by Mike Andrew -
SGN Staff Writer
When Ina Percival took her daughter Kaya to the Seattle Children's Hospital emergency room on July 7, she encountered an administrator asking 'invasive' questions about her relationship to Kaya and to Kaya's other mom.
'Had I been straight,' Percival told SGN, 'I would not have been asked those questions, and frankly I've never been asked [them] in my two and a half years with Kaya.'
Percival's story was reported in SGN's August 12 issue.
What made the situation especially frustrating for Percival was that the hospital administrator never explained clearly what information he was trying to gather.
Later, he told Percival that hospital policy was 'murky at best' when it came to LGBT families.
Percival and Kaya may have been caught in a 'policy gap' created when hospitals are slow to respond to social changes and the changes in state law that have followed them.
As more same-sex couples want to have children, doctors and medical ethicists have tried to adapt to new conditions, and to define parental relationships in ways that fit new family structures.
Many hospitals have adopted polices guaranteeing access to medical care regardless of sexual orientation, and some even include gender identity and expression.
Children's Hospital has also adopted such a policy, and even includes same-sex parents in its policy statement.
'We are deeply committed to providing the best possible care regardless of a patient's or their parents' gender, race, ethnicity, education, income, disability, and sexual orientation,' Children's said in a statement to SGN.
'Our patients have many adults who care for them, including same-sex parents, and we support giving these loving adults the ability to be with patients consistent with visitation and other rules. We honor domestic partner rights to participate in the care of children at Children's. We have done so since long before federal law changed to mandate this.'
Some hospitals, however, go beyond mere statements of policy, and take the initiative to be sure that their staff are trained to deal effectively with diverse patients.
UW Medical Center, for example, has a Center for Cultural Proficiency, which is charged with training the staff physicians to understand and deal appropriately with diverse communities - including the LGBT community.
UW Medical Center has earned top marks from the HRC for its LGBT policies.
State lawmakers have also tried to respond to new family structures by revising state law to cover children of domestic partners and define their relationship to their same-sex parents.
Who can authorize treatment?
One of the most important issues that comes up when Queer families take their children for medical treatment is who has the authority to make medical decisions.
Rep. Jamie Pedersen (D-43), the principal author of recent revisions to the state's Uniform Parentage Act, told SGN that he understood why Children's - or any hospital - would want to be sure to establish who was a child's legal parent.
'Health care entities have a significant liability if they allow health care professionals to treat a child without proper consent,' Pedersen said.
'The questions [Percival was asked at Children's] could have been inappropriate, but they could have been very appropriate,' he added. 'It's hard to say without knowing exactly what information was presented [to the hospital].'
Pedersen noted that as a result of changes in state law that he authored, as of July 22, if a child is born to domestic partners, both partners are presumed to be the child's parents and therefore have a right to authorize medical treatment for the child.
This change in state law has apparently not yet been absorbed by Children's Hospital, which said in a statement to SGN that 'domestic partnership rights don't necessarily confer that authority [to make medical decisions for a child].'
How do you find out who is a parent?
When they arrive at a hospital with their child, Queer parents will likely be asked some version of 'Are you the parent or legal guardian of this child?'
According to Children's Hospital spokesperson Louise Maxwell, this is the initial question an adult would be asked when he or she brings a child for treatment.
What happens when a Queer parent answers 'Yes' to that question? This is the point where Ina Percival's experience with Children's Hospital took a wrong turn.
In a statement, Children's Hospital told SGN that the initial questions an adult would be asked when bringing a child for treatment are 'standard' - in other words, the same in every case.
'At registration,' the hospital's statement said, 'Children's respectfully asks a series of standard questions to determine guardianship of non-biological parents including adoptive parents, step-parents, and foster parents.'
However, Percival's experience and further questioning by SGN reveal that questions are not 'standard,' and the course of questioning may differ considerably depending on hospital staff's perception of the family's makeup.
'Questions to establish guardianship do not differ based on a patient's or their parents' gender, race, ethnicity, education, income, disability, and sexual orientation,' Children's Relations Manager Kathy Porada insisted in an email to SGN.
'However, questions to establish guardianship may differ depending on family structure. For example, a biological parent who is a child's legal guardian would be asked different questions than a host parent of an exchange student.'
This means that questions could diverge considerably from the simple 'Are you this child's parent or legal guardian?' and many Queer parents could find questions about their family structure intrusive and discriminatory.
'When your child is ill your main concern is their health,' UW Medical Center spokesperson Leila Gray told SGN. 'You don't want to have to deal with all this other stuff.'
Duty to treat
Dr. Vy Chu, who practices medicine at Capitol Hill Medical Center and is affiliated with the UW's Center for Cultural Proficiency, told SGN that questions intended to establish parental rights should never interfere with treatment of a patient.
'I think every physician knows that they have a duty to treat,' Chu said. 'When an ER doc is faced with a young child with a high fever, making sure the child is stabilized is the first priority, though of course establishing custody and who is to make further decisions is important for subsequent decisions.
'In this case, from the physician, a simple, 'Are you her mother?' would suffice. Anything other than 'yes' should be followed up with 'May I ask how you are related?'
Chu added that further questioning intended to establish what Children's calls 'family structure' is not appropriate.
'I'm not a lawyer, but I'm pretty sure the burden is not on the treating physician to determine exactly how that person became the child's mother,' Chu continued.
'But even for the administration staff, 'Are you her birth mother? Adopted mother? Is your adoption paperwork in order? So you're just the Lesbian partner of the birth mom?' - all these are inappropriate.
'In this case, there should have been no questions once the Lesbian mother simply stated that she was the mother.'
Should you consider adoption?
While recent changes to the state's Uniform Parentage Act clarify the rights of domestic partners to authorize medical treatment for their children, they obviously do not solve everyone's problems with every medical provider.
Pedersen told SGN that same-sex parents should consider formal adoption as a way of proving conclusively that they have authority to make medical decisions for their children.
'A lot of people have kids somewhat informally,' Pedersen said. 'The change in the law makes it better, but it doesn't necessarily get you what you want. The consequences [of not having a clear right to authorize medical treatment] could be a lot worse than just some intrusive questions.'
'For some families, this will be a not insignificant expense,' Pedersen acknowledged. 'But just having children is a not insignificant expense.'
Pedersen added that regardless of the legal route that same-sex parents choose, having all the legal paperwork in order and available when seeking medical treatment is important.
'Domestic partners should both go on the birth certificate as parents,' he said, 'just like adoptive parents would. And having the legal paperwork [with you at the hospital] is very important.'
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