Health Committee on May 2nd, 2019

[The Chair, Liberal, Bill Casey]

We'll call our meeting to order.

Welcome to meeting 141 of the Standing Committee on Health. We'll continue our study on LGBTQ2+ issues for health.

We're very pleased to have with us today Dr. Tinus Wasserfall, who is presenting as an individual.

From Diversity ED, we have Crystal Fach, and in absentia, Adam Gariepy, who will be along later. We're not sure.

From Kelowna Pride Society, we have Dustyn Baulkham, general manager.

From Pflag Canada, we have Loretta Fearman by video conference from Barrie, Ontario.

Welcome everyone. Each organization will have 10 minutes for an opening statement.

We'll start with Dr. Wasserfall.

[Dr. Tinus Wasserfall, Family Doctor, Spectrum Health, As an Individual]

It's a pleasure to be here, and thank you all for your time.

I would like to introduce myself. I'm a family physician who has spent most of my career devoting my time to delivering health care to the LGBTQ community as well as people living with HIV. This is a very important topic to me.

I'm also here as a gay married man. I'm here as a doctor, but I've also been in the health care system as a patient, so I'd like to tell my story and get some points across on what I think is important on this topic.

I'm sure that in this committee you've heard a lot of the salient points regarding LGBTQ health care, so I thought I would just tell you stories. Hopefully, these stories will get some points across and maybe offer some solutions to what I think are the issues. I'm going to tell you patient stories. There's no personal identification in these stories, so it's all confidential. I'm going to see how much time I have to see how many stories I can tell you.

The first story I want to tell you is about a patient of mine who was distressed because his friend, a female patient, was really struggling in the health care system. She really needed a doctor. I agreed to take her on as a patient and in comes this lovely, let's say, mid-fifties, female patient, and she is a female-male transgender woman. She comes in with a bit of trepidation. I can see she's a little bit anxious and we start to talk, do a bit of introduction, and then I tell her about what we do at my clinic—what we've done for 20 years—and that we call it a medical home for patients, but a medical home specifically tailored for LGBTQ patients.

We have low barrier access. We're very respectful, staffed from top to bottom, and very aware of what this group of patients needs and how to communicate with them. We're a multidisciplinary group, doctors, nurses, pharmacists and other staff.

I started to talk to her. I said, “This is your new medical home. You will always be safe here. You will always be heard. You will always be respected.” In those few seconds that we spoke, I saw a ton of bricks falling off of her, that relief. I suspect she experienced a lifetime of prejudice, and in the medical system, not always having optimal communication and being asked uncomfortable questions.

That's my first point. What's important is that this population needs a medical home that's tailored to them. We can talk during question period about what that means, because in today's day and age, medical home doesn't necessarily need to be a specific physical place.

I have one more point to make about her. She's a happy patient, happy in her new medical home where her needs are met. She has to go for a routine colonoscopy. She goes to our local hospital and I get the report back, and my heart sank, because the report said that a 56-year-old male patient was seen and he was told this and that. My heart just sank, because I actually knew the people, those physicians, and they're great people, but there's a systemic problem in how medical professionals get educated around LGBTQ health issues, and how they communicate. If you ever met this woman, you would never refer to her as a male, and that was an atrocity.

So often, and I don't know if this is across the whole country, medical education for health care professionals around this issue is either an opt in or non-existent. My second point is that I really think that “mandatory” sounds like a prison sentence, so I don't want to say that word, but I think we really need to have it in medical education for health care professionals on all levels as a really important issue that's strongly encouraged, but I don't want to say “mandatory”. That's my first story.

My second story is about doing scoping for anal cancer. Although I'm a family physician, I trained in that. I see a 46-year-old gay man. He came in and said, “I've had complaints for a long time, a few years. I've seen a few doctors, and they told me I have a hemorrhoid.” I looked with a scope, and sure enough, unfortunately, he has anal cancer, which is quite a devastating cancer diagnosis. It's treatable, but the treatment is harsh.

