CMA against Florida: Catholic Medical Association members Hruz, Van Meter, and Lappert have worked with Alliance Defending Freedom since 2017 to develop a group of anti-trans expert witnesses

Paul W. Hruz, Quentin L. Van Meter and Patrick W. Lappert, three principal actors in the Catholic Medical Association’s anti-LGBT capture of Florida’s state health agencies, were in attendance at meetings in 2017 with the right-wing Alliance Defending Freedom to assemble “expert” witnesses for legal arguments against trans rights and healthcare. In its initial 20 April 2022 press release, the Florida Department of Health cited as its first source Hruz’s article in the CMA’s religious-medical journal The Linacre Quarterly (Hruz, 2019), inaccurately describing it as a “systematic review” when it was actually a four-page wall of text. CMA members Van Meter and Lappert provided expert report Attachments E and F to Florida AHCA/Medicaid less than a month later on 17 May. In Kadel v. Folwell, recently decided in favor of coverage of gender-affirming care for North Carolina state employees, Hruz and Lappert described their meetings with the ADF (Deposition of Paul Hruz, 29 September 2021, and deposition of Patrick Lappert, 30 September 2021).

Along with CMA members Hruz, Van Meter and Lappert, these two meetings at the Arizona offices of the ADF included:

  • Ryan T. Anderson, current president of the Christian right-wing Ethics and Public Policy Center, founding editor of the Witherspoon Institute’s Public Discourse, and a former member of the Heritage Foundation. He’s worked with Catholic institutions including the Veritas Center at Franciscan University, the Catholic Education Resource Center, and the Institute for Human Ecology at the Catholic University of America, and was an editor at the right-wing Catholic outlet First Things. Anderson has endorsed the Catholic Church’s official ex-gay organization Courage and believes gay people should be celibate, and has extensively argued against marriage equality, gender-affirming care, and abortion access.
  • Gary McCaleb, senior counsel and vice president of “advocacy research and innovation” for the ADF.
  • Jeffrey Shafer, senior counsel for the ADF.
  • Mark Regnerus, a conservative Catholic sociologist and professor at the University of Texas at Austin. Regnerus previously authored the notorious Witherspoon Institute-funded “New Family Structures Study” in 2012, a purported study of same-sex parenting which claimed to find numerous adverse outcomes in children of these families, but suffered from significant flaws such as including almost none of these children. In a 2014 marriage equality case, Regnerus’ expert testimony was found “highly unbelievable”, with the judge noting his study seemed “hastily concocted at the behest of a third-party funder”. Regnerus argued in 2021 in the Arkansas trans youth care ban case Brandt v. Rutledge that youth are not able to offer informed consent to transition, but acknowledged in deposition that he has no experience with diagnosing or treating gender dysphoria in any trans youth or adults (Brief in support of motion to exclude expert testimony of Mark Regnerus, 22 June 2022). In deposition, Regnerus describes writing for First Things and teaching a “Catholicism and Social Thought” course at UT, which includes curriculum on “how the Catholic church understands gender identity”, “Catholicism in general and understanding what the teachings of the church say on this”. He openly states that on the safety and efficacy of transition care, his Catholic faith “wouldn’t make it easy for me mentally, theologically, to sort of endorse these things” (Deposition of Mark Regnerus, 5 May 2022, pp. 258-259).
  • Michelle Cretella, former president and current executive director of the anti-LGBT hoax group American College of Pediatricians (ACPeds). Cretella is also a member of the CMA; ACPeds almost wholly overlaps with CMA’s anti-trans views and may serve as a secular front for these religious beliefs. Cretella previously claimed incorrectly on the Heritage Foundation site Daily Signal that no youth had ever decided not to transition after taking puberty blockers, when several cases of this had been known for years. She’s also asserted without evidence that any observed differences in brain structure or activity between trans and cis people would be “more likely the result of transgender behavior than its cause” due to “neuroplasticity” (Cretella, 2016), a claim printed in the journal of the fringe Association of American Physicians and Surgeons. This low-quality journal has also featured arguments that hydroxychloroquine can treat COVID-19, even though it does not work, arguments that vaccination causes autism, which it doesn’t, and false claims in 2005 that US cases of leprosy had dramatically spiked in the previous three years due to immigration, even though these cases had not increased.
  • Andre Van Mol, co-chair of ACPeds’ Committee on Adolescent Sexuality and co-chair of the Christian Medical & Dental Associations“Transgender Task Force” (termed the “Sexual and Gender Identity Task Force” in an amicus brief in Hecox v. Little). Van Mol has given presentations for the anti-gay, anti-trans conversion therapy group IFTCC, has called puberty blockers a “gateway drug”, and previously coauthored a largely inaccurate letter to the editor with Hruz and Van Meter in response to the Endocrine Society’s 2017 transgender guidelines. Taking up a recent talking point from anti-trans group Genspect, Van Mol has inaccurately claimed that the UK NHS is reducing access to gender-affirming care for youth, when it is actually expanding to several new gender clinics to reduce waiting times. He also serves on the board of the Christian anti-gay, anti-pornography group Moral Revolution, and on the board of the Bethel Church Redding charismatic megachurch, a site of various alleged “miracles”. Van Mol instructs in bioethics at the “Christian Hogwarts” Bethel School of Supernatural Ministry.
  • Allan M. Josephson, a former chief of child psychiatry at the University of Louisville. Josephson appeared on a Heritage Foundation panel in 2017 and encouraged parents in “guiding their child to align with his or her biological sex”, which would be a directed gender identity change effort considered conversion therapy. Josephson contributed an expert report for the defense in 2017 in the school restroom access case Adams v. School Board of St. John’s County in Florida (Motion to preclude Dr. Josephson from testifying, 6 December 2017).
  • Hacsi Horvath, an adjunct professor in epidemiology and biostatistics at the University of California San Francisco. Horvath is an anti-trans detransitioner who spoke at a Heritage Foundation panel in 2019 with Kara Dansky, Julie Beck, Jennifer Chavez, and moderator Ryan T. Anderson; the panel was organized by unaccepting parents who believe their trans children are suffering from the hoax condition “rapid onset gender dysphoria”. He’s also contributed to the anti-trans blog 4thWaveNow, one of three sites that originally developed the “ROGD” pseudo-diagnosis. Horvath “stopped taking estrogen in 2013 for health reasons and claims this brought him back to his senses” (Amicus brief of Walt Heyer et al., 23 August 2019, in G. & G.R. Harris Funeral Homes v. EEOC).
  • Walt Heyer, a detransitioner and anti-trans activist who appeared on another Heritage Foundation panel with Ryan T. Anderson and regularly contributes to several conservative outlets. In a 2019 amicus brief with Hacsi Horvath and other detransitioners in Harris Funeral Homes v. EEOC, Heyer claimed that his apparent gender dysphoria was actually a “dissociative disorder” caused by “engaging in cross-dressing at a young age for a two-year period”. Heyer is a contributor to Public Discourse and the Catholic Education Resource Center, and once accused a nine-year-old trans child of “spreading a ‘contagion of mass delusion’”; Heyer himself says he stopped being trans due to “redemption with Jesus Christ”.
  • An unnamed former chair of a plastic surgery department at Ohio State University.

