'Downright infuriating:' Worker sues state over transgender surgery
A librarian working for the State of Alaska says the state won’t cover her costs for transgender surgery, leading her to file a lawsuit with support from a national advocacy group.
The U.S. District Court case on behalf of 36-year-old Jennifer Fletcher, the state’s legislative librarian, was announced by Tuesday by LGBT group Lambda Legal. She is being represented by members of the group as well as attorney and Anchorage Assembly member Eric Croft, a former prosecutor and state representative.
"Whether your insurance will cover medically necessary treatment should not depend on who you are," Lambda attorney Tara Borelli said in Tuesday’s statement. “The state itself recognizes that transition-related care is medically necessary, which is why it covers hormone therapy. The only reason for this lingering blanket exclusion against surgical treatment is irrational discrimination.”
In 2015, Fletcher told Juneau radio station KTOO she was born in Laramie, Wyoming, where gay man Matthew Shepard was murdered in 1998, but went to high school in Juneau. She experienced depression and considered suicide and self-mutilation in her childhood, before realizing she was transgendered.
According to a complaint posted by Lambda Legal, Fletcher has been with the state since 2012 and was promoted to her current post in 2014. She came out to coworkers, began dressing as a woman and initiated hormone replacement therapy in that year.
Speaking by phone Tuesday, Fletcher said the state initially said her surgical costs would be covered – a statement which was “quickly retracted,” forcing her to pay for the surgery herself.
Fletcher’s colleagues at the Legislative Affairs Agency have been “absolutely awesome” in handling her transition, but she pointed out that they don’t have any control over how AlaskaCare has treated her coverage requests.
“The way this has been handled has been amazingly frustrating, in fact downright infuriating,” Fletcher said. “In at least a few cases it felt like my entire complaint, my entire concern was being callously dismissed.”
Croft said Tuesday that Fletcher had spent about $25,000 on surgical costs. Neither side had made any initial offers to settle the case, given its relatively recent filing date, and Fletcher’s counsel hasn’t been approached by other transgender state employees about possibly forming a larger suit.
“I don’t think that it’s a huge population -- it’s significant and very important for the individuals involved,” Croft said.
Cori Mills, a spokeswoman for the state Department of Law, said the state hadn't yet been formally served with the lawsuit.
"Once we are served we will review the complaint and respond accordingly," Mills wrote in an email.
Fletcher’s complaint says the state’s AlaskaCare health coverage for employees, operated by Aetna, has until recently included a blanket denial of coverage for transgender-related procedures, only adding coverage of hormone therapy in its 2018 outlines.
Counsel for Fletcher said Aetna considers surgical treatment for transgender issues “medically necessary.” A state consultant in 2016 found that adding transition-related coverage would have a possible cost increase of 0.01 percent in AlaskaCare’s active employee plan and 0.007 percent in its retiree plan – but the state was still “refraining” from providing it.
“AlaskaCare singles out transgender employees for unequal treatment by categorically depriving them of coverage for surgical treatment for gender dysphoria, which is the clinically significant distress that can result from the dissonance between one’s gender identity and sex assigned at birth,” the complaint read. “This exclusion contravenes a well-established medical consensus that such surgical treatment can be medically necessary and even life-saving.”
When Fletcher contacted the state Division of Retirement and Benefits in 2017, she was told that transition-related care requests were “subjected to additional scrutiny” because of their cost. Her request that the refusal be reconsidered was answered by the division’s director in a letter saying that “we simply lack the personnel and other resources to respond to the numerous comments and questions that you and other interested persons present.”
The state’s decision denies transgendered patients like Fletcher their “equal dignity,” according to the complaint, because the state will cover similar surgeries after mastectomies and to address severe birth defects.
“It also sends a deeply stigmatizing message that Ms. Fletcher’s worth as an employee is lesser than others, since the exclusion deprives her of compensation that other employees receive,” attorneys wrote. “The exclusion is particularly humiliating and degrading because the state provides coverage for the same medically necessary health care for individuals who are not transgender.”
Fletcher took the matter up with the federal Equal Employment Opportunity Commission in May 2017. She received clearance to sue from the EEOC in March, and filed her suit against the state last month.
Attorneys for Fletcher are seeking a declaratory judgment that her rights against discrimination based on her sex, under Title VII of the federal Civil Rights Act, were violated by the state. They also request the awarding of “compensatory and consequential damages” for the state’s conduct.
Since she began the process which led her to the lawsuit, Fletcher has quietly heard from other transgendered state employees facing similar circumstances.
“For the most part, individuals have been afraid of exposure or actual retaliation,” Fletcher said.
Asked about the state having told Fletcher that her surgery wasn’t covered on a cost basis, Croft dismissed those claims. He said no specific damage award is being sought in the case.
“This is about discrimination; the overall expense to the system is very minor,” Croft said. “It’s most important to Jennifer that this be allowed for other people in her situation.”
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