Why I bring this up is that in the gay population, anal cancer is a much more prevalent cancer than in the general population. There is screening available. There are clinics like mine also available in Vancouver, but they are minimal. I think, if I would make a recommendation, I would say that gay men need to be screened for anal cancer and need to have access to clinics like mine, where I work, to be assessed and to make sure that, even if they have cancer, it's early cancer that can be treated.

Women are the same. Cervical cancer rates, actually, are the same as anal cancer rates for men who have sex with men, so it's the same thing. All women have universal access to screening in colposcopy clinics province-wide, probably country-wide, but gay men don't have this. I think that's a very, very important point, as I said, in looking at gay men's health.

This is my next patient's story. I got called by a health care nurse. A 24-year-old guy just got diagnosed with HIV. It was very distressing. It was in the past year or two. He came in. He was in school and was devastated by this diagnosis. Of course we had a conversation, and I put him at ease by telling him that we can treat HIV today, but it would have huge health impacts on his life for the rest of his life and on many levels, not just health but social and economic. In B.C. we got universal access to PrEP just two weeks prior to this appointment with this patient. My heart sank, because I felt like he had just missed the bus.

I don't know if this committee has heard about PrEP. It's a treatment you can take every day that's more effective than condoms to prevent HIV acquisition. I just think that today in Canada we should not have any new HIV infections. I really think we should have universal access for people at risk of getting HIV. That's another point.

I have one minute, so I'll to go to my next patient. My next patient was a lovely guy. He's in his mid-eighties. I've known him since he's been in his sixties. He has HIV, well controlled, and some other health issues. You get health issues after 70, as I always tell my patients. But he's doing well and he's working every day. The last time I saw him I had a bit more time, so I asked him, “Why are you working every day? You're in your mid-eighties. It's not for financial reasons.” He told me, “ I wouldn't know what else to do. All my friends have died, and all my family have died, so this is what I can do.”

Why I bring up this point is that, for the LGBTQ community in the future, as they age, we're going to see more social isolation. We know that loneliness is a disease in itself. You can read up on the health impacts of loneliness. That's why I bring up this point. It's really a concern for us, because we know our patient population is aging. How are we going to deal with loneliness? You can ask me in the question and answer period if you think I have any suggestions.

That was my last story.

[The Chair, Liberal, Bill Casey]

Thank you very much. We definitely learn from the stories.

Now we will go to Ms. Fach.

[Crystal Fach, Co-Founder, Diversity ED]

I am also going to start a timer.

[The Chair, Liberal, Bill Casey]

I like it.

[Crystal Fach]

Good afternoon, and thank you for inviting me to speak to the committee.

I want to start by introducing myself. I am Crystal Fach. I am a 39-year-old queer, polyamorous women, single mother, who works as a professional advocate, educator and front-line support work and co-founder of Diversity ED.

I also smoke, have been impacted by violence, have a history of addiction, have lived in poverty and have had prior suicide attempts. In the LGBTQ community, I know that I have a lot of privilege. I am white, cisgender, able-bodied and straight passing.

Now I would like to tell you why I'm really here today. Early on in my career, I was working with an amazing transgender youth, 17 years old. He came to my LGBTQ youth drop-in. He had to lie to his parents as to why he was attending. His parents were very unsupportive of who he was. He would crack jokes, drop hints, and he knew it was not going to be okay to come out.

One day, he and I started practising coming out at home. The best way I prepare kids for coming out is to role play two different reactions, that of a loving response and that of an angry one. I always make sure my youth know what they are walking into and have a safety plan attached.

My young man's story did not go well. It became heated. He was assaulted and a few days later hospitalized for a suicide attempt.

While in hospital, I started to visit this young man. Nurses called him by his dead name and misgendered him. The psychiatrist did not give him a referral to any type of doctor who would even begin to talk about hormones, and the parents threatened his post-secondary education if he did not fall in line.

I wish I could say that this youth found support and then lived a happy and full life. He did not. He died by suicide within six months of leaving the hospital.

Many people had an opportunity to validate and support this young person, in particular the health care system, the nurses, doctors and psychiatrists. What I know is that if youth have people in their lives who validate and support them, they decrease their risk of suicide by 90%. That is a stat that I have sent forward.

