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Wednesday, November 8, 2023

Transgender studies

From Wikipedia, the free encyclopedia

Transgender studies, also called trans studies or trans* studies, is an interdisciplinary field of academic research dedicated to the study of gender identity, gender expression, and gender embodiment, as well as to the study of various issues of relevance to transgender and gender variant populations. Interdisciplinary subfields of transgender studies include applied transgender studies, transgender history, transgender literature, transgender media studies, transgender anthropology and archaeology, transgender psychology, and transgender health. The research theories within transgender studies focus on cultural presentations, political movements, social organizations and the lived experience of various forms of gender nonconformity. The discipline emerged in the early 1990s in close connection to queer theory. Non-transgender-identified peoples are often also included under the "trans" umbrella for transgender studies, such as intersex people, crossdressers, drag artists, third gender individuals, and genderqueer people.

Transgender studies provides responses to negative points of views about transgender people. Those negative misconceptions could be the narrow and inaccurate transgender state in psychology and medicine, etc. The ultimate goal of transgender studies is to provide knowledge that will benefit transgender people and communities.

History

In response to critiques of how transgender issues were represented in gender and gay and lesbian studies, the late 1990s saw an increase in transgender scholarship and the emergence of a specific discipline of academic study. Sandy Stone is a transgender woman whose 1987 essay "The Empire Strikes Back: A Posttranssexual Manifesto," published in response to the anti-transsexual book The Transsexual Empire: The Making of the She-Male, has been cited as the origin of transgender studies. At times a contested field, scholars in transgender studies argue that what positions transgender studies as a unique discipline is the way trans bodies are centered epistemologically in the discipline.

In 2016, through her foundation, Jennifer Pritzker gave a donation of 2 million US$ to create the world's first endowed academic chair of transgender studies, at the University of Victoria in British Columbia; Aaron Devor was chosen as the inaugural chair.

Notable works

Notable works dealing with transgender issues sometimes bridge the space between memoir, creative piece and critical work. Transgender fiction and non-fiction are often informed by the personal experiences of the authors and various transgender authors have written pieces important for the field of trans studies that were not strictly speaking critical scholarship. Some of these works include Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity by Julia Serano (about the experience of and sexist basis for transmisogyny), Stone Butch Blues by Leslie Feinberg (a novel about the complicated overlaps and tensions between butch lesbian and trans masculine identities and communities) and Janet Mock's Redefining Realness: My Path to Womanhood, Identity, Love & So Much More (a memoir detailing Mock's experience growing up within intersecting marginalized race, class and gender categories)

Other important transgender studies texts are more firmly theoretical or critical. Judith Butler, whose work is important for queer studies more broadly, was influential in the field of transgender studies specifically for the formulation of the theory of gender performativity that is the basis for genderqueer activism and theorization. Jack Halberstam is another key figure in transgender studies. Halberstam's work deals with female masculinity, the concept of "queer failure" and various theorizations of trans or gender variant embodiment and temporality. Paul B. Preciado's Testo Junkie: Sex, Drugs, and Biopolitics in the Pharmacopornographic Era is considered autotheory and intertwines personal and cultural histories of clinical hormone therapies with political histories of hormonal birth control, and performance enhancing testosterone use.

Academic journals devoted to transgender studies began with the International Journal of Transgenderism, which published its first issue in 1997. The next year saw the publication of a special issue of Gay and Lesbian Quarterly (GLQ) on transgender topics. Invisible Lives: The Erasure of Transsexual and Transgendered People by Viviane K. Namaste was published in 2000 and was "the first scholarly study of transgendered people." Transgender Studies Quarterly (TSQ), the first non-medical academic journal devoted to transgender issues, began publication in 2014 with Susan Stryker and Paisley Currah as coeditors. The first issue, "Postposttranssexual: Key Concepts for a Twenty-First-Century Transgender Studies", was a book-length double issue with over 85 short essays on various keywords related to the growing field of transgender studies. Some essays took key terms from other fields (such as "Capital", "Queer", "Disability", and "Postmodernism") and teased out the connections to transgender activist and academic thought. Other essays took words understood as important for transgender studies and discussed their theoretical histories and potential future paths ("Becoming", "Cisgender", "Identity", "Transition", and others). Since 2014, TSQ has had issues devoted to, among other topics: Archives and Archiving, Trans/Feminisms, Transpsychoanalytics, Blackness, and Sport Studies. On August 2, 2021, the Center for Applied Transgender Studies announced the launch of its flagship publication, the platinum open access peer-reviewed academic journal Bulletin of Applied Transgender Studies, published by Northwestern University Libraries. The Bulletin is the first open access journal dedicated to transgender studies and the first journal dedicated to empirical research on transgender social, cultural, and political issues.

Recently books have been published on the important intersection of race, nationalism and transgender identity including Susan Faludi's memoir "In The Dark Room" about her Hungarian Jewish father's transition at the age of 76 and C. Riley Snorton's Black on Both Sides which explains the co-constitutive histories of blackness/anti-blackness and transness/transphobia in America from the 19th century onward. Columbia University Press published, in February 2019, "the first introductory textbook intended for transgender/trans studies at the undergraduate level" by Ardel Haefele-Thomas.

Applied transgender studies

Recent scholarship in transgender studies has pushed against the field's primary emphasis on humanistic inquiry, instead centering scholarship that empirically investigates issues of social, cultural, and political significance to transgender and gender minority people globally. This emergent subfield of "applied transgender studies" conceives of itself as "an interdisciplinary endeavor to identify, analyze, and, ultimately, improve the material conditions transgender people face in daily life." The Center for Applied Transgender Studies in Chicago, Illinois has been the primary driver of the turn to applied transgender studies and it publishes the only academic journal dedicated to the area of study, the Bulletin of Applied Transgender Studies.

Teaching transgender studies

Sara E. Cooper (Professor of Spanish and Women Studies) applied for a teaching position at California State University at Chico and she received the job, in spite of her focus on Spanish studies. She writes a journal article that highlights the ridicule she sometimes received during her public speeches, but insists on educating her peers "as a matter of personal safety and respect". Cooper brings up how the LGBTQ community is not as supportive towards certain categories in their community as some of her students are led to believe and while she faced a few challenges in her career, she concludes that teaching Transgender Studies was ultimately life-changing.

Cooper's specialization was initially Women Studies, and from there, she was granted the authority over a course that is exclusive to the LGBTQ community. This mirrors the placement of Transgender Studies within the school curriculum. In Women Studies classes, transgender issues are sometimes taught as an extension of women's issues, and are rarely given attention on their own.

Susan Stryker's anthology The Transgender Studies Reader (2006) was awarded the Lambda Literary Award in the transgender category.

In 2016, Aaron Devor was appointed the inaugural chair of Transgender Studies at the University of Victoria, in Canada. Devor is the academic director of the Transgender Archives, one of world's largest collections on the history of transgender activists and research.

CeCe McDonald Case

CeCe McDonald was sent to prison after defending herself and her friends from an attacker. The attack consisted of shouting transphobic and racist terms before it took a physical turn. The issue of cisgender privilege arises when CeCe was the only one who was charged; additionally, the case can be analyzed through an intersectional lens due to the racist and cissexist nature of the attack.

