Missouri clinics halt transgender care for minors in wake of new state law

At least two Missouri health care centers have stopped prescribing puberty blockers and hormones to minors for the purpose of gender transition, citing a new state law that one clinic says “creates unsustainable liability” for health care workers.

Washington University Transgender Center at St. Louis Children's Hospital on Monday announced it stopped providing those services, and a spokesperson said University of Missouri Health Care stopped treatments for minors Aug. 28.

The new Missouri law, which took effect Aug. 28, outlawed puberty blockers, hormones and gender-affirming surgery for minors. But there are exceptions for youth who were already taking those medications before the law kicked in, allowing them to continue receiving that health care.

Both Washington University and University of Missouri said physicians there are referring current patients to other providers. Washington University will continue to provide education and mental health support for minors, as well as medical care for patients age 18 and older.

“We are disheartened to have to take this step,” the statement read. “However, Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors. This legal claim creates unsustainable liability for health-care professionals and makes it untenable for us to continue to provide comprehensive transgender care for minor patients without subjecting the university and our providers to an unacceptable level of liability.”

Meanwhile, a Planned Parenthood Great Plains spokesperson said Tuesday that the organization is under investigation by the Republican attorney general.

In an email to The Associated Press, spokesperson Anamarie Rebori Simmons said the organization does not provide gender-affirming care for minors and did not do so before the ban took effect.

“The Attorney General’s office said for the first time in a filing on September 1 that our health care organization was the subject of an investigation, which was counter to information previously provided by to us by said office,” Rebori Simmons said. “As a provider of transgender care in Missouri since 2016, we are deeply concerned about the continued attacks on the trans community including minors and will take whatever action necessary to protect patient privacy and defend essential, life-saving care.”

Health care providers who violate the transgender health care law face having their medical licenses revoked. Beyond that, any provider who prescribes puberty blockers and hormones as a form of gender-affirming care for minors faces lawsuits from those patients for as long as 15 years after they turn 21.

If the patients win, physicians must pay at least $500,000 in punitive damages alone and as much as $1.5 million in total damages.

“Providers could be held liable for damages even if they did not do anything wrong or unreasonable,” University of Missouri System spokesperson Christian Basi said.

Republican Gov. Mike Parson signed the bill in June, calling hormones, puberty blockers and gender-affirming surgeries “harmful, irreversible treatments and procedures” for minors. He said the state “must protect children from making life-altering decisions that they could come to regret in adulthood once they have physically and emotionally matured.”

Most adults still have access to transgender health care under the law, but Medicaid won’t cover it. Prisoners must pay for gender-affirming surgeries out-of-pocket under the law.

The ACLU of Missouri, Lambda Legal and the law firm Bryan Cave Leighton Paisner in July sued to overturn the Missouri law on behalf of another St. Louis health care center, families of three transgender minors and LGBTQ+ organizations.

They asked that the law be temporarily blocked as the court challenge against it plays out, but the judge disagreed, saying the lawsuit is "not likely to succeed.”

The next hearing in the case is scheduled for Sept. 22.

Every major medical organization, including the American Medical Association, has opposed the bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans have been enacted this year.

Parson also signed legislation in June to require students from kindergarten through college to play on sports teams that align with their sex assigned at birth. Both public and private schools face losing all state funding for violating the law.

Shira Berkowitz, of the state’s LGBTQ+ advocacy group PROMO, said in a statement that Parson, Attorney General Andrew Bailey and the state legislature “blatantly committed a hate crime against transgender Missourians.”

“We are working quickly with coalition partners to explore all possible avenues to combat the harm being inflicted upon transgender Missourians,” Berkowitz said.

The St. Louis clinic fell under scrutiny early this year after former case manager Jamie Reed claimed in an affidavit that the center mainly provides gender-affirming care and does little to address mental health issues that patients also faced. Republican U.S. Sen. Josh Hawley and Bailey announced investigations after Reed's claims.

Missouri’s bans come amid a national push by conservatives to put restrictions on transgender and nonbinary people, which alongside abortion has become a major theme of state legislative sessions this year. Missouri is among nearly two-dozen states to have enacted laws restricting or banning gender-affirming medical care for transgender minors.

In April, Bailey took the novel step of imposing restrictions on adults as well as children under Missouri’s consumer-protection law. He pulled the rule in May after the GOP-led Legislature sent the bills to Parson.

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Ballentine reported from Columbia, Missouri.