Our health care system failed him, and unfortunately, I see and read of the system failing people every single day. I have spent most of my career working with and for LGBTQ youth and their families. I have also been a family support coordinator and program developer for Canada's first and only transgender drop-in centre, in Windsor.

I come here today not just to share some statistics with you, but to share the stories of the very people that the health care system in Canada has been harming.

Let's start with the system as a whole. We do a disservice to gender-diverse folks when we revolve everything we do around gender: dorms and hospitals, gendered treatment centres, inaccurate genders on health cards. Yes, I know that these can be changed, but their files with previous gender are also attached to the card and gender marker. Changing documents is also expensive and can be unsafe for certain people.

I have another story. A transwoman I have been supporting had kidney stones. We went to hospital together. She wanted an ally to be there just in case. All ID had been changed. She had what uneducated folks call that “passing privilege”, which is really harmful.

When at the desk checking in, she was asked if she was pregnant. The client then came out to the staff that she was transgender. The first thing said by the staff was, “I never would have known you were not a real woman.” This might sound like a compliment, but it's the very opposite. My client was once again told that she is not a real woman.

When asked where she would be placed in the hospital, they refused to answer, which put her in a state of anxiety. Now imagine you are a transgender woman and you don't know if you are going to be put with men or women. Finally they agreed to put her in a women's ward, and then said, “Don't think you're going to get your own room. It's not happening.” This woman never asked for accommodations, but under the law, she very well could have.

While there, the nurses and doctors were told that the client was trans, and she was misgendered by almost every nurse and doctor she came in contact with. The nurses were overheard at their station saying, “Look at it putting makeup on.” She was so uncomfortable and in so much pain—I don't know if anyone here has had kidney stones—that she was more worried about putting on makeup to make the nurses and doctors feel comfortable than sitting in her pain.

This person has experienced kidney stones since. Do you think she'll go back to the hospital? Not in the least. This is not a stand-alone situation. I have many stories of trans folks being discriminated against in hospital.

This person has made three suicide attempts since this incident, and has become housing insecure and is relapsing consistently, and she had almost a year of sobriety before this situation happened.

As for recommendations, hospitals should have a mandatory audit of their spaces, forms and procedures when it comes to services for gender-diverse folks. Some hospitals have already done these audits. The problem now lies with the government's reporting. It is not always necessary to ask for gender information, and when we do we need more options besides male, female and other. Other is not an option.

Transgender is also an umbrella term and will not pull accurate data. Also, if we're not collecting data to measure the needs of transpeople then the government will never have a realistic view of what the needs truly are. We also need data so the government can start investing money into the sectors that service transpeople and their families. We need to stop measuring LGBTQ people as one large group. Sexual orientation and gender identity have different oppressions and are treated very differently in society.

We need to start thinking about putting money into the most marginalized in our community. Funding needs to go to organizations that are trans-led and working on preventive and crisis work for transpeople and keeping them healthy and safe.

Mental health and addictions in our community are at a high level. LGBTQ people experience stigma and discrimination across their lifespans and are targets of sexual and physical assault, harassment and hate crimes. This increases their risk of experiencing mental heath concerns. LGBTQ people are not mentally ill due to their identity; they experience illness due to how they are treated in society.

One of the stats I'd like to share with you is that 77% of trans respondents in an Ontario-based survey had seriously considered suicide and 45% had attempted, and this was in a year. Let’s digest that number for a second: 45%. We have an epidemic in our community and it needs to be treated as such by our government. We no longer get to put our fingers in our ears and let one more gender and sexually diverse person die by suicide. We can change these things.

Trans youth and those who had experienced physical and sexual assault were found to be at the greatest risk. Some research suggests that use of alcohol, tobacco and other substances are two to four times higher in LGBTQ populations, and 37%—this number may have gone up—of homeless youth identify as LGBTQ. That's an alarming number, and we need to be putting more effort into looking at that as well.

We need to stop allowing physicians to ignore or diminish the existence of transgender people. Transpeople need access to hormone replacement therapy. They should not be told to prove they are trans or wait until they are a bit older. Putting off hormones for a transgender person could mean life or death. Gender dysphoria is a real thing that can lead to suicide and significant mental health concerns.

