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Alberta has taken another little step away from the redneck stereotype, especially when it comes to homosexuality.
The province many other Canadians dismiss as populated by oil industry roughnecks and horny-handed ranchers is in fact increasingly cosmopolitan and multicultural.
Now the Alberta government has scrapped the part of its medical services billing codes that classified gay, lesbian, bisexual and transgendered patients as suffering from mental disorders in the same class as bestiality and pedophilia.
The code has been reworded to eliminate language that treats homosexuality as a mental illness, the
Edmonton Journal reported.
"The old version did say (homosexuality) was a mental disorder, so patients who were seeking treatment for whatever reason ... were being classified as having a mental disorder," Health Minister Fred Horne told the
Journal, noting the change came into effect at the end of May.
"Under our billing system, it is no longer classified as a mental disorder."
Homosexuality was removed from the standard reference Diagnostic and Statistical Manual of Mental Disorders in 1973.
But it remained in the ninth version of the World Health Organization's International Classification of Diseases (
ICD-9), which dates from the late 1970s and forms the basis for diagnostic and billing codes.
A 10th edition, published in 1999, deleted homosexuality as a mental disorder. Alberta hasn't adopted it in its entirety, the
Journal reported, but has used language from the newer classification to update Alberta's code system.
It now says "sexual orientation by itself is not regarded to be a disorder." Doctors will still use the same code (302.0) to bill for treatment of people with ego-dystonic disorder, in which the patient is struggling with his or her sexual orientation or gender identity, the
Journal said.
Advocacy groups had been pushing the Progressive Conservative government since 1998 to make the change. The government promised to do it in 2010 when it was revealed doctors had used the diagnostic code to bill the province more than 1,750 times for treating gays and lesbians between 1995 and 2004.
CBC News reported at the time that the government twice previously promised to remove the section and failed to do so.
The contentious language was removed from the online version of the government's diagnostic codes in 2010 but last February the
National Post reported it was still being used.
Officials said the change was slow in coming because other provinces also use ICD-9 and making a unilateral change would complicate inter-jurisdictional medical billing.
It's not clear if other provinces have tweaked their billing codes to drop homosexuality as a disorder.
Gay rights became an issue in last spring's Alberta election when blog by a candidate for the upstart Wild Rose party, Allan Hunsperger, warned if gays and lesbians didn't change their sexual orientation they were condemned to "suffer the rest of eternity in a lake of fire, hell, a place of eternal suffering."
The ensuing public backlash, along with other gaffes, helped erode Wild Rose's lead against the four-decade-old Tory government. The right-wing party finished second and Hunsberger lost his race.
Just weeks after the election, Alison Redford became the first premier to attend Edmonton's annual gay pride parade, the
Edmonton Journal reported.
"Let's just celebrate who we are, what we do, and where we live," Redford told the crowd, which chanted her name.
Metro columnist Mike Morrison noted recently Calgary has been hosting the Fairy Tales Queer Film Festival for 14 years.
"As the festival opens, there are no protests or any groups calling for it to be shut down," Morrison wrote.
"Its popularity and longevity is a sign of just how far we've come as a city and it's a wonder that the rest of Canada hasn't realized just how gay-friendly Calgary has become."
. . . now out of the dining room.
Now, if someone would get the Redford gov't up to speed with re-upping the Alta Health Care coverage for transsexual sexual reassignment surgery (SRS) we'd have done well by ourselves once again.
What follows is a rather long post but given the distress faced by so many who are transgendered I think the bandwidth is justified.
A while back the Cs said something like, "Gender [development, identity] is [or, can be] a roll of the dice." While not verbatim, that is the essence of what they said and, as seen at a site referenced below where the non-linear dynamics of gender identity and phase space are taken up at length, a very germane comment.
Now for about 99.9% of the outwardly either male or female populations (and that is a good number not one pulled out of the air to make a point) the matter of being in, say, a female body and feeling "in tune with" a female way of being is seldom given much thought, and the same is essentially true for for "feeling male" and animating a male body. The matter is simply never an issue due any more than passing consideration.
For the remaining 0.1% however, the matter is essentially all-consuming, and no amount of psychotherapy with bring the underlying discord into alignment.
Hence the genuine need for some people to leave behind as much of their initial physical sex as possible, in favor of living a life in which they can convincingly present themselves to the world from a physical analogue that resembles as closely as possible the sex to which they feel themselves to belong.
In other words: as far as possible the body is changed to matched the person's immutable, mind/soul gender identity intention. This is a complex problem . . .
Those interested in non-linear system dynamics, phase space, chaos and so on will be much informed of the work of Brazilian Dr. Torres, whose website is seen at this [Link] where you'll need to scroll down to, "Scientific Papers" and then dig to find what I describe here.
Her's is a truly excellent body of research that spans about 15 years and a worldwide clientele.
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Moving on: The World Professional Association for Transgender Health, WPATH, whose site is at this [Link]has at this [Link]has the following to say in respect of the medical necessity of SRS:
Medical Necessity Statement
WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage for Transgender and Transsexual PeopleWorldwide
The World Professional Association for Transgender Health (WPATH) is an international association devoted to the understanding and treatment of individuals with gender identity disorders. Founded in 1979, and currently with over 300 physician, psychologist, social scientist, and legal professional members, all of whom are engaged in research and/or clinical practice that affects the lives of transgender and transsexual people, WPATH is the oldest interdisciplinary professional association in the world concerned with this specialty.
