Finding LGBT Friendly Health Care Isn't So Easy In Rural California

Nov 15, 2016

Finding the perfect doctor can be a feat for anyone, but for LGBT people in rural places finding an understanding physician can sort of feel impossible. And as FM89’s Ezra David Romero reports some say visiting a doctor's office is so intimidating that often they go without care.  

In 2014 Visalia pediatrician Kathryn Hall got fed up. She sees her practice as welcoming to LGBT people, but she felt that conservative values and homophobia in Tulare County have kept many from receiving proper healthcare.

"I made the bar very, very low because we just didn't get much education on LGBT health in medical school." - Dr. Kathryn Hall

“Many of the physicians that I know are LGBT friendly, but patients don’t know that and are very afraid that they’re being judged,” Hall says.

That’s why she wanted to create a list of LGBT friendly doctors. To find them she sent out a survey to over 500 Tulare County doctors and got about 120 back. The survey asked a few basic questions like would you welcome LGBT people to your practice and would you be nice to this population of people. Most of the answers were yes, but so many never sent it back.

“I made the bar very, very low because we just didn’t get much education on LGBT health in medical school,” says Hall. “That is starting to change.”

Fast forward two years and Hall is now volunteering at the SOURCE LGBT+ center in Visalia. The SOURCE opened earlier this year under the guidance of Nick Vargas. The thirtysomething recently moved back to Visalia from the Bay Area to start a second career.  As a sexually active gay man Vargas wanted to get on PrEP. It’s an anti-HIV medication recommended by the CDC that  keeps HIV negative people from becoming infected.

“You can find something like PrEP here, but access to it can be a little hard,” says Vargas.

The SOURCE LGBT Center in Visalia opened earlier this year. Nick Vargas, in blue, helped open the center.
Credit The SOURCE LGBT+ Facebook.

Vargas says he had to teach his physician about the drug and it took a year for him to consistently get on it. That process is something he didn’t have to go through in the Bay Area.

“Once you tell them they want to be able to help,” says Vargas. “But they have to ask for it and then they have to learn how to administer it, how to follow up and that’s a process and it’s out of the scope of what they normally do.”

Stories like Vargas’ are all too common in the Central Valley according to Mario Alfaro with Planned Parenthood. As a community educator for the region Alfaro says fear of judgment is a big concern to LGBT people, especially in rural places.

“They tell us I don’t even come out to my clinician, I don’t tell them anything, I don’t want to feel judged,” Alfaro says. “It’s my only health center out in my region and I can’t get to Fresno. If I come out to them, they might judge me and then all of a sudden the only doctor I can go to has closed their doors.”

"The Valley is so conservative, it'd be really scary to go to many doctors and say that you're gay, especially for men." - Dr. Sue Stone.

I found stories like this in my reporting as well. I met a lesbian woman in her 60s from Bakersfield who’s never been asked about STD’s, gay men facing HIV issues and transgender people being refused care all together. For some it’s an issue of distance to care providers who will gladly help them and for others it’s an issue of cost. Dr. Sue Stone is an LGBT friendly physician in Fresno. She says her patients travel from as far as Merced to see her.

Dr. Sue Stone runs a holistic practice and has many LGBT oriented patients.
Credit Ezra David Romero / Valley Public Radio

“The Valley is so conservative, it’d be really scary to go to many doctors and say that you’re gay, especially for men,” Stone says. “Because gay men have such unique healthcare needs.”

Needs like blood tests and PrEP because of higher rates of STD’s. I found Dr. Stone on a list of LGBT friendly physicians in the Valley. As I called through the list I was shocked that several people who answered the phone didn’t know what LGBT stands for. Dr. Kathy Kimball with Planned Parenthood in Fresno says this is a perfect example of why people travel from as far as Tehachapi to see her. She says they might be able to make their first appointment but continuing service is hard to maintain.  

“They just can’t here every three to six months to get their medications refilled and make sure their labs are okay,” Kimball says. “I think that’s the hardest part is not seeing the outlying areas not get any services.”

Kimball has seen more than 200 transgender patients this year alone. Lots of these people are forced to come to see her in Fresno because many physicians in rural places aren’t comfortable caring for transgender people. 

"Physicians often don't recognize that they are not being inclusive or sensitive to LGBT people's concerns, so there is often a disconnect and that's where more education would be helpful." - Kathryn Hall.

Sherry Donegan is a transgender woman that recently moved to Los Angeles from Fresno because she had one to many negative experiences here, like this: “She was my primary care doctor and the front office staff says we don’t serve your kind here and said listen if you don’t leave we’re going to call the police,” Donegan says. “So I left. It’s been very, very hard and very, very difficult.”

All the physicians I spoke with say situations like Donegan’s could’ve been handled very differently. Perhaps a referral, the proper use of preferred gender pronouns and kindness from the nursing staff. That's why Dr. Kathryn Hall says cultural sensitivity trainings for staff and simple changes to make lobbies comfortable for everyone are imperative.

“Physicians often don’t recognize that they are not being inclusive or sensitive to LGBT people's concerns, so there is often a disconnect and that’s where more education would be helpful,” says Hall.

And even though there is a lot of confusion around what doctor to see because of either perceived homophobia or real anti-gay sentiments in the Valley, Hall says it won’t take that much training for doctors and nursing staffs to create safe spaces for LGBT people to receive care. But changing attitudes at least in some parts of California will take much more.