Youth should have access to hormones and hormone blockers when asking for support from physicians, regardless of their parents agreeing or disagreeing. This becomes a child protection issue and medical neglect in my opinion. Hormone blockers are safe and give children and youth breathing room to stop irreversible changes to their body through the puberty process. We need to start making sure that our youth are being medically supported. I don't know how many appointments I went to with youth, having to advocate for them to get the medical attention they need because physicians don't understand how to prescribe hormones or blockers. More education needs to be mandated because we're losing more and more kids, and this is not okay.

Some more recommendations would be more training mandated to the health care professionals, both in hospitals and throughout their early education. Better data collection would be another. We need to start getting stats for transpeople. We can't keep putting all LGBTQ people in one cluster because we're losing so many opportunities to learn more information. We need more LGBTQ visibility in preventive health care initiatives like smoking cessation, suicide prevention, mental health, addictions, and on government committees.

We need to remove unnecessary gender dorms or services. For example, treatment centres are gendered due to fraternizing. This is very heteronormative and excludes non-binary people. No government funding should support marginalizing already oppressed populations. Finally, government-run systems should never be participating in this marginalization themselves by creating physical barriers to access.

[The Chair, Liberal, Bill Casey]

Thanks very much. We'll have lots of chances to ask you questions and go into it further.

Now we'll go to the Kelowna Pride Society and Dustyn Baulkham for 10 minutes.

[Dustyn Baulkham, General Manager, Kelowna Pride Society]

Thank you, Chair and all the members, for allowing me the opportunity to speak today. I'm honoured and humbled by your request.

First, I do want to recognize that I live and work on the unceded territory of the Okanagan Syilx people.

I also want to share that I use he/him pronouns. I would also challenge the committee to include pronouns on your name tags so that we know how you identify when we're addressing people in the room, because obviously, we can make assumptions, but we're trying to say not to do that, right? We want to address people how they are as individuals. As well, when I speak today, I'll often use the term “LGBT”, but with Kelowna Pride, as well as personally, we use LGBT2Q+ as our general acronym.

When I first received the request to serve as a witness, my main question was, why me? I was looking at a lot of doctors and people who work with different LGBT health organizations, so I wasn't quite certain how I was selected or why. I've been thinking about it in the last couple of weeks as I was going through that process of “What am I going to say?” I obviously want to make sure it's valuable to the committee and the people who are taking part in the standing committee, so I'm going to offer my experience. I don't have the research or stats that go along with it, but it's going to be a bit different as a perspective for this committee.

I'll provide some of my context and background. Over the last 10 years, I've served on various boards: the Vancouver Pride Society, Fierté Canada Pride, which is a national association for pride organizations, and the Kelowna Pride Society as well. During what I call my previous life, I was a banker and I also served on LGBT committees in the bank.

I grew up in small-town Saskatchewan, in Maple Creek, with a population of under 3,000, but I've also lived in Kelowna, Chilliwack and Vancouver, as well as a little closer, in London, Ontario. Just after my term as president of the Kelowna Pride Society, we managed to find a grant which let me be hired as the current general manager. It's a part-time paid position. I'm also the executive director of the Arts Council of the Central Okanagan. As well, I have my own events company that specializes in LGBT events, but not exclusively.

Most of my examples and stories will focus on Kelowna, but that takes into account experiences I've had around the country and in my various roles.

To start off, Kelowna does not have any kind of dedicated LGBT space, which is why we do various events throughout the months of the year to try to provide that safe space for people, but at one time we used to. The Kelowna Pride Society, which was originally incorporated as the Okanagan Rainbow Coalition on June 15, 2004, started the space. That happened when I was at the University of British Columbia's Okanagan campus. Later that year, they started a community centre that was the safe space for people to meet and congregate. They had regular drop-in hours, and various different groups met in that space. The way they paid for the rent on the space was by getting a special occasion liquor licence every Saturday night. They served and sold liquor. That was actually how we paid for it.

