May 18, 2018
To: Seattle Area Health Care Provider
The City of Seattle is dedicated to creating and maintaining inclusive communities and
upholding the laws that require equal access and fair treatment. There have been significant
gains for transgender and gender-nonconforming people in access to medical care, including
gender reassignment procedures — treatments for which many insurers denied coverage in the
past. Building on these gains, there is still more room to enhance the welcoming environments
healthcare providers create for patients seeking care. The Trump administration has been
scaling back protections for transgender people on several fronts, but here in Washington state
and in Seattle we seek to support healthy communities. That requires more access and care,
not less.
RCW 49.60 is the Washington State Law Against Discrimination (WLAD). It clearly states an
intention to see the:
elimination and prevention of discrimination in employment, in credit and insurance
transactions, in places of public resort, accommodation, or amusement, and in real
property transactions because of race, creed, color, national origin, families with
children, sex, marital status, sexual orientation, age, honorably discharged veteran or
military status, or the presence of any sensory, mental, or physical disability or the use of
a trained dog guide or service animal by a person with a disability.
The RCW goes on to define “sexual orientation” to mean:
heterosexuality, homosexuality, bisexuality, and gender expression or identity. As used
in this definition, “gender expression or identity” means having or being perceived as
having a gender identity, self-image, appearance, behavior, or expression, whether or
not that gender identity, self-image, appearance, behavior, or expression is different
from that traditionally associated with the sex assigned to that person at birth. (RCW
49.60.040). [emphasis added]
The Seattle Municipal Code Chapter 14.06 says:
The general purposes of this chapter are to assure all persons equal opportunity to the
full enjoyment of places of public accommodation, to eliminate and to prevent unlawful
discrimination in places of public accommodation and to provide enforcement
mechanisms for the accomplishment of such purposes.
And provides explicit protections for a:
person's gender-related identity, appearance, or expression, whether or not traditionally
associated with one's biological sex or one's sex at birth, and includes a person's
attitudes, preferences, beliefs, and practices pertaining thereto.

 To meet our obligations and stay true to WLAD and the City of Seattle’s Human Rights code
(Title 14), the City of Seattle developed our Guidance on Gender Identity in the Workplace
which you can find at:
www.seattle.gov/personnel/resources/pubs/Gender_Identity_Guidance.pdf
An October 2010 study by the National Center for Transgender Equality, and the National Gay
and Lesbian Task Force found that discrimination by healthcare providers contributes to the
high incidence of transgender people delaying or forgoing preventative and necessary medical
care, putting them at greater risk of HIV infection, smoking, drug/alcohol use, and increased risk
of suicide. The 2015 U.S. Transgender Survey found that in Washington state “22% of
respondents did not see a doctor when they needed to because of fear of being mistreated as a
transgender person.” The survey also found that “38% of those who saw a health care provider
in the past year reported having at least one negative experience related to being transgender.
This included being refused treatment, verbally harassed, or physically or sexually assaulted, or
having to teach the provider about transgender people in order to get appropriate care.”
Discrimination against any members of our community for services as basic and lifesaving as
healthcare cannot be allowed to stand.
In 2014, Insurance Commissioner Mike Kreidler sent a letter to health insurance carriers in
Washington State expressing the legal and health related responsibilities of insurance carriers
to serve all people in Washington. Specifically, Mr. Kreidler noted that state laws pertaining to
equal protection from discrimination did in fact assure carriers that transgender individuals have
the same rights to health coverage as their non-transgender counterparts. That letter is attached
here for your reference.
At the beginning of this year, 2018, I had an opportunity to hear from advocates for women’s
and transgender people’s healthcare access. One thing that struck me when hearing from the
Gender Justice League was that members of the transgender community had to inform each
other of which providers would serve them. It seems that all healthcare providers should provide
equitable access, and that there shouldn’t need to be an ad hoc community list of approved
providers for both basic and urgent services.
I am reaching out to you as a provider in our community to learn the following:
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What policies and procedures do you have in place to ensure equitable access for
transgender and gender-nonconforming patients?
o This includes both how you create a welcoming and supportive environment as
well as your standards of care.
Where have you faced challenges, and where have you seen successes?
What has been your experience with making referrals to specialists, behavioral health
professionals and/or community-based resources?
What partnerships are you engaged in to better your service?
What can the City of Seattle do to support policies that create equity in access and care
for the transgender community?
If your institution has a patient’s bill of rights, can you share that with us?
Are there any other guidelines or policies that you are currently working on or planning to
develop in the near future?

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 You can send an email to my office at Debora.Juarez@seattle.gov. I appreciate you taking the
time to provide information back to my office so that I can learn how the City can best support
healthcare providers to serve everyone in our communities.
If you have further questions, please contact my office at (206) 684-8805.
Sincerely,

Debora Juarez, Seattle City Councilmember District 5

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