When Jakob Rumble decided to seek legal action against Fairview Southdale Hospital after an experience where he felt he was discriminated against as a trans man, he started out with two goals. First, he wanted to confirm that transgender people are protected under the anti-discrimination provision of the Affordable Care Act (ACA) and second, he wanted to ensure that what he experienced would happen as little as possible in the future, with health care providers taking on the appropriate training to serve transgender patients.

Grievances listed in Rumble’s complaint include being forced to wear a pink bracelet that said “F” for female, having “Ob/Gyn” written on his whiteboard for every staff member- even non-medical to see, even after repeatedly stating he identifies as male. That’s in addition to the rough treatment and outward hostility Rumble says he experienced.

Fairview was contacted for comment about the case, but had no comment due to pending litigation. You can read the complaint here

Though his lawsuit against the hospital is far from over, he’s already achieved the first goal. That’s because Judge Susan Richard Nelson’s decision over a motion for dismissal of the case clarifies that transgender people are indeed a protected class under the new healthcare law. You can read the judge’s dismissal here

“I’m really happy about that,” Rumble says, in response to the judge’s decision. “If it hadn’t happened yet then it needed to… Now it will be easier to bring those claims.”

Rumble has been working as an organizer and activist since before he was 18, so when he had the experience at Fairview Southdale, he decided that if he were supporting someone else, he would encourage them to speak out. “I kind of had to do it,” he says. “I needed to practice what I preach.”

It was difficult, being a very private person. Since the case began, he’s been overwhelmed with all the attention he has been getting. “I don’t appreciate some of the things that have happened and people reaching out to me,” he says. Random strangers add him on Facebook, and people even recognize him on the street.

Just as litigation that followed the 1964 Civil Rights helped clarify what the law actually meant, so court cases that draw on Section 1557 will help define what exactly it does.

Jill Gaulding, an attorney from Gender Justice, who is one of the lawyers representing Rumble, says that while the discrimination case may take months or even years, the judge’s ruling is already a victory. “We think it is a really important ruling that’s getting a lot of attention.” The 63 page document “addresses a lot of issues, but the overarching point is that it is the first time the court has looked closely at what the new Civil Rights law with the ACA.” One of the most important things, she says, is that “the law protects transgender patients from discrimination.”

Discrimination against transgender goes beyond simply using the wrong pronoun initially, Gaulding said. “It’s about a lack of respect or humanity.” Once someone is told their correct gender and pronoun, and repeatedly ignore it and take on a hostility, it becomes something other than ignorance.

According to research cited in Rumble’s complaint, transgender patients are statistically very likely to experience discrimination in health care settings. One survey from 2009, conducted by Lambda Legal, found that 70 percent of transgender and gender non-conforming respondents experienced discrimination in health care settings, while nearly eight percent experienced physically rough or abusive treatment. The National Transgender Discrimination Survey found 28 percent of respondents reported verbal harrassment and 2 percent reported being physically attacked.

Ellen Krug, a transgender woman who is the Executive Director of Call for Justice, says she’s sure the ruling will have an immediate impact. “You can be sure that every major health insurer and provider will be aware of this decision… you can’t treat trans people poorly when they show up in your ER. That’s a message that’s very important.”

At the same time- Krug says that you can’t paint with a broad brush and say that the health delivery system in the Twin Cities is uniformly anti-trans. Krug has had good experiences at places like Park Nicollet’s OB/GYN and at Health Partners. Still, she’s had negative experiences herself, like a nurse two summers ago in an emergency room making a point to question whether Ellen Krug was her legal name, “which made me feel like crap,” she says.

Dominic Giovon Chilko, a transgender man, says his experiences in health care settings haven’t been the best either, mostly due to being misgendered. “I had to stop going to one doctor because he refused to use male pronouns.” He had been seeing the doctor his whole life.

Chilko hopes that in addition to reducing discrimination, more can be done to get insurance companies to cover gender re-assignment. “Getting our surgeries covered under Obamacare would lessen the stress for the trans community,” he says. “More transgender people would come to light and there would be less suicide,” he says.

Ethan Turcotte, who has been out as a trans man for about seven years, once had a nurse refuse to take his catheter out, even though he was on heavy pain medication at the time. Turcotte had to pull it out himself, despite the fact that he didn’t know how to do it.

Turcotte says he generally brings a partner or friend when visiting the doctor, as a support person, especially if he is seeing someone new or knows he has to take his shirt off.

Even when an advocate is there, Turcotte has had negative experiences. Once, when he had a really bad cough five years ago and went to a clinic, the nurse had him take his shirt off, saying “Oh, you’ve had surgery?” Then, when she sat down at her computer, added, “What kind of surgery was it?

Turcotte’s advocate responded to the nurse’s question by asking, “Is this relevant?” The nurse responded that she guessed it wasn’t.

Turcotte likens it to a white person who sees a woman with amazing natural hair, and they immediately want to to touch it. “You can’t comment on someone else’s body,” he said. “It’s very othering.”