Queer studies

From Wikipedia, the free encyclopedia

Originally centered on LGBT history and literary theory, the field has expanded to include the academic study of issues raised in archaeology, sociology, psychiatry, anthropology, the history of science, philosophy, psychology, sexology, political science, ethics, and other fields by an examination of the identity, lives, history, and perception of being queer.

Queer studies is not the same as queer theory, which is an analytical viewpoint within queer studies (centered on literary studies and philosophy) that challenges the existence of "socially constructed" categories of sexual identity.

Background

Queer is the implicit identity of gender and sex, and how it is incorporated in individuals lives. It can be used as an adjective, verb and a noun. Queer has been used intersectionality in academia, becoming a mode of analysis. This is since the reclaimed-slur encompasses inclusivity into the 21st century. Some find using the term queer studies more defining than LGBTQ+ Studies, as it provides more universal experiences.

Many topics within queer studies focus on the open possibilities beyond heteronormativity; detailing texts, cultural artifacts produced by queer individuals, as well as expanding beyond into how queer interacts with daily life.

Though a new discipline, a growing number of colleges have begun offering academic programs on the expansive topics of queer. This has been a trend in higher education since the early 90's.

Queer as a reclaimed slur

Queer has become the topic of controversy over the reclaiming of the word used against LGBTQ+ individuals for the last century. There is a debate on the use of LGBTQ+ studies or queer studies. LGBTQ+ provides categorical depiction in the subjects, Whereas queer has a history of being a common descriptor for someone who was any emotion from happy to drunk in the 19th century, then a slur against same sex individuals in the 20th century. Queer did not have an implicit sexual definition until the early 20th century and reclamation of the slur started during Late 80's and 90's. This was a response to the over all LGBTQ+ movement, with influence of the AIDs crisis during this time. Some say queer offers an expansion of definition without categorical labels, while some do still not accept queer in the LGBTQ+ community due to its harmful history.

History

During the 1920s, same-sex subcultures were beginning to become more established in several larger US cities. Studies centering around queer life and culture originated in the 1970s with the publication of several "seminal works of gay history. Inspired by ethnic studies, women's studies, and similar identity-based academic fields influenced by the critical theory of the Frankfurt School, the initial emphasis was on "uncovering the suppressed history of gay and lesbian life;" it also made its way into literature departments, where the emphasis was on literary theory. Queer theory soon developed, challenging the "socially constructed" categories of sexual identity.

The first undergraduate course in the United States on LGBTQ studies was taught at the University of California, Berkeley in the spring of 1970. It was followed by similar courses in the fall of 1970 at Southern Illinois University Edwardsville and at the University of Nebraska–Lincoln (UNL).

According to Harvard University, the City University of New York began the first university program in gay and lesbian studies in 1986. The City College of San Francisco claims to be the "First Queer Studies Department in the U.S.", with English instructor Dan Allen developing one of the first gay literature courses in the country in Fall 1972, and the college establishing what it calls "the first Gay and Lesbian Studies Department in the United States" in 1989. Then-department chair Jonathan David Katz was the first tenured faculty in queer studies in the country. Hobart and William Smith Colleges in upstate New York were among the first to offer a full-fledged major in LGBTQ Studies in the late 1990s and currently has one of the few tenure lines specifically in a stand-alone LGBT Studies program as a period when many are being absorbed into Women and Gender Studies programs.

Historians John Boswell and Martin Duberman made Yale University a notable center of lesbian and gay studies in the late 1980s and early 1990s. Each historian published several books on gay history; Boswell held three biennial conferences on the subject at the university, and Duberman sought to establish a center for lesbian and gay studies there in 1985. However, Boswell died in 1994, and in 1991 Duberman left for the City University of New York, where he founded its Center for Lesbian and Gay Studies. A 1993 alumnus gift evolved into the faculty committee-administered Fund for Lesbian and Gay Studies, which developed a listing of courses relevant to lesbian and gay studies called the "Pink Book" and established a small lending library named for Boswell. The committee began to oversee a series of one-year visiting professorships in 1994.

Anti-Gay Curriculum Laws

Anita Bryant, a popular face in the media and widely known by the public, was at the forefront of the “Save Our Children” movement in 1977, born in response to an Oklahoma ordinance criminalizing discrimination due to sexual preference. This campaign aimed to discourage the hiring of homosexual schoolteachers, Bryant claiming that they would molest the children and wrongfully serve as an example that any marriage outside of a one between a man and a woman is respectable. The movement and its publicity gained Bryant much public support and eventually resulted in the overturning of the gay rights ordinance just half a year after it was implemented.

Bryant’s campaign caught the attention of California state senator John Briggs, who eagerly expressed his interest in expanding the Save Our Children campaign to his state, which initially took the form of Proposition 6 or the Briggs Initiative. This initiative allowed for employment discrimination against those who engaged in homosexual activity in public, or publicly encouraged or promoted homosexual activity towards co-workers and their students. Unlike Bryant’s movement which focused solely on gay teachers, Briggs’ campaign could be applied to homosexual and heterosexual people alike, since his initiative discriminated against the discussion of homosexual behavior, which could be done by anyone. Briggs’ initiative was ultimately denied in 1978.

Yale–Kramer controversy

In 1997, writer and AIDS activist Larry Kramer offered his alma mater Yale $4 million (and his personal papers) to endow a permanent, tenured professorship in gay studies, and possibly build a gay and lesbian student center. His requirements were specific, as Yale was to use the money solely for "1) the study of and/or instruction in gay male literature..." including a tenured position, "and/or 2) the establishment of a gay student center at Yale..."

With gender, ethnic and race-related studies still relatively new, then-Yale provost Alison Richard said that gay and lesbian studies was too narrow a specialty for a program in perpetuity, indicating a wish to compromise on some of the conditions Kramer had asserted. Negotiations broke down as Kramer, frustrated by what he perceived to be "homophobic" resistance, condemned the university in a front-page story in The New York Times. According to Kramer, he subsequently received letters from more than 100 institutions of higher learning "begging me to consider them".

In 2001, Yale accepted a $1 million grant from his older brother, money manager Arthur Kramer, to establish the Larry Kramer Initiative for Lesbian and Gay Studies. The five-year program aimed to bring in visiting faculty, host conferences and lectures, and coordinate academic endeavors in lesbian and gay studies. Jonathan David Katz assumed the role of executive coordinator in 2002; in 2003 he commented that while women's studies or African American studies have been embraced by American universities, lesbian and gay studies have not. He blamed institutionalized fear of alienating alumni of private universities, or legislators who fund public ones. The five-year program ended in 2006.

In June 2009, Harvard University announced that it will establish an endowed chair in LGBT studies. Believing the post to be "the first professorship of its kind in the country," Harvard President Drew G. Faust called it "an important milestone". Funded by a $1.5 million gift from the members and supporters of the Harvard Gay & Lesbian Caucus, the F. O. Matthiessen Visiting Professorship of Gender and Sexuality is named for a mid-20th century gay Harvard American studies scholar and literary critic who chaired the undergraduate program in history and literature. Harvard Board of Overseers member Mitchell L. Adams said, "This is an extraordinary moment in Harvard's history and in the history of this rapidly emerging field ... And because of Harvard's leadership in academia and the world, this gift will foster continued progress toward a more inclusive society."

Academic field of queer studies

The concept of perverse presentism is often taught in queer studies classes at universities. This is the understanding that queer history cannot and should not be analyzed through contemporary perspectives. Ways to find out how people historically identified can include studying queer community archives.

