A transgender man in Nova Scotia has filed a human rights complaint after he was handed a $3,400 bill for a hysterectomy that he claims was medically necessary.
In an exclusive interview with the CBC, Jessiah MacDonald said the province's Medical Services Insurance is charging him for sexual reassignment surgery because it doesn't cover that operation.
MacDonald, 24, had the surgery in 2010. He insists in the time leading up to the operation that he was never told he would have to pay.
"I felt it was wrong because despite my gender, I still have pieces of my body and if a piece of my body gets sick, I expect it to be treated as any other piece."
Handed $3,400 surgery bill
Born Jessica MacDonald, Jessiah always felt different growing up. At 18, he told his family he wanted to be a man and started taking testosterone pills.
Medical problems began. MacDonald went to a gynecologist after experiencing abdominal pain.
"The gynecologist had mentioned during the consult that I had a small uterus and she could feel multiple polyps during the internal exam, and that was sufficient enough for her to suggest a hysterectomy. But there was no mention then that it was only if I was female. There was no mention in the nine months between that and the surgery date."
Several women in his family, including his mother, had hysterectomies before they turned 30, MacDonald said.
"The gynecologist said I had two options to deal with the symptoms I was having. The first would be to take birth control to raise my estrogen levels but she ruled that out as an option because I take testosterone. I'm a man. And the second option was the abdominal hysterectomy, which was her suggestion."
In October 2010, MacDonald went to the IWK Health Centre in Halifax and had the operation.
He said after he woke up, his doctor gave him a bill for $3,400. He said he was stunned.
"I was fairly angry and I'm sure that was apparent as it was on my face. I'm fairly certain I started crying before they left the room and they couldn't have been in my room for more than 10 minutes tops. It was more like, 'Here's your bill, we'll help you pack your stuff … please get out.'"
A week later, MacDonald said he discovered that MSI considered his operation sexual reassignment surgery.
"Once I got back home, I ended up having to take the staples out myself because no one could guarantee that the followup care would be covered as well," he said.
Files human rights complaint
MacDonald said it was never his intention to have a hysterectomy for sexual reassignment. Full reassignment involves a series of reconstructive surgeries.
MacDonald hired lawyer Kathryn Dumke, who is transgender herself, and filed a human rights complaint against MSI.
"I have never heard and I don't think anybody has ever heard of a case where a condition needed treatment and the treatment was denied because MSI questioned that it wasn't medically necessary," Dumke said.
MacDonald and Dumke want MSI to cover the surgery and change its policy so transgender people can have a hysterectomy if medically necessary.
"Someone's got to talk about it because if I don't stand up and say this is what happened to me and this is why it was wrong, then what if it happens to somebody else?" MacDonald said.
The case could be heard by a human rights tribunal if no agreement is reached. The two sides have communicated, Dumke said, but at this point it looks like the case will go to a hearing.
The Nova Scotia Department of Health and Wellness would not comment because the case is before the commission.
However, the department confirmed that this is the first time that a transgender person has complained about not being covered for a hysterectomy.
MacDonald's doctor is out of the country and was unavailable to comment.