Department of Health and Human Services Changes: Implications for Hospital Social Workers

Article excerpt

Engaging with a health care system can be overwhelming, particularly for those in traditionally marginalized and underserved populations. Lesbian, gay, bisexual, or transgender (LGBT) people are no exception. Anticipatory fear about disclosure of sexual orientation, coupled with actual negative experiences, keeps this community absent from or, if present, quiet in the health care environment, even though their risk of major illness is equal to or greater than that of the general population (Conron, Mimiaga, & Landers, 2010; Frost, Lehavot, & Meyer, 2011). According to a recent study of 4,916 people identified as LGBT, more than half of the participants reported negative health care experiences. These experiences included being refused care, having health care professionals refusing to touch them or using excessive precautions, being exposed to health care professionals' harsh or abusive language, unnecessary physical roughness or abuse from health care professionals, and being blamed for their health status (Lambda Legal, 2010). In addition to empirical findings, personal accounts of recent hospital experiences have underscored consistent disparity in health care for people identified as LGBT. The Langbehn-Pond and Strong-Fleming cases, which epitomize this disparity, spurred the presidential directive and subsequent U.S. Department of Health and Human Services (HHS) response regarding patient visitation, guidance on advance directives, and other initiatives to improve the lives of LGBT people and their families.

THE LANGBEHN-POND CASE

In February 2007, Janice Langbehn, her partner Lisa Pond, and three of their four jointly adopted children boarded a cruise ship in Miami, Florida. While waiting to set sail, Lisa, age 39, collapsed. She was transported by ambulance to the Ryder Trauma Center at Jackson Memorial Hospital, where she was admitted. Janice, who was named as Lisa's health care proxy, anticipated no problems with access to Lisa or participation in Lisa's plan of care. However, Janice's offer to provide medical information was ignored, and Janice, along with the children, was denied access to Lisa's room. The trauma social worker informed Janice that she was in an antigay city and state and, thus, she should not expect information about or access to the patient. Other than this exchange, the social worker did not participate in the case. Approximately 2 1/2 hours after Lisa's admittance, Janice learned from the doctors that Lisa's condition had deteriorated and she would not regain consciousness. Soon after, Janice was approached by a clergy member as she sat in the waiting area. She requested a priest for Lisa. The priest accompanied Janice into Lisa's room so that she could be with Lisa while he performed the Last Rites ceremony, then he escorted her back to the waiting area. Lisa died alone, without her partner or children by her side (Lambda Legal, 2008).

THE STRONG-FLEMING CASE

In December 2006, a flash flood hit the Madison Valley neighborhood in Seattle, Washington. Kate Fleming, age 41, an accomplished audio recording actress, went to her basement studio to save her life's work. The water rushed into her basement faster than she anticipated, and she could not open the basement door to get out. She placed a frightened call to Charlene Strong, her partner of nine years, who was at work. Charlene ran home, fighting through the flood waters in the couple's home to try to reach her partner. The water had jammed the basement door locks. Submerged in the waters herself, Charlene continued her frantic efforts until firefighters arrived. With the water to the basement ceiling, they had to cut through a floor to reach Kate. Kate was taken by ambulance to Harborview Medical Center, with Charlene following close behind. At the hospital, Charlene ran to join Kate in the emergency room. She was stopped by a social worker who informed her that the state could not recognize same-sex partners in emergency situations. …