Oregon man who needed hysterectomy settles lawsuit

Operation related to his transition from man to woman

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SALEM, Ore. — The state has reached an out-of-court settlement with a public employee who filed a discrimination suit after he was denied insurance coverage for an operation related to his transition from a woman to a man.

The state agreed to pay Alec Esquival $36,000 and change its policies so that it now provides insurance coverage for all operations, prescription drugs and other treatments related to medically necessary gender-reassignment surgeries, the Statesman Journal newspaper reported.

Esquival, an Oregon Court of Appeals clerk, sued the state and the Public Employees’ Benefits Board in 2011, after he was denied coverage for a doctor-recommended hysterectomy. The lawsuit filed on his behalf by Lambda Legal and Eugene attorney Jennifer Middleton argued that Oregon law has prohibited private insurance companies from discriminating based on gender or sexuality since 2007, and the benefits board should follow the same laws.

The suit contended that the case was discrimination because the state does cover hysterectomies, and only denied Esquival because of his gender.

“Alec was denied coverage simply because he is transgender,” Lambda Legal attorney Tara Borelli said in a statement. “When the state refused to provide him with coverage for the same medical procedure that co-workers could access, Alec was compensated less based on his gender identity. Oregon has now corrected that inequity.”

PEBB administrator Joan Kapowich said the board has not tracked how many gender-reassignment procedures are done each year and has no estimate on how much the new policy will cost.

Esquival was diagnosed with gender identity disorder in 2001. The disorder, which is sometimes treated with surgery, is a prolonged identification with a gender that is not the one in which a person was born.

The lawsuit said the surgery was medically necessary because the ovaries produce estrogen, which required Esquival to take higher doses of testosterone as part of his treatment, and those dosages came with a risk of cancer and other health problems.

PEBB is not the first government body in Oregon to explicitly allow insurance coverage for gender-reassignment surgeries. The city of Portland added the procedure to its coverage in June 2011, the same month Esquival filed suit.