This doctor should never be allowed near transgender children.
April 25, 2013 10:04 PM   Subscribe

A friend's 11-year old transgender child had an extremely traumatic and invalidating experience with a Medicaid primary-care provider in Corpus Christi, TX. What recourse does she have?

A distant friend of mine recently moved to Corpus Christi, Texas. She has been using me as a resource because I'm the first trans person she's met. (We met before I transitioned.) Her 11-year old child identifies as MTF transgender, and she is still trying to figure everything out (names, pronouns, etc.).

Everything I know screams at me that the child is trans. She has attempted self-harm numerous times and, by all accounts, has self-esteem and other mental issues, which appear (to me) to be directly linked to gender identity issues.

The family is on Medicaid. At the primary-care checkup today with the new primary-care doc in Texas, she asked for a reference to an endocrinologist to discuss puberty suppression. The doctor said to the child, "Look in the mirror with me. What do you see? You have descended testicles. You are growing a mustache. You're perfectly healthy. The problem is all in your head."

The doctor then told the mother that it would be unethical to send the child to an endo for blockers, and that he would not do anything to help them start that treatment, because there was nothing wrong with the child other than what was in his head.

The family's previous primary-care doctor in Arizona diagnosed the child as some flavor of intersex. When given that fact, the Texas doctor told the mom that she should go back to Arizona for help with that.

My wife received a frantic phone call from the parking lot of the doctor's office, and, by all accounts, the child is now despondent. We are scrambling to find trans-friendly support resources in the area (and have been in touch with a SAGA member in San Antonio). I am fully familiar with the WPATH standards for the care of minor children.

We have told our friend that at a minimum, her family should never have anything to do with that doctor or his practice group, ever again. Other than changing providers, though, is there anything that can be done to stop this asshole of a doctor from ever again coming near a child with gender-identity issues?
posted by QuantumMeruit to Health & Fitness (14 answers total) 6 users marked this as a favorite
You can review doctors on Yelp, and if he's part of your friend's insurance network of providers, sometimes there is a way to review them there. There are also some other websites to review doctors, although I haven't used them because most seem to charge to read the reviews. But you can Google the doctor's name and you'll see places to leave reviews.

Legally, I'm not sure what options you have and I expect someone more knowledgeable will help with that. But Yelp, at minimum, is something a lot of people use for doctor reviews. People send me private messages asking about doctors I've left good and bad reviews about, so I'm pretty sure at least some people who would want to avoid this doctor would find your friend's review. Also, if anyone does a search for trans-friendly doctors in that area, his name would come up as one to avoid.

Very sorry your friend's child was treated that way.
posted by Nattie at 10:33 PM on April 25, 2013

Via google and guesswork:

Texas Medical Board Enforcement Process:
posted by sebastienbailard at 10:43 PM on April 25, 2013

Two issues here.

A PCP is badly out of line if he pretends that gender dysphoria does not exist or fails to refer anyone who presents indications of it to a psychiatrist capable of appropriate evaluation and treatment or further referal. Failing to do so disrespectfully is even worse.

By contrast, hormone therapy for gender dysphoric 11 year olds is highly controversial; prescribing it or directly refering for it is not ethically required.
posted by MattD at 10:49 PM on April 25, 2013 [15 favorites]

This LPC-S/PhD therapist (via google, so ...) apparently works with trans folk and takes Texas Medicaid. He may be able to help with therapy and to find a trans-friendly PCP?

We are scrambling to find trans-friendly support resources in the area (and have been in touch with a SAGA member in San Antonio).

The local P-FLAG group might know some non-twit physicians, I would network there?

Also, make a couple dozen yelp and medical review accounts and drive that scumbag into the ground! That's therapy.

Maybe. The familty doesn't need a fight right now. They need a good doctor.

They should probably report the physician dispassionately, to protect others, but not try to let it suck up any energy.
posted by sebastienbailard at 11:43 PM on April 25, 2013 [11 favorites]

By contrast, hormone therapy for gender dysphoric 11 year olds is highly controversial; prescribing it or directly refering for it is not ethically required.

First, refusing to refer to someone more knowledgeable on the grounds trans people don't exist is wildly unethical. Second, it's 'highly controversial' in the news media, but puberty suppression is in the Standards of Care, which roughly means acceptance in the corridors of power of trans health care. Doesn't mean it's right for every person or that every non-asshole doctor will do it. Does suggest that if a parent enquires, you should probably refer them to someone who knows what the hell they're talking about who will either say yes, or give an actual reason for saying no.

I suspect they need to frame a complaint as 'refused treatment for previously diagnosed condition' and that condition may need to be the intersex condition. Saying 'go back to Arizona' can't be excused as 'oh, I in my expert and well-qualified opinion [yeah right] the kid isn't trans'.

