This is a slide show presentation offered as a part of a panel discussion at a continuing education training program for doctors and nurses sponsored by Sparrow Health System (Sparrow Hospital) in the Greater Lansing Michigan area on May 14, 2014. The panel consisted of Alan Fincus, an RN at Sparrow Hospital, Howard T. Spence, Attorney and Consultant in Diversity issues, Chris Swope, City of Lansing Clerk, and Madeleine Townsend, Community Activist. This discussion was based on an incident in the Detroit metropolitan area during March, 2015, where a licensed medical doctor (pediatrician) refused to provide health care services to a 6 day old baby based on the pediatrician's determination that her own personal religious beliefs prevented her from accepting a doctor relationship with the child because the child's parents were a pair of legally married lesbians.

1. Sparrow Hospital Cultural
Competency Discussion
Series – LGBT Community
A PRESENTATION MADE TO DOCTORS, NURSES, AND OTHER HEALTH
CARE PROVIDERS AT CONTINUING EDUCATION PROGRAM ON MAY
14, 2015
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 1

2. Sparrow Hospital
Cultural
Competency
Continuing
Education
Workshop
This presentation was made to
members of the Sparrow Hospital
Treatment staff on May 14, 2015. This
presentation was designed to provide
staff with an opportunity to discuss
and better understand issues related
to the effective and professional
treatment of patients from a wide
variety of cultural, demographic, and
physical backgrounds.
This particular training session focused
on assisting staff to better understand
treatment needs of members of the
LGBT community.
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 2

3. The Legal
Environment
Impacting
Treatment of LGBT
Patients
Issues relating to the acceptance and
legal and medical treatment of
members of the LGBT community are
many and constitute a fast evolving
area of the law and related
acceptance and treatment modalities
of members of the Lesbian, Gay,
Bisexual, and Transgender
populations in our state.
Recognizing a need to address
questions and training needs of
professional and administrative staff,
Sparrow Hospital has developed and
scheduled this training and discussion
opportunity for its employees.
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 3

4. Howard T.
Spence,
Presenter
Disclaimer: The views, comments, and
observations contained in this
presentation are solely those of the
presenter, Howard T. Spence, unless
otherwise indicated.
The information and comments and
suggestions made in this presentation are
not intended to be legal advice upon
which attendees can or should rely.
The views expressed in this presentation
are exclusively those of Howard T. Spence
and do not necessarily represent those of
other presenters on this panel, Sparrow
Hospital or its administration or staff, or
any organization with which the
presenter may be affiliated.
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 4

5. About Howard
Licensed attorney, having represented and advised doctors
and nurses and other professionals in matters relating to
license discipline, reinstatement, and administrative law
matters
Former Administrative Law Judge hearing contested cases
relating to occupational licensing and enforcement and
compliance with the Michigan Health Code
Former Deputy Insurance Commissioner, State of Michigan
responsible for Licensing and Enforcement
Arbitrator and Mediator on AAA, FINRA, and other ADR
Panels
Board member on the Executive Oversight Board of the
Michigan Institute for Continuing Legal Education at the
University of Michigan Law School
Member, State Bar of Michigan ADR Council
Eaton County Commissioner from Delta Township
Juris Doctor, University of Michigan Law School 1976
MPA, Gerald R. Ford School of Public Policy, University of
Michigan 1977
MBA, Michigan State University Broad Graduate School of
Business Management 1980
MLIR, Michigan State University School of Labor and
Industrial Relations, 1983
BA, Michigan State University Honors College in Social
Science, 1970
Adjunct Professor, Thomas Cooley Law School 1978 – 80
Faculty Instructor/Facilitator, University of Phoenix MBA
and Business Law program, 2005- 2009
Member ACLU and NAACP
Experienced Diversity Trainer for Executives
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 5

6. Problems of Discrimination Encountered by Members
of the LGBT Community in Obtaining Health Care
http://www.freep.com/story/news/local/michigan/macomb/2015/02/18/discrimination-
birth/23640315/
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 6
Follow the above URL link to an online video prepared by the Detroit Free Press Newspaper highlighting
the news article about a Michigan Pediatrician who made news by refusing to provide medical
treatment to a new born baby because the pediatrician concluded that the two Lesbian mothers of the
child were offensive to her in light of her religious beliefs and tenets…

7. Who Are Some of the
Players in this
Discussion About
LGBT Health Issues?
Hospitals
Doctors
Nurses
Legislators
LBGT Community Members
State Health Code Licensing Boards
Courts
Insurance Companies & Regulators
Federal Government
American Medical Association
Gay and Lesbian Medical Association
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 7

8. Issues?
What are the implications of what this pediatrician has done? Immediately following are a number of questions or issues for
contemplation and/or discussion relating to legal and ethical questions which have been raised in the Detroit area Pediatrician’s case
where the Pediatrician refused to provide medical services to the new born child who was born to a Lesbian married couple…
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 8