Paul Hruz explained the origin and purpose of these meetings in deposition:

Q. Have you met with staff from the Alliance Defending Freedom in order to discuss how to serve as an expert in cases involving transgender issues?

A. My involvement was mostly to tap into my knowledge and expertise in this area, to inform that organization of some of the relevant issues. I’ve never been coached on how to be an expert witness, nor have I necessarily been encouraged in any way. These requests have generally come from the litigating lawyers, how they received my name or to what extent and in what ways they became familiar with my knowledge and expertise in this area is not known to me. Just like the other groups that I’ve spoken to, I’ve been more than willing to be — to share the knowledge that I’ve accumulated over this last decade in this area.

Q. Did you attend a meeting at the Alliance Defending Freedom offices in Arizona in 2017?

A. I don’t recall the exact date, but I did travel to Arizona to meet with other individuals that also had unique areas of expertise in the area, yes.

Q. Just to clarify, was that one or two meetings?

A. I think I’ve had two separate meetings. The first was much shorter. And the second one was much more of presentations with actual data.

Q. What was discussed in that first meeting?

A. Again, it was many years ago. But my recollection was just to understand what was going on. It was — it was the same types of questions about the care that is being proposed and offered. But it was much less defined, I think, at that point in time. It was more of an informal type of meeting.

He also made note of the attendees:

Q. Who was in attendance at that first meeting?

A. I suspected you were going to ask me. And, you know, honestly I don’t remember the exact composition of the people that were there. If you happen to know, I can acknowledge or deny whether they were there or not. But I’ve met literally hundreds of people over the last ten years in various settings. I do know that at that first meeting, Allan Josephson was there. And I believe that Mark Ramirez [sic] was there as well.

Q. Was Jeff Shafer there?

A. Yes. He actually at that time was working for ADF.

Q. Was Gary McCaleb there?

A. Yes. And he was one of the first contacts I had from that group.

Q. When they invited you to this meeting, what was the invitation, what did they tell you it was going to be about?

A. They had desired to convene a group of people that had knowledge in this area and to be able to discuss that, is my recollection at that point in time.

Q. Was Ryan Anderson there?

A. He was at one of the meetings, the two meetings, I’m not sure which — which one.

Q. About how many people were in that first meeting?

A. Probably about eight to ten if you include Jeff Shafer and Gary McCaleb. You know, no more than a dozen, probably less than that.

Q. And the second meeting, you indicated that it involved some presentations; is that right?

A. That’s correct.

Q. Was it also in Arizona?

A. Yes.

Q. Who was present at the second meeting?

A. Similar to the first meeting. And, again, I may get mixed up, the first and second meetings. There were different people that were present. I know that Walt Heyer was at one of the meetings. Oxy [sic] Horvath was at one of the meetings as well. You’d have to give me the other names if there was any. I’m drawing a blank. It was a while ago.

Q. Was Mark Regnerus at the second meeting?

THE COURT REPORTER: I’m sorry. What was that name?

A. He was only at —

MR. GONZALEZ-PAGAN: Mark Regnerus, R-E-G-N-E-R-U-S.

A. I believe he was at one of the meetings. I’m not sure which one.

Q. (By Mr. Gonzalez-Pagan) Was Patrick Lappert at one of these meetings?

A. He would have been likely at the second meeting.

Q. Was Michelle Cortella [sic] at any of these meetings?

A. I’ve encountered Michelle at a number of different settings. I’m trying to think back. I honestly — I just can’t remember. She may have been at one of them.

Q. Was Quinton [sic] Van Meter at any of these meetings?

A. I have met with him. I’m just trying to think of what the circumstances and when he was there. Again, you know, I’ve met so many people over many different years in many different venues. It’s challenging for me to remember who was in what meeting.

Hruz also highlights the involvement of anti-trans detransitioners with the ADF:

Q. Did the ADF lawyers discuss the need to develop expert witnesses for litigation?

A. Again since it was several years ago, I’m trying to remember the exact content. I think the main focus was — was understanding what was going on to be able to understand from multiple different perspectives. One of the most helpful outcomes for myself was the opportunity to talk to the transitioners. These are adults that have had the experience of going through the affirmation approach only to discover eight to ten years after that, that it did not solve their problems. It was similar to my efforts to connect with parents and — that were experiencing this with their children as part of my understanding of the unique circumstances facing these individuals. That’s what I walked away with more than anything else. Whether there was discussions about, you know, whether there were — were litigation going on is — I just don’t recall.

Q. Were you aware that the Alliance Defending Freedom is a religious organization?

A. I think that’s — if you travel to their headquarters, that’s hard to miss.

The next day, Patrick Lappert also detailed these meetings in deposition, confirming many of these attendees:

Q. How are you familiar with the ADF?

A. I was invited down there for a conference on the subject of transgender. I was an invited presenter, I should say. They asked me to come and speak from a plastic surgeon’s perspective on how I view the current state of transgender medicine and surgery.

Q. Those were — those were the meetings in Arizona? Is that right?

MR. KNEPPER: Objection.

A. Yes.

Q. Who invited you?

A. I don’t remember who the particular name was. I — I don’t recall who the — the particular person, the one that sent me the invitation.

Q. Was it —

A. It may have been — it may have been Gary McCaleb, I want to say. I’m not positive about that, though.

Q. The ADF has moral objections to doctors performing this kind of surgery and treatment; right?

MR. KNEPPER: Objection, form, scope.

A. I would — I would characterize the ADF’s position as more than just a moral objection. It’s both moral and objective scientific objections. So the — the — the sense I got from that conference was that most of the invited speakers came to speak about — for example, Dr. Hruz was there, and he spoke about endocrinology and the endocrinol- — endocrinologic basis for sex/gender. And he spoke about the effects of — the endocrinological effects, the objective changes that are caused by, for example, puberty-blocking cross-sex hormones. I was — there was also another speaker there, I think, on the subject of — from the family medicine perspective, the overall effects on the health of the child, developmental issues. There was a presenter on the objective psychological issues. And then, I presented on the realities of the surgery. They wanted me to speak about the technical details of transgender surgery, kind of the evolution of the process of transitioning surgery, and the — and to give them a summary of the state of the science on it. So I would characterize the ADF as interested in both the moral — the moral issues and the objective, and they impinge upon one another. Clearly, to do something that is not in the — in the objective benefit of the patient is a moral problem. Did I answer your question?

Q. That’s helpful, yeah. The ADF is not a professional scientific organization; right?

A. Not to my knowledge, no.

Q. How many people were present at this first meeting?

A. Perhaps ten. I’m not certain.

Q. Outside of you and Dr. Hruz, who else do you remember being at that first meeting?

A. I remember meeting a Dr. Andre Van Mol. I believe he was at that meeting. There was a pediatric endocrinologist there by the name of Quentin Van Meter. I think he was there. There was a — there was an expert in scientific data and scientific data analysis, medical record data analysis from UC-San Francisco. I don’t believe he was a physician. I think he was a — had a doctorate in science. And he was a — he was actually a detransitioner. So he was giving not only his knowledge of the medical literature, he was just an incredible resource and reference for medical literature. You could just about ask him anything. But he was also there, I think, to speak from a personal perspective as well, being a detransitioner. There was another detransitioner there who I don’t remember their name, but they were there to speak. I think they were also an educator as well. I’m not positive about that. So it’s kind of vague for me, but I — but definitely Paul Hruz stands out because we had a very good conversation there.

