Round two: Gender Analysis calls on Florida Boards of Medicine to stop the trans youth care bans and investigate critical irregularities in the rulemaking process

From:

Zinnia Jones and Heather McNamara
Gender Analysis
Seminole County, Florida

To:

Paul Vazquez, J.D.
Executive Director, Board of Medicine/MQA
4052 Bald Cypress Way, Bin #C03
Tallahassee, FL 32399-3253

Danielle Terrell
Executive Director, Board of Osteopathic Medicine/MQA
4052 Bald Cypress Way, Bin #C06
Tallahassee, FL 32399-3256

Re: Proposed Rules 64B8-9.019 and 64B15-14.014 F.A.C. (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”)

Short title: Gender Analysis FLBOM complaint 2

To the Florida Board of Medicine and Florida Board of Osteopathic Medicine:

This message is a followup to our December 2, 2022 complaint and call for a rule hearing on the Boards’ trans youth care bans (Gender Analysis FLBOM complaint 1). Gender Analysis of Seminole County, Florida reiterates our call for the Boards of Medicine to repeal proposed rules 64B8-9.019 and 64B15-14.014 due to extensive irregularities, undisclosed biases and conflicts of interest during the rulemaking process. We repeat our previous objections as stated in our first complaint, and we now bring to your attention several additional issues that have emerged over the past two months. These recent developments further confirm that the trans youth care bans were the fixed outcome of a fatally compromised process and should be invalidated in their entirety by the Boards at the upcoming February 10, 2023 joint meeting. Continue reading

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Florida’s newest Boards of Medicine appointees wrote an anti-trans letter calling for gender “exploratory” therapy, citing a report of a trans teenager being involuntarily hospitalized for nearly two years

Background

On December 2, 2022, Governor Ron DeSantis appointed pediatric endocrinologist Dr. Monica M. Mortensen to the Florida Board of Osteopathic Medicine, followed by the appointment of pediatric endocrinologist Dr. Matthew R. Benson to the Board of Medicine on December 28. Benson previously spoke in favor of the state Medicaid trans care exclusion Rule 59G-1.050(7) at a July 8, 2022 AHCA meeting, and coauthored a September 23 letter to the Boards of Medicine with Mortensen and seven others in support of the trans youth care bans 64B8-9.019 and 64B15-14.014.

Benson and Mortensen’s positions are relevant to an ongoing issue: although the Boards of Medicine voted to advance the trans youth care ban at the November 4 meeting, it has not yet taken effect. Another joint meeting on the ban will now take place on February 10 in response to calls for a rule hearing from Southern Legal Counsel, ACLU of Florida, Gender Analysis and others. Public comment is now open for the upcoming hearing until February 7 at BOMPublicComment@flhealth.gov. Benson and Mortensen’s letter provides important clues to how they will likely approach this rule and other issues involving gender-affirming care as Board members, and this letter warrants extended analysis. Continue reading

Posted in Ethics, Florida, Gender dysphoria, Health care, Politics and law, Psychology and psychiatry, Regret and detransition, Replies, Rhetoric, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , , , , , , , | 1 Comment

Anti-trans group SEGM’s cofounder Stephen Beck is an executive at Bon Secours Mercy Health, the fifth-largest Catholic healthcare network in the US

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). Continue reading

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Update: Comment period on Florida Board of Osteopathic Medicine trans youth care ban is extended to December 28

The comment period for the Florida Board of Medicine’s proposed ban on gender-affirming medical care for trans youth, Rule 64B8-9.019 (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”), was closed on December 5, 2022. However, because of an error in the Florida Board of Osteopathic Medicine’s public notice on their version of the ban, Rule 64B15-14.014, the comment period on this board’s version of the ban has now been extended until December 28 (WUSF Public Media): Continue reading

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Closing arguments: Submit public comments before December 5 on the Florida Board of Medicine’s youth transition treatment ban

Here’s how to submit your comments on proposed Rule 64B8-9.019 (Florida Board of Medicine) and proposed Rule 64B15-14.014 (Florida Board of Osteopathic Medicine).

Short title: Gender Analysis FLBOM complaint 1

On November 14, the Florida Board of Medicine (BOM) and Florida Board of Osteopathic Medicine (BoOM, collectively the Boards) published their proposed rules to ban medical transition treatment for transgender minors, opening a 21-day comment period before these rules take effect on December 5. The BOM’s Rule 64B8-9.019 (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”) is a blanket ban on puberty blockers, HRT or gender-affirming surgery for trans youth under 18, with exceptions for those currently receiving medical treatment:

(1) The following therapies and procedures performed for the treatment of gender dysphoria in minors are prohibited.

(a) Sex reassignment surgeries, or any other surgical procedures, that alter primary or secondary sexual characteristics.

