In June, Alexa Rodriguez was denied a surgery five months after it was cleared by her doctors.

Rodriguez had been preparing to undergo a breast implant procedure at MedStar Georgetown University Hospital. When she called to schedule the appointment, though, the hospital refused to follow through with the procedure, stating it no longer performed it on transgender women.

“It’s just nonsense, and there’s no medical reason behind what they were saying,” says Mara Keisling, executive director of the National Center for Transgender Equality.

Rodriguez’s case is not isolated. Ruby Jade Corado, the founder of Casa Ruby, a Northwest DC community-services center for lesbian, gay, bisexual, and transgender individuals, says more than 20 transgender patients have been denied surgery at MedStar Georgetown.

The hospital’s refusal reveals the difficulties transgender people face in receiving medical care, both with insurance coverage and the treatment itself. Though patients like Rodriguez are routinely denied transitional surgeries, it can often go even deeper: many transgender people are refused care due to a lack of research, ignorance, or general discrimination.

A friend of Keisling’s, she says, was refused coverage on blood work because she was transgender. “[The insurance company] called it transsexual blood,” Keisling says. “And told her because of that, her blood work was excluded.”

Because transgender people often struggle with recieving transition-related procedures, many sucuumb to using unregistered doctors for their treatment. Catherine Campo was referred by Georgetown Hospital to the hospital’s Breast Health Center. Campo had been injecting herself with vestibule oil, a common practice in Latin America, says Corado. The oil began to deteriorate inside of her body, triggering a life-threatening infection and fever. Although Campo’s doctor said she needed immediate treatment to save her life, she was denied reconstructive surgery on the grounds of her being transgender, Corado said.

“It’s a little concerning to me,” Corado says. “Are providers going to have a choice of who lives and who dies?”

A 2011 survey by Keisling’s organization found that 19 percent of transgender people have been refused health care, while 1 percent have reported being physically assaulted in hospital emergency rooms. And 50 percent said they needed to instruct their doctor how to treat them.

Keisling has seen these kinds of incidents often: The time she headed to the hospital at 2 AM to help a transgender male friend because the attending physician did not know how to treat his ovarian cysts. Or when a 15-year-old transgender male client went to the emergency room for a respiratory infection, only to be given a gynecological examination. Or the nursing student who called Keisling one night, asking how to properly give emergency room treatment to a transgender patient. When the student had asked her professor the same question earlier that day, he replied that when he worked at a New York hospital, “they usually just let those freaks die.”

The District’s transgender community has been haunted for 20 years by Tyra Hunter‘s death. Hunter, a transgender woman, had been in a car accident, and after emergency medical technicians removed her clothing to get to her injuries, they withdrew treatment and ridiculed Hunter on the ride to the hospital, where she was pronounced dead. An autopsy suggested that Hunter had a 71 to 88 percent chance of survival had the EMTs not stopped treating her injuries; Hunter’s family later won a $2.9 million wrongful death lawsuit against the District.

“If a doctor decides they don’t want to engage in what could be seen as cosmetic surgery, I can get that,” Corado says. “But I don’t get it when you’re putting someone’s life at risk because you don’t want to touch them.”

Some doctors refuse health care because they do not know how to treat transgender patients, Keisling said. Though care providers do need to know what else a patient is taking to appropriately treat them, instead of researching how certain hormones interact, care can sometimes be simply denied.

“There’s a way to find out about interactions,” Keisling says. “You can look it up on the computer. You can ask another doctor. You don’t need to refuse treatment, or make a big deal about it.”

Though most of Rodriguez’s gender-reassignment treatment was performed at Whitman-Walker Health, she is still seeking other options for her breast implant surgery. Rodriguez also filed a complaint last month against MedStar Georgetown with the District’s Office of Human Rights, the Washington Blade reported.

“We’re all thinking, you do understand that I’m human, right?” Keisling says. “I have the same human ribs, or human bones, or human blood, as you have.”

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