Q. What was the format? Were there presentations, a round table discussion? How did the conversations go?

A. There was some introductory remarks, and then — and then each — each sort of specialist gave a presentation. I think I gave an hour-long presentation. And there were others like mine on those other subjects we talked about.

Q. Who made the introductory remarks at the beginning of this meeting?

MR. KNEPPER: Objection, form, scope.

A. I’m trying to remember. It was a — it was an attorney whose first name is Jeff, and I’m trying to remember what his last name was. But he seemed to be the — the — kind of the emcee, if you will. Yeah, Jeff. I’ll see if, in the course of our conversation today, the name will pop in. This is the difficulty I have with remembering names. They’ll just pop in at a moment’s notice. But it was — yeah, it was an attorney who gave the overall scope of why — why we were there, to discuss this issue, to see what — what the — what the science is showing to see where — what the — the moral aspects of good science versus bad science and issues like that, yeah.

These meetings also included the disapproving parents and families of trans people:

Q. Okay. All right. So then there was a second meeting also in Arizona; right?

A. Right.

Q. And that was also in 2017?

A. I don’t remember the date of that as well — either, no.

Q. What was the purpose of that second meeting?

A. I think it was similar, although it may have been a little bit more refined. There was not as much discussion of the really foundational science as more a review, I think, of — you know, I — I guess it was similar in terms of format. I think there were more — more people there who were speaking from personal experience. So I think the most important thing I recall from that meeting was that — that there was a mother — actually, a couple of family members of persons who experienced cross-sex self-identification who have gone through various — various phases of transitioning. And they were giving sort of a personal experience, trying to describe to us what they went through as a family, what they went through with their children. And that’s what — so that was the difference between the first and the second meeting. I think it was more of a personal thing. It had the science as well, but I think it had more of a personal side to it as well.

Q. How many people do you think attended — attended that second meeting?

A. I’m trying to think how full the room was. I think it was probably comparable maybe, a dozen perhaps. I’m not sure.

Q. Who do you remember being there by name?

A. I think that may have been when I met Dr. Cretella. I can’t remember if I met her at the first meeting or the second meeting. Oh, also at that second meeting, there was a plastic surgeon. I can’t remember his last name. I was — I remember being very encouraged to meet another plastic surgeon who saw this as an issue. And I do remember that he had been the chairman — this speaks to the issue of fear about testifying. He had been the chairman of a major plastic surgery department in a large Midwest university, had built that program for many years, had run one of the most successful residency training programs. And he had been fired because he had objections to the transgender services that the hospital administration — or the university administration wanted to introduce. And I thought it was a very heartbreaking story to see that a man had lost his entire career over his professional opinion. I don’t remember his last name, but I do know that I met him at that second meeting.

Q. Do you remember his first name?

A. I don’t.

Q. Do you remember which center he was affiliated with?

A. I believe he was from the Ohio State University. But I haven’t seen or heard from him since. He has just disappeared. I tried to reach out to him, I recall, because, again, there’s not a lot of plastic surgeons who are willing to speak on this matter. And — but I haven’t heard from him since.

Q. And you mentioned that there was some personal testimony from parents, families. What portion of the meeting was that, roughly? . . .

A. I would be guessing that perhaps a third of the meeting was — was that.

Notably, Lappert acknowledges he had not published any material on gender dysphoria or served as an expert witness before these meetings with the ADF:

Q. Before that meeting, you had not published anything about gender dysphoria, had you?

A. No.

Q. Before that meeting, you had not published anything about the risks of use of hormone blockers in minors; right?

A. No. I’ve given — I gave some — some — I think they may have heard of me not through publications, but through public speaking.

Q. All right. Give me a high-level summary of what your presentation was at that first meeting.

A. It was a –

MR. KNEPPER: Objection, form, scope.

A. — a summary, a summary of the present state of transgender medicine and surgery, a review of the scientific literature used to support the treatments that are being offered, a review of the long-term outcomes of treatment that are being offered, with particular attention to the European literature, which is more reliable. I sort of — I compared the American literature to the European literature because that’s one of the great problems we’re having in this issue. And it was already evident in that there was a great disparity between the American literature and the European literature in terms of the quality of the scientific evidence that’s being used to support the interventions. So that was — really at the heart of the presentation was what’s the state of the science and where is the reliable science coming from and what is it — what is it showing us, so. But they also — the audience wanted to have an understanding of what these plastic surgery interventions were. So there was an extensive discussion of the particulars of the surgeries, the details about the surgeries, the typical outcomes of the surgeries, so.

Q. I want to — strike that. One of the topics of discussion at that meeting was about the need to have expert witnesses for litigation; right?

MR. KNEPPER: Objection, form, scope.

A. I remember — I remember a fairly long discussion about the poverty of people who are willing to testify because of the risk that they take in testifying. That was a — that was a fairly long discussion. And the difficulty that that — that people have in finding expert witnesses because of the risks they place themselves in, in testifying.

Q. And people at that meeting were asked whether they would be willing to participate as expert witnesses; right?

A. Yes.

Q. Before that meeting, you had never testified as an expert witness?

A. Before this moment, I never testified as an expert witness.

Following these meetings with the ADF, a number of attendees including Hruz, Van Meter, and Lappert have been offered as experts in court cases and legislative hearings. In doing so, they and other CMA- and ACPeds-linked experts have been repeatedly identified as showing substantial personal bias, preexisting faith commitments against any gender-affirming care, lack of relevant experience, and other significant defects in their claimed expertise.

Florida chooses its “expert” sources: CMA members enter the 2022 anti-trans process

Paul W. Hruz

Dr. Paul W. Hruz is a pediatric endocrinologist and an associate professor at the Washington University of St. Louis Department of Pediatrics. Hruz is a member of the Catholic Medical Association, a fellow of the CMA-allied National Catholic Bioethics Center, and holds a “Certification in Healthcare Ethics” from the NCBC’s certification program (Declaration of Paul Hruz, 7 July 2021, in Brandt v. Rutledge). The Florida Department of Health’s April 2022 press release cited Hruz’s inadequate “systematic review” of transition care published in CMA’s journal The Linacre Quarterly, and the Florida AHCA Generally Accepted Professional Medical Standards determination in June 2022 referenced his Linacre Quarterly article as well as an inaccuracy-filled letter to the editor coauthored with Quentin Van Meter and Andre Van Mol (Laidlaw et al., 2019). Hruz has written for the NCBC’s National Catholic Bioethics Quarterly (Hruz, 2017), the Ethics and Public Policy Center’s political journal The New Atlantis (Hruz, Mayer & McHugh, 2017), and contributed the chapter “Medical Approaches to Alleviating Gender Dysphoria” to the NCBC’s book Transgender Issues in Catholic Healthcare (Furton, 2021).

