Health Care

Missouri transgender center says allegations of malpractice are ‘unsubstantiated’

The hospital that operates an embattled St. Louis-area pediatric transgender clinic is rejecting allegations of malpractice by its doctors.

In February, a first-person account alleging years of malpractice at the university’s transgender center by Jamie Reed, a former caseworker, made waves online, igniting a firestorm of right-wing vitriol. It also led to an investigation by a U.S. congressman and an emergency order from the state attorney general halting the administration of gender-affirming health care for youths and adults.

A review of policies and procedures at Washington University’s Transgender Center has affirmed that physicians and staff at the center are administering treatments according to accepted standards of care, Washington University officials said Friday.

“After careful consideration over the course of a more than an eight-week period, the University has concluded that allegations of substandard care causing adverse outcomes for patients at the Center are unsubstantiated,” the university wrote Friday in a summary of its findings.

Reed in her account said hospital staff often failed to properly inform transgender young people and their families of the potential side effects of gender-affirming health care, and in some cases administered care without parental consent.

Reed made identical claims in a sworn affidavit to Missouri Attorney General Andrew Bailey’s office, prompting a multi-agency investigation into the hospital and its transgender center. Her account has been challenged by reporting from the St. Louis Dispatch.

Nearly two dozen parents of children seen at the clinic told the outlet that Reed’s allegations are “just not true.”

Bailey, who is facing reelection this year, last week put into effect an emergency regulation claiming gender-affirming health care for transgender minors is already illegal under a Missouri law that prohibits the administration of certain medical interventions in the absence of “substantial guardrails.”

The sweeping emergency order, which takes effect April 27 and expires in February, includes restrictions for transgender adults, in addition to youth.

Bailey said in a post on Twitter on Friday that Washington University’s findings “don’t line up with what we’ve uncovered so far in our investigation.”

“We will leave no stone unturned,” Bailey wrote.

Bailey’s office did not immediately respond to a request for comment. The university on Friday said it was cooperating with the investigation.

Responding to Reed’s allegations in February, Sen. Josh Hawley (R-Mo.) announced the launch of his own investigation into the hospital’s transgender center, which the university on Friday said it was also cooperating with.

Hawley in a February letter to hospital leadership and the university’s chancellor, Andrew D. Martin, demanded the medical records of all transgender minors referred to the center be surrendered to his office.

“Accountability is coming,” Hawley wrote in the letter.

The university on Friday said an internal review had found that 1,165 patients have sought care at its transgender center since June 2018.

“These interactions range from an informational phone call to medical treatment but were of sufficient depth to create a medical record for each patient,” the university wrote.

A total of 531 patients since 2018 have been prescribed hormone-replacement therapy, including some who were initially on puberty blockers. An additional 67 patients were prescribed puberty blockers but not hormones. The remainder — 567 patients — were prescribed neither treatment, the university said.

Gender-affirming health care for transgender youths and adults is considered safe and medically necessary by most major medical organizations, but while some transgender people may seek medications like hormones or puberty blockers, many do not.

Just 31 percent of transgender respondents in a recent Washington Post survey said they had received gender-affirming medical care, and an even smaller 16 percent said they had undergone surgery to alter their physical appearance.

The university on Friday added that of the patients who opted to receive gender-affirming medical care, not one reported adverse physical reactions caused by the medications they were prescribed. Appropriate mental health care and counseling are required for all patients younger than 18 before treatment can be administered, the university said, as is “well-documented” parental consent.

While the transgender center has prohibited its doctors from referring young patients for gender-affirming surgeries since late 2018, six surgeries have been performed on minors by Washington University physicians since 2018, the university said Friday, all of them chest surgeries.

Washington University physicians no longer perform gender-affirming surgeries on patients younger than 18, the university said.

The university on Friday also rolled out several policy recommendations, including requiring written consent from a minor’s parent before gender-affirming health care can be administered. Under the prior policy, only verbal consent was needed.

The university said it has also taken steps to reaffirm its policy prohibiting gender-affirming surgery to the Departments of Pediatrics and Surgery.

“Our highest priority is the health and well-being of our patients,” the university said in a statement on Friday. “We remain committed to providing compassionate, family-centered care to all of the patients and families we serve, and we are grateful to our medical practitioners for their dedication to their patients and their profession.”

Tags Gender-affirming care Josh Hawley

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