Christina Ketcham is a 60-year-old transgender woman who worked for Clatsop County for nearly thirty years. She started her transition over four years ago and continues to experience significant distress from the incongruence between her typically masculine facial features and her identity as a woman. To alleviate that distress, Christina’s treating healthcare providers determined that certain facial feminization procedures are medically necessary to treat her gender dysphoria. But, the health insurance offered by her employer, and administered by Regence Bluecross Blueshield of Oregon, has a categorical exclusion for all facial feminization procedures. Based on that exclusion, Regence refused to cover any of Christina’s medically necessary facial feminization surgeries. After Christina notified Clatsop that she intended to sue them for the denial of coverage, a senior Clatsop executive referred to Ms. Ketcham as “the enemy” in a meeting room full of colleagues in retaliation. Christina reported the incident, but Clatsop failed to fully and fairly investigate the incident.

On July 18, 2019, the National Center for Lesbian Rights, Meyer Stephenson, and Debevoise & Plimpton LLP filed a lawsuit against Regence, Clatsop County, and CityCounty Insurance Services (CIS), the governmental entity that funds Clatsop County’s health insurance plan. The lawsuit, filed in Multnomah County Circuit Court, alleges claims under Oregon law for unlawful discrimination and retaliation. On September 23, 2019, Regence moved to dismiss Christina’s complaint, claiming that Oregon’s antidiscrimination laws do not apply to its conduct in maintaining and administering the health insurance plan. Shortly thereafter, the parties agreed to stay the litigation to allow the parties to engage in mediation, which occurred on January 8, 2020. Christina agreed to settle her claims against Clatsop and CIS in exchange for a signifcant amount of monetary damages, attorneys fees, and coverage for her facial feminization surgery. The claims against Regence are still pending.