Jennifer Katherine Shields.

The Ministry of Health this morning responded to an Official Information Act request made in August by A.D Tait requesting “any correspondence, briefings, summaries or presentations related to changing the current level of funding for Sexual Reassignment Surgery (SRS)” as well as “any assessments, briefings or correspondence between the Ministry of Health, DHBs and overseas providers of Male-to-Female SRS, in regards to sending patients overseas for treatment,” as discussed in the Ministry’s response to another OIA request in April.

The outlook is bleak. 

First off, the Ministry is withholding three emails (falling under the second half of the request, about overseas treatment) between them and ‘the DHB’ on the grounds of “maintain[ing] the effective conduct of public affairs through the free and frank expression of opinions” (OIA Section 9(2)(g)(i)). What does ‘free and frank expression of opinions’ mean in this context and why do they need to be withheld? Considering Andrew Little and co’s comments earlier this year and the fact that in the Ministry’s own communications released in this OIA they refer to trans surgeries as ‘elective’ I don’t have high expectations. Hopefully a complaint to the Ombudsman gets them to release those emails, or at least give some detail as to the content of them.

The first email in the release is to the Chairperson of the Health Select Committee, Simon O’Connor, from Dr Don Mackie, Chief Medical Officer, about the petition recently delivered by Tom Hamilton and 435 others. The first section is basically a summation of how crap we have it – services aren’t standardised, they’re sparse, and we’re often forced into the expensive private sector for what should be basic healthcare. The second talks about surgeries, overseas options, and the waitlist, and is basically what we already know – 73 people are on the combined AMAB/AFAB waitlist; 5 on the AMAB waitlist who have been already approved will be sent overseas “as soon as the Ministry can confirm an overseas provider”. The final section admits that “there has been little consideration of the provision of a comprehensive gender dysphoria service nationally” and “acknowledges that it is time to review the numbers publicly funded for GRS, and how these may be managed in a timely manner” (though it’s worth noting that in a later email in this release they state they have no timeline for this review).

The second email is, quite frankly, pretty horrific. It’s from a surgeon in Australia (Brisbane from the looks of it) who the MoH are considering as their overseas provider for AMAB GRS. He spends 99% of the email talking about his AFAB GRS experience and practice, stating only that he is “interested to expand this service for MtF [sic] patients at a later stage”. He makes zero mention of any experience performing AMAB GRS. If this is the Ministry’s choice, how can they justify it? A surgeon with no experience who currently doesn’t even perform the procedure they’re looking for? Are they willing to accept an even longer wait for trans fem people? An even longer wait for those 5 people already approved waiting for a provider?

The last email from MoH is in response to a doctor requesting information and clarification for a client about the waitlist and its criteria. The client made a complaint about the “lack of action on making a referral” for GRS. The doctor asks:

“I am aware that the only surgeon in NZ performing this surgery has now retired. In this context, can you please tell me exactly what level of gender reassignment surgery is currently funded via the SHCTP [Special High Cost Treatment pool]? Can you also tell me how you manage the referrals for such surgery and the large waitlist that I suspect must inevitably result. Assuming we are funding some small number of surgeries (in Australia perhaps?), are we able to share what number of people are already on a wait list for surgery so that a newly referred person knows that the wait will be a very, very long time and is [sic] public health funding is probably not a realistic solution for them.

“I am keen and it would be very helpful to be able to give this client accurate information and a realistic account of what she can expect from the public health system, assuming she meets all eligibility criteria (which I’m not confident she does anyway).”

Before even getting into the Ministry’s response the attitude towards GRS and trans healthcare in this email really unsettles me. The eligibility criteria referenced is pretty fucked – requiring 2 psychiatric reports, one psychologist report, and “demonstration of progress in transition” including “dealing with work, family, and interpersonal issues as well as significant improvement/stability in mental health”. Aside from the gatekeeping and hoop-jumping required by that many psych reports (as Megan says on twitter, does any other population need 3 psych reports to get on a funding waitlist?) the “demonstration of progress” shows a real lack of understanding as to trans experiences. My mental health hasn’t improved after coming out and starting transition, and it’s not because transition isn’t right for me. My MH was bad before, it’s bad now. While for the most part dysphoria is lesser and HRT has helped with gender issues, being an out trans woman means I have to face transmisogyny and violence on a daily basis. Show me any other population that faces daily aggression, micro and macro, without that having an impact on mental health. Same goes for “dealing with work, family, and interpersonal issues” – what about those with unsupportive families? Unsupportive workplaces? A social circle that refuses to accept them? What happens to those who end up isolated and alone after coming out? Does this render them ineligible for what is a lifesaving surgery?

Then there’s the super cavalier attitude to how long the waitlist is – realism is good, most of us already know what the wait will be like, but this email shows little to no concern as to this wait and the impact it has.

The response from the Ministry to this is the one where they talk about the timeframe for the waitlist review – “due to the increasing W/L we are looking to review these numbers, but no time frame yet”. Interestingly, they also state that they “should be able to send the first of the W/L off to the preferred provider this year”. This doesn’t align with the single provider they claim to have contacted (seeing as the scope of the request included anycorrespondence with overseas providers) who doesn’t even perform the procedure yet and likely has zero experience. Unless contact with another provider is in the three emails they withheld (not likely, considering they state these emails are between MoH and DHB) this timeframe seems unlikely, if not irresponsible.

At the very least the Ministry recommend to “always inform the patient fully [about waitlist times] and place them on the W/L anyway”.