9. - Were the Contreras discriminated against?
- If the Contreras were discriminated against, what was the basis for the
discrimination?
- Have any laws been violated?
- Did the health care provider act in an unethical way?
- If the baby was the patient, did the health care provider discriminate against
the baby?
- If the baby was discriminated against, what was the basis or nature of the
discrimination?
- Did the health care provider act in an unethical way in terms of the
discrimination against the baby?
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10. HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 10
- Did the health care provider violate the standard of care vis-à-vis the baby?
- Did the health care provider violate her Duty to cause no harm?
- Should a Doctor or a similarly situated health care provider be allowed to have
hospital privileges or to be in an emergency room setting if the health care
provider refuses to provide medical services to all patients?
- Should a limited license designation be required for health care providers who
refuse to treat all patients?
- If health care providers are allowed to refuse to treat patients for personal
reasons (such as religious beliefs or tenets), should they be required to notify the
public in advance of that refusal to provide service to selected groups?
- Does a hospital have liability risk or exposure if it contracts with or extends
hospital privileges to a health care provider who refuses to treat all presenting
patients?

11. - Would a health care provider who refuses to treat all patients be allowed to
transfer their medical or nursing license to a jurisdiction where there were legal
prohibitions against such discrimination?
- What are the implications for malpractice insurance rates and coverage for a
health care provider or hospital that refuses to provide treatment or services
based upon a religious belief?
- If a health care provider acts in a way that jeopardizes a hospital or practice
relationship with the federal government based upon religious beliefs, is that a
breach of employment contract or basis for the hospital to terminate the
employee?
- Are there particular practice issues realized when treating LGBT people that
would justify discriminating against them (other than religious or personal
beliefs or disliking LGBT people)?
- What are the possibilities of impacting this (or other types of) discrimination by
Executive order or administrative regulations at the federal level?
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12. HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 12
- If religious beliefs or preferences justify refusing to treat or discriminating
against a group of people based upon LGBT status, would religious beliefs or
preferences also justify refusing to treat people of different races, or persons
who might have attempted suicide?
- A number of jurisdictions have enacted ordinances or statutes that prohibit
discrimination against LGBT people… How do those laws play in with a
practitioner or hospital that wants to discriminate against LGBT people based
upon religious beliefs?
- What do you do if one patient protests being in the same room in the hospital
with an LGBT patient?

13. What is this Religion thing, and How Does it Impact
Discrimination?
And What about this Religious Freedom Restoration Act that is being considered in Michigan and other states to allow people to
exercise their religious beliefs by discriminating against others? How religion shapes discriminatory attitudes relating to LGBT
and racial minorities.
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14. - What constitutes a Religion or a Religious Belief?
- How has Religion impacted on discrimination in the US Historically?
- Some religions in the US have historically taught that Black people are inferior and it is sinful to have
miscegenation … Should health care practitioners or hospitals be allowed to refuse to treat Black people?
Loving v Virginia, US Supreme Court 1967)
- Should a Catholic health care provider be allowed to discriminate against or refuse to treat a Baptist
patient because of religious beliefs or preferences?
- What about the church of the “get high?” Should prisoners be allowed to demand medical marijuana
because they claim it is a sacrament of their religion?
- Should “religions” such as demonic religions or the Manson Helter skelter religion be allowed to practice
without government limitations?
- Should a religion that believes in human sacrifice be allowed to practice as an expression of religious
freedom?
- A Pew Report released this week shows that there has been a drastic reduction in the number of
Millenniums who identify as being conservative Christians…
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15. The Religious Freedom Restoration Act
A number of states have adopted a recent “model law” that purports to allow individuals to discriminate
against people and practices that are inconsistent with what a person believes as a part of their religious
system
The results have not been well received where this law has been adopted, and there has been
tremendous backlash against the conservative politicians who enacted these laws – many of which are
obviously quickly enacted without discussion or thought in an effort to demonize LGBT people and allow
“regular Christian people” to discriminate against them in public activity
Michigan Governor Snyder has indicated he would veto such a law if enacted.
There has been a bill introduced in the Michigan legislature that would prohibit cities and townships from
enacting any law to grant protections against discrimination at the local level to LGBT people.
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16. How Do Hospitals Fit Into this Discussion?
The discriminatory actions of health care providers can not only jeopardize the license status and ethical credibility of the health
care professionals who discriminate, but those actions can also present significant but avoidable liability and risk management
exposure to the hospitals and practices which hire them or present them with hospital privileges…
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17. Hospitals’ Roles in LGBT Discrimination or
Abuse Prevention…
- Control and Direct staff who are employees
or who have hospital staff admission rights
- Set policies for admission and local treatment
standards and procedures
- Establish culture and climate of acceptance
- Avoid being impacted by decisions of staff
which bring on unwelcome and potentially
very significant liability
- Train Staff on “Best Practices” for Diversity
and Inclusion of both patients and other staff
members
- Examples of Best Practices are available from
the American Medical Association and also on
industry occupational association websites
such as the HRC and AMLA websites
- Compliance with state regulatory standards
for hospital care
- Compliance with federal executive orders,
regulations, and laws to assure continued
eligibility for Medicare and Medicaid
payments for the hospital and providers
- Maintain good human relations among both
employees and patients receiving both
outpatient and admitted treatment
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18. The Human Rights
Campaign Has
Developed an
Equality Rating
Index for Hospitals
There has been a sharp increase in the
number of hospitals in our nation
which have earned HRC designations
as “Leaders in LGBT health care
equality in 2013.
http://www.hrc.org/files/assets/resou
rces/HEI_2013_final.pdf
As of 2013, the only Michigan Hospital
to earn that Equality Rating – other
than the VA hospitals in Michigan –
was the Henry Ford Health Systems.
The designation is based upon
adopting a set of “best practices” for
equality in treatment services.
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19. A Great Resource
relating to Health
Care Protections
for the LGBT
Community is the
GLMA Website
Dedicated to assuring equality for
patients from the LGBT community.
A source of resources and referrals for
health care providers who are
dedicated to assuring equality in
health care
http://www.glma.org/
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 19

