¶ … healthcare services, many people could encounter some form of discrimination on the basis of their race, gender, or even sexual orientation. Discrimination in healthcare may seem like it is not something that is a major issue. However, it absolutely does come up in many situations, states and environments. Whether based on gender, religion, race or sexuality, discrimination happens at overt or implied levels all of the time. In other situations, there are huge disparities in healthcare outcomes from one group to another and many experts say that this can only come from systemic or sporadic instance of racism from the healthcare sphere, from society in general or a combination of the two. While most people get very good care, there are situations where the healthcare and/or government sectors fall short. It is important to note that although people are not always aware of this; there are various laws that seek to protect patients from differential treatment when seeking health care services. Specifically, patients are protected by Federal law from just about any kind of discrimination and are certainly protect ted by California law from just about any kind of discrimination. 2. Week 2 -- Literature Review

When researching this topic, so many types of discrimination were found that it is currently difficult to decide on one type among discrimination based on race, ethnicity, disabilities, gender or constitutionally unprotected discrimination based on the type of work. Consequently, the literature review is still eclectic but now also includes literature on sexual orientation bias.

a. Lillie-Blanton, M., Maleque, S., & Miller, W. (2008). Reducing racial, ethnic, and socioeconomic disparities in health care: Opportunities in national health reform. Journal of Law, Medicine & Ethics, 36(4), 693-702.

This is related to discrimination in healthcare because it focuses on the need for systemic changes to reduce discrimination. Health and Welfare policy tends to concentrate on reducing health care disparities at the provider level; however, system-wide reforms are needed to insure individuals, make healthcare more available in all geographic areas, use a more diverse workforce in providing healthcare, and encouraging best practices on the clinical level to reduce health care disparities (Lillie-Blanton, Maleque, & Miller, 2008).

b. Pirruccello, J. E. (2005). Contingent worker protection from client company discrimination: Statutory coverage, gaps, and the role of the common law. Texas Law Review, 84(1), 191-223.

This is an interesting and useful article because it focuses on a type of discrimination that is not classically protected by the Constitution: the growing class of contingent workers -- those who are not regular, full-time employees - in America who suffer in the lack of healthcare coverage and other normal employee benefits provided by client companies. These workers can belong to any race, ethnicity, gender identity or differing abilities but their existence as a transient workforce makes them vulnerable to falling through the cracks in health care coverage (Pirruccello, 2005).

c. Rothstein, M. A. (2015). Limiting occupational medical evaluations under the Americans with disabilities act and the genetic information nondiscrimination act. American Journal of Law and Medicine, 41(4), 523-567.

This article is valuable when discussing discrimination because many workers must undergo workplace medical evaluations to determine their fitness for the job. Because this area keeps evolving, the statutes and regulations protecting individual workers based on race, ethnicity, gender and disabilities are growing increasingly complex. This article explores the evolving, complex system of laws, and medical-ethics attempting to deal with the growing use of workplace medical evaluations (Rothstein, 2015).

d. Sheppard, V. B., Williams, K. P., Wang, J., Shavers, V., & Mandelblatt, J. S. (2014). An examination of factors associated with healthcare discrimination in Latina immigrants: The role of healthcare relationships and language. Journal of the National Medical Association, 106(1), 15-22.

This article is related to discrimination in healthcare because it addresses the specific types of discrimination endured by a quickly growing segment of the U.S. population: Latinas.

