Fed Judge Declares Bans on Transition Care Unconstitutional

 

Key parts of a Florida law that bans gender transition care for minors and imposes hurdles on adults seeking such care are unconstitutional, a federal judge ruled on Tuesday.

Judge Robert L. Hinkle of Federal District Court in Tallahassee sided with advocacy groups and three families who had said that the law stripped them of parents’ rights to make medical decisions for their transgender children.

In a 105-page order, Judge Hinkle said that “gender identity is real” and that a “widely accepted standard of care” includes puberty blockers and hormone treatments that Florida unlawfully banned.

“The State of Florida can regulate as needed but cannot flatly deny transgender individuals safe and effective medical treatment — treatment with medications routinely provided to others with the state’s full approval so long as the purpose is not to support the patient’s transgender identity,” Judge Hinkle wrote 

The law, passed by Republican lawmakers and signed by Gov. Ron DeSantis in May 2023, barred doctors and nurses from prescribing or administering transition-related medication to those under 18 and exposed medical providers to criminal liability and professional discipline if they did so, among other provisions.

Judge Hinkle’s ruling on Tuesday also invalidated a part of the law that said transition care for adults “may not be prescribed, administered, or performed except by a physician.” That paves the way for nurse practitioners, physician assistants, and other medical professionals to provide such care.

 

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He also struck down a provision requiring adults seeking transition care to meet in person with a doctor before starting treatment.

Last June, Judge Hinkle temporarily blocked enforcement of parts of the law for the children of the three families who filed the lawsuit, pending the outcome of a trial that was held in December. Judge Hinkle was appointed in 1996 by former President Bill Clinton.

A spokeswoman for Mr. DeSantis said the state would appeal the ruling.

”We disagree with the court’s erroneous rulings on the law, on the facts, and on the science,” Julia Friedland, the governor’s deputy press secretary, said in a statement. “As we’ve seen here in Florida, the United Kingdom, and across Europe, there is no quality evidence to support the chemical and physical mutilation of children. These procedures do permanent, life-altering damage to children, and history will look back on this fad in horror.”    

The National Health Service in England began restricting gender treatments for children in April, making it the fifth European country to impose such limits.

A panel of judges for the U.S. Court of Appeals for the 11th Circuit in Atlanta, which leans conservative, previously overturned a decision by a federal judge in Alabama who ruled against transgender restrictions for minors in that state. In his order, Judge Hinkle said the Florida case was different because of the legislative record showing public officials’ “animus” toward transgender identity.

While other states have restricted the use of state funds to pay for transgender care, Florida was the first to restrict care for transgender adults who were not relying on Medicaid, said Sarah Warbelow, the vice president for legal at the Human Rights Campaign and one of the lawyers in the case.

“It meant that folks were having to drive hours to be able to receive care,” she said.

Lucien Hamel, the adult plaintiff in the case, said he was relieved by the decision.

“I can’t just uproot my family and move across the country,” he said in a statement. “The state has no place interfering in people’s private medical decisions, and I’m relieved that I can once again get the health care that I need here in Florida.” 

Provisions of the law that prohibit gender-transition surgery for minors and impose restrictions on such surgery for adults were unaffected by Judge Hinkle’s order. The plaintiffs with minor transgender children did not challenge the surgery ban; the adult plaintiff was not seeking surgery when the challenge was filed, so the judge ruled that he did not have standing to challenge the restrictions.

Other provisions that remain intact include a ban on using state funds to pay for transition care and treating transition care in child custody statutes as equivalent to child abuse.

Across the United States, more than 20 states led by Republican lawmakers have passed bans or sweeping restrictions on transition care for minors, an issue that has been at the center of the nation’s political debates.

Courts have issued mixed rulings in lawsuits challenging those laws, leaving transgender children in many states in limbo. Last November, plaintiffs in the case against Tennessee’s law asked the Supreme Court to weigh in.

During the Florida trial, a lawyer for the plaintiffs cast the law as part of a suite of policies enacted by the DeSantis administration that discriminate against transgender people, including one that restricts the use of people’s pronouns in schools if they do not match their sex assigned at birth. (Three educators challenged the pronouns law in December.) 

A lawyer for the state countered that transgender care was unproven and risky and had been underregulated and that the law in question would help protect Floridians.

Mr. DeSantis signed the law in the days leading up to the kickoff of his presidential campaign, which he ended in January. He has spoken in graphic terms about gender transition surgeries for minors, which he calls a form of “child mutilation,” putting him at odds with major medical associations.

The legislation went further than policies adopted in 2022 by the Florida Board of Medicine and the Florida Board of Osteopathic Medicine that banned hormone treatments and surgical care for transgender minors unless they were already receiving such treatments. It also penalized doctors who violated the law with up to five years in prison and required adults seeking transition care to sign a consent form.

In his order, Judge Hinkle noted that Florida had allowed for medications such as puberty blockers and hormone therapies to treat gender dysphoria for many years. “But then the political winds changed,” he wrote.

“Transgender opponents are of course free to hold their beliefs,” Judge Hinkle wrote. “But they are not free to discriminate against transgender individuals just for being transgender. In time, discrimination against transgender individuals will diminish, just as racism and misogyny have diminished. To paraphrase a civil-rights advocate from an earlier time, the arc of the moral universe is long, but it bends toward justice.”

Patricia Mazzei is the lead reporter for The Times in Miami, covering Florida and Puerto Rico. More about Patricia Mazzei