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A3 THE ASTORIAN • SATURDAY, AUGUST 3, 2019 Transgender woman sues county, insurers to pay for facial surgery By AIMEE GREEN The Oregonian A transgender woman who works for Clatsop County has fi led a $375,000 lawsuit against her insur- ance companies and her employer, saying they’ve discriminated against her by refusing to pay for facial surgery that would make it more likely that strang- ers would perceive her as female. Christina Ketcham, 59, has already undergone sex reassignment surgery, hor- mone replacement therapy, worked with a voice coach and changed her name, clothes and hairstyle to refl ect her gender identity, but her doctors also rec- ommend that she undergo “facial feminization sur- gery” to continue on that path. It could include rhino- plasty, reduction of her facial bones, a face lift and an eyelid lift. Her doctors have deter- mined the surgery is “med- ically necessary” to treat Ketcham’s gender dys- phoria. She was diagnosed with gender dysphoria four years ago but has experi- enced it since childhood, according to the suit. But from 2016 to 2019, Citycounty Insurance Ser- vices, which provides cov- erage to Clatsop County employees, and Regence BlueCross BlueShield of Oregon, which administers the plan, have turned down Ketcham’s request to cover the cost of the surgery, the suit says. Representatives from Citycounty Insur- ance Services and Clatsop County didn’t respond to requests for comment. Jared Ishkanian, a spokesperson for Regence, said the company couldn’t discuss the pending liti- gation but supports “our members with comprehen- sive, medically necessary transgender services.” Ketcham has worked for Clatsop County for nearly 30 years, the suit says. She has worked for the county’s fi sheries project as a “fi sh- eries biological aide” for 17 of those years. She has suffered ongo- ing distress as she has waited for her insurance to fund her facial surgery, her lawsuit says. “Ms. Ketcham contin- ues to be perceived by oth- ers as male,” states the suit, fi led in July in Multnomah County Circuit Court. “Her facial features and Oregon takes initial step in student success plan First employee starts work By CLAIRE WITHYCOMBE Oregon Capital Bureau Mark Ketcham Christina Ketcham’s doctors recommended that she have facial feminization surgery as treatment for her diagnosis of gender dysphoria, but insurance refused to pay, according to her lawsuit fi led in July. the shape of her face fre- quently lead others to call Ms. Ketcham ‘sir,’ ‘mister’ or ‘he-she,’ and to treat her as a man.” The surgery, depend- ing on what is done, can cost between $20,000 and $40,000, said Asaf Orr, one of Ketcham’s lawyers and a staff attorney for the National Center for Lesbian Rights in San Francisco. “Facial feminization surgery is hugely transfor- mative,” Orr said. Lawsuits such as Ket- cham’s are rare, he said. Orr tracks this area of legal practice and said Ketcham’s suit is the only active one he knows of in the nation. In early 2018, the National Center for Lesbian Rights was involved in success- fully pushing the Ore- gon Health Plan to cover a facial feminization surgery for a transgender woman, Orr said. Transgender people used to frequently have to fi ght insurance companies to pay for gender reassignment surgery, he said, and now the surgery is more widely covered. The legal battle- ground has shifted to areas such as facial feminization or facial masculinization surgeries for transgender women and men, he said. The suit says Regence “categorically excludes coverage of facial-femi- nization procedures” by “wrongly deeming them ‘not medically necessary’” as a treatment for gen- der dysphoria. But the suit says Regence covers pro- cedures such as eyelid lifts and facial bone reduction surgeries for reasons other than gender dysphoria, and those include ingrown eye- lashes and to correct jaw deformities. The suit alleges that the reason for denying the surgery for transgender patients is “a refl ection of animus toward, or an intent to discriminate against” transgender people. The suit asks a judge to perma- nently order the defendants to stop categorically deny- ing facial feminization sur- gery as a treatment for gen- der dysphoria. According to the suit, the World Professional Association for Transgen- der Health states that facial feminization surgery, along with other gender confi rm- ing surgeries, “are not ‘cos- metic’ or ‘elective’ or ‘for the mere convenience of the patient.’” Major health professional organizations — including the American Medical Association and the American Psychiatric Association — support that position, according to the association’s website and the lawsuit. The suit says Ketcham has “struggled with this feeling of incongruence” about her gender identity for much of her life. “At birth, Ms. Ketcham was assigned male, but as early as childhood she understood she was a girl,” the suit states. “As a young person, Ms. Ketcham’s family and com- munity did not provide any support or options for her to live as a woman consistent with her gender identity,” the suit continues. “As a result, she spent most of her life trying to conform to male stereotypes and living outwardly as a man, despite the severe emotional dis- tress this caused her.” Ketcham is being repre- sented by a team of attor- neys, including Orr and Portland lawyers Talia Guerriero and Christina Stephenson. SALEM — Oregon’s ambitious and costly plan to transform its public schools begins with one person. On Thursday, the fi rst employee — one of doz- ens — charged with put- ting the Student Success Act into action joined the state Department of E ducation . Lawmakers voted in May to raise new tax dol- lars to boost the amount of money fl owing toward Oregon’s public schools by $1 billion every year. It’s a major effort to increase academic achievement, improve students’ mental health, boost high school grad- uation rates and improve Oregon kids’ long-term prospects. That fi rst employee, Tamara Dykeman, will coordinate, plan and put into action the programs paid for by the Student Success