Pullman hospital considers offering sex reassignment surgery

Jessie Jane Miller grew up in rural northeast Washington, one of two twin boys in a conservative, religious family.

For years, Miller lived a closely guarded secret: “I knew that I was different and I knew that I wanted to be a woman.”

Miller was an adult before she came out as a transgender woman. That same urge for privacy initially prompted Miller to keep a low profile after her sex reassignment surgery at Pullman Regional Hospital in early June.

But when the 44-year-old Air Force veteran learned that the hospital’s board was taking public comment on whether to continue offering the surgery, which was done on a trial basis, she decided it was time to speak up.

“I was a bit baffled why public opinion should matter, especially in a college town and one of the few liberal places on the eastern side of Seattle,” she said.

Pullman Regional Hospital could become the first Washington hospital to offer below-the-waist sex reassignment surgery transitioning males to females.

Scott Adams, the hospital’s chief executive, said Oregon Health and Science University in Portland is the only other Northwest hospital he is aware of that performs the procedure, which is called vaginoplasty.

“To the best of our knowledge, we would be the first in Washington, though we have not canvassed the state’s 100-plus hospitals,” Adams said.

Miller had one of two vaginoplasties done at the 25-bed hospital in June by Dr. Geoffrey Stiller, a local plastic surgeon. Stiller did the surgery under the supervision of two preceptors. He wants to continue offering vaginoplasties in Pullman.

“He approached us about the opportunity to carry out some of his training at Pullman Regional. … We wanted to support him in his efforts to gain additional skills to care for patients,” Adams said.

However, the hospital board is evaluating whether Pullman Regional will offer the surgery on an ongoing basis. Questions remain about cost and patient care requirements, Adams said.

About 300 local residents have sent written comments to the hospital’s board of commissioners on the issue. The letters included responses from Pullman Regional’s other patients, community members and hospital staff.

Some opposed sex reassignment surgery on religious grounds, or questioned whether the small public hospital was the right place to offer the surgery.

But many of the comments were supportive. “Don’t let the bigots win,” said one letter writer.

Others said the hospital board should make the decision based on whether Pullman Regional Hospital had the resources to provide quality care, not public opinion.

Miller wants her voice to be part of the discussion. The recent surgery marked a long journey for the Moses Lake resident, who grew up in Chewelah, about 50 miles north of Spokane.

Miller said she was 20 before she learned that other transgender people existed. And even if she had known earlier, she couldn’t picture herself coming out as a transgender woman in high school.

In rural, blue-collar Chewelah, there was little diversity.

“There wasn’t a gay person in our high school; there was no LGBT in our town,” she said. “I lived in the closet. I couldn’t even tell my twin brother.”

Miller spent 5 1/2 years in the Air Force, earned a master’s degree, married and divorced. She’s the single parent of a 9-year-old daughter. She’s currently living on income from a military disability, but she hopes to someday resume working in the information technology field.

Miller started transitioning to a woman three years ago. She had previous surgeries to enlarge her breasts, reshape her nose and remove her testicles, also done by Stiller.

Her recent surgery created a vagina, clitoris and vulva using skin from the penis, scrotum and perineal skin.

Though the Pullman hospital is referring to the surgery as “gender reassignment,” the National Lesbian and Gay Journalists Association recommends using the term “sexual reassignment” to describe the treatments and surgeries used by transgender people to match their sex to their gender.

Stiller didn’t respond to a request for an interview, but Miller said she was thrilled when she learned he wanted to offer vaginoplasties. She immediately called for a consultation at Stiller’s Spokane office. So did one of her friends.

Miller said the surgery was possible for her because Stiller accepted Apple Health, which provides free or low-cost health insurance through Washington’s Medicaid expansion. National cost estimates for a vaginoplasty are in the $15,000 to $30,000 range.

Miller had to get pre-authorization from Apple Health for the vaginoplasty. It required documentation from counselors and health professionals, indicating that she was in a stable frame of mind to make the decision to have sex reassignment surgery.

Miller had looked into getting a vaginoplasty from a San Francisco surgeon who accepts Apple Health, but that surgeon had a three-year waiting list, she said.

If Pullman Regional Hospital continues to offer vaginoplasty, Miller said it could fill a gap in care for transgender patients in Eastern Washington, Idaho, Montana and even parts of Utah.

Miller had praise for her care at Pullman Regional Hospital during the recent surgery. She also was pleased to see commenters on KXLY-TV’s Facebook page questioning why the hospital board was taking public comment.

“That shows that they value other people’s privacy,” Miller said. “They don’t think it should be anyone else’s business.”

Public comment

As a public hospital, Pullman Regional is governed by an elected board of commissioners. It’s not unusual for the hospital board to take public comments, particularly on controversial topics, said Adams, the hospital’s chief executive.

After Washington’s Death with Dignity initiative passed in 2008, which allows terminally ill patients to end their lives with drugs prescribed by a physician, the board sought public input as it developed hospital policies.

“We find it valuable to engage with the community, to draw on their insights and observations, especially when making more complex decisions,” he said.

The hospital board is accepting public comments on sex reassignment surgery through Monday, but Adams said he doesn’t know when a decision will be made.

The board has a regularly scheduled meeting at 6 p.m. Wednesday. Board members will be discussing sex reassignment surgery, but not accepting public comment at that time. No decision is expected.

Oregon Health and Science University performs about 15 sex reassignment surgeries per week, including facial, top and bottom surgeries, said Tracy Brawley, an OHSU spokeswoman. OHSU also accepts Apple Health insurance.

But since vaginoplasty remains relatively rare in the region, “there’s a gap in the information we’d typically expect to see,” Adams said. That includes information about demand for the surgery, cost of care, insurance coverage and patients’ post-operative needs, he said.

Miller was in the hospital for five days, which is typical after a vaginoplasty. That’s longer than Pullman Regional’s three-day average stay, so the surgeries have potential impacts on staffing, Adams said.

The two recent surgeries in Pullman helped provide insights into costs and care, he said.

“We learned some good things that will help us continue to be successful if we decide to offer this on an ongoing basis,” Adams said.