The rapid emergence of SEGM
The Society for Evidence-Based Gender Medicine (SEGM) is a highly active anti-trans advocacy group founded in January 2020, with members involved in a multi-pronged effort to restrict access to gender-affirming care in Florida as well as other states and nations. SEGM members Romina Brignardello-Petersen and Quentin L. Van Meter contributed two of the five Florida AHCA “expert reports”, cited by the state in support of a Medicaid exclusion of all coverage for gender-affirming care as well as a ban on providers offering any gender-affirming medical treatment to trans minors. Van Meter was present as a state expert at the July 8, 2022 AHCA hearing on the coverage exclusion, along with anti-gay conversion therapist and NARTH member Miriam Grossman whose clinical supervisor is SEGM member Stephen B. Levine (deposition in Brandt v. Rutledge). SEGM advisor Michael Biggs appeared on behalf of the state at the October 28, 2022 joint Florida Boards of Medicine hearing on the trans youth care ban, and SEGM member Patrick K. Hunter on the Board of Medicine voted to advance the ban and strip any exception for use within clinical studies.
Elsewhere, SEGM has been the central subject of subpoenas by the state of Alabama to the American Academy of Pediatrics, WPATH and the Endocrine Society in the trans youth care ban case Boe v. Marshall (Lannin declaration). Alabama demanded a wide variety of SEGM-related materials from these organizations, including any communications regarding two unsuccessful anti-trans resolutions by SEGM at the AAP (AAP subpoena paras. 1-9), Brignardello-Petersen’s AHCA review (WPATH para. 41, ES para. 27), and SEGM members Van Meter, Levine, William J. Malone, and Julia W. Mason (WPATH para. 43). SEGM members Professor Richard Byng and “R. Stephens” (Richard Stephens) are part of the NHS England working group on gender dysphoria as of April 2022, and Dr. Trilby Langton of an SEGM-linked group offering “Gender Exploratory Therapy” is coauthor of the Cass Review’s ongoing systematic review of literature on gender dysphoria in youth.
SEGM and its key members have advocated for this alternative treatment of “exploratory” psychotherapy “open to a range of outcomes”, which they believe should be distinguished from anti-trans conversion therapy; nonetheless, Quentin Van Meter said of SEGM on June 6, 2022 that “what we all agree on is that the affirmation, from social to medical to surgical, is an abomination for these children”. SEGM members Van Meter and Hunter are also members of the Catholic Medical Association, a right-wing organization whose executive director declared in court that CMA’s members could never approve a standard of care allowing medical transition. SEGM cofounders Malone, Mason, and Stephen Beck also coauthored a letter against trans youth care with CMA’s Paul W. Hruz (Malone et al., 2021a); Alabama’s subpoenas to the AAP and WPATH demanded any internal communications about this letter (AAP para. 23, WPATH para. 41) or about Paul Hruz (WPATH para. 43).
Who is Stephen Beck?
Stephen Beck is among the less active members of SEGM: his authorship appears limited to two letters to the editor, Malone et al. (2021a) and Malone et al. (2021b), as well as two SEGM blog posts in December 2020. Beck did not appear as a director on SEGM’s corporate filings until January 14, 2021, and SEGM’s letters to the editor list his affiliation as “Cincinnati, OH, USA” and “Private Practice, Mason, OH 45040, USA”. However, a comment submitted by Beck to the HHS on August 13, 2019 offers hints to his activities elsewhere as well as SEGM’s early origins.
Comment ID HHS-OCR-2019-0007-148044 was posted by Beck on behalf of SEGM in support of RIN 0945-AA11, the Trump administration’s interpretation of “sex” as solely “biological sex” which effectively defined ‘transgender’ out of existence:
Submitter Name
Stephen Beck, MD, FACP, FHIMSS
Organization Name
Society for Evidence-Based Gender Medicine
The Society for Evidence-Based Gender Medicine (SEGM) strongly supports the rights of all individuals to be treated with respect and dignity, and to have access to evidence-based medicine the hallmark of quality health care. In order to achieve this goal, it is critical that healthcare providers, organizations, and payers maintain a clear distinction between sex and gender. Gender identifiers in medical records provide healthcare workers with key information about an individuals sense of self. The markers of natal or biological sex contain lifesaving information that is essential for healthcare decision-making.
