● ● ● ● ● ● ● Sentara Bayside Hospital Virginia Beach ● ● ● ● ● ● ● Sentara Virginia Beach General Hospital Virginia Beach ● ● ● ● ● ● ● Sentara Williamsburg Regional Medical Center Williamsburg ● ● ● ● ● ● ● Sentara Potomac Hospital Woodbridge ● ● ● ● ● ● ●

WASHINGTON Legacy Clinic Battle Ground Battle Ground ● ● ● ● ● ● ● Group Health Central Hospital Seattle ● ● ● ● ● ● ● ● Harborview Medical Center Seattle ● ● ● ● ● ● ● University of Washington Medical Center Seattle ● ● ● ● ● ● ● Legacy Clinic Fisher’s Landing Vancouver ● ● ● ● ● ● ● Legacy Clinic Salmon Creek Vancouver ● ● ● ● ● ● ● Legacy Salmon Creek Hospital Vancouver ● ● ● ● ● ● ●

HEALTHCARE EQUALIT Y I N D E X 2O1O w w w . h r c .or g /he i 43 44 appendix C hei-rated facilities by network

Healthcare Equality Index Rating Criteria

1a Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation”

1b Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

2a Visitation policies grant same-sex couples the same visitation access as different-sex couples and next of kin

2b Visitation policies grant same-sex parents the same visitation access as different-sex parents for their minor children

3 Provide cultural competency training addressing healthcare issues relevant to the lesbian, gay, bisexual and transgender community

4a Equal employment opportunity policy includes “sexual orientation”

4b Equal employment opportunity policy includes “gender identity or expression” or “gender identity”

healthcare equality index 2O1O www.hrc.org/hei 45 APPENDIX C HEI-RATED FACILITIES BY NETWORK

● YES ● NO ● NOT APPLICABLE

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

NO NETWORK Advocate Illinois Masonic Medical Center Chicago IL ● ● ● ● ● ● ● ● Barnes-Jewish Hospital St. Louis MO ● ● ● ● ● ● ● Baystate Medical Center Springfield MA ● ● ● ● ● ● ● ● Beth Israel Deaconess Medical Center Boston MA ● ● ● ● ● ● ● Beth Israel Medical Center New York NY ● ● ● ● ● ● ● ● Brigham and Women’s Hospital Boston MA ● ● ● ● ● ● ● Bronx Health Center Bronx NY ● ● ● ● ● ● ● Brooks Rehabilitation Hospital Jacksonville FL ● ● ● ● ● ● ● Callen-Lorde Community Health Center New York NY ● ● ● ● ● ● ● ● Children’s Hospital of Philadelphia Philadelphia PA ● ● ● ● ● ● ● Dana-Farber Cancer Institute Boston MA ● ● ● ● ● ● ● ● Duke University Hospital Durham NC ● ● ● ● ● ● ● Emory University Hospital Atlanta GA ● ● ● ● ● ● ● Faulkner Hospital Boston MA ● ● ● ● ● ● ● George Washington University Hospital Washington DC ● ● ● ● ● ● ● Group Health Central Hospital Seattle WA ● ● ● ● ● ● ● ●

Harvard Vanguard Medical Associates Newton MA ● ● ● ● ● ● ●

Iowa Methodist Medical Center Des Moines IA ● ● ● ● ● ● ● Johns Hopkins Hospital Baltimore MD ● ● ● ● ● ● ● L.A. Gay & Lesbian Center Los Angeles CA ● ● ● ● ● ● ● ● LAC/USC Medical Center Los Angeles CA ● ● ● ● ● ● ● Lutheran Medical Center Brooklyn NY ● ● ● ● ● ● ● Massachusetts General Hospital Boston MA ● ● ● ● ● ● ● Medical Center of Louisiana New Orleans LA ● ● ● ● ● ● ● New York Presbyterian Hospital New York NY ● ● ● ● ● ● ● Oregon Health & Science University Hospital Portland OR ● ● ● ● ● ● ● Pennsylvania Hospital Philadelphia PA ● ● ● ● ● ● ● Penobscot Community Health Care Bangor ME ● ● ● ● ● ● ● ● Piedmont Hospital Atlanta GA ● ● ● ● ● ● ● Rush University Medical Center Chicago IL ● ● ● ● ● ● ● ● St. Mary Medical Center Long Beach CA ● ● ● ● ● ● ● Stanford Hospital and Clinics Stanford CA ● ● ● ● ● ● ● UCSF Medical Center San Francisco CA ● ● ● ● ● ● ● ● University of California San Diego Medical Center San Diego CA ● ● ● ● ● ● ● The University of Texas MD Anderson Cancer Center Houston TX ● ● ● ● ● ● ● ● University of Toledo Medical Center Toledo OH ● ● ● ● ● ● ● Vanderbilt University Medical Center Nashville TN ● ● ● ● ● ● ● CLEVELAND CLINIC FOUNDATION Cleveland Clinic Cleveland OH ● ● ● ● ● ● ● Euclid Hospital Euclid OH ● ● ● ● ● ● ● Fairview Hospital Cleveland OH ● ● ● ● ● ● ● Hillcrest Hospital Mayfield Heights OH ● ● ● ● ● ● ● Huron Hospital East Cleveland OH ● ● ● ● ● ● ● Lakewood Hospital Lakewood OH ● ● ● ● ● ● ● Lutheran Hospital Cleveland OH ● ● ● ● ● ● ● South Pointe Hospital Warrensville Heights OH ● ● ● ● ● ● ● JACKSON HEALTH SYSTEM Jackson Memorial Hospital Miami FL ● ● ● ● ● ● ● Jackson North Medical Center North Miami Beach FL ● ● ● ● ● ● ● Jackson South Community Hospital Miami FL ● ● ● ● ● ● ●

