May 22, 2018 Dear Councilmember Juarez, Country Doctor Community Health Centers (CDCHC) received your letter dated May 4, 2018 regarding medical services for transgender and gender-nonconforming citizens of Seattle. CDCHC is a leader in Seattle for transgender and gender-nonconforming medical services, especially for people who are uninsured or on Medicaid. To help inform you about the services we provide, please read our responses to your letter below. What policies and procedures do you have in place to ensure equitable access for transgender and gender-nonconforming patients? CDCHC is the leading provider of transgender and gender-nonconforming medical care within the community health system in Seattle, and truly within Washington State, for persons on Medicaid or without insurance. CDCHC currently provides primary medical care to over 500 transgender and gender non-conforming patients. These services are provided by CDCHC’s clinical providers at both of CDCHC’s primary care medical home sites. Our patients request referrals for surgery, social support, behavioral health, and other specialty services. Implicit in all our policies and procedures is equal access to medical services for transgender and gender-nonconforming patients based on our patient bill of rights. Where have you faced challenges and where have you see successes? A great success for CDCHC is a grant we received in January 2018 to design an effective gender care program. We are currently evaluating the gender care needs in our community with the goal of implementing a comprehensive gender care program at CDCHC. What has been your experience with making referrals to specialists, behavioral health professional and/or community based resources? For specialty referrals such as surgical referrals, our Medicaid patients travel either to Idaho or Portland in order to receive these services. The only service UWMC currently offers is Orchiectomy. Generally, we too rely on our ad hoc network of gender sensitive providers. What partnerships are you engaged in to better your service? CDCHC partners with several community based organizations who serve transgender and gendernonconforming people including Seattle Children’s Gender Clinic, Gay City, Ingersoll Gender Center, and Gender Justice League to name a few. What can the City of Seattle do to support policies that create equity in access and care for the transgender community? The City of Seattle funds CDCHC through the Human Services Department. This funding is a major financial foundation for our clinical services and allows CDCHC to provide health care to any patient regardless of their ability to pay, including transgender and gender-nonconforming services. The City’s financial support is the best way to help CDCHC provide care to transgender and gendernonconforming clients. While Washington State is reforming its Medicaid services, we continue to heavily rely on support from the City of Seattle for persons who are uninsured altogether. As wealth disparity increases in Seattle, we are serving an increased number of patients with no income and no insurance at all. Additionally, we call your attention to a challenge in our ability to provide dental services to lowincome persons in Seattle due to a two-year delay by the Human Services Department in providing promised support. If your institution has a patient’s bill of rights, can you share that with us? As our patient you have the right to:  Be treated with dignity, respect and compassion;  Receive necessary and appropriate care, including:  support services,  24-hour and emergency access,  referral for specialty consultation,  interpretation services;  Receive care in a professional manner. You will…  be seen in a safe, clean, accessible environment,  be seen in a timely manner and have any delays explained,  be able to choose and change your provider,  have the right to have treatment options explained to you,  have the right to participate in shared decision-making and informed consent,  have the right to include others – as you choose – in decisions about your care,  have the right to refuse treatment,  be well informed and educated about your health condition.  You have the right to ask questions and receive clear answers,  have the right to complete confidentiality and privacy,  have access to your medical records,  have the right to complete a Living Will, which will be kept with your medical records,  have your personal values, beliefs and preferences respected,  have the right to appropriate assessment and management of pain;  Receive care regardless of race, gender, gender identity/expression, ethnicity, illness, sexual orientation, disabling condition, or ability to pay;  Respectfully express dissatisfaction with the care you receive through a patient grievance policy Are there any other guidelines or policies that you are currently working on or planning to develop in the near future? We recently receive a grant to address this question. We are working to identify gaps in service, strengthen our network and eventually become a center of excellence for transgender and gendernonconforming services. CDCHC would appreciate the opportunity to discuss these issues in depth with you personally. I also invite you to come to our clinic for a tour. Please call me at 206-299-1628 or email at rrwatts@cdchc.org to arrange a meeting. I look forward to hearing from your office. Best Regards, Raleigh Watts Executive Director Page 2 of 2