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Senate committee: Republican attorneys general abused power demanding trans medical records

AGs used ‘abusive legal demands’

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U.S. Senate Finance Committee hearing room in the Dirksen Senate Office Building. (Photo courtesy of the U.S. Senate Finance Committee)

In a 10-page report released on Tuesday by staff for the Democratic majority of the U.S. Senate Finance Committee, the Republican attorneys general of Tennessee, Missouri, Indiana, and Texas are accused of using “abusive legal demands” to collect the medical records of transgender patients in furtherance of the attorneys general’ “ideological and political goals.”

According to the document, which is titled “How State Attorneys General Target
Transgender Youth and Adults by Weaponizing the Medicaid Program and their Health Oversight Authority,” the attorneys general used specious or misleading legal pretexts to justify their issuance of civil investigative demands to healthcare providers.

For example, the office of Tennessee Attorney General Jonathan Skrmetti framed the request as part of a probe into the potential misuse of Medicaid funds, while the offices of Indiana Attorney General Todd Rokita and Missouri Attorney General Andrew Bailey cited suspected violations of consumer protection laws. The office of Texas Attorney General Ken Paxton, which demanded records from “at least two hospitals located in Texas as well as at least two medical providers” in Washington and Georgia, did not disclose why the requests were issued.

The report found that information requested by the attorneys general’s offices included “invasive items such as unredacted physical and mental health records, photographs of childrenā€™s bodies, correspondence to hospitalsā€™ general email addresses for LGBTQIA+ patients, and lists of people referred for transgender health care.”

In response, and in what the committee called “a grave violation of patient privacy and trust,” some providers turned over “near-complete, patient-identifiable” information while others used legal processes available to them such as privacy protections in the Health Insurance Portability and Accountability Act to share fewer details with the attorneys general’s offices.

The report noted that Vanderbilt University Medical Center in Nashville had “failed to object in any material manner to the Tennessee attorney generalā€™s sweeping request and then caused undue terror to young patients and their families by supplying the Tennessee attorney general with some of the records requested and then, again, by erroneously notifying some patients of medical record disclosures that had not occurred.”

News concerning Vanderbilt’s receipt of and compliance with the demands from Skrmetti’s office was made public in June, sparking widespread concern and panic among many of the center’s trans patients and their families. Some, according to the report, experienced suicidal ideation and emotional distress including depression and anxiety.

A plaintiffs’ lawsuit was filed in July over VUMC’s failure to redact personally identifying information from the medical records. The following month, the center disclosed plans to comply with an investigation by the U.S. Department of Health and Human Services Office of Civil Rights.

In a statement to NBC News, Michael Regier, the medical centerā€™s general counsel and secretary, said the hospital disputes the findings published in the committee’s report and had submitted “a detailed letter outlining our concerns about its proposed findings before it was released.ā€ 

“We made every effort to both protect our patients and follow the law,ā€ Regier said, adding that “At no point did we violate privacy laws, and we strongly disagree with any suggestion that we did.”

However, the committee’s report notes that by contrast, providers in other states like the Washington University School of Medicine in St. Louis refused to turn over patient records, citing privacy concerns and HIPPA regulations. And after staff for U.S. Sen. Ron Wyden (D-Ore.), the committee chair, had requested and reviewed copies of correspondence between VUMC and the Tennessee attorney general’s office, they concluded that the documentation “sheds light, for the first time, on the full extent of VUMC’s acute and repeated failures to protect its patients.”

For example, the report explains that after Skrmetti’s office issued the initial request to VUMC, it followed up with two additional civil investigative demands for “confidential information across 18 categories without any bounds on the number of patients or people implicated” ranging from “employment contracts for physicians to volunteer agreements for the
VUMC Trans Buddy Program to communications to and from a general email address.”

In response, the hospital shared “65,000 pages of documents, including the medical records of 82 transgender patients.” The information that was provided pursuant to receipt of Skrmetti’s office’s third civil investigative demand is unknown.

