Judge will consider dire counterclaims in Rady gender care case – San Diego Union-Tribune

Just how big is the risk that Rady Children’s Health will lose all federal funding if the court grants a temporary restraining order forcing the medical provider to resume gender-affirming care in San Diego and Orange counties?

This is the central question before San Diego Superior Court Judge Matthew Braner on Wednesday as he parses a request from California Attorney General Rob Bonta that would force Southern California’s largest provider of specialty care for children to continue providing gender-affirming medical procedures and medications to its patients.

Citing nationwide threats to Medicare and Medicaid funding, Rady announced on Jan. 20 that it would immediately stop doing gender-related surgeries and administering medications, such as hormone treatments that block puberty for its patients younger than age 19.

The decision elicited protests from families whose children were receiving care at Rady’s gender clinic and from the broader advocacy community that has fought for many years to establish such services in San Diego.

Bonta sued Rady Jan. 30, alleging that the medical provider violated the conditions of his approval of a merger agreement between Rady Children’s Hospital and Children’s Hospital of Orange County, which was completed in early 2025. Bonta’s approval requires the combined organization to maintain a long list of services, including gender-affirming care, for at least 10 years.

Judge Braner took a first cut at adjudicating the AG’s restraining order request late last week, ordering a resumption of gender-affirming care, everything but surgeries, over the weekend as lawyers for both sides worked to provide more information before he rendered a ruling.

His office bumped a hearing scheduled for Tuesday to Wednesday afternoon, following fresh briefs from both sides. Braner requested deeper dives on the punishment that Rady is likely to face if forced to resume gender care, on which other hospitals in California have taken similar actions, and on the specific status of young patients affected by the program’s sudden shutdown.

Much of the discussion in legal papers revolves around a declaration of U.S. Secretary of Health and Human Services Robert Kenedy on Dec. 18, 2025, that declared “sex-rejecting” procedures “fail to meet professional recognized standards of health care.” This phrasing is of utmost importance because the federal government may end Medicare and Medicaid funding for medical providers whose care falls short of meeting professional standards.

One day later, the U.S. Centers for Medicare and Medicaid Services published proposed rules that seek to change the conditions of Medicare and Medicaid participation, “prohibiting sex-rejecting procedures for children.”

The AG’s brief notes that Kennedy’s December declaration is not absolute. It says that the federal government may pursue excluding facilities from federal funding, but that such an action would require a “separate determination … which is subject to further administrative and judicial review.”

And, Bonta’s brief notes, California is among 18 states that have sued HHS, challenging Kennedy’s claims that gender-affirming care for minors does not meet medical standards, and calling the entire regulatory review “an attempt to intimidate providers.”

The AG’s brief notes that the U.S. Office of the Inspector General has agreed not to serve any medical providers with notices to exclude them from federal health program participation until after the court rules on a summary judgment request scheduled to be heard on March 19 or 30-days after that hearing if a ruling is slow to arrive.

“In light of this stipulation, OIG cannot begin the process of excluding any provider from federal health programs until at least early April,” the brief states.

If the lawsuit fails, the AG argues, “the administrative process of excluding (Rady Children’s Health) would take months.”

Rady’s brief disagrees with the AG’s interpretation of the federal government’s ability to act quickly in this matter.

“Although HHS stipulated it would not send exclusion-related notices until April 18 (at the latest), nothing in that stipulation prevents HHS from terminating provider agreements on 15 days’ notice,” Rady’s brief states.

Rady argues that continuing to provide care that the health secretary declared verboten in December could be cited as a reason to take immediate action in the spring or even sooner.

“Immediate effect means that conduct now could form the basis for potential termination and exclusion,” Rady’s said.

Both sides sought to better quantify how Rady’s patients have been affected by the Rady gender-affirming care cut.

The AG argues that program cuts hurt patients who were about to begin puberty-blocking medication, those “early in puberty blocker treatment,” and those who need their medication and Medi-Cal patients generally are caused “irreparable harm” by Rady’s program suspension.

“Loss of care will exacerbate these harms, including increased rates of mental health crises, suicidal ideation, self-harming behaviors, anxiety, depression and negative impacts to daily life,” the AG brief states.”

But Rady argues that it took steps to help patients currently receiving hormone therapy avoid any immediate lapses in medication access.

Rady says it issued 475 prescription renewals for 365 San Diego County patients in January and 201 for 174 patients in Orange County the same month, making sure that there was time to find alternate medical providers to renew prescriptions.

“According to RCH’s data, no desired prescriptions expire sooner than March 31,” Rady said.

The children’s hospital also quantified the number of kids who were directly affected when the program’s surgical and medication programs stopped last month, indicating that it canceled “one puberty-blocker implantation and six mastectomies.”

The medical provider notes that it continues providing services from mental health care consultations to lab work and “hormone-monitoring for patients” that allow them to work with outside medical providers to make sure that care continues.

But the attorney general argues that this approach is not enough.

“The laundry list of services, such as primary care, that (Rady Children’s Health) has purported it will provide patients after ending gender-affirming care will not relieve the immediate and irreparable harms patients will suffer,” the brief said.

But Rady Children’s makes its plea on behalf of the 800,000 children it serves throughout Southern California.

“If Rady Children’s Hospital were ordered to continue providing care the (Kennedy) Declaration forbids, it would face a very serious likelihood of termination or exclusion — an existential threat,” Rady said.

Wednesday’s hearing is scheduled for 1:30 p.m.