Editor’s note: If you or anyone you know is struggling with mental health, there are a number of ways to get help, including by calling or texting the Suicide Crisis Helpline at 988. A list of local crisis centres is also available here.
The B.C. Human Rights Tribunal has found that a family doctor discriminated against his young transgender patient by refusing to give her a puberty-blocking medication, awarding a total of $28,100 in damages.
The complaint against Dr. Henry Ajaero stems from a March 2021 appointment involving a patient, referred to as “Child Q” in the tribunal’s decision, who was 14 years old at the time and had recently been prescribed Lupron by a pediatric endocrinologist to pause puberty.
“The onset of her endogenous puberty had been distressing for her, to the point that she contemplated ending her own life,” reads BCHRT vice-chair Devyn Cousineau’s decision, which describes Lupron and the time it afforded her as a lifeline. “But her mental health was still precarious when she went to see Dr. Ajaero.”
According to the decision, Ajaero had been Child Q’s family doctor for four years at that point and, at her mother’s request, had referred her to the B.C. Gender Clinic months prior to the appointment.
What happened at the appointment
The decision explains that on the day of the appointment, Ajaero learned what the Lupron was for and decided he did not feel comfortable administering the injection, believing it was for “gender reassignment.”
He privately told the patient’s mother that he would not provide the treatment for “religious and cultural reasons,” and that no one else in the clinic could administer it.
According to the decision, Child Q and her mother left and ultimately found a walk-in clinic that administered the injection that day.
The tribunal noted that Lupron injections were required every three to four weeks under Child Q’s treatment plan, and it had been four weeks and one day since her last injection.
“This timing is important. A delay can cause testosterone to come back into the body,” the decision explains.
The tribunal also found that Child Q was “misgendered and deadnamed,” both by Ajaero during her appointment and by an office assistant during a nearly two-hour wait in the clinic, despite her mother’s objections.
“Child Q’s gender identity was not respected. Her dignity was not upheld,” Cousineau wrote.
Doctor’s defence
Ajaero told the tribunal his refusal was based on two standards—religious and expertise.
He testified that he believed “God created man and woman,” and said providing any care related to “gender reassignment” went against his religious beliefs.
Ajaero also told the tribunal he shouldn’t be required to provide care he was not qualified to deliver, including administering Lupron for the first time.
The tribunal found that Ajaero had relied on “impressionistic assumptions” about Lupron and gender-affirming care and did not adequately investigate whether administering the injection was actually outside his expertise.
The tribunal also highlighted the fact that Ajaero had previously supported some of Child Q’s gender-affirming care, including by referring her to the Gender Clinic.
“The evidence before me is that Dr. Ajaero is prepared to deliver some gender-affirming medical services without compromising his religious beliefs,” Cousineau wrote in her decision. “Dr. Ajaero has not explained why administering an injection of Lupron—a medication prescribed and overseen by another doctor to pause puberty—crosses the line.”
The impact
The tribunal found Ajaero’s refusal to administer Lupron to Child Q particularly significant because of her age, mental health and vulnerability.
According to the decision, Child Q had come out as trans in the spring of 2020 and her mental health had declined so much by the end of that year that she was self-harming and having suicidal thoughts “with a plan.”
During a telephone appointment that December with her mother, Ajaero was informed that Child Q had been hoarding Tylenol and had written a suicide note, at which point he wrote her a prescription for Ativan.
The decision noted that the college was later critical of his failure to “ensure Child Q’s suicidality was being addressed with another professional.”
Child Q addressed the suicide note during the tribunal hearing, telling the panel “I had written about how I couldn’t wait any more for myself to…experience male puberty and to keep going through that…so it was shattering in that moment to hear that I was not going to be able to receive the shot.”
Cousineau found that the refusal compounded Child Q’s vulnerability at a time when she was already struggling with severe mental health challenges.
Damages
The tribunal awarded Child Q $20,000 for injury to dignity, feelings and self-respect, finding the amount “recognizes the serious impact that the discrimination had on a vulnerable trans youth, while she was seeking important and publicly funded medical services from her family doctor.”
Ajaero was also ordered to compensate Child Q for the $8,100 she paid to obtain expert evidence for the hearing.
