Judge curbs Florida probe into U.S. medicine's trans treatment standards
A legal battle over Florida's ban on Medicaid spending for gender-affirming medical care spilled into Washington on Thursday as a federal judge partially granted an urgent request by 18 American medical and mental health groups to quash subpoenas sent to them by the state after they opposed the prohibition.
The professional associations accused Florida of targeting members such as the American Academy of Pediatrics, the American Psychological Association and the Endocrine Society after they expressed the widely accepted medical view that care such as puberty blockers, hormones and gender transition surgery can be appropriate treatment for transgender youth and adults.
The groups spoke out last fall in support of a lawsuit filed by four transgender patients and their parents to overturn the ban in federal court in Tallahassee. But the organizations said state officials responded with a "highly inappropriate and invasive" fishing expedition for internal documents and communications about their policy positions. They accused the state of hunting for "supposed internal dissent" and bias in the service of an attack on the guidelines and credibility of the groups "from the inside-out."
The state's search for internal voting results and deliberations could have a chilling effect on U.S. and international medical practitioners and researchers' First Amendment rights to association, and the "candid, uninhibited dialogue" vital to their missions and the scientific process, attorney Cortlin H. Lannin said.
However, attorneys for Florida's Agency for Health Care Administration challenged the groups' authority and basis for setting treatment guidelines.
"Openness and transparency are hallmarks of the scientific method," lead Florida attorney Mohammad O. Jazil wrote to the court. "Casting themselves in the underlying case as the standard bearers of the prevailing scientific view regarding gender dysphoria treatment," the associations now seek to shield how they reached that view from any scrutiny and whether it "is the result of careful study and debate among their memberships or the result of a handful of people dictating a result."
After an hourlong hearing Thursday, U.S. District Judge Carl J. Nichols sharply narrowed Florida's request ahead of a fast-approaching Feb. 2 deadline in the underlying Tallahassee lawsuit.
But Nichols agreed that at least some information held by the groups was needed because it could answer the central question posed by the judge in Florida of whether it is reasonable for the state Medicaid agency to find that gender-affirming treatments are "experimental" given current medical knowledge.
The court fight and Thursday's ruling underscored how aggressively Florida Gov. Ron DeSantis (R) and his administration are pressing a state attack on transgender medical treatment, a wedge-issue selected by conservative politicians in the nation's culture wars, with not just transgender patients and their families in the crosshairs but increasingly doctors and the medical establishment.
The lawsuit was filed in Florida after the state's Medicaid agency ended funding for gender transition care in August, joining Texas and Alabama, and saying "only treatments that are found to be safe, effective, and that meet medical necessity criteria may be covered." The state's politically appointed Board of Medicine has since become the first to try to ban health-care professionals that it licenses from providing such treatment to minors, threatening violators with penalties, including loss of their medical license.
Since 2020, hundreds of bills have been introduced in about half of the 50 states targeting trans people and especially trans youth, with sponsors saying the policies are meant to protect children and families from harmful procedures they may later regret. But multiple professional medical organizations say treatment can reduce emotional distress for transgender young people and reduce the risk of suicide. The finding is supported by the largest U.S. study to date, published last week in the New England Journal of Medicine, and adding to a growing body of evidence that kids' mental health improves with gender-affirming treatment.
On Thursday, Nichols said the suing patients and their families leaned heavily on the public and wide acceptance of the standards of care set and endorsed "by every major medical organization in the United States" as evidence that such treatments are not experimental.
"I think that the question of how exactly the guidelines or policy statements were adopted and whether [they] therefore truly reflect the medical consensus is relevant here," Nichols said.
Nichols said he was not blind to Lannin's clients' concern over potential "harassment or interference" with their First Amendment rights. But he said that his order was tailored to prevent that and that it was outweighed by the relevance of information that only they might possess to resolve a dispute over the best available science and medical expertise.
"The state can provide its own scientific evidence and testimony, but I don't think it could discover the question about how the guidelines exactly were arrived at here without obtaining the requested information," Nichols said.
He added that U.S. District Judge Robert Hinkle in Tallahassee has blessed a "free-ranging inquiry based on whatever each side can muster" on that question.
Still, Nichols sharply curtailed the scope of the state's information requests. The judge ordered the U.S. health associations to turn over records "sufficient to show" their total membership; how they establish guidelines and policy positions, including for gender-affirming care for gender dysphoria; and any "official communication" with their entire membership concerning specifically the latter.
He rejected the Florida agency's demand for "any" such records and for "any documents and communications" such as internal emails showing who was involved in policy formation, adding that individually identifying information of members could be redacted and barred from public disclosure.
Nichols also denied the state's request for records detailing any contact with plaintiffs or any consideration of risks and side effects of gender-dysphoria treatment, saying such information was already being handed over. And he barred as premature Florida's demand to interview under oath representatives of the pediatrics academy, endocrinology society and the World Professional Association for Transgender Health, of which the latter two set the clinical guidelines in question.
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The Washington Post's Anne Branigin contributed to this report.
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