EPOLYCLINIC Primary Care Famiiy Medicine internal Medicine Pediatrics Aesthetician Services Allergy, Asthma 84 imnmnology Anticoagulation Clinic Audiology 8; Hearing Aids Behaviorai Health Blink Optical June 8, 2018 Councilmember Debora Juarez Seattle City Hall 600 Fourth Avenue, 21nd Floor Seattle, WA 98104 Breast imaging Breast Surgery Dear Councilmember Juarez: Cardiology Clinical Research The Polyclinic is pleased to respond to your request for information regarding our Cosmetic So rgery . . . Dermatology experience caring for transgender and gender non-conforming patients. I hope this information is helpful to you in your research. I am proud of the work Diagnosticimaging we have done at The Polyclinic to help ensure we are experienced as a welcoming place for all who receive care. I also know achieving this goal takes continual Gasttoenterology improvement, and we are committed to those efforts. General Surgery Glaucoma HandSorgery Please do not hesitate to contact me if I can answer questions or be of service. Hancliherapy Hospital Medicine Infectiousillsease Thank you for your dedication to our community. infusion Center laboratory Sincerely, Lipitl Ciinic Nepnroiogy Neurology NutritionManagement Obstetrics&5ynecology Oncologytitllematoiogy Lloyd DaVld Chief Executive Officer f, 0t! lo (Elm El? DV ME A in [{Van?ymm we, Pharmacy Piiysicailvlecilclne 3 Bziiehabilitation Pliysicaiiherapy Plastic Surgery ?4 Podiatry Pulmonary Medicine if .1 Radiation Oncology 65 MW EM Rheurnatoiogy Sleep Medicine 2: (1,4291. ?33 Sports Medicine SploeSorgery 6mm! Surgery Center Travel Center Vascular g. hair/l ream/WW ?lmed CW lac/1 The Polyclinic Madison Center 904 Ave. 0 Seattle, WA 98104 a Main 206.329.1760 l?W?m mm 6 June 6, 2018 Responses for: Debora Juarez Seattle City Councilmember, District 5 Transgender Care at The Polyclinic What policies and procedures do you have in place to ensure equitable access for transgender and gender-nonconforming patients? This includes both how you create a welcoming and supportive environment as well as your-standards of care. Employee Training All new Polyclinic employees receive training to develop transgender awareness to better serve our patients. There are three components to the training; Transgender Empathy, Transgender Awareness Job Aid, and Patient Service Representative Workflow for Scheduling Transgender Patients. Here is a small sample from the job aid used in training: Tra nsgender Patients Job Aid The Polyclinic is gaining a reputation in the Seattle area as a center of care excellence for the transgender community. This is in no small part due to the efforts of our providers and staff to provide excellent care to people who are involved in changes with both emotional and physical components. The first thing to remember is to refer to each patient by the name they use to identify themselves. How to look up a patient using their preferred name: if a patient calls in, and they provide a name that may be a preferred name rather than a legal name, we can still look them up and match their record in Epic. For example, if Kelli Breckinridge calls to make an appointment, we would enter in the field of the Patient Lookup window and click the Find.Patientbutten- patient LookUp Select Patient lCustomSearchlEecentPati Groups NamelMRN: lbrekel .. .. . .. ID: SSN: Sex: Birth date: Lise sounds-like Accept. I Qancel I The resulting list of patients does not Show anyone named Kelli Breckinridge, but does display a TIMOTHY but the Name column is not wide enough to show the entire name. You will need to expand the Name column. Clinic Facilities/Signage Gender neutral bathrooms are available within the clinical areas of all Polyclinic facilities. Gender neutral signage is also prominently displayed and references to pertinent anatomy replaces ?male? ?female? designation. Tampon/pad receptacles in bathrooms used to say ?feminine hygiene?. This has now been eliminated. Lab Collection] Results When ordering lab tests at our Downtown clinic where many transgender patients receive care, patients are informed of gender marker changes in the computer system and the way this influences their lab value normal ranges. The patient is allowed to change the gender marker in the system at any time to reflect the range towards which they are transitioning. Assistance in Obtaining identification Gender Changes Also at our Downtown clinic, the barrier for providing state and federal legal documentation for gender marker changes on driver?s license/state ID, passport, birth certificate, and Social Security number has been essentially eliminated for any patient that has established care. These forms are provided on first request in all circumstances. They are given to patients at the first visit establishing care, if requested, or any time in the course of care. The documents are prepared on official letterhead by the medical assistant and signed by the physician. Organizational Policies The Polyclinic physicians, managers, and staff strongly support maintaining inclusive communities and acting in compliance with all laws that require equal access and fair treatment in all of our employment practices. Our employee handbook is updated annually and incorporates all relevant changes in law, regulations, and municipal codes. The excerpts below are intended to demonstrate the range and intent of our policies. Equal Employment Opportunities The clinic provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, national origin, age, gender, sexual orientation, gender identity, genetic information, political ideology, maritalstatus, military status, the presence of any physical, mental or sensory disability, or any other basis protected by applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including but not limited to, hiring, placement, promotion, transfer, leave of absence, compensation, training, termination, layo?? and recall. If you become aware of a potential violation of this policy, you are required to immediately report the situation as set forth in the Mandatory Reporting Procedure in this Handbook. Compliance with Laws and Standards The clinic requires full compliance with the laws and