Hruz is a religious extremist who told a mother of a trans child that “some children are born in this world to suffer and die” and recommended she read the writings of Pope John Paul II on gender (Motion to exclude expert testimony of Paul Hruz, 6 December 2017, in Adams v. School Board of St. John’s County):

For example, Dr. Hruz has testified that when he met with the parent of transgender child who was affiliated with an organization called TransParent, he was in a “very early investigative phase” of his so-called study of gender dysphoria. Hruz Depo. Tr. 103:25-104-7; id. at 102:24-103:9 (“A. Again, this was at the very early time frame when I was trying to investigate the claims for the treatment and care, and I wanted to get as comprehensive of a viewpoint as I could.”). However, the nature of Dr. Hruz’s conversation with Ms. Hutton revealed that his opposition to gender-affirming care and treatment of transgender children, as well as his opposition to a having a Transgender Center at St. Louis Children’s Hospital, was already firmly established and is rooted in his personal moral and religious views. Here, Dr. Hruz told Ms. Hutton, “there will never be a pediatric gender center at St. Louis Children’s Hospital. I won’t allow it,” Hutton Depo Tr. 30:8-30:11, at a time when he claims he was “very early” in his investigation of gender dysphoria, Hruz Depo. Tr. 103:25-104:7; id. at 102:24-103:9 (Excerpts of the deposition of Kim Hutton are attached hereto as Exhibit G).

Similarly, during his investigatory conversation with Ms. Hutton, Dr. Hruz told Ms. Hutton multiple times that her “child was not normal and would never be normal,” Hutton Depo. Tr. 28:20-28:23; that “the idea of doing surgeries on transgender people is — is wrong,” id. at 21:21-27:24; and told Ms. Hutton “to read Pope John Paul IIs writings on gender,” id. at 29:17-29:20. And in response to Ms. Hutton’s statement that transgender children, including hers, “are at a 41 percent risk of suicide if they don’t have acceptance and — and care from their parents and — and if they don’t get their medical needs met,” Dr. Hruz responded that, “Some children are born in this world to suffer and die.” Hutton Depo. Tr. 29:21-30:4.

As a result, Ms. Hutton left her conversation with Dr. Hruz—a conversation Dr. Hruz testifies he “was approaching this in a purely investigative manner” to learn about the “lived experience” of transgender children and their families, Hruz Depo. Tr. 126:16-127:3—“perplexed” due to “the religious tone of the conversation,” which she “figured [] would at least be based on science.” Hutton Depo. Tr. 37:11-37:19.

In a 2017 presentation at the St. John Paul II Bioethics Center of Holy Apostles College and Seminary, Hruz claimed that being transgender “has its roots probably in Cartesian dualism and in fact probably goes back to some of the early heresies in the church including Gnosticism” (01:59). He recognized that gender-affirming hormone therapy produces “temporary alleviation in the amount of discomfort these individuals experience”, but compared this to “somebody that that is an alcoholic and they’re going to have a temporary relief of their craving for alcohol when you give them alcohol” (36:00). Making the same incorrect claim as Michelle Cretella, he falsely states “100%” of trans youth taking puberty blockers will go on to transition (33:37).

On the treatment he believes trans people should receive, Hruz stated that “we need to educate them on the physical, emotional, and spiritual nature of human sexuality, we need to reinforce the beauty of the human person male and female from a biological standpoint, from an interpersonal standpoint”, and endorsed the “complementarity of male and female” (45:22), a Christian doctrine of misogyny that declares women are inherently unequal to men. Hruz also received the Center’s “Redemptor Hominis Award” in 2017.

Hruz has worked with HazteOir/CitizenGo, a Spanish far-right Catholic group that has supported abortion bans, the Russian anti-gay “propaganda” law, and the criminalization of homosexuality in Kenya. HazteOir has attempted to remove links to Wikileaks files exposing their connection to the militant Catholic secret society El Yunque. Hruz spoke at a 2018 HazteOir conference in Madrid described as “a rebellion against the gender ideology” (Deposition of Paul Hruz, 29 September 2021, in Kadel v. Folwell; Exhibit K in Hruz deposition):

Q. Are you familiar with the gender and sex conference?

A. Yes. And are you referring to the one in Madrid.

Q. That was going to be my question. Did you participate in the gender and sex conference in Madrid in 2018?

A. I don’t recall the exact date. But if it was 2018, yes, I did present there.

Q. Did you know that the conference was billed as, quote: A rebellion against the gender ideology and its freedom destroying damaging law, closed quote?

A. I — I don’t recall that language being presented to me when I agreed to present at that conference.

Q. Did you know that the conference was focused on opposing what it termed “gender ideology”?

A. You know, again, I was asked — and this is true for — if you’re going to go through the list of all of the places that I’ve spoken at. When I’ve been invited to present at any of these conferences, my desire is to provide the most accurate and up-to-date scientific information related to the condition of gender dysphoria. I am willing to present to any audience that is willing to hear that information. I don’t make judgment about what the motives are of the individuals organizing the conference. But merely serve with my area of expertise and my knowledge to be able to further that discussion in a productive manner. And that applies to that sex and gender conference in Madrid.

He also appears to believe incorrectly that the “watchful waiting” model precludes any medical gender affirmation when it does not (Deposition of Paul Hruz, 29 September 2021, pp. 121-140), an error previously made by CMA member and Florida AHCA report contributor G. Kevin Donovan in an article coauthored with CMA member Michelle Cretella (Laidlaw, Cretella, & Donovan, 2019). In a National Catholic Bioethics Quarterly article, Hruz described both gender-affirming hormone therapy and contraception as “biological mutiny” (Memorandum in support of summary judgment, 26 October 2018, in Bruce v. South Dakota):

Dr. Hruz has written two articles related to gender dysphoria in religiously affiliated publications that are not peer-reviewed. The first article was published in The New Atlantis, which is a quarterly publication from a socially conservative advocacy group “dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy.” Hruz Dep. at 43-44, 49. The second article was published in Catholic Bioethics Quarterly. Id. at 43-44. Dr. Hruz wrote the article as a final paper for the correspondence course he took with the National Catholic Bioethics Center. Id. at 67. In the article Dr. Hruz wrote: “The readily-accepted view that reproductive capacity can be disassociated from what it means to be male and female, which has grown from the seeds of ‘biological mutiny,’ that began with the acceptance of contraception as a solution to difficult social circumstances must be held to close scrutiny in assessing the morality of cross-sex steroid use.”

Similarly, recent Florida Board of Medicine appointee Patrick Hunter was recognized in an article by the Orlando Diocese about a student CMA branch, which stated “millions of women are still polluting their bodies with contraceptive chemicals”. Hruz holds a personal religious belief in opposition to gender-affirming care, and appears to believe it is not possible that scientific evidence would ever support the safety and efficacy of gender-affirming care in contradiction to his Catholic faith (Deposition of Paul Hruz, 25 May 2022, in Brandt v. Rutledge):

Q. Do you have personal religious views about gender transition?

MS. LAND: Object to form and relevance.

A. So you are asking what are the bases of my scientific premises that I use in formulating –

Q. No. I’m not asking about the basis of your scientific premise. I’m just asking about your personal religious views.

A. I have religious views. I think everyone does. If one does not, they are ignoring reality.

Q. So what are your personal religious views about gender transition?

MS. LAND: Objection to form, relevance and scope.