46 HEALTHCARE EQUALIT Y INDE X 2O1O w w w . h r c . o r g/hei APPENDIX C HEI-RATED FACILITIES BY NETWORK

● YES ● NO ● NOT APPLICABLE

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

KAISER PERMANENTE NETWORK

Kaiser Permanente Anaheim Medical Center Anaheim CA ● ● ● ● ● ● ● ●

Kaiser Permanente Baldwin Park Medical Center Baldwin Park CA ● ● ● ● ● ● ● ●

Kaiser Permanente Bellflower Medical Center Bellflower CA ● ● ● ● ● ● ● ●

Kaiser Permanente Fontana Medical Center Fontana CA ● ● ● ● ● ● ● ●

Kaiser Permanente Fremont Medical Center Fremont CA ● ● ● ● ● ● ● ●

Kaiser Permanente Fresno Medical Center Fresno CA ● ● ● ● ● ● ● ●

Kaiser Permanente Hayward Medical Center Hayward CA ● ● ● ● ● ● ● ●

Kaiser Permanente Los Angeles Medical Center Los Angeles CA ● ● ● ● ● ● ● ●

Kaiser Permanente Manteca Medical Center Manteca CA ● ● ● ● ● ● ● ●

Kaiser Permanente Moanalua Medical Center Honolulu HI ● ● ● ● ● ● ● ●

Kaiser Permanente Oakland Medical Center Oakland CA ● ● ● ● ● ● ● ●

Kaiser Permanente Panorama City Medical Center Panorama City CA ● ● ● ● ● ● ● ●

Kaiser Permanente Redwood City Medical Center Redwood City CA ● ● ● ● ● ● ● ●

Kaiser Permanente Richmond Medical Center Richmond CA ● ● ● ● ● ● ● ●

Kaiser Permanente Riverside Medical Center Riverside CA ● ● ● ● ● ● ● ●

Kaiser Permanente Roseville Medical Center Roseville CA ● ● ● ● ● ● ● ●

Kaiser Permanente Sacramento Medical Center Sacramento CA ● ● ● ● ● ● ● ●

Kaiser Permanente San Diego Medical Center San Diego CA ● ● ● ● ● ● ● ●

Kaiser Permanente San Francisco Medical Center San Francisco CA ● ● ● ● ● ● ● ●

Kaiser Permanente San Rafael Medical Center San Rafael CA ● ● ● ● ● ● ● ●

Kaiser Permanente Santa Clara Medical Center Santa Clara CA ● ● ● ● ● ● ● ● (Kiely Campus)

Kaiser Permanente Santa Rosa Medical Center Santa Rosa CA ● ● ● ● ● ● ● ●

Kaiser Permanente Santa Teresa Medical Center San Jose CA ● ● ● ● ● ● ● ●

Kaiser Permanente South Bay Medical Center Harbor City CA ● ● ● ● ● ● ● ●

Kaiser Permanente South Sacramento Medical Center Sacramento CA ● ● ● ● ● ● ● ●

Kaiser Permanente South San Francisco South San Francisco CA ● ● ● ● ● ● ● ● Medical Center

Kaiser Permanente Sunnyside Medical Center Clackamas OR ● ● ● ● ● ● ● ●

Kaiser Permanente Vallejo Medical Center Vallejo CA ● ● ● ● ● ● ● ●

Kaiser Permanente Walnut Creek Medical Center Walnut Creek CA ● ● ● ● ● ● ● ●

Kaiser Permanente West Los Angeles Medical Center Los Angeles CA ● ● ● ● ● ● ● ●

Kaiser Permanente Woodland Hills Medical Center Woodland Hills CA ● ● ● ● ● ● ● ●