Act, according to the job description. While she has myriad duties, much of the work will involve shepherding the agency through the landmark new program. Dykeman, who previ- ously worked as an ana- lyst for the legislative pol- icy and research offi ce, is expected to work with multiple teams, offi ces and divisions of the educa- tion department and advise department leaders on how the agency can innovate, grow and improve. She will report to the department’s director and deputy superintendent of public instruction, Colt Gill. Among her other duties, Dykeman is also supposed to foster relationships inside and outside the agency, bringing together students, teachers, school districts and other inter- ested people and groups to make the legislation effective. The money raised by the new tax will support new and ongoing state efforts to renew Oregon’s fl agging public education system. Those efforts range from increasing preschool slots to helping Latino , Native American and b lack students do better in school to cutting class sizes. Over the next year, the department plans to hire about 70 new workers to make the expanded pro- grams run, including grant managers and research analysts. Lawmakers autho- rized $25 million to pay for those positions, con- tracts and “other costs nec- essary” to implement the law. Legislators directed the department to improve education for Oregon stu- dents who aren’t being adequately served by its public schools, Gill said. For example, a good share of the money will go to school districts and charter schools for “stu- dent investment.” The state will apply the same formula the state normally uses to distrib- ute money for schools, but with a key tweak. The process will be weighted to account for poverty in a given school district to boost the edu- cation money available for poor students. “I think that’s a critical aspect,” Gill said. School d istricts have to have a plan for spending the money that has been approved by the education department to get the extra state money, according to legislative records. Those positions will include auditors to check that all that new money is spent properly. “The Legislature was really clear around design- ing the implementation of this process around two things,” Gill said. “One is that we keep equity at the forefront, and the second is that we are accountable for the public dollars that we’re spending.” Local school districts won’t start seeing the new money until the 2020-21 school year. Gill noted that the Stu- dent Success Act is the state’s largest investment in education in at least three decades. “It’s one that we are diving into as quickly as possible, but as cautiously and thoughtfully as possi- ble,” Gill said. Two other state agen- cies are expanding to brace for the expanded schools effort. The state Depart- ment of Revenue got an extra $4 million to put in place the system to collect the new corporate tax and the state Department of Justice received $460,000 to work on legal issues around the new tax. The Oregon Capital Bureau is a collaboration between EO Media Group, Pamplin Media Group and Salem Reporter. OREGON CAPITAL INSIDER Get the inside scoop on state government and politics! THE KIDS ARE LOOKING FOR YOU – BE A CASA! Brown signs a bill narrowing death penalty By DIRK VANDERHART Oregon Public Broadcasting It will soon be much harder for Oregon pros- ecutors to seek the death penalty. On Thursday, Gov. Kate Brown signed Senate Bill 1013, which limits the types of crimes punishable by death to terrorist acts and murders of children and police offi cers, among other things. “Oregon’s L egislature made the wise decision to ‘close the front door’ — most of the way, at least — to death row, reserving death sentences for only the rar- est and most heinous mur- ders,” Brown said at a sign- ing ceremony, according to prepared remarks. “This is an important step, in Oregon and nationally, toward one day eliminating the death penalty nationwide.” In a state with a fi ckle past concerning capital pun- ishment, SB 1013 presented a novel approach. Rather than asking voters to scrub the death penalty from the books, lawmakers decided to use their own authority to limit which offenses are punishable by death. Aggravated murder, the only capital offense under state law, currently contains a list of 19 factors that could qualify someone for the death penalty. Those include things like paying another person for a murder, killing someone in the course of tor- turing them, and murdering someone to conceal a crime. When SB 1013 takes effect in late September, the defi nition will be more sim- ple. Under the change, ter- rorist attacks that kill at least two people, premeditated murders of children under age 14, and the premeditated murder of a law enforcement offi cer would qualify. Con- victed murderers who kill another prisoner while incar- cerated are also included. The bill also alters the questions Oregon jurors must answer in order to sen- tence a defendant to death, removing a query about whether the person is likely to be dangerous in the future. Death penalty opponents argue that question is impos- sible to answer and could result in Oregon’s law being found unconstitutional. The bill saw fi nal pas- sage in the frenetic fi nal days of this year’s legisla- tive session, but not without objection. Prosecutors have argued that it too strictly nar- rows the death penalty and say that voters should decide changes to capital punish- ment. Family members of murder victims also testi- fi ed against the bill — and had a hand in forcing a late amendment adding murders of law enforcement offi cers to the bill. 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Join us and make a difference. CLASSES AT CLATSOP COMMUNITY COLLEGE South County Campus Contact us at 503-338-6063 casa@clatsopcasa.org www.clatsopcasa.org Clatsop CASA Program complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, disability, religion, sex, gender identity, sexual orientation, or age. Clatsop CASA Program operates its program, services and activities in compliance with federal nondiscrimination laws.