While queer studies initially emerged in the North American and, to a lesser extent, European academy and mostly relates to Western contexts, it recently has also developed in other parts of the world. For instance, since the 2000s there has been an emergent field of Queer African Studies, with leading scholars such as Stella Nyanzi (Uganda), Keguro Macharia (Kenya), Zethu Matebeni (South Africa), S.N. Nyeck (Cameroon), Kwame E. Otu (Ghana), and Gibson Ncube (Zimbabwe) contributing to the development of this field. Their work critiques the eurocentric orientation of Western queer studies, and examines the longstanding traditions of sexual and gender diversity, ambiguity and fluidity in African cultures and societies.

Queer studies at non-U.S. universities

Brazil

At Universidade Federal de Minas Gerais (UFMG) in Brazil there are many initiatives on Queers Studies. UFMG offers a multidisciplinary program on Gender and Sexuality for undergrad students: "Formação Transversal em Gênero e Sexualidade: Perspective Queer/LGBTI" (https://www.ufmg.br/prograd/). In its Faculty of Law, ranked amongst the best in the country, Marcelo Maciel Ramos established in 2014 Diverso UFMG - Legal Division of Gender and Sexual Diversity (www.diversoufmg.com) and a study group on Gender, Sexuality and Law, which is now led also by Pedro Nicoli. Diverso UFMG organizes since 2016 the Congress of Gender and Sexual Diversity (Congresso de Diversidade Sexual e de Gênero: www.congressodiverso.com) that has become one of the biggest and most important academic events on Women and LGBT studies in Brazil. At the Faculty of Philosophy and Social Sciences, Marco Aurélio Máximo Prado has been running since 2007 Nuh UFMG (Human Rights and LGBT Citizenship Division), a successful initiative on LGBT studies.

China

Fudan University, located in Shanghai, China, opened the country's first course on homosexuality and acquired immune deficiency syndrome (AIDS) prevention in 2003 entitled "Homosexual Health Social Sciences". In an article focusing on this college course, Gao and Gu utilize feedback from participants, detailed interviews with professors, and a review of course documents to discuss China's first course with homosexuality at its core. Their article analyzes the tactics used to create such a course and the strategies used to protect the course from adverse reactions in the press. The authors especially take note of the effects of the course on its attendees and the wider gay community in China. The authors note that "Homosexual Health Social Sciences" was described as a "breakthrough" by South China Morning Post and Friends' Correspondence, a periodical for gay health intervention. Surveys were given to attendees of the class and many responded that the class helped them understand the homosexual perspective better. One student stated that "Even if we cannot fully understand these people, we need to respect them. That is the basis for real communication." Many of the course attendees admitted that the course changed their lives. One Chinese police officer had been hiding his sexuality his entire life stated "The course really enhanced my quality of life…" Another man who had been prescribed treatment for his homosexuality for 30 years heard talk of the course in a newspaper and expressed "This precious news has relieved my heart."

"Homosexual Health Social Sciences" was developed to be interdisciplinary to cover the social sciences, humanities, and public health. Interdependence on different academic focuses was achieved in the curriculum by covering "Theories of homosexuality and Chinese reality", "homosexual sub-culture" and "Men seeking men (MSM) intervention in human immunodeficiency virus (HIV) prevention," in addition to reading literature with gay characters and themes and taking field trips to a gay bar. The article goes on to describe the attendance of this course and its significance by clarifying that the official registration in the class was low, with only one student in 2003 and two in 2004. Officially registered students were not the only people attending the classes though because the course was open to the general public. The average attendance in 2003 was 89.9 and rose to 114 in 2004.

Gao and Gu also reveal the precautions taken by the creators of the course to shelter the new class from harsh criticism. The authors depict the creators' fear of attracting too much negative attention from the Chinese media could adversely affect the course and its continuation. Most coverage on this course at Fudan University was delivered in English at the beginning. This phenomenon was explained by one journalist from China Radio International—Homosexuality is very sensitive issue in Chinese culture so by discussing it in English, it is distanced from the conservative Chinese culture. Fudan University led Chinese academia to develop more comprehensive curriculum that will educate future health care professionals on the needs of more Chinese citizens.

South Africa

On the African continent, South Africa has been setting the trend of developing queer studies. This is partly due to the country's constitutional framework, which explicitly protects against discrimination on the basis of sexual orientation. One of the leading South African queer studies scholars Zethu Matebeni, who is an activist, writer, documentary film maker, and academic, working as Professor and South Africa Research Chair in Sexualities, Genders and Queer Studies at the University of Fort Hare. She curated the volume Reclaiming Afrikan: Queer Perspectives on Sexual and Gender Identities (2014) and co-edited the book Queer in Africa: LGBTQI Identities, Citizenship, and Activism (2018).

Present-day issues in the US

The US Supreme Court has made gay marriage legal but as a result the discourse has shifted from the issue of legalizing gay marriage to attacking queer studies and prohibiting certain conversations around the queer community. Attempts are now being made in school settings to prohibit teachers from encouraging same-sex relationships, sex before marriage, and therefore leaving same-sex relationships outside the definition of marriage. This also results in a regulation on the education of safe sex, HIV, and AIDS.

Homophobic curriculum laws have continued to be present in schools in recent years across the US. In 2017, studies showed that 20 states had implemented anti-gay laws affecting school curriculums. These included laws that made it mandatory for teachers to educate from an anti-gay standpoint, and ones that gave teachers the freedom to choose between using these homophobic curriculums or not including sex education in their curriculum at all. Many states also have curriculum laws that require teachers to educate their students from the viewpoint that abstinence before marriage is the sole option for safe prevention against pregnancy or sexually transmitted diseases. Emphasis being on abstinence before marriage, this often excludes same sex couples due to their absence from the definition of marriage in their state.

Book Bans

In 2022, an estimated 5,000 books featuring LGBTQ characters and stories have been banned from bookshelves, libraries, and classrooms according to a report by PEN America. Their research shows that 41% of books banned featured queer protagonists or secondary characters, 40% featured protagonists or secondary characters of color, and 22% featured sexual content. 40% of these book bans, regardless of topic, are estimated to be in direct result of lawmakers’ public opinion and presence, as well as enacted legislation. PEN America also reports that the overwhelming majority of these titles are books that fall in the young adult category, restricting education relating to gender, sexuality, diversity, and difference from 13-17 year olds. PEN America also reports that 96% of these bans were put into place against the National Coalition Against Censorship and ALA’s guidelines.

PEN America reports that Maia Kokabe’s Gender Queer: A Memoir is the most banned title, with bans in 30 districts. Kokabe’s memoir discusses their experience growing up feeling outside of the gender binary and not feeling like they fit into their body. It follows parts of Kokabe’s childhood into their early adult years and experiences coming to terms with their gender identity and coming out. Gender Queer was met with a contrast of responses, many expressing gratitude and love for the sharing of their story, as it was written with an audience of family, friends, and those that can identify and sympathize with Kokabe in mind. Others claimed the book is too sexually explicit, specifically in its illustrations which include that of the human body, but no sex scenes. In an interview with NPR, Kokabe discusses how they felt they included the appropriate amount of illustrations to tell their story accurately and due to their importance in the representation of their journey with gender and sexuality. They also express their stance that they illustrated the book in a much less explicit manner than it could have been had it been written by a different author.