LEGACY HEALTH SYSTEM

Legacy Clinic Battle Ground Battle Ground WA ● ● ● ● ● ● ●

Legacy Clinic Canby Canby OR ● ● ● ● ● ● ●

Legacy Clinic Emanuel Portland OR ● ● ● ● ● ● ●

Legacy Clinic Firwood Sandy OR ● ● ● ● ● ● ●

Legacy Clinic Fisher’s Landing Vancouver WA ● ● ● ● ● ● ●

Legacy Clinic Good Samaritan Portland OR ● ● ● ● ● ● ●

Legacy Clinic Mount Hood Gresham OR ● ● ● ● ● ● ●

Legacy Clinic Northeast Portland OR ● ● ● ● ● ● ●

Legacy Clinic Northwest Portland OR ● ● ● ● ● ● ●

Legacy Clinic Salmon Creek Vancouver WA ● ● ● ● ● ● ●

HEALTHCARE EQUALIT Y I N D E X 2O1O w w w . h r c .or g /he i 47 APPENDIX C HEI-RATED FACILITIES BY NETWORK

● YES ● NO ● NOT APPLICABLE

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

Legacy Clinic St. Helens St. Helens OR ● ● ● ● ● ● ●

Legacy Clinic Tigard-King City Portland OR ● ● ● ● ● ● ●

Legacy Clinic Tualatin Tualatin OR ● ● ● ● ● ● ●

Legacy Clinic West Linn West Linn OR ● ● ● ● ● ● ●

Legacy Clinic Woodburn Woodburn OR ● ● ● ● ● ● ●

Legacy Emanuel Children’s Hospital Portland OR ● ● ● ● ● ● ●

Legacy Emanuel Hospital & Health Center Portland OR ● ● ● ● ● ● ●

Legacy Good Samaritan Hospital Portland OR ● ● ● ● ● ● ●

Legacy Meridian Park Hospital Tualatin OR ● ● ● ● ● ● ●

Legacy Mount Hood Medical Center Gresham OR ● ● ● ● ● ● ●

Legacy Salmon Creek Hospital Vancouver WA ● ● ● ● ● ● ●

MEMORIAL HEALTH SYSTEM

Joe DiMaggio Children’s Hospital Hollywood FL ● ● ● ● ● ● ●

Memorial Hospital Miramar Miramar FL ● ● ● ● ● ● ●

Memorial Hospital Pembroke Pembroke Pines FL ● ● ● ● ● ● ●

Memorial Hospital West Pembroke Pines FL ● ● ● ● ● ● ●

Memorial Regional Hospital Hollywood FL ● ● ● ● ● ● ●

Memorial Regional Hospital South Hollywood FL ● ● ● ● ● ● ●

MOSES CONE HEALTH SYSTEM

Annie Penn Hospital Reidsville NC ● ● ● ● ● ● ●

Behavioral Health Center Greensboro NC ● ● ● ● ● ● ●

Moses H. Cone Memorial Hospital Greensboro NC ● ● ● ● ● ● ●

Wesley Long Community Hospital Greensboro NC ● ● ● ● ● ● ●

Women’s Hospital of Greensboro Greensboro NC ● ● ● ● ● ● ●

MULTNOMAH COUNTY HEALTH DEPARTMENT

East County Health Center Gresham OR ● ● ● ● ● ● ●

La Clinica de la Buena Salud Health Center Portland OR ● ● ● ● ● ● ●

Mid County Health Center Portland OR ● ● ● ● ● ● ●

North Portland Health Center Portland OR ● ● ● ● ● ● ●

Northeast Portland Health Center Portland OR ● ● ● ● ● ● ●

Southeast Portland Health Center Portland OR ● ● ● ● ● ● ●

Westside Health Center Portland OR ● ● ● ● ● ● ●

PLANNED PARENTHOOD OF GREATER IOWA

Ames Center Ames IA ● ● ● ● ● ● ●

Ankeny Center Ankeny IA ● ● ● ● ● ● ●

Cedar Falls Center Cedar Falls IA ● ● ● ● ● ● ●

Creston Center Creston IA ● ● ● ● ● ● ●

Fort Dodge Center Fort Dodge IA ● ● ● ● ● ● ●

Healthy Connections Des Moines IA ● ● ● ● ● ● ●

Iowa City Center Iowa City IA ● ● ● ● ● ● ●

Knoxville Center Knoxville IA ● ● ● ● ● ● ●

Newton Center Newton IA ● ● ● ● ● ● ●

Quad Cities Center Bettendorf IA ● ● ● ● ● ● ●

Red Oak Center Red Oak IA ● ● ● ● ● ● ●

Rosenfield Center Des Moines IA ● ● ● ● ● ● ●

Sioux City Center Sioux City IA ● ● ● ● ● ● ●

Spencer Center Spencer IA ● ● ● ● ● ● ●

48 HEALTHCARE EQUALIT Y INDE X 2O1O w w w . h r c . o r g/hei APPENDIX C HEI-RATED FACILITIES BY NETWORK

● YES ● NO ● NOT APPLICABLE

Facility Name City State Top Performer 1a 1b 2a 2b 3 4a 4b

Storm Lake Center Storm Lake IA ● ● ● ● ● ● ● Susan Knapp Health Center Des Moines IA ● ● ● ● ● ● ● The Family Practice Center Des Moines IA ● ● ● ● ● ● ● West Center Urbandale IA ● ● ● ● ● ● ● SENTARA HEALTHCARE Sentara Bayside Hospital Virginia Beach VA ● ● ● ● ● ● ● Sentara CarePlex Hospital Hampton VA ● ● ● ● ● ● ● Sentara Leigh Hospital Norfolk VA ● ● ● ● ● ● ● Sentara Norfolk General Hospital Norfolk VA ● ● ● ● ● ● ● Sentara Obici Hospital Suffolk VA ● ● ● ● ● ● ● Sentara Potomac Hospital Woodbridge VA ● ● ● ● ● ● ● Sentara Virginia Beach General Hospital Virginia Beach VA ● ● ● ● ● ● ● Sentara Williamsburg Regional Medical Center Williamsburg VA ● ● ● ● ● ● ● SPARROW HEALTH SYSTEM Clinton Memorial Hospital Saint Johns MI ● ● ● ● ● ● ● Sparrow Hospital Lansing MI ● ● ● ● ● ● ● Sparrow Specialty Hospital Lansing MI ● ● ● ● ● ● ● St. Lawrence Hospital Lansing MI ● ● ● ● ● ● ● UNIVERSITY HOSPITALS OF CLEVELAND Bedford Medical Center Bedford OH ● ● ● ● ● ● ● Case Medical Center Cleveland OH ● ● ● ● ● ● ● Conneaut Medical Center Conneaut OH ● ● ● ● ● ● ● Geauga Medical Center Chardon OH ● ● ● ● ● ● ● Geneva Medical Center Geneva OH ● ● ● ● ● ● ● Ireland Cancer Center Cleveland OH ● ● ● ● ● ● ● MacDonald Women’s Hospital Cleveland OH ● ● ● ● ● ● ● Rainbow Babies and Children’s Hospital Cleveland OH ● ● ● ● ● ● ● Richmond Medical Center Richmond Heights OH ● ● ● ● ● ● ● University Hospitals Extended Care Campus Chardon OH ● ● ● ● ● ● ● UNIVERSITY OF MICHIGAN HEALTH SYSTEM A. Alfred Taubman Health Care Center Ann Arbor MI ● ● ● ● ● ● ● Brighton Health Center Brighton MI ● ● ● ● ● ● ● Canton Health Center Canton MI ● ● ● ● ● ● ● Chelsea Health Center Chelsea MI ● ● ● ● ● ● ● Commonwealth Neuropsychology Clinic Ann Arbor MI ● ● ● ● ● ● ● Dexter Family Medicine Dexter MI ● ● ● ● ● ● ● Domino’s Farms Health Center Ann Arbor MI ● ● ● ● ● ● ● East Ann Arbor Ambulatory Surgery Ann Arbor MI ● ● ● ● ● ● ● & Medical Procedures Center East Ann Arbor Health & Geriatrics Center Ann Arbor MI ● ● ● ● ● ● ● Howell Pediatrics and Teen Center Howell MI ● ● ● ● ● ● ● Livonia Center for Specialty Care Livonia MI ● ● ● ● ● ● ● New Hope Outreach Clinic Ann Arbor MI ● ● ● ● ● ● ● Psychiatry Ambulatory Services Ann Arbor MI ● ● ● ● ● ● ● Saline Health Center Saline MI ● ● ● ● ● ● ● UM Briarwood Medical Group Ann Arbor MI ● ● ● ● ● ● ● University Hospital Ann Arbor MI ● ● ● ● ● ● ● West Ann Arbor Health Center Ann Arbor MI ● ● ● ● ● ● ● Ypsilanti Health Center Ypsilanti MI ● ● ● ● ● ● ● UNIVERSITY OF WASHINGTON MEDICINE Harborview Medical Center Seattle WA ● ● ● ● ● ● ● University of Washington Medical Center Seattle WA ● ● ● ● ● ● ●

HEALTHCARE EQUALIT Y I N D E X 2O1O w w w . h r c .or g /he i 49 50 appendix D testimonials from hei 2O1O top performers

healthcare equality index 2O1O www.hrc.org/hei 51 appendix D testimonials from hei 2O1O top performers

Making the Business Case for LGBT Inclusion l Top Performer: Advocate Illinois Masonic Medical Center Location: Chicago, Ill. Years rated in HEI: 3 Size: 1,668 full-time employees, 408 beds Years as Top Performer: 1

Advocate Illinois Masonic Medical Center (IMMC), a clinically comprehensive teaching hospital located in Chicago’s Lakeview community, has been a community anchor for nearly 100 years and was named one of the top 100 major teaching hospitals in the United States in 2009. Its history and daily culture honor diversity and inclusion. Located within one of the largest LGBT communities in the United States, IMMC has a history of specialized service to this community that includes: one of the first inpatient HIV/AIDS units in the Midwest, specialized outpatient programs located in the community that focus on patient and provider education, and an innovative relationship with the Howard Brown Health Center, a large clinic that provides the LGBT community with healthcare and wellness programs.

It’s often said that doing right is doing good business. IMMC’s relationship with Chicago’s North Side LGBT community is an example of such a community partnership in action. For years, IMMC has been a leading provider of clinical services to the LGBT community and highly values this key community partnership. Doing right means IMMC meets its values of responsible stewardship by providing healthcare services and resources to all members of its community.

Providing quality and needed clinical services to Chicago’s LGBT community occurs through a variety of channels at IMMC. Continued investment in primary care physician practices — bringing services to the community — has attracted hundreds (if not thousands) of new patients to the medical center annually. Expanding specific specialty services such as general urology, colorectal disease and gynecology also serve to ally patients with the medical center and its services.

Direct advertising, both in local media and in community events, has a positive economic effect in both new service launches and in maintaining a robust presence for physician practices, programs and institutional perception in the community. Sponsoring local LGBT events, including participation in the LGBT pride parade and a variety of organizational fundraising events, pays economic dividends in addition to fostering LGBT community partnership. The community recognizes IMMC’s ongoing presence and trusts us when in need of services.

IMMC invests in the LGBT community, while the LGBT community recognizes that trust with clinical use. Doing the right thing truly does pay off.