This was obviously a time much before apps such as Grindr and whatnot were out there to connect people. It was just a space where you could be yourself, and people from the various elements of the LGBT community were always there. In the seven years that I've lived in Kelowna, in two different spurts, it was one of the few times that we actually saw many people from the trans community come out to events. Unfortunately, it closed around 2013 because of liquor law changes. We could no longer afford to run that space. The challenge of being a pride society is that we don't qualify for charity status, so we can't get certain grants that are out there. While we've found some workarounds in certain ways, it still does provide a bit of a challenge.

On a positive note, the one thing that has come up since it has closed has been the Etcetera Youth Group. Every Thursday—so actually later today—they get to meet. They call themselves the Glitter Critters. It's a free drop-in group and they have two different age ranges: 11 to 14 and 14 to 18. Lately they've just been bursting at the seams because of the youth who come there. Originally, it was created by Kelowna Pride, but again, to go back to that charity status, we couldn't get the appropriate grants to do it, so we partnered with other groups to ensure this program was sustained.

I won't go into detail about some of the challenges that happened about a year and a half ago, but it did almost shut its doors. Thanks to the community coming together, Bridge Youth & Family Services now is the primary organization that actually runs the Etcetera Youth Group, and it's run out of the Foundry, which is part of the Canadian Mental Health Association in Kelowna. As well, the Boys and Girls Club is part of it, as is the Kelowna Pride Society, and then there are a lot of engaged community members. Partnerships like these in smaller communities are the way that we've found to actually make sure that groups like this can exist, both financially as well as from a space.

After I was asked to speak to this committee, I reached out to one of the facilitators, because while I've supported the program both personally and from my company, I wanted to learn a bit more about what people are seeing on the front line, people who don't have the opportunity to come here to speak today as I did.

Leslie is one the facilitators. She used to be on the pride board. According to her, the program seems to cater more to the trans/non-binary kids, as they are the ones needing the most support, but of course, all are welcome to attend. What she has seen is that the majority of the trans/non-binary creators who come to Etcetera are on the autism spectrum. She feels this might be because the trans kids who are not autistic are capable of creating and maintaining strong support networks without a group. She admits that she has seen a skewed sample of kids, as she only sees those who attend. I want to add that Leslie has her master's in social work and is a clinical counsellor, so it's not just some random assessment by an uneducated person.

In the group, she estimates that approximately 5% to 10% of the youth in attendance are not out to their parents; they're lying to their parents to go to this group. She has also shared that some of the parents of the youth who attend have refused to use their actual pronouns. On the flip side, the youth attending some of the Etcetera drop-ins have been able to work with some of the parents to help educate them, and they have come around and started to accept these youth for who they actually are.

In the past in Kelowna, we've had different groups such as a gender identity group and Senior Gay Men in Kelowna, but these groups have fallen apart in the past year or so due to lack of leadership, human capacity and financial resources. At the time, these groups were well regarded, but the people leading the groups have their own struggles in life and didn't have anywhere to turn, so they had to step down to focus on themselves. We need people with lived experience running these groups. It can't be someone like me, a middle-aged, cisgender white male. I can't step up to run the gender identity group, because I don't have that lived experience. I think Crystal addressed this previously.

All the smaller communities I've lived in lack safe spaces for the LGBT community, and I honestly think the apps that are out today have made that worse. Back in the day, people would often turn to gay bars and gay centres, but with people not attending these places as much because they feel they can get what they need from an app, they don't have those resources anymore. From what I've seen in my various roles at pride and the events that I run, people are more lonely now than they have ever been, because they don't have those shared spaces and hubs, and that's what I think we need more of, especially in smaller communities.

One thing I've seen through my years with pride societies—and I do this myself sometimes—is this internalized view of homophobia and transphobia. What I mean when I say that is, based on past experiences, if someone or some group, business or organization does not blatantly say or show that they are welcoming to the LGBT community, we assume they are not welcoming at all. This is why we have created some of the events we have in Kelowna for the LGBT community and bring people into businesses. It's the same when it comes to health care and doctors. Just looking at someone, you don't know how they identify or whether they have knowledge of the LGBT community. This can be a barrier to getting medical help when you're scared to go in. I've experienced this myself many times.

We need resources and hubs of information where we can find the inclusive and welcoming doctors who will understand our unique needs, whether I'm a cisgender white gay male or a transperson. It's difficult enough to find a family doctor, let alone to find one who understands the LGBT community.