Attempts to educate and fight against these book bans have been taking place across the country. Free libraries, library pop-ups, and book giveaways have been go-to methods for grassroots organizations and activists to make banned books accessible. Little Free Library members install wooden curbside mini-library boxes and fill them with books of their choice. These books are available to take for free for any passers by. In 2022, the organization reported 140,000 Little Free Libraries had been installed across the nation, with 87% of their owners stating that they make banned books available in their boxes. Bookstore owners and booksellers have been taking actions into their own hands and giving their books away, covering some costs out of their own pocket and gaining donations both in person and through social media. Authors and publishers have started taking similar actions, carrying around their own books, handing them out, and donating to free libraries. While in most cases a book ban hurts the book’s sale rate and the author’s exposure, some bans result in higher publicity and recognition, like in the case of All Boys Aren’t Blue by George M. Johnson, now a bestseller. Publicity on its ban put it on the radar of many readers who would otherwise have never found it, and it is now in its 10th printing. In an increasingly accessible digital age, digital libraries and book websites are also making banned books more accessible. Free library apps, like the Brooklyn Public Library, allow digital library cards and access to readers which can be used from any device anywhere in the country.

Don't Say Gay or Trans'' Bill or Act

The Parental Rights in Education Act (HB 1557), also known as the "Don't Say Gay or Trans'' Bill or Act, was signed by Florida governor Ron DeSantis on March 28, 2022. The act prohibits public schools from discussing sensitive topics such as sex education, gender identity, and sexual orientation in grades kindergarten through third grade, and prohibits any discussion deemed to be not age-appropriate by state standards. The act does not specify what is inappropriate or who makes this decision.  This act also includes restrictions on a public school’s ability to protect and maintain the privacy of a student’s gender identity or sexual orientation from their parents. As a result, school counselors will be limited in how they serve as a confidential resource for students. The act also gives parents the right to sue the school district if they feel their rights have been violated. On May 17, 2023, DeSantis signed a new bill expanding his measures on LGBTQ education in schools in the state of Florida, including lengthening the prohibition of sex and gender topics in kindergarten through eighth grade, as well as restricting these topics in sixth through twelfth. The bill also requires that schools teach “that sex is determined by biology and reproductive function at birth; that biological males impregnate biological females by fertilizing the female egg with male sperm; that the female then gestates the offspring; and that these reproductive roles are binary, stable, and unchangeable.”

There has been an increase in protests as students and parents across the country respond negatively to the bill, as some assert that the broad language is meant to specifically target the LGBTQ community. As a result, some public schools have punished and suspended students for staging demonstrations on campus. Other educators have faced backlash for showing support for the LGBTQ community, such as discussions about gender identity in class and showing movies or documentaries that showed openly gay characters. Some have been censored, suspended, and even fired. Equality Florida, an LGBTQ group that is currently suing the DeSantis administration for the proposed law, argues that it marks an “extraordinary government intrusion on the free speech and equal protection rights” in public schools.

The discourse caused by this bill also led to backlash from The Walt Disney Co. employees, who shared their disappointment in the company on social media for not speaking out publicly against the bill. According to Disney CEO Bob Chapek, Disney leaders were opposed to the bill "from the outset, but we chose not to take a public position on it because we thought we could be more effective working behind-the-scenes, engaging directly with lawmakers — on both sides of the aisle." He has stated that Disney has pledged 5 million dollars to the Human Rights Campaign (HRC) in support of protecting LGBTQ rights, but the HRC has declined to accept the money until they further their commitment to supporting the LGBTQ community.

On February 1, 2023, College Board, the organization that is responsible for creating standardized tests such as the SAT and AP, revealed the changes that it made to its African American studies course. This came after Florida governor Ron DeSantis and the Republican party condemned the class and banned the original version from Florida schools. The new version is without names of major events in contemporary history, mention of the Black Lives Matter movement, black feminism, black queer theory, critical race theory, or intersectionality. According to a College Board representative, however, “To be clear, no states or districts have seen the official framework that will be released on February 1, much less provided feedback on it.” However, College Board has historically given in to many conservative leaders demands in other courses, such as AP United States History, where readings would focus less on colonial settler’s harm towards indigenous people and more on founding fathers and their religious influences.

42 different versions of the “Don’t Say Gay” bill have been proposed since 2021 in 22 state legislatures, including Arkansas, Georgia, Indiana, and many others. All of these bills similarly prohibit discussion and inclusion of LGBT Q related topics. These bills are also associated with many other bans that have taken place in Florida and many other states, such as bans on gender affirming medical care, pride flags in public places, drag shows, and others.

Intersectionality

As more and more universities and schools begin to add more resources and classes for students to take about queer studies, there is also a growing recognition that gender, sex, and identity also coincides with race, nationalities, class, disabilities, etc. This overlap is also known as “intersectionality”, a word that has roots in black feminist activism. This term was coined by Columbia professor and activist Kimberlé Crenshaw. According to Crenshaw, “Intersectionality is a lens through which you can see where power comes and collides, where it interlocks and intersects. It’s not simply that there’s a race problem here, a gender problem here, and a class or LBGTQ problem there. Many times that framework erases what happens to people who are subject to all of these things.” The word intersectionality was added to the Oxford Dictionary in 2015.

While this was originally used as a term to describe the specific type of oppression that African American women face, it has grown relevant to many other groups of people. According to them, “The theory of “intersectionality” — which posits that individuals simultaneously experience oppression based on multiple social categorizations, and that this oppression is multiplicative — has made queer studies more inclusive.” The idea of intersectionality came to be after second wave feminism, which is thought to only benefit straight, white, middle-class women. Third wave feminism became the springboard for intersectionality, when there became an awareness that women faced different types of oppression based on their race, gender, and class. Kimberlé Crenshaw maintains the fact that the idea of intersectionality and true feminism is lost if black women continue to be overshadowed by their white counterparts. The idea of intersectionality began when discussing feminism, but has grown to be relevant in many other subjects such as LGBTQ discrimination.

Future of Queer Studies

Many contemporary scholars are theorizing how Queer Studies can address the issue prevalent in academia where the lived experience and issues of white U.S. subjects are centered while the experiences of other identities, specifically non-white, trans and transnational, are marginalized. The collection of essays in Charting the future of queer studies in communication and critical/cultural studies: new directions and pathways (2021) considers how imperative it is to "take a transnational and decolonizing turn to move away from solely white and US-centric ways of conceptualizing queer lives and experiences."

Writings like this are examples of Queer (post)colonial studies as an emerging lens through which to consider how the production of academic knowledge is influenced by domination, oppression, and history of imperialism and colonialism in order to contribute to the field in ways that "refuse Western heteronormative structures".

Emergency Medical Treatment and Active Labor Act

The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004, or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.

The cost of emergency care required by EMTALA is not directly covered by the federal government, so it has been characterized as an unfunded mandate. Uncompensated care represents 6% of total hospital costs.

Prior legislation

The Hill-Burton Act of 1946, which provided federal assistance for the construction of community hospitals, had established non-discrimination requirements for any institutions that received this federal assistance - including the requirement that a "reasonable volume" of free emergency care be provided to community members who could not pay, for a period for 20 years after the hospital's construction. Amendments to the Act in 1975 removed the 20-year expiration date and instead required any hospitals receiving Hill-Burton funding to provide free care in perpetuity. However, the provisions of the Act were vague and rarely enforced.