A. I am a physician-scientist, and I’m a pediatric endocrinologist. I look at all of — again, this gets back to your question earlier about the relationship between faith and reason. And I have repeatedly stated in many venues that there is no contradiction between faith and reason. Yet my focus is on science, which would fall in the category of reason. So that I don’t see any conflict between what I can know by science versus what others can understand on the basis of a faith understanding. But they’re not mutually exclusive and everything that I have seen from a rigorous attempt at unbiased assessment of the scientific evidence is in concert with those statements that are made in nonscientific rounds related to theology or philosophy.

Q. So let’s say there were a dozen studies, including randomized trials that met the standards that you believe for rigorous assessment and institutional review board oversight that demonstrated the effectiveness of cross-sex hormone therapy to treat gender dysphoria, would you support the treatment even though it’s still distorts biological reality, as you describe it?

MS. LAND: Objection to form.

A. My understanding, I have never in my entire life, in my professional career, ever experienced that conflict and I doubt very highly that that would ever occur. But I, again, am a physician-scientist and I follow the facts where they lead.

Q. So I just — since we’re allowed to ask — sorry — I just want to ask again because you didn’t answer the question; do you have personal religious views about gender transition separate from what you explained about your medical views?

MS. LAND: Objection to form, asked and answered.

A. It doesn’t occur in a vacuum. So my religious views cannot be disassociated from my scientific views. But I’ve already answered your question that I do have religious views.

Q. And what are they?

MS. LAND: Objection to form, asked and answered.

A. They are in consonant from what I’ve learned from science that I described in very much detail within my declaration and throughout this deposition.

Q. What are they with respect to gender transition?

MS. LAND: Objection to form, asked and answered.

A. I would say there is an intrinsic teleologic relationship between male and female for the purpose of reproduction. That’s a basic scientific fact. It can also be understood from a theological or philosophical perspective. They are not in conflict with each other. There are approaches to medical care that seek to preserve the integrity of the human person, and that understanding of that teleologic relationship again where the science that I’ve seen thus far has been entirely in concert with statements that are made from a philosophical or theological perspective.

In his chapter on gender dysphoria for the NCBC, Hruz rejects even the possibility of gender-affirming care being acceptable or helpful, as he considers it contrary to “ethical boundaries” established by “Catholic anthropology”, violating the “intrinsic body-soul unity” (Hruz in Furton 2021, p. 3):

Central to this work is the consistent application of fundamental principles of Catholic anthropology and bioethics. Pope St. John Paul Il’s teaching on the Theology of the Body, with its understanding of human dignity and bodily integrity, can inform the ethical boundaries that must be established when working with people who experience gender dysphoria. Continued efforts to provide the best possible care must remain centered on the ultimate good of affected persons as dignified members of the entire human family. Hypotheses based on asserting that experimental intervention will realign an individual’s body with his or her so-called true self as male or female according to the individual’s mind distort the objective biological understanding of sex and are therefore untenable. If viewed in light of an intrinsic body—soul unity, the hypothesis essentially asserts that separating what cannot be separated is beneficial. Regardless of the investigator’s intent, he or she has reasonable grounds to question the proportionality—for both the affected individual and society as a whole—of violating this fundamental principle of the very nature and meaning of sex.

Hruz also rejects the possibility of future gonadal or uterus transplants that would allow trans people to attain their desired fertility, asserting that these hypothetical procedures still “do not overcome the fundamental objection, from a Catholic perspective, that they constitute direct and intentional destruction of innate biological function” (Hruz in Furton 2021, p. 17). He states that “concluding that desistance is a desirable outcome seems reasonable” (p. 10) and argues that trans people cannot consent to transition treatment if they are depressed (p. 20):

Similarly, individuals with transgender identity who also have clinical depression or other serious psychiatric comorbidity may have limited capacity to objectively weigh proposed clinical interventions with potentially irreversible consequences and would therefore fail to meet psychological-abilities criteria.

Hruz offers an incoherent concept of “informed consent” that shows no regard for the basic expressive freedoms of transgender citizens and assumes the cis people around us must “consent” to us being out as trans (p. 22):

One overlooked challenge to obtaining informed consent for any gender-affirming intervention is the assumed participation of the community. Since support of a patient’s desired gender is not restricted to the affected person but rather enlists the participation of multiple individuals within the surrounding community, it is appropriate to question whether current use of the gender-affirmation paradigm leads to unwilling participation in social experimentation. The consent of parents, neighbors, teachers, siblings, and peers in pronoun usage and bathroom access is not solicited.

Hruz finally asserts that reliance on “the Catholic Church’s teachings” to “respect human dignity without violating body integrity”, and other “non-negotiable moral principles”, will “undoubtedly make effective therapeutic approaches more precise” (p. 27):

The general framework for future investigative efforts addressing the problem of gender dysphoria, as presented in this discussion, relies both on universally accepted scientific standards of research and on the ethical guidance provided by the Catholic Church’s teachings on human dignity and the Theology of the Body. Objective evaluation of the nature and scope of the problem yields a clear moral imperative to develop effective and long-lasting solutions to the complex needs of individuals with gender discordance. To be successful, this work must respect human dignity without violating bodily integrity. Better understandings of the various contributing factors, both biological and environmental, and of the effects of psychological and medical interventions will undoubtedly make effective therapeutic approaches more precise. Continued recognition of anthropological assumptions and non- negotiable moral principles can help the medical community distinguish hypotheses that are plausible and worthy of investigation from those that are untenable even without experimental testing.

In the 10 June 2022 ruling in favor of the plaintiffs in Kadel v. Folwell (Memorandum opinion and order), much of Hruz’s expert testimony was excluded due to his lack of sound arguments or relevant qualifications:

First, Hruz is not qualified to offer expert opinions on the diagnosis of gender dysphoria, the DSM, gender dysphoria’s potential causes, the likelihood that a patient will “desist,” or the efficacy of mental health treatments. Hruz is not a psychiatrist, psychologist, or mental healthcare professional. He has never diagnosed a patient with gender dysphoria, treated gender dysphoria, treated a transgender patient, conducted any original research about gender dysphoria diagnosis or its causes, or published any scientific, peer-reviewed literature on gender dysphoria.

Additionally, Hruz is not a surgeon and has no experience with surgery for gender dysphoria and, therefore, is not qualified to testify to the risks associated with surgery or the standard of care used by surgeons for obtaining informed consent for surgery.

Third, Hruz provides no scientific basis to his conclusion that “parents are often manipulated and coerced by misinformed political activists or providers who threaten them with dire warnings that the only two options are ‘treatment or suicide’” or that endocrinologists generally do not obtain informed consent from their gender dysphoric patients. Hruz is not a statistician and does not discuss in his report how he came to those conclusions, what data he relied upon, or what methodology he applied to that data. This testimony will therefore be excluded as unreliable.