I know in B.C. that Trans Care BC has been doing a great job of bringing together those resources for the trans community. I saw they're coming to speak next week, which is great. I know they support TransParent Okanagan, which is a local group started by parents who had trans children and wanted to support other parents going through that same process of trying to understand their trans youth. Trans Care's work, especially in the interior, has reduced the number of requests Kelowna Pride has received for trans-inclusive doctors. We used to get those on an almost weekly basis, and we had nowhere to turn to provide this information, outside of a friend of a friend recommending this or that doctor.

In closing, I am looking forward to seeing what comes from this committee and how the health of the LGBT community could be better supported.

Thank you for allowing me the time to speak today.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we have Ms. Fearman. Thank you for patiently waiting. You have 10 minutes.

[Loretta Fearman, Chapter Facilitator, Barrie-Simcoe County, Pflag Canada]

Thank you for this opportunity.

My name is Loretta Fearman—pronouns she/her. I am the proud parent of a gay son and a lesbian daughter. I co-facilitate Pflag Barrie-Simcoe County, which we started three years ago after attending parenting LGBTQ2I youth workshops in Midland, Orillia and Barrie. We recognized the need for peer-to-peer support for those who are raising LGBTQ2I youth, more specifically, families raising transgender youth.

I present today a snapshot of the lives of three of our families—the names have been changed—and I offer recommendations necessary for our youth to survive and thrive.

Here is our first family. Sarah is an intersex youth, assigned male at birth, living in Barrie—pronouns she/her. Sarah's mother writes that for years they knew that something was different about their child. When she started puberty, they knew something wasn't right. They asked the family doctor about the lack of genital growth. She said it was nothing to be concerned about. A few years later, Sarah started questioning her sexual orientation, and soon thereafter her gender identity. The doctor referred them to the Transgender Youth Clinic at the Hospital for Sick Children. Sarah was no longer identifying with her gender assigned at birth.

After several appointments and blood work, the results showed that her hormone levels were off, and she was diagnosed with partial androgen insensitivity syndrome, a type of intersex condition. If doctors were more aware of the spectrum of intersex conditions, Sarah could have benefited by going on hormone blockers at a younger age.

There is much stigma about being intersex. They are not accepted by cisgender folks, and they are not accepted by the trans community. That is why many intersex people, like Sarah, choose to identify solely as trans. Intersex folks need validation and acceptance. Life has been stressful for Sarah. She experiences shame, guilt and anxiety, and her depression has made it difficult for her to go to school. She has started self-harming and has been on suicide watch several times. Her mother still cannot go to bed until Sarah has fallen asleep. Sometimes it's not until 3:00 or 4:00 in the morning.

Next we have Joe. Joe is a cisgender gay youth living in the Blue Mountains area. Joe struggled with coming out. He finally came out to his mother, Nancy, at age 14 and immediately asked for conversion therapy because he did not want to be gay. Joe was taken to a therapist prior to seeking out conversion therapy. The therapist told him that conversion therapy does not work and has caused extreme harm to individuals. He insisted that only his mom know that he is gay. The unawareness has put an excessive amount of stress on his family.

Joe's grades have declined, and he regularly skips school. Now, at age 15, he has started using drugs to self-medicate and has moved out of the house. His parents worry every day for his safety.

Nancy has reached out to various agencies for help. She started with New Path, an organization that works on a first-come, first-served basis. After a long wait and much paperwork, they referred her to the Canadian Mental Health Association, only for her to be told that Joe must be the one to request help.

The Georgian Bay Family Health Team helped when Joe was suicidal. However, when it came to long-term counselling, the family was referred to the CMHA in Barrie, 50 minutes from where they live. Not having a local agency proves difficult for Joe and his family. Nancy tells me that her family is in crisis and that they do not know where to turn, so she continues to make calls.

Joe is one of our fortunate youth because his family loves and accepts him. There are many LGBTQ2I youth who have been kicked out of the house by unaccepting parents.

We know that approximately 40% of the homeless youth identify as LGBTQ2I. We know that we live in a heteronormative society, and we know that for many LGBTQ2I folks, stigma still exists, contributing to their shame, self-denial, internalized homophobia-transphobia, self-harming, anxiety, depression and suicide.