ethical standards that govern our industry. All employees have the duty to ensure that The Polyclinic and all of its physicians, professional staff, employees, managers, administrators, and representatives comply with such laws and standards. Examples of compliance issues covered by this policy include suspected fraud, theft, embezzlement, accounting and auditing irregularities, bribery, kickbacks, and misuse of clinic assets. If you believe that any clinic physician, professional staff member, employee, manager, administrator, or representative is not in compliance with any applicable law or ethical standard, you are required to immediately report the situation as set forth in the Mandatory Reporting Procedure in this Handbook. Discrimination and Harassment We believe it is essential to provide all employees with a respectful and safe working environment. As a result, we do not tolerate harassment or mistreatment of our employees in the workplace or in work? related situations, including unlawful harassment or discrimination on the basis of the following protected categories: Race, color, ethnicity, or national origin; Age; Religion or religious creed; Sex, including pregnancy, childbirth, breastfeeding or related medical conditions; Sexual orientation; Gender, gender identity, gender expression, transgender status, or sexual stereotypes; immigration status, citizenship or ancestry; Marital status; Protected military or veteran status; Physical or mental disability, medical condition, genetic information or characteristics; Political views or activities; or Any other characteristics protected by applicable law. Inappropriate conduct under this policy may include conduct that creates a disrespectful, intimidating, hostile, degrading, humiliating or offensive environment for an employee, Engaging in such conduct is a violation of this policy. Improper interference with the ability of another clinic employee to perform their job duties is also a violation of this policy. -. Because the intent of this policy is to deter conduct that is unwanted, unreasonable-and demeaning, The Polyclinic may consider an employee?s conduct to be in violation of the policy even if it falls short of unlawful harassment under applicable law. When determining whether conduct violates this policy, we will consider whether a reasonable person could conclude that the conduct created an intimidating, hostile, degrading or demeaning environment. This policy applies to all clinic employees, and it is the responsibility of all clinic employees to follow and uphold the policy. Additionally, we do not tolerate discrimination or harassment of employees by non- employees, nor do we tolerate harassment of non-employees by our employees. Prohibited conduct can range from extreme forms such as violence, threats, or physical touching to less obvious actions like ridiculing, teasing, or repeatedly bothering colleagues or refusing to talk to them. For example, harassment may include the following types of conduct: Derogatory or insensitive jokes, pranks, or comments; Slurs or epithets; Unwelcome sexual advances or invitations; Non-verbal behaviors such as staring, leering or gestures; Ridiculing or demeaning comments; lnnuendos or veiled threats; Intentionally excluding someone from normal workplace conversations and making them feel unwelcome; - Displaying or sharing offensive. images such as posters, videos, photos, cartoons, screensavers, emails or drawings that are derogatory or sexual; - Offensive comments about appearance, or other personal or physical characteristics, such as sexually charged comments or comments on someone?s physical disability; 0 Unnecessary or unwanted bodily conduct such as groping or massaging, blocking another?s normal movement, or physically interfering with the work of another individual; or Threats or demands that a person submit to sexual requests as a condition of continued employment or to avoid some other loss, and offers of employment~related benefits in return for sexual favors. This list is not exhaustive, and there are other behaviors that constitute unacceptable conduct under this policy. was joking? or didn?t mean it that way? are not defenses to allegations of harassment. Every employee is responsible for helping The Polyclinic maintain a work environment free from harassment and discrimination. If you become aware of a potential violation of this policy, you are required to immediately report the situation as set forth in the Mandatory Reporting Procedure in this Handbook. Where have you faced challenges and where have you seen successes? Success in caring for transgender patients has grown substantially since family medicine physician Dr. Kevin Hatfield joined The Poiyclinic Downtown in 2002. Dr. Hatfield enthusiastically welcomed patients in the community and now has one of the largest panels of transgender patients in the region. in 2016 and 2017, Dr. Hatfield was recognized as a Top Doctor in Transgender Care in Seattle magazine. WM Mn.? As his practice has grown, Dr. Hatfield has worked with his specialist colleagues in endocrinology, urology, gynecology, plastic surgery and others toprovide more comprehensive care to this patient population, underscoring the vaiue of multi?specialty medical groups like The Polyclinic. We specialize in coordination of care across all the specialties that must be involved to effectively and sensitively support the needs of our patients who seek specialized services including gender re-assignment. This only comes when there is a culture of acceptance and a desire to make sure the needs of our patients are met. One of the challenges we?ve faced in caring for transgender patients is the difficulty in standardizing patient intake paperwork. Some physicians unfamiliar with the importance of gender neutral terminology continue to use outdated language in the sexual history portion of intake forms which can be distressing to patients who are gender nonconforming. Incremental improvements are being made but they are not yet universal. What has been your experience with making referrals to specialists, behavioral health professionals and/or community-based resources? Specialists