Mandated and non-mandated care

Congress passed EMTALA to eliminate the practice of "patient dumping", i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual seeks treatment for a medical condition "or a request is made on the individual's behalf for examination or treatment for that medical condition."

The U.S. government defines an emergency department as "a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions." This means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.

An emergency medical condition (EMC) is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs." For example, a pregnant woman with an emergency condition and/or currently in labor must be treated until delivery is complete, the mother and fetus are stabilized, or a qualified personnel identifies the labor as a "false labor", or Braxton Hicks contractions, unless a transfer under the statute is appropriate.

Patients treated under EMTALA may not be able to pay or have insurance or other programs pay for the associated costs but are legally responsible for any costs incurred as a result of their care under civil law.

Non-covered medical conditions

Not all medical conditions qualify for uncompensated mandated services imposed by EMTALA, which is contrary to the misperception that many individuals assume that if they are ill, they will be treated, regardless of their ability to pay.

The sole purpose for the EMTALA mandated MSE is to require emergency departments to make a determination whether an emergency medical condition does or does not exist, using their normal assessment and diagnostic protocols. Since the MSE is a mandated EMTALA service, health insurers are required to cover benefits for their subscribers. They are also required to cover EMTALA mandated services necessary to stabilize individuals determined to have an EMC.

EMTALA intentionally omitted any requirement for hospitals to provide uncompensated stabilizing treatment for individuals with medical conditions determined not to be an EMC. Therefore, such individuals are not eligible for further uncompensated examination and treatment beyond the MSE.

A significant portion of emergency department visits are considered not to be EMCs as defined by EMTALA. The medical profession refers to these cases as "non-emergent". Regardless, this term is not recognized by the law as a condition defined by the EMTALA statute. A term more relevant for compliance with EMTALA is "non-emergency medical condition". If this "non-emergent" term is used in the context of EMTALA, it needs to be defined as medical conditions that fail to pass the criteria for determination of being a true EMC as defined by EMTALA statute.

Admitted patients who experience a medical emergency while at the hospital are normally not covered by EMTALA, but are instead protected by varying state laws and quality assurance under the deemed status of the facility.

Hospital obligations

Hospitals have three obligations under EMTALA:

  1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable to do so, must receive a medical screening examination (MSE) to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may start the process of payment inquiry and billing only once they have ensured that doing so will not interfere with or otherwise compromise patient care.
  2. When an emergency department determines that an individual has an EMC, the hospital must provide further treatment and examination until the EMC is resolved or stabilized and the patient can provide self-care following discharge, or if unable to do so, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals cannot discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
  3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. That includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility. Hospitals have no obligation under EMTALA to provide uncompensated services beyond the screening exam unless it determines that the patient has an emergency medical condition.

Amendments

Since its original passage, Congress has passed several amendments to the act. Additionally, state and local laws in some places have imposed additional requirements on hospitals. These amendments include the following:

  • A patient is defined as "stable", therefore ending a hospital's EMTALA obligations, if:
    • The patient is conscious, alert, and oriented.
    • The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital's ability.
    • Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital's ability to ensure the patient does not need further inpatient care.
    • The patient is able to care for himself or herself, with or without special equipment, which if needed, must be provided. The required abilities are:
      • Breathing
      • Feeding
      • Mobility
      • Dressing
      • Personal hygiene
      • Toileting
      • Medicating
      • Communication
      • Another competent person is available and able to meet the patient's needs following discharge.
  • All patients have EMTALA rights equally, regardless of age, race, religion, nationality, ethnicity, residence, citizenship, or legal status. If patient's status is found to be illegal, hospitals may not discharge a patient prior to completion of care, but law enforcement and hospital security may take necessary actions to prevent a patient from escaping or harming others. Treatment may be delayed as needed only to prevent patients from harming themselves or others.
  • Overloaded hospitals may not discharge a patient unable to pay to make room for a patient who is able to pay or is otherwise viewed by society as a more valued citizen. If the emergency department is overloaded, patients must be treated in an order based on their determined medical needs, not their ability to pay.
  • Hospitals may not deny or provide substandard services to a patient who already has outstanding debt to the hospital and may not withhold the patient's belongings, records, or other required services until the patient pays.
  • Hospitals and related services cannot receive a judgment against the patient in court filings made more than 36 months after the date the patient was discharged or the last partial payment the patient made to the hospital, contractor, or agent. After that period, the patient may not be threatened with legal action if payment is not made and may not be denied future outpatient services from the same company/agency that a patient is able to pay.
  • If a patient has been awarded monetary damages against the hospital or any related or affiliated services by a court of law or has settled out of court on damages, the hospital and related/affiliated services may neither withhold money for lack of payment nor count the money toward the bill in lieu of making payment to the patient. Voluntary consent for such an arrangement is permitted only if initiated by the patient. Hospitals may not threaten or coerce a patient into such a settlement or mislead the patient into believing such an arrangement is required or recommended.
  • Patients cannot face criminal prosecution for failure to pay even if the patient comes aware of inability to pay to the hospital. Hospitals and third-party agents may not threaten patients with prosecution as a means of scaring the patient into making payment. Patient can be prosecuted under existing federal, state, or local laws for providing false name, address, or other information to avoid payment, receive bills, or to hide fugitive status.
  • A hospital cannot delay treatment while determining whether someone can pay or is insured but that does not mean they are completely forbidden from asking or running a credit check. If the patient fails to pay the bill, the hospital can sue the patient and the unsatisfied judgment will likely appear on the patient's credit report. A third-party collector for a hospital bill would be covered under the Fair Debt Collection Practices Act.
  • Hospitals are prohibited from discriminating against or providing substandard care to those who appear impoverished or homeless, are not well-dressed or groomed, or exhibit signs of mental illness or intoxication. If the hospital fears that a patient may be a threat to others, the hospital may delay care only as necessary to protect others.
  • Hospitals are required to sufficiently feed patients unable to pay at a level equal to those able to pay, while meeting all physician-ordered dietary restrictions.
  • Hospitals are not required to provide premium services to the patient not related to medical care (such as television) when failure to provide that service does not compromise patient care.
  • Hospitals and affiliated clinics may avoid providing continued outpatient care, drugs, or other supplies after discharge. If such services are recommended but a patient is unable to pay, the hospital is required to refer the patient to a clinic or tax-funded or private program that enables the patient to pay for such services and to which the patient has reasonable access. Hospitals must reasonably assist patients as necessary to obtain such services by providing information as the patient requests.

Effects

Improved health services for uninsured

The most significant effect is that, regardless of insurance status, participating hospitals are prohibited from denying a MSE to individuals seeking treatment for a medical condition. Currently EMTALA only requires that hospitals stabilize the EMC. According to some analyses of the U.S. health care social safety net, EMTALA is an incomplete and strained program.

Cost pressures on hospitals

According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated. When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. In the first decade of EMTALA, such cost-shifting amounted to a hidden tax levied by providers. For example, it has been estimated that this cost shifting amounted to $455 per individual or $1,186 per family in California each year.