20. Applicable Laws and
Opinions
SOME OF THE LAWS WHICH PROVIDE GUIDANCE REGARDING THE
DUTY OF CARE TO MEMBERS OF LGBT COMMUNITY AND DUTY NOT
TO DISCRIMINATE AGAINST LGBT COMMUNITY MEMBERS…
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21. - A regulation published November 17, 2010, by the Federal Department of Health and Human Services
requires any hospital that receives Medicare and Medicaid funding to allow patients the right to decide who
visits them. The regulation also prohibits discrimination against visitors based on their gender identity or
sexual orientation. Hospitals must now inform all patients of their right to select visitors.
- There is NO federal law to prevent discrimination against the LGBT community and there is no law in Michigan
(at the state level) which prohibits such discrimination. There is a gap between what people believe is right
and what they believe is real and what is actually reality.
- The Elliott-Larsen Civil Rights Act is Michigan’s law to prohibit discrimination. It includes protections for
religion, race, color, national origin, age, sex, height, weight, family status, and marital status. Michigan does
NOT protect LGBT residents from being refused business or medical services.
- Some 38 cities and townships in Michigan, including Lansing, East Lansing, and Delta Township, have enacted
ordinances which make it illegal to discriminate against LGBT persons in many areas, but those ordinances do
not specifically address providing medical services to LGBT people.
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22. - A new bill called the Religious Freedom Restoration Act (RFRA) has passed through the Michigan House of
Representatives, prohibiting the government from intervening if health care workers, such as EMTs and
pharmacists, and other business people refuse service on the grounds of protecting personal religious
beliefs
- The Affordable Care Act (ACA or ObamaCare) put into place new patient protections that keep insurers
from discriminating against LGBT people on the basis of health status. The law also bars health insurance
companies from discriminating against patients based on their sexual orientation or gender identity.
Insurers cannot drop a patient for having HIV or cap their lifetime medical costs to wriggle out of covering
expensive anti-retroviral medications.
- The American Medical Association’s Code of Ethics states that doctors cannot refuse to treat patients
based on race, gender, sexual orientation or gender identity.
- The Michigan Health Code provides licensing standards for health care professionals including
requirements that health care providers comply with the state community standard of care and comply
with ethical considerations.
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23. Panel of Presenters at First Sparrow Cultural
Competency Series Discussion May 14, 2015
Allan Fincus, RN; Howard T. Spence, Attorney; Lori Adams Simon, Moderator and Sparrow Diversity Training Specialist; Chris
Swope, City of Lansing Clerk; Madeleine Townsend, Community Advocate
HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 23

24. HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 24

25. HOWARD T. SPENCE - SPENCE AND ASSOCIATES, CONSULTANTS 25
Thanks to Sparrow Health Systems for Sponsoring the 2015 Cultural Competency Discussion Series for its Health
Care Providers and for Inviting me to Participate in this important Discussion.
Thanks to Lawrence Wilhite, General Counsel and Board member at Sparrow Health Systems for Developing this
training program for Health Systems Staff and for Attending and Participating in this Interaction.
Thanks to Jacqueline Thomas-Hall, Director of Diversity/Inclusion & Pastoral Care at Sparrow Health System and her
assistant, Lori Adams Simon, MPA, Diversity/Inclusion Community Advocate at Sparrow Health Systems for
coordinating and facilitating this training program for Sparrow Associated health care providers.
Thanks to Alan Fincus, RN at Sparrow; Chris Swope, Lansing City Clerk; and Madeleine Townsend, Community
member and Activist for Interacting with me as Panel members.
Thanks to the 50+ Sparrow Associates who attended this initial training session on the “Intersections of Culture,
Care, and Safety –Navigating Health Care with the Lesbian, Gay, Bisexual and Transgender Community.”
And Thanks to Jay Kaplan, Senior Attorney at the Michigan American Civils Liberty Union (ACLU) office who provided
helpful hints and guidelines and access to resources related to the topics of this symposium.