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National

United Methodist Church removes 40-year ban on gay clergy

Delegates also voted for other LGBTQ-inclusive measures

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Underground Railroad, Black History Month, gay news, Washington Blade
Mount Zion United Methodist Church is the oldest African-American church in Washington. (Washington Blade photo by Michael Key)

The United Methodist Church on Wednesday removed a ban on gay clergy that was in place for more than 40 years, voting to also allow LGBTQ weddings and end prohibitions on the use of United Methodist funds to ā€œpromote acceptance of homosexuality.ā€ 

Overturning the policy forbidding the church from ordaining ā€œself-avowed practicing homosexualsā€ effectively formalized a practice that had caused an estimated quarter of U.S. congregations to leave the church.

The New York Times notes additional votes “affirming L.G.B.T.Q. inclusion in the church are expected before the meeting adjourns on Friday.” Wednesday’s measures were passed overwhelmingly and without debate. Delegates met in Charlotte, N.C.

According to the church’s General Council on Finance and Administration, there were 5,424,175 members in the U.S. in 2022 with an estimated global membership approaching 10 million.

The Times notes that other matters of business last week included a “regionalization” plan, which gave autonomy to different regions such that they can establish their own rules on matters including issues of sexuality ā€” about which international factions are likelier to have more conservative views.

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Federal Government

Republican state AGs challenge Biden administration’s revised Title IX policies

New rules protect LGBTQ students from discrimination

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U.S. Secretary of Education Miguel Cardona (Screen capture: AP/YouTube)

Four Republicans state attorneys general have sued the Biden-Harris administration over the U.S. Department of Education’s new Title IX policies that were finalized April 19 and carry anti-discrimination protections for LGBTQ students in public schools.

The lawsuit filed on Tuesday, which is led by the attorneys general of Kentucky and Tennessee, follows a pair of legal challenges from nine Republican states on Monday ā€” all contesting the administration’s interpretation that sex-based discrimination under the statute also covers that which is based on the victim’s sexual orientation or gender identity.

The administration also rolled back Trump-era rules governing how schools must respond to allegations of sexual harassment and sexual assault, which were widely perceived as biased in favor of the interests of those who are accused.

ā€œThe U.S. Department of Education has no authority to let boys into girlsā€™ locker rooms,ā€Ā Tennessee Attorney General Jonathan Skrmetti said in a statement. ā€œIn the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms.”

“Florida is suing the Biden administration over its unlawful Title IX changes,” Florida Gov. Ron DeSantis wrote on social media. “Biden is abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”

After announcing the finalization of the department’s new rules, Education Secretary Miguel Cardona told reporters, ā€œThese regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights.”

The new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, a question that is addressed in a separate rule proposed by the agency in April.

LGBTQ and civil rights advocacy groups praised the changes. Lambda Legal issued a statement arguing the new rule ā€œprotects LGBTQ+ students from discrimination and other abuse,ā€Ā adding that it “appropriately underscores that Title IXā€™s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.”

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Federal Government

4th Circuit rules gender identity is a protected characteristic

Ruling a response to N.C., W.Va. legal challenges

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Lewis F. Powell Jr. Courthouse in Richmond, Va. (Photo courtesy of the U.S. Courts/GSA)

BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.

Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.

In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.

The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.

In West Virginia, a similar exclusion applied to those on the stateā€™s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.

Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care ā€œapply to everyone, not just transgender people.ā€ The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans ā€œapplying to straight, gay, lesbian, and bisexual people equally,ā€ even though straight people would be entirely unaffected by such bans.

Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.

See this portion of the court analysis here:

4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’

Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.

Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.

The majority was unconvinced, ruling, ā€œgender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.ā€ In doing so, the majority cited several cases, many from after Geduldig was decided.

Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.

The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use ā€œXX chromosomesā€ and ā€œXY chromosomesā€ to get around sex discrimination policies:

The 4th Circuit majority rebuts the stateā€™s proxy discrimination argument.

Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Actā€™s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”

Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.

Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.

The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people.Ā Twenty-one Republican statesĀ filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic statesĀ joined an amicus brief in support of the healthcare rights of trans individuals.

Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuitā€™s jurisdiction, West Virginia and North CarolinaĀ already have gender-affirming care bans for trans youth in place, andĀ South Carolina may consider a similar bill this week.

The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolinaā€™s bill from passing into law.

The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, theĀ Supreme Court recently narrowedĀ a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.

Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.

Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, ā€œThe courtā€™s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful ā€¦ We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.ā€ 

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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