However, because of the recent influence of managed care and other cost control initiatives by insurance companies, hospitals are less able to shift costs, and end up writing off more in uncompensated care. The amount of uncompensated care delivered by non-federal community hospitals grew from $6.1 billion in 1983 to $40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured, but it is unclear what percentage of this was emergency care and therefore attributable to EMTALA.

Financial pressures on hospitals in the 20 years since EMTALA's passage have caused them to consolidate and close facilities, contributing to emergency department overcrowding. According to the Institute of Medicine, between 1993 and 2003, emergency departments visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Ambulance are frequently diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances were diverted over a half a million times, not necessarily due to patients' inability to pay.

Emergency abortions

After Roe v. Wade was overturned in June 2022, transforming the legal landscape for abortion in the United States, the HHS clarified that EMTALA protections for clinicians apply regardless of state laws.

Gender archaeology

From Wikipedia, the free encyclopedia
Venus of Willendorf

Gender archaeology is a method of studying past societies through their material culture by closely examining the social construction of gender identities and relations.

Gender archaeologists examine the relative positions in society of men, women, and children through identifying and studying the differences in power and authority they held, as they are manifested in material (and skeletal) remains. These differences can survive in the physical record although they are not always immediately apparent and are often open to interpretation. The relationship between the genders can also inform relationships between other social groups such as families, different classes, ages and religions.

Feminist theory in gender archaeology has presented a new perspective and introduced some biases in the overall archaeological theory. This new perspective that focused on feminist viewpoint in archaeology was initiated by the rapid evolution in the 20th century, of the Western Societies outlook and interpretation of gender. The development of this perspective commenced from the late 1960s feminist movement.

Archaeologist Bruce Trigger noted that gender archaeology differed from other variants of the discipline that developed around the same time, such as working-class archaeology, indigenous archaeology, and community archaeology, in that "instead of simply representing an alternate focus of research, it has established itself as a necessary and integral part of all other archaeologies."

Theory

Sex and gender are often used interchangeably in archaeological research. This dismisses the cultural constructiveness of gender by connecting it to the biological perspective of sex. Gender is present in material culture and can display how a culture was socially constructed. Archaeologists emphasizing the gender and sex dichotomy reject gender exploration within a culture and advances gender determinism. Furthermore, it promotes ethnocentrism by mirroring Western gender tradition in ancient cultures.

The feminist theory of gender archaeology gave archaeologists a new perspective of the past. This modern structure for theoretical perspective addressed many of the patriarchal biases instilled in the interpretation and excavation of past archaeology. Modern methods "treat gender as a process, not a thing". The new gender studies introduced biases in archaeological theory. This shift of focus is theorized to be from the increase in women in the archaeological field and from the change in the social interpretation of gender. Women archaeologists began in the last twenty years, focusing on how the gender roles of our ancestors are not being represented correctly and also the gender roles were not as rigid as once believed. The theory supports that prior archaeologists were not equipped to differentiate between the sex and gender of our ancestors. Due to this lack of technology, scientists made assumptions about a variety of topics including the division of labor between the sexes and past societies' views of sexual anatomy and desires. This caused a gap in our understanding of past social structures. Gender archaeology pushes for theories that are gender inclusive, unbiased, and factual.

Feminist archaeology

As a response to the little representation of female archaeologists and the invisibility of women in archaeological research, feminist archaeology was established. Feminist archaeology allows for the study of feminine roles in societies and verifying their importance. Additionally, it provides research of the women in prehistoric societies and analyzes the gendered activities that portray female agency and social engagement. Furthermore, feminist archaeology pushes a social and political agenda of female representation and the advancement of women in modern society. However, the social justice aspect of feminist archaeology tends to not be inclusive of race and class which can differentiate the experiences of a woman. Other movements such as black feminist archaeology further studies the intersectionality of race, gender, and class.

Black feminist archaeology

Black feminist archaeology was created as a response to feminist archaeology and the misconceptions about black women present in archaeological research. The stories of black women, especially stories during slavery, are typically written by non-black scholars. These scholars tend to "otherize" black women and shape the stories based on pre-conceived stereotypes. The roles of black women in early archaeological writings would be based on assumptions and stereotypes. Black feminist archaeology encourages the stories of black women to be told by black female archaeologists. Giving black women cultural authority on female slavery helps eliminate further otherizing and helps deepen the understanding of the experiences encountered by black slaves. Furthermore, it allows for archaeology to be linked to a larger mission for social and political justice.

Black feminist archaeology allows archaeologists to view the roles of black women through a gendered lens. Viewing black slaves through a gendered lens provides archaeologists with the ability to explore the alternative roles of black slaves as women. For example, female slaves were often portrayed through a domineering and overbearing stereotype. Black women are often displayed as hyper-emasculating and anti-patriarchal in past archaeological research. These stereotypes were used to describe the gender roles present in captive households. Black feminist archaeologists studied the captive households without the attachment of stereotypes and concluded that captive households had a multidimensional family domestic system. Due to the conditions of slavery, women often played a dominant role in the family structure. This is due to the long hours worked by slave men not by previous misconceptions that enslaved men were absent from the home and enslaved women were anti-patriarchal.

History

Archaeological research and theory often reflects the larger society at the time. Early archaeological research was often masculinized due to the dominant patriarchal society. The concept of gender was not traditionally explored in early archaeology because most research was male-centered and there was little representation of female archaeologists. Because of the masculinized make up of archaeology, racism, sexism, and ethnocentrism is often associated with the field and is prevalent in early archaeological works. Again, because archaeology often reflects the larger society, present day archaeological research is often more inclusive of gender and operates on a broader cultural landscape.

Archaeology used to be a mostly male-dominated field that discouraged gender research. But, in the last few decades with the rise of the 2nd feminist movement, female archaeology students began rejecting prior assumptions about gender and experiences in the past because they believed these assumptions distorted societies perception. The ongoing feminist movement that began in the late 1960s provoked the conception of a modern, feminized outlook on archaeology. Archaeology students were not satisfied with the limited information available about past women's roles and experiences, and the assumptions that were made for decades. So they took it upon themselves to use new technology and research how women in the past lived. Began focusing on the difference between sexuality and gender, and the importance of Intersectionality. Margaret Conkey and Janet D. Spector (1984) are considered the first in the Anglo-American field to examine the application of feminist approaches and insights to archaeological practice and theory. However, Scandinavian, and specifically Norwegian, archaeologists had already in the early seventies started to follow a processual recipe for studying gender relations both within (pre)history and the profession itself. This resulted in a workshop titled "Were they all men?" arranged by the Norwegian Archaeological Association in 1979, and a dedicated journal for feminist and gender studies in archaeology; K.A.N. Kvinner i Arkeologi i Norge [transl. Women in Archaeology in Norway] that published from 1985 until 2005.

Due to archaeology being a male-dominated field, it was prone to gender biases in research. These gender biases also apply to the topics that archaeologists investigate, with some topics more associated with women than men, such as cultural heritage, GIS, and isotope analyses. Little is known about gender roles in various ancient societies, but there is often an asymmetrical approach when depicting male and female roles in these societies. There are instances where male archaeologists have depicted the role of males of ancient times by mirroring present-day gender roles. Concepts of non-binary gender relations have been ignored due to the patriarchal structure of archaeology. For example, the figurines of the La Tolita-Tumaco culture combine male and female characteristics for a non-binary representation. Although these figurines were discovered a century ago, researchers did not acknowledge the mixed-gendering until recently because of gender biases.

