Two years ago, Roberta, a 59-year-old Arlington County resident, reported to Virginia Hospital Center for a breast-cancer screening. “There’s a man here to have a mammogram!” a clinician announced across the room when she arrived for her appointment.

Roberta is not a man—she’s a transgender woman who began publicly transitioning from male to female six years ago. And like any woman, she requires regular mammograms for the breasts she developed through hormone therapy. “Technically, they know what they’re doing, and they’re really, really good,” Roberta says of the hospital’s staff. But when it comes to treating transgender patients with care, “they’re clueless.”

Last month, the Human Rights Campaign released its 2010 Healthcare Equality Index in an attempt at providing healthcare providers a clue. The report surveyed 16 Washington-area hospitals on their patient anti-discrimination policies, looking for explicit mentions of sexual orientation and gender identity. While eight local hospitals’ policies explicitly recognize the rights of gay, lesbian, and bisexual patients, none mention gender identity or expression—in other words, a commitment to respecting patients like Roberta.

Which means going to the hospital—rarely a particularly pleasant experience—often produces an overlay of uncertainty and anxiety for transgender patients. Without a firm policy in place, the care transgender patients receive often comes down to chance; a caregiver who’s familiar with transgender issues may treat patients perfectly fine, but if they encounter the wrong employee, problems can ensue. Even, sometimes, within the same hospital.

Take the case of Washington Hospital Center, one of the local hospitals to include sexual orientation—but not gender identity—in its nondiscrimination policy. Last October, Stacey Roberts cut open her left pointer finger while slicing fruit. So she headed to the District hospital’s emergency room, where she received a bandage from a nurse—and a transphobic attitude at check-out. The employee who completed Roberts’ hospital visit “repeatedly insisted on calling me ‘sir,’” she says. “For each question he asked me, he blatantly added the term ‘sir’ at the end.”

Roberts—who says she was “dressed very feminine, in a dress”—listened to the man address her as the incorrect gender half a dozen times before requesting that he modify his language. “I didn’t even ask him to call me by feminine pronouns,” says Roberts. “I just asked him to stop gratuitously calling me sir.” The employee refused. Though Roberts identifies as female, and began presenting a feminine gender expression years ago, she has yet to secure a legal name and gender change. And until the government officially recognizes Roberts as a woman, the clerk claimed, he’s “legally required” to treat Roberts as the gender listed on her identifying documents. (That’s news to local LGBT activists.)

That same month, another District transgender woman checked into Washington Hospital Center following a suicide attempt. After swallowing “a lot of pills,” she was rushed by friends to the hospital, where she spent several days in the mental-health ward. “I’ve had really negative experiences at other hospitals in the area,” says the woman. So once she regained consciousness at Washington Hospital Center, “I was really surprised—pleasantly surprised—that everyone was super-respectful.” The woman says hospital staff had “no problem” identifying her as female and providing her trans-specific healthcare throughout her stay. Despite the mental-health ward’s highly regimented routine, “they let me go to the bathroom at certain times on my own to deal with trans-related stuff,” says the 31-year-old, who asked to remain anonymous due to the nature of her treatment. Staff was also quick to prescribe the hormone medication she takes daily. “The treatment I got there was really important,” she says. “If I’d had a negative experience there, it would have made everything a lot worse.”

Those two wildly different experiences stem from a hospital with a confused LGBT anti-discrimination policy. According to a Washington Hospital Center representative, the institution “has long observed a broad policy of nondiscrimination and is committed to providing care to all those with an emergent need, without regard to any status protected by law.” But once the policy gets into specifics, it reveals a fundamental misunderstanding of the LGBT community. “With respect to Washington Hospital Center’s nondiscrimination policy, we are in the process of revising it to enhance our current reference to sexual orientation to include the more specific reference to gender identity or expression,” the hospital said in a statement, adding that “staff education will accompany implementation to ensure all patients are treated in a sensitive manner.”

Except gender identity or expression is not a “more specific” reference to sexual orientation. Roberts, for example, is a transgender woman who also happens to be a lesbian—and those two identities are not one and the same.

In a few weeks, Washington Hospital Center’s policies will, technically, be in compliance with the HRC’s expectations. “In the Healthcare Equality Index survey, we asked for specific language—explicit language that policies were inclusive of LGBT families,” says Tom Sullivan, deputy director for the Human Rights Campaign Family Project. But improved written policies might not translate into actual improvements in care. “I don’t think there’s a correlation between having protections for gender identity and actually providing trans-specific and trans-friendly healthcare,” says a local man who prefers the term “trans” to “transgender,” and has had several negative experiences at local hospitals.

A couple of years ago, the 20-something—who wished to remain anonymous—sought treatment at Sibley Memorial Hospital for possible appendicitis. When he arrived, he disclosed his trans status to his doctor for medical reasons. “I explained to the doctor that I’m FTM and what that means,” he says. “She had no clue what was going on. It’s one thing to not know about trans-specific healthcare, but it’s another to be so ignorant that you say things that are medically impossible. She asked me when I had my uterus implanted.” Other hospital personnel expressed disbelief that the bearded man standing before them was trans. “People were just visibly shocked,” he says. “And they were open about that shock. They said, ‘Oh my god. Really?’ In a medical situation where you’re disclosing all kinds of information, that’s not a response that’s ever appropriate.”

Sibley maintains that it has policies on the books meant to protect transgender patients against such affronts. Sheliah Roy, director of public relations and marketing for the hospital, notes that its patients’ bill of rights includes the right to “receive hospital services without discrimination on the basis of any factor to which discrimination is prohibited by law.” Because discrimination based on gender identity has been prohibited in D.C. since 2007, Sibley’s policy technically covers transgender patients. Transgender patients at hospitals in Maryland and Virginia don’t benefit from similar legal protections.

“Every time I go to the hospital,” Roberta says, “I have to give ‘Trans 101’ to everyone I meet.” Unless hospitals write coherent guidelines and provide training on their own, that responsibility may keep falling on patients.

Photo by Darrow Montgomery