…
The conflation of sex and gender in healthcare is alarming and is poised to subject hundreds of thousands of transgender and cisgender-identifying individuals to unintended medical harm from receiving incorrect diagnoses and being subjected to incorrect treatments. It will also greatly impede scientific research, not only in the area of transgender treatments, which sorely lacks quality long-term outcome evidence, but also in other areas of medical research.
For these reasons, SEGM supports the HHS proposal to clarify the definition of sex for healthcare purposes. In addition, SEGM calls on healthcare organizations in the US to develop guidelines for the appropriate use of the sex and gender fields in the Electronic Medical Records (EMRs) to ensure that individuals suffering from gender dysphoria are treated with respect and dignity and receive accurate and appropriate medical care.
“FHIMSS” refers to a fellow of the Healthcare Information Management Systems Society. A LinkedIn profile of Stephen Beck MD, FACP, FHIMSS (@stephenbeckmd) in Mason, Ohio at Bon Secours Mercy Health shows this account praising an anti-trans article (Evans, 2022) by SEGM cofounder Marcus Evans in March 2022:
[Text of image: Marcus Evans
10 months ago
Available on line but behind a paywall I’m afraid.
‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents
onlinelibrary.wiley.com • 32 min read
Stephen Beck MD, FACP, FHIMSS
9mo
Now Open Access! Thanks for sharing this important case study and analysis Marcus !]
Additionally, a Twitter account under the name of Stephen Beck (@StephenBeckMD) follows several accounts relating to Bon Secours Mercy Health, HIMSS, health IT topics and electronic health records (@HIMSS, @mercy_health, @HITpol, @hitconsultant, @BluetreeNetwork), as well as SEGM members and related anti-trans groups (SEGM @segm_ebm, GETA @GETAtherapy, @genspect, @widerlenspod, Julia Mason @JuliaMasonMD1, William Malone @will_malone, Roberto D’Angelo @DrRDangelo, Sasha Ayad @SashaLPC, Stella O’Malley @stellaomalley3, Patrick Hunter @PatrickHunterMD, Lisa Littman @LisaLittman1, Ryan T. Anderson @RyanTAnd, Mary Rice Hasson @maryricehasson).
The account has a history of interactions with anti-trans activists and groups in the months prior to the August 13, 2019 submission to HHS, including Ryan T. Anderson (April 25, June 24) and Kelsey Coalition (May 25). Prior to SEGM’s official incorporation in January 2020, the Beck account approvingly responded to Canadian Gender Report (October 1), William Malone (November 3), GETA/ICGDR’s Sasha Ayad (December 8), and Roberto D’Angelo (December 23). During this time, the Beck account defended gender identity change efforts and denied that this is conversion therapy (September 6), while suggesting that trans patients have personality disorders and psychosis that should not be treated with HRT (November 6).
The August 13, 2019 HHS submission, Twitter account activity, and LinkedIn account activity confirm that Dr. Stephen R. Beck FACP FHIMSS at Bon Secours Mercy Health in Mason (and Cincinnati) Ohio is SEGM’s board member Stephen Beck of Mason (and Cincinnati) Ohio.
Beck brings a wealth of industry experience to SEGM as well as potential institutional connections, having served as chief medical information officer at the Catholic healthcare network Mercy Health in Cincinnati (formerly Catholic Health Partners) from June 2011 to October 2016 and currently serving as CMIO at Bon Secours Mercy Health (BSMH) in Cincinnati since September 2021. The merger of Bon Secours Health System with Mercy Health in 2018 created the fifth-largest Catholic health system in the United States, with facilities or subsidiaries in Ohio, Kentucky, Michigan, Tennessee, Virginia, Pennsylvania, Maryland, New Jersey, New York, North Carolina, South Carolina, and Florida. Beck’s author biography at HIT Consultant details his extensive background in electronic health record systems:
Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Information Officer at Catholic Health Partners. He has more than 15 years of experience in planning, implementation, training and follow-up of EHR installations in civilian and military populations and was one of the first physician users of a fully integrated EHR in Southern Ohio. Dr. Beck was among the first physicians to attain CPHIMS certification, has been a content reviewer for the HIMSS National Conference, and chaired the HIMSS National Professional Practice Task Force. He is a Fellow of both HIMSS and the American College of Physicians and serves on the HIMSS Clinical Decision Support Workgroup.
Beck has also worked closely with UpToDate, an evidence synthesis service similar to the Cochrane Collaboration; SEGM’s Stephen Levine disclosed that he and other SEGM members were participating in multiple Cochrane evidence reviews on gender-affirming medical care as of mid-2021 (Levine depositions in Fain v. Crouch, BPJ v. West Virginia, and Kadel v. Folwell; Levine report in Figliola v. Harrisonburg City Public School Board).
