Hospitals Fret Executive Orders Targeting Trans Youth
Page Med today history.
Last Friday, St. John’s Community Health, a large network of federally qualified health centers in Southern California serving 430,000 people annually, attempted to withdraw funds from a $1.67 million CDC grant specifically intended for transgender health services.
“We haven’t been able to get to it,” said Jim Mangia, president and CEO of St. John’s. Page Med today“even if there was an injunction prohibiting federal departments from carrying out funding freezes or cessations on the basis of [the president’s] decrees. » And even if the money is needed to pay salaries and service expenses.
The remaining balance of that four-year grant, which began in June 2022 — $743,706 — was removed from their account as a result of President Trump’s Jan. 28 executive order, “Protecting Children from Chemical and Surgical Mutilation,” he said.
Despite that, St. John’s is determined to fight back and will find the money elsewhere, he said. It receives some $230 million annually from various sources to maintain its multiple programs and operations at 20 sites across three counties.
“Our view is that we must stand up and push back against any attempt to limit access to health care for the populations we serve,” he said. “We plan to make our voice heard loud and clear … to take all necessary measures to protect health services for our patients,” including filing lawsuits.
Impact on clinicians
Providers at many non-governmental organizations across the country, like St. John’s, which serve LGBTQ+, trans, immigrant and other medically underserved populations, are in panic mode. They are concerned not only about the consequences of losing funding for their services, but also about the message these interruptions or pauses send to patients.
They also fear being targets of hate crimes, as this population is aware of being vulnerable to attacks.
“Since the inauguration, there has been a fear in the community — an understandable fear — that if they go to a federal hospital or clinic like ours, they will be picked up and kicked out,” said Christopher Veal, MD, a physician at Chicago-based Howard Brown Health. The facility is one of the largest LGBTQ+ health centers in the country and a major center for non-surgical gender-affirming care services. Some patients at the clinic are both transgender and undocumented, he said.
It’s unclear whether Howard Brown Health, which also treats other underserved populations, will continue to receive the federal grants it has been awarded and budgeted to care for its 38,000 patients a year. He seeks clarification on seemingly inconsistent messaging from the administration.
In a statement, Howard Brown said the executive order “has no immediate impact on our operations,” which “will continue to provide gender-affirming care to all patients who rely on our services.”
But Veal said personally that he and many of his fellow doctors “will not feel comfortable with our funding sources until this administration is over.” They have already targeted gender-affirming care and transgender people in particular, with campaign phrases such as “Kamala is for them, Trump is for you.” And they won’t stop until we can no longer provide these services. »
Veal, who specialized in suicide prevention since medical school, fears the executive orders will lead to a climate in which suicide attempts are more common. He’s heard of Chicago-area programs that have halted educational programs on the subject out of fear and disappearing funds.
“We are being bullied”
Riley Read, PA, who works at a clinic dedicated to trans care in St. John’s, said Page Med today that the new administration’s actions “have caused enormous fear and an increase in the number of patients presenting with complications related to anxiety, panic attacks, an increase in suicidal tendencies and suicidal ideation…stomach problems and insomnia.” Some people want to know if they need to stock up on medication.
Policy changes also impact providers, including himself, often breaking his heart over the dilemmas patients face. Patients come in with real fears, Read said, “and it’s hard not to feel that with them…but at the clinician level, it’s heartbreaking and very difficult to deal with.”
He fears the executive orders won’t stop at transgender patients. “That doesn’t mean that in 2 weeks, we’re not going to be talking about another group” who will lose access to services.
Read said if current policies continue, all health care facilities will simply have to find other sources of funding. “We’re all in a dilemma. We’re afraid of retaliation, but it’s our job as clinicians to stand up and take that fear and act on it, and not back down and feel bullied. [although] we are being bullied.
Rumors abound, several clinic executives said Page Med todaythat waves of hospitals would halt all gender-affirming surgeries they had scheduled for any patient under 19, for fear of losing federal reimbursements. And it has already started.
Health systems respond
On Tuesday, Children’s Hospital Los Angeles announced it would no longer launch hormone therapy for gender-affirming care for patients under 19, in light of the executive order.
“At this time, CHLA is suspending the initiation of hormonal therapies for all patients under the age of 19 receiving gender-affirming care and maintaining the existing pause on gender-affirming surgeries on minors,” the statement said. “The physical and mental health, safety and well-being of all our patients remain our top priority. »
NYU Langone Health in New York reportedly canceled appointments this week for transgender children who were scheduled to receive puberty-blocking drug implants. Boston Children’s also canceled scheduled appointments for minors, according to a lawsuit, the Boston Globe reported.
Children’s Nationwide Hospital in Washington, D.C., said it suspended prescriptions for puberty blockers and hormone therapy while it assessed the situation, and Virginia Commonwealth University and Children’s Hospital in Richmond suspended medications and surgeries for patients under 19 receiving gender-affirming care.
According to a report from The United States todayDenver Health in Colorado and University of Colorado Health have stopped performing gender affirmation surgeries for patients under 19 years old. And in Chicago, Lurie Children’s Hospital said it was reviewing the executive order.
On Tuesday, several plaintiffs, including young transgender adults and their family members, as well as several organizations, filed a 44-page complaint against President Trump, HHS, the National Institutes of Health and several Trump appointees. The complaint accuses his administration of issuing several related executive orders that attempt to end programs by withholding federal funds, which the plaintiffs claim they do not have the authority to do.
“The Executive Orders unconstitutionally usurp Congressional authority by withholding legally appropriated federal funds from medical institutions, providers, and researchers, such as the GLMA. [an LGBTQ+ advocacy organization] “They are violating the rights of thousands of transgender people under the age of nineteen…by denying them necessary medical care solely on the basis of their gender and transgender status.”
Asked for its reaction to the administration’s orders, an Endocrine Society spokeswoman pointed to an amicus brief filed with the U.S. Supreme Court last September in which it detailed numerous reasons why treatment is medically necessary for adolescents with gender dysphoria.
National Nurses United, the largest registered nurses’ union, said in a statement it was “outraged by the Trump administration’s implementation of several policies attacking and endangering the health, safety and lives of transgender Americans.”
Meanwhile, New York Attorney General Letitia James said providers in her state should continue offering gender-affirming care to patients under 19 despite the executive order. If they stopped, she said, they would violate New York’s anti-discrimination laws.
Similarly, California Attorney General Rob Bonta warned Children’s Hospital Los Angeles on Wednesday that if it refused to provide services to transgender patients, it could be violating his state’s law.
Gender-affirming care is not just a surgical procedure. It is provided in a variety of medical interventions, including puberty blockers and hormonal pills, but it can also include mental health care, counseling, social support, and assistance with updating legal documents. All of these services are under threat from this new administration, clinic officials said. Page Med today.
Even research projects are interrupted. According to the Washington PostThe Trump administration ordered the NIH to stop a large-scale study of preventing HIV infection in transgender youth of color before it could even recruit patients.
Last week, the CDC ordered its scientists to retract any publication of any research article submitted to a medical or scientific journal to remove all “prohibited terms,” including transgender, pregnant, pregnant people, LGBT, transsexual, non-binary, assigned male at birth, assigned female at birth, and biologically male.
Transgender people over the age of 13 number about 1.6 million in the United States, according to a 2022 report from the UCLA School of Law Williams Institute, which used data from the U.S. Behavioral Risk Factor Surveillance System and other surveys.
