GB

*66 Opinion

In 1975, the appellant, hereinafter referred to as G. B., consulted Dr. John Brown, a plastic surgeon, who diagnosed him as suffering from gender identity dysphoria or transsexualism. Dr. Brown determined that it was medically necessary and reasonable to perform surgeiy, which would involve the removal of the male sex organs and construction of female genitalia.

Dr. Brown filed a treatment authorization request with the San Francisco Medi-Cal field office. The request was denied by Dr. Wayne Erdbrink, a Medi-Cal consultant who is an ophthalmologist. No examination of any kind was ever performed on G. B. by the Department of Health.

G. B. requested a hearing pursuant to Welfare and Institutions Code section 10950 and got it. It was held in San Francisco on October 28, 1975, before Lester Lisker, a referee for the Department of Health, who ordered the treatment authorization request be granted.

The order of the referee was reversed by the Director of the California Department of Health (hereinafter referred to as Director). His refusal to authorize Medi-Cal to pay for the proposed surgery is set forth in a document entitled “Decision of the Director” and was signed…

I dissent. I would hold that respondent, Dr. Jerome Lackner, the Director of the Department of Health (Director), acted within his discretion in refusing to extend the benefits of the *72 Medi-Cal program to authorize payment for appellant’s transsexual surgery. 1

The majority today embarks upon a dangerous course of judicial intermeddling with the policy decisions of the Department of Health. If this operation must be funded, Medi-Cal will be forced to authorize other surgical treatments as “cures” for neuroses. The Legislature has vested the Director with adequate discretion to. determine the parameters of the Medi-Cal program. If the Legislature wishes the State of California to pay for transsexual operations, it may so provide. That is not a matter in which this court should become involved.

I. California Statutory Law

Medi-Cal is California’s state plan for participation in the federal Medicaid program. ( 42 U.S.C. § 1396 et seq.) The details of this plan are embodied in the Medi-Cal Act. (Welf. & Inst. Code, § 14000 et seq.) The Director is charged with the duty of making policy. (Welf. & Inst. Code, § 14105; California Assn, of Nursing Homes etc., Inc. v. Williams (1970)…

In 1975, the appellant, hereinafter referred to as G.B., consulted Dr. John Brown, a plastic surgeon, who diagnosed him as suffering from gender identity dysphoria or transsexualism. Dr. Brown determined that it was medically necessary and reasonable to perform surgery, which would involve the removal of the male sex organs and construction of female genitalia.

Dr. Brown filed a treatment authorization request with the San Francisco Medi-Cal field office. The request was denied by Dr. Wayne Erdbrink, a Medi-Cal consultant who is an ophthalmologist. No examination of any kind was ever performed on G.B. by the Department of Health.

G.B. requested a hearing pursuant to Welfare and Institutions Code section 10950 and got it. It was held in San Francisco on October 28, 1975, before Lester Lisker, a referee for the Department of Health, who ordered the treatment authorization request be granted.

The order of the referee was reversed by the Director of the California Department of Health (hereinafter referred to as Director). His refusal to authorize Medi-Cal to pay for the proposed surgery is set forth in a document entitled "Decision of the Director" and was…