Rochester Institute of Technology is facing at least three state- and federal-level civil rights complaints relating to the dismissal earlier this year of a staff doctor who was managing hormone replacement therapy for transgender students.

The doctor, Annamaria Kontor, was on staff at the college's Student Health Center. She is a pediatrician who had attended, at RIT's expense, several training sessions on hormone replacement therapy (HRT), and was monitoring that therapy for a handful of students until she was fired May 24.

She points to unanimous guidance from professional organizations that primary care doctors, with some basic training, are capable of monitoring HRT for patients. RIT, like other area colleges, does not have a specific written policy on the topic.

Nonetheless, Kontor's termination letter stated: "The Student Health Center's practice prohibits prescribing hormone therapy for the purpose of gender transition."

It was signed by Dr. Wendy Gelbard, the college's associate vice president of Student Health, Counseling and Wellness. In an essay submitted to the RIT student news magazine, the Reporter, which first wrote about Kontor's firing in July, Gelbard maintained that administering and monitoring HRT for transgender students was "beyond the scope of practice of the Student Health Center."

"While we strive to offer a breadth and depth of services, it is not possible to meet every student's health care needs within the scope of practice of the Student Health Center," she wrote. "That being said, we are fortunate to be situated in Rochester, where there is a strong medical community rich with resources."

Kontor declined to comment until the end of the internal RIT complaint process, which has been delayed several times. RIT spokeswoman Ellen Rosen said the school and Gelbard would not comment because it was "a personnel matter," and declined to address more general questions about the university's policy.

Both sides, though, have established their positions publicly, through interviews and, for Kontor, on a personal website.

Gelbard also wrote that Kontor had ignored several notices not to provide hormone therapy to transgender students.

There does not, however, appear to be any university policy that addresses the topic one way or another. An archived version of the Student Health Center's website shows the description was changed two months after Kontor's firing. Where it first said the center offers "comprehensive primary care" and stressed "continuity of care," it now describes "basic primary care," and does not mention continuity of care at all.

Kontor has denied receiving any warnings about HRT. Among the points RIT would not publicly address is how Gelbard learned of Kontor's care for transgender students; according to the Reporter, she found out through a review of student records.

The fundamental question is whether a nonspecialist such as Kontor is capable of monitoring hormone replacement therapy for transgender patients.

The leading medical organizations have all endorsed primary care doctors' ability to do so. They include the American Academy of Family Physicians, The American Academy of Pediatrics and the World Professional Association of Transgender Health.

"With appropriate training, feminizing/masculinizing hormone therapy can be managed by a variety of providers, including nurse practitioners, physician assistants and primary care physicians," according to WPATH's guidelines.

The American College Health Association issued transgender recommendations in 2015, including that schools "train clinical health care providers on the initiation and continuation of gender-affirming hormones."

According to her website, Kontor has participated in dozens of hours of care in transgender health care, including a weeklong conference sponsored by WPATH. She also served on the advisory board for RIT's Q Center, a campus hub for LGBTQ students, and attended a full-day workshop and expert panel on the topic through RIT's Center for Women and Gender last December.

That panel included Emma Forbes-Jones, a WPATH-certified psychologist in private practice in Rochester. She said prescribing hormones for transgender people is no more complicated than doing so in other contexts, including birth control or ovarian disease.

"Prescribing HRT for people with a gender dysphoria diagnosis is within the allowed practices of primary care ... and I know (Kontor) obtained training that qualifies her to prescribe," Forbes-Jones said. "The fact that RIT appears to be picking and choosing what best practices are allowed is, I think, pretty terrible. And it leaves people hanging, because qualified providers are really in limited number."

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The main community provider for transgender care is Trillium Health, which sees about 350 patients.

Bill Schaefer, director of Trillium's Transgender Center, said the wait for a new patient visit is typically several months, though the organization is now adding additional staff to meet the demand.

Ryan Roy waited until he arrived at RIT in September 2016 before coming out as transgender; he feared being ostracized in the conservative community in Maine where he grew up.

He began hormone replacement therapy at a Planned Parenthood in Ithaca that November, then began seeing Kontor for regular check-ups and prescription refills.

The first he learned of her dismissal was when a request for a new refill that he sent her through the campus messaging system came back as undeliverable. Trillium had no appointments for months, and the college didn't provide any other help, he said.

"At that point I was stranded, without anyone taking care of my prescription," he said. "It was very sudden and abrupt."

Roy filed a federal Title IX complaint alleging discrimination and also initiated a petition through RIT's student government, gathering 431 signatures. It has not yet received a response; student government leaders did not respond to a request for comment. OUTspoken, an LGBTQ group on campus, hosted a forum on transgender health last week.

Another student, Henry Trettenbach, said it took him several months to get an appointment with Trillium. Both he and Roy also said RIT was entirely unhelpful after Kontor's dismissal, including not notifying them that she'd been fired to begin with.

Trettenbach also filed a Title IX complaint, and Kontor filed one with the New York State Division of Human Rights. Kontor was scheduled for a closed-door hearing Thursday.

"She’d talk to you to be sure you’re OK — she paid more attention to me than any other doctor," Trettenbach said of Kontor. "I just wish we could go back to how it was last year, where you could go to the Student Health Center and have your appointment, and that’s it."

Rosen, the RIT spokeswoman, wrote in an email: "Our staff works tirelessly to ensure students get access to the care they need and we have an assigned case manager who is a tremendous resource in identifying community specialty providers and assisting students to ensure access to care without interruption."

More generally, Forbes-Jones said, RIT has earned a reputation as welcoming to LGBTQ students. It offers gender-inclusive housing, where people of different genders can choose to live together, and most campus communications do not use gendered pronouns.

"In many ways, RIT has been ahead of the curve (on transgender issues)," she said. "This practice of not allowing primary care doctors to do something that falls under primary care, and excluding this set of kids, seems out of step from the direction they seemed to be moving in. … They have a broader reputation as an institution that’s welcoming to the trans community, and this is definitely not in line with that."

JMURPHY7@Gannett.com

Other local colleges also do not offer hormone replacement therapy

Rochester Institute of Technology is noteworthy in that transgender students once could have their hormone replacement therapy (HRT) managed by an on-campus pediatrician, then had that service removed. For the most part, other local campuses have never offered it at all.

The University of Rochester's student health center allows that practice in theory but currently does not have any pediatricians trained to do it. Instead, students seeking HRT are referred to the Adolescent Medicine division at the University of Rochester Medical Center.

The College at Brockport, Nazareth College, Roberts Wesleyan College and SUNY Geneseo all refer transgender students to outside specialists for HRT; Brockport said it is trying to increase its capacity to serve transgender students.

Monroe Community College has no primary care physicians on staff, only a nurse practitioner and physician's assistant.

St. John Fisher College’s Health and Wellness Center offers general medical care to all of its students. Specialty care is referred to outside specialists or may be provided by the College medical team in direct collaboration with those specialists, and based on their scope of practice.

JMURPHY7@Gannett.com