Children’s Hospital Colorado is fighting the DOJ in court over a subpoena about gender-affirming care ...Middle East

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Children’s Hospital Colorado is fighting the U.S. Department of Justice in court over a demand that the hospital provide federal investigators with sensitive patient medical information, employee personnel files, internal emails, billing records and other documents related to gender-affirming care.

The DOJ subpoenaed Children’s in July seeking the information, after the administration of President Donald Trump issued a series of executive orders and memos attempting to crack down on gender-affirming care for transgender youth across the country. In August, Children’s asked a federal judge in Denver to quash the subpoena, saying it amounts to a punitive fishing expedition and that DOJ officials admit they have no evidence of any wrongdoing by the hospital or its doctors.

The case had been sealed at Children’s request until November, when a judge ordered that it be made public.

“The subpoena’s purpose is transparent,” the hospital’s lawyers wrote in their motion to quash. “It is designed to intimidate and harass Children’s Hospital into stopping its lawful provision of gender-affirming care to transgender youth and was issued because the administration disagrees with Colorado’s decision to support that form of health care.”

Attorneys for the federal government responded that the subpoena is part of a valid investigation.

“The investigation concerns potential misconduct undertaken in the context of a politically sensitive subject matter, but that fact does not in any way make the subpoena invalid or unenforceable,” they wrote.

The judge, U.S. District Court Judge S. Kato Crews, has not set a timeline for issuing a ruling.

Children’s Hospital Colorado motion to quash subpoenaDownload

New challenge to Medicaid access

The fight is happening as the Trump administration undertakes new actions against hospitals that provide gender-affirming care to youth.

Last week, the U.S. Department of Health and Human Services announced proposed rules that would block hospitals from the Medicare and Medicaid systems if they provide gender-affirming care — what the administration called “sex-rejecting procedures” — to children under the age of 18. Because nearly all hospitals treat a lot of patients covered by the two programs, prohibiting a hospital from participating in them would cause significant financial harm.

The exterior of Children’s Hospital Colorado in Aurora, photographed on Oct. 18, 2019. (John Ingold, The Colorado Sun)

For instance, in a declaration filed along with Children’s motion to quash the subpoena, Dr. David Brumbaugh, the hospital’s chief medical officer, said nearly half of Children’s patients are covered by Medicaid.

The proposed rules, which still must go through a formal rulemaking process, would also prohibit federal Medicaid funding for gender-affirming care, meaning that states wanting to continue covering such care through Medicaid would have to use only their own money.

“This Administration will protect America’s most vulnerable,” Health Secretary Robert F. Kennedy Jr. said in a statement announcing the proposed rules. “Our children deserve better — and we are delivering on that promise.”

Children’s Hospital Colorado officials said they have not made any changes in response to the announcement. 

“Children’s Hospital Colorado is currently assessing the details of the proposed rules and is committed to sharing any potential impact with patients and families with as much notice as possible,” the hospital said in a statement to The Sun. “There is no change to our care model at this time.”

On Tuesday, the attorneys general of 19 states, including Colorado, sued the Trump administration seeking to strike down an official declaration underlying the proposed rules that declared gender-affirming treatments “do not meet professionally recognized standards of health care.”

“Documents sufficient to identify each patient”

The DOJ subpoena sent to Children’s this summer was part of a wave of similar subpoenas to children’s hospitals across the country.

The subpoenas followed a memo issued by Attorney General Pam Bondi directing the DOJ’s Civil Division to “act decisively to protect our children and hold accountable those who mutilate them under the guise of care.” Attorneys for the federal government wrote in court documents that the subpoena to Children’s is part of an investigation into “whether off-label promotion and/or unlawful dispensing of puberty blockers and cross-sex hormones for use by minors violated federal law.”

The subpoena demands that Children’s turn over a massive amount of information to the federal government.

This includes “complete personnel files” for potentially hundreds of employees, including the hospital’s highest-ranking executives, who have worked in connection with the hospital’s TRUE Center for Gender Diversity; billing records and external communications related to gender-affirming care; internal communications between employees about gender-affirming care; and contracts, training materials, policy and procedure manuals and promotional materials.

The exterior of Children’s Hospital Colorado in Aurora, photographed on Oct. 18, 2019. (John Ingold, The Colorado Sun)

The list also includes “documents sufficient to identify each patient” who was prescribed puberty blockers or hormone therapy, including their name, address, Social Security number and information about their parents or guardians. The subpoena demands medical records for each of those patients, as well as information on informed consent and parental or guardian authorization for the treatment.

 “The confidentiality of all medical records is paramount, but the records related to gender diverse patients are among the most sensitive that Children’s Hospital maintains,” Brumbaugh, the hospital’s chief medical officer, wrote in his declaration for the case. “Transgender people suffer from high levels of stigmatization, discrimination and victimization, contributing to negative self-image and increased rates of other mental health disorders.”

More than 3,000 patients

In their motion to quash the subpoena, lawyers for Children’s said federal attorneys have told them “they have no reason to suspect any form of wrongdoing by Children’s Hospital, or any evidence of misconduct by Children’s Hospital or anyone connected with it.”

Brumbaugh wrote in his declaration that the TRUE center has treated more than 3,000 patients since 2020, though not all of those patients have received gender-affirming care. He said the hospital has identified no adverse events from its gender-affirming care, which is a medical term to describe negative consequences resulting in unintentional injury or illness.

Children’s argues that this shows the subpoena is a bullying tactic intended to intimidate both patients and doctors. Brumbaugh wrote that the number of patients seeking care at the TRUE Center has decreased — a six-month waitlist at the beginning of the year is no more.

“The uncertainty of whether their records will ultimately be produced through a subpoena has caused these patients and their families significant distress,” Brumbaugh wrote.

The DOJ’s attorneys responded that they don’t need evidence of wrongdoing to seek information from the hospital.

“Administrative subpoenas simply do not require an agency to possess articulable suspicion of misconduct on the part of the subpoena recipient,” they wrote.

Department of Justice opposition to motion to quashDownload

Other children’s hospitals that received DOJ subpoenas about gender-affirming care have succeeded in court challenges around the country.

In September, a federal judge in Massachusetts quashed a subpoena to Boston Children’s Hospital, finding that it was “motivated by bad faith.” A federal judge in Pennsylvania quashed a subpoena in November to Children’s Hospital of Philadelphia, holding that the medical records of individual patients were not relevant to the DOJ’s stated investigation.

A federal judge in Washington state quashed a subpoena in October to a telehealth provider regarding gender-affirming care. The DOJ has appealed in at least the Massachusetts and Washington cases.

In the Children’s Hospital Colorado case, the attorneys general from 20 states — including Colorado — and the District of Columbia have filed a friend-of-the-court brief supporting the hospital’s arguments.

The states argue that they have a sovereign interest to regulate medical care within their borders. Their brief says the states “will all be harmed if the (Department of Justice) is permitted to harass and improperly investigate medical providers with the express intent of eliminating medically necessary gender-affirming care.”

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