A number of them, particularly if they are foreign born, have very bad experiences in our healthcare system. This article explains the need for more research about the type, occurrence and frequency of discriminatory experiences in the system. It also explains the importance of good communications between patients and

Snead, B., Hsieh, P.-C., & Snethen, G. (2016). Sexual identity and discrimination: Creating a welcoming environment for sexual minority consumers. Therapeutic Recreation Journal, 50(2), 172-175.
This article shows the healthcare community's proactive approach to building and maintaining a welcoming environment for sexual minorities. Sexual minorities may delay or avoid addressing healthcare issues and even if they seek healthcare, they may withhold information from healthcare providers for fear of a negative reactions from healthcare providers. Experts have found that sexual minorities who reside in highly prejudiced communities experience 12 years earlier mortality than those living in areas where homosexuality is more commonly accepted. Consequently, the effect of sexual orientation discrimination in healthcare, and even the perception of discriminatory treatment, clearly impacts the health of sexual minorities. As a result, at least some sectors of the healthcare industry are fashioning a more openly accepting environment for sexual minorities to encourage their use of healthcare and their complete honesty with healthcare providers (Snead, Hsieh, & Snethen, 2016).

3. Week 3 -- Laws and Regulations

Both Federal and California laws and regulations deal with discrimination against all protected classes, including but not limited to race, gender and sexual orientation. As is often the case in civil rights issues, the Federal government leads the way and sets the tone, which is then followed by the states. Health insurers are prohibited, under the Affordable Care Act, from varying rates on the basis of an individual's health status or gender. An example: Patient A and Patient B should pay the same if they are comparable, regardless of the fact that one of the patients is a woman who on the basis of her gender could seek gynecological services from time to time (United States Congress, 2010). There is also the Age Discrimination Act (1975) which expressly prohibits discrimination by health care providers, particularly those who receive funds from the Department of Health and Human Services, on the basis of age (United States Congress, 1975). For instance: Patient an ought not to be denied organ transplant, if he or she is a prime candidate for the same, on the basis of his or her advanced age. Title VI of the 1964 Civil Rights Act also expressly prohibits discrimination on the basis of the nationality, color, race, or even age of an individual. In essence, this particular law largely applies to recipients of federal funds, including but not limited to Medicaid and Medicare. However, family health centers, day care facilities, adoption centers, and nursing homes are also covered by this law (United States Congress, 2016). An example: Patient A should not be provided with benefits or services that are NOT consistent with those offered to Patient B and C under a specific health care program. Following the federal government's lead, the State of California's laws and regulations also guard against discrimination in healthcare based on the protected categories, primarily by following Federal laws and regulations. The California Department of Health Care Services joins federal authorities in monitoring and enforcing the laws against discrimination in healthcare (California Department of Health Care Services, 2016),

4. Week 4 - Cases

f. Guadalupe T. Benitez v. North Coast Women's Care Medical Group, Inc. et al., (2001) San Diego County Superior Court Case No. GIC 770165, Appellate Case No. DO 45438.

Guadalupe Benitez is a lesbian who was refused requested infertility treatments commencing in 1999 due to her doctors' religious beliefs. Her doctors are conservative Christians who assert the "religious freedom" to withhold care from Benitez that they customarily provide to heterosexual patients. Benitez filed suit in San Diego Superior Court in 2001, which ruled in her favor in 2004 based on a clearly religiously-neutral civil rights law banning discrimination in healthcare based on sexual orientation. North Coast and its fellow defendants -- the offending doctors -- appealed to the California Court of Appeals. Sixteen associations, including but not limited to the California Women's Law Center, the Gay and Lesbian Medical Association and California Latinas for Reproductive Justice, filed amici curiae ("friends of the court") briefs in support of Benitez. In 2005, the Court of Appeals ruled that trial court's decision in Benitez' favor was premature and that the trial court should first hold a trial about whether the doctors violated the civil rights law before deciding whether religion can provide a defense to a civil rights claim. Benitez appealed that decision to the California Supreme Court. Thirty healthcare-related associations filed amici curiae brief supporting Benitez while sixteen conservative groups filed amici curiae briefs supporting North Coast's assertion that religious belief/freedom should allow them to deny healthcare to Benitez. In 2009, the California Supreme Court unanimously ruled in favor of Benitez, based on Federal and State law prohibiting discrimination. In 2009, the Parties reached settlement for an undisclosed…