Florida's ban on gender-affirming care for transgender people under 18 and its new restrictions for adults may be enforced while a lawsuit works its way through the courts, a federal appeals court ruled Monday.
That means that doctors in Florida may no longer provide gender-affirming care for minors such as puberty blocking or hormone therapies, even if the parent or guardian gives permission, with some exceptions. Children undergoing or "threatened" with such procedures may be taken into custody by the state on behalf of guardians or parents who disagree. Transgender adults wanting gender-affirming care must now deal with more steps to get it.
Violations could mean fines, jail time and/or loss of license for the doctors involved, and could leave them liable to civil penalties for up to 20 years.
The ban was one of several measures from Gov. Ron DeSantis and Republican state legislators last year that targeted the state's LGBTQ+ population . U.S. District Judge Judge Robert Hinkle blocked parts of the law in June in response to a lawsuit claiming the law was discriminatory.
The bill sponsors stressed that the measure was intended to protect children, although mainstream medical associations including the American Academy of Pediatrics and the World Health Organization all support gender-affirming care for minors as a treatment for gender dysphoria, the distress a person feels when their gender does not align with their sex assigned at birth.
The Supreme Court has agreed to hear a challenge to a similar ban in Tennessee for the next term, which begins in October.
Here's what this means for Floridians.
Anti-trans care: Before vote to ban trans youth healthcare, Florida doctor board skewed comment toward allies
‘Why does this state hate me?’ Florida bans gender-affirming care for some trans youth
What transgender gender-affirming care is banned in Florida?
SB 254 , Treatments for Sex Reassignment, bans gender-affirming or transition-related care for any patients under 18, with two exceptions:
- Patients born with "a medically verifiable genetic disorder of sexual development"
- Patients who were already receiving such treatment before May 17, 2023
Aside from those two exemptions, children and adolescents who need gender-affirming care — which studies and patient accounts have shown help a great deal to alleviate depression, anxiety and suicidal ideations from gender dysphoria — must cease any treatment in Florida.
Surgical gender-affirming care for minors also was banned, but the lawsuit did not challenge it. Surgical transitioning for minors is extremely rare.
Any minors still eligible to receive gender-affirming care are required to have the following tests and visits as determined by a joint committee of the Board of Medicine and Board of Osteopathic Medicine:
- Every three months: suicide assessments
- Every four months: relevant laboratory testing
- Every six months: visits with the treating physician
- Every year: X-rays of the hand and bone density scans (DEXA scans)
- Every year: mental health assessments by licensed psychiatrist or psychologist
State funds may no longer be used for gender-affirming care through state health insurance or managed care plans.
Florida may take children undergoing or 'threatened with' gender-affirming care
Under SB 254, the state also may take custody of any child "present in this state" who "has been subjected to or is threatened with being subjected to sex-reassignment prescriptions or procedures."
Critics of the bill called it the Florida “abduction” bill because they claimed it allows children to be “legally kidnapped” by disagreeing parents of children undergoing or considering gender-affirming prescriptions or procedures, even if the opposing parent lives across state lines.
Gender-affirming care for transgender adults now more complicated
Some required services for adults and grandfathered minors can now only be “prescribed, administered, or performed" by a physician and lengthy, complicated consent forms must be signed while in the same room as that physician, effectively banning telehealth treatment.
And it can only be a licensed physician now. Advanced practice registered nurses (APRNs) or any other providers may no longer prescribe, administer, or perform gender-affirming care, further reducing availability and potentially increasing costs.
Penalties for doctors are steep
A doctor providing gender-affirming care for minors is now committing a third-degree felony.
A doctor providing gender-affirming care to adults who does not comply with the new amount of tests and paperwork is committing a first-degree misdemeanor.
Any healthcare practitioner arrested for "committing or attempting, soliciting, or conspiring to commit" any aspect of the new law will have their license suspended.
Florida Statutes also now permit anyone who was a minor and receiving gender-affirming care after the law was signed to sue the healthcare provider for personal injury or death resulting from such care for up to 20 years after the prescription or procedure ended, with no limitations on punitive damages.
'Thought I'd squeaked by': Transgender Floridians grapple with lack of medical care
Why are parents of transgender children suing Florida?
The law passed in 2023 was blocked in June by Judge Hinkle in response to a class-action suit consisting of four transgender adults and seven parents of transgender minors , brought against Florida Surgeon General Joseph Ladapo, the Florida Board of Medicine, the Florida Board of Osteopathic Medicine and other state leaders.
In his ruling, Hinkle called out the state for the onerous restrictions placed solely on transgender patients with unnecessary restrictions and "untrue and misleading" consent forms that were seemingly designed to discourage care rather than for medically necessary reasons.
The lawsuit claims the new mandatory consent forms include false and misleading statements that address treatments the patient will not receive and are in some respects incomprehensible.
Hinkle also pointed out the " overwhelming weight of medical authority" regarding gender dysphoria, the benefits of gender-affirming care, and the lack of Florida residents expressing regret over treatment.
"With all the resources available to the State of Florida and the full range of discovery under the Federal Rules of Civil Procedure, the defendants could find not a one," Hinkle wrote.
Hinkle included several direct quotes from DeSantis, Ladapo and multiple legislators, including a quote from Rep. Webster Barnaby, R-Deltona calling transgender people "demons and imps ," and noted multiple instances of false statements about child mutilation, castration and sterilization made by legislators and in a "deeply flawed, bias-driven report generated by the Florida Agency for Health Care Administration at the urging of the Executive Office of the Governor."
Hinkle previously granted a preliminary injunction against the law in June 2023, and struck down a Florida law and rule that banned Medicaid payments for gender-affirming care a few weeks later.
Florida restricts gender-affirming care: Florida's transgender affirming care ban is now law. Here's what SB 254 does:
What did the appeals court say about Florida's gender-affirming care ban?
On Monday, two of the three judges on the U.S. Court of Appeals for the 11 th Circuit struck down Hinkle's block, saying that the state will probably win the case and that they didn't believe that "animus" — which has several meanings in legal terms, but here it suggests an intent to harm or discriminate against transgender people — was behind the legislation.
The third judge dissented , listing the multiple cases from the suit of Florida legislators insulting transgender people and pointing out the potential harm of enforcing the law.
"On balance," Judge Charles R. Wilson said, "evidence in the record demonstrates that the plaintiffs and class-members would suffer if the stay were granted — withholding access to gender-affirming care would cause needless suffering.
The class-action lawsuit is still in litigation but now Florida's ban and restrictions may be enforced while the courts decide.
Reach out for help
"54% of trans and nonbinary youth in Florida seriously considered suicide in the past year," said Kasey Suffredini, Vice President of Advocacy and Government Affairs at The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ+ youth.
"These young people are not inherently prone to suicide risk, but rather they are placed at a higher risk because of how they are mistreated and stigmatized in society," he said.
To reach a Trevor Project mental health counselor:
Ana Goñi-Lessan, Tallahassee Democrat, contributed to this article
This article originally appeared on The Daytona Beach News-Journal: Florida can enforce transgender gender-affirming care ban, restrictions. What that means
Local Florida State
Most Popular
Comments / 0