Fourth, it does not appear that Hruz has any experience with the AMA, WPATH, or American Psychological Association upon which to base his criticisms. (See ECF No. 215-3 ¶ 34.) He is therefore not qualified to testify about the credibility of those organizations. Moreover, Hruz’s criticism of the AMA appears largely based on its historical support of eugenics procedures not at issue in this case, and Hruz has not explained what scientific methodology if any he used to compare and contrast treatment of gender dysphoria with the eugenics movement. (See id. ¶ 34.A.) Hruz is not qualified to opine on the deficiencies of the DSM and the American Psychological because he is not a mental health professional.

Finally, it does not appear that his repeated references in his report to a “Gender Transition Industry,” “Cancel Culture,” and political activists working to “silence open public debate” has any basis, scientific or otherwise. (See id. ¶ 65.) He provides no evidence of such a conspiracy or any reliable methodology supporting his opinion as required by Rule 702. Rather, his conspiratorial intimations and outright accusations sound in political hyperbole and pose a clear risk of inflaming the jury and prejudicing Plaintiffs. It is the Federal Rules of Evidence, not some “Cancel Culture,” that excludes this portion of Hruz’s testimony. Since these claims are not based in any methodology and will not assist the trier of fact, this testimony is inadmissible.

Quentin L. Van Meter

Dr. Quentin L. Van Meter is a pediatric endocrinologist based in Atlanta, Georgia and is president of ACPeds and a member of CMA. Van Meter wrote the expert report Attachment E for Florida Medicaid, which does not appear to be an original work and instead copied large sections from his previous testimony in 2016 and an ACPeds position statement by Michelle Cretella. Van Meter supports anti-gay and anti-trans conversion therapy and is on the board of the conversion therapy organization IFTCC. He believes no youth or adults should ever transition, admits he is sought out specifically to provide anti-trans testimony and calls transition “child abuse” to get “attention”, and was previously excluded as an expert on gender-affirming care for youth in a custody case.

Van Meter called trans youth “a monumental epidemic of increasing proportions” at the August 5 Florida Board of Medicine hearing, has said being trans is “a cult phenomenon” due to “internet access and hysteria”, and has argued for discrimination against trans youth at school in order to discourage other trans youth from coming out: “The Board’s designated expert believes that allowing Gavin to use the same restrooms as other boys could spread a ‘social contagion’ that causes other students to question their own gender identity” (Memorandum in support of summary judgment, 26 March 2019, in Grimm v. Gloucester County School Board).

Read more: Florida’s anti-trans expert Dr. Quentin L. Van Meter was discredited on trans youth care in court, believes trans people are “delusional”, and promotes anti-gay conversion therapy

Patrick W. Lappert

Deacon Patrick W. Lappert is a plastic surgeon in Birmingham, Alabama, author of Florida Medicaid expert report Attachment F, and a board member of the Catholic Church’s official ex-gay ministry Courage, which believes gay people should be celibate and trans people should not transition. An anti-trans catechesis by the Bishop of Arlington, cited by the CMA in a 2021 lawsuit as a basis for their religious objections to supporting gender-affirming care, also recommended the anti-LGBT groups Courage, EnCourage, and Truth and Love. Courage promotes a group format similar to Alcoholics Anonymous for LGBT people and has aimed to attract unaccepting parents of trans youth; the anti-trans group Genspect, supported by CMA member Patrick Hunter of the Florida Board of Medicine, has also endorsed “Twelve Step programs” for trans people and their families.

Lappert admits that his training on gender dysphoria consisted of a half-day course on the weekend (Reply in support of motion to exclude Lappert, 25 July 2022, in Brandt v. Rutledge). Testifying for the Alabama trans youth care ban S.B. 184, Lappert compared trans youth to a hypothetical child saying “I self-identify as an Olympic athlete, I need anabolic steroids” (Complaint for declaratory and injunctive relief, 11 April 2022, in Walker et al. v. Marshall et al.). He has described providing gender-affirming care as a “moral violation” for healthcare professionals, called this care “diabolical”, and claimed that even discussing gender identity with children is “sexualizing” and “grooming” them (Memorandum of law in support of motion to exclude Lappert, 2 February 2022, in Kadel v. Folwell):

These include, for example, his views that the religious conception of “the human person” “defines the ‘end’ of medical and surgical care.” (Ex. 2 at 459.) They also include his opinions that “changing a person’s sex is a lie and also a moral violation for a physician,” and that gender-affirming surgery is “diabolical in every sense of the word.” (Id. at 464 & Ex. 16 at 1, 7; Ex. 2 at 465 (agreeing that he “hold[s] those views”). And finally, these also include his inflammatory views that parents who “discuss[] gender identity issues with children” are “sexualizing them” (Ex. 2 at 462), and that these conversations are “grooming a generation” for abuse. (Id. at 461 & Ex. 15 (Dr. Lappert’s presentation titled “Transgender Surgery & Christian Anthropology”) at 23; see also Ex. 16 at 1, 2 (another interview with Dr. Lappert titled “Plastic surgeon: sex-change operation ‘utterly unacceptable’ and a form of ‘child abuse’”; reporting that “regarding children, Lappert said, sexualizing them at a young age with these ideas is grooming them for later abuse.”).)

Specifically, Lappert called gender-affirming surgery “diabolical” on the grounds that trans patients can still preserve their fertility by storing gametes, a form of reproductive technology he considers immoral. He described fertility preservation as like slavery and said “transgender surgery is right at the heart of that evil” (Exhibit 16):

Because these procedures result in sterilization, they are tied to assisted reproductive technology, Lappert explained, with patients asked how they want to “preserve their fertility,” donating either sperm or ova, should they want children later.

“Those things will be put aside and for future assisted reproductive technology, essentially turning human persons into commodities,” Lappert said.

“Because they will be told, you have a right to have a child even though you’re having this transgender surgery,” he said. “You have a right to have a child. So we’re going to do these things for you. Well, that’s the language of slavery, to speak of a person that’s having a right to another person is the language of slavery.”

“It’s leading us to seeing the human person as a commodity that is regulated by the government, by government institutions, universities, and by laboratories,” Lappert continued. “And that is a huge evil. It’s a huge evil and never forget, that transgender surgery is right at the heart of that evil.”

“First of all because it utterly perverts our sense of human sexuality,” he said. “It internally divides the human person from their very own bodies. And now it’s separating the human community from their reproductive faculties, in the era of assisted reproductive technology. So this is diabolical in every sense of the word. Diabolical.”

In September 2018, Lappert delivered his presentation on “Transgender Surgery and Christian Anthropology” at the University of Mary, which hosts a master’s program in Catholic bioethics in concert with the NCBC. His slideshow (Exhibit 15) portrays transgender identities as a “spiritual wound” and a “materialistic anthropology” in opposition to a “Catholic anthropology”, and describes human nature as “that which is perfectly realized in the Incarnation of Jesus Christ”. Lappert claims gender dysphoria and transition are “obsessive thoughts leading to compulsive behaviors” or “OCD with BDD [body dysmorphic disorder]”, an assertion that is not supported by existing science on this subject, and laments that health insurance is “directed toward transitioning, not treatment of OCD”. Like Hruz, Lappert uses the language of heresy in a closing prayer to Mary: “Thou alone hast destroyed every heresy in the whole world.” Lappert has also spoken at length on “the scourge of transgenderism” with Church Militant, a right-wing Catholic outlet with ties to Nick Fuentes’ white nationalist “groyper” movement.