Education in Canadian schools is essential to normalize gender diversity and provide an understanding of diverse sexual orientations. When youth talk about their experiences and identity freely without shame and fear, it makes them feel normal.

Here is our third family. Tom, 16 years old, is a transgender boy—pronouns he and him—living in Simcoe County. Tom's mother has shared their story. Tom did not identify with his assigned-at-birth gender, but due to a lack of education and resources, it wasn't until grade 9, at age 14, that he realized what it meant to be transgender. After extensive research, they asked their family doctor for a referral to a local medical doctor who specializes in transgender patients. Several months later, they got an appointment. On April 21, 2017, Tom began taking testosterone.

When they sought a referral for top surgery, they decided to go to Montreal, since Toronto wait times were one year longer. The medical documentation required for surgery approval was arduous. It resulted in multiple visits to several professionals simply for the purpose of filling out paperwork. The wait for approval was significant. Once approved, only then could Tom go on the wait-list at the Montreal clinic. OHIP's predetermination for surgery is valid for only two years. Fortunately, it did not expire, but during this wait time, Tom became increasingly depressed. He had to be hospitalized and was put on suicide watch.

Tom had top surgery in July 2018 in Montreal. This required time off work. All expenses were paid out of pocket. The surgery was successful. Tom became a different person. Today Tom is a confident boy who no longer needs mental health counselling in Whitby for body dysphoria. He no longer takes prescription medications for his depression. Tom doesn't need to waste a half hour every morning taping and every evening removing the binding tape from his raw skin.

Tom has since switched to a local doctor who specializes in pediatric endocrinology. In February 2019, they submitted the paperwork to OHIP for approval of Tom's next surgery, a total hysterectomy, this time in Toronto. They recently received the approval from OHIP, but again, it's valid for two years. They now wait for his surgery date. Tom's wait times so far have been far less than other transgender folks in similar situations. However, any delays for support and medical care that could detain him from feeling his authentic self have been extremely difficult on their family, but primarily on him. They say they can only imagine what families who have different economic circumstances and longer wait times must face when it comes to the safety and mental health of their loved ones who are seeking surgery.

We have a number of recommendations.

We need medical and support staff to be cognizant of using correct pronouns, preferred names and current terminology.

We need gender and sexual diversity included as part of health education taught in Canadian public schools and in post-secondary medical training. We would like hospitals to form committees that include LGBTQ2I folk, much like Orillia Soldiers’ Memorial Hospital has adopted.

We would like to ask that there be adequate funding to support ongoing programs in such LGBTQI organizations as Rainbow Health, Egale, AIDS committees, and regional organizations like the Gilbert Centre. They are essential for the community to survive and thrive.

We need hospitals in every province where gender confirmation surgery is accessible and affordable so that dangerously long wait times are reduced. We need mental health care for ages two to 24. Currently, there is a gap for children under the age of 14, and more support is needed for our youth who are 14 and older.

Finally, we would like to see ongoing media campaigns resembling the new LBGTQ2 commemorative loonie—“50 years of progress”—where facts are shared in a positive manner to educate the public.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

We'll now go to our seven-minute round of questions.

We're going to start it off today with Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you to all of you for coming. This has been a very interesting study. We've learned a lot of very important things.

Ms. Fach, as a physician, I am ashamed to hear the stories you are telling of your friend's experience in the medical system. I graduated from medical school 25 years ago. I know there were attitudes like that then. I was hoping that in a quarter century things would have changed, but they apparently haven't.

We talked about support for young people. The subject has come up of gay-straight alliances in schools and how valuable they seem to be. We hear universal praise for these associations and how they need to be protected. We also know that there are some school officials and politicians who are insisting that the parents of children who attend these have to be notified.

What would you say to those who advocate for such a policy?

[Crystal Fach]

That is going to be a safety concern because not all youth have parents who are accepting. If you're needing permission slips for kids to attend these programs, we're going to lose more kids again. We're going to create more isolation, or we're going to cause harm at home. That is 100% a safety issue. We cannot out kids ever. That needs to be kiboshed for safety reasons for sure.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Mr. Baulkham, would you agree? Do you have anything else to add to that?