Everything I can find in Texas is near Houston or Dallas. (Well, I found a non-recommendation for a therapist in San Antonio.) Maybe you or your friend (depending on who has more energy) can phone these places and see if they know anyone closer. Physicians, therapists and doctors who do informed consent, in case that's not just a subset of the physicians list. WPATH has a provider search, but for Texas it only turns up like five therapists all in Dallas or Houston (plus a surgeon in San Francisco--I guess something got broken). But maybe they're more people to call.
posted by hoyland at 4:58 AM on April 26, 2013 [9 favorites]

Corpus Christi is a small, conservative Texas town.

I don't think your friends are going to find the medical support they need there.

As a responder above noted: your friends need to be in a larger city (e.g., Austin, Houston, Dallas) or preferably elsewhere to get the kind of support that they're looking for.
posted by dfriedman at 5:59 AM on April 26, 2013 [8 favorites]

I would make a complaint to the state medical board.

I would call Medicaid to discuss options.

This doctor is dangerously out of touch on a number of issues, this is a medical issue, not a psychological issue.

Christ, what an asshole.
posted by Ruthless Bunny at 6:29 AM on April 26, 2013 [2 favorites]

Corpus Christi is a small, conservative Texas town.

This (sort of -- it is a city, has over 300K people. But it feels like a small town in a lot of ways).

Look, I grew up in Corpus, and there are a lot of good people there. There's a growing gay community, and growing acceptance in the city for homosexuals. Trans acceptance, though? That's going to take a lot longer.

I do think your friend may be able to find a pediatrician with an open mind, but that doctor may or may not take Medicaid, and it may be difficult for her to find that doctor just by going through the phone book, as it were. I think the likelihood of finding an endo in Corpus who is willing to treat her child is going to be even harder. She needs to be prepared to travel for that specialized care. Houston is more likely than Austin (because Houston has a huge medical treatment industry and Austin doesn't), and Houston is closer than Dallas. This is actually not all that uncommon -- I traveled from Corpus to Houston as a child for specialized care from a pediatric ophthamologist. It was worth the 3-4 hour drive for my relatively common issue; it'll be much more so for the treatment her child needs.

As for finding a local, open-minded doctor -- I don't know if your friend is religious or not, but Corpus is a city where church is a pretty important part of getting integrated into the community (and then getting trusted recommendations for doctors, dentists, therapists, haircuts, where to buy a car, etc.). So she may be very well served trying to find the right church community. She might try the Unitarian Universalist Church of Corpus Christi as a first step.
posted by devinemissk at 6:55 AM on April 26, 2013 [8 favorites]

Additionally, you should consider making a call to TLDEF.
posted by roomthreeseventeen at 7:32 AM on April 26, 2013 [1 favorite]

It occurs to me that if you're up for cold-calling, there's a medical school in San Antonio. Texas A&M has family practice rotations at the children's hospital in Corpus Christi, but no medical school there. Trying physicians affiliated with the medical schools might have better odds than the phone book when it comes to finding someone willing to learn (and might help find someone who does pediatric endocrinology, rather than having the pediatricians say 'you need an endocrinolgoist' and the endocrinologists say 'take her to a pediatrician').
posted by hoyland at 8:36 AM on April 26, 2013

I'd file a complaint with the Joint Commission ASAP about that doctor. What a total ass.

Check out this dude in Galveston: Walter Meyer

He's a psychiatrist AND endocrinologist that works with trans* children and prescribes hormone blockers, my only concern is from articles I've read it seems like he can be cautious in his treatment.
posted by elsietheeel at 8:50 AM on April 26, 2013 [1 favorite]

Hormone blockers (which are not hormones) are standard treatment for some transgender children. Disagree that doctor's failure to provide referral to qualified specialist was ethical due to (non-expert) controversy of treatment.
posted by ClaudiaCenter at 9:15 AM on April 26, 2013 [1 favorite]

I forwarded this question to a friend who works for the National Center for Excellence in Transgender Health, and she sends this link, and will try and find some academic research while she's at work today.
posted by mollymayhem at 10:06 AM on April 26, 2013

I'm very sorry to hear of your friend's child's all-too-common experience. Few U.S. primary care doctors know much about medical services for trans* adults or children, and many, especially in more conservative communities, are actively transphobic. Accessing quality trans* care for a child tends to require substantial parental research and self-advocacy and financial resources, which are hard to come by for people on Medicaid. I'm glad that you are available to try to help.

Your question focuses on what to do about the doctor who treated the child very poorly. I can point out that there are standards of care for treating trans* children with which the doctor was clearly not in compliance. But personally, I'd suggest focusing on finding support for this child, and resources for your friend. I'd suggest contacting the Transgender Center in Houston to see if they have statewide physician directories, and support organizations for trans* kids such as TransActive and Trans Youth Family Allies. If the child is hitting puberty and starting to experience unwanted masculinization, getting access to testosterone suppression to postpone pubertal changes is probably a central and time-sensitive concern.

The battle to get trans* care included for more than an hour in all of medical schooling, and to show primary care doctors that ignorance and bigotry are unacceptable, is a huge one. I salute you for wanting to do your part. Once your friend is connected with supportive services, I hope that you will continue that fight, though it's sure to be a long one.
posted by DrMew at 10:40 AM on April 29, 2013 [1 favorite]

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