Missouri says clinic that challenged transgender treatment restrictions didn't provide proper care

Missouri officials struck back at one of the clinics that unsuccessfully challenged new state restrictions on gender affirming care, accusing the clinic in a lawsuit of failing to provide proper care for transgender minors even before the new law took effect.

Missouri's Republican Attorney General Andrew Bailey announced the counter lawsuit against St. Louis-based Southampton Community Healthcare on Sunday, two days after it was filed in court.

The ACLU of Missouri, which represented the clinic in challenging the law that bans minors from beginning puberty blockers and outlaws gender-affirming surgeries, didn't immediately respond Sunday to the new filing. And no one answered the phone at the clinic Sunday.

The lawsuit said Southampton's doctors admitted in court during the hearing over the new law that they failed to provide comprehensive mental health evaluations to all their patients. Bailey's office argues that violated Missouri's consumer protection law because the clinic didn't follow the accepted standard of care that was in place long before the new restrictions that called for psychiatric evaluations.

“These providers failed Missouri’s children when they rejected even a diluted medical standard and subjected them to irreversible procedures. My office is not standing for it," Bailey said.

If Bailey prevails in his lawsuit against Southampton, the clinic could be ordered to pay $1,000 for each violation and pay restitution to any patients who underwent gender transition procedures without a full mental health assessment.

The new law, which took effect Aug. 28, outlaws puberty blockers, hormones and gender-affirming surgery for minors. Though it allows exceptions for those who were already taking those medications before the law kicked in, the fallout was fast: Both the Washington University Transgender Center at St. Louis Children’s Hospital and University of Missouri Health Care in Columbia stopped prescribing puberty blockers and hormones for minors for the purpose of gender transition.

Most transgender adults still have access to health care under the law, but Medicaid won’t cover it. Under the law, people who are incarcerated must pay for gender-affirming surgeries out of pocket.

Every major medical organization, including the American Medical Association, has opposed bans on gender-affirming care for minors and supported their access to medical care when treatments are administered appropriately. Lawsuits have been filed in several states to fight against restrictions that were enacted this year.

The Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders or as birth control pills.

The FDA has not approved the medications specifically to treat gender-questioning youth. But they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat transgender patients say those decades of use are proof the treatments are not experimental.

Critics of providing gender-affirming care to minors have raised concerns about children changing their minds. Yet the evidence suggests detransitioning is not as common as opponents of transgender medical treatment for youth contend, though few studies exist and they have their weaknesses.