[Dustyn Baulkham]

I agree 100% with what she's saying.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay. That appears to be the feeling of everyone we have spoken to, yet we still hear this.

Dr. Wasserfall, you talked about elderly LGBT people and some of the isolation they have.

We've heard from some that there's a problem when they reach the point where they can no longer live independently and are in care. They've described some of the experiences that some of these people have had in care homes. There's a phenomenon, apparently, of elderly LGBT people becoming re-closeted, as it were, because of the environment in personal care homes.

We need to fix this. Do you have any idea of what kind of solutions we might have or how we can start addressing this?

[Dr. Tinus Wasserfall]

I don't have the solution, but yes, unfortunately I've had those experiences as well with patients who get very frail and go into care homes. They really get treated poorly as far as their sexual orientation goes.

The question is the same for the general population. We need to keep our elderly patients healthy and living independently for as long as they can. I think that a part of that for the LGBTQ community is creating social networks, and that's possible.

Some of that is happening in Vancouver, where we're engaging elderly people in their own social networks to be more socially apt. We know that social interaction keeps people healthier, and that goes with being more physically active. We've seen some of those programs in Vancouver, specifically for gay men, and they've been very successful. That's one of the suggestions I would make.

What I've heard again and again today, which is interesting because all of us talked about that, is that education of any person who works in the health care system is super important. I was thinking about it. Whether you're the receptionist welcoming a patient, the person who takes blood from a patient, the doctor, or the care aide at the elderly care facility, whoever you are in the health care system, it's super important. There needs to be a systemic approach to anybody who interacts with people and patients.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

I would agree.

As I've said to a number of panels, 25 years ago the sum total of our medical education on this issue was that it's probably a good idea to be nice to gay people. That was pretty much it. Again, it doesn't sound like things have really improved over time.

[Dr. Tinus Wasserfall]

As I said when I spoke, at this moment it's either a non-existent or an opt-in educational experience for health care professionals. I'm talking about doctors.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

This is changing gears a bit. This is purely a medical question.

You talked about your recommending screening for anal cancer in gay men, this being similar to the demographics for cervical cancer in women, and we know HPV infection can be a precursor to that.

Would you recommend HPV immunization for that population?

[Dr. Tinus Wasserfall]

For sure. Once again, I can only talk about B.C., but in B.C., HPV immunization is now approved by the province for people up to the age of 24 years. I think that's a little bit too short of a time span. I don't want to get too much into the science of it but to give you an idea, in the general population, anal cancer rates are 1.5 incidence rates per year, 1.5 to 2 per 100,000. It's fairly low. Cervical cancer rates pre-screening, before there was the cervical pap test, were 35 per 100,000. In the gay men population, it's estimated that anal cancer rates are about 45 per 100,000. It really begs to be screened and to have effective treatments.

There have been studies that have shown that even in what we call post-exposure, ideally the HPV vaccine needs to be given before exposure. That's why we give it to nine-year-old kids. That's when it's most effective, but there have been quite a few studies both in men and women in post-exposed people who have evidence of HPV-related disease that the vaccine is still effective. It's to a lesser degree, but it's still effective.

Just as a reminder to this committee, HPV is like the common cold. Everybody gets it. I think that a vaccination is very important for the whole general population, but definitely for the gay men population.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you very much.

[The Chair, Liberal, Bill Casey]

The time is up.

Mr. Lobb, you have seven minutes.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks, Mr. Casey. It's nice to see you today.

The first question I have is for our good doctor here.

Is there any legal reason why a doctor would address somebody as "mister" who was born male, is trans to female and who identifies as female?

It seems that every single time we have a guest come in on this topic, one of the first complaints is always that doctors are not referring to them the right way. I am wondering if there is a legal reason they have to call someone “mister”.

[Dr. Tinus Wasserfall]

There is no legal reason at all, no. I think it's more a failure on the health care professionals' side to address people in the correct way.

As I stated at the beginning, I've been working with this community for a long time, and we are still doing training on the right terms and the right things to say, because we want to treat our patients first of all with respect.