California sues Rady Children’s over transgender health care cutoff

On Friday evening, California Attorney General Rob Bonta filed a lawsuit against the state’s largest children’s health provider. The complaint accused Rady Children’s Health in San Diego of taking steps to illegally terminate gender-affirming care for transgender youth.

News of the lawsuit spread quickly through chat groups of parents of transgender kids, LGBTQ organizations and the broader transgender community. It was the first major action the state has taken against a hospital that had severely limited or ended transgender health services.

Many in the community see this move as a major step towards protecting transgender health, but some still question why the state’s legal claims don’t rest on broader civil rights questions. Instead, the key argument relies on the state’s corporations code — a provision governing business transactions — to try to compel Rady into continuing gender-affirming care.

The claim filed against Rady alleges the health system violated a merger agreement signed last year when Rady took over Children’s Hospital of Orange County and Children’s Hospital of Mission. That agreement requires Rady to maintain existing services, including transgender health care.

“We have anti-discrimination laws on the books. We have legal protection of gender-affirming care on the books. But if Rob Bonta does not feel confident in his ability to win a case on the basis of those laws do we really have those laws?” said Kanan Durham, executive director of Pride at the Pier, an Orange County group organizing opposition to Rady’s announced transgender clinic closure.

Durham said he was in a room full of trans people when the news of the lawsuit broke. People cheered, he said. But many were conflicted about the narrow application of the claim.

California’s civil rights law — the Unruh Civil Rights Act — is the backbone of the state’s guarantee of equal access to transgender health services, which can include puberty blockers, hormones, surgery and therapy, said Megan Noor, a staff attorney at the Transgender Law Center. The law prohibits discrimination on the basis of sexual orientation or gender identity. 

Noor said that means, for example, if a hospital offers puberty blockers to a cisgender child who is starting puberty too young, they cannot deny access to that same treatment to a transgender child even if it is for a different purpose, such as giving the child more time to explore their gender identity. 

Other laws require insurers to cover gender-affirming care and protect the privacy of transgender patients and their doctors.

In a press release, Bonta said “We will fight to uphold the law and ensure Californians can access gender-affirming care without facing unfair roadblocks.” His office, in an unsigned statement, said it had no comment on enforcement of the state’s civil rights law.

Ben Metcalf, a spokesperson for Rady Children’s Health, said in a statement that the organization could not comment on pending litigation, but called the decision to shutter gender-affirming care services “very difficult.”

“That decision was guided by our responsibilities as a nonprofit pediatric health care system to continue serving all children and families across our communities, including through participation in essential federal programs,” Metcalf said.

Rady notified parents of transgender children in mid-January that it would be closing its Center for Gender Affirming Care on Feb. 6.

Hospitals under pressure

Over the past year, transgender youth and their parents have watched with growing fear as California’s largest health systems retreated from providing transgender health services to people under the age of 19.

Children’s Hospital of Los Angeles was the first to stop care. Then Stanford Medicine, Kaiser Permanente, Sutter Health and most recently Rady limited or announced plans to terminate care. Sutter had told parents in December that it would stop providing services to their children, but quietly backtracked under fierce public pressure.

Hospitals say their hands were forced by an unfriendly federal government that does not recognize the existence of transgender people. 

On his first day in office, President Donald Trump issued an executive order characterizing transgender health procedures as “chemical and surgical mutilation” and directing agencies to defund any supportive programs. 

Since then his administration has intensified the pressure against health care organizations. Over the summer, federal investigators issued subpoenas to clinics and hospitals around the country, alleging fraud and seeking medical records. The U.S. Department of Health and Human Services in November published a self-described peer reviewed report “on the medical dangers posed to children” of gender-affirming care.

Rady, in a statement issued prior to the state’s lawsuit, confirmed the Health and Human Services inspector general was investigating the hospital, and said “the environment around gender-affirming care has changed dramatically.” 

The American Medical Association, American Academy of Pediatrics and dozens of independent scientific studies reject the claim that gender-affirming services are harmful to children with gender dysphoria. Instead, they conclude that “trans and non-binary gender identities are normal variations of human identity and expression” and having access to supportive health care positively impacts youth mental health and decreases suicidality.

