Ontario loses battle to refuse to pay for penis-sparing vaginoplasty for non-binary resident
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In a unanimous decision released this week, a three-judge panel of the Ontario Court of Appeal confirmed a lower court's ruling ordering the Ontario Health Insurance Plan to pay for the patient, identified as K.S. in court records, to undergo the novel phallus-sparing surgery at a Texas clinic.
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'K.S. is pleased with the Court of Appeal's decision, which is now the third unanimous ruling confirming that her gender affirming surgery is covered under Ontario's Health Insurance Act and its regulation,' K.S.'s lawyer, John McIntyre, said in an email to National Post.
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The legal battle between K.S., whose sex at birth was male, dates to 2022, when the Ontario Health Insurance Plan (OHIP) refused a funding request for surgery to construct a vagina while sparing the penis, a procedure this is not available in Ontario, or anywhere else in Canada.
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OHIP argued that, because the vaginoplasty would not be accompanied by a penectomy, the procedure isn't one specifically listed in OHIP's Schedule of Benefits and therefore shouldn't be publicly funded. OHIP also argued that the requested surgery is considered experimental in Ontario and, thus, also ineligible for coverage.
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K.S. appealed to the Health Services Appeal and Review Board, which overturned OHIP's refusal, arguing that 'vaginoplasty' should be covered, whether a penectomy, a separate procedure included on the list of publicly funded sex-reassignment surgeries, is performed or not.
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OHIP appealed that decision to the Divisional Court but lost again after the panel dismissed the province's appeal and declared the surgery, which leaves intact a functioning penis, an insured service.
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The province's latest appeal was heard on Nov. 26. The three-judge appeal court panel rejected OHIP's arguments that the proposed surgery isn't an insured service because it won't be accompanied by removal of the penis — a penectomy 'neither recommended by K.S.'s health professionals nor desired by K.S.,' according to the court's written decision.
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K.S., who is in her early 30s, 'has experienced significant gender dysphoria since her teenage years, as well as physical, mental and economic hardships to transition her gender expression to align with her gender identity,' the court said.
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