Marc A. Senesac Vice President, Human Resources

Michael Swarzman Vice President, Business Development

Advocate Illinois Masonic Medical Center

52 healthcare equality index 2O1O www.hrc.org/hei appendix D testimonials from hei 2O1O top performers

Protecting All LGBT Patients from Discrimination

Top Performer: Baystate Medical Center Location: Springfield, Mass. Years rated in HEI: 2 l Size: 4,338 full-time employees, 659 beds Years as Top Performer: 1 Baystate Medical Center in Springfield, Mass., is the region’s only academic, research and teaching hospital. It is part of Baystate Health, the largest private employer in western Massachusetts with more than10,000 employees, serving a population of 800,000 residents, and is one of the largest not-for-profit healthcare systems in New England. We are acutely aware of the diversity within the region and are committed to addressing the needs and concerns of all people appropriately.

Our charitable mission is to improve the health of the people in our communities every day, with quality and compassion. We use national best practices and often use benchmarking tools to understand how well we’re doing in meeting the needs of those we serve. HEI 2009 was one of those tools and it helped us to identify a gap in our communication with our LGBT patients and with our LGBT care providers. When the HEI 2009 report was published, our Patients’ Bill of Rights did not include “gender identity or expression.” We were in the company of 89 percent of HEI 2009-rated facilities. We recognized this as an opportunity to improve. This gap helped us realize that our Patients’ Bill of Rights did not fully align with our mission and our operating principles.

Transgender individuals face discrimination daily in varied forms, and our goal is to ensure that their experiences are consistent with the high-quality, compassionate care that is the hallmark of our organization. I explained the issue to the Patient Care Policy Committee that oversees our Patients’ Bill of Rights. I shared with them the importance of ensuring physical and emotional safety to transgender patients, not only in practice, but also in our policies. The group quickly agreed that this policy should include “gender identity and expression.” A week later, the updated policy was available online, making it accessible for all employees, with protections for transgender individuals identified in the first sentence.

Having this commitment in print, now as part of our system-wide policy, gives us something to point to that says, “Yes, we support you and accept you wholly.” It also gives us support when providing internal education: It shows that education about transgender issues and care is supported by the leadership of the organization.

In November 2009, we held a full-day regional conference on transgender healthcare for providers within our organization as well as those external to Baystate Health. Educational programs provide the opportunity to share the knowledge we possess about the transgender community and transgender healthcare. We will continue to learn and share information so all care providers can improve the services delivered to the transgender community.

At Baystate Medical Center, our commitment is to provide the best possible healthcare in an environment that treats our patients with dignity and respect. We are proud to provide an environment of care that supports each individual and their needs, including our LGBT community members.

Visael “Bobby” Rodriguez Chief Diversity Officer Baystate Health

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Leveraging LGBT & Allied Employees: The LGBT Employee Group

Top Performer: Beth Israel Medical Center Location: New York, N.Y. Years rated in HEI: 1 Size: 7,289 full-time employees, 1,111 beds Years as Top Performer: 1

Beth Israel Medical Center’s LGBT Committee was formed in 2008 as a subcommittee of the medical center’s Diversity Council. The goal of our committee is to establish and maintain a culture of inclusion within which all LGBT patients and staff feel that they are in a l safe, supportive and non-judgmental setting. The committee’s membership has grown quickly since its inception and includes front-line staff, administrators, providers from several disciplines, a hospital trustee and representatives from external affiliate organizations.

In 2009, a subcommittee was formed and charged with reviewing Beth Israel’s existing policies and procedures to ensure LGBT healthcare equality in policy and practice, and to evaluate whether we would meet the criteria outlined by the Healthcare Equality Index. Many of the medical center’s policies were already in line with the HEI recommendations, and a few needed some minor updating. Some policies were amended with the full support and assistance of the medical center administration.

Additionally, the committee developed a list of “Top Ten Provider Tips for Serving the LGBT Patient Population” based on available literature from reliable sources, such as the Gay and Lesbian Medical Association. This was distributed to providers through a blast e-mail to all medical center staff, and was also posted in patient care areas. The tips list (as well as other resources) remains accessible to providers and staff via the medical center’s intranet website. Hard-working members of the committee are also currently working on a similar provider-education tool specifically geared toward our transgender patient population.

In recognition of National LGBT Health Week, on April 13, 2010, providers from Beth Israel donated their time and expertise to provide a panel presentation regarding issues related to LGBT medical and mental health, and issues of importance to LGBT individuals seeking healthcare. This panel presentation was given to members of the diversity councils of KPMG LLP and several of their affiliate organizations. The committee is also in the process of bringing in a consultant to conduct transgender sensitivity trainings at the medical center in order to foster awareness and sensitivity toward this patient population.

Lastly, since the LGBT committee was formed, there have been two after-work LGBT networking/social events. All staff are invited to attend these events through blast e-mails (as well as staff from our affiliate hospitals), and the events have been quite well-attended. The committee is planning to participate in several upcoming community events, including sponsorship in the 2010 New York City LGBT Pride Parade in June.

LGBT Committee Beth Israel Medical Center

54 healthcare equality index 2O1O www.hrc.org/hei appendix D testimonials from hei 2O1O top performers

Demonstrating Commitment to LGBT Staff & Families

Top Performer: Dana-Farber Cancer Institute l Location: Boston, Mass. Years rated in HEI: 2 Size: 5,118 full-time employees Years as Top Performer: 1

Dana-Farber Cancer Institute has long been active in its commitment to LGBT staff and families. In 2009, we strengthened this commitment by including LGBT-inclusive language in our Patient Rights and Responsibilities document and by including LGBT topics in our Schwartz Rounds and other cultural competency programs. Externally, we have been a multi- year sponsor of many LGBT events, including the annual Boston Pride Festival, to ensure that all members of the LGBT community know they can come to Dana-Farber for cancer care, education and prevention. In addition to our research on cancer, Dana-Farber is the only cancer center to be a federal Center for AIDS Research.

In 2009, Dana-Farber received the Outstanding Employer of the Year award from the Greater Boston Business Council, the LGBT “chamber of commerce” in Boston, for its work in the community and in creating a safe and welcoming place for its staff, patients and their families.

We are proud of our past commitment to the LGBT community and know we will continue to create a more welcoming healthcare experience for all who come to Dana-Farber for their cancer care.

Edward Benz, M.D. President and Chief Executive Officer Dana-Farber Cancer Institute

healthcare equality index 2O1O www.hrc.org/hei 55 appendix D testimonials from hei 2O1O top performers

Translating Inclusive Practice into Policy

Top Performer: Group Health Central Hospital l Location: Seattle, Wash. Years rated in HEI: 3 Size: 104 full-time employees, 326 beds Years as Top Performer: 2

Group Health is very proud to be one of the top performers in the Healthcare Equality Index again this year! Assuring healthcare equality for our LGBT members and their families is essential to their health and well-being. From the beginning, Group Health has attracted caring, innovative people who step up and ask, “What’s next for our patients’ health?” Additionally, Group Health has a long history of providing non-discrimination protections in employment and healthcare benefits for domestic partners and families of LGBT staff. These practices are core to our values at Group Health.

