Seattle Children’s Hospital sues Texas attorney general over trans patient records

By William Melhado

The Texas Tribune

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Seattle Children’s Hospital has sued the Texas Office of the Attorney General to block the release of patient information after the agency sent the Washington-based health care system an investigative subpoena demanding any patient records of Texas residents who have received transition-related care.

The hospital system filed a petition in the Travis County District Court on Dec. 7, requesting the court dismiss a subpoena from the  attorney general’s office, or alternatively issue an extension of and modification to the list of requested documents.

The attorney general’s civil investigative demand came more than two months after a new Texas law went into effect that bans the use of puberty blockers and hormone therapy for transgender youth. Suspecting that Seattle Children’s was providing youth in Texas with puberty blockers or hormone therapy, the attorney general’s office sent the hospital system a subpoena on Nov. 17, demanding the responsive documents by Dec. 7.

The AG’s office stated in court filings that it was investigating the hospital for potentially violating the Texas Deceptive Trade Practices Act.

A sworn affidavit from a hospital administrator included in the lawsuit stated that no clinical staff for Seattle Children’s provide gender-affirming care in Texas, or do so remotely from outside of the state.

The discovery tool issued by Attorney General Ken Paxton is the latest effort by his office to scrutinize the lives of transgender Texans and their families. Over the last several years, Republicans in Texas have sought to restrict transgender youth from accessing transition-related care, playing on sports teams that align with their gender and using certain public restrooms. Doctors and advocates argue gender-affirming care is lifesaving for transgender youth who face higher rates of suicide attempts and mental health problems than their cisgender peers.

It’s not clear how many other hospital systems across the country, if any, received similar subpoenas from Paxton’s office. The Attorney General’s Office did not respond to questions about the subpoena and lawsuit.

Seattle Children’s Hospital argued that producing the information would violate federal and state health care privacy laws. The hospital’s lawsuit also pointed to Washington’s new “Shield Law” passed earlier this year, which prevents entities based in the northwest state from complying “with a subpoena, warrant, court order, or other civil or criminal legal process for records … related to protected health care services that are lawful in the state of Washington.”

It is legal to prescribe gender-affirming care, including puberty blockers, hormone therapy and transition-related surgery — which are rarely performed on minors — in Washington.  

Additionally, the hospital argued that the Texas attorney general’s office does not have jurisdiction over the Washington-based hospital system, where the email and health record systems both reside.

“Furthermore, the Demands are an unconstitutional attempt to investigate and chill potential travel by Texas residents to obtain healthcare in another state,” the petition stated.

An affidavit included in the lawsuit from Dr. Ruth McDonald, the hospital system’s Chief Medical Operations Officer, stated that Seattle Children’s does not employ clinical staff in Texas to provide gender-affirming care.

“Likewise, SCH providers have not provided telemedicine services to Texas residents for ‘gender-affirming care,’” McDonald’s affidavit read.

McDonald told the court that the hospital does not have records of anyone receiving transition-related care paid for with public money from the state of Texas.

The subpoena demanded the hospital system provide medications prescribed to children who reside in Texas, the children’s diagnosis, the number of Texas children in the hospital’s care and the name of Texas laboratories used to administer tests for those youth.

Additionally, the subpoena directed the hospital to produce documentation outlining how physicians diagnose gender dysphoria and endocrine disorders, and protocols for how children are weaned off of transition-related treatments according to Texas law. Doctors have previously stated that there is no guidance from medical associations on how children should be weaned off transition-related care.  

The attorney general’s office also demanded sworn written statements from doctors at Seattle Children’s who treated Texas children, describing the medications prescribed and information related to patients’ diagnoses.

The subpoena demanded these records from January 2022 until November 2023.  

“Seattle Children’s took legal action to protect private patient information related to gender-affirming care services at our organization sought by the Texas Attorney General. Seattle Children’s complies with the law for all health care services provided,” a spokesperson for the hospital said in a statement to The Texas Tribune. “Due to active litigation, we cannot comment further at this time.”

The subpoena sent to Seattle Children’s was not the first instance of state leaders seeking information about transgender Texans.

Early last year, Gov. Greg Abbott directed the Department of Family and Protective Services to investigate the families of transgender children who were receiving transition-related care. Abbott’s directive cited an opinion issued by Paxton which argued that this type of health care could be considered child abuse under Texas law.

In June 2022, Paxton sent a sweeping request to the Department of Public Safety for a list of individuals who had changed their gender on their Texas driver’s licenses and other department records during the past two years.

Prior to the ban on transition-related care going into effect this year, Paxton’s office investigated multiple Texas hospitals for providing transition-related care to children. After Paxton announced one of those investigations, parents received calls from Dell Children’s Hospital in Austin telling them their appointments were canceled and their doctors had parted ways with the adolescent health


clinic.

This article originally appeared in The Texas Tribune.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.


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