» OHIP ordered to pay for penile-sparing vaginoplasty

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Behold your tax dollars at work. OHIP has been ordered, for the third time, to pay for an out-of-country surgery for an Ontario trans, nonbinary patient who wants to keep the P while she gets the V.

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The provincial insurer argued that vaginoplasty is a listed, insured gender-affirming service — but only if it came along with the usual removal of the person’s existing penis. But K.S., who doesn’t identify as exclusively male or female, wanted to have both.

Called penile-preserving vaginoplasty, the procedure creates a fully functional vagina without surgically removing the penis.

According to the decision, K.S., who’s sex assigned at birth was male, is female dominant and “suffered physical, mental, and economic hardships to transition her gender expression to align with her gender identity.”

In May 2022, her doctor submitted the required request for prior funding approval to OHIP for a vaginoplasty — but without the usually accompanying removal of her penis. “(K.S.) identifies as transfeminine but not completely on the ‘feminine’ end of the spectrum and for this reason it’s important for her to have a vagina while maintaining her penis,” the doctor explained.

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Since that wasn’t offered anywhere in Ontario, K.S. was asking for OHIP to fund the novel “bottom surgery” at the Crane Center for Transgender Surgery in Austin, Texas.

When OHIP denied coverage, insisting the vaginoplasty wasn’t covered without a penectomy, K.S. successfully appealed to the Health Services Appeal and Review Board where she testified that removing her penis carried risks of incontinence, sexual dysfunction and removal of her nonbinary identity.

OHIP’s expert, Dr. Yonah Krakowski, told the board that current opinion agreed that penile preservation vaginoplasty was experimental. “There is no peer-reviewed literature to support its indications, or the surgical techniques used in the process. Further, there is no longer term data reporting psychological or physical outcomes,” said Krakowski, Division Head of Trans Surgery at Women’s College Hospital.

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Still, the board agreed vaginoplasty without penectomy is a specifically listed service in OHIP’s schedule of benefits and must be approved for public coverage.

OHIP then took the matter to the Divisional Court, which also ruled in K.S.’s favour. Vaginoplasty and penectomy are listed as separate, approved surgeries under OHIP, the court found. And forcing someone to “remove their penis to receive state funding for a vaginoplasty would be inconsistent with the values of equality and security of the person.“

Now, Ontario’s highest court has also come down against OHIP’s refusal.

“The vaginoplasty recommended for K.S. is an insured service because vaginoplasty is specifically included in the Schedule of Benefits’ listing of specific sex-reassignment surgical procedures that are insured services, and because K.S. meets the stringent requirements for prior authorization of that surgery,” wrote Justice Benjamin Zarnett on behalf of the three-judge panel.

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Those requirements include assessments which confirm the patient has a diagnosis of gender dysphoria, underwent 12 continuous months of hormone therapy, lived for 12 continuous months in a gender role congruent with their gender identity, and is recommended for the surgery. 

“K.S. is pleased with the Court of Appeal’s decision, which is now the third unanimous ruling confirming that her gender affirming surgery is covered under Ontario’s Health Insurance Act and its regulations,” her lawyer John McIntyre wrote in an email to the Toronto Sun.

According to the Canadian Civil Liberties Association, an intervenor in the case, “the Court of Appeal for Ontario is a victory for equitable and non-discriminatory healthcare funding for trans, non-binary and gender diverse people in Ontario.”

OHIP was also ordered to pay K.S.’s legal costs of $23,500 — on top of the $20,000 in costs they had to pay for their appeal to the Divisional Court.

But really, that’s out of our pockets, of course, including the thousands of (American) dollars it will cost for this out-of-country niche and experimental surgery.

mmandel@postmedia.com

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