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Health Minister Eric Hoskins is proposing a change that would allow all qualified health-care providers in Ontario to refer transgender patients for sex-reassignment surgery.Chris Young/The Globe and Mail

Ontario wants to make it easier for transgender people to get a medical referral for sex reassignment surgery, but they will still have to leave the province for the procedures.

Currently, only the Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto can refer a patient for sex reassignment surgery, which is covered by the Ontario Health Insurance Plan.

Health Minister Eric Hoskins announced proposed changes Friday that would allow qualified health-care providers anywhere in Ontario to refer transgender patients for surgery. Exactly who should be trained will be worked out after the government's 45-day period for public comment on the new regulation.

"Ontario is taking action to reduce wait times and improve access for sex reassignment surgery," Hoskins announced at Toronto's Rainbow Health Clinic. "We will be moving from what currently is a single site to potentially what could be hundreds and hundreds of sites."

Hoskins said every Ontarian has the right to be who they are, and the health-care system should reflect that vision.

"I recognize that this is only a first step in our government's work to strengthen health supports for the trans community," he said.

There's been a big increase in the number of people in Ontario seeking gender identity services, and the waiting list for sex reassignment surgery referrals at CAMH has grown to more than 1,150 people.

Even after people get a referral for sexual reassignment surgery, they often face a years-long wait and must travel to Montreal or the United States to get the procedures performed.

"I can only imagine the additional anxiety of knowing the path one has to travel to seek out and receive support, and be affirmed, must dramatically increase that anxiety," Hoskins said as he pledged to build Ontario's capacity to offer the surgery.

Ontario has spent about $9 million to pay for out of province sex reassignment surgery for trans patients since the Liberals reinstated OHIP coverage in 2008, which grew from five patients in the first year to 136 in 2014-15.

One of the most vulnerable times for transgender people is when they are ready for surgery, but face a prolonged wait, said Anna Travers of Rainbow Health.

"This change would reduce wait times by allowing many trans clients to get surgical approvals from their own local primary care teams," she said.

Martine Stonehouse, who was in the middle of her sex reassignment surgeries when the Progressive Conservative government of Mike Harris de-listed OHIP coverage, called Friday's announcement "great," but a long time coming.

"Having only one assessor site isn't practical, and has caused a bottleneck since we got the surgery re-listed in 2008," Stonehouse said. "There's so many people out there who need services but can't get access."

Nicole Nussbaum, a lawyer who works with the transgender community, said forcing every trans person in Ontario who wants surgery to go through CAMH has created a logjam and unmanageable workload that will be eased by other doctors.

"While there is certainly a great deal of expertise at CAMH, many health and mental health professionals in this province are already providing high quality transgender or transition-related care," she said.

New Democrat Cheri DiNovo called Hoskins' announcement "a wonderful first step," and a direct result of a resolution unanimously passed in the Ontario legislature in June affirming the rights of lesbian, gay, bisexual, transgender and queer people.

"Now that trans folk actually have human rights they are exercising them," said DiNovo. "The fear is once we have broader access points (to sex reassignement surgery referrals) then what happens? We don't have the surgeons in Ontario to perform the procedures."

Hoskins promised more funding for CAMH and the Rainbow Clinic to help them cope with increased demands while the province gets other health care professionals trained and ready to do the referrals.

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