美国国家公共电台 NPR--More states increasingly restrict access to medical care for transgender people

More states increasingly restrict access to medical care for transgender people

Transcript²

Laws passed in Florida and Texas will restrict the care available to transgender persons. NPR's Leila Fadel talks to Joseph Knoll³, a nurse-practitioner⁴, about how the restrictions⁵ affect his patients.

LEILA FADEL, HOST:

Access to medical care for transgender people is being restricted in several states where Republicans hold majorities in the legislature. And the number of bans is growing. This week, lawmakers in Texas approved a ban on gender¹ affirming care for minors⁶. In Florida, Governor Ron DeSantis signed a similar ban into law that also restricts some care for trans adults. So what does this mean for medical providers and for their patients? To understand that, we're joined by Joey Knoll, a nurse practitioner and the medical services director at SPEKTRUM Health, a community health center in Orlando, Fla. Good morning, Joey.

JOEY KNOLL: Good morning, Leila.

FADEL: So what care under this new ban can you and can't you provide to your transgender patients now that this ban is law?

KNOLL: Yeah. Essentially⁷, we can continue to provide primary care services to our patients. But the prescribing of any hormones⁹ or gender affirming specific regimens are completely banned.

FADEL: So what happens to patients who are in the middle of that type of treatment, hormone⁸ therapy treatment? What happens to them?

KNOLL: Yeah, well, we anticipated this coming, so we rushed to see all of our patients and make sure that they had plenty of prescription¹⁰ medications available to get them through as we navigate¹¹ this and come up with a more long-term solution for their needs.

FADEL: In a recent editorial, you wrote that this ban is a, quote, "cruel and unconscionable, unscientific experiment on young people's bodies" and that Florida's governor is, quote, "cutting off lifesaving support for transgender young people in order to gain attention for his own political career." Can you tell me why this risks young people's lives?

KNOLL: Well, what makes it especially cruel is that we're banning health care. We're banning access to health care. And the DeSantis administration has gone further to restrict educational resources as well. Their argument has been that there's no science to support this, which is factually inaccurate¹². But if they were really concerned with the health and well-being¹³ of Floridians, why would they go to the great lengths of ensuring that universities are not allowed to spend any funds to do any research on this matter?

FADEL: What are your patients asking you in the middle of all this? You said you were preparing your patients. What were they asking you? And what are they saying now?

KNOLL: The biggest question I get from my patients is, do I need to leave Florida? Am I safe here?

FADEL: What about you? How have you adjusted so that you don't run afoul of this new law?

KNOLL: Oh, great question. You know, we're taking great lengths to be compliant¹⁴ and follow all the rules that we can, and also interpret it to ensure that we can do our best to meet the needs of our patients. So to try to navigate it, it's a matter of working with partners inside and outside the states just to bridge access and in the hopes that nobody loses complete access. But this is all happening in real time. And we're already starting to see people that are struggling with access.

FADEL: So what does that actually look like? When you say bridging that access, are you telling your patients to go to another state to get the care they need? I mean, how are you doing that? And what are the consequences for you if you do break this new law?

KNOLL: Yeah, good questions. So we are working with some of our out-of-state colleagues that are going to visit Florida. We have, you know, thousands and thousands of patients who need access to care. And the law does allow, at some point, MDs and DOs to be able to continue these services. It just happens that our organization, like a lot of organizations, is comprised of nurse practitioners¹⁵. And myself and my colleagues in my practice, we are autonomous¹⁶ nurse practitioners, which means we do not have a requirement to tether to a physician. So we find ourselves in the situation where we did not have an MD or DO. So we're working with some physicians outside of state that will travel to Florida intermittently¹⁷ to serve these patients.

FADEL: Now, for people who actually agree with what the governor has done, who say maybe minors are too young to make these decisions about their bodies, what would you say to them?

KNOLL: Yeah, I would say that they probably haven't spent enough time getting to know trans people. The rhetoric¹⁸ that the governor and, you know, the rest of the opponents to GAC keep using is that they want to protect kids, help kids be kids. The truth is, we're not talking about 5 and 6-year-olds. We're talking about 16, 17, 18-year-olds. And so I think that preserving access to care for these individuals is important. And if we were worried about health and safety, we would ensure that people already on treatment would be able to continue.

