Patients are being denied necessary care. It needs to change.

As a fourth-year medical student studying in Ontario, I have witnessed the transformative potential of healthcare to empower patients and improve lives. I have also seen how barriers to care perpetuate inequities and, in turn, target vulnerable groups. 

I still remember my first patient in obstetrics and gynecology while on my rotation in Kingston, who arrived at the Kingston General Hospital (KGH) contraception clinic. She was told it would be a one-year wait, in either KGH and Napanee, for her bilateral salpingectomy (the modern day “tube tying” or permanent sterilization). 

No word was ever spoken about the potential of having this procedure done at Hotel-Dieu Hospital (HDH). Although I was confused, I accepted this knowing we were embedded in an overworked, overburdened healthcare system. 

Little did I know as a third year student at the time, that HDH is given 6 times more operating time for its gynecology department, yet an unwritten rule exists allowing it to deny this care to patients.

At Kingston Health Sciences Centre, gender-affirming surgeries and surgical methods of contraception are restricted from being performed at Hotel Dieu Hospital. This limitation reflects a discriminatory approach to healthcare access that demands urgent attention.

To be frank, there is no formal policy prohibiting these procedures at HDH. What exists is an implicit policy that creates confusion among medical trainees and denies vulnerable patients access to necessary care. 

The gynecologic procedures involved in gender-affirming surgeries, such as total laparoscopic hysterectomies and bilateral salpingo-oophorectomies, are OHIP-funded and deemed medically necessary for patients experiencing gender dysphoria. These same surgeries are routinely performed at HDH for other conditions like fibroids, uterine bleeding, or cancer. Yet, when the indication is gender-affirmation, these procedures are flagged and prohibited from booking operating room time. 

Transgender individuals already face overwhelming barriers to accessing care, as highlighted in our petition. Denying these patients access to surgery at HDH is not just a delay in care — it is a violation of human rights, and a reflection of prejudice that HDH persistently attempts to shelter. 

As future healthcare providers, we have a responsibility to shape a more inclusive and equitable healthcare system. 

In addition, procedures like bilateral salpingectomies and intrauterine device (IUD) insertions are performed routinely at HDH for reasons such as cancer prevention. However, when the indication for these procedures is contraception, they are prohibited. 

This selective offering of care, based on the indication of the procedure, undermines patient autonomy and rights, compromising their ability to make their own care decisions.

The general gynecology department at HDH receives six times more operating room time compared to Kingston General Hospital (KGH). As a result, KGH operating rooms are reserved for more complex cases and patients with higher comorbidities. By forcing straightforward procedures like gender-affirming surgeries and surgical contraception to be done at KGH, we are exacerbating wait times for patients requiring more complex surgeries, contributing to delays that could compromise patient outcomes.

This situation contradicts the very values that KHSC claims to uphold. Its website emphasizes the commitment to caring for the most vulnerable members of our community and treating each person with respect and dignity. Yet, the current practice of selectively denying access to certain surgeries contradicts these principles. In addition, this practice is in direct violation of the Canadian Human Rights Act — which ensures that individuals are free from discrimination based on factors such as sex, gender identity, and sexual orientation.

As medical trainees, we are taught to uphold the highest standards of equity, inclusion, and patient-centered care. Queen’s Medical Doctor Program explicitly states its mission is to train physicians who champion health equity and address the needs of marginalized communities. Queen’s Postgraduate Medical Education also affirms its commitment to creating a supportive, inclusive learning environment. How can we achieve these goals when the institutions responsible for our training allow discriminatory practices to exist?

We must push our institutions to confront the systemic discrimination embedded within healthcare policies and practices. This is especially critical in the field of gynecology, which has a troubled history of mistreating marginalized groups which has clearly not been entirely resolved. It is our duty to change this trajectory.

My colleagues and I are calling on the leadership of Queen’s School of Medicine and Kingston Health Sciences Centre to investigate and rectify the discriminatory practices that restrict gender-affirming surgeries and surgical contraception from being performed at HDH. This initiative was spearheaded by Dr. Chris Vizena, a fifth-year resident in Obstetrics and Gynecology at Queen’s University, who wrote the letter in the petition. We have hundreds of signatures from across the country, but more support is urgently needed.

The time to act is now. 
 

Emma Dennison is a fourth-year medical student at Queen’s University.