Ontario loses battle to refuse to pay for penis-sparing vaginoplasty for non-binary resident
Ontario's top court has ruled the province must cover the cost of an out-of-country, penis-sparing vaginoplasty for a 'transgender and non-binary resident' who wishes to have both female and male genitalia.
Article content
Article content
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.
Article content
Article content
Article content
'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.
Article content
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.
Article content
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.
Article content
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.
Article content
Article content
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.
Article content
Article content
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.
Article content
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.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CBC
28-04-2025
- CBC
Doctor operating safer supply clinics billed OHIP $2.5M last year
A doctor running a network of addiction clinics across Ontario, including an Ottawa location that offers safer opioid supply, is billing public insurance about $2.5 million per year. Dr. Suman Koka is the sole officer and director of Northwood Recovery, which has locations in North York, Hamilton and Manitoulin Island. It operates under the name Recovery North in Sudbury, Timmins and Sault Ste. Marie. Northwood Recovery opened its first Ottawa location in Hintonburg last year, but quietly moved it to Chinatown this March. Neighbours in both Hintonburg and Chinatown have criticized Koka for prescribing opioid medications to fentanyl users. They say his patients are trading the prescription drugs on the street to get harder substances, attracting dealers and crime to the area. City councillors representing both neighbourhoods have urged Northwood Recovery to change its operations or shut down. In an interview last month, Koka confirmed that the Ottawa clinic offers safer supply, a harm reduction approach intended to help users replace street drugs like fentanyl with safer prescription narcotics. Among other treatments, Koka prescribes hydromorphone, which is also known by the trade name Dilaudid. He confirmed that he primarily meets with patients at the Ottawa clinic remotely through telemedicine. CBC submitted a freedom of information request to the Ontario Ministry of Health seeking records of Koka's total billing to the Ontario Health Insurance Plan (OHIP). It reveals that he billed just over $2.3 million in 2023 and nearly $2.5 million in 2024. Those totals do not represent Koka's profit or take-home pay, since at least some of the money would be used to cover overhead costs at his clinics, which could include rent, supplies and administrative staff. But the totals are far in excess of typical billing. The average gross clinical payment for Ontario physicians was $388,557 in 2022-23, according to the Canadian Institute for Health Information. Payments for the top quintile — the top 20 per cent of physicians by billing — were $568,432 on average. CBC also submitted a request for Koka's billing for telemedicine specifically. He billed $524,302 for virtual care services in 2024, including video and telephone consultations. The figures were current as of January 22 of this year. The documents include a note that physicians still have a three-month period to submit additional claims for processing. Koka had previously appeared on a Toronto Star database of highly paid doctors published in 2019. According to the Sudbury Star, which cited the Toronto Star's reporting, Koka billed $1.5 million in 2018-19, putting him in the top one per cent of doctors ranked by OHIP billing. Koka did not respond to a request this week with detailed questions about his 2023 and 2024 billing. He did not explain how he is able to personally see enough patients to bill millions of dollars per year, or whether he is delegating some of the care. But in a March interview, CBC asked him whether he was still one of Ontario's highest paid doctors. "I'm not sure about that, but I'll tell you I'm probably one of the hardest working doctors in Ontario," he said at the time. Previously cautioned for telemedicine practices Doug Angus, a professor emeritus at the University of Ottawa's Telford School of Management, said Koka would have to see a very high volume of patients to generate that kind of money. Angus, who specializes in health economics, said Koka's reliance on virtual care could allow him to cycle through patients quickly. "That's changed the game completely," he said. "There's a lot of general practitioners who would love to have that kind of situation, but there's no way they can generate that kind of gross income with face-to-face visits." He said that the ministry has tried to rein in high billers, but it's difficult to monitor. He said they haven't yet addressed the question of how many patients a doctor can effectively see. Koka's membership page on the College of Physicians and Surgeons website shows he has 15 practice locations, as well as hospital privileges at the Health Sciences North regional hospital in Sudbury. His medical professional corporation has 13 different addresses. The college cautioned him in 2019, after a patient complained that Koka didn't meet with him at all. Instead, a physician assistant at his office prescribed methadone after a virtual appointment. The college found no sign that the physician assistant had proper training — and noted that delegating care is only appropriate in the context of an existing doctor-patient relationship, which did not exist in that case. Somerset Coun. Ariel Troster met with Koka last month, along with area MPP Catherine McKenney. In a post to her website, Troster said she insisted on wraparound supports for patients and better security protocols during the meeting. She said the clinic has hired a security guard and a nurse and committed to removing people from the program if they divert their medications. In his March interview with CBC, Koka said Northwood Recovery takes drug diversion very seriously. He said patients found to be trading or selling their medications are discharged from the program. According to Koka, even suspicion can lead the clinic to put patients under a stricter regime where they must take doses on site. He said telemedicine has increased the number of people he is able to see, allowing more people to access addiction treatment. "Whether it's through video conference or whether through in person, the interaction is the same," he said.