The essential role of Catholic faith at Bon Secours
Catholic faith, ethics, and practices form an integral part of BSMH’s operations, with several members of the Congregation of the Sisters of Bon Secours religious order and Bon Secours Mercy Ministries also serving on the BSMH board of directors. Online, Stephen Beck regularly welcomes new employees to “the ministry”. The Bon Secours Sisters in Ireland previously operated a maternity home in Tuam from 1925 to 1961; the facility was noted for its extraordinarily high infant mortality rate, and was found in 2016 to have disposed of hundreds of children’s remains in unmarked sites within sewage tanks on the property. BSMH and the Bon Secours Health System in Ireland announced an intent to merge in 2019, and a 2020 report of Bon Secours Mercy Ministries identifies Sister Marie Ryan as a BSMH board member and former chairperson of BSHS Ireland.
BSMH’s Code of Conduct notes that they comply with the United States Conference of Catholic Bishops’ Ethical and Religious Directives (ERDs); Oberlin College student health services provider Harness Health Partners is a subsidiary of BSMH and has refused to prescribe birth control to Oberlin students. A 2019-2021 “Formation Plan” by BSMH’s Center for Ministry Formation states that a “Foundations of Catholic Health Ministry” two-day program is required for all vice presidents and above:
A two-day program with interactive presentations and activities that address key areas of ministry leadership. The program highlights our identity as a Catholic health care ministry and provides basic information on scripture, church and sponsorship, ministry, Catholic social teaching, ethics, and prophetic voice.
The content of the Foundations program, including applications of the USCCB’s ERDs to “selected ethical issues”, is detailed further in a December 2020 pamphlet:
A virtual two-day program with interactive presentations and activities that address key areas of ministry leadership in Bon Secours Mercy Health. The program provides basic information on the roots of Catholic health care by examining Scripture, Church, Reign of God, Catholic Social Teaching, Ethics, Advocacy, Sponsorship and Prophetic Ministry. The program explores ways leaders can embody and apply the mission, vision and values of Bon Secours Mercy Health, which is rooted in the heritage of Catholic health care and the legacy of the founding religious communities. The program equips participants with a foundational knowledge to lead, serve and continue the compassionate ministry of Jesus.
Objectives:
Describe the roots of Catholic health care.
Articulate the mission, vision and values of Bon Secours Mercy Health, and apply them to various management issues.
Articulate relationships among Church, Sponsor and Bon Secours Mercy Health.
Explain how Catholic Social Teaching influences the role of a leader in Catholic health care.
For selected ethical issues, explain Church teaching as presented in the Ethical and Religious Directives for Catholic Health Care Services.
Describe the responsibility of advocacy in the context of Catholic health care.
Another annual program, “Stories of Grace”, is required for all directors and above:
An annual, four-hour ministry formation experience offered in local markets to all leaders in Bon Secours Mercy Health. The program includes themes related to theological principles, biblical stories, founding congregations, and ministry culture and their relationship to the strategic direction and operations of the organization.
Bioethics at Bon Secours and beyond
Staff ethicist Josef D. Zalot of the anti-trans National Catholic Bioethics Center also worked as regional director of ethics and spiritual care at Mercy Health Cincinnati from 2015-2017, overlapping with the time when Stephen Beck was an executive:
Prior to coming to the NCBC, Joe served from 2015 to 2017 as the Regional Director of Ethics and Spiritual Care for Mercy Health–Cincinnati. In this role he chaired the regional ethics committee, reviewed and drafted ethics and spiritual care policies, and initiated a nurse ethics education program.
The NCBC, an allied organization with CMA, is an alarmingly transphobic organization that functions as an enforcement arm of the USCCB’s religious policies within healthcare settings, conducting “ethics audits” including “diagnosis and procedure codes”:
The NCBC provides services to Catholic health ministries to address issues in health care ethics and to strengthen Catholic identity. The NCBC provides a comprehensive assessment of Catholic health ministries (including policies, educational programs, collaborative arrangements, and diagnosis and procedure codes) via its Catholic Identity & Ethics Review (CIER) program or can perform case-specific reviews of incidents, policies, and printed materials.
