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

Posted on December 3, 2022 by Zinnia Jones

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).

Previously:

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

Tracking organized anti-trans submissions to the Florida Board of Medicine October 28 meeting, which passed a ban on medical transition for trans youth

Posted on November 1, 2022 by Zinnia Jones

The agenda submissions featured the state’s handpicked experts as well as public comments from conversion therapists, trans-hostile providers in major hospital systems, anti-trans parents promoting detransitioning, and leading members of the Catholic Medical Association and National Catholic Bioethics Center.

Previously:

On October 28, the Florida Board of Medicine and Florida Board of Osteopathic Medicine held a joint meeting and voted to pass an effective ban on medical transition care for trans youth under 18, advancing this sham rulemaking process to another joint meeting this coming Friday, November 4. Unlike the Florida Medicaid coverage exclusion of all transition care (Rule 59G-1.050(7)) which has already taken effect and is currently in litigation in Dekker et al. v. Marstiller et al., these rules have not yet taken effect but will ultimately take the form of “practice standards” (proposed Rule 64B8-9.019 and Rule 64B15-14.014) that are binding on all medical providers in the state. Continue reading →

Posted in Catholic Church, Ethics, Faith and religion, Florida, Health care, Politics and law, Regret and detransition, Statistics and demographics, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , , , , | Leave a comment

Rapid response: Live coverage of Florida Board of Medicine 28 October 2022 anti-trans rulemaking meeting (raw)

Posted on October 28, 2022 by Zinnia Jones

Previously:

On October 28, 2022, the Florida Board of Medicine and Florida Board of Osteopathic Medicine held a joint meeting to advance a politically-motivated ban on any medical transition treatment for youth under 18, including puberty blockers, HRT or surgeries, outside of yet-to-be-defined exceptions for “clinical trials”. This illegitimate process, featuring invited far-right experts with religious precommitments to transphobia and a DeSantis appointee on the Board working in secret with anti-trans groups SEGM and Genspect, is also the first time this medical transition care for youth has been banned at the state level by executive action rather than a legislative act.

Notably, the lineup of speakers for public comment started with nine detransitioners, and included six individuals currently working with the state of Florida to defend the state’s recent Medicaid trans care exclusion ban, with only six pro-trans voices allowed to speak against the proposed restrictions before public comment was closed. This process now advances to further rulemaking this coming Friday, November 4, at another joint meeting of the boards.

More coverage: Florida Board of Medicine Advances Ban on Transition-Related Care for Minors (Them.us)

In the interest of public discussion, my livetweeting of the proceedings as streamed by the Florida Channel is reproduced below in its raw entirety, with any known errors marked; other errors may remain. This is an initial update prior to an organized post summarizing today’s events, and an archived video from the Florida Channel is now available.

Continue reading →

Posted in Catholic Church, Endocrinology, Ethics, Florida, Health care, News, Politics and law, Regret and detransition, Replies, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , | Leave a comment

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

Posted on September 1, 2022 by Zinnia Jones

Previously:

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). Continue reading →

Posted in Catholic Church, Ethics, Faith and religion, Florida, Hoaxes, Politics and law, Regret and detransition, Rhetoric, Surgery, Trans youth, Transphobia and prejudice | Tagged , , , , , , , , , , , , , , , , , , , | 2 Comments

Catholic Medical Association members wrote a majority of Florida Medicaid’s anti-trans expert reports. Last year, CMA declared a faith-based commitment against approving of any transition care.

Posted on August 25, 2022 by Zinnia Jones

Previously:

Declaration of Mario Dickerson, executive director of the Catholic Medical Association, 4 November 2021, in American College of Pediatricians et al. v. Becerra et al.

The Catholic Medical Association (CMA) is a right-wing advocacy group claiming a membership of about 2,500 Catholic doctors and other healthcare professionals in the United States (Declaration of Mario Dickerson, 4 November 2021). Previously, CMA described being gay as “preventable and treatable” (“Homosexuality & Hope”, 2009), opposed bans of anti-gay conversion therapy, opposed legal marriage equality, claimed abortion is “not healthcare”, denied abortion could ever be medically necessary, promoted “abortion pill reversal”, argued for Catholic religious exemptions to COVID-19 vaccine mandates, and opposed medical transition treatments.

Since April 2022, Florida healthcare agencies have made ongoing efforts against transition care, with the involvement of “experts” from anti-trans groups like the Society for Evidence-Based Gender Medicine (SEGM), Genspect, and the American College of Pediatricians (ACPeds) hate group. However, the CMA and its related groups are an even more extensive source of influence in the Florida anti-trans process and in wider political, legal, and religious action against gender-affirming care in the US healthcare system:

