Medical students and residents raise an alarm over “unwritten rules” denying essential healthcare to individuals.
In a recent open letter addressed to Queen’s School of Medicine’s Senior Leadership team, a group of medical students and residents are bringing attention to what they describe as discriminatory practices surrounding access to gender-affirming surgeries and surgical contraception at Kingston Health Sciences Centre (KHSC).
The letter—which was addressed to Dean of Health Sciences Dr. Jane Philpott, Associate Dean of Postgraduate Medical Education Dr. Karen Schultz, and Associate Dean of Medical Doctor (MD) Program Dr. Eugenia Piliotis—has garnered almost 500 signatories, including students and faculty, at the time of publication. The letter highlights significant concerns about the accessibility of certain medical procedures at Hotel Dieu Hospital (HDH), one of KHSC’s two hospital sites with the other being Kingston General Hospital (KGH).
“It has recently come to our attention that patients seeking gender-affirming surgery or surgical methods of contraception cannot have their procedure at Hotel Dieu Hospital (HDH) and can only have them performed at Kingston General Hospital (KGH). Our research to date has not revealed a specific policy or documentation that prohibits these surgeries from HDH, rather it seems to be an unwritten rule,” the letter reads.
While HDH routinely performs surgeries such as laparoscopic hysterectomies, a procedure designed to remove part of the reproductive system, for medical conditions like fibroids, abnormal uterine bleeding, and certain cancers, these same surgeries are prohibited when the purpose is gender-affirming care.
The letter emphasizes operations like laparoscopic hysterectomies, and bilateral salpingectomies—a procedure to remove one or both fallopian tubes—for gender-affirming care are considered medically necessary for individuals experiencing gender dysphoria.
Intrauterine device (IUD) insertions, a routine procedure for gynecologists, are also unavailable for gender-affirming care, the letter states. While both bilateral salpingectomies and IUD insertions are performed at HDH for reasons like cancer prevention, they’re prohibited when intended for contraception.
These procedures, which are covered by Ontario’s Health Insurance Plan, are essential in improving the mental health, quality of life, and overall well-being of transgender patients, Dr. Chris Vizena, an Obstetrics and Gynecology resident at KHSC, said in an interview with The Journal.
According to Dr. Vizena, Kingston’s Gynecology Department operates out of the two KHSC hospitals: KGH and HDH. However, there’s a discrepancy.
“The Gynecology Department gets six times more operating room opportunity at HDH than we do [at] KGH, and so our service operates at both but by large, most of what we do surgically is at Hotel Dieu Hospital,” Dr. Vizena said.
Dr. Vizena notes while HDH is a publicly funded hospital it operates under the ethical guidelines of the Catholic Health Alliance of Canada, which imposes restrictions on certain procedures that conflict with Catholic values. As a result, gender-affirming surgeries and sterilization procedures for contraceptive purposes are often not permitted at HDH.
This restriction, Dr. Vizena explains, creates a significant barrier for patients seeking gender-affirming care or surgical contraception by increasing wait times and creating confusion for both patients and practitioners about why certain procedures are allowed for some conditions but denied for others.
Dr. Vizena believes many patients are unaware of the ethical guidelines HDH follows, as these restrictions aren’t always clearly communicated. Patients often receive a call months later informing them of their procedure date at KGH, without realizing they were deemed ineligible for surgery at HDH.
“The reason why this practice has been allowed to continue unchecked for so long is because patients don’t even know it’s happening,” he said. “Patients will go see their gynecologist and they’ll have a discussion about the risks, benefits, and alternatives to the surgery and then they’ll sign consent form, and then they’ll be placed on a wait list.”
“The patients don’t even know they weren’t eligible for their surgery at Hotel Dieu. They just get a call many months later that says your procedure is going to be on this date at KGH, and so the patients don’t realize they’ve been made ineligible to have their procedures done sooner at a different hospital that’s right down the street because of the Catholic faith and how they feel about the operation,” Dr. Vizena added.
In a statement to The Journal, KHSC reaffirmed its commitment to ing the transgender community, though it did not directly address the issue of the restrictions at HDH.
“Kingston Health Sciences Centre (KHSC) recognizes the dignity and diversity of our patients, their families, our staff, physicians, volunteers, learners, and community partners, and s the transgender community. In keeping with our commitment to these individuals, KHSC provides many types of insured services associated with the provision of gender-affirming care,” KHSC said.
KHSC asserts it’s made its acute-care system adaptable to meet the community’s evolving needs, as demonstrated during COVID-19. Further, in their statement to The Journal, KHSC emphasized, as a major provider of complex and specialized care, it balances various priorities while remaining committed to addressing the healthcare needs of the entire community, including transgender individuals.
KHSC reaffirmed its commitment to ing the transgender community, though it didn’t directly address the issue of the restrictions at HDH.
Emma Dennison, a fourth-year medical student at Queen’s, echoes Dr. Vizena’s concerns, adding the situation contradicts the values outlined in Queen’s MD program, which emphasizes equity and inclusion in healthcare.
“This doesn’t align with what we’re taught, especially in first- and second-year medical school, when you’re primarily taught in the classroom. When you go on to work in the hospital for the last two years, which is called clerkship, you’re in a system that doesn’t align with that mission,” Dennison said in an interview with The Journal.
Dr. Vizena and Dennison agree that, by continuing to align itself with institutions like HDH, the University, specifically the medical program, is failing to live up to its mission.
In a statement to The Journal, the University acknowledged the concerns raised by students and residents but emphasized the hospital’s policies fall under the jurisdiction of KHSC.
“Queen’s Health Sciences acknowledges receipt of this letter. However, these decisions belong to KHSC and are outside the scope of the University,” the University said.
While Dr. Vizena and Dennison understand Queen’s doesn’t directly control the policies at KHSC, they believe the University still holds a responsibility to advocate for changes that align with the values it teaches.
“These aren’t Queen’s policies but we as learners are part of Queen’s,” Dr. Vizena said. “What we’re asking the Senior Leadership at the medical school to do is to help us and us. […] We need louder voices than ours to help put this on the agenda of KHSC.”
—With files from Meghrig Milkon
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