While we have long had a culture of inclusiveness and non-discrimination protections, participation in the HEI survey helped us see that our policies did not necessarily fully reflect our culture or set expectations of inclusive behavior and non-discriminatory practices for our staff. Policies that set expectations for care and behavior allow the organization to take corrective action if those expectations are not achieved.

This realization moved Group Health forward in assuring that non-discrimination policies included gender identity and expression as well as sexual orientation for both employees and patients. We made sure that hospital visitation policies included a definition of family that included spouses, domestic partners and both different-sex and same-sex significant others, and that the concept of parenthood was to be liberally construed without limitation for the purpose of visitation rights.

We understand how important it is to incorporate cultural competence around LGBT members into our practices. It is a strategy that we believe enhances the quality of care our patients receive, positions us well for growth and delivers on the Group Health promise of integrated, compassionate care.

Desiray Bailey, M.D. Chief of Medical Staff

Erin Leff, M.B.A. Hospital Administrator

Group Health Central Hospital

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Creating a Culture of Inclusion: The Hospital Diversity Council l Top Performer: Rush University Medical Center Location: Chicago, Ill. Years rated in HEI: 2 Size: 7,052 full-time employees, 676 beds Years as Top Performer: 2

Compassion and understanding are at the core of medicine. The capacity to heal people inherently requires understanding that health is influenced by more than physical factors alone, including emotional, sociological and cultural factors.

These principles underlie Rush University Medical Center’s commitment to fostering a culture of inclusion. This commitment also is essential given that Rush serves wide-ranging and diverse communities. In order for members of the Rush community to work well together and to provide our patients with effective, appropriate care, we strive to make Rush a place where personal differences are not just accepted, but understood, respected and valued. This culture of inclusiveness is also an essential part of preparing the students of Rush University to provide care for the country’s increasingly diverse population. To advance this commitment, Rush established the Rush Diversity Leadership Group, which provides guidance about ways of promoting diversity, inclusion and equity. The DLG’s work reflects an understanding that the more we pay attention to and understand the diversity of our patients, staff, faculty and students, the more successful we will be as an institution of healing. Members of the DLG are drawn from all areas of Rush and represent the many communities we serve, including the lesbian, gay, bisexual and transgender community. Updates from the LGBT community are included in each meeting agenda.

The non-discrimination policy is the cornerstone of Rush’s formal culture of inclusion and goes beyond what is required in federal and Illinois law. We specifically forbid discrimination, harassment or unequal treatment in 14 categories, including sexual orientation and gender identity and/or expression. Rush’s initial participation in the Healthcare Equality Index prompted the formal addition of language to our non-discrimination policy and all other relevant policies to cover gender identity and/or expression explicitly. All medical center policies define “family members” to include any person with whom a patient has a significant relationship, which ensures same-sex partners and same-sex parents have the identical rights as different-sex partners and parents regarding patient visitation in the hospital and in decision-making about their partner’s or child’s medical care.

Rush’s commitment to inclusiveness is evident in our employee health benefits. More than a decade ago, Rush became one of the first medical centers in the city to offer same-sex domestic partner benefits to employees.R ush took proactive steps and made the financial commitment to provide these benefits because we equally value all of our employees and their relationships and seek to support their needs.

Along with taking steps to ensure that LGBT patients, employees, faculty and students are treated equally, Rush is taking a lead role in advancing medical care in areas of concern for the LGBT community. A Rush researcher directs a consortium of Chicago health providers in a collaborative center for HIV/AIDS research that is funded by the National Institutes of Health. In another example, Rush nursing faculty members have partnered with the Howard Brown Health Center in Chicago to develop a program for training nurses to provide care for geriatric LGBT and HIV-positive individuals.

In taking steps to create and maintain a culture of inclusion, Rush aims to better understand and communicate with patients from all communities in order to provide culturally sensitive care that addresses their unique needs and concerns. In addition, Rush’s diversity commitment upholds the respect for human dignity that is fundamental to the way medicine should be.

For more information about any of these initiatives and how Rush went about achieving them, please contact the Rush Office for Equal Opportunity at 312-942-7093.

Larry J. Goodman, M.D. President and Chief Executive Officer Rush University Medical Center

healthcare equality index 2O1O www.hrc.org/hei 57 appendix D testimonials from hei 2O1O top performers

Bringing Policies Alive: LGBT Cultural Competency Staff Training

Top Performer: UCSF Medical Center Location: San Francisco, Calif. Years rated in HEI: 3 Size: 7,800 full-time employees, 722 beds Years as Top Performer: 3

At UCSF Medical Center, our work for LGBT equity and inclusion is multi-level. We view the policies and benefits evaluated by the HEI as the essential institutional bedrock on which all of our other LGBT-related efforts are based. And we have layered a number of other initiatives l on top of these foundational policies and benefits to ensure their effectiveness.

One of our key initiatives to ensure the ongoing effectiveness of the HEI-rated policies and benefits is LGBT training for our medical center personnel. We design this training not only to make our personnel aware of the policies and benefits we offer but also to explain what those policies and benefits actually mean in the lives of LGBT patients and their families.It’s one thing for people to read words on a page, and another for them to hear how those words actually help people have good healthcare and employment experiences.

We’ve gotten very positive feedback on the LGBT training we offer. Our personnel tell us that, after the training, they feel much more knowledgeable and comfortable vis-à-vis LGBT patients and colleagues — and appreciate feeling that way. In fact, even personnel who are LGBT themselves or who have LGBT friends and family members tell us how much they learn from the training.

All of the training we offer provides general information about LGBT people and their healthcare concerns, as well as about UCSF’s policies and benefits. For example, our training explains what the “LGBT” acronym stands for, provides demographic information about LGBT people, and discusses the history of “coming out.” It goes on to describe the healthcare concerns of LGBT people as a group, including worries about encountering bias, being denied visitation and losing confidentiality. It also discusses the particular healthcare challenges faced by transgender patients and LGBT parents, youth and elders.

The training is always customized to meet the needs of particular medical center personnel. For example, registration staff learn about various ways that LGBT patients identify themselves, so that they can respond knowledgeably and record information accurately. Billing personnel receive information about potential snafus like name and gender mismatches with transgender patients, so that they can resolve them quickly and sensitively. Nursing supervisors learn about best practices in working with perceived and actual bias on the wards, while human resources staff discuss how best to respond to LGBT discrimination complaints. And, of course, medical personnel receive information about LGBT health risks and disparities that may well not have been part of their training.

Based on our experience at UCSF, we would encourage all medical centers to consider LGBT training for their personnel. At UCSF, training has brought our LGBT policies and benefits alive, and played a vital part in creating a truly equitable and inclusive atmosphere.