  • In April 2022, the Florida Department of Health’s “Treatment of Gender Dysphoria” guidelines cited a “systematic review” by CMA member Paul W. Hruz in the CMA’s journal The Linacre Quarterly; his article was not a systematic review. Three of the five expert reports against transition treatment provided to Florida AHCA/Medicaid were by CMA members: Attachment E by Quentin L. Van Meter (also the president of ACPeds), Attachment F by Deacon Patrick W. Lappert, and Attachment G by G. Kevin Donovan. Additionally, CMA member Patrick Hunter was appointed by Governor Ron DeSantis to the Florida Board of Medicine in June 2022 as AHCA advanced its exclusion of transition care from Medicaid.
  • In August 2021, CMA and ACPeds filed a lawsuit against the US Department of Health and Human Services (American College of Pediatricians et al. v. Becerra et al., 2021) in which their respective leaders, executive director Mario Dickerson and president Quentin L. Van Meter, used identical language claiming their members would not endorse any standards of care supporting transition. Dickerson of the CMA filed his declaration on November 4, citing various Catholic doctrinal statements from the Vatican and the Diocese of Arlington, while Van Meter of ACPeds filed his declaration five days later and omitted any reference to Catholic beliefs. Michelle Cretella, former president of ACPeds, is also a member of CMA, and ACPeds may serve largely as a secular front for CMA.
  • Because this is an absolute faith-based commitment by CMA and its members, Florida AHCA/Medicaid’s choice of CMA members to contribute three of five expert reports was a guarantee that a majority would not approve of our transition care in any way. These CMA members made no efforts to recuse themselves from this process or to disclose their prior commitment that they would ultimately always find against transition treatment regardless of the process. This effort led to the advancement of a rulemaking process against transition care by the Florida Board of Medicine by a 14-1 vote on August 5, and Medicaid’s exclusion of coverage for transition care starting on August 21.
  • CMA and its “allied organization” the National Catholic Bioethics Center (NCBC) operate a credentialing pipeline with the University of Mary’s “master’s in bioethics” program, inviting professionals from any field (“including professionals and specialists from centers for biomedical and biological research, universities, and government institutions involved in shaping public policy”) to attend brief seminars and complete online modules to receive a “certification in healthcare ethics” for $3,450. This can be converted to an MS in bioethics following additional courses at University of Mary. Patrick Hunter of the Florida Board of Medicine has no experience working with trans youth or adults, and received an MS in bioethics from the University of Mary in 2020. He now testifies that he holds an “advanced degree in bioethics” (Declaration of Patrick Hunter, 1 May 2022, in Eknes-Tucker v. Ivey), while other recipients of this degree clarify it is a “master’s degree in Catholic bioethics from the University of Mary in North Dakota, in association with the National Catholic Bioethics Center” (Jane Doe 1 in Doe et al. v. Board of Regents of the University of Colorado et al.).
  • The importance of developing a stable of anti-trans experts with the credentials to testify as expert witnesses was discussed by CMA members Hruz, Van Meter, and Lappert at a 2017 meeting hosted by the anti-LGBT Alliance Defending Freedom (ADF) (Deposition of Paul W. Hruz, 29 September 2021, and deposition of Patrick Lappert, 30 September 2021, in Kadel v. Folwell). Lappert, too, has no experience diagnosing or treating gender dysphoria and did not begin offering anti-trans expert testimony until after this meeting.
  • The NCBC has developed extensive theological arguments for why social and medical transition are “always morally evil” and “never morally permissible”, and facilitating anyone’s transition is “cooperation with evil” (Furton et al., 2021). Even if transitioning were found to be unambiguously beneficial to trans people, NCBC contends it is still always unacceptable because it is contrary to their interpretation of Catholic teaching; the NCBC has argued against Catholic healthcare organizations that do find transitioning to be morally permissible under Catholic belief (Harrison, pp. 56-57, 68-69 in Furton et al. 2021). Their staff work with Catholic Church dioceses to enforce anti-trans policies in Catholic hospitals and facilities via “Catholic identity” contracts and agreements, including regular audits conducted by an NCBC “survey team” as part of an “ethics review” (Deposition of Gail P. Cunningham, 14 April 2022, and deposition of Father Louis Asobi, 11 April 2022, in Hammons v. University of Maryland Medical System et al.). The NCBC issues reports about Catholic healthcare facilities to local bishops and other Catholic leaders, and Catholic hospitals appear to use spreadsheets to track “gender transition diagnoses” for auditing.
  • NCBC policy for hospitals mandates misgendering and deadnaming even trans patients who have had a legal name change, as well as routinely discontinuing HRT for trans patients admitted to any Catholic facility to avoid cooperating with “evil” (NCBC, “Transgender Issues in Catholic Health Care”, February 2017). Because 1 in 6 US hospital beds are in Catholic hospitals, this is an ongoing threat to the health of any trans person who may have a medical emergency near such a facility.

Catholic Church doctrine on trans people and transitioning, explained and enforced by the Catholic Medical Association and the National Catholic Bioethics Center, provides a clear roadmap for banning all forms of gender affirmation at all ages in any state that allows these groups to take control of trans healthcare. This is an unchanging position based on a religious belief and a faith commitment, and all members of the CMA and NCBC can be presumed to hold an absolute opposition to gender-affirming care regardless of evidence. Continue reading →

Posted in Catholic Church, Ethics, Faith and religion, Florida, Hoaxes, Politics and law, Transphobia and prejudice | Tagged , , , , , , , , , , , , , , , , , , , , , , | Leave a comment