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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
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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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CASA VOLUNTEER TRAINING
Learn how you can be trained in just a month to
make a difference in the life of a child in foster care
In-person and online training are combined
for all learning styles
Classes are free to everyone
October 9 th – November 13 th
We need volunteers more than ever to advocate for
children in foster care. A Court Appointed Special
Advocate is a community volunteer who advocates for a
child who has been abused or neglected. CASA volunteers
work hard to ensure that children in foster care in Clatsop
County will have a safe and nurturing permanent home as
soon as possible. 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.