In Kadel v. Folwell, Lappert misleadingly represented himself as board-certified in surgery and plastic surgery; these certifications had been lapsed for years and these accrediting boards do not permit incorrectly representing oneself as a current member (Memorandum of law in support of motion to exclude Lappert, 2 February 2022):

Dr. Lappert’s report represents that he is “Board Certified in Surgery and Plastic Surgery.” (Ex. 1 at 1.) This is not true. As he admitted, his “plastic surgery board certificate expired at the end of 2018.” (Ex. 2 at 23.) His “board certification in surgery” expired “in 2002”; thus, he has not “been board-certified in surgery” for “over nineteen years.” (Id. at 31-32.)

These are not trivial fibs, because physicians are not allowed to hold themselves out as board-certified unless they actually have a current board certificate. The American Board of Plastic Surgeons unequivocally prohibits such misrepresentations, stating that “when a physician misrepresents certification status,” as Dr. Lappert did here, “ABPS may notify local credentialing bodies, licensing bodies, law enforcement agencies, and others.” (Id. at 30; Ex. 3 at 3.) And the American Board of Surgery takes a similarly dim view of such misrepresentations, as Dr. Lappert also acknowledged. (Ex. 2 at 32 (agreeing it does not “surprise [him] that the [ABS] does not allow doctors to represent that they are boardcertified in surgery unless they have a current board certificate.”).)

And contrary to the American Society of Plastic Surgeons’ Code of Ethics, Lappert offered expert testimony on gender-affirming surgeries that he had never performed:

It is also telling that the Code of Ethics of the American Society of Plastic Surgeons (“ASPS”) prohibits members from giving this kind of unfounded testimony.2 Section IV of that Code of Ethics says that “to help limit false, deceptive and/or misleading testimony, Members serving as expert witnesses must: 1. Have recent and substantive experience (as defined in the Glossary of the Code) in the area in which they testify[.]” (Ex. 4 at 6.) The Glossary, in turn, defines “recent and substantive experience” to mean (among other requirements) that the member “has performed the specific procedure in question within three (3) years of the date of being retained as an expert witness.” (Id. at 8.)

Dr. Lappert fails these requirements. Far from having actually performed any of the gender-affirming procedures that he criticizes in his report (see Ex. 1 at 29-39)—ever, let alone within the last three years—Dr. Lappert was emphatic that he would never perform such surgeries because he does not “see them as beneficial.” (Ex. 2 at 150.)

Lappert’s testimony in Kadel v. Folwell was also largely excluded by the court due to his lack of relevant experience, and he was found to have made “conspiratorial accusations” that “are nothing more than rank speculation designed to distract or inflame the jury” (Memorandum opinion and order):

Lappert is not qualified to render opinions about the diagnosis of gender dysphoria, its possible causes, the efficacy of the DSM, the efficacy of puberty blocking medication or hormone treatments, the appropriate standard of informed consent for mental health professionals or endocrinologists, or any opinion on the non-surgical treatments obtained by Plaintiffs. Lappert is not a psychiatrist, psychologist, or mental health professional, nor has he ever diagnosed a patient with gender dysphoria. He is not an endocrinologist, nor has he ever treated a patient with hormone therapies. By his own admission, he “do[es] not hold [himself] out as an expert in diagnosing mental health conditions outside, potentially, of body dysmorphic disorder” and does not have any “expertise in treating mental health conditions.” (ECF No. 209-3 at 75:7-16.)

Lappert is also not qualified to opine on the efficacy of randomized clinical trials, cohort studies, or other longitudinal, epidemiological, or statistical studies of gender dysphoria. He is not a statistician or epidemiologist, and there is no evidence in his report or deposition that he has any experience, specialized training, or knowledge about crafting a research study, analyzing data, or conducting a clinical trial. (See generally id. at 129:13–134:19.) His publications appear to include case reports and opinion essays, and he has not published any original research in two decades. (Id.) His brief academic career appears limited to teaching and overseeing clinic practitioners, not conducting research.

His testimony concerning informed consent, however, is irrelevant. First, his testimony that Plaintiff Thonen-Fleck was incapable of giving informed consent is based on his age, history with mental illness, and lack of medication. (ECF No. 211-2 at 53–54.) Even if true, Lappert does not dispute that Thonen-Fleck’s father was able to (and did) give informed consent. (See ECF No. 179-3 ¶ 13 (“Based on medical advice, I understand this surgery to have been medically necessary.”).) Lappert’s broader discussion of informed consent merely sets up his conclusion that surgeons are not adhering to that standard of care generally—a speculative conclusion that is not supported by any survey or data, scientific or otherwise. Thus, Lappert’s discussion of informed consent is not admissible.

And as with Dr. Hruz and Dr. McHugh, Lappert’s analogy of treatments of gender dysphoria to eugenics efforts in the early and mid-twentieth century lack any reference to what scientific methodology he used to compare and contrast the treatments.

Third, Lappert has provided the Court with no data or methodology used to draw his conclusion that surgical treatment for gender dysphoria has “never been generally accepted by the relevant scientific community.” (See ECF No. 215-4 at 22.) Lappert agrees that “every major expert medical association disagrees with [him]” and have “all taken [the] position that this treatment is in fact medically necessary,” (ECF No. 209-2 at 40:15-22), and virtually every major health insurer agrees, (id. at 384:21–385:3, 427:4–428:7, 430:12–431:6, 434:17–434:20; see ECF Nos. 209-10 at 2; 209-11 at 1–4; 209-12 at 3–8; 209-13 at 2–3)). There is no evidence that he has conducted any surveys that would support his repeated conclusory claims concerning the “relevant scientific communities (biology, genetics, neonatolgy [sic], medicine, psychology, etc.).” (ECF No. 215-4 at 40.) Thus, Defendants have failed to meet their burden to show that this testimony is based on reliable science.

Finally, Lappert makes repeated references in his report to a “Transgender Treatment Industry (‘TTI’).” (See id. at 12.) He opines that “[m]embers of the TTI have a vested interest in believing that science has already justified their existence,” asks “[w]ill one day the medical profession look at support for transitioning youth in the same manner the eugenics movement is now regarded?”, and hypothesizes that healthcare providers “want the patient to suffer depression and anxiety [because] such untreated suffering motivates vulnerable patients to undergo the often painful and damaging experimental ‘transitioning’ process.” (Id. at 12, 15.) In his deposition, however, he made clear that he does not “know where [the term TTI] came from” does not “know who originated it,” and doesn’t “know even if it was me that originated it, actually.” (ECF No. 209-3 at 19:19–20:2.) He is not aware of any peer-reviewed scientific article that has used that term. (Id. at 20:17-21.) Thus, the Court finds that references to a Transgender or Gender Treatment Industry and related conspiratorial accusations are nothing more than rank speculation designed to distract or inflame the jury and has no business in expert testimony.

