Nathaniel Le May at the National Arts Centre in Ottawa on Jan. 27. OHIP has decided to fund a gender affirming surgery for Mr. Le May after he was denied coverage for a procedure for nearly a year.Blair Gable/Blair Gable Photography
OHIP has reversed its stance and decided to fund a gender-affirming surgery for Nathaniel Le May, an Ottawa public servant who accused staff at Ontario’s government-run insurance plan of discrimination after he was denied coverage for a procedure for nearly a year.
Mr. Le May, who identifies as transmasculine non-binary, is seeking a phalloplasty, the surgical construction of a phallus. Originally, OHIP repeatedly denied funding the surgery unless it was performed in tandem with a vaginectomy, which removes the vagina, and which in turn necessitates a hysterectomy, owing to cervical cancer risks. Mr. Le May did not want these additional surgeries, arguing they would amount to forced sterilization.
Last week, OHIP reversed course and approved funding for a phalloplasty, without a vaginectomy.
“I’m happy that it’s funded. Now there’s a precedent: People can refer back to my case,” Mr. Le May said.
While the funding approval was a personal win, it arrived mere days before Mr. Le May was scheduled to appear at an appeal hearing he’d lodged against OHIP. Here, he was seeking broader remedies that would ensure other non-binary and transgender people wouldn’t be denied similar health coverage in future. With Mr. Le May’s surgery approved on June 7 after months of denials, his June 12 appeal at the Health Services Appeal and Review Board was abruptly cancelled.
The move concerns advocates calling for more accountability in transgender health care, which remains a largely misunderstood field in medicine.
“With no interpretive guidance from the board, other transgender patients may find themselves in the same situation,” said Frank Nasca, a recent law graduate who helped Mr. Le May prepare for his appeal.
“The board’s decision reflects a lack of commitment to systemic change for the trans community,” said Mx. Nasca, who is transgender.
Ontario’s Ministry of Health did not respond to The Globe and Mail’s questions about why OHIP changed its stance to fund Mr. Le May’s surgery, or whether it would fund similar surgeries in future. An e-mailed statement sent June 14 from the ministry said it does not comment on matters under the jurisdiction of a court, appeal board or tribunal. (There is no active legal proceeding in Mr. Le May’s case.)
Through his appeal submissions, Mr. Le May had been pushing for OHIP to remove any “interpretive ambiguity” from its funding approval forms and to bring the language in line with the physician services clearly listed under Ontario’s Health Insurance Act. Here, gender-affirming surgeries such as phalloplasty are listed individually – not bundled together with other surgeries, the way they’ve been on OHIP’s documentation forms.
Today, the standard of care in transgender health care revolves around considering medically safe surgeries on a case-by-case basis, to alleviate gender dysphoria. Forcing people to check a box for a male-to-female or female-to-male package of surgeries under the banner of “sex reassignment” is outmoded, experts say.
“I would recommend to OHIP’s gender-affirming surgery program that when there are issues and trans people are saying, ‘This is breaching my rights; this is not aligned with the standard of care,’ that they get proper medical advice from someone who is certified in the standard of care,” Mr. Le May said.
His appeal submissions had included testimony from Devin O’Brien-Coon, an associate professor at Harvard Medical School and a doctor who specializes in gender-affirming surgery at Boston’s Brigham and Women’s Hospital.
Contradicting OHIP’s original letters to Mr. Le May – which stated that in order to get funding, his phalloplasty needed to be accompanied by a vaginectomy – Dr. O’Brien-Coon stressed there was no medical reason to perform those surgeries together in Mr. Le May’s case. Asking any patient to submit to the unnecessary removal of a uterus and vagina in order to secure public funding amounts to “coercive conduct that violates medical ethical obligations,” Dr. O’Brien-Coon wrote.
In the now called-off appeal, Mr. Le May argued that OHIP’s repeated denials for health coverage infringed on his human rights and created undue delay in his access to gender-affirming care. He’s now considering legal action through the Human Rights Tribunal of Ontario.
“The less barriers we put in front of somebody who’s already struggling with dysphoria and other forms of distress, the better,” said Yael Sela, a social worker and psychotherapist with the trans health team at Ottawa’s Centretown Community Health Centre.
“Surgery can be life changing,” Ms. Sela said. “I see that in the clients that I talk to. After they have surgery, things can really change in a significant way.”