Prominent archaeologists Margaret W. Conkey and Joan M. Gero detail the various ways gender is shaped in archaeological research. Gender can appear as sociobiological strategy, social construction, political economy, agency, and as an evolutionary process. These six theoretical approaches allow for the engendering of archaeology and imparts a well-developed position on gender.

The infamous Nefertiti bust has become a symbol of feminist power and gender-bending rule.

Although the new feminized outlook on archeology addressed detrimental biases in the analysis of past societies and made progress in the study of gender, the feminist theory created a new set of criticisms about archeological research. Some archaeologists have openly criticized gender archaeology. One of those responsible was Paul Bahn, who in 1992 published a statement declaring that:

The latest outbreak - which bears a great resemblance to the good old days of the new archaeology (primarily a racket for the boys) - is gender archaeology, which is actually feminist archaeology (a new racket for the girls). Yes, folks, sisters are doing it for themselves... Hardly a month goes by without another conference on 'gender archaeology' being held somewhere by a host of female archaeologists (plus a few brave or trendy males who aspire to political correctness). Some of its aims are laudable, but the bandwagon shouldn't be allowed to roll too far, as the new archaeology did, before the empresses' lack of clothes is pointed out by gleeful cynics.

Gender archaeology in cross cultural studies

It has been argued that gender is not genetically inherited but a process of structuring subjectivities, whereas sex is biologically determinate and static (Claassen 1992, Gilchrist 1991, Nelson 1997). To some professionals in the field, however, sex is not “the ground upon which culture elaborates gender” (Morris 1995, 568–569) and “sexing biases have been identified among the methods used in sexing skeletons… When sex is assigned to a skeleton of unknown sex, it is a cultural act” (Claassen 1992, 4), pointing out the more prominent cultural biases in the field of archaeology. These philosophies make Western biological anthropological methods of determining sex of fossils, not appropriate for cross-cultural studies given that not the same physical characteristics are used by all cultures to determine an individual's sex. This approach of sexual fluidity, meaning that sex is not a cross-cultural concept and it is mostly culturally assigned, has been undermined by the wide application of DNA analysis to skeletal remains in Western archaeology. The conclusions drawn from such studies performed by Western archaeologists, will be biased by their cultural influences and concepts of sex, biology and DNA.

Hoping that analysis of both the material culture and ethnographic studies of the ancient society will provide a clearer picture of the role gender plays/played in that society, archaeologists are using more diverse types of data and incorporating other aspects of the collected data that they did not include before. Gender studies have often analyzed both males and females (Gilchrist 1991, Leick 2003), however, recent fieldwork has challenged the notion of this particular male-female dichotomy by expanding the categories to include a third or fourth gender in some non-Western societies that are explored (Herdt 1994, Hollimon 1997). Another way in which the fieldwork has challenged the usual study of gender archaeology is by analyzing more material culture like objects, activities and spatial arrangements in the landscape (Nelson 1997).

Patient dumping

From Wikipedia, the free encyclopedia
Homeless veteran receives medical treatment. Homeless patients are one of the groups who are especially vulnerable to patient dumping.

Patient dumping or homeless dumping is the practice of hospitals and emergency services inappropriately releasing homeless or indigent patients to public hospitals or on the streets instead of placing them with a homeless shelter or retaining them, especially when they may require expensive medical care with minimal government reimbursement from Medicaid or Medicare. The term homeless dumping has been used since the late 19th century and resurfaced throughout the 20th century alongside legislation and policy changes aimed at addressing the issue. Studies of the issue have indicated mixed results from the United States' policy interventions and have proposed varying ideas to remedy the problem.

History

Early history

The term "patient dumping" was first mentioned in several New York Times articles published in the late 1870s, which described the practice of private New York hospitals transporting poor and sickly patients by horse drawn ambulance to Bellevue Hospital, the city's preeminent public facility. The jarring ride and lack of stabilized care typically resulted in death of the patient and outrage of the public. Scholars report that private hospital administrations were motivated by a desire to keep mortality rates and costs down when they advised ambulance drivers to send poor patients in critical condition directly to the public hospitals like Bellevue even if a private hospital was closer. After the deaths associated with patient dumping or inappropriate patient transfer added up, the first attempt at legislative reform in the United States was pushed through the New York Senate around 1907, largely by Julius Harburger. The legislation penalized private hospitals when they sent ill patients away or obligated staff to transfer them to another hospital. Notwithstanding the passage of city ordinances prohibiting the practice, it continued. The practice of patient dumping continued for several decades, and in the 1960s it was brought back into the public eye by the media, but not much was done to resolve the issue. Many homeless people who have mental health problems can no longer find a place in a psychiatric hospital because of the trend towards mental health deinstitutionalization from the 1960s onwards. It continues to this day especially in New York City, where Bellevue receives a large share of Manhattan's indigent.

1980s resurface in the public eye and policy interventions

"Patient dumping" resurfaced in the 1980s, nationwide, with private hospitals refusing to examine or treat the poor and uninsured in the emergency departments (ED) and transferring them to public hospitals for further care and treatment. In 1987 33 complaints of patient dumping were made to the US Department of Health and Human Services, and the following year 1988, 185 complaints were made. Since private hospitals ceased publishing their mortality rates, analysts pointed to high costs of dealing with Medicaid's reimbursements and uninsured patients as the motivation. This refusal of care resulted in patient deaths and public outcry culminating with the passage of a federal anti-patient dumping law in 1986 known as the Emergency Medical Treatment and Active Labor Act (EMTALA). In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed which was meant to regulate how patients were transferred and also end patient dumping. COBRA was not a complete solution, and in the years after its passage hospitals struggled with creating appropriate discharge protocols and the cost of providing health care for homeless patients. Statistically, Texas and Illinois had the highest rates of patient dumping because of economic difficulties. Researchers have reported that the language in COBRA was not precise enough to significantly disincentivise healthcare providers to discontinue patient dumping practices. For example, in the 1980s Texas state law had a loop hole that allowed hospitals to transfer patients to nursing homes.

Early 21st century policy

Homeless dumping continued to be an issue in the United States into the 21st century. University of California Los Angeles professor Abel (2011) claimed that these policy interventions have not been effective because the United States' health care system is too heavily influenced by the patients ability to pay. In the early 21st century, illegal immigrants were reportedly subject to patient dumping by being deported or repatriated. Research articles also describe dumping of homeless individuals or mentally ill individuals by police as another form of inappropriately shifting people from one area of a city to another instead of taking them to adequate care facilities like shelters. In September 2014, the U.S. Commission on Civil Rights issued a report entitled "Patient Dumping".

Statistics

A report published in 2001 by Public Citizen's Health Research Group stated that there were widespread violations of EMTALA throughout the United States in 527 hospitals. Between 2005 and 2014 another study reported 43% of the US hospitals studied had been under EMTALA investigation which resulted citations for 27% of the hospitals. The other findings of this study were that the number of EMTALA violations have been decreasing for the period between 2005 and 2014, and that the majority of the citations were given to hospitals for issues with policy enforcement. However, there is not a consensus among researchers about how to effectively measure the effects of EMTALA at reducing patient dumping or improving patient care.