FADEL: Joey Knoll is a nurse practitioner and the medical services director at SPEKTRUM Health. Thank you so much.

KNOLL: Thank you.

1 gender   

n.（生理上的）性，（名词、代词等的）性

参考例句：

• French differs from English in having gender for all nouns.法语不同于英语，所有的名词都有性。
• Women are sometimes denied opportunities solely because of their gender.妇女有时仅仅因为性别而无法获得种种机会。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 knoll   

n.小山，小丘

参考例句：

• Silver had terrible hard work getting up the knoll.对于希尔弗来说，爬上那小山丘真不是件容易事。
• He crawled up a small knoll and surveyed the prospect.他慢腾腾地登上一个小丘，看了看周围的地形。

4 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

5 restrictions   

约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则）

参考例句：

• I found the restrictions irksome. 我对那些限制感到很烦。
• a snaggle of restrictions 杂乱无章的种种限制

6 minors   

n.未成年人( minor的名词复数 )；副修科目；小公司；[逻辑学]小前提v.[主美国英语]副修，选修，兼修( minor的第三人称单数 )

参考例句：

• The law forbids shops to sell alcohol to minors. 法律禁止商店向未成年者出售含酒精的饮料。 来自《简明英汉词典》
• He had three minors this semester. 这学期他有三门副修科目。 来自《简明英汉词典》

7 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

8 hormone   

n.荷尔蒙，激素，内分泌

参考例句：

• Hormone implants are used as growth boosters.激素植入物被用作生长辅助剂。
• This hormone interacts closely with other hormones in the body.这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。

9 hormones   

n. 荷尔蒙，激素 名词hormone的复数形式

参考例句：

• This hormone interacts closely with other hormones in the body. 这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。
• The adrenals produce a large per cent of a man's sex hormones. 肾上腺分泌人体的大部分性激素。

10 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

11 navigate   

v.航行，飞行；导航，领航

参考例句：

• He was the first man to navigate the Atlantic by air.他是第一个飞越大西洋的人。
• Such boats can navigate on the Nile.这种船可以在尼罗河上航行。

12 inaccurate   

adj.错误的，不正确的，不准确的

参考例句：

• The book is both inaccurate and exaggerated.这本书不但不准确，而且夸大其词。
• She never knows the right time because her watch is inaccurate.她从来不知道准确的时间因为她的表不准。

13 well-being   

n.安康，安乐，幸福

参考例句：

• He always has the well-being of the masses at heart.他总是把群众的疾苦挂在心上。
• My concern for their well-being was misunderstood as interference.我关心他们的幸福，却被误解为多管闲事。

14 compliant   

adj.服从的，顺从的

参考例句：

• I don't respect people who are too compliant.我看不起那种唯命是从，唯唯诺诺的人。
• For years I had tried to be a compliant and dutiful wife.几年来，我努力做一名顺从和尽职尽职的妻子。

15 practitioners   

n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师）

参考例句：

• one of the greatest practitioners of science fiction 最了不起的科幻小说家之一
• The technique is experimental, but the list of its practitioners is growing. 这种技术是试验性的，但是采用它的人正在增加。 来自辞典例句

16 autonomous   

adj.自治的；独立的

参考例句：

• They proudly declared themselves part of a new autonomous province.他们自豪地宣布成为新自治省的一部分。
• This is a matter that comes within the jurisdiction of the autonomous region.这件事是属于自治区权限以内的事务。

17 intermittently   

adv.间歇地；断断续续

参考例句：

• Winston could not intermittently remember why the pain was happening. 温斯顿只能断断续续地记得为什么这么痛。 来自英汉文学
• The resin moves intermittently down and out of the bed. 树脂周期地向下移动和移出床层。 来自辞典例句

18 rhetoric   

n.修辞学，浮夸之言语

参考例句：

• Do you know something about rhetoric?你懂点修辞学吗？
• Behind all the rhetoric,his relations with the army are dangerously poised.在冠冕堂皇的言辞背后，他和军队的关系岌岌可危。