Nurse fears transgender patients will ‘fall through the cracks’ as Brampton clinic faces shut down

By: Angelyn Francis, Local Journalism Initiative Reporter, Toronto Star
When Erin Ziegler first had a patient disclose their gender transition in  2013, she welcomed them, but Ziegler also realized she had some learning to  do.
The nurse practitioner at Wise Elephant Family Health Team (WEFHT), a medical  clinic in Brampton, sought training from Rainbow Health Ontario on providing  gender affirming care. Within a few years, the transgender medicine program  became official and in 2018, every worker at WEFHT was trained to serve the  trans community.
“That one patient … opened my eyes to the needs of this community,” said  Ziegler, director of WEFHT’s transgender medicine program.
But in December 2020, the province of Ontario sent a letter to WEFHT pulling  its funding and directing it to close at the end of March 2021. The matter is  now in court with a hearing set for April 28 to decide the fate of the  clinic.
If the family health team closes, Brampton will lose one of its only health  clinics offering gender affirming care for the trans community. Not to mention  the total 7,000 patients WEFHT serves every year who also have to find a new  clinic.
Family health teams are unique and are staffed by a variety of health-care  workers — registered nurses, nurse practitioners, dietitians, social workers and  psychologists — in order to provide wraparound service and help vulnerable  populations.
The pending closure hasn’t stopped the need for WEFHT’s gender care  program.
“We are continuing to get referrals every week for our program,” Ziegler told  the Star in early March. “I got two today.”
“I worry for my patients that if our clinic is not there, where will they  go?” Ziegler said. “I think a lot of the patients would get lost in the system  or fall through the cracks.”
Leaders at WEFHT are worried that the province doesn’t understand that it’s  not as simple as moving the transgender medicine program, and its other programs  to another location, should WEFHT close.
Ziegler has been having conversations with her patients about their options  should WEFHT close, and she says she’s been met with “worry,” “anxiety” and  “stress.”
When she’s suggested linking them with another provider, patients will ask,  “Well, is that provider in a safe place. I trust you. How am I supposed to trust  somebody else?” she said.
Tripp Smith, 32, has been a patient of Ziegler’s for four years.
“Being able to see Erin and her helping me along my journey, 110 per cent  saved my life,” he said.
Smith heard about WEFHT from a friend and says he “lucked out” finding a  place that has made him feel so comfortable and safe.
He and five others in his life who also use the trans health program are at a  loss for what they will do if it shuts down at the end of the month.
“We have no idea where we’re going to go,” Smith said. “It’s hard enough for  us — for anyone — to really find a family physician.” But looking for something  so specific makes matters even more difficult.
Over the years, Ziegler said she has seen more than 300 patients through  WEFHT’s trans program from all over the province. There is no catchment area for  the program, which has made it an accessible option for people from Brampton and  beyond.
Currently, 150 patients use the trans program, which offers gender affirming  care through hormone therapy and surgery, but also provides information for  people who may just be contemplating taking these steps. Of the 150, fewer than  10 have a regular family doctor according to Ziegler.
Valerie, 16, had been looking for a place to talk about transitioning since  she was 14.
“There was definitely a point where I was considering, like, OK, how do I get  to Toronto and get back within one day on my own?” she said.
But when a counsellor referred her to WEFHT, it only took a 10-minute bus  ride.
Valerie isn’t out to her parents as yet, so there were limits to the kind of  gender care she could receive, but the staff at WEFHT has helped her take steps  — from blood tests, to answering questions.
“It was definitely … freeing from this idea that I had to deal with my care  on my own,” Valerie said. “They were at least partially giving me a piece of  that puzzle.”
“It’s an unbelievable privilege to go on the journey with them,” Ziegler  said, “and see them grow and develop and become confident and live their true  selves.”
Several patients have written testimonials calling the clinic  “indispensable,” and saying it is the only place they trust to do their  transition.
And amid the province’s decision to pull funding for the clinic, the trans  community in Brampton will lose an accessible and safe health-care program.
In December 2020, when WEFHT chair of the board Elaine Moore received the  letter to close from the province, she was surprised.
“We were quite taken aback,” said Moore, a former Brampton city  councillor.
One issue that is on the table is family health teams must be affiliated with  a physician group to operate. The founding physicians of WEFHT left  in 2019.
In order to remedy this, WEFHT asked to create a new agreement with the  province, so that it can rebrand under a new name and form a partnership with  new physicians. According to the clinic, the province did not respond to those  requests.
Instead, the province has decided to have WEFHT close. In the letter, the  ministry cites a section of the funding agreement that allows it to terminate  without cause with 90 days notice.
As the matter is still being dealt with by the divisional court, the Ministry  of Health would not comment on this story.
Lawyers representing WEFHT and the ministry will be back in court on April  28.
“We’re concerned about the ministry’s approach of cannibalizing this program,  all of our programs, quite frankly. They are unique,” said Moore, who was a  patient of WEFHT prior to joining the board.
In addition to gender care, WEFHT also serves members of the homeless  population and others who for whatever reason do not have a primary  physician.
“You have a group of highly vulnerable patients that could very well choose  not to seek health care,” Moore said.