April 17, 2024

Trans adults seek to block new Florida health care law

TALLAHASSEE, Fla. – Citing a “crisis of availability” of care, transgender people are asking a federal judge to block a new state law making it more difficult for trans adults to access hormone-replacement therapy and surgery.

The law, passed by the Republican-controlled Legislature this spring and championed by Gov. Ron DeSantis, requires patients diagnosed with gender dysphoria to sign informed-consent forms crafted by state medical boards.

Under the law, only medical doctors and osteopathic physicians — not nurse practitioners — are allowed to order hormone therapy. The law also requires transgender people seeking gender-affirming care to undergo lifelong mental health exams by state board-licensed psychiatrists or psychologists.

The new restrictions have erected “unnecessary barriers” to care and “impose medically unsupported requirements” on trans people, plaintiffs argued in a revised version of a lawsuit filed Friday.

The law (SB 254) also banned doctors from ordering gender-affirming care for children but allowed minors already receiving such treatment to continue, under certain conditions.

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Parents of transgender children filed a lawsuit challenging the restrictions, and U.S. District Judge Robert Hinkle last month blocked a ban on the use of puberty blockers and hormones to treat children diagnosed with gender dysphoria, calling the prohibition “an exercise in politics, not good medicine.” The state is appealing Hinkle’s ruling.

The lawsuit was revised Friday to add several adults as plaintiffs.

“One overall effect of the transgender medical restrictions has been to create a crisis of availability for transition-related care in Florida, with demand for that care vastly outstripping the supply of physicians authorized and willing to supply it. This has created extremely long wait times for treatment that leaves patients without their medications or access to other forms of care for prolonged periods, risking significant harm to their physical and mental health while they remain untreated,” the revised lawsuit said.

In a motion for a preliminary injunction filed Monday, the plaintiffs’ lawyers asked Hinkle to block parts of the law dealing with adults.

The law “singles out transgender individuals and creates arbitrary, harmful and medically unjustified restrictions that deter them from obtaining needed medical care,” the motion said.

The motion also argued that the “restrictions on transgender adults’ ability to obtain care, and those in the informed consent forms, are not even rational. Rather than fostering any interests in health or safety, they undermine them.”

Adult plaintiffs who joined the lawsuit alleged they have been unable to find treatment or have had long-scheduled surgeries canceled since DeSantis signed the law in May.

A declaration filed by plaintiff Lucien Hamel, a 27-year-old transgender man who lives in Indian River County, said he “was incorrectly assigned the sex female at birth,” began dressing as a male as a child and started receiving “transition-related medical care” four years ago.

Hamel said he had been receiving testosterone from a nurse practitioner at a clinic in Melbourne until the new law went into effect, but he’s now unable to find a health-care provider who is authorized to prescribe testosterone and is taking new patients.

“Being forced to go without testosterone has had, and will continue to have, devastating consequences for me physically, emotionally and psychologically. Because of being unable to obtain care, I experience debilitating fear, anxiety, self-loathing and despair,” Hamel said..

Hamel, the father of a 7-year-old son, said he can’t afford to relocate to another state.

“Thus, I am trapped in a state that is denying me access to critical medical care that I need to live and thrive,” he added.

Plaintiffs on Monday also filed declarations from doctors who specialize in treating people diagnosed with gender dysphoria. The doctors said the state’s approach is contrary to widely accepted medical standards and pointed, in part, to the informed-consent forms approved last month by the state Board of Medicine and the state Board of Osteopathic Medicine.

The consent forms say “medical treatment of people with gender dysphoria is based on very limited, poor-quality research with only subtle improvements seen in some patients’ psychological functioning in some, but not all, research studies.”

Dan Karasik, a professor emeritus of psychiatry at the University of California-San Francisco, said the forms are “riddled with false and misleading statements” and thereby “undermine informed consent.”

Daniel Shumer, a pediatric endocrinologist and professor who serves as the medical director of the Comprehensive Gender Services Program at Michigan Medicine, University of Michigan, also criticized the forms.

“When a regulatory agency interferes with the informed consent process to require doctors to misstate information, impose medically unsupported requirements and create unnecessary barriers to ongoing care, the process is corrupted and patient autonomy is undermined. Nowhere is this more apparent than in the consent form itself …,” Shumer said.

Kenneth Goodman, founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy, said in a declaration that the state-approved forms “depart from well-established principles of medical ethics” and undermine physicians’ decisions about how best to serve their patients.

The “doctor-patient relationship is of fundamental importance and therefore should be free from legislative or regulatory interference that does not serve a medical justification,” Goodman said. “These principles apply as a matter of professional ethics notwithstanding any individual’s personal viewpoint on gender identity or whether

gender transition care should be legally accessible.”

Debate about the bill restricting gender-affirming care focused largely on children during the legislative session that ended in May.

“We cannot speak something into existence that doesn’t exist. We cannot change our sex,” Rep. Ralph Massullo, a Lecanto Republican who is a dermatologist, said in May before the House gave final approval to the measure. “And for those children that this bill addresses, they cannot change their sex, and they need to learn that fact.”

Florida is among a number of Republican-led states that have approved measures to curb or prohibit gender-affirming care for transgender children and adults. DeSantis, who is running for president, has made the issue one of his priorities.

In a separate lawsuit, Hinkle on June 22 blocked a state ban on Medicaid coverage for transgender children and adults, saying the effort was “invidious discrimination.” The state also is appealing that decision.

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