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Chrystofer Maillet paid almost $7,500 out of pocket for a double mastectomy due to a long wait for approval from CAMH’s Adult Gender Identity Clinic.

Dave Chan/The Globe and Mail

The Ontario government will expand the number of places where transgender people can obtain approvals for publicly insured sex reassignment surgeries, The Globe and Mail has learned.

A source close to Health Minister Eric Hoskins said Thursday that the Liberal government is reviewing regulations to determine the best way to increase access beyond Toronto's Centre for Addiction and Mental Health (CAMH,) which is currently the lone site for pre-operative approvals – not just for Ontario but also for Newfoundland and Labrador and, until last year, Saskatchewan.

CAMH will no longer be the sole gatekeeper for such procedures, the source confirmed, but it is too early to say where the other approval sites will be.

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In the meantime, the government also plans to provide "additional support" to CAMH's Adult Gender Identity Clinic, where there are now 970 people in the queue – and where it takes as long as two years to secure a first appointment.

The government is not planning a formal announcement, the source said. The news comes on the eve of Friday's Trans Pride March in downtown Toronto, part of the city's Pride festivities.

The Globe first drew attention to the bottleneck at CAMH in April when it wrote about the case of Chrystofer Maillet, an Ottawa trans man who paid almost $7,500 out of pocket for a double mastectomy.

The Ontario Health Insurance Plan would have covered the procedure if Mr. Maillet, now 36, had first obtained an approval letter from the CAMH clinic. But he could not endure the wait.

When he finally landed an appointment at the clinic – nine months after his March, 2013, surgery – the clinic's staff deemed him a good candidate for the procedure and wrote a letter saying so.

Mr. Maillet used that letter in an appeal to a quasi-judicial panel that reviews OHIP rejections, but the board ruled against him in January, writing that OHIP's rules clearly state the CAMH approval must precede the surgery.

Mr. Maillet has since filed a Charter challenge to the OHIP regulation.

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"I think that by forcing people to travel halfway across the [province] to do an interview process to allow them access to health care that everyone should have automatically, it's an unfair process," Mr. Maillet said last month. "It just seems like we're making it a whole lot harder for anyone to just be themselves."

Other trans patients have since come forward with similar complaints.

Bobbie Pearson, a 57-year-old trans woman from London, Ont., appeared Wednesday before the same panel that rejected Mr. Maillet's claim. She is seeking reimubursement for the $20,000 genital surgery she underwent in Pennsylvania last month.

A decision in her case is not expected until later this summer at the earliest.

The NDP's health critic wrote an open letter to Dr. Hoskins on Wednesday chiding his government for moving too slowly to solve the problem at CAMH.

"Far too many trans Ontarians continue to experience elevated risk of depression and suicide in the face of ongoing discrimination, harassment and violence," France Gélinas wrote. "It is heartbreaking and it is wrong that vulnerable individuals should be confronted by barriers to care that make it more difficult to access the health-care services they need."

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CAMH's president and the psychiatrist who leads the facility's small Adult Gender Identity Clinic have both said the rule limiting approvals to CAMH should be scrapped.

The demand for sex reassignment surgery has surged in recent years. Last year, the clinic approved 177 surgeries, up from 59 in 2010.

The Ministry of Health and Long-Term Care, meanwhile, spent almost $2.2-million on sex reassignment surgeries in 2014-2105, up from about $22,000 in 2008-2009, the year the procedures were relisted by OHIP after a 10-year hiatus.

The quality and availability of trans health services varies across Canada. Every jurisdiction except New Brunswick, Nunavut and the Northwest Territories now publicly insures at least some sex reassignment surgeries.

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