Gender Identity Disorder (GID), more commonly known as transsexualism, is a condition recognized in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV, 1994, and DSM-IV-TR, 2000), published by the American Psychiatric Association. Transsexualism is also recognized in the ICD Classification of Mental and Behavioural Disorders, tenth revision, as endorsed by the Forty-third World Health Assembly in May 1990, and came into use in WHO Member States as of 1994.
The criteria listed for Gender Identity Disorders (GID) (at F.64) including transsexualism (at F.64.0) are descriptive of many people who experience dissonance between their sex as assigned at birth and their gender identity, which is developed in early childhood and understood to be firmly established by age 4,[1] though for some transgender individuals, gender identity may remain somewhat fluid for many years. The ICD 10 descriptive criteria were developed to aid in diagnosis and treatment to alleviate the clinically significant distress and impairment known as gender dysphoria that is often associated with transsexualism.
The WPATH Standards of Care for Gender Identity Disorders were first issued in 1979, and articulate the "professional consensus about the psychiatric, psychological, medical and surgical management of GID." Periodically revised to reflect the latest clinical practice and scientific research, the Standards also unequivocally reflect this Association's conclusion that treatment is medically necessary. Medical necessity is a term common to health care coverage and insurance policies in the United States, and a common definition among insurers is:
"[H]ealth care services that a Physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease; and (c) not primarily for the convenience of the patient, physician, or other health care provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease. [2]
"Generally accepted standards of medical practice means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, Physician Specialty Society recommendations and the views of Physicians practicing in relevant clinical areas and any other relevant factors."
The current Board of Directors of the WPATH herewith expresses its conviction that sex (gender) reassignment, properly indicated and performed as provided by the Standards of Care, has proven to be beneficial and effective in the treatment of individuals with transsexualism, gender identity disorder, and/or gender dysphoria. Sex reassignment plays an undisputed role in contributing toward favorable outcomes, and comprises Real Life Experience, legal name and sex change on identity documents, as well as medically necessary hormone treatment, counseling, psychotherapy, and other medical procedures. Genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes; the Real Life Experience component of the transition process is crucial to psychological adjustment, and is usually completed prior to any genital reconstruction, when appropriate for the patient, according to the WPATH Standards of Care. Changes to documentation are important aids to social functioning, and are a necessary component of the pre-surgical process; delay of document changes may have a deleterious impact on a patient's social integration and personal safety.
Medically necessary sex reassignment procedures also include complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation as appropriate to each patient (including breast prostheses if necessary), genital reconstruction (by various techniques which must be appropriate to each patient, including, for example, skin flap hair removal, penile and testicular prostheses, as necessary), facial hair removal, and certain facial plastic reconstruction as appropriate to the patient.
"Non-genital surgical procedures are routinely performed... notably, subcutaneous mastectomy in female-to-male transsexuals, and facial feminization surgery, and/or breast augmentation in male-to-female transsexuals. These surgical interventions are often of greater practical significance in the patient's daily life than reconstruction of the genitals." [3]
Furthermore, not every patient will have a medical need for identical procedures; clinically appropriate treatments must be determined on an individualized basis with the patient's physician.
The medical procedures attendant to sex reassignment are not "cosmetic" or "elective" or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition. [4] Further, the WPATH Standards consider it unethical to deny eligibility for sex reassignment surgeries or hormonal therapies solely on the basis of blood seropositivity for infections such as HIV or hepatitis.
These medical procedures and treatment protocols are not experimental: decades of both clinical experience and medical research show they are essential to achieving well-being for the transsexual patient. For example, a recent study of female-to-male transsexuals found significantly improved quality of life following cross-gender hormonal therapy. Moreover, those who had also undergone chest reconstruction had significantly higher scores for general health, social functioning, as well as mental health. [5]
"In over 80 qualitatively different case studies and reviews from 12 countries, it has been demonstrated during the last 30 years that the treatment that includes the whole process of gender reassignment is effective." [6]
Available routinely in Europe and in many other countries, these treatments are cost effective rather than cost prohibitive. In Europe, , numerous state health service providershave negotiated contracts with their insurance carriers to enable medically necessary treatment for transsexualism and/or GID to be provided to covered individuals. The European Court has also upheld gender reassignment as a valid health treatment to be provided by European States (L v Lithuania [2007] ECHR (case no. 27527/03)). All states in Europe now provide treatment routeways for transsexual people. Increasingly, insurers are being obliged to realize the validity and effectiveness of treatment , and coverage is being offered, increasingly at no additional premium cost.
"Professionals who provide services to patients with gender conditions understand the necessity of SRS, and concur that it is reconstructive, and as such should be reimbursed, as would any other medically necessary treatment." [7]
The WPATH Board of Directors urges state healthcare providers and insurers throughout the world to eliminate transgender or trans-sex exclusions and to provide coverage for transgender patients including the medically prescribed sex reassignment services necessary for their treatment and well-being, and to ensure that their ongoing healthcare (both routine and specialized) is readily accessible.
This clarification constitutes the professional opinion of the signatories below, comprised of all members of the WPATH Board of Directors and Executive Officers as of this date, June 17, 2008.
[Signatories and references are found at this [Link] ]