A Healthcare Risk Control (HRC) member recently asked for guidance on handling situations when patients object to sharing a room with a transgender patient. While the hospital's policy is to place transgender patients in private rooms when possible, if no private rooms are available, patients who identify as male are placed with male patients, and patients who identify as female are placed with female patients. Although hospital staff report on these patients away from the room, a patient or family member may react badly on learning that the patient's roommate is transgender.
In our response, we note that the Human Rights Campaign and Lambda Legal have jointly published a guide, Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies. The guide, which was updated in May 2016, includes a model policy addressing room assignments (see policy 5, pages 9–11).
The model policy states, "Complaints from another patient related to a roommate's gender identity or expression do not constitute grounds for an exception to [the] room assignment policy." If the roommate continues to complain, room dividers (e.g., curtains) may be used for privacy. If the roommate still complains, the roommate should be relocated to another room if doing so would be safe and medically appropriate, the policy states.
If a transgender patient reports being harassed by a roommate, the policy indicates that a staff member who is trained in transgender cultural competency and has experience with patient relations and complaint management should relocate the roommate if doing so would be safe and medically appropriate. "If the roommate cannot be relocated, the transgender patient should be moved," the model policy states. "The transgender patient's health is not to be compromised by an unsafe room assignment."
If other questions or concerns arise related to room assignments, the model policy again calls for consultation with a staff member who is trained in transgender cultural competency and experienced in patient relations. Ethics consultation may be appropriate as well; see HRC's guidance article Institutional Ethics Committees for general information about ethics consultation.
Other sections of the model policy may be of interest as well. For example, the policy discusses options that may be available if a transgender patient does not wish to share a room with a roommate. If no private room is available, the policy indicates that the patient may be placed in an empty double room, with the other bed "blocked." If no private or empty double rooms are available, the policy suggests moving other patients, if doing so would not compromise their health or safety, to open up a private room for the transgender patient. If no patients can be safely moved to open up a private room, the model policy states that the transgender patient "should be allowed to remain in the Emergency Department or Admitting Office without harassment until a private room becomes available," assuming the transgender patient still prefers that option over sharing a room.
Although roommates and their family members may learn of the patient's transgender status through various means, it may help to ensure that providers and staff are not disclosing protected health information in a way that violates the Health Insurance Portability and Accountability Act (HIPAA) or other privacy and confidentiality laws. Lambda Legal has published a resource on HIPAA, gender identity, and sexual orientation, but organizations should consult legal counsel in developing policies and training in regard to privacy and confidentiality.
ECRI Institute offers other resources that address the care of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients and their families, as well as development of a supportive environment and policies for LGBTQ staff. These include the Risk Management Reporter article Are LGBT-Inclusive Approaches for Patients and Staff on Your Radar? and the guidance article Culturally and Linguistically Competent Care.
The recommendations contained in Ask HRC do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.