Evidence of meeting #142 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was community.
A recording is available from Parliament.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
You indicated before that MSP covers surgeries, for example, in Montreal. Is it expected, then, that MSP would cover surgeries in this clinic as well?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
These will be covered, and the door will remain open to Montreal, so people in B.C. will have additional options for surgery.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
Do you expect this to draw transgender people in the west to Vancouver, rather than their going east, for example?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
At this time, it will be B.C. residents with MSP coverage who will have to access the Vancouver program. It won't have capacity to serve people from other jurisdictions.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
How will this improve the time frames that you mentioned before? You said earlier that it takes from nine months to two years, give or take, for trans people in B.C. to get service in Montreal. Is that going to change dramatically, or at all?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
It should change over time. This program is part of an overall surgical strategy in B.C. to have appropriate wait times for all surgical services. This will be captured in that work provincially. It will take time to scale up, but over time the expectation will be that those surgeries fall into the standard benchmark. It will probably be considered what we call a priority 5 surgery, for which from the time of consult, people shouldn't wait more than six months.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
Is it just going to be genital surgery, or is there going to be other surgery, such as—?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
Part of the announcement last November by our Minister of Health was also a scale-up around upper body surgery. We had only two health authorities offering chest and breast surgeries, and we have now, in the last year, moved to having those surgeries offered in every health region and to having 15 surgeons offer that care now; this number is up from five about a year ago.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
How will this affect the cost to people having the surgery? They won't have to travel as far, perhaps. Will it bring it into a more reasonable financial range for more people?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
I think there will be very few costs out of pocket in the new model in our province. I think what we'll see is improved ability to return to work and less down time for people. The surgeons are quite confident that complication rates will go down because the travel will be limited and patients will have access to their surgeon much closer to home for appropriate follow-up and aftercare. We will see people be able to get back into the workforce and back to their lives much more quickly.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
I've heard testimony that some trans people don't seek reassignment surgery. Is that because they don't want it, because they can't get it, or because it's too expensive generally or takes too long?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
I'm not a trans person, so I can't comment on anyone's individual reasons, but these are complex surgeries, especially the masculinizing genital surgeries. There is quite a high complication rate at the best of times. I think it would depend on what really matters for that person concerning their gender affirmation goals and what their care plan.... It's about building a care plan that works for them. It's a very unique choice for each individual, and—
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
Would having a facility closer to home make it arguably the case that more of the people who don't get the surgery now might get it?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
I think some people who would have faced a lot barriers to travelling to Montreal may now be able to access surgeries, though people have to be fairly stable in their lives, and able to weather the recovery period, in order to access the surgery. We may see an increase.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
If I can have my four seconds left for a quick change of pace.... With the gender markers—male, female and X—is X an acceptable addition? Is that enough? You also spoke about removing gender markers entirely. Is that the preferred way to go?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
I'm not an expert on this topic, but I know there are very few people who actually go by X as their gender marker. I've heard from many folks in the community that they would rather see a range of options, or the removal altogether. It's a step in the right direction. I think we're encouraged by that.
Provincial Lead, Peer and Community Support Networks, Trans Care BC, Provincial Health Services Authority
As I believe Washington mentioned earlier, if you have an X on your ID, yet all the systems and services you're trying to access with that ID do not accept it, it does create further complications around accessing those systems and services.
Executive Director, YouthCO HIV and Hep C Society
At YouthCO, as an employer, we've worked really hard to reduce the number of times we've been collecting that information. We've actually found that we don't need to collect it for most of the work we do as an employer, although my experience as an employee in other places is that it has been a key part of information collected. I think reducing that and providing more options for folks is a very actionable thing the federal government can do as an employer, as well.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Thank you, Chair.
I hope this question doesn't offend anybody. I'm going to ask Jack, because I think you're going to be the most resilient on this.
If, hypothetically, I wanted a boob job—breast surgery—I think I would have to pay for it, because it's cosmetic. If a trans man wants to have a breast implant, is that covered or not?
President, Canadian Professional Association for Transgender Health
It depends on what province you live in.
President, Canadian Professional Association for Transgender Health
For implants, yes. It's a very complex issue. For example, if you were a cisgender woman who had breast cancer, and you wanted reconstructive surgery—you didn't just want the mastectomy, but implants to have reconstruction—that would be covered by your insurance plan. In some provinces, breast construction for trans women is covered, and in other provinces, it is not.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Okay, good.
The next question is about stigma. We know there's a lot of stigma that keeps people from seeking medical help, especially in the trans population. We asked an interesting question at a previous meeting. “How do you advertise there's a trans-educated, or trans-specific, service, without making it fearful for them to go, because it's advertised, and people might pick on them?” Is there a specific online way that would be better, or an idea about the best way to present there?
Provincial Program Director, Trans Care BC, Provincial Health Services Authority
This is where we're really excited about training health care providers all over the place to be really competent in providing this care, so those who don't want to go to a specialized service that says “trans” on it can just show up and have a conversation with their doctor, or perhaps a counsellor in their community. That's work we're doing in B.C., through what we're calling an informed consent model for services that people should be able to get. In general, they will be able to show up and have at least a first conversation with their GP, or their primary care provider or team.
Of course, specialized services will always be needed for some people, but not for all, so we're working in what we call a tiered service model framework. I think working from the base of a tiered model, making sure general services are safe and comfortable, really alleviates that. Also, for rural folks, or people who do face barriers to showing up, some are really critical online supports and services. I think it's a good domain for people to get support.
