D.C. Mayor Muriel Bowser on Monday said she expects to support the current version of a bill pending before the City Council that would require continuing education programs for licensed healthcare professionals that include LGBT-related “cultural competency” training.
Bowser’s comment follows testimony on Oct. 29 by her director of the city’s Department of Health, Dr. LaQuandra Nesbitt, calling for major changes to the bill – the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015. LGBT advocates oppose her suggested changes.
Nesbitt told the Council’s Committee on Health and Human Services during a public hearing on the bill that she and Bowser support the general intent of the measure but believe it should be expanded to include cultural competency training “for all populations and sub-groups to whom healthcare professionals provide services.”
LGBT healthcare advocates joined more than a dozen representatives of healthcare organizations, including doctors and clinical social workers, in testifying at the hearing in favor of the version of the bill introduced in April by Council members David Grosso (I-At-Large) and Yvette Alexander (D-Ward 7). Alexander chairs the Health and Human Services Committee.
“I expect that we’ll support the Council bill,” Bowser told the Washington Blade following a news conference on Monday. “We will probably go with how they wrote it and if there are ways to enhance it down the line that’s what we would do,” she said.
The mayor’s comment will likely generate a collective sigh of relief from LGBT activists who expressed concern that Nesbitt had been pushing for a broader bill that could decrease its effectiveness in addressing the need for cultural training on medical issues impacting LGBT people.
Grosso told the Washington Blade he has no objection to cultural competency training pertaining to other population groups. But he said adding other groups to the bill would dilute its ability to address what he and others have said is lack of understanding and cultural sensitivity by many doctors and other health care providers toward LGBT patients.
The current version of the bill would amend an existing health care licensing law to require health care professionals, including doctors and mental health practitioners, to receive two credits of instruction on LGBT subjects as part of their continuing education programs.
“Despite the District’s strong policies against discrimination, our community, which is more than 10 percent of the District’s population, remains at risk,” said Rick Rosendall, president of the Gay and Lesbian Activists Alliance, in his testimony before the committee.
“[R]egarding the scope of this bill: Why is it limited to LGBTQ?” Rosendall asked. “For one thing, only so much can be covered meaningfully in two credits worth of training time. More crucially, our community faces the particular challenge of invisibility,” he continued. “If we are subsumed under a generic, all-encompassing category, we are effectively excluded.”
Alison Gill, senior legislative counsel for the Human Rights Campaign, told the committee that a 2009 nationwide survey found that more than half of LGBT respondents reported being refused needed care or being treated in a “discriminatory, disrespectful manner” by health care providers.
“Culturally competent care is especially important for LGBT people, as they continue to face substantial disparities in health, resulting from the stress of pervasive stigma; substance abuse and other health-endangering coping strategies; a reluctance to seek medical care due to fear of and actual healthcare discrimination; and the disproportionate impact of sexually transmitted disease,” Gill told the committee.
With the exception of Nesbitt, all of the nearly 20 witnesses testifying at the Council hearing expressed strong support for the bill as introduced by Alexander and Grosso. However, the executive vice president of the Medical Society of the District of Columbia, K. Edward Shanbacker, submitted a letter to the committee opposing the bill.
“The Medical Society believes strongly that the medical profession alone has the responsibility for setting standards and determining curricula in continuing medical education,” Shanbacker said in his letter. “In the District, the mechanism for that is the Board of Medicine, which has in the past opposed content-specific requirements surrounding continuing medical education,” he said.
Grosso said he has an answer to those, including the Medical Society, who say only doctors’ organizations and medical licensing boards should develop continuing education training on cultural competency matters.
“My answer to them is well you haven’t put this one in place and it would be important for us to put it on the books now,” he said, referring to LGBT cultural competence training.
He pointed to testimony by witnesses at last week’s Council hearing who told of LGBT patients who have been treated in a disrespectful manor and sometimes refused treatment by doctors unfamiliar with the special health needs of LGBT people, especially transgender people.
Dr. Raymond Martins, senior director of clinical education and training at D.C.’s Whitman-Walker Health, told the committee many of the mostly LGBT patients he has seen at Whitman-Walker have reported unpleasant experiences with other physicians and healthcare providers.
“Sadly, in this metropolitan area as well as throughout the country, physicians and other health providers do not receive adequate LGBT clinical and cultural competency training during medical school and their post graduate years,” he said. “This unfortunately leads to discrimination and poor health outcome for LGBT people,” Martins testified.
Grosso said he is hopeful that the bill will be finalized and brought up for a vote by the full Council before the end of the year. Eight other members of the 13-member Council signed on as co-sponsors of the bill.