G. Kevin Donovan

G. Kevin Donovan is a member of the CMA, former director of the Pellegrino Center for Clinical Bioethics at Georgetown University, and contributed Florida Medicaid expert report Attachment G. Donovan has argued in the CMA journal Linacre Quarterly that “consequences of contraception have directly led to an acceptance of a broad number of behaviors and attitudes that society insists must be tolerated”, which “challenges the commitments of Catholic physicians both personally and professionally” (Donovan & Sotomayor, 2020). Citing the Bible and the catechism of the Catholic Church, he lists transitioning as one of many “moral failings” and “an offense against reason” along with contraception, marriage equality, and oral sex:

From the perspective of the Catechism of the Catholic Church (1999, n.1849), sin is seen as “an offense against reason, truth and right conscience…love of oneself, even to contempt of God.” It is, as it always has been, a preference for our own desires, or our own will, over that of God. There are indeed great many kinds of sin; Scripture provides several lists of them. The letter to the Galatians contrasts the works of the flesh with the fruit of the spirit: “Now the works of the flesh are plain: fornication, impurity, licentiousness…selfishness, drunkenness, carousing, and the like” (5 Galatians, 19:21). To most, this would seem like an unequivocal listing of things to avoid, even if they have never been completely avoided throughout history. To some today, it might also look like the unapologetic agenda for many people’s weekend. Things seen in the past as moral failings are increasingly practiced openly, even celebrated in contemporary culture. This is where our moral fault lines begin. As a society, we have become increasingly more tolerant—tolerant of contraception, sexual promiscuity, pornography, oral and anal sex, both for heterosexual as well as homosexual couples, and as a consequence, same-sex marriage. Of course, the field of bioethics has matched these issues with moral challenges of its own: abortion, embryo destruction for research, transgender surgeries, physician-assisted suicide, and euthanasia.

During the Republican select investigative panel on fetal tissue research following selectively edited videos about “baby parts” at Planned Parenthood facilities, Donovan appeared to question whether a pregnant 14-year-old is capable of consenting to receive an abortion:

During the hearing, Rep. Mia Love (UT-4) expressed deep concern with the issue of consent and minors. She stated: “So, imagine [a] 14-year-old going into a clinic to undergo a very invasive procedure without someone there that she trusts to walk her through, to make sure that she is not being taken advantage of, to make sure that she is making the right decision.” She asked, “How can anyone be sure that that minor, under difficult circumstances, fully understand[s] the long-term repercussions behind [her] decision when the current law wouldn’t even allow that minor to get behind the wheel of a vehicle?” Dr. G. Kevin Donovan, a witness, agreed that this presented a troubling problem.

In an amicus brief cosigned by Donovan in Harris v. EEOC, trans identities and transitioning were again described as “gnostic”:

Anthropologically, this view presents us with a vision of the human person that is utterly fragmented, rather than natural and holistic. Like the ancient gnostic vision, it implies that the body is a kind of external housing, possessed by the subject, but less than fully personal. If the body is an external possession, the implication is that people ought to be able to treat it like they do any property. … “Sex” for women, would be reduced to mere appearance without the underlying substance, the naturally dimorphic body. If the Court wishes to prevent discrimination based on stereotypes, it should not inscribe into law this gnostic vision of a disembodied self and its dream of conquering or escaping nature and the body.

Like Van Meter, the authors of the brief appear to object to trans children being in schools at all:

When a school requires a ten- year-old child to affirm in word and deed that a classmate whom he knows is a boy is now a “girl,” this does not simply affirm the second child’s right to self- expression. It radically calls into question the meaning of “boy” and “girl,” not just for the classmate, but for everyone, including the first child himself, and in relation to everyone in his life, from his mother and father, to his brothers and sisters, and all of his friends and relatives. Insofar as “gender identity” is an ideological construct, this is of course the very intention of its advocates. It is simply impossible for it not to shape everyone’s understanding of himself or herself, of others and of the world, without choice or even full awareness.

Like Hruz, Donovan has also incorrectly stated that “watchful waiting” excludes any medical transition. Additionally, at a Catholic Medical Association “White Mass”, Donovan spoke out against electronic health records, a broadly accepted method of putting a patient’s chart on a computer.

Patrick K. Hunter

Dr. Patrick K. Hunter is a member of the CMA, a pediatrician in Orlando, Florida, a member of the Department of Pediatrics at the University of Central Florida (Hunter, 2021), and a member of the Florida Board of Medicine appointed by Gov. Ron DeSantis in June 2022. In his expert declaration in Eknes-Tucker v. Ivey, Hunter stated that he holds an “advanced degree in bioethics” (Declaration of Patrick Hunter, 1 May 2022). However, this was received via the University of Mary’s master’s program in bioethics, which features exclusively Catholic medical ethics:

I am a pediatrician with a master’s degree in bioethics. I received my medical degree from the University of Louisville School of Medicine in 1992 and completed a pediatric residency at Tripler Army Medical Center in 1995. I obtained board certification in general pediatrics in 1995 and have continuously maintained that certification. I obtained a Master of Science degree in bioethics from the University of Mary in 2020.

Hunter acknowledges that this program largely targeted gender-affirming care:

I have always had a keen interest in medical ethics and often considered formal education in the field. I originally wanted to explore the merging of medicine and business—hospital systems dominating the marketplace and physicians becoming employees—and how this evolution was impacting the ethics of medical care. What I was learning about gender dysphoria further propelled my interest in an ethics degree. I undertook a study of bioethics, completing my master’s degree in bioethics in 2020. 16. In my degree, much effort was focused on the growing popularity of the so-called “gender-affirmative care,” which delivers life-altering, permanent interventions to minors that involve sterilizing procedures. I have focused on ethical dilemmas, such as whether minors have the capacity to give a meaningful informed consent.

Hunter’s CV submitted in Eknes-Tucker v. Ivey indicates he has no history of publishing any material on transness or gender dysphoria prior to an anti-trans letter to the editor in 2021. His previous work consisted of one presentation on a polydactyly syndrome in children and one study on the use of infant pulse oximeters in hospitals:

The Western Society of Pediatric Research Annual Meeting, February 1994: Pallister Hall syndrome in siblings, a case report and review of the literature Abstract and presentation

Smith AE, Vedder TG, Hunter PK, et al. The Use of Newborn Screening Pulse Oximetry to Detect Cyanotic Congenital Heart Disease: A Survey of Current Practice at Army, Navy, and Air Force Hospitals. Military Medicine. March 2011; 176(3) 343-346

Hunter PK. Political Issues Surrounding Gender Affirming Care of Transgender Youth. JAMA Pediatrics. December 2021; 176(3):322-323. doi:10.1001/jamapediatrics.2021.5348

Hunter has promoted the work of Genspect, a disturbing group that has recommended school staff ban any tucking which may conceal a child’s “crotch bulge of the penis and testicles so that they are not conspicuous through clothing”. Along with four other pediatricians, including the director of SEGM, Hunter signed a March 2022 resolution to the American Academy of Pediatrics decrying gender-affirming care; Genspect blacked out these names, and Hunter retweeted the resolution without disclosing that he had signed it. During the August 5 hearing at the Florida Board of Medicine, Hunter incorrectly claimed that Sweden had banned all transition care for minors, then joined all but one board member in voting yes to initiate the anti-trans rulemaking process.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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