Shane Snowdon Director, LGBT Resource Center University of California San Francisco

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Ensuring Successful Participation in the Healthcare Equality Index: An Incremental Approach

Top Performer: The University of Texas MD Anderson Cancer Center Location: Houston, Texas Years rated in HEI: 1 Size: 17,058 full-time employees, 571 beds Years as Top Performer: 1

At The University of Texas MD Anderson Cancer Center, everything we do is connected to our core values of caring, integrity and discovery. Participating in the HEI survey supports l these values and provides a lens from which to benchmark our progress in meeting the needs of our LGBT patients and work force. We are honored to be among the “Top Performers” recognized by the Human Rights Campaign Foundation’s Healthcare Equality Index 2010. Being a Top Performer is a great indicator that we are meeting our institutional mission to serve the unique needs of our patients, their loved ones and our work force.

Every patient and member of our work force is critical to our success in fighting cancer, so it is imperative that we provide a welcoming and respectful environment. In 2008, we participated in our first HEI survey to benchmark ourselves against the best practices of other top-performing organizations. This helped us identify our needs and build upon our strengths. As a result, a multi-disciplinary committee composed of key stakeholders was convened to review our performance. The major findings of this committee led to many significant changes such as:

zzExpanding the Patient Bill of Rights by using more inclusive language that supports our LGBT patients and their loved ones; zzEnsuring that our Equal Employment Opportunity policy is fully inclusive of our LGBT community; zzAnd creating diversity education programs that focus on sexual orientation and gender identity in the workplace and the patient population.

Our success would not have been possible without the advocacy and support of the MD Anderson Diversity Council and our Gay, Lesbian, Bisexual and Transgender Employee Network. MD Anderson sponsors the network, which is the first of its kind within the Texas Medical Center. The network’s mission is to identify the issues and concerns of LGBT employees while focusing on MD Anderson’s core values and mission. Created in 2004, the purpose of the network is to:

zzEnsure that sexual orientation and gender identity/expression are not barriers to full participation in the professional and academic workplace; zzPresent recommendations for increasing awareness of the unique concerns of LGBT employees and patients; zzAnd foster a sense of community for LGBT employees and patients.

The network has made great strides in accomplishing its goals by sponsoring educational forums and networking opportunities that are open to all MD Anderson employees. The network has actively promoted external engagement by:

zzSponsoring guest speakers to provide employee and community education about LGBT issues; zzAnd promoting MD Anderson’s cancer mission at public events, such as the 2009 pride festival, where the network provided free melanoma screenings and education.

On behalf of MD Anderson, I thank the Human Rights Campaign Foundation for this opportunity to participate in the Healthcare Equality Index 2010 survey. We hope our involvement will continue to promote the value of diversity, equality and inclusion in the workplace and in our relationships within the communities we serve.

John Mendelsohn, M.D. President The University of Texas MD Anderson Cancer Center

healthcare equality index 2O1O www.hrc.org/hei 59 60 appendix E lgbt patient protections within 2OO of the largest u.s. hospitals

Table indicates if Patients’ Bill of Rights/non-discrimination policy is inclusive of “sexual orientation” and “gender identity” for 200 of the largest hospitals in the U.S. The table includes at least one hospital from every state and the District of Columbia.

Policy information was collected from two sources:

1. Patients’ Bill of Rights/non-discrimination policy information that hospitals self-reported through the Healthcare Equality Index survey

2. Publicly available Patients’ Bill of Rights/ non-discrimination policies

58 percent include “sexual orientation”

7 percent include “gender identity”

healthcare equality index 2O1O www.hrc.org/hei 61 appendix E 2OO of the largest U.S. hospitals

l yes l no

Hospital Name HEI 2010 City State Sexual Orientation Gender Identity

Abbott Northwestern Hospital Minneapolis MN l l

Alaska Regional Hospital Anchorage AK l l

Albert Einstein Medical Center Philadelphia PA l l

Avera McKennan Hospital Sioux Falls SD l l

Banner Desert Medical Center Mesa AZ l l

Banner Good Samaritan Medical Center Phoenix AZ l l

Baptist Hospital of Miami Miami FL l l

Barnes-Jewish Hospital l St. Louis MO l l

Baystate Medical Center l Springfield MA l l

Beaumont Hospital - Royal Oak Royal Oak MI l l

Beebe Medical Center Lewes DE l l

Benefis Healthcare Great Falls MT l l

Beth Israel Deaconess Medical Center l Boston MA l l

Beth Israel Medical Center l New York NY l l

Bloomington Hospital Bloomington IN l l

Boston Medical Center Boston MA l l

Brigham and Women’s Hospital l Boston MA l l

Brookdale University Hospital and Medical Center Brooklyn NY l l

Brookwood Medical Center Birmingham AL l l

Broward General Medical Center Fort Lauderdale FL l l

Buffalo General Hospital Buffalo NY l l

California Pacific Medical Center San Francisco CA l l

Cape Fear Valley Health Fayetteville NC l l

Carilion Medical Center Roanoke VA l l

Carolinas Medical Center Charlotte NC l l

Case Medical Center l Cleveland OH l l

Cedars Medical Center Miami FL l l

Cedars-Sinai Medical Center Los Angeles CA l l

Centra Health Lynchburg VA l l

Central Texas Veterans Health Care Temple TX l l

Charleston Area Medical Center Charleston WV l l

Christiana Care Newark DE l l

Christus Schumpert Health Shreveport LA l l

Christus Spohn Memorial Hospital Corpus Christi TX l l

CJW Medical Center Richmond VA l l

Clarian Health Indianapolis IN l l

Cleveland Clinic l Cleveland OH l l

Community Medical Center Fresno CA l l

Covenant Medical Center Lubbock TX l l

62 healthcare equality index 2O1O www.hrc.org/hei appendix E 2OO of the largest U.S. hospitals

