Treatment, Not Judgment

When Tom Clyde gets sick, he hesitates before seeing a doctor. Insurance is not the problem--Clyde has coverage through his employer, L.A. County, where he works in the epidemiology department as an HIV counselor and phlebotomist. The issue is his sexual orientation.

“A lot of times I avoid going to a doctor because I feel judged,” says Clyde, who is gay. “It’s scary enough going to the doctor without having to worry about feeling uncomfortable.”

Clyde’s experience is a common one for gays and lesbians in Los Angeles and throughout the country. The result, say gay leaders and health professionals, is that many in the gay community fail to get the health care they need.

But the launch last week of Lambda Medical Group by the Los Angeles Gay and Lesbian Center may change that. Located in the Miracle Mile district, the facility offers full health care to the gay and lesbian community. It is the first gay health center in L.A. to provide the full spectrum of primary care and the only one in the country designed to accept private as well as government insurance, the center says.

The move represents a significant expansion for L.A.’s largest gay and lesbian organization, which already runs numerous health-care programs out of its Hollywood headquarters. It also signals a new direction for the gay health care community, which for nearly two decades has been concentrated almost solely on the AIDS crisis.

“We can’t afford to lessen our focus on AIDS,” says Lori Jean, the center’s executive director. “But we can expand it. We’ve set up this infrastructure. We have a responsibility to let others in.”

Lambda’s goal is to offer an alternative to what many gays and lesbians consider a pervasive problem: unequal treatment by the medical profession.

“The perception that you might get bad treatment is almost universal,” says Michele Eliason, author of “Who Cares? Institutional Barriers to Health Care for Lesbian, Gay and Bisexual Persons” (NLN Press, 1996) and associate professor at the University of Iowa’s College of Nursing. “Most gays and lesbians have fear and trepidation about entering the health care system. It comes from personal experiences and what friends have told them.”

In her book, Eliason cites numerous studies documenting negative attitudes toward gays and lesbians among doctors, nurses and other practitioners. Patient studies have also revealed a pattern of bias. Mistreatment runs the gamut, from inappropriate questioning based on the assumption of heterosexuality to overt discrimination following disclosure of sexual orientation.

“We’ve been doing openly gay and lesbian health care for years, and we’ve had a lot of people share horror stories with us,” says Suzann Gage, executive director of Progressive Health Services in West Hollywood. She recalls one patient who went for a routine gynecological examination and, after revealing that she was a lesbian, found herself being referred for psychological evaluation. In another instance, a lesbian was repeatedly told to avoid intercourse following a surgical procedure. When she divulged her sexual orientation, the doctor noted it in her charts, prompting nurses to regard her differently.

One of the most common problems faced by gays and lesbians is how the medical system deals with their partners.

“I’ve found it’s pretty hard when you go to a doctor to talk about your partner,” Clyde says. “They just assume it’s a woman right away. It’s uncomfortable to tell someone what’s going on.”

When gay people do disclose, they often find that their partners are not afforded the same access and decision-making rights as spouses (a policy that also affects many unmarried heterosexuals).

Avoiding Routine Care

Fearing insensitive or discriminatory treatment, gay people often avoid or delay seeking health care.

“Many gays and lesbians don’t get routine care because they don’t want to go into the health care system, so they don’t get the screenings they need,” says Eliason, citing mammograms and Pap smears as two examples.

This can be especially dangerous in cases of breast cancer and cervical cancer because they can be more effectively treated if they’re detected earlier. Others don’t say they’re gay, which can also affect the quality of care they receive by preventing practitioners from addressing specific health needs.

While homophobia is often a factor in treatment, another obstacle that gays and lesbians face is the dearth of specialized training received by providers.

“There’s no medical school curriculum that includes alternative lifestyle health factors,” says Ricardo Hahn, chairman of USC’s Department of Family Medicine, which provides staff for the LAGLC’s health-care facilities, including Lambda Medical Group.

As a result, says Hahn, “There’s not just an insensitivity, but a nonawareness of the medical issues that affect gays and lesbians.” Matters of particular concern to gays and lesbians range from safe sex to psycho-sexual health to employment and insurance issues, he says.

LAGLC leaders have long recognized the difficulties faced by gays and lesbians in obtaining quality health care. Still, they were far from certain that sufficient demand existed for a medical facility devoted to gay and lesbian primary care, so they undertook a feasibility study and organized focus groups. They were surprised by the results. “We were almost overwhelmed by the positive response,” says Jean. Much of the support came from gay employee groups such as the one at Walt Disney Co.

