The resignation of a prominent gender-health psychiatrist in Edmonton, as well as a policy change about how patients are approved for top surgery — a procedure involving the removal of breast tissue to produce a more masculine chest — has led to ballooning waitlists and delays in accessing health services for trans people in the province.
Nick North was initially slated to have a revision to his top surgery later this fall, but that procedure has been pushed back to an indefinite date
“I had my first surgery last October and we always knew I’d need a revision, we were just sort of waiting on how big of a revision it would be,” North told HuffPost.
He said at a meeting in the spring, his doctor found a pocket of fluid that needed to be removed, and they tentatively planned a follow-up surgery for this October. Over the summer, that date was pushed back to early 2020.
But last week, North received an email from his doctor saying he was 68th on the list and there was no “ballpark” as to when the surgery would be.
“And other people [in the past few weeks] have been getting basically the same email,” North said.
New requirements for approval
Amelia Marie Newbert is the co-executive director and founder of Skipping Stone, a trans resource group in Calgary. She says the approval process was changed early around January of this year.
“So what we’re seeing now is people’s applications for top surgeries get returned and saying that they no longer meet that prescribed criteria,” Newbert said.
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Previously, a patient needed a doctor or psychologist’s referral to schedule and have top surgery covered in Alberta. Patients now, however, require approval from a registered psychiatrist to receive the surgery.
“Because there are so few psychiatrists in the province doing trans-affirming care, that’s extended some of the wait times literally years,” she said.
Newbert says that global standards of practice around trans health care — including in other Canadian provinces like Ontario and British Columbia — don’t require psychiatrist approval for top surgery.
She said some patients who had approved surgery dates had those dates rescinded, sometimes with less than a month’s notice, if they didn’t have psychiatrist approval under the new policy.
“It’s heartbreaking. There are people who were sitting there and going, ‘Okay, my surgery is going to be in two months’,” she said. “And then just in the last couple of weeks, they had a letter come back going, ‘I’m sorry, you no longer meet the criteria’.”
The resignation of Dr. Michael Marshall
Newbert says a second factor compounds the increased wait-times experienced by trans folks looking to get top surgery in Alberta — the recent resignation of one of the province’s leading gender psychiatrists.
Because there are so few psychiatrists in the province doing trans-affirming care, that’s extended some of the wait times literally years.Amelia Newbert, Skipping Stone
Michael Marshall resigned from Edmonton’s gender clinic earlier this month, citing a lack of sustainable provincial funding for the clinic.
“It is with regret I had to leave and with a heavy heart I left,” Marshall told Global News. “In order to work for a population that is underserved and vulnerable, there are certain requirements, and without those requirements it was a struggle to do so.”
Almost all of the staff at the gender clinic were funded by University of Alberta grants secured by Marshall himself. But those grants are set to expire in early 2020.
“Securing grants as a means of providing care is not sustainable,” Marshall said.
Newbert said that Marshall’s departure and the uncertainty around the gender clinic’s future will lead to worsening services for trans people in Alberta.
“What we saw was that, you know, the clinic could have barely got off the ground, and had no sustainable funding, it not only wasn’t able to sort of live up to the potential that people had hoped for,” she said. “Now is questionable whether or not it will exist at all.”
In a statement to HuffPost, Alberta Health Services executive director, addiction and mental health Mark Snaterse said that the province is aware of the impact Marshall’s resignation has.
“Recruitment has begun for new physicians to support the Gender Program. In the meantime, AHS will ensure there is appropriate coverage to continue providing specialized health and mental health care for transgender, gender nonconforming and nonbinary people,” he said.
According to Snaterse, there are currently about 580 patients being seen by the Gender Program and there is a waitlist of about 650 people, who are waiting for an initial appointment with the clinic.
“Wait times are a challenge across the healthcare system and across specialties and it’s something we are consciously working on addressing,” he said.
The long wait
North says that waiting for a gender affirming procedure, like top surgery, can be incredibly painful and difficult for trans people.
“If I didn’t have top surgery, I would have this physical reminder, day in and day out that there’s something that doesn’t fit properly,” he said. “It would be like having an open wound on your arm. It’s that intense.”
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Newbert agrees, and says lack of access to health care like gender affirming surgeries can lead to increased mental health challenges for trans people.
“We already know trans folks in the province, in the world over, because of these barriers, because of stigma, because of the discrimination, face huge, huge amounts of distress that manifests as anxiety, depression and suicide attempts,” she said.
Skipping Stone has issued three public calls to action around trans health care in the province.
Increase funding for the delivery of trans affirming health care.
Allocate funding for a province-wide, system navigator specifically for trans and gender diverse individuals (similar to models such as Trans Care BC or Rainbow Health Ontario). This system navigating organization should be community-driven, operate at arm’s reach from the health care system, and act as a single source of truth.
Update and amend outdated and restrictive policies and practices relating to the care of trans and gender diverse Albertans.
“Now that people have planned their lives around surgeries, they’ve lost them. What’s going to happen? What sort of toll does that take on people emotionally and psychologically and physically?” Newbert said.
“And all we can try to do here is plug the holes support the best we can.”