l yes l no

Hospital Name HEI 2010 City State Sexual Orientation Gender Identity

Crozer-Chester Medical Center Upland PA l l

Dartmouth-Hitchcock Medical Center Lebanon NH l l

Duke University Hospital l Durham NC l l

Emory University Hospital l Atlanta GA l l

Erie County Medical Center Buffalo NY l l

Erlanger Medical Center Chattanooga TN l l

Evanston Hospital Evanston IL l l

Fletcher Allen Health Care Burlington VT l l

Florida Hospital Orlando FL l l

Forsyth Medical Center Winston-Salem NC l l

George Washington University Hospital l Washington DC l l

Greenville Memorial Hospital Greenville SC l l

Hackensack University Medical Center Hackensack NJ l l

Harborview Medical Center l Seattle WA l l

Hartford Hospital Hartford CT l l

Hospital of the University of Pennsylvania Philadelphia PA l l

Huntington Memorial Hospital Pasadena CA l l

Huntsville Hospital Huntsville AL l l

Inova Fairfax Hospital Falls Church VA l l

Iowa Methodist Medical Center l Des Moines IA l l

Jackson Memorial Hospital l Miami FL l l

James H. Quillen VA Medical Center Mountain Home TN l l

Johns Hopkins Hospital l Baltimore MD l l

Kaiser Permanente Los Angeles Medical Center l Los Angeles CA l l

Kaiser Permanente Moanalua Medical Center l Honolulu HI l l

Kettering Medical Center-Sycamore Kettering OH l l

Kingsbrook Jewish Medical Center Brooklyn NY l l

LAC/USC Medical Center l Los Angeles CA l l

Lakeland Regional Medical Center Lakeland FL l l

Lancaster General Hospital Lancaster PA l l

Lee Memorial Hospital Fort Myers FL l l

Lehigh Valley Hospital Allentown PA l l

Lewis-Gale Medical Center Salem VA l l

Loma Linda University Medical Center Loma Linda CA l l

Long Island Jewish Medical Center New Hyde Park NY l l

Lutheran Medical Center l Brooklyn NY l l

Maimonides Medical Center Brooklyn NY l l

Malcom Randall VA Medical Center Gainesville FL l l

Manatee Memorial Hospital Bradenton FL l l

healthcare equality index 2O1O www.hrc.org/hei 63 appendix E 2OO of the largest U.S. hospitals

l yes l no

Hospital Name HEI 2010 City State Sexual Orientation Gender Identity

Massachusetts General Hospital l Boston MA l l

Medical Center of Central Georgia Macon GA l l

Medical University of South Carolina Charleston SC l l

Memorial Hermann Hospital Houston TX l l

Memorial Regional Hospital l Hollywood FL l l

Mercy Medical Center Des Moines IA l l

MeritCare Medical Center Fargo ND l l

Methodist Hospital Houston TX l l

Methodist Hospital San Antonio TX l l

Methodist University Hospital Memphis TN l l

MetroHealth Medical Center Cleveland OH l l

Miami Valley Hospital Dayton OH l l

Michael E. DeBakey VA Medical Center Houston TX l l

Mid Coast Hospital Brunswick ME l l

Mission Hospital Asheville NC l l

Mississippi Baptist Medical Center Jackson MS l l

Montefiore Medical Center Bronx NY l l

Morristown Memorial Hospital Morristown NJ l l

Morton Plant Hospital Clearwater FL l l

Moses H. Cone Memorial Hospital l Greensboro NC l l

Mount Sinai Medical Center Miami Beach FL l l

Nassau University Medical Center East Meadow NY l l

Nebraska Medical Center Omaha NE l l

New Hanover Regional Medical Center Wilmington NC l l

New York Presbyterian Hospital l New York NY l l

Newark Beth Israel Medical Center Newark NJ l l

North Mississippi Medical Center Tupelo MS l l

North Shore University Hospital Manhasset NY l l

Northside Hospital Atlanta GA l l

Northwestern Memorial Hospital Chicago IL l l

Oakwood Hospital & Medical Center Dearborn MI l l

Ohio State University Medical Center Columbus OH l l

Oregon Health & Science University Hospital l Portland OR l l

OSF St. Francis Medical Center Peoria IL l l

OU Medical Center Oklahoma City OK l l

Our Lady of the Lake Regional Medical Center Baton Rouge LA l l

Palmetto Health Richland Columbia SC l l

Parkland Health and Hospital Dallas TX l l

Parkview Hospital Fort Wayne IN l l

64 healthcare equality index 2O1O www.hrc.org/hei appendix E 2OO of the largest U.S. hospitals

l yes l no

Hospital Name HEI 2010 City State Sexual Orientation Gender Identity

Piedmont Hospital l Atlanta GA l l

Pitt County Memorial Hospital Greenville NC l l

Rex Healthcare Raleigh NC l l

Rhode Island Hospital Providence RI l l

Riverside Methodist Hospital Columbus OH l l

Robert Wood Johnson University Hospital New Brunswick NJ l l

Rush University Medical Center l Chicago IL l l

Salem Hospital Salem OR l l

San Francisco General Hospital San Francisco CA l l

San Pedro Peninsula Hospital San Pedro CA l l

Sarasota Memorial Hospital Sarasota FL l l

Scripps Mercy Hospital San Diego CA l l

Shands at the University of Florida Gainesville FL l l

Shands Jacksonville Medical Center Jacksonville FL l l

Sharp Memorial Hospital San Diego CA l l

South Texas Veterans Health Care San Antonio TX l l

Southcoast Hospitals Fall River MA l l

Sparrow Hospital l Lansing MI l l

Spectrum Health Grand Rapids MI l l

St. Anthony Hospital Oklahoma City OK l l

St. Barnabas Hospital Bronx NY l l

St. Barnabas Medical Center Livingston NJ l l

St. Francis Hospital Memphis TN l l

St. John’s Hospital Springfield MO l l

St. John’s Hospital Springfield IL l l

St. John’s Mercy Medical Center Saint Louis MO l l

St. Joseph’s Hospital Tampa FL l l

St. Joseph’s Hospital & Medical Center Phoenix AZ l l

St. Joseph’s Regional Medical Center Paterson NJ l l

St. Luke’s Hospital Chesterfield MO l l

St. Luke’s Medical Center Milwaukee WI l l

St. Luke’s Regional Medical Center Boise ID l l

St. Mary’s Hospital Rochester MN l l

St. Vincent Infirmary Medical Center Little Rock AR l l

St. Vincent’s Medical Center Jacksonville FL l l

Stanford Hospital and Clinics l Palo Alto CA l l

Staten Island University Hospital Staten Island NY l l

Strong Memorial Hospital University of Rochester Rochester NY l l

Sunrise Hospital & Medical Center Las Vegas NV l l

healthcare equality index 2O1O www.hrc.org/hei 65 appendix E 2OO of the largest U.S. hospitals

