Federal Judge Blocks Florida’s Call for Psychiatric Evaluation of Minors Seeking Transgender Help

TALLAHASSEE, Florida. — Two minors who are plaintiffs in challenging a state rule banning Medicaid coverage for gender-affirming care for transgender people will not need to undergo “psychiatric screenings” as required by Gov. Ron DeSantis’ administration, a federal judge ruled Monday.

Lawyers for the state health management agency, which primarily oversees the Medicaid program, last month asked U.S. District Judge Robert Hinkle to allow evaluation of patients identified as “Susan Doe” and “KF.”

But during Monday’s telephone hearing, Hinkle said the state had shown no need to subject the children to a two-hour evaluation.

“If you want to know if these plaintiffs need this kind of help, probably the most important thing is to start with the attending physicians who said they need this help,” Hinkle said, noting that the state did not try to remove the plaintiffs’ doctors from office. “I have come to the conclusion that these minors should not be forced to undergo the required examinations.”

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The DeSantis administration last summer approved a rule preventing Medicaid from paying health care providers for treatments such as puberty blockers, hormone therapy, and sex reassignment surgery after they determined those treatments were “experimental.” These surgeries, services, and medications can cost thousands of dollars per month.

Four transgender plaintiffs, including Susan Doe and C.F., filed a federal lawsuit challenging the rule, arguing that treatment for gender dysphoria is “medically necessary, safe, and effective” for transgender children and adults. The federal government defines gender dysphoria as clinically “a significant disorder that a person may experience when the sex or sex assigned at birth does not match their personality.”

In the lawsuit, parents of children diagnosed with gender dysphoria expressed concern that changes to the Medicaid program would negatively impact their children’s mental health and could even lead to suicide attempts.

In a petition filed January 17, lawyers for the DeSantis administration requested an assessment “to confirm whether the plaintiffs suffer from gender dysphoria” and “whether comorbidities such as depression and anxiety may be a major cause of the plaintiffs’ emotional distress.”

Hinkle initially turned down a request that South Carolina psychiatrist Gita Nangia conduct an evaluation, but gave the state another chance to show how the results of the exams would affect “the controlling substantive question of whether the treatment in question is experimental.” In November, the judge also issued a ruling saying that none of the plaintiffs would be required to “submit to a transgender denier or skeptic.”

The state filed a new evaluation request on Jan. 30, suggesting that Louisiana psychiatrist Joshua Sanderson administer the exams. Sanderson said in court documents that he believes treatment for gender dysphoria should be delayed until adulthood and that such treatment is “experimental” for all patients.

Mohammad Jazil, an attorney representing the state, told Hinckle during Monday’s hearing that the plaintiffs argued they needed treatment to “relieve or at least improve their mental suffering” and that “denying services would adversely affect their mental health.” condition.”

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“That may very well be true, but I’m not entirely sure yet,” Jazil countered.

Evaluations can reveal whether minors have comorbidities that cannot be separated from gender dysphoria, or whether the treatment they are seeking will “exacerbate” some other mental health problem.

“This is another stick in my string as I’m trying to show that it was reasonable for the state to conclude that puberty blockers that are for juveniles are experimental,” he said.

But Omar Gonzalez-Pagan, the Lambda Legal attorney representing the plaintiffs, urged Hinkle to deny the request.

“I don’t think there was any clarification in either the petition or today’s court appearance as to why it is absolutely necessary to conduct an invasive and intrusive interrogation of the two underage 13-year-old plaintiffs,” Gonzalez said. Pagan said. “There is no proven need here.”

In his oral ruling on Monday denying the state’s request, Hinkle said Sanderson “already made a decision about the need for treatment” at the heart of the trial.

“When you analyze the relative burden against the likely benefit, the balance is in the balance of the plaintiffs. This examination is unlikely to be of great benefit, ”the judge said.

Because the experts proposed by the state claimed they had examined “thousands” of patients diagnosed with gender dysphoria, evaluating two more patients would not change their mind, Hinkle added.

“The idea that two more anecdotes would sway defense experts just doesn’t make much sense,” he said.

The rule went into effect in August, and in October Hinkle refused to issue a preliminary injunction to block it.

DeSantis, widely seen as a potential GOP frontrunner in the 2024 presidential election, and his allies have taken a number of steps to cut the gender-affirming appeal. For example, at the request of the Department of Health, state medical boards recently moved to ban Florida doctors from using puberty blockers, hormone therapy, or surgery to treat children diagnosed with gender dysphoria.

The governor, who frequently raises the issue in public speeches, is vehemently defending the state’s approach.

“They do gender reassignment surgery and… so actually we have young people who went through this when they were underage and they say it’s a huge mistake. And it’s not really evidence when you start talking about gender reassignment and puberty blockers. So… (if) you perform these procedures on these minors, you will lose your medical license here in Florida. That is what is happening,” he told reporters in Bradenton last week.

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