A transgender man is suing the University of Maryland Medical System in federal court, claiming his rights were violated when his gender-affirming surgery was canceled by one of the hospital system's subsidiaries.
Jesse Hammons was scheduled to have a hysterectomy in January at the University of Maryland St. Joseph Medical Center in Towson. The procedure, routinely performed on cisgender women at the same hospital, was deemed medically necessary for Hammons, who had been diagnosed with gender dysphoria. However, about a week before the scheduled surgery date, the center canceled the procedure because it “conflicted with the hospital’s Catholic religious beliefs,” according to the lawsuit.
“Defendants canceled the surgery based on a discriminatory and unconstitutional application of Catholic religious doctrine,” the suit states. “When they canceled Mr. Hammons’ medically necessary surgery, Defendants thus treated Mr. Hammons — as a man who is transgender — differently from nontransgender patients who require medically necessary hysterectomies for other medical conditions.”
The lawsuit, filed Thursday in the U.S. District Court for the District of Maryland, claims that by canceling the surgery, the hospital violated the Constitution’s First and 14th Amendments and the Affordable Care Act’s ban on sex discrimination in health care.
‘Private’ or ‘taxpayer-owned’?
St. Joseph Medical Center, a historically Roman Catholic institution just north of Baltimore, was founded over 100 years ago and was fully acquired in 2012 by the University of Maryland Medical System. UMMS, which maintains that it is a private, nonprofit organization, received over $40 million in “state appropriations” in 2018, according to its most recent annual report, and Maryland’s governor appoints members of the UMMS board.
When UMMS acquired St. Joseph Medical Center, the hospital system vowed to retain the hospital’s “Catholic identity,” which today means it still follows the Ethical and Religious Directives for Catholic Health Care Services, or ERDs, faith-based health guidelines that ban procedures like abortion, euthanasia and gender-confirmation procedures.
Michael Schwartzberg, director of communications for the University of Maryland Medical System, told NBC News in an email that he would not comment on the specifics of pending litigation, but he disputed the claims of the ACLU, which is representing Hammons, that UMMS is “taxpayer-owned.”
“UMMS is a privately-held corporation (since 1984), and SJMC is a privately-held, not-for-profit hospital, and SJMC is mandated to abide by the ERDs,” Schwartzberg said, noting that all Catholic hospitals in the U.S. are bound by the ERDs.
“All physicians and advanced practitioners seeking privileges at UM SJMC agree to abide by the ERDs prior to the granting of privileges,” Schwartzberg said.
Joshua Block, a senior staff attorney with the ACLU LGBT & HIV Project and the lead attorney in Hammons' case, disputed Schwartzberg’s characterization of UMMS as private, claiming that the medical system is de facto controlled by the state of Maryland. Citing its receipt of taxpayer funds and its largely governor-controlled board, Block argued that the UMMS is bound by the Constitution’s church-state separation.
Hammons’ complaint cites a 1995 Supreme Court ruling that found that Amtrak, being a government-created private corporation, had a responsibility to uphold the First Amendment.
In that ruling, Lebron v. National R.R. Passenger Corp., Justice Antonin Scalia wrote that when the federal government creates a corporation "and retains for itself permanent authority to appoint a majority of the directors of that corporation, the corporation is part of the government for purposes of the First Amendment."
Block said that Hammons' lawsuit “raises all the same fact patterns about sex discrimination against transgender patients in the context of transition-related surgery at hospitals, but it also has this added feature where it’s not just a private religious hospital but part of the University of Maryland hospital system."
“So not only does it violate statutes against discrimination, but the Constitution — both the Equal Protection Clause and the Establishment Clause," he said.
Block said the ACLU had the case ready soon after Hammons’ surgery was canceled in January but paused because of coronavirus court delays. He said June’s landmark Supreme Court decision in Bostock v. Clayton County, Georgia — which found that federal job discrimination protections extend to LGBTQ people — has only made the filing stronger.
“The landscape after Bostock certainly strengthens our claim under the ACA,” Block said, referring to a ban on health care sex discrimination contained within the Affordable Care Act.
The Trump effect
Even after the Bostock decision, the Trump administration is continuing its effort to reverse Obama-era transgender protections in health care.
In June, days before that case was decided, the Department of Health and Human Services issued the final version of a rule that explicitly strips transgender protections from the Affordable Care Act’s nondiscrimination language.
That rule is set to go into effect on Aug. 18, though on Tuesday, 23 Democratic state attorneys general filed suit to block its implementation.
Chase Strangio, ACLU’s deputy director for transgender justice, said the legal interpretation advanced through years of Trump administration policies — that sex discrimination bans in various laws do not prohibit discrimination based on sexual orientation and gender identity — won’t go away on its own.
“There's nothing self-executing about the decision,” Strangio said of the landmark Bostock ruling. “Implementation of civil rights laws is a multi-year project always, because we have strong resistance to them.”
He said he expects that courts will be called upon to enforce the precedent-setting finding central to the Bostock decision: “It is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.“