Catholic hospitals have adopted NCBC guidance stating that Catholic facilities should forcibly detransition any trans patients by withholding their prescribed HRT, a practice that is known to be harmful. NCBC’s audits have included “every single encounter with a patient for the purpose of treating a gender dysphoria diagnosis” (memorandum in Hammons v. UMMS):
Because the National Catholic Bioethics Center regularly audits St. Joseph, as discussed above, St. Joseph closely follows its interpretation and policy guidance on the ERDs. Riddle Tr. 79:5-14. Thus, when it comes to gender-affirming care, St. Joseph also follows the National Catholic Bioethics Center’s guidance, and refuses to provide any treatment for gender dysphoria. Asobi Tr. 88:16-21, 90:20-91:4, 92:3-94:12; Riddle Tr. 100:23-103:6, 104:1-6, 106:9-18. In particular, St. Joseph follows and implements a National Catholic Bioethics Center guidance document that states, “Gender transitioning of any kind is intrinsically disordered because it cannot conform to the true good of the human person, who is a body-soul union unalterably created male or female. Gender transitioning should never be performed, encouraged, or positively affirmed as a good in Catholic health care. This includes surgeries, the administration of cross-sex hormones or pubertal blockers, and social or behavioral modifications.” Ex. 13 at 004.
In a section titled “Cooperation With Evil,” the National Catholic Bioethics Center also dictates that, should a transgender patient come into a Catholic hospital for “unrelated reasons,” hospitals must not provide them with the hormones they are already taking because it “amounts to formal cooperation with gender transitioning and is immoral.” Id. And when the National Catholic Bioethics Center audited St. Joseph, it requested data on every single encounter with a patient for the purpose of treating a gender dysphoria diagnosis. Ex. 14 (Catholic Identity and Ethics Review); Riddle Tr. 134:7-17.
That hospital’s electronic records system was later programmed to send an alert when a diagnosis contained the word “gender”. Father Tadeusz Pacholczyk states that NCBC is not affiliated with the USCCB “or any other official Church entity” and is “not funded by the institutional Church”. At the same time, NCBC has provided “official texts” of Vatican documents, and hosts “the largest gathering of U.S. bishops outside of their own USCCB meetings”. In these workshops, 150 bishops learn from the NCBC about topics including “problematic understandings of the human person in certain emerging gender theories”:
Workshop on Bioethics
Every two years the NCBC, in collaboration with the Knights of Columbus, offers a special conference to 150 bishops from the United States, Canada, Mexico, Central America, the Caribbean and the Philippines. It is the largest gathering of U.S. bishops outside of their own USCCB meetings. The center’s conference is held in Dallas and focuses on a range of current clinical and pastoral topics, ranging from collaboration between Catholic and non-Catholic institutions, to emerging cultural and political threats, to Catholic health care ministry, to problematic understandings of the human person in certain emerging gender theories.
Additionally, NCBC’s CIER ethics audits are described as “always a shared endeavor of the local bishop, a Catholic health care organization, and the NCBC”. Zalot’s chapter in NCBC’s Transgender Issues in Catholic Health Care describes the group as unambiguously disapproving of any gender-affirming medical care (p. 86):
As previously explained, transitioning one’s gender (or attempting to do so) is contrary to Catholic anthropology and Church teaching, not to mention logic, basic biology, and medical evidence. As such, interventions directed toward this end are never morally good or neutral; they are always morally evil.
Zalot is the source of NCBC’s policy of forcibly detransitioning patients (p. 93), and he indicates NCBC believes that even if transitioning were convincingly shown to be beneficial, it would still not be permissible (p. 88):
Even if we assume that the type of mutilation envisioned produced beneficial psychological effects, these could not be justified under the principle of totality. When Pius speaks of the possible destruction or mutilation of parts of the body for the sake of the whole, he is referring to the whole of the physical body. He is not speaking about the intellect or the will. The intellect and the will are powers of the soul, which is a spiritual entity.
Stephen Beck’s coauthor Paul W. Hruz, a fellow of NCBC, also contributed a chapter to the volume, making the religious assertion that any gender-affirming medical treatments would “distort the objective biological understanding of sex and are therefore untenable” (p. 3). Notably, in a recent ruling in Hammons v. UMMS, a state-owned hospital’s enforcement of NCBC’s anti-trans guidance was found to constitute illegal discrimination under ACA section 1557 after the hospital refused to perform a gender-affirming hysterectomy. Zalot’s role as regional director of ethics and spiritual care at Mercy Health Cincinnati almost certainly presented an opportunity to insert these Catholic anti-trans doctrines and practices into the same workplace where SEGM’s cofounder has spent nearly a decade. ■
