42p0 × 66p0 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