This section focuses on known activities that undermine LGBTQ+ equality or patient care. Healthcare organizations can have points deducted from their score if they have policies in place that may lead to discriminatory treatment or a large-scale official or public anti-LGBTQ+ blemish on their recent records. Learn more about this criterion in the HEI Resource Guide.
The largest deduction of 25 points is for major offenses that come to the attention of the HRC Foundation such as revoking LGBTQ+ inclusive policies and practices or having policies in place and/or engaging in proven practices that are contrary to the organization's written LGBTQ+ patient or employment policies. HRC realizes that no institution is perfect and that situations may arise where an individual or small group act in a way that is not in alignment with the organization’s policies and commitment to LGBTQ+ equality and patient care. This criterion is not intended to penalize an organization in those situations where an isolated negative action takes place, provided that the organization addresses the situation and takes action to ensure that their commitment to LGBTQ+ patient care remains uncompromised.
The HRC Foundation does not take the application of this penalty lightly and prior to this year, it has only been used in one instance. Unfortunately, this year three hospitals have received the 25 point deduction: University of Texas Southwestern Medical Center and Children’s Health in Dallas received the deduction for discriminating against transgender children by not providing them with the same care that they provide to other children; and Mercy San Juan Medical Center for discriminating against a transgender man, Evan Minton by denying him a hysterectomy. Learn more about each of these cases by following the links above.
This year, the HEI introduced a new penalty option under the Responsible Citizenship criteria. This penalty is for organizations that either follow a religious directive or have a policy in place that prevents them from providing specific medically necessary treatments, such as hysterectomy or mastectomy, to some patients based on a diagnosis of gender dysphoria, but allows them to provide the same treatment to other patients based on other diagnoses, this may result in discriminatory treatment that is in conflict with their non-discrimination policy.
This year, this penalty was applied to 137 HEI 2022 participants. The majority (115) of these participants are facilities operated by the Veteran’s Health Administration, which due to an exclusion in the VA medical benefits package are unable to provide gender-affirming surgeries. The other group of 22 hospitals that received this penalty are Catholic healthcare facilities that interpret one or more of the Catholic Ethical and Religious Directives in a way that means they will not perform certain gender-affirming surgeries while they would provide the same surgeries for other patients based on other diagnoses.
Organizations with this type of directive or policy in place may only be subject to a five-point deduction (to offset the points received for the Patient Non-Discrimination Policy) if they take certain actions to mitigate the potential for discriminatory situations to occur. These actions include providing a statement on their website about the services that are not provided, having a referral mechanism in place, and communicating this limitation to area surgeons.
After taking these communication steps an organization would only be assessed a 5 point deduction. If after this deduction, the organization has a final score of between 80-95 and meets the other criteria for earning the Top Performer designation (full credit in criteria 1 and at least partial credit in criteria sections 2, 3, & 4), the organization may earn the Top Performer designation.