Toronto Sun
25-04-2025
- Toronto Sun
MANDEL: Ontario must cover U.S. surgery for trans patient who wants a vagina — and to keep her penis
Medical doctor writing on patient personal health care record discharge form, or prescription paperwork in hospital office, clinic centre for healthcare and life insurance concept. Photo by iStock / GETTY IMAGES Behold your tax dollars at work. OHIP has been ordered, for the third time, to pay for an out-of-country surgery for an Ontario trans, nonbinary patient who wants to keep the P while she gets the V. This advertisement has not loaded yet, but your article continues below. THIS CONTENT IS RESERVED FOR SUBSCRIBERS ONLY Subscribe now to read the latest news in your city and across Canada. Unlimited online access to articles from across Canada with one account. Get exclusive access to the Toronto Sun ePaper, an electronic replica of the print edition that you can share, download and comment on. Enjoy insights and behind-the-scenes analysis from our award-winning journalists. Support local journalists and the next generation of journalists. Daily puzzles including the New York Times Crossword. SUBSCRIBE TO UNLOCK MORE ARTICLES Subscribe now to read the latest news in your city and across Canada. Unlimited online access to articles from across Canada with one account. Get exclusive access to the Toronto Sun ePaper, an electronic replica of the print edition that you can share, download and comment on. Enjoy insights and behind-the-scenes analysis from our award-winning journalists. Support local journalists and the next generation of journalists. Daily puzzles including the New York Times Crossword. REGISTER / SIGN IN TO UNLOCK MORE ARTICLES Create an account or sign in to continue with your reading experience. Access articles from across Canada with one account. Share your thoughts and join the conversation in the comments. Enjoy additional articles per month. Get email updates from your favourite authors. THIS ARTICLE IS FREE TO READ REGISTER TO UNLOCK. Create an account or sign in to continue with your reading experience. Access articles from across Canada with one account Share your thoughts and join the conversation in the comments Enjoy additional articles per month Get email updates from your favourite authors Don't have an account? Create Account The provincial insurer argued that vaginoplasty is a listed, insured gender-affirming service — but only if it came along with the usual removal of the person's existing penis. But K.S., who doesn't identify as exclusively male or female, wanted to have both. Called penile-preserving vaginoplasty, the procedure creates a fully functional vagina without surgically removing the penis. According to the decision, K.S., who's sex assigned at birth was male, is female dominant and 'suffered physical, mental, and economic hardships to transition her gender expression to align with her gender identity.' In May 2022, her doctor submitted the required request for prior funding approval to OHIP for a vaginoplasty — but without the usually accompanying removal of her penis. '(K.S.) identifies as transfeminine but not completely on the 'feminine' end of the spectrum and for this reason it's important for her to have a vagina while maintaining her penis,' the doctor explained. Your noon-hour look at what's happening in Toronto and beyond. By signing up you consent to receive the above newsletter from Postmedia Network Inc. Please try again This advertisement has not loaded yet, but your article continues below. Since that wasn't offered anywhere in Ontario, K.S. was asking for OHIP to fund the novel 'bottom surgery' at the Crane Center for Transgender Surgery in Austin, Texas. When OHIP denied coverage, insisting the vaginoplasty wasn't covered without a penectomy, K.S. successfully appealed to t he Health Services Appeal and Review Board where she testified that removing her penis carried risks of incontinence, sexual dysfunction and removal of her nonbinary identity. OHIP's expert, Dr. Yonah Krakowski, told the board that current opinion agreed that penile preservation vaginoplasty was experimental. ' There is no peer-reviewed literature to support its indications, or the surgical techniques used in the process. Further, there is no longer term data reporting psychological or physical outcomes,' said Krakowski, Division Head of Trans Surgery at Women's College Hospital. This advertisement has not loaded yet, but your article continues below. Still, the board agreed vaginoplasty without penectomy is a specifically listed service in OHIP's schedule of benefits and must be approved for public coverage. OHIP then took the matter to the Divisional Court, which also ruled in K.S.'s favour. Vaginoplasty and penectomy are listed as separate, approved surgeries under OHIP, the court found. And forcing someone to ' remove their penis to receive state funding for a vaginoplasty would be inconsistent with the values of equality and security of the person. ' Now, Ontario's highest court has also come down against OHIP's refusal. 'The vaginoplasty recommended for K.S. is an insured service because vaginoplasty is specifically included in the Schedule of Benefits' listing of specific sex-reassignment surgical procedures that are insured services, and because K.S. meets the stringent requirements for prior authorization of that surgery,' wrote Justice Benjamin Zarnett on behalf of the three-judge panel. This advertisement has not loaded yet, but your article continues below. Those requirements include assessments which confirm the patient has a diagnosis of gender dysphoria, underwent 12 continuous months of hormone therapy, lived for 12 continuous months in a gender role congruent with their gender identity, and is recommended for the surgery. Read More '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 regulations,' her lawyer John McIntyre wrote in an email to the Toronto Sun. According to the Canadian Civil Liberties Association, an intervenor in the case, 'the Court of Appeal for Ontario is a victory for equitable and non-discriminatory healthcare funding for trans, non-binary and gender diverse people in Ontario.' OHIP was also ordered to pay K.S.'s legal costs of $23,500 — on top of the $20,000 in costs they had to pay for their appeal to the Divisional Court. But really, that's out of our pockets, of course, including the thousands of (American) dollars it will cost for this out-of-country niche and experimental surgery. mmandel@ RECOMMENDED VIDEO World Columnists Toronto & GTA Canada Columnists
Vancouver Sun
24-04-2025
- Vancouver Sun
Ontario loses battle to refuse to pay for penis-sparing vaginoplasty for non-binary resident
Ontario's top court has ruled the province must cover the cost of an out-of-country, penis-sparing vaginoplasty for a 'transgender and non-binary resident' who wishes to have both female and male genitalia. Article content Article content 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. Article content Article content Article content '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. Article content 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. Article content 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. Article content 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. Article content Article content 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. Article content Article content 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. Article content 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.