“I definitely feel more comfortable raising questions with a gay doctor, even if they are not gay-specific,” says Brad Bergman, co-chairman of Disney’s Lesbian and Gay Employees United, which has about 200 members. Bergman intends to look into Lambda, and says that many of his colleagues may do the same. Beyond the issue of consumer interest, there was also the critical question of whether insurers and employers would come on board and include Lambda in their plans. Once again, the answer was a resounding yes.

“I thought the level of homophobia would keep people from wanting to jump on the bandwagon, but the opposite was true,” says Jean. Thus far, such large insurers as Blue Cross, Cigna and Foundation Health have agreed to include Lambda in their coverage, as have Medi-Cal and Medicare. While hoping that this enthusiasm reflects growing social tolerance, she acknowledges that it could have more to do with the highly competitive nature of the medical marketplace. “They may not like us, but they’re willing to take our money.”

The receptiveness of insurers appears to be linked directly to changes in the AIDS epidemic. With the advent of more effective treatments for AIDS and HIV, the focus in gay health care circles is turning more and more from emergency care to health maintenance. This in turn is shining a spotlight on the issue of access to medical care for the larger gay community.

“Since AIDS, most of the emphasis has been on taking care of those who are HIV-infected,” says Marki Knox, a gynecologist at Women’s Medical Group in Santa Monica and one of Lambda’s two staff doctors. “The non-infected population kind of got left in the dust.”

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While Lambda Medical Group appears to have solid backing, not everyone in the gay community is lining up behind the facility, which required an investment of $300,000 to $400,000. Some activists argue that by seeking out a paying clientele, the LAGLC is undermining its historic commitment to serving the entire gay and lesbian community.

“I saw the original proposal, and the question was raised about what happens to poor people, and the answer was that they would be sent over to USC County Hospital,” says Don Kilhefner, co-founder of the LAGLC and a practicing psychologist. “I think there’s something ethically wrong when a gay and lesbian center serves only people with money, and those who are destitute are turned over to the county hospital.”

Patients without insurance will, in fact, receive treatment at Lambda Medical Group, paying on a sliding-scale basis like that used at the center’s Jeffrey Goodman and Audre Lorde clinics, according to Jean. She acknowledges, however, that the new facility was not intended to provide care for a large number of the uninsured, noting that she expects Lambda to eventually make a profit.

“If we were to be overwhelmed by people who have neither government nor private coverage, that’s not something that we could continue with for long,” says Jean. Kilhefner and other skeptics also question the need for Lambda, noting that a network of gay doctors already exists in Los Angeles and claiming that a separate facility is not the answer to homophobic attitudes in the medical field.

“I wonder if ghettoized care is the way we should be going,” comments one longtime gay activist who asked to remain anonymous. “If we perceive inadequacies in the current health care system, maybe we should address those in the context of the changes that the larger system clearly needs.”

LAGLC officials counter that such an approach is unrealistic, at least in the short term. “You’d have to convince 52 medical schools to include in their curriculum a tract on gay and lesbian health,” says Keith Waterbrook, LAGLC’s director of health services. “Do you know how long that would take?”

Supporters of the new facility also dispute the contention that L.A. already has enough gay and lesbian practitioners to meet the needs of the community. “That network exists, but it really only is available to those who can pay for their health care,” Knox says. “Secondly, you really have to know where to go. It’s communicated through this underground network.”

LAGLC leaders hope that Lambda will handle 1,400 patients its first year and eventually increase to 4,400. The center has launched a major advertising campaign, and expects word to travel fast throughout the gay community. Eliason, for one, believes the facility will not only succeed, but spawn similar health centers in other cities. At the same time, she would be happy if its lifespan were limited. “I hope within 10 or 15 years we won’t need them,” she says. “The health care requirements of gays and lesbians are not really different, it’s just the attitude of providers that keeps them from getting what they need.”

Lambda Medical Group

Address: 5757 Wilshire Blvd., Museum Square Building, Suite 2

Phone: (877) 452-6232

Office Hours: Monday-Friday, 8 a.m.-5 p.m.

Staff: Two doctors are on staff, but additional medical support is provided by the gay and lesbian center’s clinics and the USC School of Family Medicine. Public and private insurance accepted; check with your insurer to see whether your plan includes Lambda.