Severe Legal Penalties for Physicians Providing Gender-Affirming Care are Justified
Repercussions for Transgender Clinical Programs In a Wave of New Legislation
By Peter A. McCullough, MD, MPH
Young mothers and fathers ask me how any doctor can prescribe life altering hormones and remove the normal breasts in a young girl with gender dysphoria and confusion around the time of puberty? The published data demonstrate “gender affirming” care does not cure gender dysphoria and it is sterilizing in ~80%. Commonly kids with autism are targeted. Sadly, these procedures increase the rates of homicide, suicide, and death from all causes. Because the medical profession is not policing itself, states are stepping in with severe consequences for doctors who prescribe gender changing hormones perform disfiguring surgery.
Mallory et al, published this sobering report for doctors in transgender medicine: “The policy landscape on gender-affirming care has significantly changed within the past decade, with high variability in access to care between states. By 2022, approximately half of US states had implemented protective state-level health policies related to gender-affirming care coverage in private and public insurance.1 However, despite consensus between professional medical associations regarding gender-affirming standards of care, bans on this care, particularly for minors, have gained legislative traction within the past 5 years.
Proposed bills related to bans on gender-affirming care for minors increased from 4 in 2018 to 43 in 2022, with a total of 4 states (Alabama, Arkansas, Arizona, and Texas) enacting laws or policies banning access during this period. In the ongoing 2023 legislative session, 118 bills have been proposed across 31 states related to restricting access to gender-affirming care.2 By April 2023, 11 of these bills had been passed into law (in Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Utah, and West Virginia) and 1 administrative rule was enacted in Florida. Thus, in total, 15 states have laws and policies that ban gender-affirming care for minors. Within the stipulations of state bans, physicians who continue care face 4 major direct penalties: (1) medical license disciplinary action; (2) a private right of legal action against physicians, which can include extensions on malpractice statutes of limitations; (3) civil legal action the state can take against physicians; and (4) felony provisions that enable criminal penalties against physicians.
Many of these states’ laws deem the practice of providing gender-affirming care for minors as “unprofessional conduct.” The laws in Arizona, Arkansas, Georgia, Indiana, Iowa, Tennessee, Utah, and West Virginia hold that physicians are subject to discipline by the appropriate review board. The enacted laws in Kentucky, Mississippi, and South Dakota further state that physicians who violate these laws will have their license to practice medicine revoked by the state medical board.
Laws in 8 states (Arizona, Arkansas, Indiana, Iowa, Mississippi, South Dakota, Tennessee, and Utah) provide a private right of legal action, allowing citizens to bring lawsuits against physicians for providing gender-affirming care. In addition, these states extend medical malpractice statutes of limitations for claims related to providing gender-affirming care for minors. Some states allow malpractice action against a physician until the patient is 25 years old (South Dakota and Utah) and other states allow lawsuits to be filed from 10 to 30 years after the patient reaches 18 years of age (Arizona, Arkansas, Indiana, Iowa, Kentucky, Mississippi, and Tennessee).
In addition to creating a private right of action, laws in 5 states (Arizona, Arkansas, Iowa, Mississippi, and Tennessee) provide that the state may take legal action against physicians who provide gender-affirming care to minors. For example, Tennessee allows the attorney general to bring action against a physician for providing gender-affirming care for a minor within 20 years of the violation, with a civil penalty of $25 000 per violation.
Last, 3 states have criminalized the provision of gender-affirming care. Both Alabama and Idaho made it a felony for physicians to provide gender-affirming treatments for patients aged 18 years and younger, punishable by up to 10 years in prison or a fine of $5000 to $15 000. In Texas, a governor’s directive issued in February 2022 defined certain gender-affirming services for youth as “child abuse” and stated that health care professionals facilitating access to these services are subject to criminal penalties, as are all licensed professionals with mandatory reporting duties for “failure to report such child abuse.”3
In summary, the writing is on the wall for transgender medicine. As quickly as academic and community hospitals opened up gender change clinics they better shut them down and issue parents and children an apology. Harming children with hormones and mutilating surgery is not good clinical practice nor is it welcome in the house of medicine.
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McCullough PA. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals Transgender Epidemic Driven by Tidal Wave of Autism Spectrum Disorder