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Alleged Transgender Discrimination Case Proceeds under ACA § 1557 in Minnesota District Court

on Monday, 20 April 2015 in Health Law Advisory: Zachary J. Buxton, Editor

On March 16, 2015 the Minnesota United States District Court denied a Defendant hospital and physician professional association’s Motion to Dismiss Jakob T. Rumble’s discrimination complaint under the Patient Protection and Affordable Care Act (ACA) (Rumble v. Fairview Health Services; D.Minn. (2015 WL 1197415). The suit marked the first time a court has interpreted the ACA’s civil rights provision, Section 1557, that prohibits discrimination based on race, color, national origin, sex, age, or disability.

In June 2013 Rumble, a teenage female-to-male transgender male, presented to the Fairview Southdale Hospital’s emergency room with excruciating genital pain. After waiting four and a half hours to see a physician, the patient was subject to alleged harsh questioning from the emergency room physician, subjected to an excruciatingly painful genital examination, and experienced other mistreatment by hospital staff and physicians. The emergency room physician terminated the painful exam only after three requests – two from the patient and one from the patient’s mother, whom was present in the exam room – for the exam to stop due the overwhelming pain caused by the exam.

Without the benefit of administrative guidance interpreting the ACA civil rights provision, Minnesota District Court Judge Susan Richard Nelson found an Office of Civil Rights (OCR), the Department of Health & Human Services sub-agency charged with enforcing ACA § 1557, letter persuasive. The July 2012 letter, written by OCR Director Leon Rodriguez, opines that “Section 1557’s sex discrimination prohibition extends to claims of discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity[]” (OCR Transaction Number: 12-000800).

Judge Nelson also found that the ACA provision is applicable to Fairview Southdale Hospital and Emergency Physicians, P.A., the organization that employs the emergency room physicians who staff Hospital’s emergency room, because both receive federal funds through credits, subsidies, or contracts of insurance through the Medicare and Medicaid programs.

The Plaintiff’s first count alleged violation of ACA § 1557, his second count alleged violation of the Minnesota’s Human Rights Act (MINN. STAT. § 363A.11).

Zach J. Buxton

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