Case History #3

Frankie is a 66-year-old retired postal worker who has been in and out of 12-step programs and outpatient treatment for 10 years. This will be his first inpatient treatment episode. Frankie came to the intake session with Janice, his female partner of 16 years. The couple lives together in a home they purchased 12 years ago. They are not legally married, but their friends and family consider them husband and wife. They have two grown children (one each from previous marriages) and five grandchildren. Frankie expects that Medicare will pay for his treatment. Janice works for the city and is covered by the city’s HMO plan.

After intake, Frankie is settled in a room with another male patient. On Frankie’s first night at the facility, a nurse observes that Frankie has female genitals. Frankie’s roommate demands that he be moved out of the room. The nurse has told her supervisor that she's not going to work “with that ‘weirdo’ in Room 112.”

What legal issues does this case present?

1) Who is responsible for the cost of Frankie’s care? Since Frankie and Janice are not legally married, and cannot be, Janice is not responsible for the cost of Frankie’s treatment. Janice may want to support part of the costs of treatment, but there is no legal requirement that she do so, and unless her employer provides health benefits to domestic partners, her HMO will not contribute.

2) Will Medicare cover Frankie’s treatment if his declared gender is not in accord with his biological sex? Ask Frankie whether Medicare identifies him as male or female. If he gives a different gender from what appears on the original Medicare application, there may be problems with payment.

3) Who is considered “next of kin”—Janice? or Frankie’s child? Since Frankie’s and Janice’s relationship is not State sanctioned, Frankie’s child is considered his next of kin. However, if Frankie would prefer to name Janice as his next-of-kin for visiting and emergency-notification purposes, the program should respect his wishes.

4) Can the program fire staff who refuse to work with Frankie because he is transgendered? Yes. Unless the staff person is protected by a union contract with a provision covering this situation, he or she can be fired at any time, unless the action is taken because he or she is female, a member of a minority group, or disabled. In the United States, most employment is “at will,” which means that either the employer or employee can end the relationship at any time and for any reason, unless that reason violates one of the civil rights statutes discussed above.

What policy issues does this case present?

1) What policies should the program have in place to ensure that LGBT individuals are treated fairly? Programs should have written policies in place that require staff to be willing to treat all clients without regard to race, gender, disability, or sexual orientation. Job descriptions should make treatment of clients (regardless of their status) an integral part of the responsibilities of each position. Staff should be screened before hiring to ensure they are willing to abide by the program’s treatment rules and should be required to attend educational and sensitivity training about LGBT individuals.

2) Should the program move Frankie away from his objecting roommate? Yes. No one should have to endure a hostile roommate. Moving Frankie avoids a difficult situation and helps with his treatment. With Frankie’s consent, the program should conduct a sensitivity session to educate clients about transgendered individuals as well as those who are lesbian, gay, or bisexual.