Quebec's medical system is in the midst of some major changes when it comes to accessing sex reassignment surgeries (SRS) in the province.
Up until recently, transsexual and transgendered folks seeking publicly-funded SRS procedures had to first be psychologically assessed at the Human Sexuality Unit (HSU) of the Montreal General Hospital before proceeding with surgery at public hospitals outside of Canada — often in countries as far away as the Czech Republic or Thailand.
Usually, only a half-dozen or so people per year were approved for surgery abroad after going through a rigorous review process comparable to that of the Centre for Addiction and Mental Health in Toronto.
"The power of Dr Assalian and his team at the [Montreal] General Hospital is now decentralized to a network of mental health professionals who have experience in working with trans communities and writing letters of evaluation," says Nora Butler Burke, an outreach worker with the Montreal-based advocacy group Action Santé Travesti(e)s et Transsexuel(le)s du Québec. "[HSU is] no longer the sole authority at this point."
This is because, in September 2009, a three-way agreement was signed between the Ministère de la Santé et des services sociaux, the Agence de la Santé et des services sociaux and the Centre hospitalier de l'Université de Montréal (CHUM), which has mandated changes in the approach to SRS in Quebec — such as the decentralization of assessment procedures, shortening the process for accessing surgery and making it legal to fund procedures done at private clinics.
That last point is a key shift. The agreement allows the province to enter into a public-private contract between CHUM and the Centre Métropolitain de Chirurgie Plastique (CMCP) in Montreal — the only Quebec clinic with an SRS specialist — in order to provide in-province SRS procedures.
Dr Pierre Brassard, the owner of the Centre Métropolitain clinic and a long-time practitioner of SRS, will guide patients in putting together their SRS applications and provide publicly-funded SRS procedures through his private clinic.
"In order for the patients to have their file looked at, they need to meet [certain] criteria — they need letters of recommendation, they need the 'real life test,' they need hormonal replacement therapy," says Brassard. "For that aspect, we're simply a guide to patients because not many doctors know [how] to meet these criteria."
"This is great in a lot of ways in terms of the quality of [Brassard's] service. For some of the surgeries, he has a very good reputation," says Butler Burke. "Also people don't have to travel and worry about not having a support network around them or about translation or all these other kinds of factors. It's definitely being heralded as a victory that we're moving away from a more antiquated model of providing care to trans people."
"It's also a question of results and taking care of possible post-op complications," says Brassard. "If you have your surgery in Thailand, [then] you fly back after two or three weeks and you get into [medical] trouble, who's going to take care of you?"
As Brassard's new administrative partner, CHUM will review all SRS applications prior to surgery to ensure applicants are eligible and procedures have been followed. The hospital will then approve or deny surgery based on these applications and process all payments made to Brassard's clinic after SRS procedures take place.
Because of this new agreement, the Régie de l'assurance maladie du Quebec (RAMQ), Quebec's provincial health agency, is no longer in charge of overseeing the administration of SRS in the province. Funding for SRS will now be managed by CHUM directly in order to centralize the entire administrative process for SRS, from start to finish.
In this way, the administrative elements of SRS and the medical care will be separated out between the two organizations.
"Brassard will not be acting as a judge in this process. All eligible patients will proceed [to CHUM for review]," says Nathalie Forgue, a communications advisor with CHUM, which is Quebec's largest medical centre for adults. "CHUM will receive these anonymous requests, examine the files and then give authorization for surgery."
Despite the positive nature of the recent changes, activists say there is more work to be done to improve access to health services for trans people in Quebec.
“We’re really trying to make sure that our point isn’t lost that the majority of trans people in this province and in Canada are low income and not able to access essential services,” says Butler Burke. “I could go on and on about all the social issues that are still unaddressed. If we talk about sex workers, migrant workers and people [living here] without status and IV drug users, people who are HIV positive… these people need access too. Simply modifying the ways we do surgery in the province is not enough.”
Centre Métropolitain de Chirurgie Plastique.
srsmontreal.ca.