Associated factors

Patients living in poverty or in homelessness are often seen as less than ideal patients for hospital administrations because they are unlikely to be able to pay for their healthcare and tend to be hospitalized with severe illness. Other factors associated with patient dumping are being part of a minority group and being uninsured. Historically, hospitals have been reported to compete against each other to maintain low mortality rates at the expense of low-income patients. Competition within hospitals to see more patients and faster also increases the rate of inappropriate patient discharges.

Some researchers and scholars trace the issue of homeless dumping to the issue of homelessness and claim that addressing the issues of homelessness will prevent patient dumping. The increase of homelessness and poverty rates increases the number of people who are unable to pay for consistent healthcare which leads to emergency hospitalization of patients with exacerbated medical conditions. Social factors have allowed homelessness and poverty rates to further increase, and deinstitutionalization has led to psychiatric patients to lose access to services and be dumped on the streets.

Intervention strategies

The introduction of Medicaid and Medicare had helped hospitals shoulder the burden of providing care to poverty-level and elderly patients, but the many people in United States without health insurance were still vulnerable to inappropriate patient transfer or dumping. Scholars and researchers point to these patients' lack of access to preventative and consistent healthcare treatment as well as inappropriate discharge procedures and follow-up protocols as the causes behind the frequent rehospitalization.

In 1985 Illinois developed the Illinois Competitive Access and Reimbursement Equity (ICARE) program, but it had adverse effects like disrupting indigent patient's continuity of care, losing patients, and creating two hospital systems: one for uninsured lower-income patients and one for insured higher-income patients. The ICARE policy had a negative impact on the quality of healthcare that low-income and homeless patients received because it created disjointed treatment experiences when hospitals met their allocated funding quota and transferred patients to (or dumped patients on) other hospitals that still had funding and public hospitals. Proponents of the ICARE policy cited the reduction in Illinois' Medicare expenditure as evidence of the policy's success.

The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) was meant to regulate Medicare-participating hospitals and ensure that patients received appropriate medical treatment regardless of their ability to pay. Some scholars described how EMTALA provided a means to take legal action against healthcare providers and hospitals that did not comply, and provided examples of cases in Florida, California, and North Carolina. Even though hospitals have had to pay penalties, patient dumping remained an issue throughout the country. Legal scholars Kahntroff and Watson (2009) also reported that the implementation of the policy has been flawed with issues of lack of adherence and confusion on what is compliance. A study that looked at 5,594 hospitals in the United States between 2005 and 2014 reported that the number of EMTALA investigations has decreased through that period which may be an indication that hospitals and physicians are improving their adherence to EMTALA protocols. The decrease in EMTALA investigations might also indicate that patient access to emergency care and treatment is improving. Researchers also interviewed doctors who reported that EMTALA citation fines were a disincentive to violate EMTALA protocols.

In 1988 the COBRA Act was meant to be a series of revised regulations which required hospital emergency rooms to treat every patient that walked through the door and doubled the fine for violations. News Editor for the American Journal of Nursing, Brider (1987), reported that public hospital staff in Illinois were under a lot of pressure due to the influx of patients that were being sent to them from other hospitals, and that the incidence of patient transfers or patient dumping increased through a loophole in COBRA.

The incentives offered to doctors in terms of payment for their services have an effect with patient care outcomes and can minimize the chance of patient dumping or shifting patients to other providers. A study conducted on doctors at the Fairview Health Services hospital in Minnesota reported that grouping doctors into teams to incentivize collaboration between the doctors to ensure the average of the team provided high quality health care for the patient. But doctors who out performed other doctors on their teams did not like the program because the other doctors who were underperforming did not have the incentive to improve. Some of the doctors interviewed in the study claimed that underperforming doctors would only start providing better care if their pay was affected by their lower quality services.

Discussion of intervention strategies

Some researchers and scholars have concluded that despite the policy interventions of the 1980s, the practice of patient dumping continued to be a problem in the United States and that a solution required a reformation of the entire healthcare system. These researchers shared the opinion that the most effective solution to address the health care needs of people living in poverty and those who are homeless is to provide universal healthcare because that would eliminate hospitals incentives to turn patients away based on their ability to pay for services. Other researchers emphasize that better developed protocols and procedures for patient discharge are one of the most important strategies to reduce rehospitalization rates because patients living in homelessness and poverty lack appropriate dwelling to continue the recuperation process. Another strategy to minimize rehospitalization rates proposed by researchers was to create recuperation programs for patient who lack access to one after they are discharge. Respite programs can be especially helpful for homeless patients to have safe places to recuperate and stop the cycle of chronic re-admittance. A study conducted using information about homeless patients in New Haven, Connecticut, reported that homeless patients had a 22% higher hospital readmittance rate than patients with insurance.

Regional or community wide programs to oversee under-resourced patient recuperation or respite care seem to be the most sustainable because they pool resources from multiple hospitals and a larger population to provide appropriate recuperation facilities and minimize the risk of any one hospital or healthcare facility from having to provide the majority of the resources and cost associated with the increase of patients from the area's underserved patient population. Researchers say that the cost of rehospitalizing patients for more critical conditions is higher than the cost of providing appropriate healthcare and following careful patient discharge procedures, which in some cases are beyond the requirements outlined by policies like the EMTALA.

However, there are studies that have indicated that hospitals sometimes face delays when discharging a homeless patient because they also have the responsibility of finding appropriate housing and care. Extended hospitalization increases the chance of infectious disease transmission and draws resources from other patients.

Global perspective

Canada

A study conducted on physicians in Ontario investigated how different payment systems impacted patient care in terms of the number of cost shifts and dumping incidences and reported that other factors like altruism or ethics of the doctors and patient behavior played a role in how doctors shifted costs. Some researchers hold the view that the Canadian healthcare system is better designed to minimize the occurrences of patient dumping.

Taiwan

A study published in 2006 that used voluntary surveys in its methods claimed that the results of the surveys indicated patient dumping was a problem within Taiwan's healthcare system. Researchers report that funding issues with government budgets and pressure that hospitals felt to stay competitive were among of the contributing factors to patient dumping. A previous study published in 2003 also supported the claim that Taiwan's healthcare system is negatively impacted by patient dumping in terms of healthcare quality and increased costs.

United Kingdom

In the a study conducted in the United Kingdom the issue of inappropriately discharging a patient has more to do with delaying the discharge than expediting the discharge. In 2004 a report was published in the UK that claimed that prisons were overcrowded and that one of the populations at risk of living in adverse conditions were mentally ill incarcerated individuals who were dumped in prisons.

Usage

Other associated names or terms

Other terms used in related to the practice of patient dumping are frequent-user patient, revolving-door, and bed block-blockers. These terms were contrived by some hospital staff who noted how these patients had reoccurring hospitalizations. Other ways homeless dumping is described is with phrases like inappropriate patient discharges and economically motivated transfers.

Usage in the media and press

  • Associated Press; February 9, 2007; Los Angeles. A hospital van dropped off a homeless paraplegic man on Skid Row and left him crawling in the street with nothing more than a soiled gown and a broken colostomy bag, police said.... Police said the incident was a case of "homeless dumping" and were questioning officials from the hospital.
  • Associated Press, October 25, 2006; Los Angeles. "L.A. Police Allege Homeless Dumping." Authorities have launched a criminal investigation into suspected dumping of homeless people on Skid Row after police witnessed ambulances leaving five people on a street there during the weekend.

Butane

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