You've broken out in a cold sweat. You're short of breath. And you feel pressure in your chest. You've got health insurance and know you should be going to the emergency room -- yet you don't.
The situation seems to defy logic, but now imagine that you're living in a small, conservative community. You're a transgender man. And your primary care doctor is more than 100 miles away because you were humiliated by the staff during your visit to the local doctor's office. You've heard horror stories about the local hospital.
This isn't hypothetical. It's a situation that plays out in small towns and large cities across the nation. According to a landmark survey by Lambda Legal, 70 percent of transgender people and 56 percent of lesbian, gay, and bisexual people have reported discrimination in health care services. And large numbers reported being refused care outright -- with transgender people, people of color, and people living with HIV being disproportionately denied treatment.
A record-breaking 426 received the highest designation as "Leader in LGBT Healthcare Equality" -- a jump of 100 percent from 2013. To earn such a distinction, Equality Leaders must document that they have adopted and publicized foundational policies for LGBT equity and inclusion -- including nondiscrimination policies for patients and staff, equal visitation policies, and training in LGBT patient-centered care.
And while more hospital administrations than ever are changing policies and implementing practices to ensure everybody gets equitable care, too many aren't. And too many patients are suffering.
Just the other day, a staff member told me that her partner was delaying critical care because of worry about how they'd be treated at the hospital. Fortunately, the staff member knew our HEI could help -- and they went together to the nearest Leader on the list. But it's a stark reality if you don't have a Leader nearby.
Beyond our HEI, there are ways to move hospital policy forward. Prompted in part by President Obama's 2010 call to ensure equal visitation to same-sex couples hospitals are now required to have equal visitation policies for same-sex couples and their families -- or risk losing their Medicaid and Medicare funding. In fact, many hospitals cite this requirement when coming to us for help putting policies into practice.
But no similar requirement is in place for written nondiscrimination policies covering sexual orientation and gender identity. That's the peace of mind that LGBT people really need.
So we live in this limbo where even the most unfriendly hospital must honor a partner's wishes to have their partner by their bedside -- or, with advanced directives in hand, make medical decisions on their behalf. But they can still face discrimination by that same hospital simply for being LGBT.
The Department of Health and Human Services has it in its authority today the ability to start drafting regulations requiring that hospitals implement LGBT-inclusive nondiscrimination policies -- or risk losing their taxpayer funding.
This mandate wouldn't make hospitals suddenly welcome LGBT people with open arms, but it would give recourse to those who are harassed or humiliated when they seek care. Most important, such a mandate would help ensure that LGBT people don't delay seeking care when it can literally be a matter of life or death.
JEFF KREHELY is the vice president and chief foundation officer for the Human Rights Campaign.