‘Dangerous’: How a Top Civil Rights Attorney Describes Attack on Trans Health Care

In recent weeks, the Bay Area’s trans community has experienced a series of painful political setbacks, following a wave of backlash across the country.

On July 24, Oakland-based Kaiser Permanente said it would join a growing list of medical providers in the state to roll back or fully restrict gender-affirming surgical treatment for trans youth in July, leaving patients and families with few options for care.

Kaiser cited a challenging “legal and regulatory environment” — a clear takeaway from the Trump administration’s January executive order that sought to target funding and other support for hospitals that provide such care. And last month, the Department of Justice subpoenaed more than 20 doctors and clinics that perform gender-affirming procedures on minors.

California has pushed back, with state Attorney General Rob Bonta filing a lawsuit against the administration on Friday on behalf of more than a dozen other states. Bonta framed the issue as a life-and-death matter, citing the higher rates of suicide and other forms of self-harm among young people whose assigned gender at birth doesn’t match their identity. To deny these youth lifesaving care, Bonta argued, is both “cruel and irresponsible.”

According to Shannon Minter, legal director at the National Center for LGBTQ Rights and a longtime civil rights attorney, Trump’s order represents a broader legal threat to doctor-patient confidentiality and sets a troubling precedent for federal overreach.

Minter, who led the fight for marriage equality in California’s landmark 2009 case, spoke with KQED from his home in East Texas about the legal implications of this order — and why everyone, not just trans people, should be paying attention.

KQED: Could I get your initial reaction to the news that California is suing the Trump administration over the president’s successful efforts to deny gender-affirming care to youth across the country?

Minter: I’m very grateful to California for pushing back on this. I don’t think I’ve ever seen anything like this level of intimidation and bullying and harassment from the federal government going after medical providers. And it’s just absolutely essential that states stand up for patients and for the families who need this care and for medical privacy for all of us.

KQED: What is the legal basis for Trump’s executive orders? Is there a precedent for this kind of top-down action?

Minter: Unprecedented, and there is absolutely zero legal basis for these orders. The federal government has ordered the Department of Justice to threaten — with criminal and civil prosecution — hospitals who are simply providing medical care to these young people. The lawsuit points out that there is no basis for it.

This is really mafia-like behavior on the part of the federal government, just pure intimidation and coercion. There is not a single federal law that in any way prohibits, much less criminalizes, providing medical care to these young people.

KQED: What are the chances of success for this lawsuit?

Minter: Very, very high. Some of the challenges are tougher than others. This one, I think, has got an extremely high likelihood of success because there’s just no legal foundation for what the federal government is doing here.

There’s literally no federal law that supports them coming after these hospitals and asking for medical records and threatening some kind of vague civil or criminal prosecution. That’s just not the way our legal system works.

The federal government, if they’re going to threaten any of us with a criminal prosecution or civil prosecution, they have to be able to point to a law that we are allegedly violating. And the problem for the federal government here, is there is no federal law that prohibits doctors or hospitals from providing this medical care.

There’s just nothing to back up this use of force by the Department of Justice. That’s why I say this is really kind of like mafia-like behavior. It’s just a sheer exercise of federal coercion and abuse of federal power. And I do believe the courts will shut this down very quickly.

KQED: And a presidential executive order doesn’t count as legal precedent?

Minter: No, no, the president can’t just make something up out of thin air and threaten criminal prosecution based on an executive order.

KQED: What legal rights to care do young people seeking gender-affirming care in California have in California?

Minter: California, as well as many other states, have enacted laws that prohibit discrimination against transgender people in health care. Those laws are fully operative in California and many other states.

And that’s also one of the bases for the claims in this lawsuit: that the federal government is trying to interfere with and override state law in an area in which the federal government has no business.

Nothing in our Constitution gives the federal government any authority whatsoever to regulate medical care. That’s something that is left to the states. Traditionally, in our system of government, that’s something the states do.

The 10th Amendment prohibits the federal government from doing anything to interfere with areas in which states have authority. And so this lawsuit is saying, among other things, this order violates the 10th Amendment.

KQED: Is it not ironic that the federal government is typically in favor of states’ rights when it comes to regulating issues like abortion, but then, when it comes to gender-affirming care, the federal government is now actively interfering with state laws?

Minter: It is ironic. I really hope people recognize the federal government is taking advantage of the fact that many people don’t know much about transgender people.

They may think, ‘Oh, this has nothing to do with me.’

Maybe people even don’t approve of the care themselves, so they’re not paying attention to it. But this sets a terrible precedent. This is the federal government literally coming in, demanding private patient medical records from hospitals, and also purporting to tell states and hospitals how to perform health care, like what types of care they can and cannot perform.

This is a federal takeover of our state health care system, getting us all used to the idea that the federal government can demand any of our private records anytime they want to for any reason they want to. That is so dangerous.

KQED: What’s at stake for the young people and families who are being affected by this?

Minter: It’s terrible for these families. Nobody knows a child better than that child’s parents. These are parents who have been through a process consulting with medical experts, coming to terms with the fact that their child has a very serious medical condition — gender dysphoria — and that their child is among the very small number of young people who really need and benefit from medical treatment for that condition.

This care is so effective, and many kids who receive it are doing great. There was a really comprehensive study systematic review that was just conducted by the University of Utah that looked at every available study on this topic and found that the care is safe and effective, that it significantly reduces suicidality in young people. And that there are virtually no regrets — almost no one who obtains this care has any reason to wish they hadn’t.

Losing that care for these families is really devastating. You can only imagine — if you know your child is getting the care they need, and they’re doing great, and you know what will happen if they lose that care, that they’re going to be really severely harmed. Parents are in a panic, understandably.

KQED: What other legal action can the state or patients and their allies take?

Minter: Well, the state is doing the best thing it can do, which is ask a federal court to tell the federal government to knock it off and to leave these providers alone.

In terms of what families can do, a lot of families are making sure to notify these hospitals that they do not give the hospitals permission in any way, shape or form to share their private medical records. So that’s always a good thing to do.

All of us can reach out to these hospitals and express support and tell them, please do keep providing this care and please do not cooperate with these unlawful subpoenas. We don’t want hospitals to ever, ever violate their oath of confidentiality to patients. The more everyone can speak up and not be misled — don’t be distracted by the fact that this is about one particular group of people. This is really about protecting all of our medical freedom and the privacy of our medical information.

KQED: Do you think Bonta should sue providers for denying patients their legal care or are providers in between a rock and a hard place?

Minter: I do think that providers need to comply with state law.

I understand it’s frightening to be served with a subpoena by the federal government. But it’s disappointing to see providers pausing the care. I think we might have a moment of grace — maybe it was a spur-of-the-moment reaction to being served with the subpoena like that.

But it’s unlawful, it’s wrong, they’re betraying their patients and they need to get back to providing this care. And if they don’t, yes — I think the attorney general can and will and should sue them if necessary. I like to think it wouldn’t come to that.

Families can also sue them, and I’m pretty sure that will happen if these providers recover and get back to doing what they’re supposed to be doing, which is serve all their patients. Of course, you can’t just decide you’re gonna stop providing care to a particular group of people because the federal government is targeting that group. That is really a blatant violation of California law.