(b) Puberty blocking, hormone, and hormone antagonist therapies.

(2) Minors being treated with puberty blocking, hormone, or hormone antagonist therapies prior to the effective date of this rule may continue with such therapies.

The Notice of Proposed Rule (26536889) states that a hearing can be requested by contacting BOM executive director Paul Vazquez:

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Paul Vazquez, J.D., Executive Director, Board of Medicine/MQA, 4052 Bald Cypress Way, Bin #C03, Tallahassee, Florida 32399-3253, Paul.Vazquez@flhealth.gov

Comments can also be submitted through a form on the Notice page. The Board of Osteopathic Medicine’s Rule 64B15-14.014 (“Standards of Practice for the Treatment of Gender Dysphoria in Minors”) is substantially the same ban, with a limited exception for use of puberty blockers and HRT in certain clinical trial settings, applying only to the small proportion of doctors who hold a D.O. degree:

(1) The following therapies and procedures performed for the treatment of gender dysphoria in minors are prohibited.

(a) Sex reassignment surgeries, or any other surgical procedures, that alter primary or secondary sexual characteristics.

(b) Puberty blocking, hormone, and hormone antagonist therapies.

(2) Nonsurgical treatments for the treatment of gender dysphoria in minors may continue to be performed under the auspices of Institutional Review Board (IRB) approved, investigator-initiated clinical trials conducted at any of the Florida medical schools set forth in Section 458.3145(1)(i), Florida Statutes. Such clinical trials must include long term longitudinal assessments of the patients’ physiologic and psychologic outcomes.

(3) Minors being treated with puberty blocking, hormone, or hormone antagonist therapies prior to the effective date of this rule may continue with such therapies.

Similarly, this Notice of Proposed Rule (26536986) states that a hearing can be requested by contacting BOM executive director Danielle Terrell:

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Danielle Terrell, Executive Director, Board of Osteopathic Medicine/MQA, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 32399-3256, or by email at Danielle.Terrell@flhealth.com.

The November 4 meeting notice (p. 2) specifies the materials required for any appeals of the Boards’ decisions:

If any person decides to appeal any decision made by the Board with respect to any matter considered at this meeting or hearing, he/she will need to ensure that a verbatim record of the proceeding is made, including the testimony and evidence from which the appeal is to be issued.

In our capacity as the organization Gender Analysis of Seminole County, Florida, we call for a hearing on undisclosed conflicts of interest, patterns of bias and additional improper actions by the Board of Medicine and Board of Osteopathic Medicine during the rulemaking processes of proposed Rules 64B8-9.019 and 64B15-14.014 F.A.C., including but not limited to:

  • Disregard for evidence of any quality and the findings of clinicians and researchers with relevant expertise in care for trans youth.
  • Heavy reliance on marginal opinions offered by small anti-trans advocacy groups, which do not constitute evidence, in formulating the proposed Rules, contrary to the Boards’ intended purpose as apolitical bodies.
  • Egregious misuse and misinterpretation of published studies on trans health outcomes and gender affirmation, frequently misrepresenting these findings as showing something that they do not.
  • Undisclosed prior commitments by a BOM member and state experts to reject any practice standards incorporating gender-affirming care, as part of their membership in the religious anti-trans advocacy organizations Catholic Medical Association (CMA).
  • Undisclosed cooperation between the Department of Health (FLDOH) and the Boards to provide a lineup of anti-trans speakers who are concurrently serving as witnesses for the Florida Agency for Health Care Administration (AHCA) in the ongoing Medicaid exclusion case Dekker et al. v. Marstiller et al.
  • The BOM’s deliberate misrepresentation of anti-trans detransitioners as far more numerous than they are, using this lineup of a small number of heavily reused individuals who have repeated their claims in several other states.
  • Undisclosed coordination between a BOM member and the anti-trans groups Society for Evidence-Based Gender Medicine (SEGM) and Genspect, to promote poorly-defined and unsupported anti-trans models of “care” for trans youth.
  • Permitting intrusive personal attacks against the bodies of transgender Floridians while cutting off a pro-trans speaker’s criticism of Governor DeSantis’ administration, on the grounds of civility and decorum.

Due to the pervasive nature of these biases and conflicts of interest and the Boards’ continued failure to address these urgent issues of public concern, we additionally call for an independent investigation into the origins and course of the anti-trans rulemaking efforts of the Boards, FLDOH, AHCA and any other relevant state agencies, including the Executive Office of the Governor. Our detailed outline of the Boards’ improper actions is provided below, with requested actions on these matters where appropriate. Continue reading

Posted in Catholic Church, Ethics, Faith and religion, Florida, Health care, Politics and law, Regret and detransition, Replies, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , , , | 1 Comment