Most recently, the U.S. Centers for Medicare and Medicaid Services is considering proposed rules that would eliminate government funding for hospitals that provide transgender health care to minors. If formalized, the rules would effectively create a near-total national ban on gender-affirming services for young people because nearly all hospitals in the U.S. receive more than 50% of revenue from Medicare and Medicaid payments, according to the American Hospital Association.

Advocates, legal experts and parents say that even with this existential threat hanging over health providers, for now, it’s just that: A threat.

“Nobody needs to stop this care at this point. It is a policy that has been announced. There has not been a law passed, nothing has been finalized,” said Kathie Moehlig, executive director of TransFamily Support Services based in San Diego. “We have to resist.”

Parents and advocates look to leaders to uphold state protections

Bonta has sued the Trump administration multiple times in an effort to protect transgender patient care, but some parents and advocates say his office needs to do more to uphold state law. 

The attorney general must review nonprofit hospital transactions, and can impose conditions to preserve patient care. 

Dannie Ceseña, director of the California LGBTQ Health and Human Services Network, said it was meaningful that Bonta did that in Rady’s merger, adding language protecting gender-affirming and other specialty health services for 10 years. 

“What about all of the other hospitals and families that don’t have this protective clause? They are still violating families’ civil rights. They are still stopping access to care,” Ceseña said. “Why isn’t the attorney general doing more in regards to this issue?”

Last February, the California Department of Justice sent a letter to Children’s Hospital Los Angeles warning that its refusal to serve transgender minors would violate the state’s civil rights law. In July, the hospital permanently closed its transgender health clinic.

Ceseña says he feels the state has been inconsistent in its support of the trans community. He and other LGBTQ advocates expected the state to sue Children’s Hospital Los Angeles and others well before the Rady lawsuit. And specifically, to protect civil rights for trans children. 

“We need to stop with the letters. We need to stop with the announcements. We need to see action,” Ceseña said. “Our kids are suffering.”

Others say it’s significant that the state stepped in at all after months of “despair.”

Arne Johnson, a Bay Area parent and organizer with Rainbow Families Action, acknowledged that many members of the community had “complex feelings” about the  latest lawsuit.

But he said he cried after hearing of the lawsuit against Rady. 

“The thing that is so powerful for so many of us who have been working so hard and crying out for someone to do something is that it’s the first time the state has recognized our children are valid members of society and worthy of protection by the laws of this state,” Johnson said. “That’s all we’ve been asking for.”

Parents are fighting back 

Parents of transgender kids say they have been moved to action by the steady erosion of gender-affirming care in the state. In December, hundreds of Northern California parents protested Sutter Health’s initial decision to stop gender-affirming care.

Last month, more than 600 people rallied outside of Rady Children’s Hospital in San Diego while another 100 protested at the system’s affiliate Children’s Hospital of Orange County.

Ceseña said this marks a “huge change” since the start of the Trump administration among families who have transgender children and had previously kept their heads down in hopes that the issue would blow over.

That includes Todd, a San Diego native and father to a 15-year-old transgender boy. He asked to be identified by his middle name only to protect the identity of his son.

Before Rady informed parents it would stop services, Todd hadn’t been too involved in the transgender community. But he attended the protest and is looking to do more; Rady’s decision felt like a “betrayal,” he said.

“It felt like people who said ‘you can trust us’ were now collaborating with the people trying to hurt us,” Todd said. 

Todd’s son came out to his parents when he was 11. He saw a therapist for two years before going to Rady’s where, for more than a year, the family spoke with doctors and counselors to “help him understand himself” and “find the words and language to explain to himself what he was feeling.” 

The process looks different for every child and family, Todd said. Some kids think surgery is important to them, while others don’t; some want puberty blockers and hormone therapy, while others just want to be in an environment that is supportive. The process – broadly supported by the American Academy of Pediatrics and other leading medical societies – is often lengthy and involves the whole family, Todd said.

“If you’re not dealing with it personally, you don’t have to know those details, but what you do have to do is allow doctors and families to do the correct things to make their families healthy,” he said. 

Todd said he’s optimistic the state’s lawsuit will help Southern California families and build momentum.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.