Judge curbs Florida probe into U.S. medicine’s trans treatment standards


The legal battle over Florida’s ban on Medicaid spending on gender-affirming health care spread to Washington on Thursday, when a federal judge partially granted an emergency request by 18 U.S. medical and mental health groups to quash subpoenas the state had sent them after when they opposed the ban.

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 reassignment surgery may be appropriate treatment for transgender people. youth and adults.

The groups spoke last fall in support of a lawsuit 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 “grossly inappropriate and invasive” fishing expedition for internal documents and communications about their political views. The state has been accused of preying on “alleged internal dissent” and bias in the service of attacking the groups’ guidelines and credibility “from the inside out.”

The state’s search for the results of internal voting and debate could have a chilling effect on the First Amendment rights of American and international doctors and researchers to association and the “frank, unfettered dialogue” that is critical to their missions and the scientific process, said attorney Cortlin H .” said Lannin.

However, attorneys for the Florida Health Care Agency challenged the groups’ authority and basis for setting treatment guidelines.

“Openness and transparency are hallmarks of the scientific method,” Florida Solicitor General Mohammad O. Jazil wrote to the court. “Basically posing as the standard bearers of the prevailing scientific view on the treatment of gender dysphoria,” the associations are now trying to shield how they arrived at that view from any scrutiny and whether “it is the result of careful study and discussion among their membership or the result of a handful of people, which dictates the result.”

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After an hour-long 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 lawsuit in Tallahassee.

Trans residents sue Florida over Medicaid ban on gender-affirming care

But Nichols agreed that at least some of the information the groups have is needed because it could answer a central question posed by a Florida judge, whether it is reasonable for the state Medicaid agency to find that treatments that confirm gender, according to the current state “experimental”. medical knowledge.

The court battle and Thursday’s ruling underscored how aggressively Florida Gov. Ron DeSantis (R) and his administration are pushing the state’s assault on transgender treatment, an issue that conservative politicians have picked up in the national culture wars, not just transgender patients and their families in the crosshairs, and increasingly also doctors and medical institutions.

The lawsuit was filed in Florida after the state’s Medicaid agency ended funding for gender transition care in August, joining Texas and Alabama, saying “only treatments found to be safe can be covered , effective and meet the criteria of medical necessity.” The state’s politically appointed Board of Medicine has since become the first to try to ban licensed medical professionals from providing such treatment to minors, threatening to violators with penalties including loss of medical license.

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As of 2020, hundreds of bills targeting trans people and especially trans youth have been introduced in about half of the 50 states, with sponsors saying the policies are intended to protect children and families from harmful practices they may later regret. But many professional health organizations say treatment can reduce the emotional distress of transgender youth 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 adds to growing evidence that children’s mental health improves with gender-affirming treatment.

On Thursday, Nichols said the sued patients and their families relied heavily on the public and widespread acceptance of standards of care set and endorsed by “every major medical organization in the United States” as proof that such treatments are not experimental.

“I think the question is how precisely the guidelines or policy statements were adopted and whether [they] so truly reflecting the medical consensus here is important,” Nichols said.

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Nichols said he was not blind to Lannin’s clients’ concerns about possible “harassment or interference” with their First Amendment rights. But he said his order was tailored to prevent that and was outweighed by the relevance of information only they might have to resolve the dispute on the best available scientific and medical expertise.

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“The state can provide its own scientific evidence and testimony, but I don’t think it would be able to discover the question of how precisely the guidelines were arrived at here without obtaining the requested information,” Nichols said.

He added that U.S. District Judge Robert Hinkle in Tallahassee had given his blessing to a “free-flowing investigation based on whatever each side can gather” on the issue.

Still, Nichols severely limited the scope of the state’s requests for information. The judge ordered the American Medical Associations to turn over records that “sufficiently demonstrate” their collective membership; how they establish guidelines and policy positions, including gender-affirming gender dysphoria care; and any “official communication” with their entire membership specifically relating to the latter.

He denied the Florida agency’s request for “any” such records and “any documents and communications,” such as internal emails, that show who was involved in policymaking, adding that members’ personally identifiable information could be redacted and prohibited public disclosure.

Nichols also rejected the state’s request for records detailing any contact with the plaintiffs or any consideration of the risks and side effects of gender dysphoria treatment, saying such information had already been turned over. He ruled as premature Florida’s request to interview under oath representatives of the Academy of Pediatrics, the Society of Endocrinology and the World Professional Association for Transgender Health, the latter two of which set the clinical guidelines in question.

Anne Branigin contributed to this report.


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