One of the Texas Children’s Hospital buildings is shown in the Texas Medical Center Thursday, Oct. 21, 2021 in Houston.
Melissa Phillip, Houston Chronicle / Staff photographer
Texas Children’s Hospital has three months to create the nation’s first clinic designed to reverse gender transition care, and must provide that care for free, according to the newly released terms of a settlement with Attorney General Ken Paxton.
The terms, which were released Wednesday, detail several measures the hospital system will have to take after being investigated for three years by both the state and the U.S. Department of Justice over allegations that they illegally provided transgender care to children.
“This historic settlement is a resounding defeat for the radical gender ideology that has preyed on Texas children under the guise of ‘care,’” Paxton said in a statement. “Texas Children’s has agreed to pay millions back to Texas. The detransition clinic, which is the first of its kind, must open within months. Activist doctors who harmed children have been fired.”
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The settlement requires the hospital to advertise the “detransition clinic” on its website, and for the first five years, provide free care to any patient who has previously received transgender care, regardless of age, including hormone therapy and surgery.
The hospital must also bar five doctors associated with the hospital from working with the medical system. And the hospital has to release a statement saying it did provide gender transition care, and permanently delete a previous statement that denied any wrongdoing and said the system would only settle “to protect our resources from endless and costly litigation.”
Gender transition care for transgender children is now illegal in Texas.
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But Paxton first announced an investigation into the system before that, in 2023, after a doctor claimed the hospital was illegally providing such care. The probe into the hospital was then expanded in 2024 after a nurse alleged the hospital was obscuring its care for transgender youth by intentionally miscoding patients’ treatments in order to receive Medicaid payments.
In addition to paying the state $9 million, TCH will have to pay the legal fees of the nurse, Vanessa Sivadge. She will also receive nearly $2 million out of the state’s settlement for being a whistleblower.
In a statement, the hospital said its focus is health.
“Last week we finalized a settlement agreement with the Texas Attorney General and the U.S. Department of Justice bringing a close to this chapter to focus our resources on life-saving care and discoveries,” Texas Children’s said. “Our focus remains on creating a healthier future for children and women across Texas and the world.”
Texas is one of 27 states that have passed laws limiting transgender care for minors, despite pushback from major medical associations, which generally endorse the practice that supports people whose gender identity doesn’t align with the sex they were assigned at birth.
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Treatment can include behavioral or medical interventions such as puberty blockers, hormones or surgery. Surgeries are rarely performed on transgender youth.
In recent years, the GOP has taken up the issue, and Paxton has mentioned the issue frequently in his bid for U.S. Senate. He has sought to tie his Democratic opponent, James Talarico, to support for gender transition care for minors.
An estimated 1% of Americans aged 13 and older identify as transgender, and not all of them seek gender transition care. Experts say it’s rare for people to seek to reverse those interventions.
Going forward, TCH will have to provide training for their medical staff on Texas’ laws restricting transgender care and maintain two lists of patients who have any mention of “gender identity disorders” or “gender dysphoria” in their medical record. One is a “break the glass” list, usually used in medicine to bypass privacy or security protocols in an emergency situation. The purpose of the other list was not identified.
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The state required that access to these lists be restricted and recorded.
The settlement will also institute tighter restrictions on hormone therapy medication for any patient under 18 at TCH. When those medications are prescribed, the doctor will have to confirm that the purpose is not gender transition care.