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Minton v. Dignity Health

California Court of Appeals, First District, Fourth Division

September 17, 2019

EVAN MINTON, Plaintiff and Appellant,
DIGNITY HEALTH, Defendant and Respondent.

          San Francisco County Superior Court No. 17-558259 Honorable Harold E. Kahn Judge.

         Counsel for Appellant:

          COVINGTON & BURLING LLP, Christin Haskett and Lindsey Barnhart ACLU FOUNDATION OF NORTHERN CALIFORNIA, Elizabeth O. Gill and Christine P. Sun ACLU FOUNDATION OF SOUTHERN CALIFORNIA, Amanda Goad and Melissa Goodman AMERICAN CIVIL LIBERTIES FOUNDATION, Lindsey Kaley Julie Wilensky and Asaf Orr for National Center For Lesbian Rights and twelve additional nonprofit organizations as amicus curiae on behalf of Plaintiff and Appellant.

          DURIE TANGRI LLP, Benjamin B. Au, Laura E. Miller, Lauren E. Kapsky, Francisco J. Silva, Long X. Do and Lisa Matsubara for the California Medical Association on behalf of Plaintiff and Appellant.

         Counsel for Respondent:

          MANATT, PHELPS & PHILLIPS, LLP, Barry S. Landsberg, Harvey L. Rochman, Joanna S. McCallum and Craig S. Rutenberg David L. Shapiro GREENE & ROBERTS LLP, Stephen J. Green, Jr., STRADLEY RONON STEVENS & YOUNG, LLP, Mark E. Chopko and Jennifer Gniady for The Catholic Health Association of the United States and Alliance of Catholic Health Care as amicus curiae on behalf of Defendant and Respondent.

          POLLAK, P. J.

         Plaintiff Evan Minton appeals the dismissal of his complaint against defendant Dignity Health, doing business as Mercy San Juan Medical Center, after the court sustained Dignity Health's demurrer without leave to amend. He contends the court erred in concluding that his complaint, based on Dignity Health's refusal to permit his doctor to perform a hysterectomy on him at one of its hospitals because of his sexual identity, fails to allege a violation of Civil Code[1] section 51, the Unruh Civil Rights Act (Unruh Act). Although the parties and several amici curiae regard the action as presenting a fundamental conflict between plaintiff's right to full and equal access to medical care and the hospital's right to observe its religious principles, we conclude that the present appeal may be resolved on narrower grounds. Without determining the right of Dignity Health to provide its services in such cases at alternative facilities, as it claims to have done here, we agree that plaintiff's complaint alleges that Dignity Health initially failed to do so and that its subsequent rectification of its denial, while likely mitigating plaintiff's damages, did not extinguish his cause of action for discrimination in violation of the Unruh Act. Accordingly, we shall reverse the judgment and remand for further proceedings.

         Factual and Procedural Background

         Minton filed a verified complaint alleging a cause of action for violation of section 51, subdivision (b), which guarantees all persons within the jurisdiction of the state “full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatsoever.” His complaint alleged as follows: Dignity Health is a tax-exempt nonprofit corporation that owns and operates a large network of hospitals. Dignity Health does business in Sacramento County as Mercy San Juan Medical Center (Mercy). Minton is a transgender man diagnosed with gender dysphoria.

         The complaint alleges that gender dysphoria is a serious medical condition codified in the Diagnostic and Statistical Manual of Mental Disorders. “The medical diagnosis for the feeling of incongruence between one's gender identity and one's sex assigned at birth, and the resulting distress caused by that incongruence, is ‘gender dysphoria.' ” The “widely accepted standards of care for treating gender dysphoria” include “medical steps to affirm one's gender identity and help an individual transition from living as one gender to another.” Transgender men often decide to undergo hysterectomy as a gender-affirming surgical treatment for gender dysphoria and “[a]ccording to every major medical organization and the overwhelming consensus among medical experts, treatments for gender dysphoria, including surgical procedures such as hysterectomy, are effective and safe.”

         As a course of treatment for his diagnosis, Minton's physician, Dr. Lindsey Dawson, scheduled a hysterectomy for Minton at Mercy on August 30, 2016. The complaint alleges that it was “the professional opinion of Mr. Minton's hysterectomy surgeon and two mental health professionals who counseled Mr. Minton” that the “hysterectomy was medically necessary care to treat his diagnosis for gender dysphoria.” On August 28, 2016, Minton mentioned to a nurse at Mercy that he is transgender. The following day, Mercy notified Dr. Dawson that the procedure was cancelled. Mercy's president, Brian Ivie, informed Dr. Dawson that she would “never” be allowed to perform a hysterectomy on Minton at Mercy because “it was scheduled as part of a course of treatment for gender dysphoria, as opposed to any other medical diagnosis.” Mercy routinely allows Dr. Dawson and other physicians to perform hysterectomies for patients on the bases of diagnoses other than gender dysphoria, including “for indications such as chronic pelvic pain and uterine fibroids.” Mercy's refusal to allow Dr. Dawson to perform the hysterectomy caused Minton “great anxiety and grief.” The complaint explains that the timing of Minton's hysterectomy was particularly sensitive because it needed to be completed three months before his phalloplasty that was scheduled for November 23.

         Ivie suggested that Dr. Dawson could get emergency admitting privileges at Methodist Hospital, a non-Catholic Dignity Health hospital about 30 minutes from Mercy. Ultimately, Dr. Dawson was able to secure emergency surgical privileges and performed Minton's hysterectomy at Methodist Hospital on Friday, September 2.

         The complaint concludes, “Defendant prevented Dr. Dawson from performing Mr Minton's hysterectomy to treat his diagnosis of gender dysphoria, a medical condition unique to individuals whose gender identity does not conform to the sex they were assigned at birth. [¶] Defendant does not prohibit physicians at its hospitals from treating other diagnoses with hysterectomy. [¶] By preventing Dr. Dawson from performing Mr. Minton's ...

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