A transgender woman, who was referred for gender-affirmation surgery in Germany, says she was unable to receive “basic healthcare” on her return to a Dublin hospital.
Paige Behan (26) from Ballyfermot, Dublin, felt “humiliated” and “devastated” when neither the urology, gynaecology nor plastics teams would treat her at St James’s Hospital – the largest acute academic teaching hospital in the State – last month, despite her being referred by her GP for a worsening wound infection at the site of her surgery.
Instead she was advised to travel late at night, while distressed and bleeding, to the National Maternity Hospital (NMH) at Holles Street, which St James’s Hospital said was “more equipped to deal with neo-vaginal complaints”.
No transport was provided to Holles Street, which was not contacted by St James’s to advise that Ms Behan was on the way. She was “understandably very distressed by this treatment”, her clinical notes from Holles Street state.
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She was admitted for two nights at the NMH, treated with intravenous antibiotics and referred as an out-patient to Beaumont Hospital. She is now well.
Ms Behan believes she could not receive “basic care” because St James’s Hospital staff “didn’t know how to treat me as a transgender woman”.
“So they pushed me out to another hospital and didn’t even tell that hospital I was coming,” she said.
Ms Behan says she knew she was female since she was 12. From age 18 she was prescribed hormone therapy though she felt despair at being unable to access timely gender-affirmation surgery. She was hospitalised for several suicide attempts.
She was diagnosed with gender dysphoria following psychiatric evaluations that she found gruelling. Last year she was referred for “life-saving” surgery at the Rotkreuzklinikum München hospital in Munich, by the HSE at St Colmcille’s Hospital, Loughlinstown. This surgery is not available in Ireland.
Surgery to create a vagina was performed by plastic surgeons at the Munich hospital on July 14th. A hospital-contracted infection delayed her return home and she travelled back on August 9th.
On August 12th she visited her GP for a check-up. Two days later, feeling unwell, she returned to her GP, who diagnosed an infection at the site of her surgery and prescribed antibiotics. Two days later, still unwell, she was referred by her GP to the emergency department in St James’s Hospital.
“I arrived at 12.30pm on the Friday and was seen by a nurse.” Bloods were taken, she says, and a cannula was placed in her arm. She understood she would be treated with IV antibiotics and the plastics team was awaited to examine the infection.
Following “hours waiting”, however, she was seen by a member of the urology team, who advised her that plastics, gynaecology and urology teams would not be admitting her. The urologist, she says, was “very apologetic”. Ms Behan was “in disbelief”, however, that her infected wound would not be treated “at a big Dublin hospital”.
“They just told me to go to Holles Street. It was late at night and I was bleeding. I felt completely failed. I asked for my discharge summary and got my own taxi, roaring crying, to Holles Street.”
The discharge summary says: “Not for plastics admission as speciality does not provide gender reassignment surgery ... Not for gynae admission here in SJH as they only admit [for cancer]. Advise patient attend Holles Street as more equipped to deal with neo-vaginal complaints ... not for urology admission as urology would not be suited to wound management ... I apologised to Paige for not being able to admit her for care”.
Ms Behan said: “It was after midnight when I got to Holles Street ... The admissions lady brought me straight into the emergency gynaecology wing. I was seen by a junior doctor and a gynaecologist. They were amazing and admitted me about 1.30am into a private room.” She was treated with IV antibiotics, spent two nights and was referred on to Beaumont Hospital as an outpatient.
The experience at St James’s was “humiliating” and “wrong”, she says.
“I have fought for the last10 years, constantly advocating for myself, sitting in front of healthcare professionals, jumping through hoops to prove that what I am doing is correct. I am not harming anybody by transitioning. For me, it was either transition or die,” she said.
A spokesman for the Transgender Equality Network of Ireland (TENI) said the organisation was “disappointed” but “ not surprised” by Ms Behan’s experience.
“We hear many stories from trans people who cannot access the care they require in Ireland,” the group said.
The group called on the Minister for Health Stephen Donnelly “to address this issue so that patients like Paige can be guaranteed the treatment they need”.
A HSE spokesman said: “The new national clinical programme will, over the next two years, develop an updated clinical model of care for gender healthcare services. This model of care will include advice and guidance on several clinical interventions, including surgery. The HSE is committed to building a gender healthcare service in Ireland for the Irish population that is based on experience and clinical evidence, respect, inclusiveness and compassion.”
In response to a series of queries from The Irish Times about Behan’s case, St James’s Hospital said: “The treatment and care provided at St James’s Hospital is underpinned by the National Standards for Safer Better Healthcare, which outlines the required standards for the provision of safe, effective and person-centred care.”
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