l yes l no

Hospital Name HEI 2010 City State Sexual Orientation Gender Identity

Swedish Health Services Seattle WA l l

Tampa General Hospital Tampa FL l l

Temple University Hospital Philadelphia PA l l

Thomas Jefferson University Hospital Philadelphia PA l l

Touro Infirmary New Orleans LA l l

Trinity Health Minot ND l l

UAMS Medical Center Little Rock AR l l

UCLA Medical Center Los Angeles CA l l

UCSF Medical Center l San Francisco CA l l

UMass Memorial Medical Center Worcester MA l l

University Hospital l Ann Arbor MI l l

University Hospital Albuquerque NM l l

University Medical Center Las Vegas NV l l

University of Alabama Hospital Birmingham AL l l

University of California Davis Medical Center Sacramento CA l l

University of Colorado Hospital Denver CO l l

University of Iowa Hospitals & Clinics Iowa City IA l l

University of Kentucky Hospital Lexington KY l l

University of Maryland Medical Center Baltimore MD l l

University of Minnesota Medical Center Minneapolis MN l l

University of Mississippi Medical Jackson MS l l

University of North Carolina Hospitals Chapel Hill NC l l

University of Texas Medical Branch Hospitals Galveston TX l l

University of Utah School of Medicine Salt Lake City UT l l

UPMC Presbyterian Pittsburgh PA l l

VA Eastern Kansas Health Care Topeka KS l l

VA Greater Los Angeles Health Care Los Angeles CA l l

VA Maryland Health Care Baltimore MD l l

VA New Jersey Health Care East Orange NJ l l

VA North TX Health Care Dallas TX l l

VA Palo Alto Health Care Palo Alto CA l l

VA Puget Sound Health Care Seattle WA l l

Vanderbilt University Medical Center l Nashville TN l l

VCU Health Richmond VA l l

Veterans Affairs Medical Center Cleveland OH l l

Veterans Affairs Medical Center Martinsburg WV l l

Via Christi Regional Medical Center Wichita KS l l

Wake Forest University Baptist Medical Center Winston-Salem NC l l

WakeMed Raleigh Campus Raleigh NC l l

66 healthcare equality index 2O1O www.hrc.org/hei healthcare equality index 2O1O www.hrc.org/hei 67 68 healthcare equality index 2O1O www.hrc.org/hei healthcare equality index 2O1O

Creating a National Standard for Equal Treatment of Lesbian, Gay, Bisexual and Transgender Patients and Their Families

Editors Ellen Kahn, HRC Family Project Director Tom Sullivan, HRC Family Project Deputy Director

Author Alison Delpercio, HRC Family & Workplace Project Coordinator

About The Human Rights Campaign Foundation Family Project aims to serve as a the HRC comprehensive resource for lesbian, gay, bisexual and transgender families. The Foundation project provides information on a wide range of issues, including adoption, civil Family unions, custody and visitation, donor insemination, family law, marriage, parenting, Project 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 and foster care agencies, elementary schools and healthcare facilities.

Acknowledgments Thank you to HRC interns Patrick Ahern for his assistance in outreach to facilities; and Melanie Chambers, Linnae O’Flahavan and Liz Cooper for their assistance in report preparations. We also acknowledge the contributions to this report by HRC staff Samir Luther for assistance in data analysis and Janice Hughes, Carolyn Simon and Robert Villaflor for editorial and design guidance. A special thank you to Tony Frye for design.

Thank you to the many representatives of our HEI 2010 Top Performers for their dedication to LGBT healthcare equality and their assistance in writing the testimonials and statements that appear in this report.

Finally, thank you to the HRC Workplace Project for its pioneering work on the Corporate Equality Index and the many LGBT workplace resources linked to in this report.

This report was funded in part by a generous grant from Pfizer Inc.

Endorsing Partner

The Gay & Lesbian Medical Association is the country’s largest group representing LGBT healthcare professionals. www.glma.org

healthcare equality index 2O1O www.hrc.org/hei 69 70 healthcare equality index 2O1O www.hrc.org/hei healthcare equality index advisory council

The Healthcare Equality Index Advisory Council supports the Human Rights Campaign Foundation’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. Hutson W. Inniss CIGNA Medical Group Tapestry Health Systems Inc. of Arizona Kevin Jordan, M.D. Desiray Bailey, M.D. Touro Infirmary Group Health Central Hospital Ritchie Miller Dana Beyer, M.D. Deloitte Financial Office of Councilmember Advisory Services LLP Duchy Trachtenberg, Montgomery County, Md., Council Julian Myers Benton Independent Consultant Diane Bruessow, RPA-C LGBT Physician Assistant Caucus Randall Sell of the American Academy Drexel School of Public Health of Physician Assistants Shane Snowdon Sonya Bruton LGBT Center, University Altarum Institute of California San Francisco

Leslie Calman David Staats, M.D. The Mautner Project University of Oklahoma

Mary Foley Matthew Stiff, J.D. UCSF School of Nursing Katz, Marshall & Banks LLP

Rebecca Fox Paul Wertsch, M.D. National Coalition for Wildwood Family Clinic LGBT Health Amy Wilson-Stronks Robert Garofalo, M.D. The Joint Commission The Howard Brown Health Center

Romana Hasnain-Wynia, Ph.D. Feinberg School of Medicine

healthcare equality index 2O1O www.hrc.org/hei 71 A Dedication

The Healthcare Equality Index 2010 is dedicated to the memory of Lisa Pond and the advocacy of her surviving partner, Janice Langbehn.

The healthcare landscape for all lesbian, gay, bisexual and transgender people has significantly changed, thanks in no small way to these two women.

We first shared the story of Lisa and Janice in the inaugural edition of the Healthcare Equality Index. The couple were on vacation in Florida with their children in February 2007 when tragedy struck. Lisa suffered a brain aneurysm and was rushed to the emergency room at Jackson Memorial Hospital in Miami.

When Janice arrived at the hospital with the children, she was told she was in an “anti- The Langbehn-Pond Family,1998. gay city and state” and would need a healthcare proxy before being allowed to see her Michael (standing), Lisa, Janice, Katie, David and Danielle. partner of nearly 18 years or know of her condition. Even after the documents were faxed to the hospital by a friend, it took hours before Janice was finally allowed to see Lisa. Janice was accompanied by a priest, who performed last rites.

In the three years since Lisa’s death, Janice has worked tirelessly to ensure that no other family should have to suffer these indignities. Represented by Lambda Legal, Janice sued the hospital and spoke at community events in Florida and around the country. As Janice has maintained throughout, this is not about a “gay right; it’s about a human right” to decide who should be with you in sickness and death.

In early 2010, after intense lobbying efforts and discussions between hospital administrators and a coalition of local and national LGBT activists, the hospital finally announced the implementation of new policies protecting the rights of LGBT patients and their families. These policy changes include an LGBT-inclusive definition of family and are reflected in Jackson Memorial Hospital’s rating in the HEI 2010 report. The hospital’s announcement did not, however, address the need for grievance procedures or include a formal apology to the Langbehn-Pond family.

Then, on April 15, 2010, Janice received a phone call from President Obama, who had just signed a memorandum ordering the development of federal rules directly addressing the type of discriminatory treatment her family had experienced in Miami.

“In those short minutes of speaking with our president, it was clear he got the issue, and now in reading his memorandum, he understood what happened to Lisa, the kids and I was wrong on many levels — especially on the human level,” Janice wrote later in her blog. “None of this brings Lisa back. But what it does do — for the next gay couple — is that, hopefully, if your partner is dying, you won’t be locked behind a door for eight hours as they slip from this earth and not be allowed to say goodbye.”

We all owe a great deal of thanks to Janice and her family. Janice’s efforts in the aftermath of personal tragedy have made the healthcare industry take notice of the type of discrimination that LGBT families face in healthcare settings. More importantly, it has changed the landscape so that in the future, no person is subjected to this treatment. We are indebted to Janice for her advocacy.

72 healthcare equality index 2O1O www.hrc.org/hei

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