within The Polyclinic have been tremendously supportive our gend'ercare patients. I has feedback from patients consistently has been overwhelmingly positive with many patients saying they ?love? the specialists that they have seen. Referrals to behavioral health specialists however has been frustrating. There is a lack of availability for gendercare patients without commercial insurance to see mental health providers even when there is a desperate need. Additionally, there is no community-based resource to help patients find counselors with gender proficiency that accept particular insurance products. Many insurance panels are ?closed? to new therapists with gender proficiency. Cultural competency within the gender community for counselors, and remains a difficult skill set for patients to access, and the financial barriers are extremely high for patients without excellent insurance coverage. What partnerships are you engaged in to better your service? Dr. Kevin Hatfield maintains routine attendance at the lngersoll Gender Center Provider Consult Group as well as the Washington Academy of Trans Health to expand familiarity in the community with the resources that The Polyclinic offers to patient?s seeking genderca re. He and several colleagues are also actively involved with the training of medical students and medical residents from the University of Washington and regional residency programs to help increase access for patients throughout Puget Sound. ?1 i i it What can the City of Seattle do to support policies that create equity in access and care for the transgender community? Access to services like behavioral health is difficult for all individuals who have Medicaid or are uninsured. The Cit of Seattle could advocate for increased reimbursement to providers through I Medicaid at the state level, which may create access for more people. WW Another way to assist the transgender community would be to offer legal representation to patients who are denied care by insurance companies. Some insurers refuse to cover gender-related medicwal care from anyone other than select specialists who are extremely difficult to access; these policies do not follow established best practice guidelines for genderca re. If your institution has a patient?s bill of rights, can you share that with us? The Polyclinic?s Patient Rights and Responsibilities is attached. Are there any guidelines or policies that you are currently working on or planning to develop in the near future? There are several projects under consideration to improve the patient experience for our transgender patients including: 0 Provide ongoing training and support to ensure all Polyclinic providers understand the importance of recording the correct notes during patient encounters and also the use he patient's preferred name in all aspects of care that is delivered. Develop a new ordering system for prescriptions to allow both the birth name AND the preferred patient name if the patient has not yet changed it legally so that visits to the pharmacy reflect the identification that the patient desires but preserves the legal identification necessary. Currently piloting a new sexual orientation and identity module that recently became available in our electronic health record system, which assists in capturing a patient?s gender status. This will be rolled out across the organization as additional sensitivity training is provided to clinic employees. POLYCLINIC PATIENT RIGHTSANDRESPONSIBILITIES The Dolyclinic wants you to receive the best possible care. To that end, we want you to be a partner in your care. You have specific rights and responsibilities that will help make your care as safe and effective as possible. Patient Rights As a patient at The Poiyclinic you have the right to: - Receive care without discrimination clue to race, creed, color, national origin, ancestry, religion, gender, sexual orientation, marital status, age, and/or handicap. - Participate actively in decisions regarding your medical care and the right to refuse treatment. . Have all communications and records pertaining to your health care kept con?dential in accordance with state and federal medical record and patient con?dentiality and privacy laws. - Examine and receive an explanation of your bill regardless of the source of payment. - Receive considerate care in a sate and private environment that respects your values, beliefs and life philosophy. . Express comments or feedback regarding your ca re to your physician or other care provider or a member of our management team. Patient Responsibilities As a patient at The Polyclinic you have the responsibility to: - Provide accurate and complete information about your health, including current conditions, past illnesses, hospitalizations, medications and other health?related issues. - Ask questions when you need clari?cation about your care and what you are expected to do. - Follow the care, service, or treatment plan developed with your cooperation and tellyour health care-team it you have any concerns about your ability to tollow the plan. - Accept the consequences ot your actions it you choose not to Follow the treatment plan. - Keep your appointments or to notify the clinic in advance it you are unable to do so. - Be respectful of The Polyclinic statF, other patients and property. - Assure the financial obligations regarding your care are ful?lled as as possible and to cooperate with The Polyclinic regarding billing, payment and insurance reimbursement. - Not bring Firearms and/or animals (except service animals) into any Polyclinic facility. Your Concerns All Polyclinic providers, physicians, and staff are dedicated to understanding and resolving your concerns. We pledge to you our timely evaluation ot your concerns and a collaborative approach to resolution. it we are unable to resolve your concern to your satisfaction, you have the right to contact: The Washington State Department of Health Contact [ntormatiom HSQA Complaint Intake PO Box 47857 Olympia, WA 98504-7857 Phone: 360256-4700 I Toll Free: 800-633-6828 I Email: Centers for Medicare Medicaid Services Of?ce of the Medicare Bene?ciary Ombudsman Toll Free: