North Carolina had the fourth-highest number of health care institution “leaders” in an annual survey-based report from an LGBTQ rights group.

By Yen Duong

In a state where advocates for transgender health still shudder remembering HB2, the “bathroom bill” of 2016, area hospitals have stepped up in their treatment of LGBTQ patients.

North Carolina boasted 24 “leader” hospitals which received a perfect score in the 2019 Healthcare Equality Index, a survey from a national LGBTQ advocacy group. Two other N.C. hospitals were “Top Performers” with scores of 80-95, and three other hospitals in N.C. also participated and received lower scores in the Human Rights Campaign index.

Across the nation, 680 hospitals participated in the voluntary survey, which analyzed criteria such as sexual orientation and gender identity non-discrimination policies for patients and employees, inclusive employee benefits and community engagement.

North Carolina had the fourth-highest number of leaders, after California, New York and New Jersey.



This map shows healthcare “leaders” in yellow with the HRC equals sign logo, participants in blue with their scores, and non-participants in gray with information on their publicly-available policies. Map credit: Human Rights Campaign.

“Sometimes, honestly, it’s just about leadership and who is there driving these kinds of things and these kinds of initiatives,” said Tari Hanneman, who runs the index as a director with the Human Rights Campaign. “The ultimate goal is that we want to make sure that LGBTQ people and their families are respected and cared for and given equal opportunities and equal benefits in all of the institutions of everyday living.

“Until we pass the [national anti-discrimination] Equality Act and have a more level platform across the states, it really is up to these individual institutions to provide those.”

History of the HEI

In 2007, the HRC rolled out the Healthcare Equality Index, and 78 hospitals participated in the then-confidential and unscored survey. Hanneman said the Healthcare Equality Index was motivated by the success of HRC’s long-running Corporate Equality Index, which “set the standard” for LGBT-friendly policies.

For instance, in 2004 the corporate index first started asking companies if they offered health insurance plans which explicitly covered treatment for gender transition such as hormone therapy and sex reassignment surgery as well as benefits such as mental health visits and short-term medical leave.

“That was transformative for health care: to understand that providing health care for trans people was not a weird, unusual requirement, [and] that this is medically necessary care that a lot of health insurance plans just hadn’t had experience with underwriting,” said Ames Simmons, the policy director of LGBTQ advocacy organization Equality NC. Simmons sat on the advisory board for the Healthcare Equality Index. “There was a move to work with the industry about how to underwrite these kinds of plans.”

This year was the first that the Healthcare Equality Index scored hospitals on offering a transgender-inclusive health insurance plan. The 2007 index only included policy standards for non-discrimination based on gender identity and sexual orientation, equal visitation rights and staff training.

“One of the functions of an index is to advance the criteria as a way of trying to move institutions forward in their acceptance of LGBTQ people and provision of services,” Simmons said. “That’s why over time, there have been additions to the criteria.”

In 2017, the Healthcare Equality Index included a spotlight on North Carolina, which noted that more hospitals had participated that year in response to HB2. Hanneman, who lived in Winston-Salem for seven years, proudly pointed out that North Carolina is doing well in the Healthcare Equality Index and attributed it to the participation of several large hospital systems such as Duke, UNC and Novant.

Novant hospitals make up half the leaders

Twelve of this year’s 24 leaders are Novant hospitals. That’s no coincidence, said Gina Fambrough, who manages Novant’s diversity and inclusion programs. In 2017, the system made it a priority to get every Novant hospital on the list. In contrast, in 2016, only three of Novant’s largest hospitals—Forsyth, Matthews and Presbyterian in Charlotte—received “leader” status on the survey.

“The parts that are challenging with the application are the employee benefits and policies portion, and the community engagement,” Fambrough said. “It’s really been a call to action to really make sure that you’re invested in the community, that you’re hearing from the community, that you’re serving the community.”

Fambrough offered several examples of ways that Novant met the “community engagement” requirement: sponsoring local pride parades and sending recruiters to the pride events for employment; sponsoring an “alternative prom” at an LGBTQ teenage center in Winston-Salem; and sponsoring a gala and providing meals to teens at an LGBTQ center in Charlotte.

Although the Healthcare Equality Index website includes free trainings and sample non-discrimination policies for hospitals to use, filling out the survey and trying to meet the standards can still be onerous, especially taking the time for staff training, Simmons said.

“That’s something that requires fiscal investment by hospitals: just taking people off the floors is something that they would have to plan for,” Simmons said. “It’s not something that you casually mention in grand rounds.”



The Trans in the South report lists over 400 trans-friendly medical providers across 13 Southern states. Map credit: Trans in the South.

To help keep up training, Novant partners with organizations such as LGBTQ family and friends non-profit organization PFLAG, Equality NC and HRC, Fambrough said.

“I remember receiving a call from our Kernersville pediatric clinic, saying ‘Hey, we have our first transgender [pediatric] patient; we don’t know how to do this. Can you help?’” Gina said. “Some people get very tripped up with pronouns and preferred names. … How can I in a respectful way have this conversation around [patient’s] anatomy when I’m trying to respect how they want me to refer to them?”

Transgender health access

Per the Healthcare Equality Index report, 70 percent of transgender people said they had faced serious health care discrimination, and 23 percent said they had skipped out on necessary health care in the past year for fear of mistreatment.

That’s not surprising to Ivy Gibson-Hill, an advocate who runs a Trans in the South resource page listing trans-friendly providers across 13 Southern states. They described hearing multiple cases of a transgender person seeking a prescription for testosterone and leaving their doctor’s office with a prescription for estrogen due to the doctor’s ignorance.

“I think that a lot of that is more prevalent in the South,” Gibson-Hill said. “And a lot of that is because our culture here is so steeped in religion, that this discrimination has a religious stamp of approval here that I think is fairly unique to other regions.”

In that vein, HRC and SAGE, an LGBTQ seniors advocacy group, will unveil a Long-Term Care Equality Index next year to measure how long term care facilities, skilled nursing facilities and other elder care facilities treat LGBTQ seniors, said Simmons.

“I think that thinking … about transgender people is a new thing for a lot of long-term care facilities,” Simmons said.

Ultimately, the indices and reports such as Trans in the South aim to make health care accessible for LGBTQ patients and employees, Gibson-Hill said.

“I really dream about a day when every trans person in every town across the South has access to at least one medical provider who will treat them with dignity and respect in their hometown,” Gibson-Hill said. “I feel like that is an achievable goal.”