ST. LOUIS COUNTY, Mo. — The Missouri ACLU on Monday sued to block new state restrictions on both adults and children seeking gender-affirming health care, which are set to kick in Thursday.
ACLU, Lambda Legal and Bryan Cave Leighton Paisner LLP attorneys representing transgender Missourians and health care providers asked a St. Louis County judge to stop the first-of-its-kind rule from taking effect.
They argue that Republican Attorney General Andrew Bailey has no authority to use a state consumer-protection law to regulate gender-affirming care through emergency rule-making.
The rule is "a baseless and discriminatory attempt to limit the healthcare options for transgender individuals, who already face several barriers accessing necessary and life-saving medical care,” said Dr. Samuel Tochtrop of plaintiff Southampton Community Healthcare, in a statement.
On Wednesday, Bailey attempted to get the case moved to federal court. That attempt was denied Wednesday afternoon when Judge Henry Autrey remanded the hearing back to Missouri state court.
“You can’t just file something in federal court because you’d like it to be in federal court," he said Wednesday. "There is this little thing that sometimes bites people in the behind called jurisdiction.”
Staff attorney with Lambda Legal, Nora Huppert, told 5 On Your Side the agency is representing Southampton Community Healthcare in St. Louis, a trans adult, and two anonymous families with transgender adolescents.
Before gender-affirming medical treatments can be provided by physicians, the regulation requires people to have experienced an “intense pattern” of documented gender dysphoria for three years and to have received at least 15 hourly sessions with a therapist over at least 18 months. Patients also would first have to be screened for autism and “social media addiction,” and any psychiatric symptoms from mental health issues would have to be treated and resolved.
Some individuals will be allowed to maintain their prescriptions while they promptly receive the required assessments.
Huppert explained, "The rule isn't limited to new patients. It applies to everyone. There is a provision that allows people to continue a specific intervention that has already begun, but the rule is so confusingly and vaguely designed. It also makes clear that people who are already pursuing gender-affirming care will have to comply with the new requirements to continue to access care."
She shared, they are concerned about health care providers looking at the language and deciding not to provide the care.
"Because they cannot interpret the rules and don't want to risk a felony," she added.
Bailey marketed the restrictions as a way to protect minors from what he describes as experimental treatments when he announced plans to create the rule in March. He applied limits to adults as well in the final rule.
“We have serious concerns about how children are being treated throughout the state. But we believe everyone is entitled to evidence-based medicine and adequate mental health care,” Bailey spokeswoman Madeline Sieren said after the rule was filed April 13.
A spokesperson with the Attorney General's office sent this statement following the lawsuit announcement:
"Our regulation enacts basic safeguards for interventions that an international medical consensus has determined to be experimental. Rather than ensure that patients are protected by common sense safeguards, these organizations are racing to court in an effort to continue their ideologically-based procedures masquerading as medicine.”
The rule is an unusual step by Missouri's attorney general, who has limited jurisdiction under state law. The office is responsible for defending state laws, handling felony criminal appeals, and prosecuting financial crimes and consumer fraud.
The lawsuit alleges the rule “is an improper, extra-legislative overreach by an un-elected political appointee” seeking to use the state's consumer-protection law, which plaintiffs describe as “an act purposed on making sure that cars are sold with titles and that hardware stores abide by a warranty on a vacuum.”
If the rule takes effect, doctors who provide gender-affirming health care must first provide a lengthy list of potential negative side effects and information warning against those treatments.
Health care providers will need to ensure “any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved” before providing gender-affirming treatments under the new rule. Physicians also must screen patients for social media addiction, autism and signs of “social contagion with respect to the patient’s gender identity.”
The FDA approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders or as birth control pills.
The FDA has not approved the medications specifically to treat gender-questioning youth. But they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat transgender patients say those decades of use are proof the treatments are not experimental.
Critics have raise concerns about children changing their minds. Yet the evidence suggests detransitioning is not as common as opponents of transgender medical treatment for youth contend, though few studies exist and they have their weaknesses.
Republican Senator Nick Schroer from St. Charles County said his concerns are on minors.
"These kids, in my opinion, are being experimented. When it comes to how we protect minor children in our state, we don't let them get tattoos, you don't let them in a rated movies, and they can't even tan. You can't go to a tanning bed in the state of Missouri unless you're 17 and with parental consent. I do think that it is paramount that we put the safety of our children first," he told 5 On Your Side.
He said through bill hearings and testimonies, he's able to meet some parents and individuals that have detransitioned.
"They have said they were pressured by these doctors," Schroer added. "This seems to be a social contagion where a lot of these kids, not only in the state of Missouri, but across the the country, are now seeing this as a cool trend."
James Thurow and his wife Danielle Meert are the former leaders of TransParent USA St. Louis Chapter and they say, they never felt this pressure.
The group gives support to parents of trans children.
Their 16-year-old son is trans.
Meert saw her son suffering academically and emotionally a few years ago.
When he came out as trans, Meert said they affirmed him and everything changed.
"He’s been thriving. He was failing in schools and now he's getting straight A’s and he has his first job and looking forward to college," she told 5 On Your Side.
Thurow added, "We love our kid and we never do anything to hurt him. They’re impeding on our parental rights, our kid’s bodily autonomy, it’s just so upsetting. It’s such an egregious overstep. My son just wants to be a kid and wants to live his life."
The duo has even talked about leaving the state.
But Meert said, they won't leave behind what they've built and fought for.
For the last few years, the two have made the trek from St. Louis to Jefferson City to battle over trans bills.
Meert believes this most recent ruling sends a message.
"It absolutely sends a message that our families are not welcomed here. That’s not what Jesus would do. My biggest message for the AG is to do your job and leave my kid alone and take care of actual problems in the state of Missouri," she shared.
Meert admits it's been a tough four years and said the last four weeks have been extremely hard.
That's why they are at ease this lawsuit is coming in.
She said, "I think last night was the first night I slept through the night in a long time."
The Missouri Chapter, American Academy of Pediatrics (MOAAP) is compromised of more than 1,000 pediatricians from across the state and released this statement on the ruling:
“The Missouri Chapter of the American Academy of Pediatrics, representing over 1,100 pediatricians across the state stands for the health and well-being of children and youth in Missouri through their important relationship with their doctor.
Transgender and gender-questioning youth should be focusing on learning, growing, and thriving – not whether they will be able to access evidence-based care that is supported across mainstream medical organizations. These proposals will harm young Missourians and the families, physicians, and communities that care for them.
The Missouri AAP stands with our physician members in their dedication to evidence-informed care in support of the families they care for in Missouri and across the country – today and every day.”
SQSH is a St. Louis Queer+ Support Helpline which offers support for queer and trans communities.
Staff say it's seen an uptick in calls following the AG's ruling.
The calls are related to trans Missourians' worries about their loss of access to gender-affirming healthcare.
We're told they've also seen a worsening in mental health, wellness, and optimism about life and living in Missouri.
Calls also included inquires of out-of-state resources and processing grief and anger around the ruling.
If you'd like to reach out to SQSH, the number is 314-380-7774 from Friday to Monday 1:00 p.m. to 7:00 p.m. CT.
St. Louis County Judge Kristine Keer will hear a motion for a temporary restraining order (TRO) in the case of Southampton Community Health vs. Andrew Bailey on Wednesday at 1:30.
The judge will see if they will issue a TRO before the rule is set to take effect on Thursday.
Associated Press writer Heather Hollingsworth reported from Mission, Kansas.