Judge extends order requiring Rady Children’s to continue gender-affirming care – San Diego Union-Tribune

A restraining order in place since early February that required Rady Children’s Health to resume all gender-affirming care, save surgeries, will remain in place through June 24 as San Diego Superior Court Judge Matthew Braner considers granting a preliminary injunction that is broader than the current status quo.

Braner presided over a hearing on the injunction request Monday afternoon, hearing testimony from Dr. Patrick Frias, Rady’s chief executive officer, before indicating to lawyers from both sides that he was not inclined to rule immediately on the matter, despite the fact that both sides already had an extra month to hone their arguments.

Though Braner has gone along with California Attorney General Rob Bonta’s demands to restore a significant portion of Rady’s gender-affirming care program after Rady announced significant changes on Jan. 20, he made it clear that a request to resume gender surgeries, which have remained off limits since the pediatric health system’s decision, face an uphill battle.

“I’m not inclined to grant an injunction with respect to surgery,” Braner said.

Bonta sued Rady on Jan. 30, requesting a permanent injunction requiring the organization, which includes Rady Children’s Hospital of Orange County, to resume gender care medication administration and other aspects of the program on grounds that these services are required to continue for at least a decade after the AG approved a merger between Rady and Children’s Hospital of Orange County in early 2025.

Rady has said in public statements and court filings that it reluctantly curtailed its program in response to federal threats that would deny Medicaid, Medicare and other reimbursements to all hospitals providing “sex-rejecting procedures for individuals under the age of 19.”

Rady, which cares for about 800,000 children throughout Southern California, estimates that federal sources comprise about 40% of its total revenue.

Several other children’s hospitals have taken similar actions, though others have kept their programs open.

There have been two significant developments since Rady’s decision and Bonta’s lawsuit.

A federal judge in an Oregon district court stopped U.S. Health and Human Services Secretary Robert Kennedy Jr. from moving forward with his stated plan to cut all Medicaid funding for hospitals that provide gender-affirming medications and surgeries, ruling the decision was illegal and stating that the case “is one of a long list of examples of how a leader’s wanton disregard for the rule of law causes very real harm to very real people.”

There is speculation, however, that this district court ruling will be appealed to the Ninth Circuit Court of Appeals. Meanwhile, the American Society of Plastic Surgeons issued a new position statement on gender-affirming surgery that recommends that “surgeons delay gender-related breast/chest, genital and facial surgery until a patient is at least 19 years old.” The professional organization said that it changed its stance “in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population.”

The announcement was immediately lauded by Kennedy in an official statement that commended the society “for protecting children from harmful, sex-rejecting procedures.”

Pressed by state attorneys at Monday’s hearing, Frias said that even though the courts have declared Kennedy’s threat to defund hospitals illegal, Rady is generally committed to offering care to its young patients that is within the recommendations of professional associations.

“Right now … we’re offering puberty blockers, hormone therapy (and), as always, we continue to (offer) wrap-around services,” Frias said. “From a surgery perspective, that’s a different issue, because that’s now been said to not be the standard of care by the Society of Plastic Surgeons.”

Frias said legal rulings notwithstanding, he remains concerned about social media posts made by Trump administration officials indicating that Rady and others have been forwarded to the U.S. Office of Inspector General for investigation, a previous subpoena from the U.S. Department of Justice and security issues that have cropped up as the federal focus on gender care has intensified.

“As we continued to provide the care while many of our peers were slowing it down, we were getting threats, largely through social media posts, that were very critical of our providers, of our leadership and of our health system for allowing these and they go all the way up to death threats saying that people should be hanged and systems should be shut down and we should be put in jail,” Frias said.

But there also are fears that denying gender-affirming care can end with dire consequences.

The attorney general filed a declaration in the court record written by “Sloane C,” who says she is the parent of a teenager whose “chest surgery” Rady canceled in January. The parent, who said she did not include her real name for fear of reprisal, wrote that her child “seriously contemplated suicide,” after learning of the cancelation.